Primate brain before (left) and 48 hours after estrogen (right) Just to add a couple of my own anecdotes to the pile…
The Breastfeeding writer
A 35 year old newspaper columnist, 8 weeks post-partum and breastfeeding, calls me. “I can’t write! I’m sitting here staring at my computer and nothing is happening. I have a deadline tomorrow and I just can’t find the words I need to express myself.”
Breastfeeding is a time of low estrogen levels, and breastfeeding women will often complain of vaginal dryness. But this was a new complaint I had not heard before. She sounded just like my menopausal patients. So I gave her some estrogen. She called me several days later – “It’s like someone turned on a switch! I’m back!”
The Peri-menopausal Exec
49 years old, high functioning, multi-tasking, juggler of many things. This is a woman who can talk on the phone while typing an important email and hold a meeting all at the same time. Carries names in her head like a roladex.
Her ovaries were removed 6 months ago along with a hysterectomy. A totally unnecessary piece of surgery, by the way. All she needed was the uterus removed, but her doctor told her that if she were his wife, he’s take out the ovaries, so that’s what she agreed to…
Now, she finishes the day and realizes she has barely gotten anything done. Someone who could easily do three things at once is now down to one-at-a-time tasking, and even that is going slowly. “I can’t keep up with my pace. My brain just won’t make the connections fast enough” All her lab values are normal, including her thyroid functions and hematocrit.
We give her estrogen. Within a few weeks, she is almost back to her old self.
The Human Research Data
Now, these two stories are not typical. Most peri-menopausal and menopausal women don’t have such dramatic deficits or recovery. Some have no symptoms related to brain function at all. Those that do typically complain of problems with word recall or names, or a feeling of “fuzziness” in the brain. “Clogged up” is a phrase I hear often. These symptoms are sometimes relieved with estrogen, and sometimes they are not.
Results from research studies have been contradictory. No studies have found an effect of estrogen on memory in populations of women undergoing normal menopause. But in studies of women undergoing surgical menopause, estrogen has been found to improve memory, particularly verbal memory.
In my opinion, most of the studies that have been done to date have not used testing that measures the kind of brain function estrogen seems to affect. Most have used dementia screening or Alzheimer’s screening or basic tests of overall memory.
Menopausal women are not complaining about dementia or losing their memory. What they complain about is problems finding words and names, problems making sophisticated verbal constructions, problems writing fluently, and problems multitasking. And fuzziness.
I don’t think we have a good objective measure of brain fuzziness.
The Primate Data
Whenever I think about estrogen and the brain, I think about monkeys. If you look at the brains of primates, what you find is that estrogen increases the number of dendritic outgrowths – connectors, if you will – between brain cells. (They’re the little red things up there in the photo). The increase in dendritic outgrowths is rapid – within 24 -48 hours of giving estrogen, there is a measurably dramatic change in the number of connections between brain cells.
Take away estrogen, the number of brain cell connections decreases. Interstingly, if one adds progesterone continuously to the regimen, you attenuate the estrogen effect.
It’s the best evidence I’ve seen to date that correlates with what my patients tell me. Loss of estrogen leads to loss of connectivity between brain cells. It takes longer to find a word, find a name. Harder to write. Harder to multitask.
Now What?
I’m not going to belabor the whole “Should I take HRT?” question here. You can read what I think about that issue here.
What I will say is that the story on estrogen is far from over.
What I believe is that for some women, estrogen is important for brain function. Who those women are, how to identify them and how to weigh this against the potential risks of HRT as we now know it, are all questions whose answers are too individual to answer for women as a whole.
Stay tuned…
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Photo from J Neuropsychiatry Clin Neurosci 13:313-317, August 2001
I appreciate your common sense approach.
Interesting. I experienced some difficulty with word-finding a few years ago while being treated for ovarian cancer, but I always assumed it was chemo brain, not the surgically induced menopause.
Do males then suffer from poor memory?
I know that what I’m about to write is anecdotal but since my early menopause, my memory has improved! How fantastic is that? I also believe I’m smarter. When breast feeding my third child I took exams and passed them with flying colors. Recently I took up writing something I’ve been meaning to do for years. I’ve never felt so organized.
Ah thank heavens for the menopause. To think all along it was those pesky monthly peaks of estrogen that was holding me back.
RL – THanks
Anonymous #1 – Chemo brain, menopausal brain – Who knows, maybe both? What’s so great is that you’ve survived Ovarian cancer, and that in itself is worth losing a few words for. Best wishes for a sustained recovery and many more years in which to search for words…
Anonymous#2
Good question – I have no idea.
Your experience with menopause just goes to show that everyone’s brain and everyone’s menopause is different. Amazing, isn’t it?
I have tried to live without Estrogen but it’s NOT WORTH IT! I feel sorry for women who don’t have a physician to work with them on estrogen replacement when they are having miserable symptoms. Unfortunately, the pendulum has swung too far away from HRT. If you don’t need it, fine, but millions of women do. I’m one of them and I help patients with the risks and benefits to make the decision.
Thanks for this post. For the last five years I’ve been using the same word-finding strategies that I used to teach my stroke patients. On top of that I actually supplement my speech with sign language to get a message across to my family. Since I’m Italian, folks just think that I’m animated and use my hands a lot.
