Why Sleep, Mood and Cognitive Symptoms Happen
Sleep disturbance, emotional changes and cognitive difficulties are some of the most common concerns during the menopause transition. Hormonal fluctuations affect the brain’s sleep centres, mood regulation pathways and attention networks. Night sweats, bladder changes, and midlife stressors can add further disruption.
Many women describe a combination of broken sleep, low mood, irritability, anxiety, poor concentration and “brain fog”. These symptoms are real, common and treatable.
Sleep Disturbance
Why sleep becomes difficult
Sleep can be disrupted by night sweats, needing to get up to pass urine, physical discomfort, anxiety or a racing mind. This can lead to tiredness, reduced concentration, irritability and memory issues. Midlife responsibilities often compound the problem.
What you can do to help yourself
Keep a regular sleep routine
Aim to go to bed and get up at a similar time every day, including weekends.
Get natural light early in the day
Morning daylight supports your internal clock and helps regulate melatonin.
Limit caffeine
Many women need to stop caffeine by early afternoon, and some notice they sleep better if they avoid it after lunchtime. Remember that chocolate contains caffeine too.
Eat earlier in the evening
A heavy late meal can cause indigestion or reflux, which disturbs sleep.
Exercise regularly
Aim for at least 30 minutes most days, ideally outdoors. Avoid intense exercise close to bedtime as raised body temperature can delay sleep.
Reduce alcohol
Alcohol may help you fall asleep quickly but disrupts deep sleep and REM sleep.
Avoid evening naps
Short dozes on the sofa reduce sleep pressure and make it harder to fall asleep later.
Keep your bedroom cool
A drop in core body temperature helps your body initiate sleep.
Create a wind-down routine
A simple pattern such as a warm bath, gentle stretches or reading signals to your body that it is time to rest. Moving straight from busy activity into bed rarely leads to good sleep.
Quiet your mind
Writing a list for the next day or using a calming technique can prevent intrusive thoughts from disturbing you.
Limit screen use before bed
Blue light suppresses melatonin. Devices in the bedroom can also prompt thoughts about work or responsibilities. Keep the bedroom for sleep if possible.
Go to bed only when sleepy
If you lie awake for more than 15 to 20 minutes, get up and do something quiet before returning to bed when you feel tired again.
Remove visible clocks
Clock-watching increases anxiety and makes falling asleep harder.
Aim for seven to eight hours of sleep each night
Can medication help?
HRT
Hormone Replacement Therapy is the most effective treatment for vasomotor symptoms such as night sweats and can significantly improve sleep when sweats are the main cause of disruption.
Local vulval and vaginal oestrogen
Helpful if itch, bladder frequency or vaginal dryness are waking you at night.
Sleeping tablets
Prescription sleeping medicines are not recommended for long-term use. They do not create restorative sleep and can cause next-day grogginess, falls, impaired concentration and dependence.
Other helpful approaches
Mindful breathing
Slow, structured breathing helps settle a busy mind.
- Lie comfortably with eyes closed
- Breathe in through your nose to a count of three
- Hold briefly for a count of four
- Exhale gently through the mouth to a count of five
- Repeat, bringing your attention back whenever your mind wanders
Cognitive Behavioural Therapy for Insomnia (CBT-I)
CBT-I is the most effective non-pharmacological treatment for persistent insomnia. It works by changing unhelpful sleep patterns and thoughts. It is available through some NHS services and privately.
The National Sleep Foundation also offers further information and strategies.
Mood Changes
Why mood shifts occur
Oestrogen plays a significant role in regulating serotonin, dopamine and noradrenaline. As levels fluctuate, many women experience:
- Low mood
- Irritability
- Anxiety
- A reduced ability to cope with stress
- Loss of confidence
Life events such as caring responsibilities, work pressures and family changes often occur at the same time, amplifying symptoms.
What can help mood
Lifestyle foundations
Regular exercise, time outdoors, good sleep hygiene, limiting alcohol and prioritising rest all support emotional wellbeing.
Talking therapies
CBT can be helpful for anxiety and low mood. Counselling or coaching can support confidence, coping strategies and self-esteem.
HRT
For women who can take it, HRT is often highly effective when mood changes are driven by hormonal fluctuation. Many women report calmer, more stable mood and reduced anxiety.
Antidepressants
Useful when symptoms are primarily mood-related or when HRT is unsuitable. They may also help with vasomotor symptoms in some women.
Cognitive Changes and “Brain Fog”
Why cognition is affected
Many women notice difficulty concentrating, forgetfulness, slower processing or a sense of “fog”. This is linked to fluctuating oestrogen, disturbed sleep, stress and midlife workload.
These changes are frustrating but usually temporary and improve with treatment of underlying symptoms.
How to support cognitive function
Improve sleep quality
Restorative sleep is one of the most important factors for memory and attention.
Stay physically active
Regular exercise increases blood flow to the brain and supports cognitive health.
Break tasks into smaller steps
This helps maintain focus and reduces overwhelm.
Use reminders and lists
Simple organisational tools take pressure off memory.
HRT
There isgood-quality evidence that HRT improves cognitive symptoms by treating factors that strongly impair cognition during menopause, especially:
- Vasomotor symptoms (flushes and sweats)
- Poor sleep
- Anxiety
- Low mood
Night sweats and insomnia in particular have a major effect on attention, working memory and processing speed.
Interestingly, HRT is not proven to directly improve brain fog on its own, but when HRT reduces vasomotor symptoms and restores sleep quality, many women notice a significant improvement in clarity, concentration and memory.
Mental stimulation
Reading, learning new skills or doing puzzles can help keep cognitive pathways active.
When to Seek Additional Support
Speak with a qualified clinician if:
- Sleep remains severely disrupted for more than three months
- Mood symptoms are affecting daily life
- Panic, persistent anxiety or low mood develop
- Cognitive changes are worsening or causing concern
- You have symptoms of depression
Together we can explore the most suitable treatment options and create a personalised plan to support your wellbeing.
