It can be unsettling to notice changes in your memory, focus, or mental sharpness, particularly during life transitions like menopause.
Signs like forgetfulness or difficulty concentrating might be mistaken for something more serious, such as dementia. You might have questions like: Is this just a temporary phase, or could it be something more serious, like dementia? It’s easy to confuse the two since some symptoms, like mood changes and memory struggles, overlap.
While brain fog and dementia may share certain symptoms, they stem from different causes and often require distinct approaches to address. Understanding the differences between menopause-related brain fog and dementia is key to knowing when to seek support. Above all, understanding the similarities and differences is a great way to put your mind at ease about your cognitive abilities.
What is menopause brain fog?
Brain fog is not a medical diagnosis but a term used to describe a collection of cognitive symptoms, including forgetfulness, difficulty concentrating, and a sense of mental cloudiness. It is a common complaint among women going through perimenopause and even after menopause, with about 40% of women aged 40 to 55 reporting such challenges1. It is the second most common symptom after reports of hot flushes and night sweats.
Brain fog might look like struggling to remember recent information, finding the right words, or multitasking effectively. For many women, these symptoms can emerge during menopause due to fluctuating hormone levels, particularly oestrogen, which plays a crucial role in brain function. Other contributing factors may include poor sleep, stress, and lifestyle changes that often accompany this phase of life.
The good news? Brain fog associated with menopause is usually temporary and often improves with time or lifestyle adjustments. Studies suggest that cognitive performance often returns to a premenopause baseline within a few years after menopause, indicating that these challenges are typically linked to the perimenopause period2. If you need help identifying your symptoms, our team of menopause experts is here to help.
What is dementia?
Dementia is a general umbrella term that refers to brain changes that lead to memory loss, difficulties with communication, and challenges in solving daily problems or completing familiar tasks. For example, Alzheimer’s disease is a specific type of dementia3. Symptoms of dementia can range from mild issues, such as short-term memory lapses or misplacing items like a wallet, to more severe problems, such as forgetting appointments, getting lost in familiar neighbourhoods, or experiencing difficulty finding the right words or even mobility challenges4.
One particularity about dementia symptoms is that they worsen over time and are caused by damage to brain cells. This damage makes it harder for brain cells to communicate with each other, leading to the progressive nature of the condition. Depending on the brain regions affected, symptoms may vary. For instance, Alzheimer’s disease typically begins with memory loss but can evolve to include other cognitive impairments3.
It’s also important to note that some symptoms of dementia might be caused by other factors, such as depression or side effects of medications. This is why a professional evaluation is critical for an accurate diagnosis.
Why are women at higher risk of dementia?
This is an area of medicine which requires much ongoing research and isn’t fully understood but there are some possible theories. Women may be more exposed to the risk of dementia for several reasons. One primary factor is that women tend to live longer, increasing their likelihood of developing age-related conditions like dementia. Hormonal fluctuations, particularly involving oestrogen, may also contribute to this increased risk. This hormone is known to protect brain function, so its fluctuation or decline during menopause could impact cognitive abilities5.
Additionally, depression, which is twice as common in women as in men, is linked to an increased risk of dementia6. The role of testosterone on women’s brain function is also being researched, as well as certain genetic factors.
At what age does dementia typically occur?
Dementia primarily affects people aged 65 and older, though it can occur in younger individuals in rare cases. The risk of dementia increases with age, but it is not an inevitable part of ageing. Early recognition of symptoms and being quickly evaluated can help manage or slow the progression of the condition.
How to differentiate between brain fog and dementia
Menopausal brain fog is typically temporary. Symptoms may include forgetfulness, trouble concentrating, and slower thinking. Interestingly, research suggests that cognitive challenges during menopause may not directly correlate with hormone levels, such as oestrogen. For example, studies indicate that higher levels of oestrogen do not necessarily equal better cognitive performance, making the connection complex7,8.
Dementia symptoms are more severe and progressive compared to menopausal brain fog. Dementia often includes memory loss that disrupts daily life, difficulty with planning and problem-solving, and confusion with time or place.
When it comes to duration, dementia symptoms worsen gradually over time, while brain fog often improves after menopause1.
If you are experiencing brain fog, consider whether you also have other menopause-related symptoms, such as what we call “vasomotor symptoms” (hot flushes, night sweats) or sleep disruptions. While these symptoms do not directly cause brain fog, they can exacerbate cognitive challenges, such as memory lapses1.
Discover the full list of menopause symptoms.
