Memory-wise
Page 6
If you think your workload could explain why your memory is not at its best, then consider ways to reduce it. Think about time management, pace yourself, and include brief times to relax properly, at your desk, in the car park, at the bus stop. Being relaxed has a positive effect on your attention level. You might like to investigate some specific relaxation techniques, such as deep-muscle relaxation, meditation, mindfulness, breathing practices or yoga.
During times when you feel your memory is letting you down, be kind to yourself, and introduce supportive memory strategies. Chapter 6 describes specific strategies to help nurture your memory. A visit to your doctor will help establish whether there are any health issues that could be affecting your memory. Of course there are sometimes factors that are beyond our control, but there are often things that you can do with your health, lifestyle and attitude towards remembering that can help you get more out of your memory.
Key points WHAT ELSE AFFECTS MEMORY?
• At any age, our ability to remember can fluctuate.
• Our memory abilities are influenced by various factors, some of which are under our own control—including aspects of our health, our lifestyle and, importantly, our attitudes and beliefs in our own skills.
• To get the most out of your memory, it is important to be aware of these factors and, if necessary, actively do something about them.
CHAPTER 4
Memory during menopause
My life is out of control because of my forgetting.
Donna, 44
Mum, have you got Alzheimer’s or something? I’ve told you that already, don’t you remember?
Charlotte, 17
I’ve never been able to talk to anyone about this, and no one told me what to expect. I’ve been scared that I’m going around the bend.
Clara, 54
Some people just breeze through menopause—maybe that’s why women don’t talk to each other about it, because we don’t all have the same experience.
Anjali, 59
There is so much stigma—it’s like menopause is a dirty word. I am surrounded by younger people at work; I try to hide my memory failures. There is no way I would talk to people at work about menopause—they probably wouldn’t know what it means.
Abuya, 48
What is menopause?
We learn about the changes that happen to us at puberty when we are at school, but most of us haven’t been taught about menopause. What do you know about menopause? Have a go at this short quiz to check your knowledge! Choose true or false for the following 10 questions. The answers are provided here.
1 Menopause marks the end of a woman’s reproductive years. True or False?
2 The average age of menopause (defined as 12 consecutive months without a menstrual period) is 59. True or False?
3 During the time leading up to menopause, the levels of hormones produced by the ovaries fluctuate. True or False?
4 ‘Perimenopause’—the transition phase close to menopause, when menstrual patterns typically become irregular (in the length of the period, the time between periods, and the level of flow)—always lasts for five years. True or False?
5 ‘Premenopause’ is the time before perimenopause. True or False?
6 After menopause, women are said to be ‘postmenopausal’. True or False?
7 Women can experience premature or early menopause after surgical removal of the ovaries, or chemotherapy or radiotherapy treatment for cancer. True or False?
8 All women experience hot flushes during menopause. True or False?
9 Mood changes, irritability and anxiety are not common during menopause. True or False?
10 Many women complain of forgetfulness during menopause. True or False?
This chapter will answer questions such as:
• How many women notice forgetfulness during menopause?
• How do women feel about their memory during menopause?
• What type of memory difficulties do women notice at midlife?
• Is there any evidence that memory is worse during menopause?
• What helps when you notice forgetfulness around menopause?
Research on memory during menopause
Over the past few decades, researchers have begun to study memory during menopause in more detail, and in recent years I have conducted research on this topic. It all started with my involvement in education sessions for women about memory and menopause at the Royal Women’s Hospital in Melbourne, Australia. These sessions were part of a broader education program about menopause, covering practical information and tips for a range of menopause symptoms. For several years, I provided these sessions together with Associate Professor Christina Bryant, a friend and colleague who is a clinical psychologist. Our topic was ‘Mood and memory during menopause’. We found that the women attending the sessions benefited from gaining a better understanding of what can happen in terms of mood and memory, and what is helpful when you experience these symptoms. As Christina continued her work in the Menopause Clinic at the hospital, she noticed that women coming to see her would describe forgetfulness and concern about memory. Being an academic as well as a clinician, Christina suggested that I do some research on this topic. So I spent several years doing just that, completing my PhD in 2013 on memory during menopause.
My doctorate research project was conducted at the hospital, and I saw 130 women, who attended either menopause or gynaecology clinics.1 The women ranged in age from 40 to 60, and were divided into groups according to their stage of menopause. There were 36 premenopausal, 54 perimenopausal and 40 postmenopausal women. Each woman completed questionnaires focusing on their feelings about memory, and underwent a detailed neuropsychological assessment of their memory abilities.
Answers
1 Menopause marks the end of a woman’s reproductive years.
True. The first menstrual period during puberty marks the start of a woman’s reproductive years, and the last menstrual period signifies the end of the reproductive years.
