Menopause Brain Fog: What the Evidence Says

Brain fog is a recognised part of the menopause. The NHS lists problems with memory or concentration among the symptoms of perimenopause and menopause, and says they may feel worse if you have sleep problems and feel very tired.¹ Perimenopause is the time when your periods start to change, often becoming irregular, before they stop; you reach menopause when you have not had a period for 12 months.¹ Most people score a little better each time they repeat the same test. In a large US study, women in perimenopause did not show that gain, and in that four year study it came back after menopause.²

If you have noticed this in yourself, the changes are real, even when they are small on a test. For most women, forgetfulness around the menopause is not dementia.^2,3 No treatment is recommended for brain fog on its own, but a GP can check for other causes and talk through your wider symptoms.^4,9,17 This guide sets out what the research shows, what NICE and the NHS say, and when forgetfulness is a reason to see a GP.

What is menopause brain fog?

Menopause brain fog is an everyday name for the forgetfulness, poor concentration and muddled thinking many women notice around the menopause. It is not a medical diagnosis. A short 2024 article for doctors describes it as menopause-related difficulty with thinking that women notice themselves, and says it extends beyond memory to a broad range of thinking skills.³

It is common. A 2011 review reports a survey of 12,425 women aged 40 to 55 in the Study of Women's Health Across the Nation (SWAN). In that survey, 31% of women who were still premenopausal reported forgetfulness.⁷ The figure was 44% in perimenopause and 42% after a natural menopause.⁷ Even after allowing for other factors such as age, mood and sleep, women in perimenopause were still 1.4 times as likely to report forgetfulness as premenopausal women.⁷

A smaller study from Seattle, reported in the same review, found that 60% of 230 women aged 33 to 55 had noticed an unwelcome change in their memory over the past few years.⁷ They described trouble recalling words and numbers, losing things around the house, difficulty concentrating and forgetting appointments. In that group, the changes were linked to paid work, job stress and juggling several roles, not to the stage of menopause.⁷ Both studies are surveys, so they show how often women report problems, not what causes them. Brain fog can have more than one cause, and if you are juggling several roles at once, the everyday pressures of midlife can sit alongside the menopause.⁷

Brain fog has many causes beyond the menopause; our guide to the causes of brain fog covers the wider picture.

What happens to memory and thinking during perimenopause?

Some of the clearest evidence comes from SWAN, which gave 2,362 women the same thinking tests each year for four years. Normally, people do a little better each time they take the same test again. Women in perimenopause did not show that gain, which the researchers read as a sign they were not learning as well as before. After menopause, scores rebounded to premenopausal levels.²

The tests covered processing speed, verbal memory (recalling a short story) and working memory (repeating a list of numbers backwards). The researchers concluded that the thinking difficulties linked to the menopause transition "may be time-limited".²

The 2024 article for doctors by Pauline Maki and Nicole Jaff reaches a similar view. It says long-term studies find small but reliable declines in measured memory as women move into perimenopause, and that these are not explained by advancing age alone. When memory declines do occur, performance stays within normal limits for all but a very small number of women.³

So where does that leave you? If you have been told it is all in your head, these studies suggest otherwise: the changes are real, and they can be measured. On average, they are also small.

For the basics, see our guide to how memory works.

Why might menopause affect memory and concentration?

Nobody knows for certain. A 2011 review of the research describes two kinds of explanation: direct effects of changing hormones on the brain, and indirect effects through symptoms such as hot flushes, poor sleep, low mood and anxiety. The evidence for each is incomplete.⁷

On hormones, the same review reports that experiments in animals and people suggest oestradiol (the main form of oestrogen before the menopause) acts on brain systems involved in mood and memory.⁷ How much this explains the brain fog you notice day to day has not been shown in people.

Symptoms are the other strand. In SWAN, women with more depressive symptoms were slower on a test of processing speed, and women with more anxiety learned less well on a memory test. In that analysis, hot flushes and disturbed sleep had no direct effect on test scores, and none of these symptoms accounted for the dip in learning during perimenopause.⁷

Hot flushes are not a closed question. Several studies found no link between the hot flushes women reported and their test scores, but one small study that measured hot flushes with a monitor did link them to poorer verbal memory. The review's authors judged the question still open.⁷

In short, hormonal change may play a part, and low mood and anxiety affect thinking in their own right. The role of hot flushes and sleep in measured memory is uncertain, though the NHS notes that poor sleep can make memory and concentration problems feel worse.¹ For more on how mood and stress affect the brain, see our guide to mood, stress and the brain.

