Let's talk about menopause brain

Was going to write something here, but forgot what I was going to say...

“I’m sorry, I totally lost my train of thought,” I say, looking directly at my laptop camera in a desperate attempt to connect with the person I’m interviewing via Microsoft Teams.

“Don’t worry, it happens to me all the time,” she says. “Brain fog is real.”

Research published today has likened the effects of the menopause to Alzheimer’s, with a loss of grey matter affecting memory, attention, spatial navigation and more.

I do not doubt it.

Credit: Mart Production, Pexels

I am 43 years old and in full menopause. After being diagnosed with breast cancer at 29, I had chemotherapy, radiotherapy and the drug tamoxifen, which put me in instant perimenopause. Throughout my thirties, I had hot flushes and fatigue while I carried on with my busy job, trying to appear normal while kicking away like a swan underwater.

At 39, when the cancer spread to my bones, I started on the stronger stuff: injections to shut down my ovaries and daily tablets to stop me producing oestrogen.

I entered full menopause pretty much overnight, my hot flushes ramping up to hourly, and my brain entering into a permanently slower state.

It is never more evident than when we’re playing Frustration, or Ludo.

It hurts my brain just to look at this

As a family, we take it in turns to hit the button, which flips the dice and determines whether you can play. If you get a six, you can take your player out and start moving it around the board. My husband and stepdaughters play fast, often hitting the button to take their turn before I’ve realised what’s happening.

“Come on, Lala,” my teenage stepdaughter will say, kindly but with the tiniest hint of an eye-roll at my slowness. (Lala is the beloved nickname that only she calls me.)

“Is it my turn?” I’ll say, eventually realising they’re all staring at me, comedically checking their watches.

As hard as I try to concentrate, I can’t keep up with their game play. Often, I’ll bow out after one game because it tires me out so much. Even my mother and mother-in-law play faster, despite being 30 years my senior.

But here’s the thing: I’m not incapable. I haven’t got stupider. I can still speak three languages, if you’ll forgive the #humblebrag. I edit a newsletter every week and I’m 70,000 words deep into a new novel.

I’m just slower, and more forgetful. I can’t recall people’s names – even people I speak to every day. I forget really important stuff, like if a relative has died or had a serious diagnosis. I’ve always been shit-hot at spelling and grammar (#humblebrag no.2, apols) but I now can’t remember if my friends are Tamsin or Tamzin, Brian or Bryan.

The best explanation I’ve heard was from Professor Nazanin Derakshan, who I interviewed on the Breast Cancer Now Podcast in 2024.

In a study by the BRIC Centre, women with and without breast cancer were given a simple cognitive task, where they had to identify the letters that didn’t match in a string of letters. All the participants got the right answer in the end, but the women with breast cancer were slower to reach it.

“When you look at brain activity, women with a breast cancer diagnosis are recruiting from a wider network and are trying harder to get the answer right, compared with women who don’t have breast cancer,” Professor Derakshan told me. “When you look at their responses – whether they made more errors or not – there’s no difference. If you just look at performance, there’s no difference. But when we look at the brain, we see the difference: I had to try harder and recruit more resources to achieve the outcome that you did with little effort.”

It’s exactly like a swan kicking its legs underwater – all you see is the swan gliding along, but it’s working really hard to look so serene.

Credit: Ketut Subiyanto, Pexels

Cancer-induced menopause is, of course, much more severe than natural menopause. It often happens overnight, and there are side effects from the drugs and treatment on top of the effects of menopause. Most women with breast cancer can’t take HRT, so we just have to learn to live with the brain fog and cognitive head-fuckery.

If you know someone suffering from menopause or cancer-related cognitive decline, my one piece of advice is to be patient. When someone you love is trying desperately to string a sentence together, the worst thing you can say is: “Come on, spit it out!”

I highly recommend Dani Binnington’s podcast, Menopause and Cancer, and there are loads of useful episodes on the Breast Cancer Now Podcast too.

Consider this permission to give yourself a break today, whatever you’re going through. Laura x