It’s (Not) All in Your Head
It’s surprising just how many symptoms can accompany menopause. According to Medical News Today and other experts, the list includes as many as 34 different effects — some of them unusual and somewhat disturbing, such as “electric shock” sensations, “brain zaps,” a burning mouth, thinning hair and widespread itchiness (see related story here).
And here’s another one you may not have expected: brain fog. That feeling that you’re less than mentally sharp, that your brain is running more slowly or that it’s “filled with cobwebs,” as Meghan Monthie, M.D., a board-certified family physician and owner of Albany’s direct primary care practice Heirloom Family Medicine, explains.
Many women go through brain fog. According to UCLA Health, it’s estimated that up to two-thirds of women experience cognitive impairment during menopause.
“This can manifest in a variety of ways, from walking into a room with a purpose and then promptly forgetting why, losing your train of thought midsentence, difficulty concentrating or multitasking, forgetting the word for something you use every day or just feeling scattered and unorganized,” Monthie says.
Other causes may be at play when it comes to brain fog: things like chronic stress, lack of sleep and nutritional deficiencies, as Desiree Mollnow, MSN, FNP-BC, founder and CEO of Latham’s UpState of Health, details. But one cause of brain fog for menopausal women can be hormone fluctuation.
Brain fog can be frightening. In fact, you may believe that you’re in the early stages of dementia, and you wouldn’t be alone in that fear. To help clarify, reassure and explain menopausal brain fog, our experts are here to fill you in.
Monthie says that brain fog is incredibly common during perimenopause and menopause, and “these moments can be really unsettling and quietly confidence-eroding for women who are used to performing at a high level at home and in the workplace.”
She also explains the biology.
“We have estrogen receptors in many parts of our body, including our brain,” she says. “Estrogen plays a huge role in our memory, attention and how our brain cells communicate with one another.”
Since estrogen levels drastically drop after menopause, she says that our memory, executive function and focus can plummet, too. Additionally, mood changes like anxiety and depression can further worsen that brain fog. And Monthie says that juggling caring for children and aging parents doesn’t help, either.
Additionally, Mollnow, who specializes in hormone replacement therapy, says, “Progesterone affects sleep, which, if poor, will affect our energy and clarity the following day.”
With all this forgetfulness and fogginess, you might believe that you have dementia, especially if you have a family history.
“The good news is that menopause-related brain fog and dementia look very different clinically,” Monthie reassures. “With brain fog, patients typically notice their cognitive hiccups, which bothers them. Memory issues can be inconsistent, with some days being better than others. And most importantly, the general ability to function and do your daily tasks remains intact.”
But with dementia, she says, short-term memory loss is the predominant feature, and this decline is persistent, progressive and usually recognized by loved ones first.
“There is also a significant impact on patients’ ability to safely perform their daily tasks,” she says.
To better understand brain fog, in 2025, researchers conducted a review of existing studies to examine how menopause affects brain structure and its links to cognitive, emotional and physical health, and the results were presented at the annual meeting of The Menopause Society in October.
The study found that menopause actually reshapes the structure of the brain, in which the gray matter volume of the frontal and temporal cortices and the hippocampus decreases. These areas drive memory and decision-making.
“Studies like these are exactly what we need to help show the profound effects our hormones have,” Mollnow says. “Oftentimes, women beat themselves up because they do not feel as sharp or get labeled as ‘crazy’ or ‘emotional,’ yet there are so many physical changes occurring due to the fluctuation of our hormones.”
To be absolutely sure about the cause of your brain fog, Monthie recommends sharing a detailed health history with your primary care physician, who can complete a cognitive evaluation in the office.
Treatment Options
In the past, Monthie says, physicians often recommended “waiting out” the brain fog, but nowadays there’s a menu of options that can come together to create a personalized treatment plan.
While you may notice improvement with your brain fog over time, if your quality of life is being deeply affected, Monthie says that you could turn to hormone therapy that’s tailored to your unique symptoms and medical history, and also make lifestyle changes, such as optimizing sleep, managing stress, exercising regularly and sticking to a well-rounded diet.
It also can help to perform a blood or saliva test to evaluate your hormone levels. If you’re found to be deficient in certain hormones, Mollnow says, hormone replacement therapy is an option.
“Many of the women I see in my practice are used to being the ones who hold everything together, and they’re the last to get support (for) themselves,” Monthie says. “It’s okay — and I also encourage you — to prioritize your own health, as doing so facilitates your ability to show up as your best self for everyone and everything else.”
Top image source: iStockphoto.com/mikkelwilliam
