Memory Loss During Menopause: Causes, Symptoms, Treatments

Once upon a time, I was smart. That was me sitting front and center at the seventh-grade spelling bee. I aced organic chemistry in college. At cocktail parties, I remembered people’s names and engaged in witty banter. I could read a map.

Today, at 49, I can barely remember the word for wallet (“Has anyone seen my…you know…that thing that holds all of the things…you use it to pay?”) and rely on several dozen daily Apple watch alarms to ensure I don’t forget to go to work, pick my kid up from soccer practice, and pull the broccoli out of the oven before it bursts into flames.

This is a frequent refrain among women in perimenopause, says Kathleen Jordan, MD, Chief Medical Officer at Midi. 

“Most women in midlife, when asked, confess to some moments of brain fog, although they report it at different levels of severity,” says Dr. Jordan. “They are juggling a million things like they always have: running departments and households, yet now it can be tricky to recall simple things, like the name of their neighbor or the movie they saw last week.”

Brain fog, which Dr. Jordan describes as “mental sluggishness, with all the capabilities still there but slow to emerge at times,” is a prevalent symptom of perimenopause and menopause. Thanks to the well-cemented link between reduced estrogen levels and memory decline, we know that an uptick in memory flubs in your 40s and 50s is expected. We also know that fractured sleep, anxiety and depression, and runaway stress levels—all common in midlife—further compromise cognitive function.

It’s annoying. And, the truth is that despite my being 90% certain these cerebral glitches fall under the umbrella of menopause memory loss, the inability to string together a coherent sentence is starting to feel worrisome.

“Many women, myself included, experience brain fog when they reach midlife and fear it could be dementia,” says Joanna Strober, CEO and co-founder of Midi Health. “I was convinced in my mid-40s that I was developing Alzheimer’s.” (Good news: It wasn’t that.)

Does menopause cause memory loss? For many women, yes. But we also know that hormonal and nonhormonal treatment options exist to help de-fog your mind and get you back to feeling more like yourself.

The first step to tackling “meno brain” and remembering the name of your dog, once and for all: understanding how the powerful hormonal twists and turns of perimenopause influence your brain.

Understanding the Neuroendocrine Transition

Estrogens are wonderfully neuroprotective hormones, meaning they help safeguard brain health. “Women have estrogen receptors in many regions in the brain,” explains Jill M. Goldstein, PhD, MPH, a professor of psychiatry and medicine at Harvard Medical School and founder and executive director of the Innovation Center on Sex Differences in Medicine at Massachusetts General Hospital. That includes regions of the brain responsible for regulating mood, temperature, sleep, pain sensitivity, and yes, memory. When levels of estradiol—the primary form of estrogen that drives brain function—start to fluctuate and decline in perimenopause, so do the functions associated with those brain regions, like the memory-governing hippocampus. 

A few reasons estradiol is so intimately tied to memory:

Estradiol helps regulate glucose, the brain’s favorite fuel.

Glucose, a type of sugar, is the brain’s primary fuel, feeding neurons and stoking brain metabolism. Estrogen receptors are involved in glucose regulation, so when they’re deprived of the estrogen they need to function, it impacts the amount of fuel in the brain. (Dr. Goldstein says women lose up to 25% of their brain glucose during the menopausal transition.)

Estradiol spurs the formation of new brain cells.

Despite feeling like everything is going downhill, it’s not! Consider this: neurogenesis—aka the formation of new neurons, or brain cells—is still possible in several brain regions as we age, particularly in the hippocampus. But neurons require numerous ingredients to reproduce and grow, a number of which are regulated by… You guessed it! Estradiol.

Estradiol also promotes the expression of a memory-friendly growth factor called brain-derived neurotrophic factor (BDNF). BDNF stimulates new brain cell formation and supports the connections between neurons, called dendrites, which help us retain knowledge and cement memories into place. 

Higher levels of BDNF are linked with improvements in certain types of memory in postmenopausal women, including associative memory. This is the ability to remember something when it is associated with something else, such as linking names to faces or music to song titles.

Then there’s estrogen’s sister sex hormone, progesterone. This also factors into what causes memory loss and forgetfulness in midlife. For example, Dr. Goldstein notes that a brain region involved in memory and executive functioning, called the dorsolateral prefrontal cortex, “is regulated not only by estradiol but by progesterone, too.” 

Progesterone’s waxing and waning during perimenopause and its decline in menopause is associated with menopausal symptoms such as brain fog and short-term memory challenges, along with mood shifts and hot flashes.

