Last Tuesday you stood in your kitchen. Just stood there. Full minute maybe. Why did you come in? No idea. Wednesday morning, Emma's name. Gone. You work with Emma. Sit next to her every single day. Six years. Had lunch with her last week. Friday in that meeting, mid-sentence, the word just... nothing. You're standing there, mouth opening and closing, everyone staring, and you can actually feel your face getting hot. Then 2:47am you're Googling "early onset dementia symptoms" because what the hell is happening to you?
We see you. We know how frightening this has been. And we need you to know something right now, before the panic gets any worse: this is almost certainly perimenopause brain fog, not dementia.
What Menopause Brain Fog Actually Feels Like
Brain fog isn't a medical term, but it's perfect for describing this. That cotton wool head feeling. The mental fuzziness. The way your thoughts move through treacle.
You might be forgetting where you put things. Keys in the fridge, anyone? Losing your train of thought mid-conversation. Walking into rooms and having absolutely no idea why you're there. Struggling to find words you've used your entire life. Finding it harder to concentrate on tasks that used to be automatic.
Some women? It's mild. Annoying, sure, but manageable. For others, it's properly terrifying. We've spoken to women who've been convinced they're developing something serious. Women who've cried in their cars before work because they can't remember basic things. Women who've considered leaving jobs they love because they're worried they can't perform anymore (and yes, we know that fear is probably keeping you awake at night too).
Research shows brain fog isn't just about memory. It affects attention, processing speed, how quickly you can retrieve information. It's not one thing going wrong. It's multiple cognitive systems all feeling foggy at once.
Frustrating doesn't even begin to cover it, does it?
You're Not Losing Your Mind (And It's Definitely Not Dementia)
Here's what you need to hold onto: dementia before 64 is rare. Really rare. If you're in your 40s or early 50s and these symptoms appeared relatively suddenly, especially if they're linked to when your periods changed, it's almost certainly hormonal. We know you've Googled the symptoms. We know they overlap. We know that's absolutely terrifying.
But dementia and brain fog are different in crucial ways.
Dementia symptoms progress gradually over time, getting steadily worse. Brain fog tends to come and go, often worse when you're tired or stressed. Studies show that when memory declines occur during perimenopause, performance levels remain within normal limits for all but a very small number of women. Your brain is adjusting, not failing.
We also know you might have family history that's making this more frightening. If dementia runs in your family, brain fog symptoms can feel like watching a terrible future unfold. The not-knowing is often worse than having an answer. But here's the thing: perimenopause brain fog improves. Dementia symptoms worsen progressively.
If you're worried, genuinely worried, a menopause specialist can help distinguish between the two.
Why Your Brain Feels Like It's Full of Cotton Wool
Your brain is absolutely packed with oestrogen receptors. Everywhere. Oestrogen isn't just about your ovaries and periods. It plays a massive role in how your brain functions, particularly in areas involved with memory, learning, and attention.
Perimenopause? Your oestrogen levels go mad. Not just dropping. Fluctuating wildly. Up, down, no pattern. The NHS explains that brain fog is a recognised symptom of perimenopause and menopause. Your brain, which has been happily working with stable hormone levels for decades, suddenly has to cope with this hormonal roller coaster. It's like trying to drive a car when someone keeps messing with the fuel supply.
Oestrogen helps regulate how your brain uses glucose for energy. When oestrogen drops, your brain literally gets less fuel. No wonder you feel fuzzy.
But it's not just oestrogen. Progesterone and testosterone also play roles in cognitive function. All three hormones work together to keep your neurons firing, support new cell growth, help different parts of your brain communicate with each other. When they all start changing at once? Your brain notices.
And here's what makes it worse: other menopause symptoms pile on too. Night sweats wreck your sleep. Poor sleep absolutely devastates cognitive function. Anxiety and low mood (also common during this transition, in case you were wondering if that's just you) make concentration harder. Hot flushes during important meetings make it impossible to focus.
And we get that understanding WHY doesn't make it less scary.
