How to beat menopausal brain fog

If words are slipping out of reach or you’re struggling with your memory, discover more about this frustrating menopausal symptom 

• Brain fog is moments of forgetfulness or wooliness
• Decreasing hormone levels have an impact on brain function
• Changes are usually temporary and can be improved by taking a holistic approach to treatment

We know it helps to keep a sense of humour – and yes, when you discover your car keys in the fridge or forget your best friend’s name, you can roll your eyes and have a laugh at your own expense. But after a while, when your mind goes blank during a work presentation or you forget to pick up your child from an event, brain fog can become worrying or even terrifying.

What is brain fog and why does it happen?

Brain fog isn’t a medical term, but it describes those moments of forgetfulness, confusion or ‘woolliness’, where you just can’t think straight. It can present itself in numerous ways, including struggling to find a simple word, forgetting things, reading the same page of a book over and over because you can’t take in the information, or not being able to maintain a train of thought.

It doesn’t just occur in menopause – your brain can feel sluggish when you’re jetlagged, hungover, or poorly with a cold or flu. Some people experienced it as a symptom of COVID. However, difficulties emerge during menopause when menstrual cycles become irregular and are skipped [1].

RELATED: The menopause brain: why it might be feeling strange and what you can do about it

This is because oestrogen, progesterone and testosterone have significant roles to play in your brain – it’s an area of much interest in the academic world with increasing evidence and awareness of the multifaceted role they play. Therefore, the decreasing levels of these hormones in perimenopause and menopause can have an impact on function. Of course, not every woman will experience brain fog but a study that followed a cohort of women through menopause found about two thirds reported memory complaints [2].

How does brain fog affect women?

Cognition complaints at menopause include difficulty recalling words and numbers, disturbances in daily life (misplacing items like keys), trouble concentrating (absent mindedness, losing a train of thought, more easily distracted) and forgetting appointments and events [3].

RELATED: Driving anxiety and the menopause

Reassuringly, although these learning and verbal memory complaints are inconvenient and can be worrying, research has found that a normal range of function is typically maintained – about 11–13% of women show clinically significant impairment [4].

Brain fog associated with menopause is also usually temporary. Neuroscientist Dr Lisa Mosconi has carried out the largest examination of the menopausal brain to date, and says that during the menopause your brain goes through a transition, a renovation of sorts, and needs time to adjust. Your brain will compensate through increased blood flow and energy production, and eventually will rebound.  

A study that measured women’s cognitive performance found that during premenopause, verbal memory and processing speed improved with practice and repeat testing but during perimenopause, this improvement with practise was not seen. However, in early postmenopause, performance did, once again, improve with practise, demonstrating that the decline in learning or cognitive performance was time limited [5].

For some women, however, the withdrawal of oestrogen in perimenopause can have a more serious impact, and make them more vulnerable to Alzheimer’s disease. That’s why taking steps now to support and protect your brain is so important.

RELATED: Brain fog or dementia?

Is there a treatment for brain fog?

While it can be comforting to know most cognitive issues won’t last, it can still be frustrating to deal with them during the menopausal transition and for some women, it can be debilitating, especially if it leads to social anxiety.

It is worth speaking to a menopause specialist about any concerns you have as they will be able to advise on a holistic approach and help determine what steps you can take.

Evidence suggests that HRT can have a positive impact on cognition when given in the perimenopausal or early postmenopausal period [6]. Women who have undergone a surgical menopause are also thought to be more likely to benefit cognitively from HRT [7].

Now, here comes the science bit – it sounds complicated but it’s worth knowing! Oestrogen increases the number of connections in your hippocampus [8], the part of your brain important for memory and certain types of learning.

Testosterone strengthens nerves in your brain and contributes to mental sharpness and clarity [9]; it also strengthens arteries that supply blood flow to your brain, which may be crucial in protecting against memory loss. Researchers have closely studied how testosterone levels affect men, especially in areas like memory, recall of information and decision making with promising results reported after testosterone supplementation [10].

Anecdotal evidence from women we speak to seems to suggest the same. Newson Health carried out an audit of its peri- and postmenopausal patients – women who were already established on HRT (oestrogen and/or progesterone) completed a questionnaire measuring their menopause symptoms before and after testosterone was added to their regimen. The audit found testosterone significantly improved concentration and memory.

Progesterone works to regulate cognition, mood, inflammation and repair and function of cells, including nerve cells. You can read more about the role of hormones here.