Common Cognitive Changes During Menopause

For some women, meno brain means a hard time remembering certain words or slowed processing speed—in other words, trouble keeping up with a fast-paced conversation. For others, it’s difficulty concentrating or overall fuzzy thinking.

For New York City–based comedian Alyce Chan, age 49, the word-finding trouble can strike anywhere, from home (she recently summoned her kids to dinner by calling out, “The laundry is ready!”) to work, where she’s been known to forget a joke or two onstage, admitting to the audience, “Sorry guys, I’m in perimenopause.” 

Atlanta journalist and author Kate Rope, age 52, recalls a recent double-doozy: “At my gym, I called another member—someone I’ve worked out with for several years—by the wrong name. I apologized, but what I ended up saying was, ‘I’m so sorry, it’s the meri-penomause.’ We both cracked up, and then she joked, ‘That should be the title of your next book.’” (As Rope relayed this story to me over the phone, she attempted to leave and lock her car, not realizing she’d accidentally left it running.)

Chan and Rope can laugh about their forgetfulness, but for Victoria McHugh, age 49, of Lake Geneva, Wisconsin, menopause took such a toll on her brain that “it felt disabling. I used to be able to handle all of the moving pieces of my life, but suddenly it took every ounce of focus and concentration to get anything done.” 

As a therapist who sees patients Mondays and Tuesdays, McHugh says, “the cognitive effort it took me to get through just those days of work meant Wednesday was a wash. I couldn’t do anything—not even send an email. My brain and body felt disconnected. And then my mood was shitty because I couldn’t do the things I thought I should be doing.”

When Australian researchers surveyed 417 women ages 41 to 61 about their midlife memory challenges, several trends emerged. Nearly half of the perimenopausal women surveyed said they tripped over tip-of-the-tongue moments at least once per day; over one-third reported having to double-check whether they’d done something they were supposed to do at least once daily. Losing things around the house and reading a book or magazine without realizing they had already read it were common, too. 

Other surveys reveal that women’s careers frequently take a hit during midlife as perimenopausal symptoms like poor concentration and flagging memory tax women’s performance and productivity. 

What Else Causes Memory Loss and Forgetfulness?

Other memory bandits:

• Poor sleep: Night sweats, stress, and other midlife symptoms (insomnia, restless leg syndrome, sleep apnea, etc) leave nearly half of U.S. perimenopausal women struggling with sleep. Post-menopause, that number rises to 60%. Fractured sleep does more than turn you into Oscar the Grouch; it can worsen cognitive symptoms like brain fog and cloudy focus.
• Stress: Between work, relationships, the demands of children or aging parents, and the turmoil of current events, many women find their stress levels surge during midlife. Anxiety is a massive memory suck, consuming mental energy and leaving less room for memory and focus. Stress can also increase cortisol levels, triggering overall inflammation and “creating a bit of havoc on cellular and cognitive functioning,” says Dr. Jordan.
• Mood changes: As estrogen bobs and weaves in midlife, so do mood-regulating brain chemicals like serotonin and dopamine, both of which use estrogen as a building block. This leaves women vulnerable to perimenopausal mood shifts, depression, anxiety, and chronic overwhelm—as many as 70% of women experience mood fluctuations during the menopause transition. Depression impairs both working memory (which allows you to temporarily retain limited amounts of info for immediate use, like when reading a book or carrying on a conversation) and verbal memory (which allows you to pull up the right word when you need it). 

Thyroid disease, drug and alcohol abuse, low levels of certain vitamins and minerals, and some medications can also contribute to midlife memory loss. 

Some Reassuring News About Menopause and Memory Loss

Now for some encouraging news: The odds are extremely high that your word retrieval issues and sluggish processing speed are not early dementia. Though dementia is a concern later in life for women, “for women in their 40s, 50s, and 60s, dementia is rare,” says Dr. Jordan. “Chances are this is not ‘the beginning of the end,’ as some fear, with plenty of easy and actionable measures to feel like your more confident self.”

More heartening info: Dr. Goldstein says most women experience a bounce-back in memory postmenopause. Research from the Study of Women's Health Across the Nation (SWAN) indicates that the hits to cognitive performance felt by so many midlife women “may be time-limited,” as evidenced by the fact that “improvement[s] rebounded to premenopausal levels in postmenopause.”

Still, women do have a greater lifetime risk for dementia compared with men. This may be linked with menopausal loss of neuroprotective estrogen and is all the more reason to do what you can to shore up your cognitive reserves now, or the brain’s ability to withstand cognitive decline that’s associated with aging. This can include making lifestyle changes (more on that below), engaging in social interactions regularly, and challenging your cognitive skills with games.

