Brain fog is estimated to affect around two-thirds of women at the menopause; that familiar feeling of walking into a room and not knowing what you were there for. Or forgetting words mid sentence. The good news is that although brain fog is common, it’s often worse in the first few years of the menopause and then returns to normal in the post-menopause phase.

This article was included in issue 97 (Summer 2023) of The Menopause Exchange newsletter.

Possible causes
Oestrogen has been shown to play an important role in brain function, cognition and neurotransmission, but this role is complex. The hormone helps to increase glucose in some areas of the brain that are related to cognition, so when oestrogen is lacking, cognition is affected. However, the onset of brain fog can be more complex than just oestrogen levels declining at the menopause, and other menopause-related symptoms may have an impact. Flushes, mood changes and issues with sleep can all affect thinking and the foggy feeling. If lifelong brain health has been poor, there will be additional risks.

The treatment of the above menopausal symptoms may help to reduce the symptoms of brain fog. However, it’s important to be certain that any brain fog is related to the menopause and not to other underlying health issues. More recently, for example, Long Covid has been producing similar symptoms to brain fog.

Signs and symptoms
Brain fog can be difficult to define and articulate. It’s a group of symptoms that involve memory and attention issues, difficulty in recalling words, difficulty in keeping a train of thought, with being easily distracted, and problems associated with forgetting, such as: “Where are my keys?”

Brain fog encompasses being unable to make decisions, lacking mental clarity, difficulty in learning new information and making use of new information. These symptoms can start when the menstrual cycle becomes irregular and may persist into the menopause and post-menopausal phases. Their severity, as with all of the menopause, is individual, and can range from mildly irritating to affecting daily life and working life.

There’s always a worry that these symptoms aren’t due to the menopause but are linked to dementia. However, early dementia is rare, and although a large proportion of women experience brain fog, many don’t develop dementia.

Treating brain fog
When looking for what may help with brain fog associated with the menopause, it would be reasonable to think that hormones would be the answer. However, there has been very limited research into this. Any studies suggest that the type and delivery of hormones also have a part to play in brain fog, as does age, with younger women seeing the greatest benefit if HRT is given in the peri-menopausal phase. If, for example, hot flushes are an issue, then treating with HRT may help to reduce them and have better sleep, which may in turn help to reduce brain fog. Studies looking at women who have their ovaries removed when they’re under the age of 40 suggest that these women have an increased risk of dementia unless they use HRT, which can decrease the cognitive decline.

What can you do?
Brain fog is common and should pass for most women, but there are several self help and lifestyle measures that you can look at to help with brain fog and reduce the symptoms. This is also a good time to assess your overall health and wellbeing and look at any factors that can have an effect on brain fog and future dementia risks.

Try these helpful tips
Check your medicines: Discuss your prescribed medicines with a healthcare professional, as some of these may alter sleep and cognition, leading to brain fog. Examples include sleeping tablets, anti-depressants and some medicines for high blood pressure.
Check your heart health: High blood pressure can lead to cognitive impairment, so you need to make sure your blood pressure is within the normal range. If not, see a healthcare professional to discuss treatments for high blood pressure and check and correct your blood fat and cholesterol levels. Ensure you’ve been assessed for diabetes and treated if needed.
Arrange a hearing test: Poor hearing can impact on brain fog.
Exercise your body: 150 minutes of moderate activity a week will help you to keep a healthy mind as well as a healthy body. Exercise may also help with sleep and help with blood flow to the brain, which in turn decreases brain fog.
Use meditation or mindfulness: This will help with sleep and decrease anxiety.
Consider supplements: Although there’s limited evidence, some women have found help with omega 3, black cohosh, red clover, ginseng, dong quai and vitamin B complex.
Decrease weight: Ensure your BMI (body mass index) is normal. A Mediterranean diet may help, and avoid diet drinks as these may have an impact on dementia.
Stop smoking: This has an adverse affect on blood flow to the brain.
Avoid excessive alcohol intakes.
Stay connected: Keep social engagements, and don’t become socially isolated as you need support.
Exercise your brain: Give your brain exercises to challenge it, along with reading and learning new skills and new languages.
Use lists to help you remember things.
Get more sleep: Try sleep hygiene and cognitive behavioural therapy (CBT).
Keep hydrated.
Discuss HRT: HRT may help with brain fog by reducing some of the compounding factors: this will then allow your symptoms to settle.
Do something new: Try to have some regular time for yourself.

About the author

Debby Holloway is a menopause specialist and trainer for menopause as well as being a non medical prescriber.

Created Summer 2023
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