Free Women Q&A · Brain and mood
Walk into a room and forget why? Lose a word you use every day? That's brain fog, and it's real. The leading explanation is that fluctuating estrogen makes the brain areas for memory and words work harder, and poor sleep, hot flashes and anxiety pile on. Your test scores can look normal while you feel anything but [1]. For most women it settles, and there is plenty to try.
A place to start
Lifestyle options
Clinical options
What may be going on
Several things stack up at once, and they can feed each other. Here is what we know about each.
Estrogen acts on parts of the brain that handle memory, attention and finding words. In perimenopause it fluctuates and declines rather than simply falling, so those areas keep having to adjust. This is the leading explanation, but the evidence for it in women is still limited.
What we can see: there is moderate evidence that women in perimenopause don't get the usual practice boost on repeated memory tests, and that it comes back after menopause [3]. Average scores stay within the normal range, with small dips in learning and recalling words [2]. Yay, it does improve after menopause.
But that doesn't mean we should dismiss it. When we are so used to thinking clearly and getting sh*t done, brain fog makes us doubt ourselves, doubt our abilities and think we are getting old. We're not, but we can try some things to reduce the brain fog.
Night sweats and hot flashes break up sleep, and a tired brain is slower at paying attention and remembering. There is moderate evidence that broken sleep and frequent hot flashes are both linked to memory difficulties at this stage [2].
Estrogen also influences the brain's mood chemicals, including serotonin. When it fluctuates, some women become more sensitive to stress and more prone to anxiety and low mood. Again, this is the leading explanation, and the evidence is limited. It isn't proven for every woman.
What we can see: there is moderate evidence that women who started out with little anxiety were more likely to report a lot of it in perimenopause and after menopause [4]. And there is strong evidence that depressive symptoms are more common in perimenopause, with about 40% higher odds than before it [5]. Both measure symptoms, not diagnoses.
If you have always been the person who gets it right, noticing a slip can feel like proof that something is badly wrong. Worry, worse sleep and more slips may feed each other. We didn't find a study that tests this in menopause, so the evidence is unclear. It is a fair question, not yet a finding.
No. Brain fog is not dementia. It can manifest itself in many different ways including dissociation, fatigue, forgetfulness and excessive cognitive effort which can make tasks harder and slower, but they stay doable, whereas dementia progresses and disrupts daily life. There is moderate evidence that most women do not develop dementia from brain fog, though researchers are still studying whether perimenopausal brain fog says anything about risk much later in life [2].
You are not alone
You are not alone at work in experiencing brain fog, feeling anxious about going to work, and being able to do your job, or just feeling bleurgh. Some women feel that they just don't feel alive, or don't feel joy.
These figures describe different survey populations; they are not directly comparable.
What we don't know is whether symptoms measurably change how well women do their jobs. The studies so far don't show a consistent link, and all have weaknesses, so the evidence is limited [8]. But we know that women are reducing their hours, taking less responsibility at work, or even leaving the workforce, because they believe they aren't as a capable as before. The research hasn’t shown that this is true so it's tough, but believe in yourself, and try one of the things you can do about it.
What you can do about it
Lifestyle and everyday tools come first, then clinical options. Each group runs from the strongest evidence to the weakest.
Lifestyle options
Clinical options
With creatine, it is all about consistent daily use, keeping up your fluids and choosing a reputable creatine monohydrate.
At work
We want to just have the tools, so that we can continue to turn up to work as normal, but we also want workplaces where, when there is an impact, the environment is supportive. When you consider we are the educators and mentors and we have such an important role in society and the workforce.
Most of the Canadian women in the surveys about the workplace were quietly working harder rather than asking for help [6][7]. Very few had taken time off or received formal support [6].
This is general information, not medical advice. What suits you depends on your symptoms and history, so discuss it with a clinician.
When not to simply power through
Perimenopause is a common cause of these changes, but it is not the only one. Talk to a clinician if:
If your thinking is getting steadily worse, or you are losing your way in familiar places, say so. A clinician can rule out other causes.
Useful resources
Links and relationships: external links are provided for convenience. Free Women will clearly label any paid, affiliate or commercial relationship. A link is not a substitute for individual medical advice.
