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Perimenopausal brain fog

What is perimenopausal brain fog?

Did you know that many women going through menopause show cognitive changes (also known as brain fog)?

Despite the magnitude of this issue, women frequently do not feel able to discuss this with their doctor or employer due to embarrassment or stigma.

Perimenopause is the time leading up to a woman’s last menstrual period.[KH1.1] It typically starts in the mid-late forties and lasts four to ten years. During this time, sex hormones ebb and flow, and can cause problems such as irregular periods, hot flushes and night sweats. Cognitive changes during perimenopause (also known as brain fog) affect up to two-thirds of women in the perimenopause1.

Brain fog is often described in terms of declines in attention, processing speed, and memory. As a result, a woman may notice difficulties in mental focus, slower thinking, task-switching and forgetfulness. For instance, she may have trouble recalling words or events, lose everyday items, or have trouble concentrating on a task.

Affected women may live with shame or anxiety rather than disclose how their brain fog is affecting them. Difficulty managing work demands can be a real problem, leading to some women reducing working hours, with financial consequences1. Some women experience significant disruptions with their day-to-day functioning, relationships and quality of life2. Even amongst doctors there can be a relative lack of awareness and understanding of this issue, although specialists such as gynaecologists are often better informed1.

The hormone oestrogen drops over the perimenopause, potentially causing negative effects on sleep, mood and cognition. The worse the sleep, mood or both may correlate with the severity of the cognitive slowing3. Although there has been some research into brain changes with perimenopausal, it is not fully clear how brain fog is linked to these changes.

If a woman has concerns about her memory or thinking, it is important that she seeks medical advice. Some conditions such as an underactive thyroid or anaemia may masquerade as brain fog and require medical assessment to rule out If indicated, a comprehensive assessment of cognitive functioning can be conducted by specialist clinicians, such as clinical neuropsychologists.

Fortunately, some large studies have shown that the cognitive changes seen in perimenopause tend to return to normal in the post-menopausal phase (one year after the last menstrual period)3. This is welcome news for those who are worried about dementia. [KH4.1] Treatment may be helpful for underlying causes such as night sweats, sleep disturbance or depression. However, most data show that hormone (or menopausal) hormone therapy does not improve brain fog, so currently it is not recommended for perimenopausal brain fog alone3. Good sleep hygiene, counselling, treatment of depression or anxiety with therapies such as mindfulness or cognitive behavioural therapy can be helpful options for many women2.

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Medical disclaimer

This article contains general information relating to a medical condition. Such information is provided for informational purposes only and does not replace medical advice given by your healthcare professional.

References

1.Thomas E, Verdonk P, Rhodius-Meester H, Muller M. Minding menopause in patients with cognitive impairment: a patient’s perspective and reflections on clinical practice. (CC BY 4.0). BMC Womens Health [Internet]. 2023 Dec 1 [cited 2025 Oct 6];23(591). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10638716/

2. Spector A, Li Z, He L, Badawy Y, Desai R. The effectiveness of psychosocial interventions on non-physiological symptoms of menopause: A systematic review and meta-analysis. (CC BY 4.0). J Affect Disord [Internet]. 2024 May 1 [cited 2025 Oct 8]; 352:460–72. Available from: https://www.sciencedirect.com/science/article/pii/S0165032724003550?utm_source=chatgpt.com#s0085

3. Than S, Moran C, Beare R, et al. Cognitive trajectories during the menopausal transition. (CC BY). Frontiers in Dementia [Internet]. 2023 Jan 27 [cited 2025 Oct 8];2:1098693. Available from: www.ukbiobank.ac.uk.