RELATED: Can HRT reduce your risk of dementia?

How else can I manage my brain fog?

There is no silver bullet for treating brain fog but, like with other menopause symptoms, you can help to manage it by looking at your lifestyle and making any necessary adjustments.

Exercise, particularly aerobic, is known to boost memory and can improve your mood and sleep. Your brain needs good quality sleep so that it can process, repair and improve memory retention. However, it’s not always easy to sleep when you’re suffering from night sweats, restless legs, anxiety or other menopausal symptoms. A calming routine can help, and some women find magnesium useful for helping to calm the body.

RELATED: Should I take supplements during menopause?

Dietary tweaks can also benefit the memory – ensure you are getting the right balance of vitamins, including vitamin D (low levels have been linked to poor cognition and low mood) and limit highly processed foods and those in saturated fats.

According to Alzheimer’s Society there is some evidence that eating a Mediterranean-style diet can reduce the risk of developing problems with memory and thinking, and getting some forms of dementia.

RELATED: How the Mediterranean diet can help menopausal symptoms

If you find your memory lapses embarrassing, don’t be tempted to avoid company – socialising can stimulate your memory. It can also help to treat your brain like a muscle – it needs exercise to keep it functioning at its best. Mentally stimulating activities, such as playing board games, crafts, reading, word and number games, learning a language, can help.

Planning ahead can help with the anxiety that can arise from brain fog. Keep a diary and within it schedule preparation time for any tasks that need doing, plus breathing space in between appointments so you get a chance to refocus and prepare.

Finally, remember to be patient with your brain and practice self-compassion. Yes, you might muddle up your child and pet’s names, walk into a room and forget why you’re there or scramble around for a word during a work presentation, but your brain is undergoing a huge renovation project and will eventually be all the better for it.

References

1. Maki P.M., & Jaff N.G. (2022), ‘Brain fog in menopause: a health-care professional’s guide for decision-making and counselling on cognition’, Climacteric, 25(6), pp570–578. https://doi.org/10.1080/13697137.2022.2122792
2. Greendale G.A., Derby C.A., and Maki P.M. (2011), ‘Perimenopause and cognition’, Obstetrics and Gynecology Clinics. 1;38(3): pp519-35. Doi: 10.1016/j.ogc.2011.05.007
3. Maki P.M., & Jaff N.G. (2022), ‘Brain fog in menopause: a health-care professional’s guide for decision-making and counselling on cognition’, Climacteric, 25(6), pp570–578. https://doi.org/10.1080/13697137.2022.2122792
4. Maki P.M., & Jaff N.G. (2022), ‘Brain fog in menopause: a health-care professional’s guide for decision-making and counselling on cognition’, Climacteric, 25(6), pp570–578. https://doi.org/10.1080/13697137.2022.2122792
5. Greendale G.A., Huang M.H., Wight R.G., Seeman T., Luetters C., Avis N.E., Johnston J., Karlamangla A.S. (2009), ‘Effects of the menopause transition and hormone use on cognitive performance in midlife women’, Neurology. 26;72(21):1850-7. doi: 10.1212/WNL.0b013e3181a71193
6. Sharma A., Davies R., Kapoor A., Islam H., Webber L., Jayasena C.N. (2023), ‘The effect of hormone replacement therapy on cognition and mood’, Clin Endocrinol (Oxf). 98. pp285-295. doi:10.1111/cen.14856
7. Sharma A., Davies R., Kapoor A., Islam H., Webber L., Jayasena C.N. (2023), ‘The effect of hormone replacement therapy on cognition and mood’, Clin Endocrinol (Oxf). 98. pp285-295. doi:10.1111/cen.14856
8. Luine V., Frankfurt M. (2013), ‘Interactions between estradiol, BDNF and dendritic spines in promoting memory’, Neuroscience, 3 239, pp.34-45. https://doi.org/10.1016/j.neuroscience.2012.10.019
9. Celec P., Ostatníková D., Hodosy, J. (2015), ‘On the effects of testosterone on brain behavioral functions’, Frontiers of Neuroscience. 17;9:12. doi:  10.3389/fnins.2015.00012
10. Hua JT, Hildreth KL, Pelak VS. (2016), ‘Effects of Testosterone Therapy on Cognitive Function in Aging: A Systematic Review’, Cogn Behav Neurol. 29(3):122-38. doi: 10.1097/WNN.0000000000000104