Memory-wise

by Anne Unkenstein

  It’s not just feeling negative about getting older that may affect our perceptions about memory. In our study, we found that a woman’s attitude towards menopause was an additional factor that related to feelings about memory. Women in the perimenopausal group who reported a more positive attitude towards menopause tended to say that they felt more confident and positive about their memory, when compared to women who reported a more negative attitude towards menopause.

  The perimenopausal women in our study who performed most poorly on a measure of attention were the women who tended to report more forgetfulness. Memory lapses are often related to not paying enough attention, and there are many reasons why women find it difficult to pay attention during menopause. Our study showed that perimenopausal women who reported more anxiety and mood symptoms, and more sleep disturbance and hot flushes, reported more negative feelings about their memory. Of course, anxiety, depression and poor sleep can make it difficult to pay attention and focus. Add to that the demanding lives women often lead at midlife, working both in and out of the home, and being there for children, parents and friends, and we can see why midlife memory lapses related to not paying full attention can occur!

  Our research also showed that women going through menopause reported less control over their memory than women who had not yet reached the menopausal transition.

  At times I get anxious and frustrated because I feel that I am unable to control aspects of my life anymore, like vagueness, loss of concentration, and at times memory lapses for things like names.

  Libby, 47

  The more I noticed my memory problem, the more I got anxious.

  Bea, 55

  I’m scared about having Alzheimer’s.

  Bernadetta, 58

  Concern and anxiety about memory during menopause can have a real impact on self-confidence. When your confidence is low, it can affect your work performance, personal relationships and everyday functioning. In a large study in the United Kingdom, 40 per cent of the perimenopausal and postmenopausal women who took part reported a negative impact of menopause on their work performance, which was particularly related to perceived difficulties with concentration and memory.8

  I left my job because of these changes. I couldn’t do what I was in charge of doing—it was so overwhelming. There were hundreds of women at my work and they wouldn’t talk about menopause or losing memory. I got no support from my work. They wouldn’t admit to it being something we all go through.

  Cynthia, 58

  What helps when you notice forgetfulness around menopause?

  I don’t just want their sympathy—I want to know why it’s happening and is there anything I can do to make it better.

  Melinda, 54

  The results of my doctorate research project pointed to a clear need to support women regarding memory concerns during the menopausal transition. Fortunately, I had been involved in conducting memory support groups for older adults for several years, using a program devised by a Melbourne-based group of researchers.9 After consulting this research team, we decided to trial the memory support group at the Royal Women’s Hospital with groups of women who were experiencing menopause. Women attended the group once a week for four weeks. We discussed how memory works, normal age-related changes in memory, and memory illnesses, such as dementia. The women were trained to use a range of specific memory strategies, and provided with information about enhancing memory by focusing on health and lifestyle factors. The results were clear: attending the memory support group improved the women’s beliefs and self-confidence around memory.10

  What I’ve learned from coming to this course:

  • Not to be so hard on myself, the importance of mindfulness, and knowing when my memory is more likely to let me down.

  • I have always prided myself in my memory. It has always been a strength. You have taught me that some aspects of the change in my memory are natural and I have no control over them, but I don’t feel so much like I’m on the edge of a cliff because you have shown me there are many aspects I can control.

  Tanya, 49

  So, what did we do in the groups to bring about this change in women’s self-confidence around memory? What helps when you’re concerned about memory during menopause?

  Understand your memory

  Talk about memory with other women who are going through menopause. Women attending the memory groups found it reassuring to know that other women had similar memory lapses and shared their concern about memory.

  I feel better knowing that others have the same issues with memory. I have been telling all my friends what we are doing in the sessions, and helping them to understand about memory, too.

  Jocelyn, 55

  Learn how memory works (outlined in Chapter 1 of this book). It is normal for memory to fluctuate, especially if you are having difficulty paying attention. Forgetting is a normal part of the memory system that prevents overload.

  Now I know that it is normal to have a few memory lapses.

  Hoa, 50

  This is really good timing—I wouldn’t have wanted to know this when I was 30, but now it’s good information for me, for my parents and for my children.

  Vivian, 50

  Learn about the difference between everyday memory lapses that can be age-related (see Chapter 2) and more significant memory loss, which can occur with dementia and other memory illnesses (see Chapter 8).

  I feel so relieved to know that my memory lapses are normal.

  Mandy, 49

  Develop more realistic expectations of your memory. Our research on memory during menopause showed that women with higher expectations of their memory tended to feel worse about their memory. You may feel better about your memory if you don’t put so much pressure on yourself.

  Celia, aged 52, had worked in childcare for most of her career and had started to worry about her memory because she was finding it hard to recall over 100 children’s names, and the names of the children’s parents. She had always prided herself in her memory for names. After learning about how memory works and normal age-related changes in encoding and retrieval, Celia said that she felt reassured about her memory. She felt that it was okay not to be able to learn all those names in a short period of time.

