DOI: 10.31038/AWHC.2024743

Abstract

A woman’s transition through menopause is a multifaceted experience that encompasses more than just the end of reproductive capacity. It presents unique challenges and opportunities for mental health scholars and practitioners. Importantly, hormonal fluctuations that occur during menopause impact a woman’s neurological and cognitive functioning. As a result, women may experience a variety of cognitive challenges commonly collectively referred to as brain fog. To this end, brain fog is a hallmark symptom of menopause. The application of neurocounseling to menopausal mental health care presents a novel pathway for holistic, personalized treatment. This article presents current information regarding cognition during menopause and neurocounseling. The article concludes with recommendations for the application of neurocounseling as a treatment approach for brain fog within a menopausal mental health care.

Keywords

Menopause, Brain fog, Cognition, Neurocounseling, Neuroscience, Mental health

Cognition During Menopause

During menopause, many women experience noticeable changes in cognition, often referred to as brain fog . These cognitive changes are largely influenced by hormonal fluctuations, particularly the decline in estrogen, which affects brain function. Estrogen plays a key role in cognitive processes, including memory, attention, and learning. As estrogen levels drop during perimenopause, women may face several cognitive challenges. For example, many women report memory problems such as forgetfulness or difficulty recalling information, especially short-term memory issues. A decline in attention span and focus is common, making it harder to concentrate and complete tasks that require sustained attention. During this time some women notice that it takes longer to think through tasks or solve problems than before suggesting that some perimenopausal women have a lower processing speed. In addition, perimenopausal women may struggle to find the right words during conversations, leading to feelings of frustration. Overall, many women experience a general sense of mental cloudiness or difficulty thinking clearly, affecting problem-solving and decision-making during menopause, and perimenopause in particular [1-5].

These cognitive changes can affect daily life and work, contributing to emotional distress such as anxiety and frustration. This is further exacerbated by the fact that there is no universal assessment or benchmark for the onset of perimenopause [5]. Thus, brain fog is many women’s first encounter with the symptoms of menopause. As a result, many women struggle to detect their symptoms as those of menopause and not simply aging or stress [6]. While this may be inconsequential for some women, the lack of knowledge and preparedness can create significant psychological distress for others. For most women, cognitive changes are temporary and tend to improve post-menopause. Nevertheless, the impairment can last years as a women undergoes perimenopause and be quite debilitating [5]. Lifestyle interventions like exercise, healthy diet, mental stimulation, and stress management can help mitigate cognitive difficulties during this phase. Moreover, menopausal hormone therapy (MHT), such as the use of prescribed estrogen via patches, pills, vaginal creams, combined estrogen-progesterone pills, gel-based applications, and certain intrauterine devices (IUDs), can help mitigate the underlying hormonal cause of cogntitive impairment. However, these interventions do not address the neurological aspects of a woman’s hormonal fluctuations that contribute to psychological distress [1,7].

Neurocounseling

Neurocounseling is an interdisciplinary approach that integrates neuroscience with counseling practices to better understand and address mental health issues. It focuses on how brain function and neurological processes influence behavior, emotions, cognition, and overall mental health. By incorporating knowledge of the brain and nervous system, neurocounseling helps mental health practitioners design more effective interventions tailored to the biological underpinnings of a person’s mental health challenges [8,9].

The neurocounseling approach involves using tools like brain imaging studies, neurofeedback, mindfulness practices, and cognitive-behavioral strategies to promote positive changes in brain functioning and emotional regulation. The goal is to help patients and clients improve their mental health by combining traditional therapeutic methods with insights from neuroscience, fostering a deeper understanding of how the brain and nervous system respond to therapy. Neurocounseling is particularly useful in treating conditions such as anxiety, depression, trauma, ADHD, and other disorders where brain function plays a critical role. The use of neurocounseling to support menopausal women is relatively unexamined [10-12].

Implications for Menopausal Mental Health Care

Mental health practitioners can use neurocounseling to effectively treat cognitive challenges such as brain fog during menopause by incorporating neuroscience-based techniques that target both the brain and behavior. Given that cognitive changes during menopause, such as memory issues, difficulty concentrating, and brain fog, are often linked to hormonal fluctuations, neurocounseling offers a holistic and empowering approach to managing these challenges. A summary of how six aspects of neurocounseling can be used to address cognitive aspects of menopausal mental health follows.

Psychoeducation

Psychoeducation is an integral aspect of neurocounseling [11]. Mental health practitioners can educate patients and clients about the neurological basis of cognitive changes during menopause, helping them understand that these difficulties are normal and often temporary. This awareness can reduce anxiety and foster a more compassionate view of their menopausal experience.

Cognitive-behavioral Therapy (CBT)

Neurocounseling can integrate CBT techniques to help clients and patients manage negative thought patterns that may arise from cognitive struggles [10]. For example, women who feel frustrated by forgetfulness can learn strategies to reframe their experiences and reduce the emotional burden associated with menopausal cognitive challenges.