Is it menopause brain fog or dementia?

For most women, forgetfulness around the menopause is not dementia. Measured changes are usually small and stay within the normal range, and in one large US study they recovered after menopause.^2,3 The NHS says dementia is not a natural part of ageing, and that it is important to talk to a GP sooner rather than later if you are worried about your memory.⁸

The two can look alike. The NHS lists early symptoms of dementia that include memory loss, difficulty concentrating, struggling to follow a conversation or find the right word, and being confused about time and place.⁸ It explains that these symptoms are often mild and may get worse only very gradually, and that problems not severe enough to be diagnosed as dementia are often called mild cognitive impairment. Some people with mild cognitive impairment stay the same, and some go on to develop dementia.⁸

The lists overlap, and the NHS advises against trying to work out the cause of memory loss yourself. Occasionally it is a sign of dementia, but it can also be a natural part of getting older or come from treatable things such as stress, anxiety, depression or sleeping problems.⁵

The NHS says memory problems are often nothing serious, but it is best to get checked. A GP will ask questions to find the cause and may refer you to a memory specialist.⁵ For the longer view, see our guide to brain health after 50.

Can other health problems cause similar symptoms?

Yes. Several common, treatable conditions can feel like brain fog. The NHS lists difficulty concentrating or thinking clearly as a common symptom of an underactive thyroid, and problems with memory, understanding and judgement as a symptom of vitamin B12 or folate deficiency anaemia. Both can be checked with blood tests.^9,10

Low mood can do the same. Not being able to concentrate on everyday things is one of the symptoms of depression the NHS lists, and it advises seeing a GP if you have had a low mood for more than two weeks.¹¹

So it helps not to put every lapse down to the menopause, because these conditions have their own treatments.^9,10

Does HRT help with menopause brain fog?

Neither NICE nor the NHS recommends hormone replacement therapy (HRT) specifically for brain fog. NICE's menopause guideline makes no recommendation on HRT for memory or concentration, and the NHS lists hot flushes, night sweats, sleep problems, mood swings, anxiety, low mood and vaginal dryness as symptoms HRT can help, without listing memory.^4,12

On dementia, NICE is clear. It says HRT should not be offered for the purpose of preventing dementia. It also says that for women who start combined HRT (oestrogen with a progestogen) at 65 or over, dementia risk might increase, and that the risk is unlikely to increase with oestrogen-only HRT.⁴

The trials of HRT and thinking skills point the same way. They tested healthy women who were not chosen because they had brain fog. In the KEEPS trial, 693 recently postmenopausal women in their early 50s were randomly given one of two types of HRT or a dummy treatment (a placebo) for up to four years. HRT brought no benefit on any thinking test.¹³ About ten years later, 275 of them were tested again, and there was still no difference between the groups in either direction.¹⁴

The ELITE trial gave 567 healthy women oestradiol tablets or a placebo for about five years. Some were within six years of menopause and some ten or more years past it. Oestradiol neither helped nor harmed memory or other thinking skills, however long it had been since menopause.¹⁵

In these healthy postmenopausal women, HRT did not change thinking skills either way, so the trials cannot say whether it helps women who do have brain fog.^13,15

HRT is a decision to make with a GP or menopause specialist. NICE asks doctors to discuss the benefits and risks of each option with you, tailored to your age, circumstances and risk factors.⁴

What else can help with brain fog during menopause?

There is no single answer, but the NHS sets out everyday steps for menopause symptoms. They include regular sleep routines, a healthy, balanced diet, regular exercise, relaxing activities such as yoga, tai chi or meditation, and talking to other people going through the same thing. It also advises not smoking and keeping alcohol within recommended limits.¹⁶

Talking therapy is another option. The NHS says cognitive behavioural therapy (CBT) can help with low mood, anxiety and sleep problems, and can help manage hot flushes.¹⁶ NICE recommends considering menopause-specific CBT for hot flushes and night sweats and for sleep problems linked to them, and CBT for low mood that falls short of depression when it comes with hot flushes.⁴ Those recommendations are about the symptoms named, not about memory itself.