​​What to Take for Memory Loss During Menopause

When you book a virtual visit with a menopause specialist through a platform like Midi, you’ll be invited to share your cognitive concerns, including when your symptoms started, how they manifest, how much they trouble you, other midlife symptoms that may be contributing to your brain fog (like sleep-sapping night sweats), and more.

If your challenges are consistent with typical brain fog symptoms, your clinician will discuss evidence-based tools that can help improve any contributing factors (such as easing intense anxiety or improving your sleep). This “often includes a combination of lifestyle adjustments, hormones, and/or supplements,” Dr. Jordan says.   

Lifestyle Strategies 

Even small tweaks to your nutrition, sleep hygiene, and exercise routine can have big ripple effects. The following strategies can help clear away some of those midlife cobwebs while helping protect your cognition in the long run:

Nutrition 

Diet-wise, following an anti-inflammatory Mediterranean-style diet is an excellent brain-health strategy. Focus on plant-forward meals that incorporate lots of veggies, fruits, whole grains, nuts, beans and legumes, and healthy fats like olive oil, plus small amounts of lean fish and protein. 

A more intense version of the Mediterranean diet, called the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet, protects brain health even more by combining the most neuroprotective components of the Mediterranean diet with the DASH (Dietary Approaches to Stop Hypertension) diet. That means prioritizing leafy greens, berries, nuts, beans, whole grains, olive oil, and fish, while limiting red meat, cheese, sweets, fried and processed foods, and butter.

Exercise 

Getting your heart pumping regularly floods the brain with oxygen-rich blood, which may help ease brain fog. There’s also evidence that exercise fights inflammation and promotes the growth of new blood vessels in the brain, improving memory, learning, and overall brain health. Specifically, exercise triggers BDNF production, in turn increasing the number of neurons in the hippocampus.

Sleep 

“I can’t emphasize enough how important sleep is for total body health and brain health,” says Dr. Jordan. Cultivating sleep-friendly habits can help you snag more restful sleep, such as cutting back on caffeine and alcohol; keeping your bedroom cool, dark, and tech-free at night; maintaining a consistent sleep-wake schedule; and making daily exercise a must. 

Hormone replacement therapy (HRT) 

HRT, in the form of supplemental estrogen (plus progesterone if you still have your uterus), can help relieve brain fog, word-retrieval difficulties, and other hormone-related midlife memory challenges by tackling the core issue: declining estrogen levels. By adding back just a fraction of the estrogen you’ve lost in perimenopause and menopause, HRT can help clear away some of the mental mist and get you back to viewing your brain as a friend, not a foe. (Because HRT only replaces a small amount of hormones, it is often now referred to hormone therapy, or HT, instead of HRT.) 

There’s also some evidence that supplementing estrogen levels at midlife may protect your brain from dementia and other cognitive diseases in the long term. “But the timing matters,” Dr. Goldstein says. “HT can have a positive impact when initiated during late perimenopause—the roughly 4 years before menopause—or the first few years following menopause. However, studies have found that initiation during later menopause (i.e., several years postmenopause) can have deleterious effects on the brain and increase risk for disorders of aging such as Alzheimer’s disease.”

Available in pill, patch, cream, or gel form, your HRT dose will be personalized according to your health history and symptoms. 

Nonhormonal Supplements

HRT isn’t for everyone, though. For instance, some women aren’t candidates due to a history of stroke or certain types of blood clots, some types of heart or liver problems, or cancer that might be stimulated by hormones (including some kinds of breast and uterine cancer). Other women simply prefer to avoid hormonal supplementation. 

If that’s the case, you still have lots of options. The following supplements have a solid safety record, and though more research is needed to confirm their effectiveness with menopausal brain fog, we at Midi consider them viable options:

Creatine 

You probably think of creatine as a muscle-building supplement—and it is!—but this amino acid–based compound acts as a natural energy source for your brain, too. 

“There’s mounting evidence that, by supporting women’s brain, metabolism, mood, and energy, creatine can help with brain fog,” says Dr. Jordan.

Midlife women using creatine supplements often report a boost in cognition, “possibly by restoring brain energy levels and homeostasis,” Dr. Jordan says.

Vitamin B12

There are eight B vitamins—often grouped together as the B complex—and they’re essential for everything from keeping your cells healthy to supporting your brain and nervous system. B6, B9, and especially B12 are key players when it comes to mental clarity, energy, and cognitive function. When you're low on these nutrients, brain fog, forgetfulness, and sluggish thinking can start to creep in.

