Menopause brain fog, anxiety and low mood

SASian Anderson, Writer and editor, MyGLP. Sources checked 5 November 2026.

The symptoms, in NHS words

The NHS menopause symptoms page lists the mental health symptoms first:

• mood swings, low mood or depression
• anxiety, irritability and stress, often linked to poor sleep
• poor memory and concentration, often called brain fog

The NHS also says symptoms change over time. Hot flushes may ease and be replaced by low mood or anxiety. So a woman in her early 50s whose flushes have settled may still be in the menopause when the worry starts.

Many women have been told these symptoms are stress, or "just your age". In the government survey behind the 2022 Women's Health Strategy for England, 84% of respondents said there had been times a healthcare professional did not listen to them. Being heard starts with naming the pattern.

Why antidepressants are not the first answer

NICE guideline NG23 asks doctors to think about HRT and CBT for low mood linked to the menopause. A commentary in BMJ Sexual and Reproductive Health summarised the NICE position: there is no clear evidence that SSRI or SNRI antidepressants ease low mood in menopausal women who have not been diagnosed with depression, and they should not be started automatically.

This does not mean antidepressants are wrong for you. The NHS page on other medicines for menopause symptoms says SSRIs and SNRIs help mood symptoms in people diagnosed with depression or anxiety. Depression can start in midlife, and it needs proper treatment whatever the cause. The point is the order of the conversation. If your low mood arrived with irregular periods, flushes or broken sleep, ask whether hormones are part of the picture before you accept a prescription.

CBT for mood and anxiety

The NHS self-help page describes CBT as a talking therapy which can help with low mood and anxiety in the menopause. You can refer yourself to NHS talking therapies in England without seeing a GP first, as the NHS early menopause page points out.

Brain fog: what is going on

Brain fog covers losing your train of thought, forgetting names, walking into a room and not knowing why, and struggling to concentrate in meetings. The NHS lists poor memory and concentration among menopause symptoms. Night sweats make the fog worse, because a broken night hits memory and focus the next day. Treating flushes and sleep often lifts the fog with them. Our hot flushes guide covers the options.

Many women worry brain fog is early dementia. The NHS lists poor memory and concentration as a common menopause symptom in its own right. HRT is not a treatment to prevent dementia. The NHS benefits and risks page says nobody knows yet whether HRT reduces dementia risk and any effect is likely small. The NICE discussion aid shows combined HRT started at 65 for 4 years was linked with 18 dementia cases per 1,000 women against 9 without. So the case for HRT rests on symptoms, not on protecting memory in later life.

Testosterone is not a mood treatment

Private clinics sometimes offer testosterone for energy, motivation and memory. The BMS tool for clinicians on testosterone says randomised trials have not shown benefit for mood, energy or cognition. The licensed reason to try testosterone is low sexual desire. Our testosterone guide explains when it is offered.

When it is something else

Midlife brings other causes of low mood, worry and fog, and some have simple blood tests. Ask your GP to think about these alongside the menopause.

• An underactive thyroid causes tiredness, low mood and slowed thinking. See our thyroid guide.
• Low iron from heavy perimenopausal periods causes tiredness and poor concentration. See iron, tiredness and heavy periods.
• Sleep apnoea breaks sleep without you knowing and leaves you foggy in the day. See the sleep guide.
• Depression and anxiety disorders need their own diagnosis and treatment. If your mood used to dip before periods, mention it. Our PMDD and PMS guide covers the premenstrual side.
• Eating too little on a weight loss medicine can leave you flat and foggy. See tired all the time.

How to raise mood symptoms with your GP

1. Keep a two-week diary of mood, sleep, flushes and periods. Patterns help the GP link symptoms to hormones.
2. Say the word menopause or perimenopause at the start of the appointment.
3. Ask, "Could this be hormonal, and would HRT or CBT be worth trying first?"
4. If you are offered an antidepressant, ask whether the GP thinks you have depression, and why.
5. Ask for a double appointment or a GP with an interest in menopause if you need more time.

If mood symptoms are hurting your work, our menopause at work guide sets out your rights under the Equality Act 2010.

Sources

1. Menopause and perimenopause: symptoms (NHS)
2. Menopause: identification and management (NG23) (NICE)
3. Commentary on the NICE menopause guideline (BMJ Sexual and Reproductive Health, 2016)
4. Other medicines for menopause symptoms (NHS)
5. Menopause and perimenopause: things you can do (NHS)
6. Early or premature menopause (NHS)
7. Benefits and risks of HRT (NHS)
8. Incidence of medical conditions with and without HRT: a discussion aid (NICE)
9. Testosterone replacement in menopause (tool for clinicians) (British Menopause Society, 2026)
10. Women's Health Strategy for England (Department of Health and Social Care, 2022)