It was experiencing brain fog that first kickstarted Aimee Spector’s research into menopause.

“Brain fog” is a term that describes a “constellation of cognitive symptoms” - including problems with memory, attention and organisation - that are common during perimenopause.

At its worst, it can make you forget the names of people you know really well, which “can be quite scary”, says Spector, who is professor of clinical psychology of ageing and director of University College London’s Menopause Mind Lab; a team of researchers and clinicians dedicated to understanding more about the impact of menopause transition on cognition and mental health.

“Verbal memory seems to be the thing that’s really affected - remembering words; remembering things that you’ve read or seen on TV,” she explains. “For a teacher, this might be really hard if you have to remember lots of kids’ names, lots of detail, maybe lots of factual information that you need to have immediately available in your memory.”

Brain fog can have a significant impact on women in the workplace, and is at least partly responsible for some choosing to leave their jobs.

According to Menopause Mandate’s 2025 survey, which Spector was involved with, 39 per cent of women have considered changing or quitting their job due to menopause symptoms, and one in six have actually done so.

Despite this, only 37 per cent of women reported that their company had workplace training or support, and only 35 per cent said their employer had a menopause policy.

For schools, where retention is already a crippling issue, making sure that experienced teachers are not being unnecessarily driven out of the profession due to a lack of support is vital. So what do school leaders need to understand about this stage of life and how to help those going through it? We sat down with Spector to find out.

Tes: Could you start by defining what we mean by the word “menopause” and how that differs from “perimenopause”?

Aimee Spector: Menopause is one day in a person’s life, which is one year after their final menstrual period, and perimenopause is the time leading up to that.

It’s a little bit confusing because people often use the term “menopausal” when they are really talking about perimenopause.

Pre-menopause, your menstrual cycles are not changing, and you remain in the reproductive period. Then you have perimenopause, where you have disrupted cycles, and that can go on for many years. That tends to be where most symptoms happen.

Then the menopause is the one day where periods stop and after that, you’re post-menopause for the rest of your life.

The average age of menopause in the UK is 51, but estimates are lower in other countries and it seems to come earlier in Black and Asian women compared with white women. We don’t really understand why such differences exist and really need more research on this.

What are the common symptoms of perimenopause?

While people always used to talk about hot flushes and night sweats and maybe poor sleep and mood, we are learning that the psychological and brain-related symptoms actually seem to be more problematic and more pronounced.

‘People often talk about issues around organisation, like misplacing things, forgetting their train of thought’

The recent Menopause Mandate survey is a really useful source, because it surveyed over 15,000 women, and brain fog was the highest reported symptom. In that survey, 86 per cent of women said they had brain fog. Normally, this is very much about memory and attention, but people also often talk about issues around organisation, like misplacing things, forgetting their train of thought.

Other psychological symptoms like anxiety and depression were also quite high. But hot flushes and night sweats were only reported by 53 and 54 per cent of women.

What’s happening in the brain to cause these symptoms?

We know that in perimenopause, when your cycles are irregular, your hormones are going up and down all the time, which happens in puberty as well.

The brain is really good at adapting to change. After brain injury or stroke, for example, the brain can adapt. But if things are changing day by day and hour by hour, the brain finds that quite difficult, and that might be one of the reasons why we have these brain issues, which can then be compounded by poor sleep.

A lot of people are having night sweats that wake them up in the night. If you’re knackered, you can’t remember stuff, or you might get into a cycle of low mood and depression. And when people are depressed, they sleep worse, which further affects the brain fog.

You also might worry about the brain fog happening and what that’s going to look like and what people are going to think, and that anxiety can affect memory as well.

It’s really complicated as to why it happens. There are many different factors that might come into play, rather than saying it’s just because of the hormonal changes.

Could you explain a bit more about how the perimenopause affects mood and mental health?

I think that the data on anxiety and depression is the strongest. We published a meta-analysis in 2024, combining data from over 9,000 women globally, which looked at the chance of being diagnosed with either depressive disorder or depressive symptoms at different menopausal stages. We found that people in perimenopause have a significantly higher likelihood of being diagnosed with either. So perimenopause seems to be a period of vulnerability. I think there’s similar emerging research in terms of anxiety.

In addition, there is emerging evidence that you are more likely to be diagnosed with attention deficit hyperactivity disorder (ADHD) in perimenopause. There’s some thinking that people who have been masking symptoms or have had high-functioning ADHD get hit by hormonal changes and lack of sleep and brain fog and can no longer get by as they once could. And actually, some of the symptoms of brain fog, such as disorganisation and losing things, can be quite similar to ADHD symptoms.

There’s also increased risk of the first episode of psychosis and eating disorders as well. So there are various mental health things that we need to be aware of.

If women do experience symptoms such as problems with memory, are these difficulties usually temporary or do they persist after menopause?

It’s nearly always temporary. Often you’ll forget a word, but it will come back five minutes later. So it’s not totally gone. It’s very different to something like dementia, where it really has gone.

What people find is that it might fluctuate throughout their cycle, at certain times of the month or even certain times of the day. But generally speaking, when researchers have followed women over long periods, those women have scored better on various tests once they have got to post-menopause and hormone levels have stabilised.

