Everything You Need to Know About Menopausal Brain Fog

More than 60 percent of women experience brain fog at some point during perimenopause or menopause, says Dr. Lisa Mosconi, neuroscientist and author of The Menopause Brain (out March 12). When women experience this brain fog, they often fear that it’s a sign of something worse. “Many women are terrified that they’re developing early-onset dementia,” she says. “But menopause is a neuroendocrine transition — it’s a phase of life impacting your brain as much as your ovaries.” In this week’s issue of PEOPLE, Dr. Mosconi answers our questions about this common, frustrating symptom.

What causes brain fog?
“Your risk of having brain fog is higher if you have night sweats and disturbed sleep, but it’s beyond that. Physiological changes in the brain in response to fluctuating hormone levels include inflammation, changes in the amount of neurotransmitters produced, changes in oxygen levels and glucose metabolism. This all impacts cognition. I want women to know, ‘You are not losing your mind. It’s not all in your head.’ Your brain is undergoing a transition and a transformation. The brain is actually rewiring itself during menopause.”

How are women affected?
“Hormonal brain fog feels like your brain is exhausted even when your body is not. Reduced focus, memory lapses, difficulty concentrating, shorter attention span, overall forgetfulness, grappling for the right words. Also, women are fabulous multitaskers in general, but a simple multitask like answering the phone while typing can become challenging. I’d love women to realize that even during menopause, when you feel like your performance is not nearly as good as it used to be, the average woman still outperforms men of the same age and educational level [on cognitive tests].”

How do you know if it’s something more serious?
“If it doesn’t go away, and you’re otherwise healthy, I recommend a cognitive test. We can do a standardized test called a MoCA, and it’s reassuring to a lot of people. For women with a family history of Alzheimer’s who are worried, I’d do a brain scan. But you can’t just go to your doctor and ask for one. You may need to join a research program or an Alzheimer’s prevention clinic.”

Can brain fog be treated?
“Estrogen is a neuroprotective hormone,” says Dr. Mosconi, whose book is out March 12. “It keeps your brain active.” We’re exploring hormone replacement therapy [HRT]. There isn’t a ton of research yet . . . but we’re seeing it can improve cognition. While brain fog isn’t an FDA-approved indication for HRT, some providers offer hormones when brain fog is together with other symptoms like hot flashes. But exercise is the first line of attack. It’s good for brain health and is linked with a reduced risk of dementia. Diet is number two. So especially diets that support gut health, because the microbiome can influence your cognitive health and your mood. And we know that having GI issues can trigger brain fog. You want to have fiber. You want to have indigestible carbohydrates like oligosaccharides that are food for the microbes in your gut. You want to have prebiotic and probiotic foods. And all of these wonderful nutrients come from plants. So a plant-forward diet, I’m not saying vegan, vegetarian. Just up your plant game. It’s also important to do it during menopause because fiber has an important regulatory effect also on estrogen levels.”

Will it end?
“The cognitive changes are usually temporary. Brain fog can last a couple of years after the final menstrual period. But then it resolves for the vast majority. The clouds dissipate, and your brain is back on. And on average, postmenopausal women are happier than their younger counterparts. You appreciate yourself better. You know yourself better. You have less patience for a lot of nonsense. And studies have shown that a part of your brain that’s called the amygdala changes its activity pattern. The amygdala is the center of our emotional regulation, and it’s that part that makes you very happy when something happy happens to you. It makes you really cranky when something annoying happens to you. After menopause, the negative part of the amygdala is turned down. So it will still make you very happy to happy things, in response to happy things, but negative things will not bother you as much. And I think that that is really a plus.The menopausal brain goes through hell, but it’s likely to emerge wiser, stronger and more content.”

For more from Dr. Mosconi on menopausal brain fog, pick up the latest issue of PEOPLE, available now.