Menopause is often associated with hot flashes, night sweats and mood changes. But new research suggests the transition may also bring measurable changes to the brain… changes that could help explain the “brain fog” many women describe during this stage of life.

A new scientific review presented at the annual meeting of The Menopause Society looked at how the brain adapts during menopause. Researchers found evidence of structural and functional shifts that may be linked to forgetfulness, difficulty concentrating and slower mental processing.

The findings have not yet been published in a peer-reviewed journal, but experts say they add to a growing body of research showing menopause is not only a reproductive transition, but a neurological one as well.

What’s happening in the brain?

The researchers reviewed previous studies that used brain imaging and cognitive testing to follow women through the menopausal transition.

One notable pattern was a reduction in gray matter volume in areas of the brain involved in memory, focus and decision-making, including the frontal and temporal lobes and the hippocampus. Gray matter makes up the brain’s outer layer and plays a key role in how we think and remember.

“These regions are essential for memory and executive function,” said Dr. Fatima Naqvi, an OB-GYN at Atlantic Health, who was not involved in the research. Decreases in gray matter in these areas have been linked to certain memory challenges.

There was also some encouraging news. Researchers observed signs that gray matter volume may partially rebound after menopause, suggesting the brain can adapt over time.

Brain scans showed another change: an increase in white-matter hyperintensities, small bright spots that can reflect changes in blood flow or inflammation. These have been linked to higher risks of cognitive and mood symptoms and were more common in women who experienced early menopause or frequent hot flashes.

The review also found a higher density of estrogen receptors in the brain during menopause; a shift researchers believe may be the brain’s attempt to compensate for falling estrogen levels.

The review did not pinpoint a single cause for these changes, but experts say declining estrogen is likely central.

“Estrogen plays an important role in brain function,” Naqvi said. “When levels drop, the brain has to reorganize how it operates with less hormonal support.”

Dr. Jennifer Wu, an OB-GYN at Northwell Lenox Hill Hospital, noted that hormones are only part of the story.

“Sleep problems, stress and mood changes are very common during menopause,” Wu said. “Any one of those can affect memory and concentration, even without visible changes in the brain.”

Researchers hope these findings will eventually lead to better treatments for menopause-related cognitive symptoms. For now, doctors stress an individualized approach.

Regular exercise, a balanced diet and foods rich in omega-3 fatty acids; such as fatty fish and walnuts,  may support overall brain health, experts say.

Hormone therapy may help some women, especially when started earlier in menopause, but results vary.

“Some women report sleeping better and feeling mentally sharper,” Wu said. “Others don’t notice much difference. It’s not a one-size-fits-all solution.”

Doctors also urge caution when it comes to supplements marketed for brain fog.

“It’s a largely unregulated space,” Naqvi said. “The safest option is to talk to a healthcare provider before trying anything.”

While more research is needed, experts say the review reinforces an important point: cognitive symptoms during menopause are real, biologically based and deserving of medical attention.

“Menopause isn’t just about the ovaries,” Wu said. “It’s a whole-body and whole-brain transition.”