Menopause and Brain Fog
After more than a decade working on the same labor and delivery unit, a few recent experiences helped me decide the topic of my first blog post.
First, I completely blanked on the name of a nurse I’ve worked alongside for years—someone who not only shared countless shifts with me but also cared for me when I delivered my now 4-year-old daughter. (Don’t worry, her name popped back into my head—at 3 a.m., of course.)
Then there was the night I accidentally went to sleep in the wrong call room and unintentionally gave my partner quite the scare at 2 a.m. when she finally got a chance to lie down. She walked in expecting an empty bed—only to find me in it!
And honestly, I think I’ve gotten more reminders lately—from nurses or billers—about charts, orders, and notes than I’ve had in the past twelve years combined.
These moments have been a little unsettling, especially for someone who takes this job as seriously as I do. Caring for women and their babies is a profound responsibility, and I don’t take that lightly. I know I’m a great doctor—and I also know when something feels off.
What I’ve been experiencing is something many women in their 40s know all too well: brain fog. It’s frustrating, sometimes funny, and occasionally humbling—but it’s also very real. And that’s why I want to talk about it.
What Is Brain Fog?
Brain fog can show up as:
Short-term memory loss
Difficulty concentrating
New-onset ADHD-like symptoms
Trouble multitasking
Up to 40–60% of midlife women report some form of brain fog during the menopause transition. The good news? A wide body of research shows that although it's common, it typically improves over time.
What’s the Hormonal Connection?
Women have estrogen receptors all over the body—including in the brain. Estrogen affects neurotransmitters and can reduce dopamine levels, which can impact focus, memory, and mood.
The brain is especially sensitive to fluctuating estrogen levels, which is why symptoms often worsen during perimenopause, when hormones are in flux. As estrogen declines, the brain compensates by creating more estrogen receptors.
Other Contributors to Brain Fog
Several menopause-related symptoms can make cognitive issues worse:
Vasomotor symptoms (hot flashes, night sweats)
Sleep disturbances
Anxiety and depression
If you're experiencing these, addressing them may also help with brain fog.
Can Hormone Therapy Help?
The role of menopausal hormone therapy (MHT) in treating brain fog is still unclear. There are no large-scale studies specifically looking at MHT or oral contraceptives for cognitive symptoms during perimenopause, which is when these symptoms usually start.
Most existing data comes from studies on postmenopausal women, many of whom were not experiencing significant menopause symptoms. These studies show a neutral effect of MHT on cognition.
A black box warning about the risk of dementia exists for MHT, based on the Women’s Health Initiative study. This showed a doubling of dementia risk in women over 65 who were on a specific hormone regimen (conjugated equine estrogen with medroxyprogesterone acetate).
However, this is not the hormone therapy I typically prescribe, and it’s important to consider the "timing hypothesis": starting MHT within 10 years of menopause does not appear to carry the same risks.
Currently, no major medical society recommends hormone therapy solely for brain fog—except in women who experience early menopause due to ovary removal. In these cases, estrogen therapy may reduce the risk of cognitive decline and late-life dementia.
Despite the lack of official approval for MHT specifically for brain fog, I can say that I have seen many, many women experience improved symptoms after starting MHT. Just like so many aspects of our health, it really comes down to shared decision making with your healthcare provider taking into account your personal history, health goals and symptoms.
What Can Help? Evidence-Based Strategies
Even if MHT isn’t the answer for every woman, there are plenty of effective, evidence-based tools to support brain health:
✅ Exercise
Engage in moderate-intensity physical activity for at least 150 minutes per week.
✅ Nutrition
Follow a Mediterranean-style diet. Prioritize:
Vitamins C and E (sunflower seeds, almonds, leafy greens, citrus, cruciferous vegetables)
Omega-3s (fatty fish, nuts, flaxseeds)
✅ Sleep & Mental Health
Prioritize sleep and address anxiety or depression.
✅ Medical Checkups
Manage risk factors:
Blood pressure (aim for ≤120/80 mmHg)
Cholesterol
Blood sugar levels
✅ Avoid Risky Habits
Avoid smoking, excessive alcohol, and head injuries.
✅ Stay Social & Mentally Engaged
Build cognitive reserve by staying socially connected, learning new skills, and challenging your brain.
Want to Learn More?
📚 Recommended Reads (available to borrow at Elevated Menopause Care)
Note: Ignore my highlights and margin notes! 😉
The Menopause Brain – Lisa Mosconi, PhD
The New Menopause – Mary Claire Haver, MD
🎧 Podcasts & Talks
TED Talk: How Menopause Affects the Brain – Lisa Mosconi (2019)
Podcast: Ovary Active – Episode 13: Your Brain on Peri
Podcast: Inside Information with Dr. Streicher – Episode 176: FOOD and BRAIN Health with Dr. Annie Fenn
References
Menopause and Brain Fog: How to Counsel and Treat Midlife Women (March 21, 2024)
Pauline M. Maki, PhD; Nicole G. Jaff, PhD, MSCP
(University of Illinois Chicago; University of the Witwatersrand, Johannesburg, South Africa)The New Menopause – Mary Claire Haver, MD (pp. 169–171)Don’t worry about sounding professional. Sound like you. There are over 1.5 billion websites out there, but your story is what’s going to separate this one from the rest. If you read the words back and don’t hear your own voice in your head, that’s a good sign you still have more work to do.
Be clear, be confident and don’t overthink it. The beauty of your story is that it’s going to continue to evolve and your site can evolve with it. Your goal should be to make it feel right for right now. Later will take care of itself. It always does.
