What Is Brain Fog During Perimenopause?

In her late 40s, Gilia Angell began having trouble thinking of certain words and explaining solutions at her job as a UX designer in Seattle.

“I was experiencing momentary lapses of a loss of words, or I’d lose my train of thought. I’d walk into another room and forget why I was there. … At work, I wouldn’t know how to explain something. I’m a person with a deep vocabulary, and I could not access it,” she said.

It was scary and stressful, and Angell worried her job was in jeopardy. “I felt like I couldn’t do my job, and everybody could tell,” she said. “It skewered my work confidence. I couldn’t ask people to wait for me to come up with what I was trying to say—you’re on the spot constantly in meetings.”

Angell began to realize she was experiencing “brain fog,” likely due to perimenopause.

“Brain fog” is a term used to describe a mixture of cognitive symptoms experienced by women around the time of the menopause transition. Brain fog symptoms “most frequently manifest in memory and attention difficulties and involve such symptoms as difficulty encoding and recalling words, names, stories or numbers; difficulty maintaining a train of thought; distractibility; forgetting intentions (reason for coming into a specific room); and difficulty switching between tasks,” according to the 2022 white paper “Brain fog in menopause: a health-care professional’s guide for decision-making and counseling on cognition,” from the International Menopause Society.

“Similar to menopause symptoms more broadly, different people have really different experiences [with brain fog],” said Christina Metcalf, PhD, an assistant professor in the Department of Psychiatry at the University of Colorado Anschutz and a clinical psychologist who sees patients at the university’s Colorado Center for Women’s Behavioral Health and Wellness.

“Some people might be bothered more, for example, with difficulties in memory, like not being able to bring things to mind, having things on the tip of the tongue,” she said. “Other folks might be struggling more with … paying attention, difficulty staying on task or concentrating, or difficulty initiating tasks.”

Dr. Metcalf is conducting research that she hopes will one day lead to evidence-based psychological interventions specifically targeted to women going through the menopause transition who are struggling with their mood and/or cognition.

“There’s so much that we don’t know. As a clinical psychologist, I want to translate what we learned from this research into things that we can implement in practice so we can best take care of people who are going through the menopause transition,” Dr. Metcalf said.

Trauma in Childhood

Dr. Metcalf is also researching whether traumatic events from childhood can worsen cognition during menopause. Such events are called adverse childhood experiences (ACEs) and can include abuse, living with a person who uses drugs or who has a serious mental illness, having a parent who went to prison, or witnessing violence as a child. Experiencing several ACEs can lead to long-term effects on physical and mental health, according to a 1998 landmark study.

In a 2022 study, Dr. Metcalf and colleagues showed that women who had more ACEs might face a “triple threat” of factors—early-life stress and increased inflammation combined with estrogen decline—that could affect their cognition during menopause.

The study showed that perimenopausal women who had exposure to two or more ACEs and had higher inflammation (as measured by a blood test) performed worse on a verbal memory test. In addition, among middle-aged women (not only perimenopausal women) who had two or more ACES and two or more current stressful life situations, higher levels of inflammation were associated with clinically significant depression.

Childhood trauma can affect different areas of the brain, including the prefrontal cortex, hippocampus and amygdala. When girls reach puberty, estrogen production surges. Estrogen is known to be a “neuroprotective” sex hormone—meaning estrogen helps protect brain cells from damage and cellular death.

While more research is needed, Dr. Metcalf hypothesizes that as women reach perimenopause and hormone levels fluctuate, it may reduce some of that neuroprotective value and lead to cognitive challenges.

ADHD-like Symptoms

An area that needs more research is whether there is any connection between menopause and symptoms that seem like attention-deficit hyperactivity disorder (ADHD). Many women report being diagnosed with ADHD only during middle age. Late diagnoses could be a result of more awareness of ADHD, especially in females. But is this actually ADHD?

One aspect of menopause brain fog is inattention or being able to focus on a task. Are some women with a new ADHD diagnosis actually experiencing symptoms of perimenopause? Dr. Metcalf and Pauline Maki, PhD, are both interested in researching the potential link between inattention and other ADHD-like symptoms and perimenopause.

“Recognizing the gap in research in this area, in our recently funded menopause brain study, I think we’re going to be the first group to use ADHD-like tests to see if we see longitudinal (long-term) changes in those women; maybe there’s a subgroup of women who experience those ADHD-like symptoms,” said Dr. Maki, a professor of psychiatry, psychology, and obstetrics and gynecology at the University of Illinois College of Medicine, where she is also director of the Women’s Mental Health Research Program and senior director of research in the Center for Research on Women and Gender.

One of the first studies to examine this potential connection was published in 2015. Researchers gave a stimulant that was used to treat ADHD (lisdexamfetamine) to 32 peri- or postmenopausal women ages 45 to 60 who had new-onset executive functioning problems but had tested negative for ADHD. The women were experiencing difficulties with executive functioning, which is a set of skills that allow you to effectively organize and plan.

The women who took the stimulant every day for four weeks saw a 41% overall improvement in executive function compared with only 17% improvement among those who took a placebo pill (which didn’t have any medication in it).

The women taking lisdexamfetamine (which is sold as Vyvanse) improved in the areas of organization and motivation for work; attention and concentration; alertness, effort and processing speed; and working memory and accessing recall. However, Vyvanse and other anti-depressants are not approved by the U.S. Food and Drug Administration for perimenopausal symptoms and are considered an off-label use.

Feeling ‘Like Myself Again’

Treatment for menopause brain fog can include a combination of healthy living, brain exercises, cognitive behavioral therapy and/or hormone therapy.

“I would just really encourage folks to advocate for themselves with their health care team,” Dr. Metcalf said. “If folks are feeling like their concerns aren’t being taken seriously, or they feel like their provider doesn’t have the right training or enough training in this area, seek out someone who does. … People deserve to feel the best they can, and they deserve to be supported during this really profound life transition.” (Clinicians with menopause expertise can be found through The Menopause Society website.)

To reduce her brain fog, Angell first tried bioidenticals and supplements, but in February 2025 she began using hormone therapy (HT) prescribed by her ob-gyn. Her vocabulary and ability to think on her feet returned. Now, at age 51, she said she feels like herself again. She also recognizes how important sleep is for overall health—she’s now a fan of afternoon naps—and said her overall energy levels have improved.

Before HT, Angell assumed that her loss for words was just a regular part of aging. “I was worried that I was just going to lose brain cells, and I would be more forgetful and less articulate as I aged—because that’s what was happening.”

But as her words returned, so did her confidence. “I now feel at full capacity to articulate myself.”