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The 'Pause
The menopause podcast with unfiltered conversations about the symptoms you hate, the changes you didn’t see coming, and the hilarious moments midlife can bring. You've got questions and we've got the experts to answer them.
The 'Pause
Help! I Keep Forgetting My Grocery List (and Everyone's Name)
Remember walking into a room and forgetting why you're there? Or that moment when you can't recall the name of someone you've known for years? You're not losing your mind — you're likely experiencing one of the most common yet least discussed symptoms of perimenopause: brain fog.
A staggering 60% of perimenopausal women report memory issues and difficulty finding words, yet many dismiss these symptoms as simply being "busy" or "stressed" rather than recognizing them as hormonal changes. Dr. Kelly Wiersema, board-certified OBGYN and menopause specialist, joins us to demystify what's happening in your brain during this transition.
We dive deep into the science behind perimenopausal brain fog, exploring how estrogen affects not just hormones but actual blood flow to the brain. Dr. Wiersema explains why these cognitive changes happen, whether hormone replacement therapy helps (spoiler: it's complicated), and why she describes perimenopause as "puberty in reverse." We also explore how factors like sleep quality, stress levels, and even sugar consumption compound these cognitive challenges.
The good news? These symptoms are typically temporary. Whether through hormone therapy, lifestyle modifications, cognitive exercises, or simply time, most women regain their mental clarity. Dr. Wiersema shares practical strategies for managing brain fog, from tracking symptoms to identify personal triggers to specific brain-boosting activities that help maintain cognitive function during this transition.
Whether you're just starting to notice these changes or have been struggling with them for years, this episode offers validation that you're not alone and provides actionable tools to navigate this challenging yet normal part of every woman's journey. Join our supportive community at The Pause Diaries on Facebook to connect with others experiencing similar challenges and share your own menopause moments.
Welcome to the Pause, the menopause podcast, with unfiltered conversations about the symptoms you hate, the changes you didn't see coming and the hilarious moments midlife can bring. I'm your host, val Leggo, and I've been a dedicated health reporter for 25 years and I wanted to normalize something that every woman goes through menopause. So together we're going to talk about it the Perry, the Menno and the Post. Welcome to the Pause.
Speaker 2:So the other day I was introducing an acquaintance at a networking event and I got through the entire group except for one person, and I have known this person for almost a decade and I could not remember her name. Nothing helped me. I kept thinking where do I know her? Is it kids? Is it work? I saw her face plain as day. I knew that I had a long-standing relationship with her and I could not remember her name and I could not pull it from my fuzzy perimenopause brain for anything. This is so frustrating. Fortunately, she was very gracious and she introduced herself. But talk about embarrassing, right. I mean. I pulled her aside later and I said I'm sorry, I just remembered your name. I apologize. I explained I was having a menopause moment. She totally understood, thankfully.
Speaker 2:But it doesn't help the fact that you just stand there and you stare at someone's face and you know that you know them and you can't for any reason think of their name. Or maybe you've had an instance where you walk into a room and you can't remember why, or you forgot a familiar word mid-sentence during a business meeting, of all things. Here's what I want you to know. You are not alone.
Speaker 2:So many women who listen to this podcast have shared similar stories and want to know why this is happening and what they can do about it, and that's why we're diving into this topic of brain fog during perimenopause. We'll explore what it is, why it happens and how much of it is linked to hormonal changes, particularly a loss of estrogen. To help us understand this better, we'll be joined by Dr Kelly Wiersma, a board-certified OBGYN and Menopause Society-certified practitioner at Trinity Health Medical Group. Thank you so much for joining us, dr Wiersma, my pleasure. Thanks for having me. This is not just a topic that so many women are interested in. I think it might be one of the very first signs that you are entering perimenopause, and we can write it off on all the things. I'm busy, I have low blood sugar, I forgot to eat lunch, but I feel like when this is happening, maybe semi-regularly, it's something that women should pay attention to. What are your thoughts on that?
