PCOS and Brain Fog
Brain fog is one of those sneaky symptoms of PCOS. It doesn’t get much attention from the traditional medical system, and we are often uninformed about the general impact of PCOS on cognitive function. I’ve heard people with PCOS state they thought “they were just dumb” before learning how PCOS can induce brain fog. Let me tell you, we are not dumb. There are reasons why we experience brain fog, and there are actions we can take to help to combat it.
1. Insulin resistance impacts brain function and brain glucose utilization
One study showed that with PCOS and insulin resistance, there was a correlation between elevated plasma insulin levels and decreased levels of brain activity in the left middle frontal gyrus. This is a region of the brain used for working memory, attention and language processing. So, the more insulin in the blood, the more likely we are to struggle with holding verbal information in the short-term memory system. A similar correlation was found between elevated insulin and decreased brain activity in the left posterior cingulate gyrus. This part of the brain is used to help us recall specific events, and to help hone our focus if we are surrounded by distractions. It’s also associated with regulation of negative emotions like anxiety and fear, and processing of positive emotions. This can lead to trouble recalling events and difficulty staying focused. It may also lead to trouble focusing if we cannot regulate negative emotions like anxiety and fear if they are awakened for whatever reason.
Another study showed that high levels of insulin and/or insulin resistance in PCOS is associated with a lower utilization of glucose, or energy, in the brain. The regions of the brain impacted are those associated with attention, decision-making, planning, working memory, language processing, memory and object recognition.
Outside of PCOS, numerous studies have shown that high levels of insulin in the blood after fasting, which is highly correlated with insulin resistance, is associated with verbal fluency challenges, memory and attention issues.
2. High Levels of Luteinizing Hormone
In PCOS, we often see elevated levels of luteinizing hormone throughout the cycle. One research study analyzed the correlation between luteinizing hormone and the functional connectivity between different regions of the brain in people with PCOS. They found a weaker connection between the left posterior cingulate gyrus, the part of the brain used for memory, attention, and emotional regulation, and the triangular part of the left inferior frontal gyrus, or the region of the brain involved in speech production. As luteinizing hormone levels increased, the connection between the two regions weakened further. Bottom line, if LH is too high, it can mean difficulty remembering or finding the right words.
Another brain imaging study found elevated LH was also negatively correlated with the strength of the connection between the right superior frontal gyrus and right middle frontal gyrus. The former is involved in short-term memory and the ability to complete tasks that require switching attention to various stimuli, and the latter is involved in behavior modification or impulse control. The latter also assists with filtering out irrelevant information. So, if LH is too high, it may mean we struggle with staying focused if there are distractions present, especially if those distractions are more interesting than what we are meant to concentrate on. Not to mention, storing information we are not super interested in will become even more challenging! This might be why you can hyperfixate on something that really interests or excites you, but when you are bored, you cannot recall a single detail.
3. High Circulating Testosterone
One of the criteria for a PCOS diagnosis, according to the Rotterdam Criteria is hyperandrogenism, either through physical symptom manifestation or through a confirmed excess of androgens in a blood test.
One study found that reaction time and word recognition performance were impaired in individuals with PCOS, and that performance actually increased when anti-androgen medications were administered, suggesting that higher testosterone levels may be the reason behind the inhibited cognitive performance. A functional MRI study, or brain imaging study, also showed that with introduction of anti-androgen treatment, accuracy in high memory load with working memory increased.
Additionally, elevated testosterone is associated with aggression and impulsivity, which can further disrupt proper brain function, attention to the task at hand and working memory.
4. Underlying Inflammation
When inflammation is chronic, which is common in PCOS, cytokines or immune cells are released. These cytokines can travel to the brain via the blood/brain barrier, and data show significant effects on the metabolism of neurotransmitters like serotonin, dopamine and glutamate. Cytokines also function to deplete tryptophan, the precursor for serotonin. Dopamine and serotonin are both used for cognitive functions like working memory and learning, behavior modification, motivation to work and learn, and more. Glutamate is involved in synaptic plasticity, or the ability of the brain to modify and adapt to new information.
By disrupting these neurotransmitters, cytokines can significantly impair motor activity and motivation, anxiety, arousal and alarm systems.
Oxidative stress also plays a role when it comes to inflammation in the brain. Inflammatory cues from the body communicate to the immune system that there is a pathogen it needs to ward off. The immune system produces reactive oxygen species, leading to an attack on neurons, which are responsible for transmitting information in the brain.
