Understanding Brain Fog During Menopause
When discussing brain fog during the menopause transition, many women describe a lack of focus, slow thinking, and forgetfulness. Research indicates that approximately three in five women in midlife experience challenges with recalling words and numbers, often needing to make lists and reminders or forgetting why they are doing something. These symptoms are frequently linked to declining oestrogen levels, which can affect serotonin and dopamine—chemicals in the brain responsible for regulating mood and cognitive functions like memory and focus.
Brain fog is common during perimenopause, even if a woman is getting sufficient quality sleep. While these changes can be distressing, they are typically temporary and tend to improve after a woman’s final menstrual period. However, when sleep is poor and confusion or forgetfulness is present, these issues can become more challenging. Women going through the menopause transition often struggle with falling asleep, waking up frequently, and experiencing less restful nights. Insomnia is associated with poorer cognitive function and can persist beyond menopause itself.
Women who have gone through menopause are more likely to suffer from insomnia compared to men or women who are not yet menopausal. The risk to brain health seems to be more about the quality of sleep—how fragmented it is—rather than the total number of hours. This may explain why night sweats are connected to worse cognitive performance.
The good news is that treating night sweats with hormone therapy or alternative treatments may lead to better sleep quality and improved brain health and function. Some evidence suggests that hormone therapy could help protect against dementia later in life if started early during perimenopause and continued long-term. More research is needed to confirm these findings.
Is This Brain Fog or ADHD?
Distraction, disorganisation, and difficulty focusing can also be symptoms of attention deficit hyperactivity disorder (ADHD). Although there is limited research on menopause and ADHD, ob-gyns often hear about it from patients. It is common for women in the menopause transition to find their ADHD symptoms worsening or to be diagnosed with ADHD for the first time. Again, changing oestrogen levels and the resulting shifts in other brain chemicals may explain the worsening of ADHD symptoms in midlife.
It is possible that women with ADHD are more vulnerable to mood disorders during the menopause transition.
Normal Ageing vs. Early Dementia
Understanding the difference between normal ageing and early dementia can be challenging. Here are some key signs and symptoms:
- Memory changes:
- Normal ageing: Sometimes forgetting a name or appointment, and remembering later; forgetting a conversation you had a year ago; writing reminders and lists.
Possible dementia: Forgetting information you just learned or recent events; asking the same questions multiple times.
Struggling with familiar tasks:
- Normal ageing: Occasionally needing help to figure out the audio system.
Possible dementia: Difficulties getting dressed, following a recipe, paying bills, or doing household chores; taking much longer to do things.
Visual and spatial challenges:
- Normal ageing: Needing a new prescription for eyeglasses.
Possible dementia: Difficulty with balance, reading, or placing objects on a table; difficulty judging distance and contrast, causing unsafe driving.
Communication challenges:
- Normal ageing: Sometimes having trouble recalling the right word.
Possible dementia: Forgetting simple words; struggling to join in or follow conversations; substituting words (like ‘the thing you sleep on’ for ‘bed’).
Confusion about time and place:
- Normal ageing: Not remembering which day of the week it is or why you went into that room.
Possible dementia: Feeling lost in familiar places and not knowing how you got there; losing track of dates and seasons.
Misplacing things:
- Normal ageing: Forgetting where you put your wallet or keys; retracing your steps to find them.
- Possible dementia: Putting things in unusual places (like a remote control in the freezer); not being able to retrace your steps to find them again.
If you’re experiencing symptoms of ADHD or related issues, it’s important to speak with your ob-gyn.
Is This Brain Fog or Early Dementia?
During perimenopause, seven in 10 women report problems with their memory. Memory issues can be upsetting, especially if you have relatives with early dementia or if you’ve read headlines linking menopausal symptoms to the risk of developing dementia. You may wonder whether you’re dealing with menopause and natural ageing or early dementia.
If you or a family member is concerned about your cognitive function, talk with your ob-gyn. Before your appointment, track any changes related to memory and thinking so you’re ready to share details with your doctor. You and your ob-gyn may discuss other possible causes, such as untreated anxiety or depression, stress, sleep deprivation, and some physical illnesses, such as thyroid disorders or vitamin B12 deficiency.
To maintain your brain health long-term, it’s important to manage any chronic diseases, including diabetes and high blood pressure. Persistently high blood pressure, high cholesterol levels, excess belly fat, and poorer cardiovascular health in midlife are all linked to increased risk of dementia later.
And get your hearing checked. Poor hearing is a risk factor for cognitive problems, perhaps because the brain does not get enough stimulation.
If your doctor rules out physical health causes for your cognitive symptoms, ask if you should see a specialist. If needed, your ob-gyn can refer you to a mental health professional or a neurologist.
Menopause: What Your Ob-Gyn Wants You to Know
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