  Anne

  Pay attention to paying attention!

  When we remember something new, we need to pay attention to it. For example, when people introduce themselves to you, you need to pay attention to their name and their face. If anything stops you from paying full attention, then you will be less likely to remember their name later on because you never got the name into memory storage in the first place.

  I was so nervous about how the meeting would go that when people came into the room and started introducing themselves to me, I wasn’t able to focus on what they were saying.

  Lin, 44

  Of course, life gets in the way, and we are not always able to pay attention and focus. Many midlife memory lapses are related to not paying full attention. It helps if you make a conscious effort to pay attention.

  I was at a social gathering during the week and was introduced to a woman. I told her that I am doing a memory course and I have been told to make associations with names. She told me her name was Sherry and I told her I would remember her name because I like drinking Sherry! We laughed and she told me that she has trouble remembering names, too.

  Peggy, 51

  Feeling anxious about your memory can set up a cycle, where your memory can start to let you down even more. Your anxiety about remembering can prevent you from being able to pay full attention to incoming information, which in itself can lead to memory lapses. When you experience another memory lapse, this gives you more evidence that your memory is a problem, and then you feel even more anxious about your memory.

  It’s a vicious circle—I feel self-doubt and self-consciousness. I run myself down and then I forget something again. I’ll be in a conversation or a meeting, and I think, ‘I need to remember this’. I become
so anxious that I’m not going to remember it and I stop listening and shut it out and later I don’t remember.

  Samantha, 55

  To help interrupt this ‘memory–anxiety spiral’, take the time to pay full attention and learn something new. You could try learning a mobile phone number or the name of someone who is important to you. Take your time to do this, and show yourself that your memory can work. See Chapter 6 for strategies to assist with achieving this new learning.

  Robyn’s 16-year-old daughter, Ava, criticised her repeatedly about not remembering what she had said to her. Robyn decided to show Ava that she could remember. Next time Ava spoke to her, Robyn stopped doing what she was doing and made an effort to focus her full attention on what her daughter was saying.

  Anne

  At a dinner, I met a woman with an unusual name. She said, ‘You won’t remember my name.’ I replied, ‘Yes I will.’ I focused on it, said it a few times and remembered to say goodbye to her. She was impressed. I felt good.

  Kiara, 51

  Use memory strategies

  At midlife, many women use strategies to support their memory. In our research study at the Royal Women’s Hospital, the perimenopausal women reported that their most frequently used memory strategy was a written reminder. Women reported using reminders in calendars, diaries, notebooks and shopping lists. These ‘external’ memory strategies, that involve using some sort of external aid to help memory, are the most commonly used techniques to support everyday memory. Other external strategies involve putting something in a special place as a reminder to do something, using technical reminder systems, and asking someone to remind you.

  Tamara, aged 57, came to the memory group saying that she didn’t want to have to rely on writing information down. She had started a new job, working on reception, and had to learn several new procedures. She was trying to keep all the new information in her head, but found that she kept getting distracted by phone calls and customers arriving at her desk. After some encouragement to try external memory strategies, Tamara organised her work systems and compiled a written procedure manual. She told the group how positive this process had been. She now felt more confident, and said that her mind was freed up for work.

  Anne

  Lily, aged 50, said she has always had a good memory and has never used written reminders. When her mother became seriously ill, Lily started to feel overwhelmed. When she went to bed each night, she would run through all the things she had to do in her mind, but she kept feeling she would forget something important, like to take her mother to a medical appointment. After taking up on the suggestion to use an organised written reminder app in her mobile phone, Lily expressed relief, saying, ‘It’s so good to dump the information from my head somewhere else, and to stop going over and over it when I lie in bed at night.’

  Anne

  I’ve got a work conference coming up next week that I’m on the organising committee for, so I know that I’m going to need to use all my reminder systems more because I’ll be overloaded.

  Connie, 59

  Most women use a combination of ‘external’ and ‘internal’ memory strategies to assist memory. Internal strategies come from within us. They often involve adding meaning to information using visualisation and association. These strategies help by focusing our attention to information, and processing the information more deeply. For example, to remember where you parked your car in section ‘E2’ of a multi-storey car park, you might visualise two elephants sitting on your car! Chapter 6 provides more information about memory strategies.

  Megan, aged 47, was having difficulty recalling the name of the man who always served her when she went to the motorbike parts shop. His name is James. We came up with the idea of imagining he is ‘James Dean’ the actor, riding on his motorbike, and she said she no longer has any trouble remembering his name!