5. Sleep Issues
I don’t know about you, but when I don’t sleep well, my brain is a jumbled mess for the entire next day. And, with PCOS, that happens far too often. The reasons why PCOS can cause sleep disturbances and sleep deprivation are plentiful, and if you want to dive into that further, check out this post.
The bottom line is that when we do not sleep well, brain functions that are intended to take place throughout the night are disrupted. It leads to overworked neurons and an inability to consolidate memories, for example, when our memories are transferred from short-term to long-term memory. If you struggle with recalling details, facts, events, or even what you ate for lunch the day before after a night of poor sleep, this may be why. Research has found that sleep-deprived individuals lack cognitive flexibility and adaptability, meaning that it is more difficult to unlearn something that has already been accepted, or adapt to a change in plans. Sleep deprivation is also associated with difficulty carrying out instructions, and can slow our thinking down so much that it can be akin to intoxication.
Sleep disturbances can further exacerbate brain fog because time asleep is time when the brain reorganizes and strengthens neural connections. Similar to the role of glutamate described above, sleep is a crucial component of neuroplasticity, or the power we have to rewire our brains, change the way we think, or process new information. When we sleep, we also release growth hormone, which promotes tissue repair and renewal. Studies have found that the stimulation of this hormone improves cognitive function. And if we’re not sleeping, we’re not releasing enough of that hormone needed for cognitive function.
6. Co-Occurring Conditions
Various conditions that tend to manifest more frequently with PCOS are also associated with poor cognitive function and brain fog. These include but are not limited to:
Anxiety
Depression
Hashimoto’s Thyroiditis
Attention Deficit Hyperactive Disorder (ADHD)
Iron-Deficiency Anemia
Chronic Stress
Nutrient Deficiencies
Food Allergies / Sensitivities
So how do we get a handle on brain fog?
Insulin Resistance: Make sure you are treating insulin resistance and eating low glycemic load meals that help improve insulin sensitivity and blood glucose levels. In addition to this, consuming 1tbsp of cinnamon daily can assist, or inositol or berberine supplements. Prescriptions available include Metformin
Elevated Luteinizing Hormones: Check your luteinizing hormone levels. Some evidence suggests eating a diet high in fiber can help to decrease LH levels, as estrogens are excreted through urine and/or feces
Elevated Androgens: Check your circulating testosterone levels. Some evidence shows 2-3 cups of spearmint tea per day, as well as eating a nutrient-dense diet focused on whole foods, can lower testosterone levels. Limiting alcohol and sugary, greasy or processed foods can also help
Inflammation: Anti-inflammatory diets, such as the famous Mediterranean diet, may help you to limit the level of inflammation at play in your body
Sleep Troubles: Again, a diet focused on low glycemic load can greatly help with sleep. Try to get natural sources of GABA from fermented foods like kefir, yogurt, and kimchi. Explore mindfulness practices that work for you to limit stress levels, or consider mental health services to have a professional collaborate with you. If needed, get a sleep test since obstructive sleep apnea is common in PCOS. You should also adopt a sleep hygiene routine and stick to it as much as possible. For more information, check out our blog on PCOS fatigue.
Other tips for improving focus and brain fog with PCOS include:
Advocate for what you need - if that’s written down instructions versus verbal instructions, state what will make you more efficient in carrying out tasks
Listen to brown noise - brown noise’s frequency spectrum is flatter, creating a relaxing environment and helping to mask distractions. Some theories also posit that the low frequency stimulate the brain, or can increase norepinephrine production, a neurotransmitter used for attention
Use essential oils:
Rosemary: Enhances mental clarity and focus
Peppermint: Invigorates to increase alertness, memory, etc.
Lemon: Citrus in general has a refreshing scent that can energize and uplift
Frankincense: Warm and grounding to help reduce anxiety so you can focus
Cedarwood: Earth scent that can help reduce stress and anxiety
Fill your work or study space with plants - plants can increase oxygen level in your space, which has been associated with enhanced clarity and focus. Exposure to elements of nature also provides stress relief and mood improvement
Take breaks! Set alarms to remind yourself to take a 5 minute break. If you work at a desk, get up and stretch or walk around to improve blood flow to the body and brain
Even though brain fog is an incredible frustrating issue with PCOS, figuring out what may be driving your case of brain fog can be incredibly empowering. Try out these tips, and let us know how they go!