How Common Is This? (Very)
You are absolutely not alone. Not even slightly.
Studies show that just over 60% of women report cognitive difficulties during their menopause transition. Some surveys put it even higher. We know seeing these numbers might worry you more (are you part of that 60%? how bad will it get?), but actually, knowing how common this is can help. You're not the only one struggling.
More than half of all women going through perimenopause are dealing with this right now. Your colleague who seems to have it all together? She might be struggling too. Your friend who's always been sharp as a tack? Might be Googling symptoms at 3am just like you. You're not alone in this. Not even close.
The symptoms women report are remarkably consistent across studies. Difficulty remembering names. Word-finding problems. Trouble concentrating. Forgetting why they walked into a room. Losing track of conversations. Taking longer to process information. Missing appointments they'd never normally forget.
It's particularly common during perimenopause (before your periods stop entirely), which can start in your early to mid-40s and last for years. Some women notice brain fog as one of their first perimenopausal symptoms, before hot flushes or period changes.
Research also shows it's having a real impact on women's working lives. Over 50% of women identified concentration problems, memory issues, and tiredness as the menopause symptoms affecting their work most. Many women worry about job performance, about being found out, about whether they can still do what they've always done well. If that's you, we get it.
Will It Last Forever?
No. Hold onto that.
Brain fog associated with menopause is usually temporary. Studies following women through the menopause transition found that cognitive symptoms often improve once you reach postmenopause, when hormone levels stabilise at their new, lower level.
Your brain is going through a transition. A sort of renovation. It needs time to adjust to working with different hormone levels. Once it adapts, many women find their cognitive function returns to how it was before. Some research even suggests memory performance gets back to baseline levels after menopause.
Perimenopause? Four to eight years for most women. We know. That feels like forever when you're in it (and we know you're probably calculating how many more years of this you have to endure). Brain fog tends to be worst during this time, when hormones are fluctuating most dramatically. It often starts to improve in the later stages of perimenopause and continues improving after your periods stop.
That said, everyone's different. Some women have mild symptoms that barely affect them. Others struggle significantly. If your symptoms are severe, if they're genuinely impacting your daily life, or if they're not improving, you absolutely should see a menopause specialist. They can assess what's happening and discuss treatment options.
One thing we want to be really clear about: if brain fog appeared suddenly and severely, if it's accompanied by other concerning symptoms like personality changes, or if you're having trouble with basic daily tasks, see a healthcare professional promptly.
What Actually Helps with Brain Fog
You want to know what you can do about this. Because knowing it's common and temporary is reassuring, but you still need to function today.
Hormone Replacement Therapy (HRT)
HRT is effective for treating menopause symptoms, including brain fog. Really effective. It works by replacing the oestrogen and progesterone your ovaries have stopped producing. Many women find their brain fog improves significantly once they start HRT.
NICE guidelines support the use of HRT for managing menopause symptoms, and the risks are generally small and outweighed by the benefits for most women.
Some women also benefit from testosterone as part of their HRT, particularly if they're experiencing problems with concentration, motivation, and energy alongside brain fog. There is mixed evidence for this, but some patients report brain fog improvements with testosterone. More research is needed. At present, testosterone is only recommended for women with persistent low libidio, when taking HRT. Speaking to a specialist can help you to identify if testosterone is right for you.
Lifestyle Changes
While HRT is often the most effective treatment, lifestyle factors can help too. We know you've probably heard all this before. We know it might sound too simple. But the evidence does support these approaches.
Regular exercise, particularly aerobic exercise, can improve cognitive function. It doesn't have to be intense. Walking, swimming, cycling. Whatever you'll actually do consistently. Research suggests that addressing nutritional factors, including iron levels, may help with cognitive performance during perimenopause.
Sleep is crucial. Your brain needs proper rest to function well. If night sweats are wrecking your sleep, treating them (often with HRT) can improve brain fog indirectly. Sleep hygiene helps too. Cool bedroom, regular sleep schedule, avoiding screens before bed.