Tags: brain fog, anxiety, low mood, work, confidence, memory, sleep, perimenopause
Evidence and transparency
On this page we describe how sure we are in plain words. The study details sit in the grid below, so the research doesn't get in the way of the answer.
| What the page says | What it means | Example |
|---|---|---|
| Strong evidence | Pooled results from many studies, or large studies that followed thousands of women | Pooled results from 7 studies of 9,141 women |
| Moderate evidence | Findings agree, but there are fewer or smaller studies, or women were observed rather than tested | One large survey |
| Limited evidence | A small study, or one without a comparison group. Promising, and we would like to see more | A pilot with 27 women |
| Unclear | We looked and there is no study yet, or the evidence is too thin to say | Whether worry and poor sleep feed brain fog |
| Tip | Common sense that has not been studied | Keep a notebook in meetings |
The sources
| # | Reference | Type and size | How sure we are |
|---|---|---|---|
| 1 | Furey et al. 2025. Subjective vs objective cognition in menopause. J Int Neuropsychol Soc. doi:10.1017/S1355617725101306 | Pooled analysis, 24 comparisons | Moderate (studies varied a lot) |
| 2 | Maki PM, Jaff NG. 2022. Brain fog in menopause: a health-care professional's guide. Climacteric. doi:10.1080/13697137.2022.2122792 | Expert review | Moderate |
| 3 | Greendale GA et al. 2009. Effects of the menopause transition and hormone use on cognitive performance. Neurology. doi:10.1212/WNL.0b013e3181a71193 | Large US cohort (size to add from card) | Moderate |
| 4 | Bromberger JT et al. 2013. Does risk for anxiety increase during the menopausal transition? SWAN. Menopause. doi:10.1097/GME.0b013e3182730599 | Large US cohort, 2,956 women | Moderate |
| 5 | Badawy Y et al. 2024. Depression risk in the menopausal transition. J Affect Disord 357:126-133. doi:10.1016/j.jad.2024.04.041 | Pooled analysis, 7 studies, 9,141 women | Strong |
| 6 | Brent SE, Shirreff L, Yanchar NL, Christakis M. 2025. Workplace impact of menopause symptoms among Canadian women physicians. Healthcare 13(21):2699. doi:10.3390/healthcare13212699 | Survey, 217 women (volunteers) | Limited |
| 7 | Menopause Foundation of Canada. 2022. Menopause and Work in Canada (Leger online survey). Sponsored by Sun Life; not peer reviewed | Survey, 1,023 women | Moderate |
| 8 | Taylor S, Callahan B, Grant J, Islam RM, Davis SR. 2025. Menopause and work performance: a systematic review of observational studies. Menopause. doi:10.1097/GME.0000000000002557 | Systematic review, 10 studies | Limited |
| 9 | Brotto LA et al. 2026. Maturitas 207:108874. doi:10.1016/j.maturitas.2026.108874 | Survey, 1,850 women (volunteers) | Moderate |
| 10 | Ballantyne EC, King JP, Green SM. 2021. Cognitive remediation pilot for women in the menopausal transition. Front Glob Womens Health 2:741539. doi:10.3389/fgwh.2021.741539 | Pilot, 27 women, no comparison group | Limited |
| 11 | VA/DoD Clinical Practice Guideline for the Management of Menopause. 2026 | Guideline | Cross-check; primary trials still to find for exercise, hormone therapy and plant estrogens |
| 12 | Bachkangi et al. 2026. Menopause Rev 25(1):36-44. doi:10.5114/pm.2026.162164 | Review | Moderate |
| 13 | Maki PM et al. 2018. Guidelines on menopause and mental health (full citation to copy from card MOOD-002) | Guideline | Moderate |
| 14 | Xu C, Bi S, Zhang W, Luo L. 2024. The effects of creatine supplementation on cognitive function in adults: a systematic review and meta-analysis. Front Nutr 11:1424972. doi:10.3389/fnut.2024.1424972 (a 2025 correction exists and has not been checked) | Pooled analysis, 16 trials, 492 adults | Moderate for memory; low certainty for speed and attention |
| 15 | Korovljeva D et al. 2025. Creatine HCl and creatine ethyl ester in perimenopausal and menopausal women (CONCRET-MENOPA). J Am Nutr Assoc (full citation to confirm; read through a news summary only) | Placebo-controlled trial, 36 women | Limited |
| 16 | McCurry SM, Sternfeld B, LaCroix AZ, et al. 2016. Telephone-based cognitive behavioral therapy for insomnia in perimenopausal and postmenopausal women with vasomotor symptoms: a MsFLASH randomized clinical trial. JAMA Intern Med 176(7):913-920 (DOI to add) | Randomized trial, 106 women, active comparison | Moderate |
| 17 | Carmody JF, Crawford S, Salmoirago-Blotcher E, Leung K, Churchill L, Olendzki N. 2011. Mindfulness training for coping with hot flashes: results of a randomized trial. Menopause. doi:10.1097/gme.0b013e318204a05c | Randomized trial, 110 women, wait-list comparison | Limited |
| 18 | Marshall S, Kitzan A, Wright J, Bocicariu L, Nagamatsu LS. 2026. Creatine and cognition in aging: a systematic review of evidence in older adults. Nutr Rev 84(2):333-344. doi:10.1093/nutrit/nuaf135 | Systematic review, 6 studies, 1,542 adults aged 55+ | Limited |
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