What is perimenopausal brain fog?
Did you know that many women going through menopause show cognitive changes? 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.
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Perimenopause is the time leading up to a woman’s last menstrual period.
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 consequences[1].
Some women experience significant disruptions with their day-to-day functioning, relationships and quality of life [2].
Even amongst doctors there can be a relative lack of awareness and understanding of this issue, although specialists such as gynaecologists are often better informed[1].
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. 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 alone[3].
Good sleep hygiene, counselling, treatment of depression or anxiety with therapies such as mindfulness or cognitive behavioral therapy can be helpful options for many women2.
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.
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.
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