2 The average age of menopause (defined as 12 consecutive months without a menstrual period) is 59.
False. The average age for a woman to reach menopause is around 50, but the most common age range for menopause to occur is between 48 and 55.
3 During the time leading up to menopause, the levels of hormones produced by the ovaries fluctuate.
True. Levels of hormones, including oestrogen and progesterone, fluctuate during the time leading up to menopause. The overall levels of these hormones decrease during the menopausal transition and, after menopause, oestrogen and progesterone are no longer produced by the ovaries.
4 ‘Perimenopause’—the transition phase close to menopause, when menstrual patterns typically become irregular (in the length of the period, the time between periods, and the level of flow)—always lasts for five years.
False. This transition stage varies in length and can last for up to 10 years.
5 ‘Premenopause’ is the time before perimenopause.
True. Premenopause is the stage of women’s reproductive years that begins with the first menstrual cycle and ends around the time that perimenopause begins.
6 After menopause, women are said to be ‘postmenopausal’.
True. A woman is considered to be postmenopausal after she has reached menopause, which is defined by looking back and knowing that there have been 12 consecutive months without a menstrual period.
7 Women can experience premature or early menopause after surgical removal of the ovaries, or chemotherapy or radiotherapy treatment for cancer.
True. These medical procedures can lead to menopause. Before the age of 40, it is called ‘premature menopause’, and before the age of 45, it is called ‘early menopause’.
8 All women experience hot flushes during menopause.
False. Hot flushes, giving a sudden warm feeling, are not experienced by all women during menopause. They are very common though, and about 85 per cent of women report having hot flushes an
d night-time sweats. Sleeping difficulties are also common around menopause.
9 Mood changes, irritability and anxiety are not common during menopause.
False. A combination of hormonal changes and sleep deprivation can contribute to mood changes, irritability and anxiety around the time of menopause. These problems can become worse at times of stress, and it is common to experience stress during this life stage. Life is full, with work both inside and outside the home, and family commitments, including children and older parents.
10 Many women complain of forgetfulness during menopause.
True. Many women notice forgetfulness around the time of menopause, and that’s what this chapter is about! It’s common to wonder whether memory lapses are part of menopause. Some women start to fear that their forgetfulness may be an early sign of dementia.
How many women notice forgetfulness during menopause?
The responses given by the sample of women from the Royal Women’s Hospital helped to answer several questions about memory during menopause. First, we looked at the proportion of women who acknowledged that they had experienced ‘poor memory in the past month’. Combining the responses of all women, including those who were premenopausal, perimenopausal and postmenopausal, about three-quarters of women (72 per cent to be exact) said they had experienced poor memory in the past month. So, a clear majority of women in this study had recently noticed poor memory.
Here is the breakdown of each group.
Have you experienced poor memory in the past month? Yes
Premenopausal group 62%
Perimenopausal group 82%
Postmenopausal group 68%
You can see that it was women in the perimenopausal stage who reported the highest memory complaints, at 82 per cent. You might expect that the women in this clinic sample would complain more about memory than women in the general community, since they had come to a hospital clinic and may have been experiencing more intense menopause symptoms. When we looked at other studies, we found that the proportion of perimenopausal women reporting memory symptoms in this study was similar to, or slightly higher than, that observed in other Australian and US community-based studies.2 So, the answer to the question, ‘How many women notice forgetfulness during menopause?’, would have to be ‘most’—and especially women who are in the perimenopausal transition stage.
How do women feel about their memory during menopause?
In our study at the Royal Women’s Hospital, we looked at how satisfied women were with their memory using a detailed questionnaire about beliefs and confidence in memory. We found that perimenopausal women were significantly less satisfied with their memory than premenopausal and postmenopausal women. When we looked at general community responses on this same questionnaire,3 we noticed that memory satisfaction in the perimenopausal women in our study was well below that in the community, indicating significant memory dissatisfaction for these women.
Women in the study had to rate the degree to which they agreed with 18 statements tapping into their beliefs and feelings about memory. The statements the perimenopausal women agreed to most strongly indicated they felt that their memory was not working as well as it used to. They acknowledged feeling unhappy, concerned, embarrassed, and lacking in confidence in relation to their memory ability. They agreed that they had hidden their memory problems so others wouldn’t notice.
I’ll be driving to a place that I’ve been to lots of times. I start to go there and then suddenly I can’t remember what direction it is in. You think you’re going nuts.
Pia, 52
I feel like there is a hole in my head. I think I need to have a brain scan to check. I feel like I’m losing my mind and I have Alzheimer’s. I get really upset when I forget things at work. It makes me feel insecure and sad.
