Menopause & Brain Fog: Does HRT Help?

Menopause can produce a range of physical, emotional and cognitive symptoms that impact overall well-being. Brain fog is a common symptom that can be frustrating to manage and leave you not feeling like yourself.

While memory loss is a normal sign of ageing and almost 40% of people will experience some form after the age of 651, menopausal brain fog is different and is a direct result of the hormone changes that occur during this transitional life stage.

If you’ve been feeling like your head is full of cotton wool, menopause could be the underlying cause. In this guide, we explain how menopause contributes to brain fog and explore how hormone replacement therapy (HRT) can be a treatment for this symptom.

Brain fog: an overview

Brain fog is a common menopause symptom which affects your memory, concentration and other cognitive abilities. Almost two-thirds of women report experiencing it during their menopausal transition2 and research has found that perimenopause has a negative effect on:

Verbal learning
Verbal memory
Processing speed
Attention
Working memory3

Brain fog can occur at any stage of perimenopause or menopause and there isn’t a specific timeframe for how long you’ll experience it. It’s usually temporary and not normally an indication of permanent cognitive decline. Brain fog tends to be most prominent during perimenopause, resolving after menopause, but it can last for longer.

You may not be able to prevent brain fog during menopause but there are lifestyle changes and treatment options that may ease your symptoms and improve your memory overall.

What causes brain fog?

Hormonal changes during menopause, particularly the decline in oestrogen, can significantly contribute to brain fog. This is because oestrogen is a critical hormone that supports brain health. It influences:

Neurotransmitter activity: Oestrogen enhances the function of neurotransmitters like serotonin and dopamine, which are crucial for mood, memory, and focus4.
Blood flow to the brain: It helps maintain vascular health, ensuring adequate oxygen and nutrients reach brain cells5.
Neuroprotection: Oestrogen protects neurons and promotes the growth of connections between them6.

When oestrogen levels drop during menopause, these processes are disrupted, which can impair cognitive function and lead to symptoms of brain fog.

In addition, menopausal symptoms like hot flushes and night sweats often interfere with sleep quality7. Poor sleep can lead to fatigue, making it harder to focus, process information, and recall memories8.

The hormonal changes in menopause can also increase stress and anxiety, which further affect concentration and memory. Elevated cortisol levels (the stress hormone) can hinder the hippocampus, the brain area responsible for memory9.

Signs of menopausal brain fog

Brain fog is a non-medical term used to describe symptoms that can impact your daily life. It won’t affect everyone in the same way but is generally characterised by forgetfulness and a general feeling that you’re not as mentally ‘sharp’ as you were before.

In one study, 72% of menopausal women reported problems remembering names at least some of the time and 50% said they had trouble remembering where they put things or forgot what they were doing10.

You may also experience:

Difficulty concentrating or focusing
Confusion
Fatigue
Losing your train of thought
Trouble retaining or recalling information
Mental exhaustion
Stumbling over your words
Trouble understanding what people are saying
Slow thought processes and reaction times
Feeling generally ‘fuzzy’
Struggling to pay attention11,12

Does HRT help with brain fog?

The impact of HRT on cognitive abilities is still uncertain.

Some studies point out the fact that it depends on factors such as timing, dosage, and personal medical history5. For women undergoing POI or early menopause, research suggests that HRT may reduce the risk of dementia1. One study even observed that starting hormone therapy during perimenopause—before the final menstrual period—had beneficial effects on cognitive performance, including verbal memory.

There are other studies, however, which have shown that once past the menopause stage, oestrogen therapy does not seem to affect cognitive function, regardless of when treatment was initiated11. Some research even indicates a possible increased risk of dementia and Alzheimer’s disease among both short-term and long-term HRT users27.

