Mood, Mind and MemoryWhat's Happening in Your Brain

How common is it?#

Very. Here's what the sources report:

• In the UK survey cited in the 2024 study, more than half of women struggled with anxiety or depression during the transition, and 69% called anxiety a very or somewhat difficult symptom.
• The AHA statement reports a 2 to 5 times higher risk of a major depressive episode in perimenopause compared with the years just before.
• Women in perimenopause are about 40% more likely to have depressive symptoms or depression than women who haven't started the transition, according to a 2024 analysis of 9,141 women (UCL (opens in a new tab)).
• Anxiety tends to peak in late perimenopause. Both depression and anxiety tend to ease after menopause.

The transition is linked to a higher chance of new depression and, more rarely, mania: in a UK study of more than 128,000 women, new cases of both rose around the final period (Shitomi-Jones et al., 2024 (opens in a new tab)). Some women with ADHD also report their symptoms getting worse, though research on this is limited. If a treatment that used to work no longer seems to, tell your doctor; it may need reviewing.

She also notes data showing a rise in suicide among some groups of women around perimenopause and menopause. It's a sobering reminder that mental health deserves real attention in these years.

Early perimenopause: the stretch nobody talks about#

A 2024 study of 272 women found those in early perimenopause reported the highest stress, and were most bothered by feelings of depression and anxiety. Their overall emotional quality of life was the lowest of any group. Women after menopause reported experiences similar to women before it.

Why does this matter? Because early perimenopause is the stage women are least likely to recognise. Many have no idea their hormones are already on the move.

Brain fog and memory#

Walking into a room and forgetting why. Reaching for a word that just won't come. Brain fog is one of the most common complaints of the transition: lost words, trouble with numbers, and changes in focus and planning that can feel like new attention problems. For most women it appears to be temporary (Mayo Clinic (opens in a new tab)). It can still take a real toll: in a 2022 UK survey of about 4,000 women, one in ten who worked through menopause had left a job because of their symptoms (Fawcett Society, via British Safety Council (opens in a new tab)).

But here's some genuinely good news. In the 2024 study, how bothered women were by poor memory did not differ between menopause stages. The strongest link was with stress: the more stressed women felt, the more memory problems they reported. A review cited in that study suggests only around 23% of women show measurable memory decline.

Your brain on menopause#

Neuroscientist Dr Lisa Mosconi, who leads a women's brain research programme in New York, offers a fascinating view inside.

Estrogen is brain fuel. Estradiol nudges brain cells to burn glucose for energy. When estrogen dips, those cells can slow down. Different brain areas feel it in different ways:

• Hypothalamus (your thermostat): hot flashes
• Brainstem (your sleep-wake switch): sleep problems
• Amygdala (your emotional centre): mood swings
• Hippocampus (your memory hub): forgetfulness

Brain energy can drop. Using PET brain scans, Dr Mosconi's team found women's brain energy was usually fine before menopause but declined across the transition, while middle-aged men generally kept high levels. One woman, scanned in her early 40s and again about eight years later, after menopause, showed a drop of around 30%. Her team linked this to menopause status rather than age. She stresses more research is needed to confirm it.

But you're just as sharp. Her team found no difference in cognitive test performance between men and women, before or after menopause, and other studies agree. Tired? Maybe. Less capable? No. Your brain is recalibrating, and it deserves time and support while it does.

A note on Alzheimer's risk. Dr Mosconi's scans found amyloid plaques (a hallmark of Alzheimer's) increased in many women during the transition, while middle-aged men had very few. She's clear that many women never develop plaques, and having them doesn't mean dementia will follow. Plaques are a risk factor, not a diagnosis.

She also reports evidence linking removal of the uterus, and especially the ovaries, before menopause to a higher dementia risk. She stresses no one should refuse surgery they need. Women simply deserve to know, and to have their brain health supported.

Why life stage matters too#

Midlife is often a pressure cooker: demanding jobs, teenagers, children leaving home, ageing parents, relationship strain. The 2024 study suggests menopause can be the straw that breaks the camel's back on top of all that.

There's a silver lining. Its authors note stress tends to fall with age, possibly because older adults build stronger coping and emotional regulation skills.

What actually helps#

• Build resilience and self-belief. In the 2024 study, women with higher resilience (the ability to bounce back) and higher self-efficacy (confidence in handling challenges) were less bothered by anxiety and depression, whatever their age or stage.
• Try cognitive behavioural therapy (CBT). Group CBT, including coping strategies for symptoms, was found to be the most effective therapy for reducing low mood in menopausal women. The Menopause Society also recommends CBT for hot flashes, because it makes them less bothersome and easier to live with, even when it doesn't make them less frequent (2023 nonhormone therapy statement (opens in a new tab)).
• Ask whether hormones are playing a part. In one small trial, women in early perimenopause who used hormone therapy for a year were less likely to develop depressive symptoms (17% vs 32% on placebo), though this hasn't yet been confirmed (Gordon et al., 2018, via MGH Center for Women's Mental Health (opens in a new tab)). Estrogen isn't a standard treatment for depression, and antidepressants and talking therapies remain the proven options, but in perimenopause it may help antidepressants work better (perimenopausal depression guidelines, summarised by the Australasian Menopause Society (opens in a new tab)). Ask your doctor what fits you.
• Turn down the stress. Dr Mosconi says the stress hormone cortisol works in balance with estrogen, so when stress runs high, estrogen's effects can suffer. Calmer days help your brain, not just your mood.
• Give meditation or therapy a go. Midlife often piles grief, ageing parents and teenagers on top of hormonal change. Talking to a counsellor, or setting aside even 5 to 10 minutes a day for a guided meditation or a few quiet moments of reflection, is a low-cost way to ease the load.
• Protect your sleep. It feeds directly into mood and memory.