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When people talk about brain fog during the menopause transition, they often mean they have a lack of focus, slow thinking, and forgetfulness.
Studies show that about three in five women in midlife have difficulty recalling words and numbers, need to make lists and reminders, and forget why they’re doing something.
Declining oestrogen is often the culprit. Oestrogen affects the levels of serotonin and dopamine, the natural chemicals in the brain that regulate mood and certain cognitive functions, including memory and focus.
Brain fog is typical during perimenopause, even when a woman is getting enough good-quality sleep. Although they can be distressing, these changes are usually temporary and improve after a woman has her final menstrual period.
Minor issues can become much more challenging when a woman isn’t sleeping well and is having symptoms of confusion or forgetfulness. Women in the menopause transition often struggle to fall asleep.
If this is your experience, you may also wake often and find your nights are less restful. Insomnia is linked to poorer cognitive function, and it tends to endure beyond menopause itself.
Women who’ve been through menopause have much higher rates of insomnia compared to men or to women who are not yet menopausal.
The risk to brain health seems to be about the quality of sleep – how fragmented it is – rather than the total number of hours. This may be why night sweats are linked to worse cognitive performance.
Studies show that about three in five women in midlife have difficulty recalling words and numbers
The good news is that treating night sweats with hormone therapy or effective alternatives may lead to better sleep quality and improved brain health and function.
There’s also some evidence that hormone therapy may help protect against dementia later in life if it is started early in perimenopause and continued long-term. More studies are needed.
Is this brain fog or ADHD?
Distraction, disorganisation, and struggling to focus can be symptoms of attention deficit hyperactivity disorder (ADHD).
There is little research on menopause and ADHD, though ob-gyns hear about it from patients.
It’s common for women in the menopause transition to find their ADHD symptoms are getting worse, or to be diagnosed with ADHD for the first time.
Here again, changing oestrogen levels, and the resulting change in levels of other brain chemicals, could explain ADHD symptoms that get worse in midlife.
It’s possible that women with ADHD are more vulnerable to mood disorders during the menopause transition.
| Sign or Symptom | Normal Ageing | Possible Dementia |
|---|---|---|
| Memory changes | Sometimes forgetting a name or appointment, and remembering later; Forgetting a conversation you had a year ago; Writing reminders and lists | Forgetting information you just learned or forgetting recent events; Asking the same questions multiple times |
| Struggling with familiar tasks | Occasionally needing help to figure out the audio system | Difficulties getting dressed, following a recipe, paying bills, or doing household chores; Taking much longer to do things |
| Visual and spatial challenges | Needing a new prescription for eyeglasses | Difficulty with balance, reading, or placing objects on a table; Difficulty judging distance and contrast, causing unsafe driving |
| Communication challenges | Sometimes having trouble recalling the right word | Forgetting simple words; Struggling to join in or follow conversations; Substituting words (like ‘the thing you sleep on’ for ‘bed’) |
| Confusion about time and place | Not remembering which day of the week it is or why you went into that room | Feeling lost in familiar places and not knowing how you got there; Losing track of dates and seasons |
| Misplacing things | Forgetting where you put your wallet or keys; Retracing your steps to find them | Putting things in unusual places (like a remote control in the freezer); Not being able to retrace your steps to find them again |
If you’re struggling with ADHD or related symptoms, talk with your ob-gyn.
Is this brain fog or early dementia?
During perimenopause, seven in 10 women report problems with their memory.
Memory problems can be upsetting if you have relatives with early dementia, or if you’ve read headlines linking menopausal symptoms to the risk of developing dementia.
You may wonder which you’re dealing with – menopause and natural ageing, or early dementia.
If you or a family member is concerned about your cognitive function, talk with your ob-gyn.
Before your appointment, track any changes related to memory and thinking so you’re ready to share details with your doctor.
You and your ob-gyn may talk about other possible causes, such as untreated anxiety or depression, stress, sleep deprivation, and some physical illnesses, such as thyroid disorders or vitamin B12 deficiency.
To maintain your brain health long-term, it’s important to manage any chronic diseases, including diabetes and high blood pressure.
Persistently high blood pressure, high cholesterol levels, excess belly fat, and poorer cardiovascular health in midlife are all linked to increased risk of dementia later.
And get your hearing checked. Poor hearing is a risk factor for cognitive problems, perhaps because the brain does not get enough stimulation.
If your doctor rules out physical health causes for your cognitive symptoms, ask if you should see a specialist. If needed, your ob-gyn can refer you to a mental health professional or a neurologist.
- Excerpted from Menopause: What Your Ob-Gyn Wants You to Know (© 2026 by the American College of Obstetricians and Gynecologists; ISBN 978-1-948258-63-0), published January 31, 2026. Reprinted with permission.
