Imagine the scene. You are a fifty-something female executive preparing to deliver the findings of a new report which will impact on the entire company. The meeting begins with a few formal items and then, your turn comes.
Suddenly you are overwhelmed by a burning sensation in your face and neck which is quickly followed by an all-over body sweat. You immediately lose your focus and completely forget your planned approach to the topic. Instead, you fumble through, relying on your statistical results to speak for themselves. Your presentation is a disaster and nobody - except you - knows why.
Such lapses in memory and concentration provoke some of the most damaging consequences for the professional lives of women going through the menopause, yet memory loss in itself is not deemed to be a serious symptom of the menopause. Comments such as "Dr Smith is really losing it these days" or "Mary just isn't as sharp as I thought" can, over time, lead to glass ceilings of another kind being imposed on women who have already climbed many rungs of their career ladders.
Similarly, home-based women can be prematurely written off as scatty old dears, long before they reach 60. That is, of course, unless they seek help from their local GP or - if symptoms are severe enough - at a menopause clinic.
"A lot of women between the ages of 45 and 55 say that they have problems remembering things and there is no doubt that impaired drive and performance are related to the interrupted sleep from night sweats and the frequent (in some cases, up to five times a day) experience of hot flushes," says Dr Maire Milner, who runs the menopause clinic at the Rotunda Hospital, Dublin. "Many menopausal women have the feeling of utter panic for no apparent reason which is due to the unpredictability of their symptoms," she says, adding that such a feeling of loss of control can force some women to withdraw from situations in which they were hitherto confident and able to operate in.
"You can diet to improve your figure. You can wear sharp clothes and make-up, have your hair well groomed but if you have a hot flush in the middle of a meeting, the upset and worry it causes can begin to take over your life," she adds. Ann Cleary, staff midwife at the Rotunda Hospital menopause clinic, concurs. "Many of the women we see would simply be more aware of how they can forget things so they learn to be more methodical about writing down appointments. They would sometimes comment on how their children say things like, `Mum, I told you about that before'."
Work and careers aside, Milner believes that there is a three-tier pressure on many women at menopausal age and such stress can give rise to memory loss. "They are often responsible for ageing parents or parents-in-law, their children are in college or in their first job and their partner may be suffering from ill-health."
Although a direct link between memory loss and oestrogen deficiency has not been established, the oestrogen contained in Hormone Replacement Therapy often brings about an improvement, together with a greater confidence in the ability to perform better. "The improvement with HRT comes as part of an improvement in general well-being which is dramatic and across the board," says Dr Milner.
Cleary adds that it is also interesting to meet women who have come through the menopause, often without the help of HRT simply because it wasn't available. "We would have older women coming in for bone scans due to the risk of osteoporosis who are now very alert and articulate in their 60s." She comments on how some such post-menopausal women are even returning to full-time study, an option that possibly would have been furthest from their minds during the menopause.
Recent research into women suffering from Alzheimer's disease - the illness most characterised by severe memory loss, mental confusion and what is know as pre-senile dementia - may however provide interesting clues to the role of oestrogen in memory. Such research points out that Alzheimer's disease (which occurs more commonly in women) appears to develop at a later stage in women who have used HRT. There are also reports of women with Alzheimer's disease improving on being given HRT.
While HRT has not yet been given clinically to patients with Alzheimer's disease, it has been tested in trials. "Although it is not proven that oestrogen reverses Alzheimer's disease, there is some very encouraging data," says Milner.
It will take further studies to elucidate the findings of this ground-breaking research before menopausal women - and, indeed, sufferers of Alzheimer's disease - will know whether their everyday forgetfulness can be attributed to oestrogen deficiency. If so, the makers of HRT will no doubt have many more customers keen to keep their memory intact right through their golden years.