The caveat to that is the figures about the number of women leaving work or changing their job and making lifestyle changes because they’re struggling with the symptoms. That’s problematic because once you stop doing things and you lose your confidence, even if your brain and hormone levels have settled, sometimes issues can be maintained by that lack of confidence and practice.

So giving people support at the time is really important.

Is there a lot of variation in terms of how people experience perimenopause symptoms and how severely they’re affected?

It’s hugely varied. Some people don’t have symptoms. Some people have symptoms but hormone therapy or another intervention will really help them.

I think that’s important to mention because there’s a bit of a doom and gloom narrative about menopause, but there are some things that are really good about being middle-aged, even in terms of our brain.

There are some psychologists in Australia who are looking at the strength of the ageing brain: the fact that we can make much better decisions than younger people; that we’ve got wisdom and knowledge and what they call “crystallised intelligence”, which comes from learning things over time.

Would you say that awareness about menopause and its effects has improved in recent years?

I think we have made a little progress, but the conversation is still quite limited in terms of who’s having it. When I’m speaking at events or doing teaching and training, there tend to be very few men there. I think many men feel that it’s not necessarily their place, and it’s a bit awkward. We don’t tend to talk openly about periods, so it’s seen as a bit of a taboo topic.

It’s quite culturally biased, too. We’re doing some research, for example, looking at South Asian women in the UK and their experience of menopause, and there are some interesting things coming out about how it’s not always discussed within families, and, even more so, not discussed with husbands.

In general, there’s still a lot of metaphor. And a lot of work around menopause is tokenistic. Many companies and schools seem to have menopause policies now, but whether people actually use them and feel that they can use them is a big question.

The policy might say you’re welcome to take a day off if you feel really awful because of your menopause, but would you actually want to say that and do it? Would it be embarrassing or would you be concerned about how you look?

Especially when we’re talking about cognitive problems; I can see it must be really hard for teachers because you might worry that if you admit to having them, people are going to judge how good you are at your job, potentially.

What can schools do to support staff who are perimenopausal and going through some of these issues?

I think menopause policies are still really important, but if you have a policy then you need to consult with the central users; check that they know what’s there and ask them whether they feel comfortable doing what the policy says. So checking it is fit for purpose, rather than something that’s just been created or copied from another organisation.

I think education is also really important, particularly for men: becoming menopause-aware, understanding what’s happening in the brain and what’s happening in the body.

‘Many schools seem to have menopause policies now, but whether people feel that they can use them is a big question’

We want menopause to be taken more seriously, but we don’t want it to be seen as some kind of disability where people can’t do their jobs. People very much can still do their job, but it’s just about having flexibility.

Sometimes that’s basic things. For example, if people are expected to wear certain clothing to school and it’s really hot, but there’s no air conditioning in the building. Temperature regulation can be really difficult during perimenopause, so it’s important to make sure that the school environment is supportive of that.

Leaders can also encourage women to seek out the right support, to go to their GP, and they can make sure that there’s time in the work day where they can do that.

You mentioned the importance of men becoming ‘menopause-aware’. How might a male school leader go about that?

I think men need to be thinking about the whole reproductive trajectory of women and how it’s really hard. You know, you’ve finally stopped your periods, which were driving you mad the whole time, or they have reduced, and you’ve had your kids. And then you’ve got this to contend with.

In terms of becoming menopause-aware, one of the things I am involved with at UCL is developing a national education programme on menopause. In the Mind Lab, we’re also developing an intervention to help women with brain fog in the workplace. So there are interventions that are being developed. But for now, the British Menopause Society and other organisations have education resources and courses - and I think men should go on these.

It might be useful for male leaders, when they have meetings with staff, especially if they’re predominantly women, just to name it, and say openly: “Look, I’m now trained in menopause. And I want people to know that if they are struggling with anything in relation to that, it’s OK to talk about it, and I’ll support wherever I can.” Simply sending an email with a link to the policy isn’t enough; you have to make people feel that it’s OK.

But equally, it’s always getting the balance right. We can’t blame everything on menopause, and there is a risk of that, as well.

Is there anything that teachers going through perimenopause can do to better manage their symptoms in the school environment?

From my own experience, I think that the thing that would be particularly challenging for teachers is the brain fog, because of the number of things that they’re having to keep in mind and remember.

What I would say, in terms of advice for them, is probably to try to use cognitive strategies. Don’t feel bad saying, “I’m going to write everything down,” and always using a notepad.

You can also use visual associations to remember a child’s name. An example might be if someone’s called Pat, imagine yourself giving them a pat on the back. That’s a bad example, but using a strategy like that is better than overreliance on yourself.

You can also try to reduce “clutter” by making sure you don’t have constant emails and messages coming through if you are trying to focus on something. One of the things we’re learning from our research is that sometimes what we think is bad memory is really just poor attention.

Mindfulness can be quite good. There’s good evidence for that and for cognitive behavioural therapy as well. Some people say hormone therapy also helps the psychological and cognitive issues, because it helps them to sleep better and improves mood, and these things are all very closely linked. So that’s another thing to think about.

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