Anywhere from 60 to 70% of menopausal women experience brain fog. Maybe that takes the form of a lawyer who can’t think of a word, an executive who loses her train of thought in a meeting, or the mother whose kids have to remind her of what they discussed just the day before. Many of these women are scared about what's happening, and don't know what to do about it. And yet, research on the topic of menopausal brain fog is sparse. So instead of receiving a diagnosis, many women are dismissed — even told they’re "just getting old."
The first step to fixing this? Taking women seriously: Brain fog is real, and the vast majority of women are not treated for their symptoms. Some might not even know if what they're experiencing is menopause-related brain fog.
I have spent my career seeing patients in the neurology clinic and doing NIH-funded research on estrogen and the brain. My goal is to harness clinical and neuroscience insights to prevent cognitive decline of brain aging due to menopause. My view is that if we can measure brain fog, we can address it — so I developed a test to do just that.
Why I created my brain fog assessment
I created the Voskuhl Menopause Brain Fog Assessment — a tool optimized for menopausal women ages 47 to 62 — based on my UCLA practice. After seeing hundreds of menopausal women with cognitive symptoms, I recognized a huge unmet need for both new tools to measure menopausal brain fog, and new treatments to alleviate it. I knew we had to do better.
Existing cognitive assessments used in Alzheimer’s Disease aren't sensitive enough for use in cases of menopausal brain fog. That's because brain fog is not global dementia: Not all cognitive areas are affected, and there isn't a decrease in IQ. Also, questionnaires developed for the earlier stages of mild cognitive impairment and subjective cognitive decline aren't tailored for women versus men. That's a problem, because there are sex differences in how the brain functions, during both health and disease.
Unfortunately, past research was done primarily in men (and in male mice), which leaves menopausal women out of the equation. We know that in menopause, specific regions of the brain are affected — and those changes are visible on MRI scans. Therefore, a good assessment for women must focus on the hippocampus and the prefrontal cortex and test the cognitive functions they drive: verbal memory, working memory, processing speed, concentration, and problem solving.
If you find yourself opening the refrigerator door and asking, “What was I looking for?” or forgetting a recent conversation with a friend, you may be wondering if you're dealing with brain fog. Here are the six questions to ask yourself, to determine if you might need to speak with your doctor. They're designed to identify specific cognitive issues related to menopause and they're the same ones that I ask women who come into my practice or find me through my telehealth company, CleopatraRx. For each, think about which of the following four replies feels most accurate, and make a note of your response — then share that info with your physician in your next annual appointment:
-Severe difficulty (>50% worse)
-Moderate difficulty (25% worse)
-Mild difficulty (<10% worse)
-No difficulty
- How would you rate your difficulty with brain fog (as compared to 10 years ago)?
This is a general question for women who often describe themselves as feeling “off.” Many say they just don’t feel like themselves: They wake up dreading mental tasks of the day, and they lose confidence. This is common, and if you’re experiencing it, you're not alone.
- How would you rate your difficulty with quickly processing new information (as compared to 10 years ago)?
With the loss of estrogen during menopause, processing speed can slow down because the synaptic connections between brain cells are decreased. Multitasking used to be easy, and now it takes more time, which is frustrating.
- How would you rate your difficulty with remembering things (as compared to 10 years ago)?
You may find that you often forget the name of someone from work, or an appointment. You try to compensate by making lists. This is a sign of cognitive issues of menopause — not global dementia.
- How would you rate your difficulty with problem solving (as compared to 10 years ago)?
The prefrontal cortex is a primary region affected by menopause and it's the part of your brain responsible for executive functioning and problem solving. You used to readily see a solution to a puzzle or problem, and now it's more of a struggle. If you find yourself no longer winning at board games, this could be why!
- How would you rate your difficulty with concentrating (as compared to 10 years ago)?
A common symptom, and one of the “usual suspects” during menopause. This is when it becomes hard to listen to a long story — you get distracted easily and lose your train of thought if interrupted while speaking.
- How would you rate your difficulty with finding the right words during conversations (as compared to 10 years ago)?
Many women I see forget common words, drawing a blank while talking. (They may have difficulty expressing complex ideas.) That's because the parts of the brain responsible for word recall are affected by menopause.
There is good news
On September 1, 2026, I published a research paper entitled, "Targeting Hormone Therapy for the Brain in Menopause" in the journal Scientific Reports. It was a case series studying menopausal women who took a tailored combination of oral estriol and progesterone for 12 months in a blisterpack (PearlPAK) patented by UCLA. There was significant improvement in cognitive symptoms — including self-reported brain fog, concentration, working memory, processing speed, verbal memory, and problem solving — known to be affected by menopause, as measured by my Voskuhl Menopause Brain Fog Assessment.
Trust your instincts
Women know themselves best, and can recognize if their ability to complete a certain type of task has changed. In my assessment, the baseline (at month 0) is your self-reported change in each cognitive task compared to 10 years earlier. But every woman is different: For example, professors may know they have difficulty finding a word, but may be so skilled at public speaking that they still do better than the general population on a verbal memory test. Other women may know they have poor concentration, but may have developed ways to compensate. Each woman serves as her own control, and each cognitive task is evaluated based on each woman’s self-assessment. Also, as I explained in my recent paper, you can take the test again 12 months later, and see how you're changing each year.
Ultimately, get an assessment (this one is free online) and trust your instincts about when you need to seek out professional help. Your brain is worth protecting, so stand up for it.
Rhonda Voskuhl, M.D. is a professor at the University of California, Los Angeles. She is also the founding neurologist of the UCLA Comprehensive Menopause Program and the co-founder of CleopatraRx.
