"Brain fog" is a tidy (and almost cute) way of describing something that can be very messy: Moments of forgetfulness can interfere with your work and your family life, leaving you frustrated. For many women, these moments become more common with age, and it’s tempting to brush them off as just that: a natural part of getting older. But experts say that memory changes aren’t actually inevitable — and women shouldn’t be so quick to simply write them off.

On this episode of Next Question, Katie sits down with Rhonda Voskuhl, MD, a professor of neurology and founding neurologist of UCLA’s Comprehensive Menopause Program, to talk about what happens to women’s brains as they age — and why scientists are only beginning to understand the enormous role hormones may play.

Menopause impacts the brain

Estrogen loss during menopause impacts nearly every aspect of a woman’s body, including her brain. That organ contains estrogen receptors, including in areas involved in memory and thinking. When estrogen levels decline around menopause, Dr. Voskuhl says some women may experience both acute and chronic effects on their cognition.

The acute ones may sound familiar: hot flashes, night sweats, and poor sleep. But Dr. Voskuhl says there’s another category of cognitive changes that can persist even after those symptoms disappear. They involve areas of the brain called the hippocampus and frontal cortex, which play important roles in memory, concentration, and information processing.

That distinction matters because, as Dr. Voskuhl points out, “For most women, symptoms like hot flashes will go away in three to seven years, but they’ll still have these cognitive issues.” 

“Brain fog” is more complicated than it sounds

We tend to file all of these neurological symptoms under one vague label: brain fog. But Dr. Voskuhl would like us to get more specific.

“Brain fog is a layman’s term,” she explains. It can describe the haziness you feel because you were up half the night with hot flashes, but it can also refer to more specific cognitive difficulties involving verbal memory, working memory, processing speed, concentration, and your train of thought. “You’ve got a lawyer who can’t think of a word,” she says. Or, Katie adds, “a journalist who can’t remember a name.”

While occasional difficulty with word recall might sound like a minor inconvenience, it can have major real-world consequences. Women often reach menopause at the same time they’re at the height of their careers and juggling enormous responsibilities at work and home. Suddenly needing more calendar reminders, forgetting conversations, or losing words can affect not only their productivity but also their confidence. “It's holding women back,” says Dr. Voskuhl. Her analysis: Cognitive symptoms don’t have to qualify as a disease to deserve serious attention.

Does menopause-related brain fog mean you’ll develop Alzheimer’s?

No — and Dr. Voskuhl is careful to point that out. But women do account for the majority of people with Alzheimer’s disease, and researchers are increasingly interested in why. One possibility scientists are investigating is whether hormonal changes around menopause could play some role in later cognitive risk. That leads to a larger question that researchers are just beginning to grapple with: Could specific cognitive changes that emerge around menopause be associated with a greater risk of Alzheimer’s later in life?

“We’re not saying everybody with [brain fog as a symptom of] menopause is going to get Alzheimer’s disease,” she stresses. In fact, Dr. Voskuhl says researchers don’t yet know whether those menopause-related cognitive changes increase Alzheimer’s risk, much less whether there’s a causal relationship. 

When evaluating women who are especially worried about their risk, she says, doctors may consider factors ranging from family history and brain imaging to biomarkers and genetics. 

What you can do to protect your brain now

While scientists work on those bigger questions, there are plenty of decidedly low-tech ways to support your brain health.

Exercise tops Dr. Voskuhl’s list: She recommends both cardiovascular exercise and strength training, along with what she calls “cognitive exercise.” That might mean reading, practicing recall, challenging your processing speed, or learning something completely new.

When it comes to diet, she’s wary of buzzy claims about miracle “brain foods” or supplements without strong evidence behind them. Instead, she recommends sticking with a healthy Mediterranean-style diet and paying attention to cardiovascular health, since what’s good for your blood vessels can boost your brain, too.

Perhaps most importantly, Dr. Voskuhl urges women to pay attention when they sense that something about their brain feels off. “Trust your gut,” Dr. Voskuhl says. “You know you.” Even if everyone around you insists you seem fine, you know best whether something that once came easily suddenly feels harder.

For more on Katie and Dr. Voskuhl’s conversation, which ranges from the future of hormone therapy to Alzheimer’s biomarkers and why women’s brains have been understudied for so long, catch the full episode of Next Question.

This interview has been condensed and edited for length and clarity.