This Is Your Brain On Menopause

If you’re a menopausal woman who has ever stood in your kitchen wondering why you opened the fridge, forgotten a familiar name in the middle of a meeting, or struggled to focus on a task you’ve done a hundred times before, you’re in good company.

Those moments of brain fog are far from unusual during the menopause transition. In fact, research suggests that roughly half (44 to 62 percent) of people in menopause report brain fog. Meanwhile, experts say that as many as 80 percent experience broader neurological symptoms like trouble concentrating, difficulty recalling information, or short-term memory lapses.

These experiences can have emotional, mental, relational, and professional impacts on the people experiencing them, says gynecologist Alyssa Dweck, M.D., O.B.G.Y.N., author of The Complete A to Z for Your V and Chief Medical Officer with Bonafide Health. For instance, “many women are reaching the pinnacles of their careers as these symptoms hit,” she says. Whether work is a factor or not, though, “these symptoms can be incredibly destabilizing,” Dweck adds.

Thankfully, there’s plenty you can do to support brain health during this stage of life. Ahead, a closer look at what’s really causing those mid-sentence blanks and how to preserve your mental sharpness as your body transitions into a new life phase. 

• ABOUT OUR EXPERTS: Alyssa Dweck, M.D., O.B.G.Y.N., is a gynecologist, author of The Complete A to Z for Your V, and Chief Medical Officer with Bonafide Health. Janette Gray, M.D., is an internal medicine specialist and author of The Truth About Sex Hormones.

Menopause Basics

Before exploring what happens to your brain during menopause, it’s helpful to understand what menopause actually is.

Formally, menopause refers to a single day that marks the 12-month anniversary of your last period (assuming there is no other identifiable reason for its absence), says Dweck. It signifies the end of ovulation—meaning the ovaries no longer release eggs and pregnancy is no longer possible—as well as a decline in production of estrogen, progesterone, and testosterone, she explains. 

Read More: 7 Diet Adjustments To Make After Menopause

The transitional years leading up to menopause are known as perimenopause, while the cluster of years before and after that single day is referred to as the menopause transition. Throughout this stage, hormone levels don’t follow a steady or predictable pattern. Rather, “hormone levels are volatile, which is why symptoms start to occur,” says Dweck. 

You see, the hormone rollercoaster doesn’t just affect your period—it also causes many other menopause symptoms, including the cognitive ones. 

Your Brain On Menopause 

The hormones most affected by menopause—estrogen, progesterone, and testosterone—may be best known for regulating your menstrual cycle and reproductive health. However, these multitasking messengers influence nearly every system in the body, including your brain, says internal medicine specialist Janette Gray, M.D., author of The Truth About Sex Hormones. “The decline of these three primary hormones can result in up to 300 different signs and symptoms that can vary from such things as insomnia, mood changes, fatigue, weight gain, loss of libido, and more,” she says. 

Estrogen, as it turns out, supports communication between neurons, as well as helps regulate the brain’s use of glucose (its cells’ primary fuel source), says Gray. When estrogen levels drop, those signalling pathways become less efficient, which can lead to forgetfulness and slower thinking. 

Estrogen also helps regulate neurotransmitters like serotonin and dopamine, both of which have been shown to influence cognition, she explains. So, when estrogen levels decline, feelings of forgetfulness and brain fog can pop up more often.

Read More: 5 Healthy Ways To Trigger A Dopamine Rush

Progesterone, which is known for its calming impact, also decreases during menopause. “Progesterone stimulates the brain through a GABA-like compound that promotes calm,” Gray explains. The downward fall of this natural relaxant can cause newfound anxiety, racing thoughts, and restlessness.

Further, while testosterone tends to decline gradually throughout a woman’s life, the change in the testosterone-to-estrogen ratio that occurs around menopause can significantly impact her inner experience, according to Dweck. Since testosterone is tied to motivation, energy, and sexual drive, even a subtle shift in this ratio can affect overall mental clarity and vitality, she says. 

The Sleep-Cognition Connection 

Hormone shifts are the primary cause of brain-fog-like symptoms during the menopause transition, but the disrupted sleep associated with menopause is also a major culprit.

“Sleep disturbance is a very common symptom of menopause and occurs for many reasons,” says Gray. One of the most notable? Estrogen helps regulate body temperature, so when levels become erratic, temperature regulation falters, leading to hot flashes and night sweats.   

Unsurprisingly, these symptoms can be a serious barrier to quality sleep. “A woman can literally wake up in a pool of sweat, and then go from burning up to having chills,” Gray explains. That cycle of waking, cooling off, needing to change clothes or sheets, and then trying to fall back asleep can repeat multiple times per night. 