June, 46
I write a shopping list and think I must put it in my purse. When I get to the shops I see that it’s not in my purse and realise that I have forgotten to put it in my purse. It worries me that I didn’t remember that I forgot to do this.
Fiona, 49
I can’t even call my kids the right name. The wrong words are coming out. I’m calling Bradley Phil. I go blank on people’s names—I’m so embarrassed. I know I just can’t get them, can’t access them. Sometimes I don’t even pick it up straight away.
Anya, 48
I’m conscious not to say the wrong thing at work. I’m hesitant. I don’t want them to hear me say the wrong thing.
Jo, 52
What type of memory difficulties do women notice at midlife?
We asked all of the women in our study to rate how frequently they experienced 20 everyday memory lapses. We found that not only did the perimenopausal women report less satisfaction with their memory, they also reported significantly more frequent memory lapses than the premenopausal and postmenopausal women. Women in the premenopausal and postmenopausal groups reported a similar frequency of memory lapses to people in the general community, but the perimenopausal women in our study reported more frequent memory difficulties than people in the general community.4
The most frequently acknowledged memory lapses by the perimenopausal women included:
• trouble recalling names and specific words
• forgetting what they were just about to do, like walking into a room and forgetting what they went in there for
• forgetting a phone number they had just looked up
• leaving something behind they meant to take with them
• forgetting something they read earlier in the day, or something they intended to buy
• trouble concentrating
• losing their train of thought
• forgetting what they were about to say.
Now—you can tell me a name and I forget it in seconds!
Tamar, 50
I will have a blank for the word I want to say and it just won’t come.
Lena, 55
I go upstairs and I think, ‘What did I come up here for?’
Debbie, 44
It’s just like it sits there and doesn’t sink in. It took me three months to learn my mobile phone number.
Angela, 51
I keep forgetting to take things with me—like when we go to our holiday house, I forget to take the phone charger.
Siobhan, 48
I used to have a photographic memory, and now I read a novel and can’t recall what I was reading.
Vicki, 54
I forget things. My son asked me to get some ham at the supermarket and I got half a dozen things, but when I got home I realised I had forgotten to get the ham. I forget to do things even though I’ve said I will do them. Some of this is because I’m really busy.
May Lin, 50
I forget what I’m talking about mid-sentence and totally lose my train of thought.
Tracey, 50
If I get symptoms of menopause, like a hot flush, I get anxious and worry about what I appear like in front of people and then I don’t concentrate. Have they noticed that my hair is dripping? Have I turned red? And do they know that my heart is pumping?
Anuja, 52
Is there evidence that memory function is worse during menopause?
We know that many women notice forgetfulness during the menopausal transition. We also know that there is a decrease in hormones, such as oestrogen, as women experience menopause, and these hormones are important for optimal brain functioning, especially in regions of the brain that are known to be important to memory. Researchers have suggested that these alterations in oestrogen levels could be detrimental to memory ability.5
So is there any evidence that memory becomes worse during menopause? There have been relatively few studies that have directly investigated this question, and the studies that have been performed have reported conflicting findings. Some cross-sectional studies have compared groups of women who are in different stages of menopause. Other longitudinal studies have observed the same group of women as they move through th
e natural stages of menopause. Each study has tested memory in a different way, which makes it difficult to compare one study to another, and to draw firm conclusions.
In our study at the Royal Women’s Hospital, we gave 130 women a challenging and detailed set of memory tests that took 90 minutes to complete. We included tests that covered the types of memory processes involved in the various everyday memory lapses that women tend to report. The women completed tasks that measured attention and concentration, speed of processing information, planning and organisational skills, and the ability to learn new information, to remember to do something at a specific time, to find specific words when put on the spot, to switch from one way of doing something to another, and to remember something when you haven’t been told to try to remember it for later.
We found no difference in performance between the premenopausal, perimenopausal and postmenopausal groups on any of these memory tests. This finding was similar to several other studies that have found no evidence of worsening memory during the menopausal transition. This is reassuring, but it doesn’t rule out the possibility that some women may experience subtle change in some aspects of memory. Indeed, some studies in which the same memory tests have been given to individual women as they transitioned through menopause have reported very small changes in women’s memory during perimenopause and early postmenopause.6
Why do women feel less confident about their memory during menopause?
Menopause is a time of transition. It’s a time when many women become aware of changes in themselves. Physical symptoms of menopause, such as changes in menstrual cycles and hot flushes, can be seen as the first signs of ageing. When women focus on these signs of getting older, perhaps they start to focus more on other aspects of their life, like memory lapses. Studies looking at perceptions of memory have shown that both men and women can become concerned about their memory at midlife,7 and the often negative stereotypes of ageing in some societies only serve to make people feel worse about their memory.