What to Know About Menopausal Brain Fog, According to Experts

• A new book, The Menopause Brain, breaks down what happens in the brain during perimenopause and menopause.
• Many women experience brain fog during this time, leading to the term “menopause brain.”
• Doctors say there are a few things you can do to help with symptoms.

Menopause is a natural life transition, but there’s a lot that’s still unknown about how it impacts various areas of the body. Now, a new book called The Menopause Brain details the impact this change has on women’s brains, and why. Delving into the “menopause brain” phenomenon and brain fog.

In the book, author and neuroscientist Lisa Mosconi, Ph.D., director of the Weill Cornell Women’s Brain Initiative, notes that more than 60% of women have brain fog at some point during perimenopause (the period before menopause) or menopause. This brain fog—which some may mistake for early signs of dementia—is due to changes happening in the brain during the menopausal transition, she explains.

Meet the experts: Lauren Streicher, M.D., a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine; Jessica Shepherd, M.D., an ob/gyn in Texas and author of the upcoming book on menopause, Generation M; Mary Jane Minkin, M.D., a clinical professor of obstetrics and gynecology and reproductive sciences at Yale School of Medicine and founder of Madame Ovary; Michael Krychman, M.D., medical director of Women’s Health Services at MemorialCare Saddleback Medical Center in Laguna Hills, CA

Mosconi’s new book has raised a lot of questions about so-called “menopause brain” as well as what can be done about it. Mosconi and other doctors break it down.

What happens to the brain during menopause?

During menopause, the body has decreasing levels of estrogen, explains Lauren Streicher, M.D., a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine. “There are estrogen receptors throughout the brain and the body,” she says. When estrogen drops in the body during perimenopause and menopause, it has an impact on the brain.

The brain “controls everything, including body temperature and libido,” Dr. Streicher says. When the brain has lessening levels of estrogen, it can create a feeling of brain fog, she notes.

“Estrogen plays a crucial role in maintaining brain health, influencing neurotransmitter levels, promoting neuroplasticity, and protecting against oxidative stress and inflammation,” Mosconi says. “As estrogen declines, women may experience changes in body temperature—a.k.a. hot flashes—sleep, mood, libido, and cognition, which are all brain-regulated functions.”

But it’s “very hard to differentiate what is the cause of this fog—it certainly could be related to the sleep disruptions that many women experience or some of the mood changes they undergo,” says Mary Jane Minkin, M.D., a clinical professor of obstetrics and gynecology and reproductive sciences at Yale School of Medicine and founder of Madame Ovary. It also could be related to changes in the hypothalamus—the part of the brain that produces hormones that control body temperature, heart rate, and hunger, among other things—“which we know occur from the decreasing levels of estrogen,” Dr. Minkin says.

Most women in their 40s and 50s have many other stressors they’re dealing with, and all of that can impact the brain, she says.

In fact, Mosconi says that the brain is actually rewiring itself during the menopausal transition. “We’ve made significant progress in demonstrating that menopause changes the brain’s structure, functionality, and even its connectivity in fairly unique ways,” she says. “Overall, menopause is a neurologically active period, which comes with both resilience and vulnerability.”

How does menopause affect memory?

There are a few ways menopause can impact the brain. “Estrogen declines may lead to alterations in brain structure and function, as well as changes in neurotransmitter production, affecting memory processes such as encoding, retrieval, and consolidation,” Mosconi says. Menopausal symptoms like hot flashes, sleep disturbances, and mood changes can also impact memory function, she says.

You may feel like you can’t focus as well as usual, have trouble concentrating as well as you did in the past, struggle with multi-tasking, and have a shorter attention span, says women’s health expert Jessica Shepherd, M.D., an ob/gyn in Texas and author of the upcoming book on menopause, Generation M. “The main thing is having body awareness—a lot of people are unaware that a lot of these things that occur could be menopause,” Dr. Shepherd says.

“Many women report brain fog during the menopausal transition,” Dr. Minkin says. “The good news is that it tends to get better as women get through the perimenopausal transition and go onto the post menopausal state.”

Michael Krychman, M.D., medical director of Women’s Health Services at MemorialCare Saddleback Medical Center in Laguna Hills, CA, agrees. “This is very, very common,” he says. “People think they’re losing their minds. They’re really having a lot of difficulty remembering numbers and words. Brain fog is not uncommon as a woman transitions into menopause.”

How to deal with menopause brain

The reason “menopause brain” happens is because the brain is deprived of estrogen, “so give the brain estrogen,” Dr. Streicher says. Hormone replacement therapy (HRT), which replaces the estrogen that the body no longer makes, can help with symptoms of menopause brain, she says.

Many women benefit from taking estrogen therapy “which is quite safe for most women,” Dr. Minkin says. “It will usually help hot flashes, sleep, and mood,” Dr. Minkin says. “If women don’t want to take hormonal therapy, there are some herbal products that can help.”

Remifemin good night, which is a mix of black cohosh and other herbs, and Relizen, which is derived from Swedish pollen extracts, can help with sleep and hot flashes, Dr. Minkin says. Dr. Minkin also points to research from Neill Epperson, M.D., chairman of psychiatry at the University of Colorado, which has found that medications like lisdexamfetamine, which is commonly used to treat ADHD, can also be helpful for menopause brain.

Mosconi also says the following can help if you’re dealing with menopause brain:

• Exercise regularly, “which has been shown to improve cognitive function and mood, and alleviate hot flashes,” she says.
• Prioritize your sleep hygiene.
• Incorporate stress management techniques like mindfulness meditation or deep breathing exercises.
• Have a balanced diet rich in nutrients essential for brain health, including omega-3 fatty acids, antioxidants, fibers, and vitamins.
• Try to avoid or minimize environmental toxins, especially endocrine disruptors.
• Stay mentally active by participating in things that challenge the brain, like puzzles, reading, or learning new skills.

Can you prevent menopause brain?

It’s not clear. “While it may not be possible to completely prevent menopause-related symptoms, the strategies listed above may help mitigate their impact,” Mosconi says. She also points out that the menopause experience “varies greatly” in women.

“While approximately 10% of women report no brain symptoms, many experience some symptoms, and some may have multiple and more severe symptoms,” she says. “The reasons behind these differences are still under investigation.”

But Mosconi says that evidence suggests that having a healthier lifestyle and prioritizing your self-care may lead to milder symptoms in menopause. “There’s power in our everyday choices,” she says.

Just don’t be afraid to talk to your doctor about what you’re going through. “If you are experiencing disconcerting brain fog with perimenopause or menopause, do check in with your gynecological practitioner for some advice,” Dr. Minkin says.

Korin Miller is a freelance writer specializing in general wellness, sexual health and relationships, and lifestyle trends, with work appearing in Men’s Health, Women’s Health, Self, Glamour, and more. She has a master’s degree from American University, lives by the beach, and hopes to own a teacup pig and taco truck one day.