The cumulative impact of these sleep disruptions is reduced overall sleep time and worsened sleep quality. Data suggests that 56 percent of women in the menopause transition get less than seven hours of sleep, compared to just 32 percent of those pre-menopause. What’s more, research has linked menopause to less rapid-eye-movement (REM) sleep and less slow-wave (deep) sleep, the stages most critical for memory consolidation and brain repair.

The lack of sufficient sleep—and, in particular, deep sleep—has many downward effects on the brain. “Disrupted sleep leads to irritability, daytime grogginess, and mental fog,” says Dweck. In fact, a January 2025 study in the Journal of Mid-Life Health found that menopausal people who reported non-restorative sleep were more likely to perform worse on cognitive tests over time.

How To Support Your Brain

The cumulative impact of the shifting hormonal landscape of menopause is a cascade of brain-related symptoms. However, these changes do not persist indefinitely. Emerging research suggests that post-menopause, the brain rebounds. And, anecdotally, many people report that their mental clarity and focus return to baseline—or even improve—once hormone levels stabilize. 

Menopausal Hormone Therapy

How to deal in the meantime? One potential route is hormone therapy, also known as menopausal hormone therapy (MHT). This treatment, which involves administration of estrogen alone (in women without a uterus) or, more commonly, estrogen and progesterone, helps to supplement declining hormone levels, explains Gray. This can stabilize some of the hormonal and chemical fluctuations that affect the brain directly or indirectly (via sleep), she says. 

However, it’s important to note that hormone therapy is not for everyone. “Hormone therapy during menopause is not currently indicated primarily for brain health,” says Dweck. Currently, The Menopause Society reports that MRT is only helpful for sleep-induced cognitive symptoms in individuals who experience night sweats, but not in the absence of these symptoms. 

With that, The Menopause Society says it’s essential to work with a menopause practitioner (directory here) or a provider who regularly treats people in this life stage who can help weigh the potential benefits, risks, and timing of treatment to determine whether it’s the right fit for you.

Natural Remedies For Menopause Brain 

Of course, hormone replacement therapy is far from your only option here. On the contrary, the best way to start easing menopause brain is with your daily lifestyle. “With certainty, lifestyle choices like optimizing diet, exercise, sleep, stress management, and social engagement all directly impact the menopause experience,” Dweck says.

1. Move Your Body

On the exercise front, the CDC recommends at least 150 minutes of moderate-intensity aerobic activity (such as running, biking, or swimming) and two to three strength-training sessions per week. This blend of movement not only supports a healthy weight at a time when 50 percent of people notice weight gain, but also “boosts mood due to release of endorphins, feel-good chemicals in the brain,” says Dweck. “Regular exercise also lowers the risk of cardiovascular disease, diabetes, and depression, and enhances immunity, all of which influence the menopause experience,” she adds.

2. Get Serious About Sleep Hygiene 

To scrape together more sleep, dial in your sleep hygiene. “The benefit of making your bedroom a quiet, dark, and cool environment cannot be overlooked,” Gray says. Keeping a consistent bedtime, limiting screen exposure before bed, and avoiding caffeine in the afternoon can also help promote deeper, more restorative sleep, she says. Meanwhile, tools that help regulate body temperature, such as cooling sheets, a bedside fan, an open window, or a chilled gel pillow insert, can all help decrease the intensity of night sweats. 

3. Enlist Supplement Support

Several supplements and herbs can also benefit brain health, either directly or by supporting sleep. For example, research suggests creatine supplementation can improve brain function,” says Dweck. Both a March 2025 study in the Journal of the International Society of Sports Nutrition and an earlier study in Nutrients found that three to five grams of creatine monohydrate per day can support cognition in women across the lifespan, including those in the menopause transition.  

Meanwhile, “magnesium can help directly with sleep,” Gray adds. This mineral promotes relaxation by supporting the production of chemicals that calm the nervous system. Consider taking 200 to 400 milligrams of magnesium glycinate or magnesium citrate in the evening. 

Some botanicals can even reduce night sweats! “Black cohosh, dong quai, and licorice root are herbs that can support better rest by reducing vasomotor symptoms,” Gray says. (“Vasomotor” refers to the constriction and dilation of blood vessels, which contribute to the hot and cold flip-flopping.) Indeed, taking 20 to 40 milligrams of black cohosh extract was shown to reduce the frequency and intensity of hot flashes in menopausal women when taken consistently for several weeks, as reported in a 2023 review in Menopause. 

Before starting any new supplement, both experts emphasize checking with a qualified healthcare provider, particularly one experienced in menopause care. The same menopause-informed clinician suited to help you decide if hormone therapy is for you can also help you determine what supplements and lifestyle interventions will best support your clarity, energy, and mood.