What Causes Perimenopause and Menopause Brain Fog—and How Can You Find Relief?

All of us forget our keys in the house or can’t remember where we parked the car from time to time. And who hasn’t come up short for someone’s name at a cocktail party? When this starts to happen more often, though, it can start to feel confusing and even a bit alarming.

The first thing to know: When you’re in midlife, this kind of menopause brain fog is absolutely normal—in fact, this is why the term “menopause brain” has gained traction. Not only that, perimenopause brain fog is also a thing, too, because hormonal fluctuations (a major element of this life stage) play a key role. Other menopause symptoms contribute significantly to mental fuzziness as well, as do stressors associated with midlife. 

No surprise, then, that brain fog is a common concern among Midi patients. “Many women, including myself, experience brain fog when they reach midlife and fear it could be the onset of dementia,” says Joanna Strober, CEO and co-founder of Midi. “I was quite convinced in my mid-40s that I was developing Alzheimer’s. For me, once I started taking hormone replacement therapy, the brain fog and forgetfulness went away.”

At Midi, we know how important it is to take women’s symptoms seriously. Midi clinicians are trained menopause specialists who can help you understand the “why” behind physical and psychological changes, including brain fog, and can offer a range of solutions, including prescription medications, supplements, and lifestyle coaching.

Read on to learn more about perimenopause and menopause brain fog—and what you can do to restore your mental sharpness.

What Does Perimenopause Brain Fog Feel Like?

When you walk into a room and forget why you’re there, your first thought probably isn’t “This is just perimenopause,” but instead, “Is something bigger going on with my brain?” That’s partially because you may not know that brain fog can begin in perimenopause, when you’re still getting your period (perhaps irregularly). In fact, a foggy brain can be one of the first perimenopause symptoms that many women notice. 

Research has found that in perimenopause, you may have a shorter attention span, a less sharp memory, and a slower processing speed (i.e., how quickly you take in information). Perimenopause brain fog symptoms can include: 

• losing your train of thought mid-sentence 
• having trouble making simple decisions
• being distracted when trying to focus, even on familiar tasks 
• struggling to think of a particular word 

The reassuring truth: Perimenopause forgetfulness and other cognitive changes are common, and they won’t last forever. Working with a clinician can help you get through cognition issues such as perimenopause memory loss and give you reassurance. 

How Hormonal Changes Contribute to Brain Fog

You might think that estrogen and other female sex hormones, like progesterone, influence only your reproductive system, but these hormones interact with nearly every system and organ in your body, including your brain. 

During perimenopause, testosterone and estrogen levels fluctuate drastically, which is a primary contributing factor in brain fog. That’s because these hormones play a significant role in cognitive function: 

• Estrogen promotes activity in the hippocampus, an area of the brain associated with learning and memory. 
• Testosterone helps strengthen nerves in the brain and is associated with mental clarity and energy; it also promotes blood flow to the brain to boost memory. 

As the levels of these hormones start to fluctuate during perimenopause, it can affect cognitive abilities. In fact, poor concentration and difficulty remembering details—losing names, appointment times, common words—affects around 60% of women going through menopause. 

Every woman’s experience of brain fog is unique. To get personalized recommendations based on your symptoms and health history, you can book a virtual visit with a menopause specialist through a platform like Midi.

When Does Menopause Brain Fog Begin and End?

Brain fog and cognitive changes will often begin in perimenopause when hormone levels begin fluctuating, research shows, and symptoms can worsen and lighten as you progress through the menopause transition before they start to improve. 

In fact, as you go through perimenopause and transition into menopause, brain fog will typically get worse and can peak. Around this time, you may well wonder when menopause brain fog will end—or if it ever will. 

Fortunately, things do typically begin to improve as you make your way through this transition and your hormones reach a more steady state. 

Stress, Sleep, and Mood: How They All Contribute to Brain Fog During the Menopause Transition

Here’s the thing about midlife: A lot gets thrown at you all at once—not only a hormonal seesaw, but the need to juggle more work and home demands. All of this can disrupt sleep and emotional stability. 

“Sleep disturbances, stress, and mood changes are common among menopausal women, and they each can adversely affect overall brain health,” explains Mindy Goldman, MD, Chief Clinical Officer at Midi Health.

