How to Think Clearly About Menopausal Brain Fog

As menopause becomes more of a topic of discussion in mainstream conversation with each passing day, it’s fair to say that its physical symptoms, not cognitive ones, are usually the focus. “Understanding how menopause affects the brain is crucial for supporting women through this transition, improving their quality of life, and addressing the whole spectrum of menopause-related changes,” says New York Times bestselling author Dr. Lisa Mosconi, who has earned a reputation as a trusted resource on menopause, and praise from RESPIN founder Halle Berry for empowering women with much-needed knowledge as they navigate this chapter of life. For proof, look no further than her latest book, The Menopause Brain: New Science Empowers Women to Navigate the Pivotal Transition with Knowledge and Confidence, which offers a deep dive into the cognitive and mental health aspects of menopause—”effectively the most disruptive [symptoms] for women,” she says.

One of the most common culprits? Brain fog. Clinically, it’s referred to as “menopause-related cognitive fatigue” or “subjective cognitive decline” and encompasses feelings of confusion, forgetfulness, and lack of focus and mental clarity—so it’s no wonder that it’s often confused with neurological conditions such as dementia or attention deficit disorders. Other cognitive symptoms that rear their head during menopause include memory lapses, difficulty concentrating, mood swings, increased anxiety or irritability, and a reduced ability to multitask effectively. 

With some studies reporting that up to 75% of women experience cognitive difficulties during menopause, it’s important to recognize what brain fog is and how to deal with it. “Because, as a society, we don’t often recognize brain fog as a symptom of menopause, many women feel completely blindsided by their bodies and brains. And many women, particularly those with a family history of Alzheimer’s disease, fear that these memory difficulties may be a sign of early dementia,” says Dr. Mosconi.

Though it remains to be seen whether brain fog can be prevented, Dr. Mosconi says there are ways to mitigate it. Hormone Replacement Therapy (HRT), which is used to replenish depleted hormone levels associated with menopause, is not currently approved for supporting cognitive function; nevertheless, clinical trials have shown promising signs that HRT can improve mental abilities, mood, and overall well-being for some people.  

Not surprisingly, a healthy gut microbiome—known to play a prominent role in many bodily functions—is also closely linked to cognitive function. “A healthy gut microbiome can improve mood and cognitive function and reduce inflammation, potentially mitigating brain fog,” says Dr. Mosconi. She recommends supporting gut health before, during, and after menopause with diverse, fiber-rich foods (beans, broccoli, or bananas, anyone?) and adding pro-and prebiotic foods to your diet. It’s also important to limit the use of antibiotics and exposure to stress, she notes, as both can wreak havoc on the gut balance. And if you haven’t already heard it enough, we’ll say it again: stay hydrated!

Despite the challenges that come with menopause, Dr. Mosconi notes that there’s a silver lining to it all, too. Once the transitional period stabilizes, postmenopausal women may experience positive cognitive changes. This includes an enhanced sense of clarity and focus, according to some research. “Additionally, this life stage can bring a sense of liberation and the opportunity for personal growth and reevaluation of life goals,” says Dr. Mosconi. “Each of these areas is a rich vein of inquiry, and ongoing research continues to deepen our understanding. For now, one of the more surprising things I’ve learned about menopause is that postmenopausal women are generally happier than younger ones —and generally happier than they themselves were before menopause.”