Brain fog

The British Menopause Society calls brain fog a cluster of thinking symptoms that can be distressing. It describes it as trouble with memory, attention, organisation, problem solving or finding words that you notice yourself, without a significant measurable decline, which can come and go and does not stop you managing daily life.

It is common. The BMS tool reports a UK analysis of over 14,000 women in which brain fog was the most reported symptom, at 86%, ahead of hot flushes at 53%. The Pakistan Menopause Society lists poor concentration and brain fog among the early symptoms, in perimenopause and just after the final period.

The BMS lists the usual pattern: struggling to recall words and numbers, misplacing things, trouble concentrating, forgetting appointments, losing your train of thought and being more easily distracted. It says they show most when you are juggling several things at once.

So: the keys in the fridge. A child's name swapped for a sibling's. Nodding through a conversation because the thread slipped away. Sharp one week, slow the next.

In Urdu most women say bhool jana, forgetting, and blame themselves for it.

The BMS says brain fog is not always hormone related and can have several causes at once. It names poor sleep and tiredness as triggers, and lists other things that can add to it: nutritional deficiencies, hormone conditions such as thyroid disease, and low mood or anxiety. The European Menopause and Andropause Society (EMAS) adds that some medicines can be linked with brain fog too.

The NHS website says memory and concentration problems may feel worse when you are not sleeping and very tired. So sleep disruption, fatigue and mood changes are often part of the story.

The BMS sets out how brain fog usually differs from dementia:

• Brain fog mostly affects women between 40 and 60, can shift with the menstrual cycle, sleep and mood, and usually improves after the menopause. Dementia is more common over 65 and gets steadily worse.
• Brain fog is mainly words, focus and short-term memory. Dementia affects several areas at once, including orientation, language and judgement, and can make an everyday task such as making a cup of tea hard to put together.
• With brain fog, it is usually you who notices. With dementia, others tend to notice too, sometimes instead of the person herself, and it often comes with changes in emotional control, behaviour or motivation.

For work, the BMS suggests a quiet space, digital aids, regular breaks and flexible approaches. For long-term brain health it points to blood pressure, cholesterol and diabetes care, staying active, not smoking, avoiding too much alcohol and staying connected. Cognitive health has more.

The BMS describes treating what feeds brain fog: sleep, mood, hot flushes and lifestyle, with HRT where appropriate after a discussion of your own benefits and risks, and CBT. It says CBT can help break the cycle of thinking that your brain is not working so you cannot do anything, which can make the fog worse.

It also reports a recent review that found no evidence HRT either raises or lowers the risk of dementia, and says the evidence is too thin to recommend testosterone for brain fog.

See a doctor if brain fog is affecting your work, your relationships or how you feel about yourself. The BMS lists blood tests a doctor may consider to rule out other causes, including a full blood count, thyroid function, vitamin B12, folate and vitamin D, a long-term blood sugar test, liver and kidney function, and markers of inflammation.

The BMS lists the signs that call for a closer look: thinking problems that keep getting worse or get in the way of work, relationships or daily life a great deal; a sudden, marked decline, or any risk to safety; unusual features such as seizures or other neurological signs; and a family history of dementia that started before 65. Ask for a prompt assessment if any of these sound like you. The Pakistan Menopause Society lists marked cognitive decline among its red flags (section 2.3).

Losing your place in salah, or in a surah you have known since childhood, can be one of the most upsetting parts of this. Questions about prayer belong with a qualified scholar. The forgetting itself belongs with your doctor.

At home, being called careless does not help. Dimaghi dhund gives you and your family a better word.