Many women with menopause brain fog understandably fear the worst when their memory starts failing. And although brain fog during menopause is extremely common and generally does not mean you have early onset of dementia, we asked a menopause specialist and consultant neurologist to explain how to tell the two apart.
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Note of reassurance: For most women, the cognitive symptoms of menopausal brain fog are not a sign of dementia
Is it common for women to think they may have dementia when in fact it is brain fog and vice versa?
According to Dr. Ashlesha Dhairyawan, a British Menopause Society accredited menopause specialist and GP verified on the healthcare review platform Doctify, the answer is yes.
“It is common as symptoms like forgetting words, struggling to concentrate or misplacing something can happen with both perimenopause brain fog and dementia, so one symptom cannot give you the answer.
Brain fog symptoms:
“Brain fog related to menopause can fluctuate. Symptoms can vary according to sleep, fatigue, hot flushes, stress and anxiety. Women may forget a name or word initially but recall it later. Losing your train of thought or difficulty finding words is common. This can affect work and everyday life, for example, by causing trouble concentrating during meetings or making it hard to multitask. However, everyday functionality is usually not affected. Women are still able to manage finances, medications, shopping, cooking, driving, and work responsibilities.”
Dementia symptoms:
“Dementia involves a progressive decline in memory rather than a fluctuation. The person repeatedly forgets conversations, appointments, or events and does not later recall them. They may ask the same question repeatedly. Everyday tasks become challenging such as managing finances or getting lost on familiar routes. Family members and work colleagues may raise concerns. Problems extend beyond forgetfulness, and there can be personality or behavioural changes.”
What are the main differences of both brain fog and dementia women should know about?
“The main difference is usually the pattern over time and whether the changes are starting to affect your ability to manage everyday life independently.
“With menopause-related brain fog, demanding tasks may feel much harder, but everyday independence is generally preserved. You might rely more on lists or reminders but still manage appointments, money, medication, work, travel and other familiar tasks. The fogginess may also come and go.
“Dementia can also affect memory, concentration and language, but the changes are more likely to become broader and increasingly interfere with everyday functioning. Someone may start having difficulty with familiar tasks, handling money or medication, understanding situations or finding their way around. Changes in judgement, language or behaviour may also become noticeable to other people.”
When does early dementia tend to start?
“Dementia before the age of 65 is uncommon, although it can occur. Being in your 40s or 50s therefore offers some reassurance, but a genuinely progressive change should still be assessed rather than automatically attributed to menopause.”
When should you be concerned?
“If the change is persistent or significant, a healthcare professional will usually look at the whole pattern. They may ask when it started, whether it fluctuates or is steadily getting worse, how it affects everyday life, what other menopause symptoms you have, how you are sleeping and whether anyone close to you has noticed a change. Your medicines, general health and family history can also be relevant.
“Depending on your symptoms, blood tests may be used to look for other possible causes. If there is genuine concern about cognitive decline, a cognitive assessment or referral for specialist assessment may be recommended. Memory and thinking tests can help identify difficulties, but they do not diagnose dementia on their own.”
It is particularly important to seek advice if you notice:
• Increasing difficulty with familiar tasks that you previously managed easily
• Problems managing money, medication or appointments
• Becoming confused about places or situations
• Significant changes in judgement, behaviour or personality
• Changes that other people are consistently noticing
• A strong family history of dementia developing before the age of 65
Symptoms that need urgent medical help include:
• Sudden confusion
• A seizure
• Facial weakness
• Weakness or numbness on one side
• Difficulty speaking
• Another rapid change in thinking or behaviour
When not to worry?
“For most women, these cognitive symptoms are not a sign of dementia…
“Menopause-related brain fog often fluctuates, while dementia is more likely to cause changes that worsen over time and increasingly interfere with everyday life.”
How can brain fog be treated?
“HRT may help some women when other menopause symptoms are contributing to brain fog. For example, if night sweats are repeatedly disrupting your sleep, treating them may leave you better rested and able to concentrate more easily. Addressing troublesome mood or other menopause symptoms may also make brain fog feel less intrusive. The direct effect of HRT on cognition is less certain. Current evidence does not establish HRT as a treatment specifically for brain fog or as a way to prevent dementia.
“If symptoms are consistent with menopause related brain fog, managing triggers such as poor sleep and fatigue, alongside lifestyle and nutrition can help. If symptoms are persistent or progressive, a broader medical assessment should be considered, especially if there has been a decline in memory over months or years along with a loss of daily function. Next steps can include assessing for reversible causes such as depression, anxiety, sleep disorders, thyroid disease, vitamin B12 deficiency, medication side effects, or alcohol misuse. A formal cognitive assessment can be considered at this time.”
How common is it for women to think they may have early onset of dementia when it is in fact brain fog?
According to Dr Kit Wu, a consultant neurologist verified on the healthcare review platform Doctify it is super common.
“I see a lot of women in their 40s and 50s who are genuinely scared they’re getting dementia, and most of the time it turns out to be the menopause. Brain fog tends to look like trouble concentrating, losing your train of thought mid-sentence, walking into a room and forgetting why, or not being able to get a word out. It comes and goes. It’s usually worse after a bad night, with night sweats, stress or low mood. Crucially, people still cope with work and home, even if it feels harder. And women with brain fog are very aware of it, sometimes painfully so. The reassuring part is that for most women it’s temporary, and studies suggest thinking and memory pick back up after the menopause transition.
“Dementia is different – it keeps getting worse, it starts to get in the way of work, home life and independence, and the person often notices less than the people around them.
“But it can go the other way too. Brain fog is talked about so much now that there’s a real risk of putting young-onset dementia, or another neurological problem, down to the menopause. If symptoms are getting worse, affecting everyday life, being picked up by others, or come with changes in personality, behaviour, walking or finding your way around, get it checked. See your GP first and ask about a specialist referral if needed. Getting seen early is never wasted, you either get reassurance or you get a diagnosis and support sooner.”
These are the main signs of early dementia
“The big thing is that it gets steadily worse and starts to affect day to day life. So things like forgetting recent conversations, asking the same question again and again, getting lost somewhere familiar, struggling to follow a conversation or find words, or finding it hard to manage money or plan a meal. Personality and behaviour can change too. In younger people it’s often not memory that goes first, it can be behaviour, language or problems judging space and distance. And quite often it’s a partner or colleague who notices before the person themselves does.”
Does early dementia run in families?
“Mostly no. Having a parent who developed dementia in their 80s only nudges your own risk up a little. Young-onset dementia is a bit different though, it’s more likely to have a genetic cause, particularly some types of frontotemporal dementia and a rare inherited form of Alzheimer’s. If several close relatives were affected at a young age, that’s worth raising with a specialist who can talk through whether genetic counselling makes sense.”
How can early dementia be treated?
“There’s no cure yet, but there’s a lot we can do. First thing is a proper assessment, because some causes of memory problems are very treatable – an underactive thyroid, low B12, depression, sleep problems, side effects from medication. For Alzheimer’s there are drugs like donepezil, rivastigmine, galantamine and memantine that help with symptoms. The newer anti-amyloid antibody drugs have been approved in the UK, but access to them is still pretty limited. And the basics really do matter: keeping blood pressure under control, staying active and socially connected, sorting out hearing loss, sleeping well.”
