Menopause, Mood and Brain Fog: What’s Really Going On

By Lindsay Powers  |  Nutritional Therapist & Health Writer, Naturally Healthy News

Published: October 2026  |  Last reviewed: October 2026

Menopause doesn’t just bring hot flushes and changed periods. For many women, it brings a noticeable shift in mood and mental clarity too: low mood, anxiety, and a kind of mental fog that makes concentrating or finding the right word harder than usual. It’s one of the least talked-about parts of the transition, and one of the most disruptive.

This piece covers what’s actually happening hormonally, how much perimenopause raises the risk of depression, and whether brain fog is measurable or just a feeling. It also reviews the evidence behind the main options for managing it: CBT, HRT, and natural approaches like ashwagandha and saffron.

Why Does Menopause Affect Mood and Thinking?

Oestrogen does far more than regulate your cycle. It influences serotonin and GABA, two brain chemicals that help stabilise mood. It also acts on receptors in the hippocampus, the brain region most involved in memory and learning.

As oestrogen levels fluctuate sharply during perimenopause, rather than declining smoothly, these systems are disrupted before they settle into a new, lower baseline after menopause. That fluctuation, not just the eventual drop, is thought to be why mood and cognitive symptoms cluster specifically around the perimenopausal years.

How Much Does Perimenopause Actually Raise the Risk of Depression?

A 2024 systematic review and meta-analysis pooling seven studies and 9,141 women found perimenopausal women had a significantly higher risk of depression than premenopausal women, an odds ratio of 1.40 [1]. That’s roughly a 40% increase in relative risk.

Crucially, that elevated risk was specific to perimenopause. Postmenopausal women showed no statistically significant increase in depression risk compared to premenopause [1]. The vulnerable window is the transition itself, not menopause as an ongoing state, which matters if you’re in it now and wondering whether this is permanent.

Is Brain Fog During Perimenopause Real?

Yes. The SWAN study, one of the largest long-term studies of the menopause transition, found around two-thirds of women report memory complaints during perimenopause [2]. Objective testing supports this: verbal memory and processing speed both showed a measurable, temporary dip during perimenopause, then recovered in early postmenopause.

Age-related decline in these areas typically doesn’t show up until much later, the late 50s and early 60s, suggesting general ageing plays a bigger role there than menopause itself [2]. SWAN also found sleep problems, depression, anxiety, high blood pressure and elevated glucose were all linked to worse cognitive symptoms during the transition, meaning some of what feels like brain fog may be addressable through those other channels, too. See Why Magnesium Glycinate Helps You Sleep if poor sleep is part of your picture.

Does HRT Help With Mood and Brain Fog?

This is really two separate questions, and it’s worth keeping them apart. HRT’s effect on day-to-day mood is mixed across the research. Some women see a real improvement, while others see little change [8]. It isn’t a guaranteed fix for low mood during the transition.

The clearer, separate finding is about long-term brain health. A 2026 UK Biobank study following over 180,000 women for up to 16 years found those taking HRT for at least a year had a 16% lower risk of Alzheimer’s disease, rising to 32% in women who reached menopause early through surgery [4].

Timing mattered enormously: the protective effect was strongest for women starting HRT between ages 46 and 56, with little to no benefit for those starting later [4]. This is observational data, so it can’t prove HRT directly prevents dementia. Still, it’s a meaningful update on the older, more alarming findings that shaped a lot of HRT caution in the first place, which mostly involved women starting HRT much later in life. None of this means brain fog today is a reason to start HRT on its own. It’s a longer-horizon consideration worth raising with your doctor if you’re weighing up HRT more broadly.

CBT: The Non-Drug Option NICE Recommends

Cognitive behavioural therapy, a structured talking therapy that helps you identify and change unhelpful thought patterns, has long been recommended by NICE for menopausal anxiety and depression [3]. Updated 2024 guidance added further evidence that menopause-specific CBT also reduces the frequency and severity of hot flushes and night sweats, and improves sleep.

It can be used alongside HRT or as an alternative for women who can’t or don’t want to take it [3]. It’s one of the better-evidenced non-drug options available, and is worth asking your GP about directly rather than assuming it’s only for more severe mental health conditions.

What Does the Evidence Say About Natural Options?

The strongest evidence is for ashwagandha. A 2025 randomised, placebo-controlled trial gave 60 women aged 45 to 55 either 600mg daily of KSM-66 ashwagandha root extract or a placebo for 56 days [5]. The psychological symptoms subscale of a standard menopause rating scale fell by roughly 45% in the ashwagandha group, against almost no change in the placebo group.

Perceived stress and mental-health quality-of-life scores improved substantially too [5]. Unusually, this trial also found ashwagandha genuinely shifted circulating hormone levels. Oestradiol and progesterone rose, while FSH and LH fell, a much more direct hormonal effect than most natural “balance your hormones” ingredients actually show in trials. It’s one small, 56-day study, though, and would need replicating before that hormonal finding is treated as settled.

Saffron extract also has real, menopause-specific trial evidence: a 12-week trial of 86 women aged 50 to 70 taking 28mg daily found a significant improvement in low mood and self-esteem compared to placebo [6]. It’s one of several saffron trials in menopausal and perimenopausal women, covered in full in Saffron for Menopause: What the Research Really Shows.

