Brain fog and cognitive changes: the invisible symptom of menopause

We have all experienced walking into a room and forgetting what we went there for, taking longer to find a word or rereading the same sentence several times because it is difficult to stay focused. These situations can happen at any age, but during the transition to menopause some women begin to notice them often enough to wonder whether their memory is changing.

These difficulties are commonly grouped under an increasingly familiar term: “brain fog.” It is not a specific medical diagnosis, but rather a way of describing problems related to memory, attention, concentration or mental sharpness.

Recent reviews show that this is far from an uncommon experience: it is estimated that around two thirds of women experience some form of concern about their cognitive health during the menopausal transition. However, feeling that memory is not working as well does not necessarily mean there is significant cognitive decline or that these symptoms are the beginning of dementia.

What happens to memory during menopause

Menopause is confirmed once 12 consecutive months have passed since the last menstrual period, but hormonal changes begin earlier. During perimenopause, estrogen levels can fluctuate considerably before declining more steadily after menopause.

The brain is one of the parts of the body that responds to these changes. Estrogens are involved in processes related to the plasticity of neural connections, neurotransmitter regulation, cerebral blood flow and energy metabolism, which is why hormonal variation is being studied as one of the mechanisms that may contribute to cognitive changes during this stage.

Research does not, however, point to a generalized loss of cognitive abilities. Instead, changes appear to be concentrated in certain areas, including learning and verbal memory, the speed at which some information is processed and, in some studies, working memory and attention.

A 2026 analysis combining the results of 26 studies and data from 9,428 women found that during perimenopause there may be small differences in certain cognitive abilities compared with earlier stages. However, researchers also note that it is still difficult to establish a single clear pattern, as studies do not always use the same criteria to determine when this transition begins or assess memory and attention in the same way.

Feeling more forgetful does not always show up in tests

One of the most interesting aspects of current research is that what a person notices in everyday life does not always match the results of neuropsychological tests.

A woman may notice that she needs more reminders, loses track of a conversation more easily or takes longer to recall a name and still obtain normal results in a cognitive assessment.

A study published in 2025 involving 5,629 women found only a small association between perceived cognitive difficulties and certain objective measures of learning. No significant relationship appeared in other cognitive domains. This does not mean that brain fog is imaginary, but rather that tests carried out under controlled conditions may not fully reflect the difficulties that arise in real-life situations, where interruptions, stress, tiredness and multiple simultaneous tasks all play a role.

In fact, one line of research proposed in 2026 suggests studying these symptoms in everyday life as well, using frequent records and digital tools to observe how concentration and mental clarity fluctuate throughout the day.

Other factors to take into account

Attributing every lapse in memory solely to lower estrogen levels oversimplifies a phenomenon in which several factors may be involved at the same time.

Hot flashes and night sweats, for example, can repeatedly disrupt sleep. Poor sleep can affect attention, learning ability and memory the following day. Changes in mood, anxiety, stress and the work and family responsibilities that often coincide with this stage of life may also contribute.

For this reason, current research describes brain fog as a multifactorial phenomenon in which neuroendocrine changes, sleep, vasomotor symptoms, emotional wellbeing, ageing and individual circumstances may all play a role.

This interaction also helps explain why the experience can vary so widely from one woman to another. Some barely notice cognitive changes, while for others they can become one of the most uncomfortable symptoms of the menopausal transition.

Brain fog is not the same as cognitive decline

Memory problems during this stage can be worrying, especially when they appear unexpectedly. However, the cognitive changes commonly associated with menopause are different from the progressive decline seen in conditions such as Alzheimer’s disease.

Longitudinal studies have identified small changes in certain measures of memory during the menopausal transition, but performance generally remains within the normal range. The Menopause Society also notes that difficulty concentrating or remembering is common around menopause and that, in most cases, these changes are far more subtle than those seen in dementia.

This does not mean that every memory problem should automatically be attributed to hormones. When changes are significant, worsen over time or clearly interfere with everyday activities, it is advisable to consult a healthcare professional to consider other possible causes.

Can brain fog be treated?

At present, there is no specific treatment designed solely to eliminate menopausal brain fog. The first step is usually to identify the factors that may be contributing to it.

Improving sleep, staying physically active, managing cardiovascular risk factors and treating mood problems may also support cognitive function. For this reason, current guidelines recommend paying particular attention to these more manageable factors.

Menopausal hormone therapy, on the other hand, requires separate consideration. It can be effective for symptoms such as hot flashes and night sweats and, by improving them, some women may also experience an indirect improvement in sleep or in their sense of mental clarity. However, current evidence does not support using hormone therapy specifically to improve cognition or prevent dementia. Whether it is appropriate should depend on each person’s overall symptoms, circumstances and individual risks.

Research into the brain and menopause has increased in recent years, but important questions remain unanswered. A review published in August 2026 in Nature Reviews Neurology specifically highlights the lack of data needed to understand more precisely how this transition affects brain health and why experiences differ between women.

What the current evidence does allow us to say is that brain fog during menopause is a common and recognizable experience, one that may have a biological basis and may also be amplified by other symptoms of this stage. Understanding it better can help not only to reduce unnecessary concern, but also to identify when these changes are part of a normal transition and when other explanations may need to be explored.