Many women report experiencing brain fog (a generous mix of mental fatigue, reduced focus, and forgetfulness) while transitioning through menopause, which they believe is due to their hormones fluctuating all over the place. What most people don’t realize is that while menopause brings profound shifts in hormone levels, it also brings profound shifts in the very structure of their brain.
A new study recently published in Menopause from The Menopause Society shows structural changes in the brain are linked with emotional, cognitive, and physiological changes during menopause. Finding that gray matter in regions tied to memory and thinking can shrink, and at the same time, white matter may show damage that is linked to blood flow issues, creating the perfect storm for brain fog. However, it is not all doom and gloom, as there is some evidence pointing toward partial recovery and adaptive changes post menopause, offering hope.
For this study, to better understand the connection between brain fog and menopause, a review of existing studies examining how menopause affects brain structure and its links to emotional, physical, and cognitive health was conducted. The results from this study are being presented at the 2025 Annual Meeting of The Menopause Society, from October 21-25 in Orlando, Florida.
Altered Brain Structure and Menopause
It has already been established that menopause can be accompanied by measurable structural changes in women’s brains. With several identifying decreases in gray matter volume within key brain regions, including the frontal and temporal cortices as well as the hippocampus regions, which play major roles in decision-making and memory. Not surprisingly, these changes are associated with a decline in certain types of memory performance, such as verbal and visuospatial abilities.
Some research has shown that white matter hyperintensities (spots visible on MRI scans, which can indicate tissue damage) become more common in women during menopause, particularly in those experiencing early menopause or frequent hot flashes. These changes may be due to reduced blood flow to the brain’s white matter, and the lesions are linked to an increased risk of neurological symptoms like balance issues, mood changes, cognitive decline, as well as an increased likelihood of both dementia and stroke.
Hormonal Adaptation and Brain Recovery
Some findings provide a glimmer of hope, suggesting that gray matter volume may partially recover after menopause, pointing to the brain’s ability to adapt via neuroplasticity. Higher levels of estrogen receptor density during menopause transition may reflect the brain’s attempts to compensate for the failing hormone levels. (However, in some cases, this has also been linked to weaker memory performance.)
Additionally, within the brain, changes in blood vessel reactivity and energy metabolism also reflect how menopause affects neural health and resilience among women.
Other hopeful evidence suggests that partial recovery of gray matter volume post menopause may potentially reflect compensatory neuroplastic processes. As well as elevated estrogen receptor density during menopause, transitioning potentially representing an adaptive response to declining hormone levels. Along with this, alterations in cerebrovascular reactivity and brain energy metabolism potentially further highlight the impact of menopause on neural integrity and functional resilience of women’s brains.
Moving Towards Improved Understanding and Treatments
“This type of work highlights the need to continue exploring the relationship between the brain and menopause, particularly their connection with the cognitive, emotional, and behavioral symptoms women experience during this stage,” says Angélica Rodríguez, PhD student in Psychology at Ponce Health Sciences University in Puerto Rico.
“This study represents the cumulative body of scientific knowledge relative to structural changes that take place in the brain during menopause,” says Dr. Stephanie Faubion, medical director for The Menopause Society. “These data will hopefully lead to a better understanding of the factors underlying some of the cognitive concerns experienced by women during the menopause transition so that we can ultimately identify effective therapies.”
Prevalence of Menopause Brain Fog
Up to 60% of women experience brain fog during menopause, with some studies showing even higher prevalence rates in specific populations. This cognitive change can affect memory, focus, and clarity, and is often linked to hormonal fluctuations and sleep disruptions, which are also common during this transition.
- Prevalence: Around 40% to 60% of women report experiencing brain fog during the menopausal transition. Some studies have indicated even higher percentages, with one source estimating that up to two-thirds (approximately 66%) of women may experience some degree of cognitive impairment.
- Contributing factors: Brain structure changes, hormonal changes/fluctuations, particularly the decline in estrogen, significantly influence brain areas involved in memory and cognition. Sleep disturbances, such as hot flashes and insomnia, also worsen cognitive symptoms.
- Symptoms: Brain fog during menopause can manifest as forgetfulness, difficulty with concentration, slower thinking, and trouble finding the right words.
When Symptoms Typically Improve
- Within a few years: Research shows cognitive symptoms often peak in late perimenopause but tend to improve within a few years after menopause, with verbal memory often returning to baseline two to three years after the transition is complete.
- The transition period: Since the transition to menopause (perimenopause) can last for years, and varies from person to person, some women may experience brain fog for a similar length of time.
Factors That Can Influence Improvement
- Overall health: Addressing other common menopause symptoms like poor sleep, hot flashes, and mood swings can help improve brain fog.
- Hormone levels: The improvement is often tied to the body’s adjustment to a new hormonal baseline after menopause.
- Lifestyle: Lifestyle habits such as regular exercise, a healthy diet, and managing stress can positively impact cognitive function.
When to Seek Professional Advice
- It’s important to talk to a doctor if your brain fog is persistent, worsening, or significantly impacting your daily life.
- If you have concerns, particularly if your memory challenges could imperil your safety, contact your physician.
Outlook: Cutting Through the Brain Fog
While it can vary from person to person, for many women, brain fog is typically a temporary symptom that improves within a few years after the menopause transition is complete. Most women experience improvement as their hormone levels settle, and cognitive function returns to normal. However, persistent symptoms can occur, especially if other contributing factors like poor sleep or mood issues are not addressed.
This article was written by TJ Webber at the WHN News Desk.
As with anything you read on the internet, this article should not be construed as medical advice; please talk to your doctor or primary care provider before changing your wellness routine. WHN neither agrees nor disagrees with any of the materials posted. This article is not intended to provide a medical diagnosis, recommendation, treatment, or endorsement. Additionally, it is not intended to malign any religion, ethnic group, club, organization, company, individual, or anyone or anything. These statements have not been evaluated by the Food and Drug Administration.
