What would you do if you suddenly started experiencing forgetfulness, difficulty concentrating, and brain fog, just as you were reaching the peak of your career and earning potential, only to find these symptoms affecting your confidence, performance, and ability to work? This is the daily reality for millions of women.
Worse, they visit a doctor and face the risk of being diagnosed with another condition altogether, or told there is no treatment.
Despite affecting millions of women, menopause-related brain fog remains poorly understood and underserved by healthcare. There is no universally accepted clinical definition of brain fog, conventional cognitive tests are not necessarily designed or validated to detect the subtle changes women experience during menopause, and there is no established treatment specifically recommended for these cognitive symptoms.
It's another example of how women's health has historically been overlooked in medical research, leaving women struggling with symptoms that can affect their careers, confidence, and quality of life.
But now a UK startup Cerebella is aiming to address the challenge with Cerebella Foundations, a self-guided programme developed by cognitive neuroscientists to help women understand and support their cognitive health during the menopause transition.
I spoke with CEO Dr Nahid Zokaei to learn more.
When menopause brain fog masks something more serious
Dr Nahid Zokaei is an academic by training, completing her PhD in cognitive neuroscience at UCL in 2014, focusing on dementia, cognitive assessment, and biomarkers.
She then spent 12 years at Oxford as a senior research fellow, running her own lab and researching cognitive health in ageing, working closely with neurology and memory clinics throughout her academic career.
“It's an evidence-based approach recommended by NICE and used internationally, but delivering it at scale is difficult,” she admits.
Towards the end of her time at Oxford, her mother began experiencing unusual memory symptoms. She repeatedly visited GPs, who attributed them to menopause. Unfortunately, she had brain cancer, which was diagnosed very late.
Zokaei admits, “I don't know whether an earlier diagnosis would have changed her prognosis, but it made me realise how little we understand about normal cognitive ageing in women. Menopause is a normal part of ageing, yet symptoms can be dismissed as menopause without sufficient investigation.”
Conversely, menopause symptoms can also be misdiagnosed as other conditions altogether. Around the same time, Professor Aimee Spector, one of the world's leading experts in non-drug psychological interventions for menopause, whom she’d been working with at UCL, began experiencing cognitive difficulties. She's an internationally recognised dementia researcher, yet she thought she might have early-onset dementia.
It turned out to be menopause-related brain fog —Even someone with her expertise struggled to tell the two apart.
Worse, recounts Zokaei, she was told there was no recommended treatment for brain fog and that she might need to reduce her working hours.
You read that right: the medical profession's best option for a woman at the peak of her career was to reduce her working hours.
The career and economic cost of cognitive symptoms
Women experiencing menopause are often at the peak of their careers, bringing years of experience, institutional knowledge, and significant professional responsibilities.
When symptoms affect their ability to work, they may reduce their hours, take time off, or leave employment altogether, creating costs for employers and the wider economy. Cerebella surveyed approximately 1,300 to 1,400 women in the UK about menopause symptoms and their experiences at work. In their analysis, brain fog was particularly associated with reduced confidence, lower productivity, and intentions to leave work.
In a study of over 14,000 women published this year, self-reported cognitive symptoms affect roughly 40–80 per cent of women during the transition; one large survey found brain fog was the most reported symptom, at 76–84 per cent.
To persuade healthcare systems, employers, and policymakers to take menopause-related cognitive difficulties seriously, companies must also demonstrate their wider economic impact.
Brain fog is not a diagnosis
To be clear, brain fog has no clinical or scientific definition. Zokaei asserts, “I have a problem with the term brain fog because it isn't one thing. It's similar to dementia, which is an umbrella term covering different conditions with different underlying mechanisms.”
Brain fog can involve difficulties with attention, verbal memory, concentration, motivation, and other cognitive functions. These can have different causes, but the consequences are often similar: reduced confidence, difficulties at work, and a feeling that you're no longer functioning as you used to.
Current menopause questionnaires include a few questions about forgetting words or experiencing memory difficulties, but they don't provide a sufficiently detailed picture of what's happening cognitively. “More sensitive cognitive tests already exist in academic research,” explained Zokaei.
“We're working to develop and validate assessments that can identify the specific difficulties an individual is experiencing."
Together with Professor Aimee Spector, they are developing a non-drug intervention that draws on cognitive stimulation, cognitive strategies, and approaches studied in midlife women.
The aim is to understand what's driving someone's difficulties rather than treating brain fog as a single, uniform symptom.
How Cerebella works — and what the evidence shows
It's early days for Cerebella. The startup is developing a structured, research-backed programme of ten sessions over five weeks, each lasting about 25 to 30 minutes. “We wanted something substantial enough to deliver a meaningful intervention but manageable for busy women in midlife,” explained Zokaei.
The sessions combine psychoeducation, cognitive behavioural therapy-based activities, and gamified cognitive exercises that target memory, attention, concentration, and cognitive flexibility.
