Is Menopause Brain Fog Normal? What Every Woman Should Know About Memory and Cognition

One of the most common things I hear from women in my office isn’t actually about hot flashes.

It’s this.

“Sandra…I’m scared I’m getting dementia.”

Sometimes it’s followed by tears, a nervous laugh, or genuine fear. Then the questions start. “Why can’t I remember words anymore?” “I walk into a room and completely forget why I’m there.” “I’ve always had a great memory. What’s happening to me?”

If any of those questions sound familiar, you’re certainly not alone. Cognitive symptoms such as forgetfulness, difficulty concentrating, and what many women describe as “brain fog” are common during the menopause transition. Research suggests these symptoms affect a substantial proportion of women, yet many are never really warned to expect them. Many women tell me they expected hot flashes and irregular periods. They did not expect to suddenly feel like they couldn’t trust their own memory.

As a clinical pharmacist and Menopause Society Certified Practitioner, I spend a lot of time helping women understand what may be part of the menopause transition, what deserves further investigation, and perhaps most importantly, what we can actually do to support brain health. One of my favorite publications on this topic is the International Menopause Society White Paper on brain fog in menopause, because it validates what so many women have been experiencing for years. It reminds us that these symptoms are real, they are common, and while they can certainly be frustrating, they are not the same thing as dementia. The newer IMS recommendations also include guidance on women’s midlife health, menopause, MHT, lifestyle, and dementia risk.

So what exactly is “brain fog”?

Although “brain fog” is not an official medical diagnosis, most women know exactly what it feels like. It’s forgetting why you walked into the kitchen. It’s standing in the grocery store unable to remember the one thing you came to buy. It’s searching for a word you’ve used a thousand times before or rereading the same email because your mind keeps wandering. I experienced this myself during a season of grief and it was incredibly frustrating to read and reread the same sentence over and over and still fee unable to absorb the content.

One of the most common changes women notice is not necessarily forgetting memories. It is difficulty retrieving information that is already there. Researchers describe this as changes in verbal memory and verbal fluency. Most women simply say, “It’s on the tip of my tongue.” That distinction matters because it helps explain what may be happening. Your brain has not erased the information. It may simply take a little longer to retrieve it.

What does the latest research actually tell us?

One of the things I appreciate most about working in healthcare is that we do not rely on social media trends or scary headlines. We look at the evidence. The International Menopause Society White Paper reviewed cognition during the menopause transition and discussed the specific cognitive changes that can occur, their duration and severity, the role of estrogen and menopause symptoms, and how clinicians can counsel women about cognition and dementia risk.

The areas often discussed include verbal memory, verbal learning, attention, processing speed, and executive function, which includes skills like planning, organizing, and multitasking. These changes are usually described as subtle, not dramatic losses of memory. They are often the small changes that leave women saying, “I just don’t feel quite as sharp as I used to.”

Researchers believe fluctuating estrogen levels may play a role because estrogen has important functions in the brain, including areas involved in learning and memory. However, the research also makes it clear that hormones are only one piece of the puzzle.

It is probably not just your hormones

This is something I find incredibly important because it changes the conversation. Think about everything else that often happens during this stage of life.

 Many women are waking several times each night because of hot flashes or night sweats. Sleep becomes fragmented. Stress levels rise as careers become more demanding, children become teenagers or young adults, and aging parents begin to need more support. Anxiety or low mood may creep in, and for many women there is very little time left to recharge.

If I gave anyone chronic sleep disruption, ongoing stress, and a long list of daily responsibilities, I would expect their concentration and memory to suffer. That is actually encouraging because it reminds us that our brains do not function in isolation. Hormones matter, but so do sleep, mental health, cardiovascular health, physical activity, nutrition, and the many demands of everyday life. When we improve those pieces, we are often supporting the brain at the same time.

The question every woman really wants answered

So let’s come back to where we started: “Sandra…am I getting dementia?” For most women, menopause-related brain fog is not the same thing as dementia. The IMS White Paper specifically addresses the need to help women understand the difference between menopause-related cognitive symptoms and dementia risk, and it provides counseling points for healthcare professionals.

