It happens to everyone throughout their life: You’re trying to find a certain word — and you definitely know it — but you can’t for the life of you remember what it is. Or you completely flub an acquaintance’s name when you run into them at the grocery store. Or walk out of the movie theater and stare at the parking lot unsure of where you actually left your car. But with menopause, this kind of forgetfulness can become more and more frequent.
Between the drop in hormones, mood swings, and lack of sleep — all of which can occur during the menopausal transition and afterwards — it’s no wonder you’re having a harder time thinking straight. Here, experts share the link between menopause and brain fog, how long you can expect it to last, and how to keep your mind sharp.
What is menopause brain fog?
There’s no exact definition, but menopause brain fog is when you feel, well, foggy. “It’s problems with verbal learning, memory, and concentration,” says Dr. Stephanie Faubion, M.D., the director for the Center for Women's Health at the Mayo Clinic, medical director for The Menopause Society, and member of the WeightWatchers scientific advisory board.
A classic way this manifests is problems with recall — essentially, “not feeling confident that you're going to remember stuff,” says Dr. Sally MacPhedran, M.D., the director of the Midlife Women's Center at University Hospitals Cleveland Medical Center and a professor of reproductive biology at Case Western Reserve University School of Medicine. Her patients tend to be nervous that “they’re going to be in front of people and forget the words that they're supposed to say,” she says.
Luckily, brain fog tends to be limited to that spur-of-the-moment gap in memory. Women going through the menopause transition are “still able to learn new skills and tasks at the same ability that they were beforehand — so it doesn't affect that,” says MacPhedran.
How common is menopause brain fog?
While hot flashes get top billing among menopause symptoms, brain fog is also incredibly common, with three out of four women reporting cognitive issues during menopause. And it can start pretty early in the process: Some research shows that brain fog can even hit before your periods become irregular. “So we know this is happening well before the last menstrual period,” says Faubion. “But how far into menopause it goes is unclear.”
Menopause brain fog causes
Symptoms during the menopausal transition tend to be interconnected: Shifts in your hormones can lead to hot flashes and night sweats, which can in turn impact your sleep — which can then mess with how sharp you feel the next morning. Here’s how it all works.
Hormones
During perimenopause — which is the phase leading up to menopause when your cycle becomes irregular — estrogen levels begin to go down. And while the exact role that plays in brain fog isn’t totally clear, estrogen does influence activity in the brain during cognitive tasks. This supports the theory that lower levels of estrogen cause your cognitive abilities to take a hit. To further support this idea, “there is some association with estrogen deprivation in Alzheimer's disease,” says MacPhedran. There is no association between brain fog in menopause and a higher risk of dementia later in life — this is just underlining the relationship between estrogen and your general cognitive health.
Stress
Stress goes up during menopause thanks to a combination of hormonal changes, concerns around body image, and worrying about other menopause symptoms — not to mention that this all happens around the time when you may be taking care of both kids and aging parents. According to research, high stress levels are linked to a decline in cognitive function, impacting the part of the brain that oversees your working memory.
Sleep disturbances
Roughly 50% of women have trouble sleeping during menopause, which can shorten your attention span, impact your concentration, and, long-term, may even affect memory. “The night sweats can lead to sleep deprivation and decrease your functioning during the day because you're irritable, you haven't slept, and you are exhausted,” says MacPhedran. “All of that just compounds the memory issues.”
Menopause brain fog treatment
Ready to clear out the fog? Experts say your best bet is to make lifestyle changes that will improve your overall cognitive health. Here’s what they recommend.
Eat a balanced diet
What you eat is important for many reasons, and improving your mental sharpness is one of them. The Mediterranean diet — which is rich in fish, leafy greens, other fruits and vegetables, and healthy fats and limits red meat and processed foods — can help. A review of the current data found that eating this way can reduce the risk of both mild cognitive impairment and Alzheimer's Disease, and can help improve overall cognitive function. Not only is it rich in anti-inflammatory compounds, like antioxidants, but the diet is rich in vitamins and fatty acids that reduce oxidative stress, which can otherwise damage tissue in the brain over time.
Exercise regularly
Staying active can be incredibly helpful for your mental powers, because a strong heart is better able to supply oxygen and other important nutrients to the brain. (The heart and the brain are closely linked, with research finding that high blood pressure, high blood sugar, and other markers of poor heart health are correlated with worse cognitive function and even dementia.) Plus, if your brain fog stems from poor sleep due to night sweats, exercise has been found to help with that as well.
Stimulate your mind
Nothing beats novelty for sharpening your mind: New experiences beyond your typical routine can help you stay sharp because novelty activates certain areas of the brain that help with memory and processing. “Keep your brain active, whether that's being in new social settings or doing new things with new people,” MacPhedran says. She also encourages women to challenge themselves mentally, say by playing Wordle and sharing their results with friends, which serves as practice for recalling words.
Get enough sleep
Sleep is often where brain fog begins. “Nobody can think clearly when they're exhausted,” says MacPhedran. To solve this issue, start by figuring out what’s disrupting your sleep. If it’s night sweats, talk with your provider about what can help minimize them. If it’s anxiety or stress, work with a mental health expert to come up with helpful strategies.
Consider hormone replacement therapy (HRT)
The evidence on whether you can improve brain fog with hormone therapy — which is when you take medication to return your estrogen and progesterone levels to where they were before menopause — is still unclear. One review of the research suggested that menopause hormone therapy is linked to better cognition, but larger, randomized studies haven’t found any clear benefit.
That said, menopause hormone therapy can help with other symptoms of menopause that may be causing your brain fog, like night sweats. This may kick off a domino effect that results in your feeling sharper, but it just hasn’t been proven yet. “We don't have evidence that says that giving hormones to improve sleep would help with brain fog, but it probably does,” says Faubion.
The bottom line
Brain fog, which is when you can’t recall a word or remember something as quickly as you used to be able to, is one of the more common menopause symptoms. It is likely due to the drop in estrogen, which can lead to changes in your brain, as well as other symptoms that can impact cognition, like sleep issues and stress. The best way to improve your recall is through lifestyle changes, like eating a healthy diet and exercising regularly. Hormone replacement therapy may not directly improve brain fog, but it could help with night sweats, which, in theory, could then help you sleep better and feel sharper in the morning.
FAQs
For most people, brain fog eventually goes away along with the other menopause symptoms once your estrogen levels stabilize and your body gets used to the new normal.
There isn’t a set amount of time, since each woman’s menopause journey is unique. It’s also difficult to measure how long brain fog lasts since some women figure out how to live with less recall. “What I've seen is that women just adapt — and so they would say their brain fog is less bothersome because they're just better at managing it,” says MacPhedran.
It’s hard to beat the Mediterranean diet for cognition; meals tend to be focused on fish, fresh fruits and vegetables, healthy fats like olive oil, and nuts and seeds. You also might want to load up on iron, as research has linked low iron levels with lower cognitive performance during perimenopause. Opt for lean proteins, or find it in oysters, mussels, and other seafood, as well as dark leafy greens, lentils, and beans.
This content is for informational purposes only and does not constitute medical advice, diagnosis or treatment. It should not be regarded as a substitute for guidance from your healthcare provider.