Speaker 3:Yeah, it definitely can be an early sign of perimenopause, and I think a lot of women don't necessarily put it together that, hey, this could be a sign of what's going on, and so I do think it's important for people to learn about it and recognize it as a symptom of perimenopause and know what are some options of things that I can do about it.
Speaker 2:And it can be so scary too. I have shared with listeners and many that I had a mother who had dementia, and so when things like this start happening, I immediately go there. I mean, and it scares me. That is like, obviously you immediately go to where this is, but it is one of the most common symptoms of perimenopause. Here's the proof of that A 2021 study in the Journal of Women's Health found that over 60% of perimenopausal women complain about memory issues and trouble putting sentences together, and I think it's important for women to realize how big that number is to really hammer home the fact that they're not alone.
Speaker 3:Yeah, I see this all the time in my office when I'm seeing patients. I have a list of symptoms that I ask about and I would say brain fog isn't one that a lot of women bring up initially, but as I'm going through the list, the vast majority of them are like oh yeah, I have that too.
Speaker 2:It's so important to write down those symptoms and be able to share them with your practitioner, because that really can hone in what specifically is happening. And when we talk about brain fog, I mean brain fog is not a medical term, but it does have symptoms that we associate with it, right, Like memory lapses, difficulty concentrating, forgetfulness, mental fatigue. I mean there's a whole host of them. What is it that is happening? That's creating it?
Speaker 3:So, you know, this is one of those things where we don't always have the exact answer, but what we think is that, you know, we have estrogen receptors throughout our whole body and particularly in our brain, and so we know that when estrogen declines as we're in that perimenopause period or menopause that you know those receptors then don't have the estrogen, and so we do think that that has a big play into what these symptoms are that people are experiencing.
Speaker 2:And I assume it's because estrogen just plays so many roles like in your brain health, like it really like when you want to talk technical, gets into those neurotransmitters right.
Speaker 3:Right. So it influences a lot of the neurotransmitters in the brain, which then affects things like your mood and your memory and your ability to focus. And we also know that estrogen helps with regulating blood flow in the brain, and so all these things contribute to these symptoms.
Speaker 2:I think that is the one thing that I found the most interesting is the blood flow to the brain, because we talk about hormones nonstop. You can see it everywhere. I see it in my feeds now because I'm talking about this topic a lot but never have I really heard the fact that it has an effect on the blood flow. Can you kind of explain, like what as your estrogen dips? Is it the fluctuations in it? That is really what is making it so bad in perimenopause.
Speaker 3:That can contribute for sure, and that's you know. One of the hallmarks of perimenopause is that your hormones can just be all over the place. I tell people that it's like puberty in reverse, and so some months you're going to have really high estrogen levels and then the next month you may have almost nothing, and so we do know that those fluctuations, or those changes, can often lead to a lot of the symptoms that women are experiencing.
Speaker 2:And whether women go on HRT or find a natural way to deal with their menopause symptoms. The one thing every woman wants to know is will my brain get back to normal after I'm through perimenopause, menopause, I'm postmenopausal, or does that ever happen, and if it does, at what point in my journey?
Speaker 3:Yeah, so, and I think you know I'm sure you've talked about this everybody's journey through perimenopause and menopause is so different, and so we talk in a lot of generalities. But you know, what the studies show us is that, in most people, that these changes are transient or short-lived, and that most times they will go back to feeling, you know, more of their normal self. So we do think that in most cases it will improve.
Speaker 2:And does that improve with or without, like a hormone replacement therapy or a natural therapy? Yes, it can.
Speaker 3:Yeah, just in the natural course of menopause.
Speaker 2:Well, that's certainly some positive news. Right To know that I might actually get to feeling like myself back. It might take me 15 years, but I'll get there. But in addition to the estrogen highs and lows, I mean, there's some other factors that are going on in your brain that can really make it a little bit more prevalent or even worse, when it comes to perimenopause and the brain fog right there's, like you know, you've got your stress and your poor sleep and all of those things.
