Why you experience brain fog during menopause - and how to deal with it, as per expert guidance
In this exclusive excerpt from her new book, Generation M: Living Well in Perimenopause and Menopause, Jessica Shepherd, MD, explains what's going on in your mind during this life-altering stage—and how you can harness the changes to feel your best.
An accountant I know who deals with balance sheets all day suddenly couldn’t remember the word revenue. A detail-oriented marketing executive has to read every memo three times instead of once. Another friend forgets the storyline of television shows within a day. None of these women are losing their minds, even though it can feel that way. What they are losing is oestrogen, which affects the brain wiring responsible for memory and how fast you process information. Combine that with a lack of sleep common in menopause and you have a perfect recipe for brain fog.
'Oestrogen is to the brain what fuel is to an engine,' says Lisa Mosconi, PhD, associate professor of neuroscience in neurology and radiology at Weill Cornell Medicine. 'Oestrogen, particularly oestradiol, the strongest form, plays a critical role in the brain’s health and functionality, earning it the title of the "master regulator" of women’s brain health. When oestrogen is in the house, everything works well.'
She explains the four key roles oestrogen plays:
It helps protect neural structures and cells from damage and promotes the survival of neurons
It is involved in cognitive processes such as memory, learning, and executive functions
It influences mood and emotional well-being, acting on serotonin and other neurotransmitter systems
Finally, oestradiol promotes the growth of new neurons and supports neuroplasticity, including the brain’s ability to change and adapt.
'After menopause, the decline of oestrogen impacts all of these brain functionalities. It’s akin to an orchestra that continues to play but to a markedly different tune,' Mosconi says. 'Without the guiding influence of oestrogen, the brain’s regulatory mechanisms, protective functions, and cognitive processes may be altered, potentially leading to changes in memory, mood, and overall brain health.'
Nearly two-thirds of women report cognitive symptoms during perimenopause and menopause, including increased stress, anxiety, brain fog, and memory loss. Carol Mehas, a New York executive, was at the top of her profession when she hit menopause. 'I’m very type A, but suddenly I felt completely off my game at work. I couldn’t control when hot flashes or brain fog would hit. I have a nice husband and beautiful kids, but everything felt off at home, too. It left me feeling helpless and completely alone.'
Mood and memory issues can be frustrating (What was that word again?) and scary (Am I getting early-onset dementia?) and can have a negative effect on relationships (Why does everything my partner does suddenly annoy me?). For many women, the symptoms manifest as a vague sense of flatness or lack of spark; for others, outright anger.
What happens during oestrogen withdrawal
Oestrogen receptors in various regions of the brain interact with the neurotransmitters responsible for mood, memory, and cognition. Think of neurotransmitters as little chemical messengers that send signals between nerve cells throughout the body. As hormone levels dip during perimenopause and menopause, these signals weaken and your brain goes through oestrogen withdrawal. Three of the neurotransmitters most affected by this include serotonin, dopamine, and norepinephrine.
Generation M: Living Well in Perimenopause and Menopause
Serotonin promotes a sense of calm, well-being, and happiness. Low serotonin levels can lead to irritability and anxiety, which, along with making you generally cranky, can disrupt sleep. There are strategies that can help you offset low serotonin. Eight weeks of aerobic exercise has been shown to increase both serotonin and endorphins. The vitamin D you get from spending as little as 15 minutes in sunlight also boosts serotonin levels. To get the benefit of both, try instituting a walking break in the morning or at lunchtime. (Certain antidepressants are designed to increase serotonin in your brain.)
Dopamine, another key neurotransmitter modulated by oestrogen, influences the reward and pleasure centres in the brain. When dopamine is low, it not only creates depressive moods but also impacts motivation, concentration, and energy. Yoga, meditation, and walking may all increase dopamine. Eating foods with magnesium and tyrosine, an amino acid, can boost dopamine production. Foods to try include chicken, almonds, apples, avocados, bananas, beets, chocolate, leafy green vegetables, and green tea.
Oestrogen also impacts norepinephrine, the neurotransmitter that regulates the fight-or-flight response, and can increase alertness. Imbalances can raise blood pressure and cause anxiety and panic. This is why some women experience panic attacks during menopause. Exercise and meditation can help to regulate norepinephrine.
What about hormone therapy?