Chronic stress

Chronic stress can do a number on cognitive function. Women in midlife often find themselves balancing situations like raising kids and caring for aging parents, often at an important stage of their career. This kind of constant stress can intensify menopause symptoms and overload working memory, as well as make it harder to concentrate.

Sleep problems

So much of perimenopause can disrupt sleep patterns: hot flashes, night sweats, heavy and unpredictable periods, and even midlife weight gain. And that can worsen cognitive symptoms. 

In some cases, undiagnosed obstructive sleep apnea (OSA) can impact the pattern and quality of sleep. Some research estimates 20% of women in midlife have moderate to severe sleep disordered breathing, which can contribute to sleep concerns.  

Mood changes

As many as 70% of women experience mood fluctuations during the menopause transition. It's also a time when depression and anxiety may appear or worsen. A key reason: Fluctuating hormones may interfere with the normal output of serotonin and norepinephrine, which help stabilize mood and energy. All of these shifts in mental well-being can make it harder to focus and think clearly.

How HRT Can Help Ease Brain Fog

Hormone therapy has been recognized as a significant intervention to manage all the hormonal ups and downs of perimenopause. And among other things, it may help women who are experiencing cognitive challenges during this phase.

Hormone replacement therapy (HRT, now commonly referred to as menopause hormone therapy, or MHT) is available in several forms, including a patch, pill, cream, spray, or gel. If it’s a good option for you, depending on your health history and symptoms, your clinician can prescribe it and guide you in which form may be best. 

If your clinician believes contraceptive therapy (such as a combination birth control for contraception and hormonal fluctuation management) is a better fit for you, that option can be evaluated for safety and efficacy based on your medical history.

Supplementing estrogen (and progesterone in women who have an intact uterus) can have a positive influence on neurotransmitter systems, enhancing cognitive function as a menopause brain fog treatment. “There are a lot of potential direct effects from estrogen on brain health that we are beginning to understand, as well as many secondary and indirect effects,” says Dr. Goldman.

Talk with your healthcare professional or book a virtual visit with a menopause specialist through a platform like Midi to discuss whether hormone therapy is the right choice for you. Midi offers both hormonal and non-hormonal treatments to help patients get the care they deserve.

Other Solutions to Fight Brain Fog Through Menopause

HRT is an option that may help brain fog during the menopause transition. But there are also lifestyle changes that may give your brain a boost. In some cases, their effects on perimenopause brain fog or menopause brain fog may not have specifically been studied, but they’ve been shown to have an impact on various aspects of cognition—especially in combination with each other: 

• Eat well: A diet rich in leafy greens and healthy fats can help keep your mind strong. Focus on consuming more berries, nuts, beans, olive oil, and leafy greens. These Mediterranean and MIND diet staples may lower your risk of cognitive decline. 
• ‍Move your body more: Walking, weight lifting, and stretching all count. Exercise has been shown to support cognitive health, and it also helps with sleep and mood—both important for brain health.
• ‍Keep learning: To help flex your memory muscles, challenge your brain in new ways, like tackling a new language or getting involved in a new hobby. Keeping your brain cognitively active appears to reduce the risk of cognitive decline and may delay the onset of dementia, research suggests.
• ‍Prioritize sleep: For a protective effect on the brain, aim for 7 to 8 hours of sleep each night. 
• ‍Keep stress in check: Finding ways to better manage stress can help you think more clearly. Mindfulness exercises, for instance, have been shown to help with perimenopause brain fog.
• ‍Make time for friends: Research shows that social isolation can negatively impact cognitive function. Staying connected to friends and family is a critical brain-health move.
• ‍Focus on health: Talk with your doctor about other risk factors for cognitive decline that are within your control. Maintain a healthy weight, manage chronic conditions like diabetes and hypertension, limit alcohol, get help to quit smoking, and stay up to date on all preventative health testing and screening tools.

Can Supplements Help Menopause Brain Fog?

As you navigate fuzzy thinking during menopause, you might start noticing a host of supplements that promise to help improve memory, boost concentration, and more. While supplements shouldn’t be a replacement for prescription medications, they may be used as an adjunct to support your care, or as an alternative if prescription medications aren't tolerated or desired.

