Menopause brain fog: memory, concentration and what can help

"Brain fog" is not a medical diagnosis. It is a descriptive term for a cluster of changes in thinking: finding it harder to concentrate, losing words or names, walking into a room and forgetting why, or feeling mentally slower than usual. The NHS lists it alongside mood changes and poor memory among the symptoms of perimenopause and menopause, saying you may notice problems with your memory or concentration.

The NHS also makes the point that perimenopause and menopause are different for everyone. Some people have symptoms that have a big impact on daily life, relationships, social life, family life and work, and others hardly have any symptoms at all. Brain fog is therefore part of a wider picture and may not be the only thing you notice.

NICE's menopause guideline identifies symptoms as including changes in menstrual cycle, vasomotor symptoms such as hot flushes and sweats, genitourinary symptoms, effects on mood, musculoskeletal symptoms and sexual difficulties. Cognitive symptoms are not listed as a separate heading there, which is one reason the NHS public advice is the most direct source on this symptom.

The sources used here do not set out a mechanism for brain fog, so no specific cause is stated. What they do describe is a set of connected symptoms. The NHS says memory and concentration symptoms may feel worse if you have sleep problems and feel very tired, and that sleep problems may be worse if you also have night sweats. Night sweats, broken sleep, low mood and anxiety can each reduce concentration on their own.

This matters because treating the factors that feed brain fog may improve it. For example, dealing with night sweats or poor sleep may help thinking during the day, and treating low mood or anxiety can improve concentration.

• Broken or short sleep, particularly with night sweats.

• Low mood, anxiety or stress.

• Hot flushes, palpitations or other distracting symptoms.

• Other health conditions that can affect thinking, which a GP can look for if your symptoms do not fit the menopause picture.

The NHS suggests general measures for perimenopause and menopause that also support thinking: getting plenty of rest and keeping to regular sleep routines, eating a healthy balanced diet, exercising regularly, trying relaxing activities such as yoga, tai chi or meditation, and talking to other people going through the same thing. It advises not smoking and keeping alcohol within recommended limits, as both may affect symptoms.

Practical coping strategies are also widely used, such as writing lists, using phone reminders and calendars, putting keys and wallets in the same place, and doing demanding tasks at the time of day you feel sharpest. These are sensible everyday techniques rather than treatments with trial evidence in the sources used here.

The NHS says that if you have symptoms of perimenopause or menopause you should talk to a doctor, nurse or pharmacist about HRT and other options. Oestrogen is the main type of HRT and can help manage symptoms, and can be taken as tablets or used as patches, spray or gel. If you have not had a hysterectomy it is important to take progestogen as well to protect the womb.

If HRT does not work, you cannot take it or do not want to, the NHS says other treatments are available. For low mood, depression or anxiety caused by perimenopause or menopause you may be offered antidepressants, and for hot flushes and night sweats you may be offered cognitive behavioural therapy. NICE's guideline asks professionals to explain what menopause-specific CBT is and to discuss the options, including face-to-face or remote sessions, individual or group sessions and self-help.

The NHS notes that herbal remedies and complementary medicines such as red clover and black cohosh are sometimes sold for symptoms but there is very little evidence on how well they work or how safe they are, and some may cause serious side effects with other medicines.

The NHS advises contacting your GP if you think you have symptoms of menopause or perimenopause and want to know what your options are. Early advice can help reduce the effects of menopause and perimenopause on your health, relationships and work.

Memory problems that are severe, rapidly worsening, or accompanied by getting lost in familiar places, personality change, difficulty with familiar tasks or confusion about time and place deserve assessment in their own right. The NHS lists memory loss, difficulty concentrating, finding it hard to carry out familiar daily tasks, struggling to follow a conversation or find the right word, being confused about time and place and mood changes as common early symptoms of dementia, and says it is important to talk to a GP sooner rather than later if you are worried about memory problems. A GP can help sort out which explanation fits your own symptoms.

Stroke-like symptoms, such as sudden weakness, facial drooping, speech difficulty or severe confusion, are emergencies and need a 999 call.

The NHS says symptoms usually last 7 to 9 years, sometimes longer, and that they can change over that time, with some symptoms improving and others replacing them. The sources used here do not state how long brain fog in particular lasts, so it is best to think of it as one of the symptoms that is expected to ease as the transition settles, with the caveat that individual experience varies.

Knowing that the symptom is recognised and shared by many people is often reassuring in itself, particularly for people worried that they are developing a serious memory condition.

On the NHS, perimenopause and menopause care starts with a GP, nurse or pharmacist. NICE says menopause should be identified as early as possible so that people get the support they need, and that healthcare professionals should discuss all the treatment options and the benefits and risks of each.

Some people choose a private menopause specialist, often for longer appointments or access to a wider range of options. The principles are the same as on the NHS, and NICE's guidance applies to NHS services. NICE lists charities such as Menopause Matters, the Menopause Charity and Women's Health Concern for further information and support.