Speaker 3:Definitely, I think poor sleep is probably one of the top ones that really can negatively affect other parts of our body too, and so, yeah, when you couple all these things together along with the changes in estrogen in the brain, that's where you can really see these symptoms come out, and this I mean.
Speaker 2:Most women that are going through perimenopause are in that moment in time where you know their kids might still be little, or they're getting into sports, they're running everywhere, they're trying to, you know, still be really great with their careers and maybe even look for that promotion, and so they can write a lot of this off. As you know, it's just a busy time, but those cortisol levels are increasing because of the stress of just trying to do it all, and so what does that do for the memory and the focus and the brain fog?
Speaker 3:Yeah, so definitely when we associate cortisol as kind of like our stress hormone. And so when you have these periods of high stress or high anxiety, we see these spikes in cortisol and the research shows us that those spikes can really affect our memory and focus in a negative way, and so all these things can kind of contribute.
Speaker 2:So, when you go in to an appointment with a woman and you see that she may be, you know, 40 plus, what are some of the questions that you want her to ask you, or what's the conversation that you want that to be about?
Speaker 3:So I think that certainly, anytime you, as a patient, notice symptoms and you're like I don't know if this is normal or not, bring those up with your doctor when you're talking, because sometimes we can put those things together and see what's what's going on. And then really, you know, I kind of hit on just all these lifestyle things. You know, what is your sleep like? What are your relationships like? What's your job? What kind of stress levels do you have? Do you have any big life changes going on? You know, because all of these things play a role. Do you have any big life changes going on? You know, because all of these things play a role.
Speaker 2:And so, as your doctor, I want to know all those things so I can help you kind of figure out what's the path that's best for you going forward. And I mean we talk about it a lot, just trying to get back to that healthy lifestyle, the good sleep, the exercise. You know sugar plays a really big role as well in perimenopause.
Speaker 3:Definitely yeah, Sugar. We see just the amount of inflammation that it can cause and what a negative effect that has on the body. So definitely looking at all these different pieces and what can you do to optimize those.
Speaker 2:And I think you know there's been so much talk about hormone replacement therapy, which is great because for so many years we didn't talk about it and now we are and are starting to explore it for themselves. I'm curious about whether or not it's going to work for them. A lot of conversations that they'd like to have with their providers around that. Is hormone replacement therapy going to cure your brain fog?
Speaker 3:I would say, nothing's ever an exact cheer. So this journey through perimenopause and menopause is really about what are the? I always think of it like what are the tools in our toolbox that we have that we can help women to optimize their lives? You know, through this period, and certainly hormone therapy is one of those things but very cautious of telling people that this one thing is going to fix everything. You know, we never it's not very often that we have those tools available, and so hormone therapy definitely can be one of the things that can help and play a role. But we want to look at all the other factors as well, and what can we do to optimize those?
Speaker 2:And I started hormone replacement therapy about six months ago, I'd say, and it was kind of like the very first. I'd say two months it was. I call it the honeymoon phase because all of a sudden, like wow, I can't believe how great I feel, I'm back to me. And then my body adjusted and then I started to get a little bit more of the what's your name or why are? You in this room. Is that pretty?
Speaker 3:common or why you're in this room. Is that pretty common? Yeah, I definitely think that that's what I tell women. You know, especially when we're starting hormone therapy at first is, again, it's a journey and it's not often that the very first thing we start you on is the right dose, the right formula, the right route for you, and we often have to do a little bit of tinkering and changing and trying things to figure out what works best for you, particularly. So that's where it's important to have a really good relationship with the person you're working with so that you can make those changes and try to get as optimal as you can and is it also important to like work your brain.
