Treatment of Menopause-Related Cognitive Dysfunction and Brain Fog

Therapies for menopause-related cognitive disturbances and brain fog include both pharmacologic and nonpharmacologic treatment modalities. Pharmacologic options span hormonal and non-hormonal therapies. Menopausal hormone therapy may improve cognition and includes estrogen-only therapy for women with surgical menopause, and combined estrogen–progesterone therapy for those in menopause with an intact uterus. Evidence-based non-hormonal medications include lisdexamfetamine and atomoxetine for new-onset executive dysfunction, while armodafinil may improve subjective cognitive functioning. Non-pharmacologic strategies encompass exercise, healthy eating practices such as the Mediterranean diet, mindfulness-based approaches, and sleep-focused treatments such as cognitive-behavioral therapy for insomnia (CBT-I), particularly when sleep disturbance contributes to cognitive impairment.