Brain fog after menopause leaves women feeling low in confidence and like a fragment of their former selves - it's not spoken about enough

Brain fog can feel like cloudiness in your head or a computer struggling with a slow connection. It's often coupled with a temporary inability to remember places or names you say every day, and it's one of the most common menopause symptoms.

“It is difficult to say when I noticed the brain fog because I had premature menopause so early - at 43 - so initially I thought it was postpartum baby brain,” says Rebecca*, a woman in her mid-50s living in the UK. "However, I would say that it manifested to a point where it couldn't be ignored about a year before my periods stopped."

Rebecca's experience of brain fog was, and remains, problematic - and she's by no means alone. New research published this year in The Lancet found that 68% of women in the study reported some brain fog, with almost 64% reporting concentration difficulties and 57% reporting memory problems.

Brain fog may be the second-most commonly reported symptom (mood swings are top of the list), but it's one of the most misunderstood and under-researched.

* Name has been changed

What causes brain fog?

For pregnant or postpartum women coping with ‘baby brain’, or for women who are going through menopause, or who are postmenopausal, the culprit tends to be oestrogen. This is why more women deal with brain fog than men.

"Oestrogen helps to modulate and support working memory, the mental workspace we use to hold information and juggle tasks. It also supports dopamine, a brain chemical involved in focus, motivation and mental clarity,” says Dr Natasha Davidson, clinical lead director of women’s health care clinics, TMC Health.

"During perimenopause, oestrogen levels don't decline smoothly. They fluctuate, sometimes dramatically. Those shifts can unsettle systems that keep our thinking sharp, so brain fog can be one of the first signs that hormones are changing.”

Sleep disruptions and insomnia in menopause, caused by night sweats and low mood, can compound the problem.

Nutritional deficiencies, poor sleep, and neuroinflammation, which is found in people with neurological, neurodegenerative or autoimmune illnesses such as multiple sclerosis, ME/CFS, dementia, and brain ageing – aka ‘inflammageing’ - can also be causes. Always speak to your doctor if you're experiencing brain fog.

What does brain fog feel like in menopause?

For Rebecca, the cognitive challenges of brain fog came as quite a shock. “I started to search for my words a lot more, and I realised I couldn’t rely on my memory for things like my calendar,” she says. “Suddenly, I had to write things down. I was frequently double and triple-booking myself when I had always been excellent at remembering dates. I often got distracted in between tasks and couldn’t remember what I was supposed to be doing."

Rebecca says the change made her feel "quite stupid" as she'd always been very organised and had a photographic memory. So, from this, her self-assurance was understandably knocked. It's something that, now in postmenopause, she has yet to recover from.

"It has hugely impacted my confidence at work, and now I'm an avid notetaker to recall meetings," she tells me. "It has also been quite embarrassing to have my husband watch my demise. I worried that he now sees me as a little bit ditzy.”

If you have experienced brain fog, you will understand Rebecca’s frustration - and her fear that she was developing a more serious condition. "I noticed that I couldn’t remember conversations I’d had with people and started worrying I had early-onset dementia," she says.

Not only is it embarrassing and debilitating, but it is often dismissed as ‘just another symptom of menopause’ - a response that receives an eye roll from many women. “I would have liked more sympathy, but we’re supposed to accept it as a fact of ageing,” says Rebecca.

Living with brain fog in postmenopause

There is a downside to reaching menopause that isn’t fully discussed: some of the symptoms that women face in perimenopause continue to cause issues. Many of us are under the (false) impression that once we’re on the other side, i.e. postmenopausal, it’s sayonara to symptoms, but this isn’t necessarily the case.

“For some women, brain fog persists after the menopause because it is part of the wider picture of hormonal decline,” explains Dr Davidson. “Oestrogen levels remain low after periods have stopped, so the brain continues to function without the support that oestrogen once provided.”

Rebecca is in this position today. “I am postmenopausal now, and I am still suffering from brain fog massively. I worry this is the new me, and it really makes me sad. I used to be so bright and switched on all the time, and now I feel like an airhead sometimes," she says.

"I am not really confident that anything major is going to change to get back to how I used to be – it isn’t as if a switch will just be flicked back. I'm a very active person with a full life, but some days I feel like my brain is super slow. It makes me hate ageing," she says.

To her credit, Rebecca has made efforts to combat this, and it has helped. "I write a lot of things down," she tells me. "I have been advised to take vitamin B to help with cognition, and I am trying to support my brain capacity by learning new skills such as ice skating and teaching myself piano."

What is the treatment for brain fog?

Rather than treating brain fog in isolation, the most effective approach is to address underlying causes, says Dr Davidson. Here’s what she recommends:

Prioritise good sleep

Protecting your sleep and treating anything that disrupts it, such as night sweats, can noticeably improve brain fog during and after menopause.

Keep a routine, keep your bedroom cool, limit screens, and stay away from stimulants like caffeine and alcohol in the evenings.

Reduce overload and anxiety

Where possible, lighten the mental load. Delegate and build in genuine rest. Write lists, use calendars and reminders, and tackle one task at a time rather than multitasking.

The same goes for anxiety. While nothing beats proper mental health intervention, such as talking therapies and medication in some cases, relaxation techniques like yoga and breathing exercises can help temporarily. Walking and other regular (moderate and not too close to bedtime) exercise can also help.

Check nutritional deficiencies

A balanced, varied diet supports overall brain health. Low iron, vitamin B12 or vitamin D can affect concentration and energy, so it's worth asking your GP about possible causes of your brain fog outside of menopause.

If you suspect a deficiency, ask your GP for a blood test rather than self-supplementing.

Consider hormonal replacement therapy (HRT)

Brain fog is symptomatic of oestrogen decline, so hormonal replacement therapy (HRT) can help, but it's not suitable for everyone, and it's not going to 'fix' every symptom.

“I’m not sure that the HRT has really relieved the brain fog, but it has relieved symptoms such as sweats and insomnia, and the lack of sleep drove me nearly insane,” says Rebecca.

HRT can also have side effects, which included "bloating, weight gain, and headaches," for Rebecca.

Talk to a professional

If brain fog is affecting your day-to-day life, don't put up with it. Speak to your GP or a menopause specialist, as effective help is available.

As noted, there are also other causes of brain fog aside from menopause, and it's also important to explore these with a professional if appropriate.

This year, woman&home's Menopause Awareness Month series explores women's experiences of developing health conditions during perimenopause, and the lasting impact they can have on their lives. From chronic fatigue and persistent UTIs to brain fog and struggling to recognise themselves in it all, these experiences go to show that menopause is more than a life stage. It can extend far beyond, affecting women's health, wellbeing and sense of self for years to come.