Brain fog in menopause is common but still poorly understood, with researchers calling for more work to explain the link and how best to support women.

For a new perspective article published in The Lancet Obstetrics, Gynaecology, & Women’s Health, researchers based in the UK and Australia reviewed the evidence on menopause-related cognitive symptoms. They found that symptoms such as forgetfulness, reduced concentration and brain fog are common during the menopause transition, but are still poorly recognised and under-researched.

More than two-thirds of women report difficulties with memory or concentration over the menopause transition. Multiple factors may contribute to these cognitive symptoms, including hormonal changes, sleep disturbances and psychological and psychosocial stress. Yet, because cognitive symptoms are not widely discussed, they can cause considerable worry, with some fearing they are signs of dementia or undiagnosed neurodevelopmental conditions.

The review paper emphasises that overall cognitive performance for women experiencing menopause-related brain fog typically remains within expected ranges and, importantly, that cognitive symptoms are not linked to an increased risk of dementia.

Professor Aimee Spector of UCL Division of Psychology and Language Sciences, co-author on the paper, said: “Cognitive symptoms such as forgetfulness and ‘brain fog’ are incredibly common during menopause, yet they are often overlooked. Our findings highlight just how complex menopause-related cognitive symptoms are, and how much we still don’t know about what drives them. More targeted research is essential if we are to identify which biological, psychological or lifestyle factors contribute most, and what types of support or treatment are likely to be effective.”

The authors argue that clinicians can play a key role in understanding and validating women’s experiences by asking about the duration of cognitive symptoms, impacts on day-to-day functioning and any other medical or psychosocial factors that could be contributing to cognitive symptoms.

The review also discusses a range of approaches that may ease cognitive symptoms, such as improving sleep quality, engaging in regular aerobic exercise and eating a balanced diet. There is also little but promising research into the impact of psychological therapies targeting cognitive symptoms, with a recent meta-analysis of three cognitive behavioural therapy-based studies showing significant improvements in memory and concentration. The evidence is more mixed for the benefits of hormone therapy on cognitive symptoms during menopause.

The authors identify cognitive symptoms as a major area of unmet need in menopause research. They call for a unified definition of menopause-related cognitive changes and for prospective, longitudinal studies that can track women from pre- to post-menopause. Better understanding of the biological, psychological and social factors that contribute to cognitive symptoms will be crucial for developing effective treatments.

Lead researcher Dr Caroline Gurvich of Monash University said: “There’s a lot of pressure to use objective measures of cognitive decline, like a memory test, for example, in a clinical trial, but the key symptom of brain fog is a subjective experience. So having a definition that acknowledges the key cognitive symptom is critical.”

This is not without precedent – we already use subjective or self-report measures for depression, anxiety and other mental health conditions with great success.

Dr Gurvich said the proposed definition would also validate women’s individual experiences while empowering them through the reassurance that any objective decline in their cognitive ability is subtle.

She added: “This is a decrease in cognitive or learning efficiency, not functionality or capacity. For many women, the perception they are losing capacity is what drives them to stop work or lose the confidence to live fulfilling lives during and after menopause. I hear all the time from women who have gone through menopause that validation would have made a significant difference to their resilience and the approach they took to living with menopause.”

Co-author Professor Martha Hickey of the University of Melbourne and Royal Women’s Hospital said: “Our analysis of the best available research shows that many women experience some degree of cognitive symptoms, such as brain fog, during the menopause transition.”

“But there’s a lack of long-term data, which means that there’s a gap in our knowledge about how the brain fog symptom develops and changes from peri-menopause to after menopause ends. It’s a real gap in our understanding.”

Professor Spector added: “We increasingly see women, typically at the peak of their careers, losing confidence in the workplace, often translating to leaving work or reducing work hours. Having simple strategies to support and retain them at work is also a broader economic issue.”

Inflammation may help flag depression in women with type 2 diabetes, new research reveals, but the link appears to vary by symptoms and by how depression is measured.

The findings suggest both the promise and the challenge of identifying biomarkers, measurable indicators in blood or other tests, for depression.

Women with type 2 diabetes are at higher risk of depression, which can accelerate diabetes complications, impair functioning and increase the risk of death. Research suggests inflammation may be a key link between the two conditions, as certain inflammatory biomarkers are frequently found in both.

Scientists have yet to identify an objective diagnostic biomarker for depression, such as something measured through blood work, a genetic test or a brain scan.

To diagnose and measure depression, mental health providers usually use questionnaires. Some add up the number of symptoms as a checklist, while others measure the severity of different symptoms.

Depression can also look very different from one person to the next, with symptoms spanning physical effects such as sleeping too much or too little, mood-related issues such as persistent sadness, and cognitive difficulties such as trouble concentrating.

Nicole Beaulieu Perez, assistant professor at NYU Rory Meyers College of Nursing and study author, said: “Depression is the most measured construct in all of science, but part of our problem is that we’re not defining depression the same, there may be different types, but we’re lumping them all together.

“The variability in depression symptoms complicates how we diagnose and treat it, particularly in the absence of validated biological markers.”

To better understand the connection between inflammation and different symptoms and measures of depression, researchers at NYU Rory Meyers College of Nursing studied 38 women with type 2 diabetes, many of whom were also living with HIV.

They analysed blood samples for 10 different inflammatory biomarkers, including CRP, IL-6, IL-4 and IL-8.

They also assessed participants for depression using PROMIS, an NIH-developed series of short questionnaires that includes measures of depression, anxiety, sleep and fatigue, as well as the CES-D, an older measure that adds up depression symptoms.

The researchers found that certain inflammatory biomarkers were linked to depression, but the associations varied depending on the measures and symptoms used.

Higher levels of depression and anxiety measured using PROMIS were associated with lower levels of IL-4.

They also found contradictory associations for CRP and IL-6. Both were positively correlated with depression when it was measured using CES-D and negatively correlated when it was measured using PROMIS.

Sleep disturbances measured using PROMIS were associated with IL-8.

Perez said: “It was interesting to see that, in some cases, the direction of these associations flipped entirely based on which measure of depression we were using.”

The findings, while preliminary because of the small number of people studied, suggest that the link between inflammatory biomarkers and depression may not be consistent across all measures or symptoms.

More research is needed to tease out the role of inflammation and whether subtypes of depression can be identified based on symptoms and objective biological markers.

Perez said: “We think there’s something going on with inflammation and depression, but if we look closely, we may find that’s true for some forms of depression but not others.”

She said she hoped that in future, pairing depression measures with biomarkers such as blood tests could provide more objectivity in diagnosing depression, which could help further destigmatise mental illness, as well as help clinicians catch it earlier and guide treatment.

Perez said: “Precision mental health has great potential.

“If we can identify a specific type of depression, for instance, one that appears to be driven by inflammation, this may inform which medications to try to target an underlying biological pathology, hopefully reducing the trial and error often needed to find an effective treatment for depression.

“By identifying specific inflammatory biomarkers linked to different dimensions of mental health, our findings suggest a path toward precision mental health that moves beyond one-size-fits-all approaches.”