I walked into a room last week and forgot why I was there. Then I lost a word I use all the time and stood there waiting, certain my brain would eventually hand it back to me. If you’re a woman in midlife, I suspect you know this feeling — and I suspect you also know the quieter thing that comes after it. The little story we start to build. The wondering if we’re losing our sharpness. And if we’ve watched a parent or someone we love live with dementia, it’s not a big leap before the wondering turns into fear.

Here’s what strikes me after nearly forty years of clinical work. Women don’t walk into my office asking whether their symptoms are dementia or menopause. They say, I don’t feel like myself. My brain feels foggy. And then, almost in a whisper, they ask if I think it could be dementia. Rarely does anyone bring the word menopause into that question. We were prepared for hot flashes and changes in our cycles, but nobody prepared us for losing a word in the middle of a meeting, or for suddenly struggling to concentrate on work we’ve done well for years.

So in this week’s episode of Becoming Real, I’m bringing together the two worlds I’ve spent my career in — dementia care and women’s health — to talk honestly about brain fog during perimenopause and menopause. We look at what’s actually happening in the brain when hormones begin to fluctuate, what the research genuinely shows about cognition during this transition, and why a woman can test completely normal and still know that something feels off. We also talk about the difference between fog that fluctuates and changes that progress, because that distinction matters more than any single forgotten name or misplaced set of keys.

And I want to say this clearly, because it’s the heart of the episode: most brain fog during the menopause transition is not dementia. But when changes persist or begin to affect how you function, they deserve an explanation — not a dismissal, not a “you’re just stressed,” and not months of quietly keeping score of your own mistakes.

If you’ve been carrying this worry alone, or if you know a woman who has, I hope you’ll listen. And I hope you’ll walk away knowing what to pay attention to, what questions to bring to your clinician, and how to advocate for your own brain with the same fierceness you’d bring to advocating for anyone else you love.

You can find the full episode wherever you listen to podcasts. And if you’d like to stay connected beyond the podcast, join my email list at drloristevic.com — that’s also where you’ll find an invitation to The Real Conversation, my free live monthly gathering for women who want to go deeper.

Until next time, be brave enough to be real.