We hosted a webinar with a menopause specialist to dig into something that gets far less airtime than hot flushes: what’s actually happening inside the brain during perimenopause and menopause, and why it affects so much more than mood. This blog pulls together the most useful, workplace-relevant parts of that session.
How Hormones Actually Affect the Brain
The starting point is simple but easy to miss: oestrogen, progesterone and testosterone aren’t just reproductive hormones. All three also work as neurotransmitters in the brain, meaning they directly affect how brain cells communicate with each other, not just what happens in the rest of the body.
Oestradiol (the main form of oestrogen involved here) supports mood, concentration, sleep and blood flow to the brain. Testosterone, which both men and women produce, supports energy, cognition and verbal recall. Progesterone helps reduce anxiety and supports sleep and overall cognitive function. When levels of all three fluctuate and then drop during perimenopause and menopause, the brain genuinely has less to work with, which is why cognitive and emotional symptoms are so common, not a sign that someone is “losing it” or not coping (this general picture of hormones acting directly on the brain is explored at length in neuroscientist Dr Lisa Mosconi’s books The XX Brain (2020) and The Menopause Brain (2024), both published by Allen & Unwin).
Common Brain Health Symptoms During Menopause
These aren’t rare or minor experiences. Research led by Cardiff University, via the National Centre for Mental Health, estimates that around 70% of women over 45 develop some form of neurological or psychiatric symptom during perimenopause (NCMH, How can the menopause negatively impact mental health?, 2024). And a UCL-led meta-analysis published in the Journal of Affective Disorders in 2024 found that perimenopausal women are around 40% more likely to experience depressive symptoms than premenopausal women (UCL / Journal of Affective Disorders, 2024).
Brain fog is the one most people have heard of: walking into a room and forgetting why, losing a word mid-sentence, or struggling to concentrate on something that used to be straightforward. It’s frustrating and, for many women, genuinely worrying, particularly in a senior or client-facing role.
Anxiety, including social anxiety, is extremely common and often one of the earliest symptoms, sometimes showing up as a vague sense of “not feeling like myself” well before anything more obvious appears.
Low confidence can follow a similar pattern: someone who was previously assured in their role and their judgment can start second-guessing themselves constantly. That’s a hormonal effect, not a character change.
Sleep disruption deserves its own mention, since it tends to make every other symptom worse. Poor sleep is strongly linked to reduced concentration and lower mood generally, and the menopause transition is a particularly common time for it to strike.
[Visual placeholder: simple graphic showing the three hormones and their main brain functions, e.g. a short table: Oestrogen → mood, concentration, sleep, blood flow / Testosterone → energy, cognition, verbal recall / Progesterone → anxiety reduction, sleep, cognition]
The Impact on Careers and the Workplace
This isn’t a minor workplace inconvenience. CIPD research found that 53% of women aged 40 to 60 experiencing menopause symptoms have, at some point, been unable to go into work because of them, and two-thirds say menopause has had a mostly negative effect on them at work overall (CIPD, Menopause in the Workplace: Employee Experiences in 2023). The same research found 17% have considered leaving their job specifically because of a lack of support, and 6% have actually left.
A separate, larger survey backs this up from a different angle. The Fawcett Society’s 2022 study of over 4,000 UK women found that 1 in 10 who worked through menopause had left a job because of their symptoms, extrapolated to roughly 333,000 women nationally (Fawcett Society, Menopause and the Workplace, 2022). Two different studies, two different exact figures, but the same conclusion: menopause is a genuine retention risk, not a background issue.
Worth sitting with too: women aged 45 to 54 currently have the highest female suicide rate of any age group in England and Wales (ONS, Suicides in England and Wales, 2024 registrations), the same age bracket where perimenopause and menopause are most common. That doesn’t mean menopause causes this, the picture is more complex than that, but it’s a strong argument for taking the mental health side of menopause support seriously, not just the physical symptoms. If this raises anything for you personally, the Samaritans are free to contact any time on 116 123.
Menopause, Brain Health and Longer-Term Risk
Here’s a nuance worth getting right, because the research doesn’t support everything you’ll read on this online. Women make up roughly two in three people living with dementia in the UK, and are around twice as likely to develop Alzheimer’s disease as they are to develop breast cancer over the rest of their lifetime (Alzheimer’s Research UK). Researchers think the loss of oestrogen and progesterone during menopause may be part of the explanation, though it isn’t considered the whole picture, and a direct causal link hasn’t been established.
It’s also genuinely important to say: brain fog during menopause is not dementia, and the two get conflated far too often. In fact, early dementia symptoms in women are sometimes wrongly put down to menopause, stress or depression, which can delay a proper diagnosis (Alzheimer’s Society). If brain fog or memory changes are persistent, worsening, or come with other symptoms that feel out of the ordinary, a GP conversation is worth having, rather than assuming it’s “just menopause.”
On HRT specifically: current NICE guidance says hormone replacement therapy does not appear to increase dementia risk, but it is not currently recommended specifically to prevent dementia or treat cognitive symptoms on their own (NICE, Menopause guidance). Whether HRT is right for an individual is a conversation for their GP or a menopause specialist, not something a workplace blog, or an employer, should be weighing in on.
What Actually Helps
A few things come up consistently in the evidence, none of which require a prescription:
- Sleep has a real structural effect on brain function. Research into the brain’s internal clock genes shows they don’t just govern when we feel sleepy, they also help regulate the overnight clearance of waste products between brain cells (Hoyt & Obrietan, Molecular Neurodegeneration, 2022), which is one reason poor sleep during this stage of life tends to make everything else worse. Protecting it (flexibility around start times, a quiet space to recover after a bad night) genuinely matters.
- Resistance exercise supports both brain function and long-term physical health, including bone density, which matters given that around half of women over 50 will develop osteoporosis at some point (Royal Osteoporosis Society).
- Nutrition, particularly adequate protein and fibre, supports cognitive function generally.
- Social connection has been linked in research to a longer, healthier lifespan, and is one of the simplest things to actively encourage at work.
- Medical support, where appropriate, including HRT and non-hormonal options like CBT, should be an individualised conversation with a GP or menopause specialist, never a blanket policy.
Supporting Menopause and Brain Health at Work
One finding from our panel is worth repeating to anyone building a wellbeing strategy: education works better before symptoms hit than a reactive conversation after the fact. That matters because awareness is still genuinely low: a YouGov poll commissioned by the Royal College of Psychiatrists found that nearly three-quarters of UK women are unaware that menopause can trigger a new mental illness (Royal College of Psychiatrists, March 2026).
Many women also don’t want to raise menopause with their manager, especially a younger or male manager, because they don’t want to be seen as struggling. Giving people access to good information proactively, through training, a webinar, or a clear point of contact, means they can help themselves without that conversation ever needing to happen if they’d rather not have it.
We’ve covered the practical side of this, including the new menopause action plan requirement for larger employers, in more detail in our menopause and mental health at work blog, so we won’t repeat it all here. The short version: menopause support isn’t a nice-to-have anymore, it’s quickly becoming a compliance expectation, and the brain health angle in this post is exactly the kind of detail a genuinely useful action plan needs to reflect, not just the physical symptoms most people think of first.
If you missed the live session, catch the full webinar recording and register for future sessions here.