Along with exercise, meditation, a diet rich in fibre and antioxidants, and getting enough sleep, hormone replacement therapy (HRT) can help to counter the effects of the loss of oestrogen on mood and cognition, especially when you get a jump start and begin HRT during perimenopause. 'There is a "critical window" theory that suggests the most beneficial time to start HRT for brain health is from perimenopause to the onset of menopause or shortly thereafter', Mosconi says.
There’s a reason I keep mentioning meditation. Mindfulness is one of the most powerful tools to improve overall mood and brain health. Certain techniques and behaviours like deep breathing and intentional focus (consciously directing your attention to what is happening in the present moment to minimise distractions) decrease stress, anxiety, irritability, and rumination. Meditation can also reduce the discomfort of hot flashes and improve sleep quality, both of which affect your mental state.
Diet can also play a role. Snacking on foods high in salt, sugar, and oil can feel like a temporary fix if you are feeling low, but you are bound to crash soon after and then crave more, which has a detrimental effect on both mood and weight. Melissa Mondala, MD, an expert in women’s nutrition, suggests incorporating foods that are proven to have a positive effect on mood into your diet. 'Foods high in omega-3 and healthy fats may help to strengthen membranes in the brain and improve the flow of neurotransmitters', she says. 'They are also high in tryptophan and tyrosine, which are precursors to serotonin and dopamine, the happy hormones that make us feel good.' Look for sesame and pumpkin seeds, flaxseeds, and pistachio nuts for a mood-boosting snack.
Understanding brain fog and memory
Desiree Jordan, an interior designer, didn’t just have trouble remembering names; she could barely focus on what she was doing from one minute to the next. 'I had so much trouble remembering what people told me five minutes ago that I began to worry I was getting early-onset Alzheimer’s', she says. 'I couldn’t focus my attention on anything long enough to get tasks done. I had a new job, which was hard enough, and this just made it worse.' She found HRT helped.
The fear that brain fog is a sign of dementia is one I hear nearly every day. Let me reassure you: Not being able to remember a word does not mean you have early-onset Alzheimer’s. One more note of reassurance: Brain fog and memory lapses eventually plateau. The influence of menopausal symptoms on long-term Alzheimer’s risk is still being investigated, but what we do know is that, while your genetic blueprint matters, a healthy lifestyle that includes diet, exercise, and maintaining social connections can help to mitigate the effects of your DNA.
Hormonal changes can make existing cognitive conditions, including ADD and ADHD, more intense during perimenopause and menopause. Terri, a retail manager in Kentucky, was diagnosed with ADD years ago. 'My symptoms got 10 times worse once I went into perimenopause. My brain would go to 20 zillion different places. I had to find new ways of handling it. Even things as simple as bringing my daughter to voice lessons won’t happen if it isn’t in my planner. Aside from writing everything down, the one thing I discovered that really helps is yoga. I had never done it before, but I found a community at one particular studio that gave me the incentive to keep going. It helps tame that scattered feeling and lets me feel more in control, even after I leave class.'
4 ways to deal with brain fog
While you may not be able to 'cure' it, there are strategies to limit its effect on your life.
1. Don’t try to fake it
Writing things down can be your salvation. If you have an important presentation at work, put your thoughts on index cards or in your phone, even if you used to be able to wing it.
2. Stop multitasking
While it is tempting to catch up on texts while watching TV or talking on the phone, multitasking impairs focus and memory.
3. Get organised
If you are having trouble remembering where you put your keys or your glasses, clutter isn’t going to help. Create 'safe spots' for your everyday objects: a hook by the door, a jewelry tray, a bin for shoes. Virtual clutter doesn’t help either. Be sure to file emails into folders and flag those you absolutely must remember.
4. Use imagery and tricks to remember names
Creating a mental image of a name or phrase can help with recall. For example, if someone tells you their name is Petra, try to picture a petri dish in the moment.
Rediscovering your sense of purpose
Menopause, like any major milestone, can be a time to take stock of where you have been, where you are now, and where you want to go. As life circumstances change, so, too, can your sense of purpose. Rather than a midlife crisis, what if you shifted your mindset and saw it as a midlife opportunity? The question is: How do I address the second half of my life? The answer can’t lie in anti-aging but in contemplating how you want aging to look and feel, and how you want to use your hard-won experience.
This excerpt originally appeared in the Winter 2025 issue of Women's Health.
EXCERPT REPRINTED WITH PERMISSION FROM GENERATION M: LIVING WELL IN PERIMENOPAUSE AND MENOPAUSE BY © 2024 JESSICA SHEPHERD. PUBLISHED BY UNION SQUARE & CO.
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