Mindfulness and Relaxation Techniques

Since stress exacerbates cognitive decline, mental health practitioners can teach mindfulness-based stress reduction (MBSR) and relaxation techniques [13]. Mindfulness has been shown to positively affect brain plasticity, promoting cognitive resilience by enhancing focus, attention, and emotional regulation. For women undergoing cognitive changes due to menopause, MBSR can be particularly useful, empowering women to assert greater control their attention and emotional regulation.

Neurofeedback

This tool allows patients and clients to monitor their brain activity in real time and learn how to regulate their brain waves. Neurofeedback can improve concentration, memory, and mental clarity, which are often impacted by menopause [10].

Memory and Attention Training

Mental health practitioners can use brain-based exercises to strengthen cognitive functions such as working memory and attention. Techniques like brain games, puzzles, and structured mental exercises can improve cognitive flexibility and processing speed [14]. As a tool within the neurocounseling framework, memory and attention training can empower women while creating an entertaining outlet. The latter may be particularly important given that many women report an increase in social isolation and a decreased participation in pleasurable activities during the menopausal transition [15].

Lifestyle Guidance

Neurocounseling emphasizes the connection between brain health and lifestyle choices. Mental health practitioners can encourage physical exercise, proper nutrition, and adequate sleep, all of which are linked to better cognitive function. They may also recommend activities that stimulate the brain, like reading, puzzles, or learning new skills, which promote neuroplasticity and cognitive improvement [13].

Conclusion

By using neurocounseling, mental health practitioners can offer women experiencing cognitive difficulties during menopause a comprehensive treatment plan that addresses both the psychological and neurological aspects of their symptoms, helping them regain confidence and mental clarity. For patients who can and are willing to take MHT, mental health practitioners using neurocounseling approach can work collaboratively with a woman’s medical healthcare provider who can prescribe MHT [1]. In this case, a combination of MHT along with neurocounseling presents a meaningful clinical pathway for the treatment of hormonal fluctuations, psychological implications, and neurological aspects of cognitive concerns among menopausal women. Women who are unable or unwilling to take MHT can also benefit from neurocounseling for symptom management and improved quality of life.

References

1. Maki PM, Jaff NG (2022) Brain fog in menopause: a health-care professional’s guide for decision-making and counseling on cognition. Climacteric 25(6): 570-578. [crossref]
2. Haver MC (2024) The new menopause: navigating your path through hormonal change with purpose, power, and facts. New York, Rodale Books.
3. Mosconi L, Berti V, Dyke J, Schelbaum E, Jett S, et al. (2021) Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Scientific Reports;11(1): 10867. [crossref]
4. Mosconi L (2024) The menopause brain: new science empowers women to navigate menopause with knowledge and confidence. New York, Avery, an imprint of Penguin Random House.
5. Malone S (2024) Grown woman talk: your guide to getting and staying healthy. New York, Crown.
6. Refaei M, Mardanpour S, Masoumi SZ, Parsa P (2022) Women’s experiences in the transition to menopause: A qualitative research. BMC Women’s Health 22(1): 53-53. [crossref]
7. Gava G, Orsili I, Alvisi S, Mancini I, Seracchioli R, et al. (2019) Cognition, Mood and Sleep in Menopausal Transition: The Role of Menopause Hormone Therapy. Medicina 55(10): 668. [crossref]
8. Beeson ET, Field, TA (2017) Neurocounseling: A New Section of the Journal of Mental Health Counseling. Journal of Mental Health Counseling 39(1): 71-83. Available from: https://doi.org/10.17744/mehc.39.1.06
9. Goss D (2016) Integrating Neuroscience into Counseling Psychology: A Systematic Review of Current Literature. The Counseling Psychologist 44(6): 895-920.
10. Russell-Chapin LA (2016) Integrating Neurocounseling into the Counseling Profession: An Introduction. Journal of Mental Health Counseling 38(2): 93-102.
11. Lorelle S, Michel R (2017) Neurocounseling: Promoting Human Growth and Development Throughout the Life Span. Adultspan Journal 16(2): 106-119. Available From: https://doi.org/10.1002/adsp.12039
12. Marzbani H, Marateb HR, Mansourian M (2016) Neurofeedback: A Comprehensive Review on System Design, Methodology and Clinical Applications. Basic Clinical Neuroscience 7(2): 143-58. [crossref]
13. Hughes M (2023) Neuroplasticity-based multi-modal desensitization as treatment for central sensitization syndrome: A 3-phase experimental pilot group. Journal of Pain Management 16(1): 67-74.
14. Al-Thaqib A, Al-Sultan F, Al-Zahrani A, Al-Kahtani F, Al-Regaiey, K, et al. (2018) Brain Training Games Enhance Cognitive Function in Healthy Subjects. Medical Science Monitor. Basic Research 24: 63-69. Available From: https://doi.org/10.12659/MSMBR.909022
15. Currie H, Moger SJ (2019) Menopause – Understanding the impact on women and their partners. Post Reproductive Health 25(4): 183-190. [crossref]