Vitamin B12, in particular, is worth paying attention to. The methylcobalamin form is the one most easily used by the body, and research has linked low B12 levels to changes in the brain’s white matter—something that can impact memory and processing speed. One study from UCSF found that older adults with lower B12 had more brain changes tied to cognitive decline. The upside: Research suggests that starting B vitamin supplements early and staying consistent may help preserve memory and keep your mind sharp over time.

Choline

Choline is one of those essential nutrients that doesn’t get nearly enough attention—yet it plays a vital role in brain health. Found in every cell in the body, choline is especially important for memory, learning, and overall cognitive function. It helps produce acetylcholine, a key neurotransmitter that supports communication between brain cells and is directly tied to memory and recall. In fact, research shows that a loss of cholinergic neurons is linked to cognitive decline, including conditions like Alzheimer’s disease.

The good news? Getting enough choline has been associated with better cognitive performance, including sharper thinking, better verbal and visual memory, faster processing speed, and a lower risk of age-related memory loss. Our bodies only make a small amount of choline on their own, so it’s important to get the rest through diet or supplements. Plus, postmenopausal women tend to need more choline, according to research. A decline in estrogen impacts the body's ability to produce the nutrient.

CoQ10  (Coenzyme Q10)

Like choline, CoQ10 is present in every cell in our bodies. It’s a powerful antioxidant that plays a key role in cellular energy production, particularly in the brain, where energy demands are high. CoQ10 supports the mitochondria—the energy powerhouses of cells—helping to fuel mental processes like focus, recall, and cognitive endurance. As we age, natural levels of CoQ10 decline, which can impact brain function and contribute to mental fatigue or memory lapses.

Research suggests that CoQ10 supplementation, via food (like salmon, eggs, and whole grains) or pill, may help protect brain cells from oxidative stress, which is linked to cognitive decline and neurodegenerative diseases like Alzheimer’s disease.

Ashwagandha 

This shrub has been used for thousands of years in Ayurvedic medicine and is considered an adaptogen, meaning it improves your ability “to resist, adapt, or become resilient” to stressors, per the National Institutes of Health (NIH) Office of Dietary Supplements. (Constantly wondering, “Is it menopause brain fog or dementia?” sure sounds like a stressor to us.) 

Ashwagandha contains compounds that many researchers believe enhance brain health, improve sleep, and act as a buffer against stress. In a 2021 clinical study, women who supplemented with 300 milligrams (mg) of ashwagandha daily for 90 days experienced improvements in three cognitive domains—visual memory, new learning, and working and sustained attention—compared with those who took a placebo. They also experienced improvements in sleep quality and overall psychological well-being, as well as a greater sense of control over their stress.

Vitamin D 

Research shows that vitamin D deficiency leaves people more vulnerable to cognitive decline and dementia as they age. More than one-third of Americans have low levels of this fat-soluble vitamin, which can be challenging to obtain via food alone (fortified milk, fish, and mushrooms are some sources). So supplementation often makes sense.

New NIH-funded research suggests that vitamin D supplementation may do more than support brain health. It may also increase health span by strengthening telomeres, the protective caps at the ends of chromosomes that naturally shorten with age and are linked with the development of certain diseases. The long-term, randomized study of 25,871 Americans (including women ages 55 and up and men ages 50 and up) showed that supplementing with 2,000 IU/day of vitamin D3 for 4 years significantly reduced telomere shortening, “preventing the equivalent of nearly three years of aging compared with placebo.” 

Let your clinician know if you’re interested in trying these or other supplements, either on their own or in combination with HRT. They can guide you in terms of dosage and potential side effects.

If your Midi clinician has any concerns about early-onset dementia, they will arrange for you to complete a medically validated online screening test called Neurotrack. If the screening suggests something more concerning is at play (like mild cognitive decline, a common precursor to dementia), your Midi clinician will help direct you to a memory expert for additional evaluation. 

But again, for the overwhelming majority of women, midlife brain fog is temporary, is not indicative of dementia, and will, in fact, improve over time.

Key Takeaways

• Brain fog and other memory challenges during perimenopause and menopause are common—with a range of causes, including hormonal changes, stress, and poor sleep. These memory troubles are also treatable.
• We know it can feel concerning, frustrating, or even scary that something more serious is brewing. Rest assured that these changes are almost always temporary and rarely a sign of dementia.
• Fight back against menopause brain fog with effective everyday strategies, including improving your nutrition and sleep habits; building exercise into your day; and using science-backed, brain-supportive supplements.
• To help moderate the hormonal changes that may be contributing to your memory challenges, HRT may be right for you. A good first step: Discuss your individual needs and concerns with a Midi clinician or other healthcare professional, who can help you understand what’s normal, what’s not, and what you can do to feel sharper and more like yourself again.