That does not mean we ignore memory concerns. If memory problems are rapidly worsening, you are getting lost in familiar places, struggling with everyday tasks, or your family has noticed significant changes in your thinking or behavior, those symptoms deserve a proper medical assessment. There are many possible causes of cognitive changes, including thyroid disorders, vitamin deficiencies, depression, medication side effects, sleep disorders, and neurological conditions.

But those frustrating “Why did I come into this room again?” moments? Those are incredibly common during the menopause transition.

What about hormone therapy?

This is another question that comes up regularly. Based on current evidence, menopausal hormone therapy should not be used solely to improve cognition or prevent cognitive decline or dementia. The 2022 Menopause Society hormone therapy position statement remains an important reference on MHT, and the 2025 IMS recommendations provide updated broader guidance on menopause care and MHT.

However, hormone therapy remains the most effective treatment for bothersome vasomotor symptoms such as hot flashes and night sweats. When those symptoms improve, sleep often improves too. And when sleep improves, many women notice they think more clearly, concentrate better, and simply feel more like themselves again.

Sometimes we are not treating the brain directly. We are treating the things that have been exhausting the brain.

The part of the research I love most

I always like leaving women with hope, and this is where the research becomes empowering. There is not one miracle supplement or one superfood that suddenly makes brain fog disappear. What the evidence consistently supports is a broader brain-health approach, including:

Physical activity

Cardiovascular risk reduction

Healthy eating patterns, sleep

Avoiding smoking, limiting excess alcohol

Staying socially and mentally engaged

The WHO dementia risk-reduction guideline also emphasizes reducing modifiable risk factors for cognitive decline and dementia.

Regular physical activity is one of the best things you can do for long-term brain health. Whether it is walking, strength training, swimming, cycling, or dancing, movement supports cardiovascular health and is associated with healthier cognitive aging. You knew I would find a way to work exercise into this conversation.

Prioritizing sleep is equally important. Sleep is when our brains consolidate memories and perform important housekeeping functions. If menopausal symptoms are disrupting your sleep, do not assume you simply have to live with it. Effective treatment options are available, and it is worth having that conversation with your healthcare provider.

A Mediterranean-style eating pattern rich in vegetables, fruit, legumes, whole grains, olive oil, nuts, and fish has also been associated with better cognitive health. I intentionally say “eating pattern” because it is not about chasing the latest superfood. It is about the choices we make most of the time.

I also encourage women to keep learning. Read books. Take a course. Learn a language. Try photography. Join a class. Turn off your GPS from time to time (gasp! :) ) Challenge your brain in ways that bring you joy. Our brains continue adapting throughout life, and that is something worth celebrating.

Finally, do not underestimate the power of connection. Time with friends, volunteering, church, walking with a neighbour, or simply sharing coffee with someone who makes you laugh all contribute to overall well-being. Those moments nourish more than just the soul.

My final thoughts

If you have been quietly worrying because you cannot remember names the way you used to or you keep losing your train of thought, I hope you leave this article feeling a little lighter. Your brain is not failing you. It may be navigating one of the most significant hormonal transitions your body will ever experience.

That transition may bring challenges, but it also reminds us how interconnected our health really is. Sleep, exercise, nutrition, stress management, relationships, and cardiovascular health all influence the way our brains function. One of the reasons I wanted to write this article is because I do not want women suffering in silence or assuming the worst every time they forget a word.

Knowledge has a way of replacing fear with understanding, and understanding allows us to take action where it matters. Menopause may change the way your brain feels for a season, but it does not define your intelligence, your value, or your future. With the right information and support, this can be another chapter of life where you continue to learn, grow, and thrive.

References

Maki PM, Jaff NG. Brain fog in menopause: a health-care professional’s guide for decision-making and counseling on cognition: IMS White Paper 2022. Climacteric. 2022;25(6):570–578.

International Menopause Society. IMS Recommendations and Key Messages on Women’s Midlife Health and Menopause. Climacteric. 2025.

The Menopause Society. The 2022 Hormone Therapy Position Statement.

World Health Organization. Risk Reduction of Cognitive Decline and Dementia: WHO Guidelines. 2019.