MAB ReviewedMenopause Brain Fog Explained: Causes, Relief, and Protecting Your Brain
Menopause brain fog—marked by forgetfulness, trouble concentrating, and losing your train of thought—is one of the most common and frustrating cognitive symptoms of the transition. Understanding how hormone changes, sleep, stress, and other factors contribute to brain fog can help you find relief, protect long-term brain health, and know when to talk with your provider.
Written by Simona Byler
Reviewed by Dr. Jaclyn Piasta
Monarch Health
Brain fog is a common symptom of the menopause transition. It can make you lose your train of thought, forget your words, and struggle to concentrate. For many women, it can also raise concerns about their overall cognitive health.
Feeling mentally sluggish? Read on as we discuss the details of brain fog, including its complex causes and the factors that can influence it. We'll also discuss common concerns about the connection between brain fog and dementia, so you'll understand how to best support your brain health.
Cognitive symptoms of menopause
Have you ever walked into a room and immediately wondered, “What did I come in here for?” only to get crickets in response? Sigh, it happens to everyone…but it can feel particularly frequent if you’re in the menopause transition.
Menopause can cause a whole host of cognitive symptoms that leave you with the same befuddled feeling. These symptoms are common and, while frustrating, they typically improve over time .
What is perimenopause brain fog?
If you’re noticing some cognitive changes during peri- and postmenopause, know that you’re not alone. 40-60% of women report experiencing brain fog during the menopause transition . But what is brain fog exactly?
Menopause brain fog refers to a group of symptoms that impact your memory and cognitive function. These symptoms can show up in various ways and can cause you to :
Forget or have difficulty remembering names, stories, words, or numbers
Forget your intentions, such as why you entered a room
Find it hard to switch between tasks
Lose your train of thought easily
Have trouble concentrating
Get distracted easily
Some menopausal people may also show signs of attention deficit hyperactivity disorder (ADHD) . Together, these symptoms can be frustrating and cause concern about more significant cognitive problems. While it’s natural to worry, rest assured that menopause brain fog is rarely a sign of a new cognitive condition!
Brain fog and cognitive health
Perimenopause can certainly make you feel forgetful, distracted, and disoriented. While these symptoms can be bothersome, they don’t automatically indicate that your brain health is deteriorating.
Brain fog is a common menopausal symptom, and it’s not usually an early sign of dementia or memory loss . Early-onset dementia is rare, affecting only 293 out of 100,000 midlife women worldwide : that’s just 0.003%. While everyone with ovaries will go through the menopause transition in due time, the vast majority won’t develop dementia.
Why does brain fog happen?
Perimenopausal women experience small declines in memory performance that age alone doesn’t explain . Memory decline is a common menopause symptom, but its cause is unclear.
Let’s take a deeper look at how hormone changes and other factors contribute to cognitive symptoms.
Estrogen and brain function
Certain areas of your brain are full of estrogen receptors. These areas include the prefrontal cortex and hippocampus, which play important roles in executive function and memory . Hormonal changes during perimenopause can impact your cognitive function, as these brain areas stop getting the usual supply of estrogen they need to function optimally .
Because of this, perimenopausal people may be especially vulnerable to brain fog; your brain hasn’t yet adjusted to these new hormone levels. Symptoms often improve once you’re officially postmenopausal and your brain has adapted to this decline in estrogen . However, it’s important to know that estrogen isn’t a magic cure-all for cognition . Like all hormones, it’s complicated!
Estrogen and inflammation
Certain estrogen receptors are critical in the body’s process of regulating inflammation. As such, declining estrogen levels in perimenopause can lead to chronic, low-level inflammation throughout the body .
While inflammation helps heal wounds and fight infections, constant, prolonged inflammation can be detrimental to your body and brain. For example, chronic inflammation during perimenopause creates a feedback loop in your ovaries:
During perimenopause, your ovaries begin to decline and produce less estrogen.
As estrogen levels drop, inflammation increases.
This inflammation makes your ovaries decline faster.
Your ovaries produce less estrogen as they decline.
Some good news: although the FDA hasn’t specifically approved menopause hormone therapy (MHT) to treat brain fog, it may help protect against chronic inflammation . However, it is still unclear if MHT can directly improve cognitive symptoms .
Other contributing factors
There isn’t an official causal relationship between vasomotor symptoms (hot flashes, night sweats, and heart palpitations) and brain fog. However, all of these symptoms are associated with declines in memory and biomarkers of Alzheimer disease .
Other menopausal symptoms that contribute to brain fog include:
Sleep disturbances
Depression
Anxiety
Cognitive changes vary widely from person to person. Things like stress, education level, and physical health can impact the duration and severity of your brain fog . Talk with your healthcare provider to learn about treatment options that can help you manage your symptoms.
Does menopause hormone therapy help with brain fog?
