What Causes Brain Fog in Menopause—And What Helps? 

I’ve always prided myself on my general sharpness and ability to multitask. But lately, I’ve been marching purposefully into rooms, then forgetting why; leaving my coffee in the bathroom and finding it cold and sad by the sink hours later; being unable to come up with the name “Hugh Grant” and desperately referring to “you know, that posh British actor? Who used to play nice guys who stammered adorably and now plays vaguely murder-y creeps?” What happened to the woman who trounced Jeopardy champions from the safety of her couch?  What’s likely happened is menopause brain fog. Now, if only I could only remember where I read that.

Perimenopause, Menopause, and Brain Fog

Midlife brain fog is real. OK, fine, “brain fog” may not be a clinical, medical term…but the words sure fit the baffling experience of being a woman of a certain age (that would be before and around menopause, which happens on average 51, according to the North American Menopause Society) and finding yourself blanking out in the middle of a grocery-store aisle. 

Rest assured that you’re far from alone. “This is one of the most common symptoms of the menopause transition, affecting almost two-thirds of women,” says James Staheli, D.O., medical director of Broad Health and a family medicine doctor in Atlanta, GA who specializes in hormone therapy. 

About the Experts

Jim Staheli, D.O. is the medical director of Broad Health, and a family medicine doctor.  He specializes in hormone imbalances, metabolic and nutritional medicine, anti-aging, and functional medicine.

Julie Holland, M.D., is a psychiatrist and psychopharmacologist in private practice in New York City. She is the author of Moody Bitches: The Truth About the Drugs You’re Taking, The Sleep You’re Missing, the Sex You’re Not Having, and What’s Really Making You Crazy.

What Menopause Brain Fog Feels Like

Estrogen is a true power player in brain function. Levels of the hormone drop as we age, which particularly affects areas of the brain concerned with memory and executive function: analyzing information, focusing attention, staying organized, seeing things from someone else’s perspective, regulating emotions, managing your time, remembering details, and making plans. 

When you get furious at yourself about your own forgetfulness, know that this too can be a sign of falling estrogen levels and menopause brain fog.

“I’m 58 and I remember a decade ago in perimenopause going to see my general practitioner and listing my chief complaint as ‘overall bitchiness,’” laughs Julie Holland, M.D., psychiatrist and psychopharmacologist in private practice in New York City and author of Moody Bitches: The Truth About the Drugs You’re Taking, The Sleep You’re Missing, the Sex You’re Not Having, and What’s Really Making You Crazy. “Suddenly I had a short fuse, which wasn’t like me, and I felt I couldn’t stop feeling angry, which I’ve since learned is an estrogen thing, when it’s waning.” 

Menopausal Forgetfulness … or Something Else?

The brain fog and memory loss of perimenopause and menopause are almost certainly normal (if annoying). Studies involving brain imaging—done before, during, and after menopause—show that the areas of the brain involved in memory, concentration, and language accessibility tend to experience lessened gray matter volume, meaning menopause and perimenopause brain fog is widespread (1). Sometimes it is not a memory problem but a speed-of-retrieval problem, in which it takes longer to access the information.

The causes of these brain changes can be hard to tease apart. “Disturbances to brain processing and memory are multifactorial and can occur because of falling estrogen levels, changes of aging, disruption of thyroid and adrenal hormones, stress, anxiety, depression, medications, Vitamin B deficiencies, prior infections, and poor sleep,” Staheli notes. Of these, anxiety and depression are the most common during perimenopause. 

What Can I Do About Menopause Brain Fog?

Memory loss in menopause is obviously frustrating. If you used to remember everything, it can feel like a defeat to start having to write notes in your calendar for every little thing. When you used to know the name of every whatever-doodle in the dog park, it can be embarrassing to ask for a reminder. 

It’s fine to use tools (the ones on your computer or phone and the ones in your own arsenal of social skills) to deal with brain fog; there’s no need for embarrassment. There may be days when we’re firing on all cylinders and days when we experience more fuzziness. “Sometimes you feel like a rock star and sometimes you feel like a rock,” Holland says, philosophically. 

Focus on improving any of the many potential causes of brain fog, whether or not they’re connected to hormonal changes. Focusing on a health lifestyle can support overall cognition:

• Practice better sleep hygiene 
• Address depression via talk therapy
• Integrate mindfulness and meditation
• Prioritize creative pursuits
• Exercise
• Incorporate a healthy diet with vegetables, fruits, and whole grains
• Talk with your doctor about vitamins and supplements for brain fog

Any of these strategies may help with memory loss in both perimenopause and menopause.

And then there’s compensating, which many of us do automatically as we get used to it. My own doctor told me, “As long as you can come up with synonyms for the word you just can’t think of, you don’t have to worry.”  

When to See a Doctor

As with most changes during menopause, it’s a good idea to see a doctor if the symptoms are interfering with your life and/or making you unhappy. There may not be a magic cure, but there are likely things that can help clear the fog.

“Just as there are multifactorial causes of brain fog, there’s also a mixture of combined treatment options,” Staheli says. “One of these is hormone replacement therapy. While brain fog has not proven to be a sole reason to start hormone replacement therapy, if other climacteric symptoms of menopause are present hormone replacement therapy should be a consideration.” 

That’s because research as to whether it helps has been mixed (2), but it may be worth trying it as a menopause brain fog treatment, especially if you have other symptoms. 

“If you feel your brain fog is affecting your quality of life, one of the easiest things to do is start estrogen and see if it helps,” says Holland. She notes that for many women, it does work. “I’ve heard it described as ‘Everything was a little gray and fuzzy and when I started estrogen, it was like the veil was pulled away.” 

If it doesn’t, however, you still have options. “You’ll need to work with your doctor on figuring out whether the problem is something else, and whether it’s progressive,” Holland says. 

Staheli says you should also see a doctor if you have these more serious issues, as they could be related to true memory loss, not merely brain fog: 

1. 1. You notice abrupt changes in memory or thinking
2. 2. You have hallucinations, delusions, or paranoia
3. 3. You go out and get lost
4. 4. Forgetfulness is putting your safety at risk; for example, you’re leaving pots on a lighted stove
5. 5. Your symptoms are interfering with your daily life, or your friends and family are worried about your memory

For most of us, the solution to brain fog and normal memory loss in perimenopause and menopause is likely a combo platter of workarounds and interventions. “It’s like that spinning beach ball on your commuter,” Holland says. “It happens; it means you’re buffering. You just want to not get knocked offline.”