Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

Have a question about women’s health or menopause? Dr. Patricia Yarberry Allen may have the answer. Click here to send in your question to be posted on WVFC.

Question: I am 49 years old and still have a light, short period every three or four months. I was managing the usual symptoms of what I thought of as menopause: hot flashes, night sweats, some sleep interruption, less energy. But gradually over the last few months, I have thought that I was developing some kind of dementia.

I can’t remember names with the ease that I always had. I have trouble remembering where I left my keys or an important Fed-Ex package that needed to go out urgently. I have always had a great capacity to do several things at once and do them all really well. I still read serious books and have no trouble with comprehension or pleasure from reading.

When I have my period, and for a week or so after the period, my normal brain returns. I have no personal or family risks for breast cancer, stroke, blood clots or heart attack. I take vitamins and calcium and some hot flash remedy from the health food store that isn’t helping much, but no other medicines. I have no medical illnesses. But I need help here.

If I don’t fix this problem I may lose my job and lose my mind. And as a single mom with kids in high school, neither of these is an option. – Betty

Dr. Pat: You certainly do have the usual menopausal symptoms and, in addition, your brain may be responding to a fluctuation of ovarian hormones. While the development of cognitive impairment that interferes with work performance is not something that most women experience during this stage of the menopausal transition, it is devastating for women who do have memory loss and cognitive fuzziness and who lose their capacity to multitask.

This is an issue that all gynecologists who specialize in the care of menopausal patients must be prepared to address. Doctors in our specialty generally understand that we must be proficient not only in issues related to female genital health, breast health and hormonal change, but we must be well-versed in the differential diagnosis of symptoms such as cognitive dysfunction in an otherwise healthy woman in her late perimenopausal transition. We are primary care doctors, after all.

You should discuss this life-altering problem with your gynecologist and review your personal risk/benefit analysis for the use of hormone therapy. You will know within a few weeks if this treatment is making a difference in your cognitive function. If you continue to have these symptoms after six weeks of hormone therapy, then you must have neurological testing that evaluates whether you do indeed have a more serious problem.

We know from many years of research that the brain has hundreds of receptors for estrogen. A recent story on menopause and memory loss in the Wall Street Journal mentioned that numerous studies have shown that declining estrogen affects visual and verbal memory, as well as language and other cognitive skills.

Hormone therapy may be taken by mouth or through the skin. The advantage of using the FDA-approved bioidentical estradiol via a skin patch is the delivery of constant levels of estrogen (not the peaks and valleys of oral hormone preparations) and avoidance of liver metabolism. I generally begin patients on the lowest possible dose of the transdermal estradiol patch known as the Vivelle dot. Since you have a uterus, you will also need a progestin to prevent endometrial hyperplasia or endometrial cancer.

Your ovaries are still producing some hormones, but producing them erratically (as evidenced by having periods every three or four months), so you may experience some erratic bleeding until the estrogen from your own ovaries subsides. A daily low-dose bioidentical progesterone (Prometrium), also FDA-approved, is probably the best option to prevent heavier, longer or more frequent episodes of vaginal bleeding during the first year of hormone treatment. Once you no longer have any vaginal bleeding on this regimen, your gynecologist may choose to give you the progesterone in a cyclic fashion.

If you find, as many patients do, that this low-dose hormone therapy improves your cognitive function, I also suggest that you look at the stressors of your “over-full life.”  Involve your teenage children in this process. Let them know that you need their support and some help with family chores. Keep a running list to help you track what is important. Learn to be mindful. If we are multitasking when our brains try to store information, the storage is not as effective. And no storage means no retrieval.

Cognitive impairment generally improves as women move through late perimenopause into the postmenopausal phase. Be optimistic. These symptoms are very likely to be temporary and often disappear after one or two years after the last period.

In our message of hope to women who are suffering, we like to emphasize the importance of The New Menopause. If all goes well in your life, you have another half to live.

* * * * *
Dr. Patricia Yarberry Allen, director of the New York Menopause Center, is a gynecologist affiliated with New York-Presbyterian Hospital and a board certified fellow of the American College of Obstetrics and Gynecology.

Join the conversation

This site uses Akismet to reduce spam. Learn how your comment data is processed.

  • Dr. Pat Allen March 25, 2008 at 9:04 am

    Thank you, Barbara. Here are some earlier columns on hormone replacement safety that may be of interest. Much depends on age and other risk factors:
    Are Hormones OK When the Nightsweats Are This Awful?
    Why Won’t My Gynecologist Prescribe Hormones for Hot Flashes?
    How Do I Cope With Menopause Symptoms?
    Menopause and Women’s Health Research

    Reply
  • Dr. Pat Allen March 25, 2008 at 8:44 am

    Wendy, thank you for passing along non-hormonal remedies that have improved your symptoms. We are all in this together!

    Reply
  • Barbara Thornbrough March 24, 2008 at 6:44 pm

    Great article, Dr. Allen. Who knew that fuzziness was part of the hormone situation? Would you at some point address the safety of hormone replacement?
    Cheers,
    Barbara Thornbrough

    Reply
  • [email protected] March 24, 2008 at 4:09 pm

    My friends and I – all of whom are in menopause – often make light of our “aging brains,” while fearing the worst – early Alzheimers. But we all shared another symptom of menopause – insomnia, or interrupted sleep. And that, in turn, affects our memory and overall well-being.
    Since starting on a cocktail of Flax seed, Fish Oil, vitamins, calcium with magnesium and Black Cohosh, I am sleeping better and my memory seems better too. Friends who have chosen to take hormones have seen a remarkable improvement as well. So there are solutions, which ever road you take.

    Reply