We’ll cut right to the chase: the evidence here is mixed at best.
No large-scale clinical trials have looked at how MHT impacts perimenopausal cognitive symptoms. While some limited data does exist for postmenopausal people, the effects of MHT on cognition are pretty neutral, neither helping nor harming .
However, MHT may help maintain cognitive health in those who experience early menopause, such as people who have their ovaries surgically removed before menopause .
MHT can also help with other symptoms that contribute to brain fog, such as hot flashes and night sweats, and subsequent trouble sleeping . Talk with your healthcare provider to see if MHT is right for you.
How to lower your risk of dementia
Dealing with brain fog can be frustrating today, and it can raise concerns about tomorrow. If you’re worried about your brain health and your risk of developing dementia, know that:
Cognitive menopause symptoms usually improve with time .
There are many ways to support brain health as you age.
Around 40% of dementia cases worldwide are due to modifiable risk factors, including smoking, high blood pressure, and physical inactivity . In many cases, you can delay and even prevent dementia by taking care of your health.
Midlife is an excellent time to adopt healthy habits that support your brain function. Consider the following strategies:
Weight management and exercise
Though midlife weight gain is common, it’s important to manage it to the best of your ability. Obesity increases your risk of dementia . Maintaining a body mass index (BMI) between 18.5 and 25 can help reduce this risk .
Similarly, getting regular exercise is an effective way to combat cognitive decline as you age. One study followed 1,462 midlife women for 44 years with some encouraging findings :
Those with high cardiovascular fitness were less likely to develop dementia.
People who maintained high cardiovascular fitness delayed dementia by 9.5 years when compared to those who had medium cardiovascular fitness.
Wondering how much exercise is enough for these benefits? The World Health Organization (WHO) recommends older adults get at least 150 minutes of moderate aerobic activity, or 75 minutes of intense aerobic activity, each week . Examples of aerobic exercise include walking, jogging, cycling, and swimming.
Strength training is important to include alongside your aerobic exercise, as it helps you maintain lean muscle mass and physical power as you age . Tracking your exercise can help you reach your targets and look after your overall health.
Heart health
Keeping your heart healthy is a great way to keep your brain healthy, too. Blood pressure is a key indicator of heart health, and it can also impact your cognitive health. A clinical study on adults aged 50 and older found that lowering systolic blood pressure to 120 mmHg prevented mild cognitive impairment, which is the precursor to dementia .
Other heart-related dementia risk factors include diabetes and dyslipidemia. Dyslipidemia is a condition in which there is an unhealthy level of fat in the bloodstream. If you have any of these conditions, reach out to your healthcare provider for guidance.
Social relationships
Loneliness, isolation, and lack of social support all increase the risk of dementia and cognitive decline . Connecting socially with friends and family can help you maintain your cognitive health throughout life, especially if you have a history of mental health issues such as depression .
Other factors
Certain lifestyle factors and other health issues can also increase your risk of dementia, including :
Smoking
Heavy drinking
Psychological stress
Air pollution
Traumatic head injury
Impaired hearing
Depression
Hyperhomocysteinemia, a condition that causes excessive levels of an amino acid in the blood. This condition can result from genetics, certain vitamin deficiencies, or other causes: ask your provider if you need additional testing.
While you can’t control all of these factors, it’s important to understand how they may affect your cognition. Taking a holistic approach to your health can help ensure you’re covering your bases in dementia prevention. Speak with your healthcare provider about which interventions best fit your unique needs and situation.
Understanding your brain fog: How tracking can help
There are a lot of factors that influence your brain function. Sleep quality, hot flashes, stress, depression…the list goes on. Using your smartwatch or other wearable device to track these factors—and how they influence your brain fog symptoms—helps you recognize important patterns.
Tracking may help you notice that your brain fog is the worst after a poor night’s sleep. This information can empower you to prioritize good sleep habits. From there, you can track if this change is enough to curb your brain fog. If it’s not, you know it’s time to try something new. As always, reach out to your healthcare provider for additional insights and guidance.
Menopause symptoms don’t happen in a vacuum: they build on each other. Tracking helps you see the big picture: how your symptoms relate, and how treating one symptom may also improve another.
Questions to ask your provider
If menopause symptoms are affecting your cognitive abilities, talking with your healthcare provider can help. Consider asking these questions to get the conversation started at your next appointment:
I’ve been struggling with menopause brain fog lately, and it’s negatively impacting my work life. Can we discuss what treatment options can help me manage these symptoms?
I’ve been using my smartwatch to track my cognitive changes over the last few months. Can I show you this report and get your opinion on how my symptoms are progressing?
DISCLAIMER
This article is intended for educational purposes only, using publicly available information. It is not medical advice, and it should not be used for the diagnosis, treatment, or prevention of disease. Please consult your licensed medical provider regarding health questions or concerns.
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