  Anne

  Midlife memory also benefits from a supportive environment, both at home and at work. We can design our environment and the appliances that we use to reduce the load on our memory. For example, at work it helps to have a list of all staff displayed, with their photos next to their names to help us remember our colleague’s names. At home, we don’t have to remember to turn the iron off, if we use an iron that turns itself off when we forget! See Chapters 7 and 10 for more information about memory strategies at work and memory-wise environments.

  Run through the midlife memory-health checklist!

  We all notice fluctuations in our ability to remember from time to time, and especially at midlife. Our memory abilities can be less efficient when we are excessively busy, emotionally stressed, or mentally or physically unwell. In particular, it can be difficult to pay attention and focus at these times. It’s common to feel a sense of loss during the menopausal transition. Your role as a parent is changing as your children become more independent, and you may be reassessing your work role or planning your retirement. You might be stressed and busy with supporting your parents and feeling negative about going through menopause and getting older. Our memory processes are sensitive to what is happening in our lives and to our physical and emotional wellbeing.

  Take a moment to run through this midlife memory health check:

  • Is your workload too heavy?

  • Are you experiencing a high level of stress or anxiety?

  • Is your sleep disturbed?

  • Are you feeling constantly sad or depressed?

  • Are you unwell?

  • Do you have pain?

  • Is your vision or hearing impaired in any way?

  • Are you taking any medication and, if so, do you know if it can affect your memory?

  • Do you drink too much alcohol, or use other drugs to excess?

  If you are concerned about your memory and you answered yes to any of these questions, it might be time to take action. The previous chapter provides more information about factors such as anxiety, depression, sleep, stress, alcohol, pain and medications. Of course there are sometimes aspects of our lives that are beyond our control, but there are often things that we can do with our health, lifestyle and emotional balance that can help us get more out of our memory. Be proactive and work on the things that you can control!

  When you’re not feeling right, you don’t think right.

  Ruth, 56

  My memory got worse in my fifties, and I put it down to menopause. My hearing has been a slight problem for many years, and when I learned that hearing is important for memory during the memory group, I decided to get my hearing tested. I had been finding it hard to hear on the phone, and I didn’t realise how bad my hearing was until the audiologist put some hearing aids on me and I could hear! The audiologist explained how my hearing loss could affect my memory and I got quite emotional. I felt so relieved to know what had caused my memory problem, and that I could now finally do something about it.

  Camilla, 56

  Before hormone replacement therapy (HRT), I had terrible sleep. I woke up every hour with hot flushes and was so sleep deprived. I found it harder to remember things I should do. This has improved with HRT, and getting better sleep. It was definitely sleep-related.

  Kaye, 55

  My memory is okay now. When I started being menopausal, I was concerned. You have to realise that if there’s something wrong with your health or if you are overloaded, it will affect your memory. Self-preservation is important—be kind to yourself.

  Maia, 59

  Nurture your brain health at midlife and beyond!

  After taking the time to think about your memory during menopause, to work on strategies to support your memory, and to make adjustments to aspects of your health and lifestyle that may lead to improved memory, you might just find yourself feeling better about your memory than you did before. The challenge now is to maintain this feeling as you get older.

  I’ve been doing all these things because of coming to this group. It has spurred me on to get organised. I feel so much more organised and
motivated for the future.

  Sheryl, 51

  You can read more about nurturing brain health in Chapter 5, but for now, let’s focus on the key evidence-based strategies that have been proposed for maintaining your memory and reducing your chances of developing dementia.

  • The healthier your body is, the healthier your brain will be. Around midlife, there can be changes in your blood pressure, blood glucose and cholesterol levels, so see your doctor regularly to manage these aspects of your health. Exercise regularly, enjoy a healthy diet, avoid smoking and keep alcohol intake low.

  • Your psychological wellbeing is important for your brain health. Seek treatment for persisting stress, anxiety or depressive symptoms.

  • Stay connected socially and take part in regular activities that involve new experiences and mental effort.

  Further support and information

  See your doctor if you remain concerned about your memory, or if you would like further information about menopause, anxiety, depression, hot flushes or sleep disturbance.

  Your local women’s health or menopause support organisation and your local dementia support organisation can provide further information and support. Details of such support organisations are provided in the ‘Resources’ section at the end of this book.

  Key points MEMORY DURING MENOPAUSE

  • It is common to notice forgetfulness during menopause.

  • Around menopause, many women feel concerned, embarrassed and lacking in confidence about memory.

  • Common memory lapses reported by women at midlife include difficulty recalling names, specific words, what you were just about to do, what you were meant to buy or take with you, something you read recently, trouble concentrating, losing your train of thought and forgetting what you were about to say.

  • Studies that have examined memory during menopause by asking women to complete memory tests have reported conflicting findings. Many studies have found no evidence of poor memory performance during menopause, but some studies have reported subtle changes in some aspects of memory.