Forgetting a word, losing a train of thought, or walking into a room and forgetting why can be unsettling for older adults, who may immediately worry about Alzheimer’s disease or dementia. But medical experts say these lapses are often tied to hormonal changes that come with age, particularly the drop in estrogen women experience during perimenopause and menopause.
Dr. Rhonda Voskuhl, a professor of neurology at UCLA and co-founder of Cleopatra RX in Los Angeles, says women noticing memory changes in midlife should measure themselves against their own past, not against a generic standard of what “normal” memory looks like.
“I think they should listen to themselves,” Voskuhl told Fox News Digital at the Livelong Women’s Health Summit in New York City on Friday. “They know. Just ask yourself.”
Voskuhl recommends a straightforward benchmark: compare how your memory and focus feel now to how they felt a decade ago.
“The first question is, are you worse than you were 10 years ago?” Voskuhl said, referring to the Voskuhl Brain Fog Menopause Assessment used at UCLA’s Comprehensive Menopausal Program. “Ten years is a pretty good spot. And they think, ‘What was I doing 10 years ago? What was I like? Was I having problems finding the words? Was I at the point where I couldn’t multitask anymore? Was I slow in my processing?’ And they’ll remember.”
That kind of self-comparison, she said, can help reveal whether cognitive changes are linked to menopause and give both patients and doctors a baseline for tracking symptoms over time.
Why Standard Tests Miss It
Standard memory tests don’t always pick up on subtle day-to-day changes. Doctors call this subjective cognitive decline — when a patient notices changes even though neurological testing comes back normal. According to the Centers for Disease Control and Prevention, roughly one in nine adults report this kind of subjective decline, but fewer than half ever raise it with a healthcare provider.
Voskuhl compared the situation to a professional athlete whose performance has slipped even though standard tests find nothing wrong.
“If somebody is an NFL football player and he says, ‘I’m weaker than I used to be,’ and I go and do my neurological test, I say, ‘Oh no, you’re still strong,'” Voskuhl said.
The player’s own sense that something has changed still matters, she said, even without a test to confirm it — and the same logic applies to women noticing changes in their own thinking.
Telling the Difference From Dementia
Experts agree the key distinction between hormonal brain fog and a neurodegenerative disease is how the memory changes affect daily life. According to the Mayo Clinic, menopausal brain fog tends to show up as temporary, inconsistent lapses — misplacing items or slower processing — while overall reasoning and independence stay intact. Symptoms often come and go and can worsen with stress or poor sleep.
Early dementia, by contrast, causes memory loss that is persistent and progressive, interfering with basic tasks such as managing finances, navigating familiar routes while driving, or exercising sound judgment.
Experts advise anyone with ongoing cognitive concerns to seek a full medical evaluation, including brain MRIs or vascular screenings, to rule out other causes such as blood vessel disease or thyroid problems.
For women who feel brushed off by their doctors, Voskuhl had blunt advice: “When they have doctors who don’t listen to them, they need to find another doctor.”
