Is It Brain Fog or Dementia?
If you're a midlife woman, brain fog is definitely not all in your head.
Posted November 21, 2024 | Reviewed by Jessica Schrader
Waking up feeling off. Fuzzy, unfocused thoughts.
Processing everyday, mundane information is painfully slow and effortful, much like slogging through mud. Not to mention, that typically reliable jolt of morning caffeine? Utterly ineffective.
Welcome to perimenopausal brain fog . Though it does originate in the brain, it is definitely not all in your head.
Brain fog, also referred to as mental fatigue or subjective cognitive decline , is actually a change in brain energy—not a deficiency. According to recent statistics, 60% of perimenopausal women will experience it.
Brain fog can present as: forgetfulness; feeling spacey, sluggish, mentally fatigued; difficulty concentrating; processing slowly; a sudden inability to multi-task; and the inability to retrieve desired words.
What causes brain fog?
Though little research has been conducted on perimenopausal brain fog, what we do know is that erratic fluctuations in estrogen levels during the perimenopause transition play a large role.
Estrogen receptors are located all over women’s bodies, including in the brain. Parts of the brain responsible for memory and other cognitive functions—the hippocampus and prefrontal cortex—are affected, directly impacting the ability to recall or process information.
Chronically disrupted sleep , common in perimenopause, along with higher stress levels, can also play contributing roles.
Is it brain fog or dementia?
When brain fog hits, women may worry they are starting to experience dementia . The difference between the two is that whereas dementia progressively worsens, brain fog is intermittent and does not interfere with one’s fundamental ability to function in daily life.
Brain fog demands more effort and energy, but the ability to recall information eventually returns. With dementia, the recall ability does not.
It may be heartening to know that, according to research, even when experiencing brain fog, the average woman outperforms men on certain cognitive tests. Though the discrepancy in functioning can feel significant, it is often not as perceptible to those around us.
Thankfully, brain fog is temporary and for the typical woman, brain energy eventually stabilizes, ushering in a new postmenopausal norm. Our brains are fantastically resilient .
What can we do about it?
Seek out a menopause-informed provider. Well-meaning, but uninformed, health care providers might dismiss or minimize brain fog as a result of normal midlife stress, overwhelm, or “a lot on your plate.” If you are experiencing symptoms, trust that you are the expert on your own body. Keep advocating for yourself.
Get informed about menopause hormone therapy (MHT). Due to the lack of research on brain fog, MHT is not recommended to prevent or treat it, although some clinicians do advocate for it. According to Lisa Mosconi, researcher and author of The Menopause Brain , “there is evidence that estrogen therapy started during perimenopause or early menopause can support and even enhance some aspects of cognition , primarily memory.” Future research will hopefully provide more evidence-based directives.
If you are also experiencing hot flashes, night sweats, or certain other troublesome symptoms, in addition to brain fog, however, MHT can be a highly effective treatment.
Rule out other causes such as sleep apnea, diabetes, thyroid disease, or medication side effects. If you have a family history of dementia, you may want to see a specialist for baseline testing.
Assess mental health. Screen for anxiety and/or depression . Seek therapy when appropriate.
Write it down. Make lists. Keep reminders. Get the information out of your mind and onto paper when possible.
Practice healthy lifestyle habits to lessen brain fog (while boosting overall health and longevity)
Eat nutrient-dense food. A Mediterranean diet high in protein is recommended. Decrease alcohol , sugar, and caffeine. Note how certain foods make you feel and adjust accordingly; this can change in perimenopause.
Name and reframe. How we think about brain fog matters. Instead of adding worry and frustration to an already challenging situation, remind yourself brain fog is temporary and understandable (which is different than minimizing or dismissing).
Ultimately, know that, although brain fog is not entirely under our control, there are steps we can take to cope and more easily ride out this often challenging phase of life.
To find a therapist, please visit the Psychology Today Therapy Directory .
Gunter, Jen, MD. (2021). The Menopause Manifesto. New York, NY: Citadel Press Books.
Haver, Mary Claire, MD. (2024). The New Menopause. New York, NY: Rodale Books.
Mosconi, Lisa, Ph.D. (2024). The Menopause Brain. New York, NY: Avery.
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Shonda Moralis, MSW, LCSW, is a psychotherapist and the author of Breathe, Mama, Breathe and Don’t Forget to Breathe.
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This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.