Lists, a shared calendar and phone reminders will not fix the cause, but they can take some pressure off while you find out what is going on.

What about vitamins and supplements? Neither NICE's menopause guideline nor the NHS menopause pages recommends any vitamin or supplement for brain fog.^4,17 The NHS says there is very little evidence on how well herbal remedies such as red clover and black cohosh work for menopause symptoms, or how safe they are. It advises talking to a doctor before taking herbal supplements or complementary medicines.^16,17 If a deficiency such as low vitamin B12 or folate is behind your symptoms, a GP can find it with a blood test.¹⁰

Our guide to long-term brain health covers the wider lifestyle evidence.

When should you see a GP about memory problems?

See a GP if memory problems are affecting your day-to-day life, or if you keep having problems with your memory. The NHS says it is often nothing serious, but it is best to get checked because any treatment you need may work better if it is started early.⁵

Contact a GP as well if you think you have symptoms of perimenopause or menopause and want to know your options, or if you, or a relative, have gradually become more forgetful or confused.^1,6

Where to go for help:

• If someone suddenly becomes confused, go to A&E or call 999. Do not drive to A&E: ask someone to drive you, or call 999 and ask for an ambulance.⁶
• If you have had a low mood for more than two weeks, see a GP.¹¹
• If you have thoughts of harming yourself or ending your life, or need urgent help for your mental health, use 111 online or call 111 and choose the mental health option. You can call Samaritans on 116 123 to talk to someone. If a life is at risk, or you do not feel you can keep yourself safe, call 999 or go to A&E.¹⁸

Frequently Asked Questions

Is menopause brain fog permanent?

Limited evidence suggests the dip in measured thinking skills may be temporary. SWAN followed 2,362 women for four years: they gained less from repeated testing during perimenopause, and this returned to premenopausal levels after menopause.² The NHS says menopause symptoms in general, not memory alone, usually last 7 to 9 years, sometimes longer.¹ If memory problems are affecting your daily life, see a GP.⁵

I'm on HRT but still have brain fog. Is this normal?

It is worth raising with your GP. NICE makes no recommendation on HRT for brain fog, and the NHS list of symptoms HRT helps does not include memory.^4,12 The NHS says a GP usually reviews HRT after three months and may change the dose or type, or refer you to a specialist, if symptoms do not improve.¹² Thyroid problems and low mood are worth checking.^9,11

What vitamin is good for menopause brain fog?

No vitamin or supplement is recommended for menopause brain fog in NICE's menopause guideline or on the NHS menopause pages.^4,17 Some conditions that cause similar symptoms, such as vitamin B12 or folate deficiency and an underactive thyroid, can be found with blood tests, so it is worth seeing a GP.^9,10 The NHS advises talking to a doctor before taking herbal supplements.¹⁶

How can I tell if it is brain fog or dementia?

You cannot reliably tell on your own, and the NHS advises against trying to work out the cause of memory loss yourself.⁵ Measured memory changes around the menopause are usually small, with scores staying in the normal range for almost all women.³ See a GP if you have gradually become more forgetful or confused. If someone suddenly becomes confused, go to A&E or call 999.⁶

How can I get rid of brain fog during menopause?

There is no single answer, and neither NICE nor the NHS recommends a treatment for brain fog on its own.^4,17 The NHS suggests regular sleep routines, a balanced diet, exercise and relaxing activities, and says CBT can help with low mood, anxiety and sleep.¹⁶ A GP can check for other causes, such as an underactive thyroid, and talk through options for your wider symptoms.^9,17

Related Reading

These guides cover the wider science of brain fog, memory and brain health.