Speaker 2:I mean, my girlfriend and I love to play wordles and so we do like every morning we do the wordle or or and I'm you know I was reading some research where it was really talking about how exercising it in that way not just thinking or doing your right tasks or writing your grocery list or whatever your to-do list or whatever it is you have that like exercising it in a different way can really help with that. It's hard to think of it as like a muscle you have to exercise, but that's kind of the way I think of it.
Speaker 3:Yeah, and I do think that the research really does bear that out, that doing things that do work your brain, especially in new ways, so learning a new skill, doing, you know, word puzzles, things like that, also being social, having relationships, conversations with people, all those things help to kind of keep our brain working at its, you know, most optimal function. And so doing all those things kind of to help I think is a good idea.
Speaker 2:And you talked a little bit about wanting to make sure that you're logging your symptoms so that when you have that conversation with your doctor, you've got kind of a track record. How long do you think you should be doing that and what, specifically when it comes to brain fog, should you be writing down before you call up your doctor and you say I want to have a discussion about the fact that things are changing for me and you know how can I make this better?
Speaker 3:because, like we talked about, your hormones fluctuate so much you may feel totally fine one month and then the next month feel totally different, and so that's where it is good to track so that you can bring that information to your doctor. But I would never tell anyone like, hey, don't go see your doctor if you haven't already done this. Yes, it's great, and the more information you can give us is going to help us to help you more. But definitely, you know, anytime you find something like this that's affecting your, you know everyday life, you know those that's important enough to take to your doctor. So don't feel like I've got to wait three months until I've tracked all this. You know it is definitely helpful, and I think the big thing with tracking is that sometimes you will be able to identify triggers that, hey, this seemed really bad on this day, what else did I have going on? Or maybe what did I eat or not eat, or things like that. You may be able to help identify patterns that help to make these symptoms better or worse.
Speaker 2:Oh, you know what? That's a really good point, because even hydration, I mean, I know on the days that I haven't hydrated enough, I am a little bit fond of this difference. Yeah, yeah.
Speaker 3:So yeah, definitely trying to figure out what might be those things for you particularly that can help is a great idea.
Speaker 2:I've been reading a little bit about something that's called cognitive behavioral therapy for menopause related anxiety and memory issues. It's an interesting concept and not really one that I think of like for menopause. Like yeah, to me a little bit about what that therapy looks like.
Speaker 3:Yeah, you, you want to look for a practitioner that is well-versed in that particular type of therapy. But definitely the research shows that not only related to cognitive things but other symptoms of menopause that cognitive behavioral therapy has actually been shown to be very useful. So that is another again tool in the toolbox for people when they're looking at managing their symptoms.
Speaker 2:All right. Well, Dr Rearsman, this has been a really great conversation. I'm excited to be able to share it with everyone who's listening, because it's definitely a big topic for women wanting to talk about, and I think you know, as I've mentioned before, one of the first signs of knowing that something's not quite right I've been forgetting a lot of things lately, or names, or what it is that I'm doing, or even like my sometimes for me it's like in the middle of driving to work. I'm like this doesn't look at all familiar to me. I appreciate you taking some time and lending your expertise to this topic. I really appreciate it.
Speaker 3:Thank you, I appreciate it.
Speaker 2:And I put Dr Risman's contact information in the PAWS website so you can reach out if you have questions. Also, just a few closing thoughts. Here's the takeaway I hope you get from listening to this podcast. You're not alone. You're not losing your mind and there are some solutions. Remember, every woman will go through perimenopause and menopause and you deserve to have the support on that journey, and that's why I created the Facebook group, the Pause Diaries, and if you haven't yet, I encourage you to join.
Speaker 2:You'll find this group of women are amazing. They love supporting each other. They love sharing tips on managing symptoms. They ask great questions that inspire future episodes of the pod podcast, so I really hope to see you there in that Facebook group. Thanks so much for listening and remember this isn't the end of anything.
Speaker 1:It's the beginning of the rest of your life, and we are going to talk about it.
