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Women's Metabolic Clarity · Topic 7 of 15

Brain Fog, Mood and Anxiety

You are not losing your mind. Your brain is going through a change too.

Educational disclaimer: This content is for education only. It is not medical advice, diagnosis or treatment. Pinnacle Coordinated Wellness is an education-first coordination layer, not a medical office, and Dr. Pat Pachciarz® is not a clinician. Nothing here is a protocol, dose or promise of results. Always talk with your own licensed clinician before making any health change. If you have chest pain, trouble breathing, thoughts of self-harm, or another emergency, call 911 (or call or text 988 for mental health crisis support).
On this page
  1. Why do I have brain fog?
  2. Why do I feel anxious or down for no reason?
  3. Does menopause raise my risk of Alzheimer's?
Question 19 of 45

Why do I have brain fog?

Short answer

  • Many women notice memory and focus slips in perimenopause.
  • A SWAN study found that during perimenopause, memory and learning scores did not improve with practice the way they usually do. They bounced back after menopause.
  • Brain scans show the brain changes how it uses energy during menopause.
  • For most women, this is a phase, not a sign of dementia.

What to look out for

  • Losing words, keys or your train of thought.
  • Brain fog with poor sleep or hot flashes.
  • Fast or worsening memory loss (get checked).

Top 3 things to act on or ask your clinician

  1. Ask: 'Could my brain fog be linked to menopause?'
  2. Ask: 'Should we check thyroid, B12 or iron?'
  3. Ask: 'What helps sleep, since sleep affects memory?'
Sources for this answer
  1. Peer-reviewed Greendale GA et al. Effects of the menopause transition and hormone use on cognitive performance in midlife women. Neurology. 2009;72:1850-7. PMID: 19470968. DOI: 10.1212/WNL.0b013e3181a71193
  2. Peer-reviewed Mosconi L et al. Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Sci Rep. 2021;11:10867. PMID: 34108509. DOI: 10.1038/s41598-021-90084-y
  3. Expert commentary, not research Dr. Mary Claire Haver on Huberman Lab: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality (podcast episode, June 2024)
  4. Expert commentary, not research Dr. Lisa Mosconi (neuroscientist): The Menopause Brain (book, Avery, 2024)
  5. Expert commentary, not research Dr. Lisa Mosconi on The Peter Attia Drive: #381 Alzheimer's disease in women: how hormonal transitions impact the female brain (podcast episode, Jan 2026)
Question 20 of 45

Why do I feel anxious or down for no reason?

Short answer

  • The risk of depression goes up during perimenopause, even in women with no past history.
  • Anxiety can also rise during the transition.
  • Changing hormones affect brain chemicals that control mood.
  • There may be a reason this is happening. You deserve support.

What to look out for

  • Sadness, worry or irritability most days for 2 weeks or more.
  • Losing interest in things you love.
  • Any thoughts of self-harm. Call or text 988 right away.

Top 3 things to act on or ask your clinician

  1. Ask: 'Could my mood changes be related to perimenopause?'
  2. Ask about screening for depression and anxiety.
  3. Ask: 'What support options are there for me?'
Sources for this answer
  1. Peer-reviewed Maki PM et al. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause. 2018;25:1069-1085. PMID: 30179986. DOI: 10.1097/GME.0000000000001174
  2. Peer-reviewed Bromberger JT et al. Major depression during and after the menopausal transition: Study of Women's Health Across the Nation (SWAN). Psychol Med. 2011;41:1879-88. PMID: 21306662. DOI: 10.1017/S003329171100016X
  3. Peer-reviewed Bromberger JT et al. Does risk for anxiety increase during the menopausal transition? Study of women's health across the nation. Menopause. 2013;20:488-95. PMID: 23615639. DOI: 10.1097/GME.0b013e3182730599
  4. Expert commentary, not research Dr. Mary Claire Haver (OB/GYN): The New Menopause (book, Rodale, 2024)
  5. Expert commentary, not research Dr. Lisa Mosconi (neuroscientist): The Menopause Brain (book, Avery, 2024)
Question 21 of 45

Does menopause raise my risk of Alzheimer's?

