You are in a meeting, or a shop, or standing in your own kitchen, and you cannot find a word. Not a complicated word. A word like fork. A word you have said ten thousand times. It is right there, and it will not come, and there is a pause that goes on a half second too long, and you watch the person in front of you notice it.
And in that half second, you do not think hormones.
You think: this is how it starts.
You think about your mother, or your grandmother. You think about the word dementia and you push it away so fast that you barely register having thought it. And then you make a joke, because the joke is the only thing available. Brain fog, ha. Where did I put my keys. Menopause brain.
We have built an entire genre of memes out of the most frightening thing happening to us, and we have done it because the alternative is saying the true sentence out loud, and the true sentence is:
I am afraid there is something wrong with my brain, and I have not told anyone.
Here is what is actually happening
You are not imagining it. That sentence is not a comfort. It is a finding.
Oestrogen is not a reproductive hormone that happens to leak into the rest of you. Your brain is full of receptors for it, and they are not scattered at random. They cluster in the hypothalamus, which governs your temperature. In the hippocampus, which lays down memory. In the prefrontal cortex, which does the work of finding the word for fork. In the amygdala, which handles fear and rage and the tone of your entire emotional life.
Now read that list again, and read your own symptoms next to it.
Hot flushes. Memory. Word finding. Sleep. A mood that arrives with a violence you do not recognise as yours.
Those are not five unrelated complaints. They are one system, running low on the thing it was built to run on.
The temperature and the terror and the forgotten word are coming from the same place. Nobody told you that, and the reason nobody told you that is that nobody told your doctor either, not properly, not in a way that made it into the seven minutes you get.
The part that should make you angry
For most of medical history, we could not tell the difference between a woman whose oestrogen was falling and a woman losing her mind.
So we did not try. We called it hysteria. We called it change of life madness. We wrote it in her notes and we sent her home, or we did not send her home. Women were committed for this. Not metaphorically. Institutionalised, for a hormonal transition that every single one of them was going to have.
That is not ancient history. That is your great grandmother.
And the residue of it is still in the room. It is in the way you make the joke instead of saying the sentence. It is in the way you sit in the appointment and downgrade your own symptoms before the doctor has even spoken, because some very old part of you knows what happens to a woman who says I think something is wrong with my mind.
You have inherited her caution. You are managing a risk she faced and you do not.
What the research actually says, including the parts I cannot promise you
I am going to be careful here, because this is the place where the internet will lie to you, and it will lie to you in a way that feels like hope.
What is reasonably well established: neurological symptoms in the menopause transition are extremely common, not rare and not marginal. The mechanism is real and it is understood. There are also documented changes in how the brain uses glucose as oestrogen falls, and that is one of the reasons researchers are looking hard at the link between menopause and Alzheimer’s disease, a condition that affects women at roughly twice the rate of men.
What looks promising: hormone therapy, and transdermal oestradiol in particular, shows encouraging results for memory and cognition in a number of trials.
And here is the sentence the supplement adverts will never show you: it is not established that hormone therapy prevents Alzheimer’s disease. It might. It is being studied seriously by people who are far better at this than I am. But it is not proven, and anyone selling you certainty about it is selling you something.
I would rather hand you an honest maybe than a beautiful lie. You have had enough beautiful lies. Most of them arrived in a pastel jar.
So what do you actually do
Sleep, as though it were a medical intervention, because it is. Seven to nine hours. Not as a treat. As treatment.
Move your body, hard enough that it means something.
Eat like your brain is an organ, because it is one. Omega threes, fibre, the anti inflammatory end of the shelf.
Keep the thing switched on. Read the difficult book. Learn the thing that makes you feel stupid for six weeks.
Deal with the stress, properly, not with a bath.
Ask about hormone therapy, if you are a candidate, and let an actual clinician decide that with you rather than a woman on the internet, including this one.
None of that is exciting. There is no secret. If there were a secret, I would have written a much more profitable book.
And then do the one thing that is genuinely hard
Say it out loud.
Go into that appointment and do not make the joke. Do not soften it, do not laugh first, do not say this is probably nothing but.
Say: my memory has changed, my words are going, my mood is not mine, and I want to know whether this is my hormones or whether it is something else. I need you to take this seriously enough to find out.
If they wave it away, that is information about the doctor, not about you. Find another one.
Because here is the thing I actually came to say.
The fear underneath all of this is not really about your keys. It is about disappearing. It is the suspicion that the woman who could hold six things in her head and be sharp in a meeting and remember every birthday is quietly leaving the building, and that what will be left is somebody vaguer and softer and easier to talk over.
She is not leaving. She is under resourced.
That is not the same thing, and the difference between those two sentences is the difference between a woman who gets help and a woman who spends ten years apologising for her own brain.
Medicine can treat the tissue.
It cannot rebuild the woman.
That part is yours, and you are going to need your whole mind for it. So go and get it back.
Nothing to fix.
Hope
xo