I really thought I was doomed for early onset Alzheimers…now I have another area to consider.
Dr Know – Agree re the pendulum, but we don’t have the data yet to begin to pull it back. Every woman must make her own decision to use HRT in light of the risks as we know them now. Sounds like you’ve made your decision, huh? 🙂
Linda – Would love to learn more about those word-finding stratgeies. Any web based resources you can point me to?
I underwent oophrectomy at 39 due to severe endometriosis. I tried to go six months without using hormonal tx hoping that any residual endometriosis would “dry up”. The hot flashes and sleep disturbances were almost tolerable with clonidine and an SSRI, but I found that the cognitive effects were intolerable.
I too had the fuzzy brain phenomenon including word finding problems. I had difficulty recalling information that I knew was stored in my brain (eg dosing for drugs that I commonly prescribed).
Once I went on estrogen things improved. I still don’t think my recall is what it was pre-BSO, but certainly markedly improved compared to when on no ERT.
I recall reading the WHI memory results when they were published and felt that they studied the wrong population and that their conclusion was opposite my N=1 study.
If anyone really wants to do a study on this, I think that all the endometriosis patients who are on GnRH agonists would be a perfect population. Once someone identified the appropriate tool for measuring brain fuzziness, they could do testing pre-GnRHa, post-GnRHa, then perhaps w/ add-back and then do long term f/u once the pt is off GnRHa.
CardioNP
Went into surgical menopause at 39 after a breast cancer diagnosis. I’m currently doing endocrine therapy, and am told I can never have any kind of HRT. I funtion OK, but don’t multi task like I used to, and I forget or use the wrong words. It’s bizarre.
Is there anything the medical community can offer women like myself?
I still get my period so I guess I am peri-menopausal because I am at the age where some women are in menopause.
I am a die hard multitasker and on the work front it’s pretty cut and dry but I find at home now I can’t see the forest for the trees and I never used to be that way.
My question is…If I am still menstruating…why would I be getting that fuzzy brain? Also,when can a woman stop being concerned with birth control? One doctor told me you have to stop having your period for one year before you are in menopause and safe having intercourse without protection.
Don’t the eggs decrease and isn’t it unlikely?
Here’s the best link I could find for word-finding strategies. To get the link to fit into the box, I had to brake it up into chunks.
http://www.capitalhealth.ca/
EspeciallyFor/Seniors/
More+Information?guid=
ECD4DDB6-5B57-44F4-A2C9-
71B2A1275B7E&type=1&TAL1ID=
5&TAL2ID=0&KE_NAME=
Speech%20&%20Language
Keep in mind that these are for the neurologically impaired patient, either post CVA, post TBI, or for those that suffer from a progressive neurological disorder.
That being said, I tend to use:
Circumlocution
Descriptive speech
Synonyms
Gestures
Pointing
Pantomime
I also find that having the listener look at me when I’m speaking helps – so that I can do all of the above at once.
Lastly, we all use these strategies in normal conversation. So don’t be self conscious about it if you have to use them more often. Most people wont even notice.
I had a spontaneous POF diagnosed at 38 after years of complaints of 2- and 3- months delays. I can trace my first delay to when I was 32 (prior to that my periods were like clockwork); other symptoms and more serious delays to about 34.
Not sure about memory, my memory at 37 wasn’t as good as at 20, but this is natural. I don’t remember if HRT improved it or not, it certainly improved quality of life, but even if I did, I don’t know if it’d be due to HRT or better sleep.
HRT was a godsend for my symptoms which were really bad. My intention had always been to stop HRT when I am 50 so that my risks are similar to those of normally menstruating women. But as I am getting closer to 50 I find myself dreading having to stop HRT… I keep hoping on some new studies or new results or safer combination (yes, I know there are no evidence that any one combination is better, but a girl can dream); I search for HRT news and studies every few months or so. Not sure if I’ll be able to stop. Also, there are virtually no studies about those of us with POF. For example, even with HRT my lifetime exposure to estrogen was probably lower than that of “normal” women. Does it mean that my risk/benefit profile for continuing with HRT a bit longer is different or not? I read everything I could find about POF, but as there are no studies…
CardioNP – The WHI memory study was a waste of everyones time and money. Garbage in, garbage out…
I like you study idea, though I don’t know if the pseudo-menopause caused by GnRH Agonists is really the same as true menopause.
Anonymous – there are docs who speicalize in the diagnosis and treatment of memory disorders, it may be worth seeing such a doc. The doc quoted in the WSJ articles is quite good.
Seaspray – Many menopausal symtpoms present in the perimenopaus, perhaps that is what is happenign to you. Or Not. I’d ask your doc (I don’t like to give out personal advice via the blog…)
Stopping birth control before menopause risks pregnancy, though indeed it is a small risk. The birth control pill is a great way to bridge the perimenopause – it treats symptoms of menopause and prevents pregnancy!
Linda – Wow – Thanks so much for these! I may try myself…
Diora – you are right we don’t have much research on HRT in the POF crowd, but that’s because I think we pretty much feel we are already doing the right thing for then, which is to given them HRT till they hit the normal age of menopause. Maybe we are assuming too much…