Short answer

  • Women make up most people with Alzheimer's. Scientists are studying why.
  • Brain scan research shows changes in brain energy around menopause.
  • Current guidance says hormone therapy should NOT be used just to prevent dementia.
  • Heart health, sleep, movement and hearing all matter for brain health.

What to look out for

  • Strong family history of dementia.
  • High blood pressure, diabetes or poor sleep.
  • Social isolation.

Top 3 things to act on or ask your clinician

  1. Ask: 'What is my brain health risk?'
  2. Ask: 'How are my blood pressure and blood sugar?'
  3. Ask: 'What does the evidence say about hormones and the brain for me?'
Expert vs. evidence: Dr. Lisa Mosconi's work suggests timing of hormone therapy may matter for the brain. That research is still early. The Menopause Society 2022 statement does not recommend hormone therapy to prevent dementia. We go with that guidance.
Sources for this answer
  1. Peer-reviewed Mosconi L et al. Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Sci Rep. 2021;11:10867. PMID: 34108509. DOI: 10.1038/s41598-021-90084-y
  2. Peer-reviewed The North American Menopause Society (now The Menopause Society). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29:767-794. PMID: 35797481. DOI: 10.1097/GME.0000000000002028
  3. Expert commentary, not research Dr. Lisa Mosconi (neuroscientist): The Menopause Brain (book, Avery, 2024)
  4. Expert commentary, not research Dr. Lisa Mosconi on The Peter Attia Drive: #381 Alzheimer's disease in women: how hormonal transitions impact the female brain (podcast episode, Jan 2026)
Sources

Every source on this page

Peer-reviewed research comes first, then society guidance, then expert commentary. Dr. Mary Claire Haver and Dr. Stacy Sims are listed first among the experts. Expert voices are commentary, not research. When an expert claim differs from the evidence, we follow the evidence and say so.

  1. Peer-reviewed Greendale GA et al. Effects of the menopause transition and hormone use on cognitive performance in midlife women. Neurology. 2009;72:1850-7. PMID: 19470968. DOI: 10.1212/WNL.0b013e3181a71193
  2. Peer-reviewed Mosconi L et al. Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Sci Rep. 2021;11:10867. PMID: 34108509. DOI: 10.1038/s41598-021-90084-y
  3. Peer-reviewed Maki PM et al. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause. 2018;25:1069-1085. PMID: 30179986. DOI: 10.1097/GME.0000000000001174
  4. Peer-reviewed Bromberger JT et al. Major depression during and after the menopausal transition: Study of Women's Health Across the Nation (SWAN). Psychol Med. 2011;41:1879-88. PMID: 21306662. DOI: 10.1017/S003329171100016X
  5. Peer-reviewed Bromberger JT et al. Does risk for anxiety increase during the menopausal transition? Study of women's health across the nation. Menopause. 2013;20:488-95. PMID: 23615639. DOI: 10.1097/GME.0b013e3182730599
  6. Peer-reviewed The North American Menopause Society (now The Menopause Society). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29:767-794. PMID: 35797481. DOI: 10.1097/GME.0000000000002028
  7. Expert commentary, not research Dr. Mary Claire Haver (OB/GYN): The New Menopause (book, Rodale, 2024)
  8. Expert commentary, not research Dr. Mary Claire Haver on Huberman Lab: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality (podcast episode, June 2024)
  9. Expert commentary, not research Dr. Lisa Mosconi (neuroscientist): The Menopause Brain (book, Avery, 2024)
  10. Expert commentary, not research Dr. Lisa Mosconi on The Peter Attia Drive: #381 Alzheimer's disease in women: how hormonal transitions impact the female brain (podcast episode, Jan 2026)
Your next step

Take this to your clinician.

  • Bring your questions and a short symptom log to your next appointment.
  • Want help organizing your questions and care team? Pinnacle Coordinated Wellness is here to listen and connect.
  • Practitioners: share this page with the women you serve.
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All 15 topics · Other topics: Weight and Body Changes · Muscle and Strength · Why HIIT or Cardio-Only Can Backfire · Insulin Resistance and Blood Sugar · Sleep and Night Sweats · Cortisol and Stress · Thyroid · Bloodwork: What to Ask For · Heart and Bone Risk After Menopause · Hormone Therapy Basics · Gut Health · Nutrition and Protein · Alcohol · The Shame and Guilt Cycle, and Identity