Menopause mood changes and brain fog – the surprising cognitive and psychological symptoms

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Many women are surprised by the changes to cognitive function that can occur around the menopause; brain fog might sound funny, but it certainly doesn’t feel that way. Psychological problems and low mood can be very common too – anxiety, phobias and panic attacks can occur for the first time.

Anne Henderson, our consultant gynecologist, explains what’s happening and how you can manage these issues by working out the root cause, which can actually be dropping estrogen levels.

She explains how hormone replacement therapy (HT) can be helpful if this is the cause, and why’s important to consider a holistic approach too.

Prefer to read? Here’s the text version of Anne’s video

Mood changes, anxiety, brain – what are these symptoms?

This is one of the most common groups of symptoms that women seek help about. It’s also a group that many women do not recognize as being associated with the menopause.

Many say they are surprised that consulting a gynecologist is helpful when they’ve effectively got psychological problems. But the key to the issue is declining estrogen levels associated with the menopause, which can have a huge impact on brain function at all levels.

Mood changes during menopause does what you eat make a difference? 

Women commonly experience symptoms which fall into two groups:

Cognitive function

Women may present worries about their memory and recall. Day to day function, their ability to multitask, their ability to concentrate – it can be hard to remember simple things like names for example.


These include a sense of anxiety, which can come on in the menopause for the very first time. Women may even present with panic attacks and phobias when they’ve previously had very stable backgrounds. Low mood is another issue; many women experience depression for the very first time with no previous history.

What’s the connection between mood changes, anxiety, brain fog and menopause?

There is a direct link between the estrogen changes at the time of perimenopause and menopause, and the psychological and central nervous system symptoms which women suffer.

This is due to the fact that certain areas of the brain – particularly those associated with mood control, with anxiety and with cognitive function, such as the limbic system and the hippocampus – have a very high number of receptors that are responsive to estrogen. When the levels of the hormones start to decline, the receptors are no longer ‘fed’, they don’t function properly and symptoms and side effects can arise.

How can it be treated or managed?

Treatment options depend very much on whether a woman is experiencing additional menopausal symptoms. If hot flashes and sweats, poor sleep, tiredness and other physical symptoms are troubling you, there is no doubt that HT can be a huge benefit across the board.

But even in women who have isolated psychological symptoms, there is a lot of scientific evidence that estrogen replacement should be the first line treatment for mood problems. It certainly performs better than SSRI (Selective serotonin reuptake inhibitors) and other forms of antidepressants, and has fewer side effects.

Here is coping with your emotions during menopause for tips and advice.

How can I get help and help myself?

I recommend patients seek help in any way that they think may be beneficial, looking holistically at the situation. I don’t think that HT should be used in isolation. Women should try to keep fit so exercise particularly weight bearing exercise can be very helpful.

Some women also look at other forms of complementary therapy; herbal therapies, meditation and so on. I’m highly supportive of all those forms of treatment because there is evidence that it can be beneficial.

What questions do other women ask about this?

Some of the commonest questions I get asked are “am I going mad?” And “is it just me?” This is probably because very few women associate the profound psychological changes that happen at the menopause with the menopause itself.

Women often associate flashes and sweats and tiredness and joint aches and vaginal dryness with a lack of hormones, but they rarely link the psychological and cognitive changes which are very real and actually in many cases can impact on the quality of life even more than the physical symptoms.

About Anne Henderson

Our fantastic Consultant Gynecologist Anne Henderson has worked within the health sectors for 15 years. From running large-scale menopause clinics where she helped hundreds of women access then-pioneering body identical hormones through to working with complementary practitioners to provide truly holistic care, Anne leads the way when it comes to caring, innovative, whole-woman focused practice.


Anne Henderson

Anne Henderson

Consultant Gynaecologist

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