Here are the potential best supplements for menopause brain fog: 

• Omega-3s: Some research has found that omega-3s, like fish oil, may help improve cognition, although more research is needed. 
• Ashwagandha: Some small studies have found that this adaptogenic may indirectly help with cognitive function, sleep, and stress relief.
• Vitamins: A 2024 study found that vitamins like B12, B6, and vitamin D were associated with better memory and processing speed during perimenopause. (Worth noting: The results were based on the women’s self-reported perceptions.) 

No supplement is going to be a miracle fix, even if you feel like it’s making some positive improvements. And because supplements can interact with certain medications, it’s always a good idea to discuss them with a clinician before adding them to your routine. 

Is It Brain Fog or Dementia?

It can be jarring when you suddenly don’t feel like your usual sharp self and start worrying that your brain fog is the start of something worse. Before jumping to conclusions, know that it’s rare to develop dementia in one’s 40s to early 50s. When you experience a midlife decline in concentration, focus, and memory, there’s a big chance it could be due to perimenopause or menopause. 

It’s also important to remember that menopause brain fog is often temporary, usually peaking during the late stages of perimenopause or early stages of menopause, then improving as you reach postmenopause. It shouldn’t be taken as a sign that cognitive decline is coming. 

Also, there’s a difference in brain fog versus dementia. Dementia affects how you function in your everyday life; it’s more than about memory. If you’ve noticed that menopause brain fog is interfering with your everyday life—like making it hard to go to work or complete basic household tasks—that may be a red flag. Another red flag is if it’s progressively getting worse as time goes on. 

If you’re concerned, consider speaking with a clinician about your worries. They can reassure you about brain fog and help you figure out whether you’re experiencing something else. 

Key Takeaways

• Brain fog is a common symptom of menopause, primarily caused by hormonal fluctuations, especially in estrogen and progesterone, which affect cognitive function. It can start during perimenopause.
• Stress, sleep disturbances, and mood changes further contribute to brain fog, as they can have an impact on concentration and memory.
• Lifestyle changes, such as regular physical activity, a balanced diet, adequate sleep, and stress management, may help alleviate brain fog.
• Hormone therapy is one option to consider, as it may favorably impact brain fog, but other solutions like lifestyle adjustments are also effective.
• Consulting with a menopause specialist can provide personalized care and strategies to manage brain fog and other menopause-related symptoms.

Frequently Asked Questions (FAQs)

What does brain fog feel like in perimenopause? 

Perimenopause brain fog will typically result in declines in memory, concentration, and focus. You might notice that you forget small details easily, struggle to think of a specific word, have difficulty getting through a task you would normally find easy to do, or struggle with processing new information. 

When does menopause brain fog go away?

Menopause brain fog will typically begin during perimenopause due to fluctuating hormones. It will usually peak during late perimenopause or early menopause, then gradually get better as hormone levels become more steady. By the postmenopause period, it should go away or improve considerably. 

What vitamins or supplements are good for menopause brain fog?

Evidence is mixed on whether or not supplements help improve menopause brain fog, and they should never be considered a miracle fix. However, some that have shown to be helpful include magnesium, omega-3 fatty acids, ashwagandha, and certain vitamins. Just remember that it's always smart to check in with a clinician before starting a new supplement to make sure it's right for you and doesn't have any contraindications with other medications you're taking.

Is it menopause brain fog or dementia?

There are some key differences between menopause brain fog and dementia. Menopause brain fog is common for women in their 40s and early 50s, whereas dementia in midlife is rare. Menopause brain fog will come and go, whereas dementia will get worse over time. And whereas menopause brain fog typically results in bouts of forgetfulness or losing your train of thought, dementia can severely impair your ability to function normally each day. 

Why do I feel like I'm going crazy during perimenopause? 

Between the fluctuation of your hormones, lack of sleep, mood shifts, and more, it’s no surprise that perimenopause can leave you feeling off-center—and it doesn’t help when your brain and memory feel less sharp. These are completely normal responses, but know that so many perimenopausal women are feeling just as off balance as you are.