Understanding Brain Fog During Menopause
When discussing brain fog during the menopause transition, it often refers to a lack of focus, slow thinking, and forgetfulness. Studies indicate that about three in five women in midlife experience difficulty recalling words and numbers, needing to make lists and reminders, and forgetting why they’re doing something.
The decline in oestrogen is frequently the cause. Oestrogen influences the levels of serotonin and dopamine, which are natural chemicals in the brain responsible for regulating mood and cognitive functions like memory and focus. Brain fog is common during perimenopause, even when a woman gets enough good-quality sleep. Although these changes can be distressing, they are usually temporary and tend to improve after a woman’s final menstrual period.
However, minor issues can become more challenging when a woman isn’t sleeping well and experiences confusion or forgetfulness. Women in the menopause transition often struggle to fall asleep. If this is your experience, you may also wake often and find your nights less restful. Insomnia is linked to poorer cognitive function and tends to persist beyond menopause itself.
Women who have gone through menopause have significantly higher rates of insomnia compared to men or women who are not yet menopausal. The risk to brain health seems to relate more to the quality of sleep—how fragmented it is—rather than the total number of hours. This might explain why night sweats are associated with worse cognitive performance.
The good news is that treating night sweats with hormone therapy or effective alternatives may lead to better sleep quality and improved brain health and function. There is also some evidence that hormone therapy could help protect against dementia later in life if started early in perimenopause and continued long-term. More research is needed in this area.
Is This Brain Fog or ADHD?
Distraction, disorganization, and struggling to focus can be symptoms of attention deficit hyperactivity disorder (ADHD). While there is little research on menopause and ADHD, ob-gyns often hear about it from patients. It is common for women in the menopause transition to find their ADHD symptoms worsening or to be diagnosed with ADHD for the first time.
Again, changing oestrogen levels and the resulting changes in other brain chemicals could explain ADHD symptoms that worsen in midlife. It is possible that women with ADHD are more vulnerable to mood disorders during the menopause transition.
Normal Ageing vs. Early Dementia
| Sign or Symptom | Normal Ageing | Possible Dementia |
|---|---|---|
| Memory changes | Sometimes forgetting a name or appointment, and remembering later; Forgetting a conversation you had a year ago; Writing reminders and lists | Forgetting information you just learned or forgetting recent events; Asking the same questions multiple times |
| Struggling with familiar tasks | Occasionally needing help to figure out the audio system | Difficulties getting dressed, following a recipe, paying bills, or doing household chores; Taking much longer to do things |
| Visual and spatial challenges | Needing a new prescription for eyeglasses | Difficulty with balance, reading, or placing objects on a table; Difficulty judging distance and contrast, causing unsafe driving |
| Communication challenges | Sometimes having trouble recalling the right word | Forgetting simple words; Struggling to join in or follow conversations; Substituting words (like ‘the thing you sleep on’ for ‘bed’) |
| Confusion about time and place | Not remembering which day of the week it is or why you went into that room | Feeling lost in familiar places and not knowing how you got there; Losing track of dates and seasons |
| Misplacing things | Forgetting where you put your wallet or keys; Retracing your steps to find them again | Putting things in unusual places (like a remote control in the freezer); Not being able to retrace your steps to find them again |
If you’re struggling with ADHD or related symptoms, talk with your ob-gyn.
Is This Brain Fog or Early Dementia?
During perimenopause, seven in 10 women report problems with their memory. Memory problems can be upsetting if you have relatives with early dementia or if you’ve read headlines linking menopausal symptoms to the risk of developing dementia. You may wonder which you’re dealing with—menopause and natural ageing, or early dementia.
If you or a family member is concerned about your cognitive function, talk with your ob-gyn. Before your appointment, track any changes related to memory and thinking so you’re ready to share details with your doctor. You and your ob-gyn may discuss other possible causes, such as untreated anxiety or depression, stress, sleep deprivation, and some physical illnesses, such as thyroid disorders or vitamin B12 deficiency.
To maintain your brain health long-term, it’s important to manage any chronic diseases, including diabetes and high blood pressure. Persistently high blood pressure, high cholesterol levels, excess belly fat, and poorer cardiovascular health in midlife are all linked to increased risk of dementia later.
And get your hearing checked. Poor hearing is a risk factor for cognitive problems, perhaps because the brain does not get enough stimulation.
If your doctor rules out physical health causes for your cognitive symptoms, ask if you should see a specialist. If needed, your ob-gyn can refer you to a mental health professional or a neurologist.
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