Brain fog during menopause overlooked and understudied, say researchers

Cognitive changes resulting from menopause need a ‘unified definition’ and further research, according to a new study.

Although brain fog affects two-thirds of women during menopause, cognitive symptoms such as forgetfulness and reduced concentration are still poorly recognised and under‑researched, says a paper in The Lancet Obstetrics, Gynaecology, & Women’s Health.

The authors are calling for a unified definition of menopause‑related cognitive changes and for prospective, longitudinal studies that can track women from pre‑menopause to post‑menopause.

They say that a better understanding of the biological, psychological and social factors that contribute to cognitive symptoms will be crucial for developing effective treatments.

Professor Aimee Spector, co-author of the paper, said: ‘Cognitive symptoms such as forgetfulness and ‘brain fog’ are incredibly common during menopause, yet they are often overlooked.’

‘Our findings highlight just how complex menopause‑related cognitive symptoms are, and how much we still don’t know about what drives them. More targeted research is essential if we are to identify which biological, psychological or lifestyle factors contribute most, and what types of support or treatment are likely to be effective.’

Dr Caroline Gurvich, lead author and professor at Monash University in Melbourne, said: ‘There’s a lot of pressure to use objective measures of cognitive decline, like a memory test, for example, in a clinical trial, but the key symptom of brain fog is a subjective experience. So having a definition that acknowledges the key cognitive symptom is critical.’

The paper states that more than two‑thirds of women report difficulties with memory or concentration over the menopause transition, and that multiple factors may contribute to these cognitive symptoms, including hormonal changes, sleep disturbances and psychological and psychosocial stress.

The authors emphasise that overall cognitive performance for women who experience menopause-related brain fog typically remains within expected ranges and, importantly, that cognitive symptoms are not linked to an increased risk of dementia.

The review also discusses a range of approaches that may ease cognitive symptoms, such as improving sleep quality, engaging in regular aerobic exercise and eating a balanced diet.

Researchers from Australia and the UK, including one from University College London, reviewed the available evidence on menopause-related cognitive symptoms and published their findings as a personal view article.

This perspective piece comes as the UK government announced the launch of a renewed Women’s Health Strategy on 14 April, aiming to bring about wide-ranging reforms in women’s healthcare.

Health and social care secretary, Wes Streeting, said: ‘It’s clear the [current] system is failing women. Women’s voices must be central to delivering effective, respectful and empathetic care. Today’s renewed strategy will tackle the issues women face every day and ensure no woman is left fighting to be heard.’

Dr Sue Mann, NHS England’s clinical director for women’s health, said: ‘Too many women are still dismissed for serious symptoms that impact on every part of their lives, whether that’s menstrual pain, irregular periods, or hot flushes and brain fog that affect many women experiencing the menopause.’

‘The renewed women’s health strategy will build significantly on the work the NHS has been doing to ensure women are heard and get the specialist care they need.’

As part of this renewed strategy, it was announced that clinical pathways for menopause have been redesigned to speed up diagnosis and treatment. Additionally, NHS Online aims to support women with menstrual and menopausal symptoms.

Furthermore, from this year, the standard NHS Health Check offered to all adults aged 40 to 74 will also include a question about menopause symptoms, giving up to 5 million women an easier route to advice and support.

A version of this article was first published on our sister title, The Pharmacist.