• Brain Fog: Causes, Science, and Evidence-Based Solutions
  The main causes of brain fog, from sleep and stress to hormonal change.
• Brain Health After 50: Evidence-Based Strategies for Cognitive Longevity
  What the research says about thinking skills in the decades after midlife.
• How Memory Works: Storage, Retrieval and Learning
  How memories are made and recalled, and why attention matters.
• Mood, Stress, and Your Brain: A Comprehensive Guide to Emotional Wellbeing
  How mood and stress shape the way we think and feel.
• Protecting Your Brain: A Science-Based Guide to Long-Term Cognitive Health
  The lifestyle evidence on keeping the brain healthy over time.

References

1. NHS. Symptoms of menopause and perimenopause. Page last reviewed 19 May 2026. Accessed 21 October 2026. https://www.nhs.uk/conditions/menopause/symptoms/
2. Greendale GA, Huang MH, Wight RG, et al. Effects of the menopause transition and hormone use on cognitive performance in midlife women. Neurology. 2009;72(21):1850-1857. doi:10.1212/WNL.0b013e3181a71193
3. Maki PM, Jaff NG. Menopause and brain fog: how to counsel and treat midlife women. Menopause. 2024;31(7):647-649. doi:10.1097/GME.0000000000002382
4. National Institute for Health and Care Excellence. Menopause: identification and management (NG23). Published 12 November 2015; last updated 15 April 2026. Accessed 21 October 2026. https://www.nice.org.uk/guidance/ng23/chapter/Recommendations
5. NHS. Memory loss (amnesia). Page last reviewed 9 October 2023. Accessed 21 October 2026. https://www.nhs.uk/conditions/memory-loss-amnesia/
6. NHS. Sudden confusion (delirium). Page last reviewed 28 May 2024. Accessed 21 October 2026. https://www.nhs.uk/symptoms/confusion/
7. Greendale GA, Derby CA, Maki PM. Perimenopause and cognition. Obstetrics and Gynecology Clinics of North America. 2011;38(3):519-535. doi:10.1016/j.ogc.2011.05.007
8. NHS. Symptoms of dementia. Page last reviewed 10 July 2023. Accessed 21 October 2026. https://www.nhs.uk/conditions/dementia/symptoms-and-diagnosis/symptoms/
9. NHS. Underactive thyroid (hypothyroidism): symptoms. Page last reviewed 28 April 2025. Accessed 21 October 2026. https://www.nhs.uk/conditions/underactive-thyroid-hypothyroidism/symptoms/
10. NHS. Vitamin B12 or folate deficiency anaemia: symptoms. Page last reviewed 20 February 2023. Accessed 21 October 2026. https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/symptoms/
11. NHS. Low mood, sadness and depression. Page last reviewed 29 July 2026. Accessed 21 October 2026. https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/feelings-and-symptoms/low-mood-sadness-depression/
12. NHS. About hormone replacement therapy (HRT). Page last reviewed 7 February 2023. Accessed 21 October 2026. https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/about-hormone-replacement-therapy-hrt/
13. Gleason CE, Dowling NM, Wharton W, et al. Effects of hormone therapy on cognition and mood in recently postmenopausal women: findings from the randomized, controlled KEEPS-Cognitive and Affective Study. PLoS Medicine. 2015;12(6):e1001833. doi:10.1371/journal.pmed.1001833
14. Gleason CE, Dowling NM, Kara F, et al. Long-term cognitive effects of menopausal hormone therapy: findings from the KEEPS Continuation Study. PLoS Medicine. 2024;21(11):e1004435. doi:10.1371/journal.pmed.1004435
15. Henderson VW, St John JA, Hodis HN, et al. Cognitive effects of estradiol after menopause: a randomized trial of the timing hypothesis. Neurology. 2016;87(7):699-708. doi:10.1212/WNL.0000000000002980
16. NHS. Things you can do to help menopause and perimenopause symptoms. Page last reviewed 19 May 2026. Accessed 21 October 2026. https://www.nhs.uk/conditions/menopause/things-you-can-do/
17. NHS. Treatment for menopause and perimenopause. Page last reviewed 19 May 2026. Accessed 21 October 2026. https://www.nhs.uk/conditions/menopause/treatment/
18. NHS. Where to get urgent help for mental health. Page last reviewed 26 April 2023. Accessed 21 October 2026. https://www.nhs.uk/nhs-services/mental-health-services/where-to-get-urgent-help-for-mental-health/