These findings should not be interpreted as a causal relationship, meaning that HRT increases the risk for dementia. More research is needed to fully understand the connection. As of now, HRT cannot be recommended as a strategy to prevent dementia, though it remains beneficial for managing other menopause-related symptoms, such as sleep disturbances or vasomotor symptoms28. Women should be reassured that HRT is unlikely to increase the risk of dementia or to have a detrimental effect on cognitive function when starting before the age of 65.

Menopause, brain fog, HRT and dementia

When discussing menopause symptoms and HRT, the risk of longer-term health conditions should be considered. For example, body-identical HRT has been shown to reduce the risk of osteoporosis, heart disease and colon cancer14.

However, with cognitive conditions, the impact of HRT isn’t as clear-cut. Dementia is a condition that affects about twice as many women as men15. The main reason for this is that women live longer than men, but when comparing women and men of the same age, the level of risk isn’t evident.

Some studies suggest that starting HRT early in menopause (within the first 10 years of onset) may reduce the risk of Alzheimer’s disease. This is known as the ‘critical window hypothesis’, which proposes that timely oestrogen replacement may protect the brain by maintaining its neuroprotective functions.

One study in particular found that oestrogen therapy for menopause was associated with a 32% reduction in dementia risk and combined oestrogen-progestogen therapy was associated with a 23% reduction in dementia risk16.

Other studies have linked long-term HRT use, particularly when started later in life or involving combined oestrogen and progestogen therapies, to a slightly higher risk of dementia17. This may be due to vascular changes or other age-related factors that interact negatively with hormone therapy.

Find out more in our guide to menopause and dementia.

The best form of HRT for brain fog

The best type of HRT for brain fog will be different for everyone based on several factors including the severity of your symptoms, age, and medical history. In many instances, HRT may not be prescribed for brain fog alone but can be effective for treating this symptom alongside other physical menopause symptoms.

HRT can come in a variety of forms, including gels, patches, sprays, tablets, pessaries, and creams.

Transdermal preparations (ones that are applied to the skin) are popular as they provide a steady hormone release and are easy to use. In a study of postmenopausal women with Alzheimer’s Disease, transdermal oestrogen was shown to produce significant improvements in attention, verbal memory, visual memory, and semantic memory18.

Progesterone therapy has also been associated with cognitive benefit, with one study indicating it positively impacts visual memory and verbal working memory19.

Lifestyle changes that can help with menopause brain fog

In addition to considering HRT, making lifestyle adjustments can improve cognitive symptoms during menopause:

Exercise regularly: Aerobic and strength-training exercises boost blood flow to the brain and support overall cognitive health20.
Eat a balanced diet: Focus on nutrient-rich foods like leafy greens, fatty fish, nuts, and whole grains to fuel brain function21.
Stay hydrated: Dehydration can impair cognitive performance, so drink plenty of water throughout the day22.
Prioritise sleep: Aim for 7-9 hours of quality sleep per night to allow your brain to rest and recharge23.
Manage stress: Practice relaxation techniques such as yoga, meditation, or deep breathing to reduce stress hormones that impact memory and focus24.
Keep mentally active: Engage in activities that challenge your brain, such as puzzles, learning new skills, or reading25.
Limit alcohol and caffeine: These can disrupt sleep and exacerbate brain fog in some individuals.
Stay socially connected: Interacting with friends and family helps stimulate cognitive function and improve mood26.

If you’re experiencing brain fog in menopause or are concerned about your long-term cognitive health, it’s important to take a personalised approach. Factors like your age, health history, and specific symptoms will guide whether HRT is right for you and help inform other management strategies.

At Menopause Care, we support women to navigate their menopause symptoms to improve their quality of life. By understanding your symptoms and concerns, we can provide you with evidence-based resources and a personalised treatment plan. To get started, book a consultation with a menopause doctor.

DisclaimerAt Menopause Care, we ensure that everything you read in our blog is medically reviewed and approved. However, the information provided is not meant to replace professional medical advice, diagnosis, or treatment. It should not be relied upon for specific medical advice.

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