For cognitive symptoms specifically, a combination of boswellia and haritaki extracts (branded Nutricog) improved memory, learning and attention scores over 120 days in a trial of 100 healthy adults aged 40 to 65 [7]. That trial wasn’t menopause-specific, as it included men and didn’t report outcomes by sex, but the age range overlaps meaningfully with the menopause transition.

Who Should Be Careful With These Approaches?

• If you have hyperthyroidism or an autoimmune thyroid condition such as Hashimoto’s, avoid ashwagandha, since it can raise T3 and T4 levels and may worsen symptoms.
• If you’re pregnant or breastfeeding, avoid ashwagandha, since it hasn’t been established as safe in either situation.
• If you’re already taking HRT or another hormone-affecting medication, check with your doctor before adding ashwagandha, since this trial found it changed circulating hormone levels.
• If you have a bleeding disorder or take blood-thinning medication, check with your doctor before taking saffron, since it may enhance the effect of some anticoagulants.
• If you’re pregnant, avoid saffron in supplement doses, since higher-than-culinary amounts have been linked to uterine stimulant effects.
• If you’re considering HRT specifically with long-term brain health in mind, talk to your doctor about timing, as the evidence suggests starting earlier in the transition matters more than starting later.
• If low mood or brain fog is affecting your daily life, see your doctor, as these are recognised menopause symptoms with several effective treatment options, not something to just push through.

Frequently Asked Questions

Is brain fog during menopause a real medical condition?

It isn’t a diagnosis in its own right, but it is a real, measurable change. Research has documented temporary dips in verbal memory and processing speed during perimenopause [2], which for most women recover in early postmenopause rather than continuing to worsen.

Does HRT fix brain fog?

The evidence for HRT easing day-to-day mood and mental fog is mixed [8]. Its clearer, better-supported benefit is a reduced long-term dementia risk when started earlier in the menopause transition, a different and longer-horizon claim covered in more detail above.

Can ashwagandha replace HRT for menopause symptoms?

No. Ashwagandha’s menopause-specific evidence currently rests on one 56-day trial, compared with decades of research behind HRT. It’s a reasonable option for women who can’t or don’t want to take HRT, or as a complementary approach, not something with equivalent evidence behind it.

How long does it take for mood to improve after menopause?

The elevated depression risk found in research is specific to the perimenopausal window itself, and returns to baseline once you’re through it. Individual timelines vary considerably, but the pattern in the evidence is reassuring: this is a phase, not a permanent shift.

Final Thoughts

Mood changes and brain fog during perimenopause are real, measurable, and time-limited, not something you’re imagining or something you simply have to endure. The depression risk is elevated during the transition itself, and settles again afterwards.

There are effective options with real evidence behind them. CBT is a well-supported non-drug route, HRT offers genuine long-term brain health benefits when timing is right, and ashwagandha is a promising, if still early-stage, natural option. None of this needs pushing through alone, and every one of these routes is worth raising with your doctor.

References

[1] Journal of Affective Disorders, 2024: The Risk of Depression in the Menopausal Stages: A Systematic Review and Meta-Analysis. https://www.sciencedirect.com/science/article/pii/S0165032724006438

[2] SWAN (Study of Women’s Health Across the Nation): Fact Sheet: Memory and Cognition During and After the Menopause Transition. https://www.swanstudy.org/wps/wp-content/uploads/2023/04/SWAN-Fact-Sheets-Cognition.pdf

[3] NICE: Updated Guideline Recommends More Treatment Choices for Menopause Symptoms. https://www.nice.org.uk/news/articles/updated-guideline-recommends-more-treatment-choices-for-menopause-symptoms

[4] UK Biobank, 2026: Menopause HRT Cuts Dementia Risk, But Only If Started Early Enough. https://www.ukbiobank.ac.uk/research-stories/menopause-hrt-cuts-dementia-risk-if-started-early/

[5] Frontiers in Reproductive Health, 2025: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study on Efficacy and Safety of Ashwagandha Root Extract for Managing Menopausal Symptoms in Women. https://www.frontiersin.org/journals/reproductive-health/articles/10.3389/frph.2025.1647721/full

[6] Frontiers in Nutrition, 2026: The Effects of a Saffron Extract (affron®) on Mood, Sleep, Self-Esteem, and Exploratory Measures of Physical Appearance in Women Aged 50 to 70. https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2026.1838513/full

[7] Nutritional Outlook, 2023: PLT Health’s New Nutricog Brain Health Botanical Ingredient Addresses Broad Cognitive Benefits. https://www.nutritionaloutlook.com/view/plt-health-s-new-nutricog-brain-health-botanical-ingredient-addresses-broad-cognitive-benefits-including-memory-learning-focus-and-decision-making

[8] Contemporary OB/GYN: Estrogen Therapy Shows Mixed Mental Health Effects in Menopause. https://www.contemporaryobgyn.net/view/estrogen-therapy-shows-mixed-mental-health-effects-in-menopause

Disclaimer: The information in this article is intended for general informational purposes only and does not constitute medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your GP or a qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read here.