Why You Have Brain Fog and When to Get Worried - Stella
Memory & focus

Why your brain is failing you and when to get worried

byDr Sonia Dua

Night sweats, hot flushes, mood swings, sleep disturbance, vaginal dryness, and erratic periods, there is no mistake that these are the classic hallmarks of menopause transition. If that’s not enough to contend with, women frequently describe changes in their brain function too. There can be an overwhelming feeling of what is often referred to as “brain fog”.

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What does brain fog feel like?

Simply put, brain fog can feel like your brain is failing you! It can range from poor concentration and forgetfulness to memory loss. Brain fog leaves women feeling understandably distressed.

All of a sudden, from being in their prime women tell me they feel like their brain has turned to mush. They say that their mind just goes blank at times, usually when in mid-conversation.

It can manifest in many different ways. Initially, it can be as trivial as forgetting where you parked your car when out shopping, missing an important birthday or forgetting why you went upstairs. It becomes more concerning when you can’t remember your child’s name. When brain fog happens on a daily basis, it can be embarrassing and hard to deal with. Often women worry that it signals the early signs of dementia (you may feel worried, but it’s probably not).

Find out more about brain fog in our symptoms library.

I met someone in the street that I recognised but couldn’t place immediately. I knew I liked her and she had a dog but it took me a good 5 minutes of conversation to realise that I had worked with her. It was only after I got home that I remembered her name. It really freaked me out”


Why does it happen during menopause?

It’s not entirely clear why a woman in menopause experiences cognitive issues and the jury seems to still be out on this.

There is a reduction in levels of oestrogen during the menopause transition and there is some evidence to support the importance of oestrogen in cognitive function. There are oestrogen receptors throughout our brains, especially in the basal forebrain which supplies the hippocampus.

The hippocampus is the part of the brain involved in learning and memory. There is some scientific evidence confirming that once a woman initiates hormone replacement therapy (HRT) and oestrogen levels increase, there is improved activity in the hippocampus. These women tend to perform better in verbal memory tests. However, the studies are small and the evidence is inconclusive, with some studies showing no significant change at all.

Recent research has shown that the menopause transition does affect brain structure, connectivity and energy metabolism which can affect cognitive function.

Anxiety, depression and insomnia, which can all occur during perimenopause, have also been implicated in cognitive decline.

How common is it in women?

Approximately two-thirds of women report some sort of brain fog in perimenopause. Inevitably, this can have a significant impact on their personal and professional lives.

How can brain fog impact women at home and work?

When working in high-pressure environments, suddenly women can find themselves struggling to keep up. Fanning themselves frantically, while trying to wipe away beads of sweat, only to then forget words mid-sentence.

Public speaking and even simple conversations can become difficult. Women can find themselves forgetting important engagements or run late because they have misplaced their keys. We have all misplaced our keys, yet when you find yourself rifling through the refrigerator for them, you know something is not quite right.

Read Lisa’s story on how she thought she had dementia when she started forgetting words.

Can it cause women to leave the workforce?

I have seen women at the end of their tether with brain fog, who have contemplated leaving their jobs due to the stress of it all. The pressure of being unable to perform as well as they used to can be daunting. There’s a hesitancy to share what’s going on because menopause is quite personal, and many prefer not to share this. There is also a fear of it being trivialized.

Menopause is a natural part of a woman’s life but, in reality, it can be quite debilitating. More workplaces are beginning to acknowledge the true extent of menopause symptoms and the impact they can have on women and their careers. Find out where you stand when it comes to menopause at work.

There is hope of more support becoming available in the workplace, to stop women prematurely leaving the workforce. If you are struggling, speak to your manager to see what support is available.

Read Jeneva’s story on how to deal with embarrassing symptoms in the workplace.

What helps brain fog?

Regular exercise and a healthy diet (especially a Mediterranean diet) are shown to help alleviate brain fog. Stimulating the brain with crosswords, reading and thoughtful discussion, or even learning a new language has also been shown to improve cognition.

It’s important to alleviate any sleep issues, such as hot flushes and night sweats. Any underlying mental health issues should be addressed with psychological support or medication if required.

How can you manage brain fog?

The cognitive changes experienced in the run-up to menopause tend to settle down over time. It’s important to find ways to get through it – here are five practical tips:

  1. Write things down. Use a diary for reminders for important engagements. Keep lists for important activities and refer to them as often as you need to. You could even use specific reminder apps to help keep you on top of things
  2. Take it one day at a time to avoid feeling overwhelmed. Focus on one activity at a time and avoid trying to multitask. Break down tasks into manageable chunks, with periods of rest and relaxation built-in. Most importantly, pace yourself
  3. Have set places for items you often misplace, such as glasses, keys, mobile and medication
  4. Try relaxation techniques to manage stress, including meditation or exercise
  5. Try to sleep more. Wear light clothing and keep the room cool if you are experiencing night sweats. Reduce caffeine intake and try to have a regular bedtime routine

Start your free online menopause assessment to see if HRT is right for you

Where can you get help?

Boost the network around you by sharing your symptoms with family and friends. Make them aware of the difficulties you’re having as they may be able to help you cope better. You will soon realise you are not alone in how you are feeling. It’s also good to speak to your GP if you have concerns about your memory.

Is there treatment for brain fog?

There are treatments available for depression and anxiety, which have been seen to improve brain fog. HRT can be used for some women for their menopausal symptoms. Each woman’s symptoms and medical history have to be evaluated and the individual treatment discussed, so it’s important to talk to your doctor. Read about the HRT debate.

How do you know you have brain fog and not dementia?

Dementia tends to occur much later in life and is rather rare in the under 50s. There are special memory tests that can be done to assess your brain function. Women experiencing changes in cognition during menopause tend to score well in these.

Does brain fog get better?

The good news is that brain fog seems to settle down over time, as women transition from perimenopause to menopause. Your body is great at adjusting to changes over time. Generally, it does seem to be a temporary lapse for most but there may be other contributing factors resulting in a persistent change in cognition for some women.

Do supplements help brain fog?

Herbal remedies are not recommended for menopause symptoms, as it is generally unclear how safe and effective they are, as well as the possibility of interaction with prescribed medicines. Talk to your doctor.

Final word

UPDATE: When it comes to brain fog and HRT, Dr Lucy Wilkinson, a GP with a special interest in women’s health says, “While HRT is highly effective for many symptoms of menopause, current research about its effect on brain fog and other cognitive symptoms is mixed and seems to show little benefit. HRT is therefore currently not started as a treatment for brain fog alone, but you may find it useful if you are struggling with other symptoms, especially if these are impacting on your concentration.”

Find out more about the stages of menopause, and more on our blog.

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