Why Does Brain Fog Happen During Menopause?

Understanding Memory and Brain Health During Menopause

When entering menopause, many women may experience symptoms known as brain fog. These may appear as forgetfulness, poor concentration, slower thinking or information processing, and a feeling that solving immediate problems has become more difficult.

These symptoms may not be related only to work-related fatigue. They may also be associated with changes in hormone levels within the body.

What Causes Brain Fog During Menopause?

The human brain, especially the hippocampus, which is involved in memory and learning, is connected to the function of female sex hormones.

When menopause begins, the ovaries reduce the production of oestrogen and progesterone. This may affect nervous system function in several ways.

• Changes in Brain Energy Metabolism: Brain cells use glucose as an important energy source. Changes in hormone levels may be associated with how efficiently brain cells use glucose.

• Changes in Neuroinflammatory Processes: Oestrogen is involved in regulating the function of glial cells. When hormone levels change, this may affect the balance of inflammatory processes within the nervous system.

• Changes in Synapses: The connections and signalling between nerve cells may change. This may be related to processing speed and memory function.

Biological Mechanisms: The Role of Astrocytes and ERβ Receptors

Neuroscience research suggests that cells which may play a role in changes in brain function include astrocytes.

Astrocytes are supportive cells in the brain. They are involved in nutrient transfer and in maintaining balance for nerve cells.

1. Changes in ENO1 Protein: In conditions where hormone levels decline, studies have found changes in the expression of Enolase 1 (ENO1) protein in astrocytes.

This may be associated with inflammatory processes and the function of brain areas involved in memory.

1. Estrogen Receptor Beta (ERβ): Astrocytes have a type of hormone receptor known as Estrogen Receptor Beta (ERβ).

This receptor is involved in nervous system function. Activation of this receptor has been studied in relation to ENO1 protein levels, inflammatory processes, and the maintenance of synapses.

Studies on Brain Function and Memory

Clinical and preclinical research has investigated the role of estriol combined with progesterone in brain function. Some interesting findings include:

• Cognitive Changes: In a follow-up study of postmenopausal women who received estriol together with progesterone, data showed changes in concentration, working memory, processing speed, and verbal memory.

• Relationship With Nerve Cells: In more detailed studies, estriol was found to be able to enter the brain and bind to ERβ receptors on astrocytes.

Researchers have studied its relationship with glucose metabolism, inflammation, and nerve cell function.

Recommendations for Supporting Brain Health During Menopause

Brain fog should be approached from multiple angles to support long-term health and quality of life.

Reference

Suthirawut, B., Khiannukul, P., & Mangkang, P. (2026). Estriol and progesterone therapy attenuates menopausal brain fog via astrocyte ERβ receptor signaling and ENO1 regulation. Journal of Neuroendocrinology, 38(3), e13512. https://doi.org/10.1111/jne.13512