You walked into the kitchen to do something, but now you can’t remember what it was. Or you feel scattered and you’re having trouble focusing on one work task at a time. These are often classic experiences during midlife. Are they just normal signs of a busy life—or symptoms of serious brain changes?
Brain fog in menopause
Brain fog is difficult to define because it expresses itself in a variety of ways. You may identify with some of these examples: (1)
- Losing your train of thought
- Forgetting the words for common objects
- Blanking on familiar people’s names
- Slower processing of information
- Difficulty making decisions
- Losing things like your phone or keys
- Forgetting appointments
- Having a hard time focusing
- Decreasing ability to multitask
- Feeling like your work performance is slipping
If you’ve experienced brain fog, you know it’s real—not just all in your head. Well, it actually IS in your head. But there’s real proof that our brains change in midlife.
Brain changes in midlife
Sex hormone imbalance, especially low estrogen and low testosterone, is a common cause of cognitive changes in women. Research using brain imaging shows that menopause impacts the structure and function of the female brain. Scans show measurable changes in gray matter, white matter, and glucose metabolism. (2)
In another study, brain imaging showed decreased brain activity in perimenopausal and postmenopausal women compared with premenopausal women. (3) Yikes! (Don’t lose hope. Keep reading to learn how hormone replacement therapies may help.)
Estrogen helps the brain communicate. Testosterone helps with thinking and processing information—things that help us perform better at work. And don’t discount progesterone, which supports sound sleep, and in turn, brain function. (1)
It’s no wonder that midlife creates an identity crisis for some women. When cognitive issues affect mood, sleep, work, and relationships, it’s hard not to feel frustrated and question our capabilities.
And deep down, brain fog makes us fear the “D” word: dementia.
Brain fog vs dementia
When brain issues crop up, the first thing many women wonder about is dementia. But having brain fog or memory issues in midlife does not necessarily mean you have dementia or that you’ll develop it down the road. In fact, for some women, brain fog and other cognitive symptoms in perimenopause may normalize after the transition to postmenopause. (1)
The differences between brain fog and dementia center around timing, awareness, and function. (1)
Timing: Brain fog is intermittent, coming and going depending on the day. You might have trouble remembering someone’s name one minute and then do a great job on a work project for the next hour. Dementia doesn’t come and go. It’s progressive with worsening symptoms over time.
Awareness: When you have brain fog, you’re aware that you can’t recall a word or name. People with dementia typically aren’t aware that they’re having cognitive symptoms.
Function: Perhaps the most significant difference is that with dementia, there’s a decline in function around the activities of daily living, like preparing meals, maintaining a home, and taking care of personal hygiene. With brain fog, you might forget to buy eggs when you specifically went to the grocery store for all the ingredients to bake muffins. Brain fog can be frustrating and can affect your life in significant ways, but it doesn’t impact your ability to perform normal, daily activities (like actually baking the muffins).
Early perimenopause and dementia risk
Research suggests that a later onset of menopause may be protective for brain health because of the longer exposure to estrogen and progesterone. So being older when you hit menopause may be better for the brain. (1)
Alternately, for women who experience perimenopause at a younger age, the body is exposed to estrogen for a shorter time. Since estrogen is the mastermind behind brain energy metabolism, its role can often be compromised prematurely. This earlier decline in estrogen may put women at risk for a variety of brain health issues, including cognitive disorders and dementia. (1,4)
Interventions to help brain fog and impact dementia risk
We may not be able to control when our bodies begin perimenopause, but we can advocate for ways to improve our own wellness. Women in perimenopause, especially those with POI, may benefit from choosing a caring provider who can identify and address midlife cognitive issues.
Some clinicians support patients with brain fog by addressing vitamin deficiencies like B-12, and using supplements such as omega-3s. Adding customized compounded therapies may provide significant support for brain health.
Our Belmar pharmacists and your doctor can work together to create compounded solutions that fit your needs, including:
- Bioidentical hormone replacement therapy (BHRT) with estrogen, progesterone, and/or testosterone
- NAD+ (nicotinamide adenine dinucleotide) therapy that may
- Glutathione nasal spray that can protect against oxidative stress and detoxify the brain.
- Sermorelin acetate, a growth-hormone-releasing hormone that supports brain function
- Low dose naltrexone that can reduce neuroinflammation to help with brain fog (5)
Supporting hormonal fluctuations with BHRT can be associated with a lower risk of dementia. The type of hormone replacement matters here: The impact of bioidentical progesterone and estrogen is particularly important in cognitive research. Evidence suggests that starting bioidentical hormones early—in perimenopause—may provide significant benefit for the brain.
Having a brain that’s firing on all cylinders is critical for your happiness and overall wellness. Ask your provider about ways to support your brain health in midlife and beyond.
References:
1. DeRosa A, Noonan RG, Crane A. Why menopause matters to the brain. Belmar Pharma Solutions clinician webinar. August 21, 2025.
Link: Why Menopause Matters to the Brain! – Belmar Pharma Solutions
2. Mosconi L, Berti V, Dyke J, Schelbaum E, et al. Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Sci Rep. 2021;11(1):10867. doi: 10.1038/s41598-021-90084-y
Link: Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition – PMC
3. Mosconi L, Berti V, Guyara-Quinn C, et al. Perimenopause and emergence of an Alzheimer’s bioenergetic phenotype in brain and periphery. PLoS ONE. 2017;12(10):e0185926.
https://doi.org/10.1371/journal.pone.0185926
Link: Perimenopause and emergence of an Alzheimer’s bioenergetic phenotype in brain and periphery | PLOS One
4. Sochocka M, Karska J, Pszczołowska M, Ochnik M, Fułek M, Fułek K, Kurpas D, Chojdak-Łukasiewicz J, Rosner-Tenerowicz A, Leszek J. Cognitive Decline in Early and Premature Menopause. International Journal of Molecular Sciences. 2023; 24(7):6566. https://doi.org/10.3390/ijms24076566
Link: Cognitive Decline in Early and Premature Menopause
5. Lebsock S. The lowdown on LDN. Belmar Pharma Solutions clinician webinar. March 4, 2025.
Link: The Lowdown on LDN – Belmar Pharma Solutions