When to see a doctor
There is no single test for dementia. Diagnosis involves reviewing medical history, assessing changes in thinking, behaviour, and daily functions like dressing or washing. Further tests, such as blood or urine analyses, may be conducted to rule out other potential causes3,4.
If you or someone close to you noticed significant changes in thinking skills, memory or behaviour, it is essential to seek medical advice. Detecting dementia early enough can allow a slow progression and provide support for affected individuals and their families3.
When it comes to the impact of menopause on the mind and body, our Menopause Care team has extensive expertise in addressing the impact of menopause on the mind and body. They can guide you toward a more holistic approach to managing your symptoms. Simply book a consultation with one of our specialised menopause doctors.
Can menopause cause dementia?
While menopause itself does not directly cause dementia, the age at which menopause occurs may influence the risk of developing dementia later in life9. A 2020 study found that reduced lifetime exposure to oestrogen—due to factors like late first period or early menopause—is associated with an increased lifetime risk of dementia10.
Research also shows that individuals who experience natural menopause earlier (younger than 40) have a higher risk of dementia compared to those who undergo menopause at a later age (above 55)9. Following a similar logic, surgical menopause (when the ovaries are removed before natural menopause for a medical reason), also increases the risk of dementia, as demonstrated in a large-scale study9.
That being said, it’s important to note that the relationship between oestrogen and the risk of dementia during menopause is not fully understood. The attempts to compensate for oestrogen loss with hormone replacement therapy do not appear to fully mitigate cognitive decline during and after menopause. This suggests that the interplay between oestrogen and cognitive function is more complex and warrants further investigation.
Things that can help protect your brain abilities
Hormone Replacement Therapy (HRT)
Hormone replacement therapy (HRT) can help with brain fog as it replaces hormones (oestrogen, progesterone and sometimes testosterone) that are at a naturally lower level during menopause. However, most research about HRT and brain fog is conflicting12.
In most instances, it suggests that HRT isn’t as effective for alleviating brain fog as it is for other menopause symptoms such as hot flushes, night sweats and vaginal dryness.
Find out more about the relationship between HRT and brain fog.
Supplements and nutrition
You might be wondering if lifestyle changes, particularly in nutrition, could help support cognitive health. That’s a great aspect to investigate; however, research on supplements such as folic acid and vitamin B12 has yielded mixed results. While some studies suggest potential cognitive benefits, others show little to no effect13.
What we know for sure , is that a nutrient-rich diet always helps in maintaining cognitive health. Diets high in omega-3 fatty acids, antioxidants, and essential vitamins are linked to improved cognitive function, delayed decline, and a reduced risk of neurodegenerative diseases14.
Exercise and healthy lifestyle choices
Regular physical activity, such as walking or moderate-intensity aerobic exercise, is highly beneficial for brain health. Activities that promote a mind-body connection, like Tai Chi, also show promise. A healthy lifestyle that includes quitting smoking, reducing or avoiding alcohol, maintaining a balanced diet (look for example at the Mediterranean diet), and staying physically active can support cognitive abilities and overall brain health1.
Other things that can help are:
- Avoiding multitasking to minimise mental fatigue
- Taking regular screen breaks to refresh focus and reduce stress
- Scheduling tasks for times when you feel most alert and focused
It’s normal to feel concerned about changes in your cognitive abilities, but understanding the root cause can empower you to take action. Menopause-related brain fog is often temporary and manageable with the right adjustments and support, while dementia requires medical attention. When in doubt, don’t hesitate to reach out to a healthcare provider for guidance. Remember, your concerns are valid, and help is available. Our menopause care team is available if you have questions regarding brain fog and other menopause symptoms.
¹Cognition and the menopause transition Maki & Henderson (July 2016)
²Effects of the menopause transition and hormone use on cognitive performance in midlife women Greendale et al. (May 2009)
³What is Dementia, Alzheimer’s Association
⁴Symptoms of dementia, NHS
⁵Steroid hormones: risk and resilience in women’s Alzheimer disease, Calvo and Einstein
⁶Association between depression and young-onset dementia in middle-aged women Yoo et al. (June 2024)
⁷Endogenous estrogen is not associated with cognitive performance before, during, or after menopause Herlitz et al. (May 2007)
⁸⁹¹⁰Reproductive period and risk of dementia in a diverse cohort of health care members Gilsanz et al. (April 2019)
¹¹Cognitive effects of estradiol after menopause: A randomized trial of the timing hypothesis Henderson et al. (Aug. 2016)
¹²¹³Diet and dementia Whalley et al. (Sept. 2004)
¹⁴Associations of Microbiota and Nutrition with Cognitive Impairment in Diseases Młynarska et al. (Oct.2024)