Managing stress where you can. Mindfulness and meditation may help. Everyone's different, but some women find it useful. Anything that reduces anxiety can potentially help cognitive function.
Eating well. Your brain needs steady glucose. Fuel that doesn't spike and crash. The Mediterranean diet keeps coming up in research as potentially protective for brain health. Plenty of vegetables, fruits, whole grains, healthy fats from oily fish and nuts.
Practical Coping Strategies
While you're sorting out treatment, these might help you manage day-to-day:
Use your phone religiously for reminders. Set alarms for appointments, meetings, tasks. Lists are your friend. Write everything down. Keep notebooks, use apps, stick notes to your desk.
Reduce multitasking. Focus on one thing at a time. Your brain is already working harder than usual.
Be open with people you trust. Tell your partner what's happening. If you feel able, talk to your manager about it. You might be surprised how understanding people can be, especially other women who've been through it.
Give yourself some grace. You're not failing. Your brain is coping with massive hormonal changes. Cut yourself the slack you'd give a friend in the same situation.
When You Should See a Menopause Specialist
If you're experiencing brain fog alongside other menopause symptoms, or if brain fog is affecting your quality of life, you should see a menopause specialist.
Not your GP first. A menopause specialist.
Menopause specialists have specific training in hormonal health that many GPs don't. They understand the nuances of perimenopause symptoms, they're up to date on the latest evidence about HRT, and they can properly assess whether your symptoms need treatment. They won't dismiss you. They won't tell you this is "just aging."
A menopause specialist can:
- Properly assess your symptoms in the context of perimenopause
- Discuss whether HRT might help
- Prescribe the right type and dose of HRT if appropriate
- Monitor how you're responding to treatment
- Adjust treatment if needed
- Consider testosterone if other hormones aren't fully addressing symptoms
If you can't access a menopause specialist directly, ask your GP for a referral to one. The NHS provides information about HRT and treatment options, and your GP should be able to refer you to specialist menopause services.
You should definitely see a specialist if:
- Brain fog is significantly affecting your work or daily life
- You're worried about your symptoms (the worry itself is a valid reason)
- Other menopause symptoms are also troubling you
- You've tried lifestyle changes and they're not helping enough
- Symptoms appeared suddenly and are severe
- You're genuinely concerned about dementia
We know you might feel like you're being a nuisance. You're not. These symptoms are real, they're recognised, and they're treatable.
¹- NHS. Menopause Symptoms. https://www.nhs.uk/conditions/menopause/symptoms/
²- NHS. Menopause Treatment. https://www.nhs.uk/conditions/menopause/treatment/
³- NICE. Menopause: identification and management. https://www.nice.org.uk/guidance/ng23
⁴- Maki PM, Jaff NG. (2024). Menopause and brain fog: how to counsel and treat midlife women. Menopause. https://pubmed.ncbi.nlm.nih.gov/38888619/
⁵- Barnett AL, Wenger MJ, Miles P, et al. (2025). Cognitive Performance in Relation to Systemic and Brain Iron at Perimenopause. Nutrients. https://pubmed.ncbi.nlm.nih.gov/40077615/
⁶- Monash University. (2021). Brain fog during menopause is real - it can disrupt women's work and spark dementia fears. https://lens.monash.edu/@medicine-health/2021/12/17/1384265/brain-fog-during-menopause-is-real-it-can-disrupt-womens-work-and-spark-dementia-fears
⁷- Sullivan Mitchell E, Fugate Woods N. Midlife women's attributions about perceived memory changes: observations from the Seattle Midlife Women's Health Study. J Womens Health Gend Based Med. 2001 May;10(4):351-62. https://doi.org/10.1089/152460901750269670
⁸- International Menopause Society. (2022). Brain fog in menopause: a health-care professional's guide. https://www.imsociety.org/wp-content/uploads/2022/10/IMS-White-Paper-2022-Brain-fog-in-menopause.pdf