The UCL ‘Menopause Mind Lab’; a team of researchers and clinicians dedicated to understanding more about the impact of menopause transition on cognition and mental health, directed by Professor Spector, has published two randomised feasibility trials investigating a similar approach. Those studies reported encouraging engagement and retention, along with improvements in quality of life and brain fog measures.
Cerebella conducted a proof-of-concept study of its digital intervention, which involved three weeks and five sessions.
"Participants reported improvements in the areas we targeted, including verbal memory, attention, and sleep. The team uses pre- and post-intervention assessments, looking at several outcomes."
"We include standardised cognitive measures used in clinical practice, but we also use more sensitive assessments, including tests developed during my academic career,” shared Zokaei.
One problem with many conventional cognitive tests is that they're not particularly sensitive to subtle changes. Some were also developed or standardised using populations that don't adequately represent women.
“For example, a traditional memory test might ask whether someone remembers an item. But remembering something isn't necessarily a simple yes-or-no question.
We can also measure memory precision: how accurately someone remembers details. That can tell us much more about subtle cognitive changes.”
The team is also interested in outcomes beyond cognitive test scores, including quality of life, wellbeing, productivity, confidence at work, and whether someone is considering reducing their hours or leaving employment.
“Ultimately, our longer-term goal is to complete the necessary clinical and regulatory work so the intervention could potentially be recommended by clinicians and reimbursed through healthcare insurance systems. We want to understand whether improvements in cognition translate into meaningful improvements in everyday life,” shared Zokaei.
Personalising treatment without compromising the science
These approaches are structured and can have a defined therapeutic dose, even though they aren't medications. As they build the app, the team is identifying which elements of each activity are therapeutically essential and which can be adapted.
For example, the underlying cognitive task may need to remain unchanged, but we can personalise the presentation, language, or surrounding content.
Zokaei explained:
“We're developing a system using retrieval-augmented generation, or RAG, to support that personalisation.
The key distinction is that we don't want AI to alter the therapeutic components that must remain consistent. Instead, it should help adapt the experience around those components.”
In the longer term, the company is also developing cognitive assessments that could support clinician-facing dashboards. The idea is that women could eventually share meaningful information about their cognitive functioning with healthcare professionals.
Those tools will require further validation before they can be used clinically.
Why brain health needs a holistic approach
I wanted to understand how Cerebella accounts for the fact that hormonal changes, stress, anxiety, sleep, and other factors can affect cognitive difficulties simultaneously and bidirectionally.
Zokaei notes that historically, we've tended to separate these issues. You have brain-training apps on one side and mental health apps on the other.
“I don't think that makes sense. Your cognition and mental health are both aspects of brain health. We shouldn't treat them as completely separate systems.
That's why our intervention includes approaches addressing psychological wellbeing alongside cognitive exercises.”
To be clear, Cerebella isn't intended for every situation or every medical condition. More serious concerns need appropriate clinical assessment and care, and users are signposted accordingly.
“But for the difficulties we're targeting, a more holistic approach is essential.”
Building trust in a crowded menopause market
The menopause market is crowded with wellness products, supplements, and apps, making it difficult for women to distinguish evidence-based interventions from marketing claims.
Zokaei says trust is a major issue as women's health becomes an emerging commercial market, and many companies are trying to enter it.
“For us, the goal is to build the clinical evidence, regulatory compliance, and professional credibility needed for Cerebella to become something healthcare professionals can recommend.
Ideally, we'd like it to be reimbursable so women don't have to pay out of pocket.
We don't want the long-term model to depend entirely on selling directly to individual women.
Education is also important. When you're developing something in women's health, you're often trying to change how people understand the problem at the same time.”
To achieve its aims as a small early-stage company, the team is working with larger organisations that have already built trust with women and healthcare communities such as Menopause Mandate, a UK not-for-profit campaign group founded by broadcaster Mariella Frostrup that advocates for better menopause healthcare, workplace support, and government policy.
“It's about making sure women understand both the problem and the evidence behind potential solutions.”
Cerebella also knows digital health solutions can place responsibility on individual women to manage their symptoms rather than address broader shortcomings in healthcare.
“We've spoken to GPs who told us they don't routinely ask about brain fog because they don't currently have an intervention they can recommend. We want to help change that,” said Zokaei.
The company is also addressing gaps in representation, recognising that menopause research has historically underrepresented women from different ethnic and cultural backgrounds.
Cerebella is working with organisations that can help it reach underserved communities and is collaborating with clinical psychologists from diverse backgrounds to review and adapt its content, including language, imagery, and the delivery of psychological interventions.
“We're still a small company, and we're beginning with the largest initial target group, but we want to build inclusivity into the product as we develop it.”
The company also recognises that menopause remains stigmatised in some communities, making culturally sensitive communication around cognitive health an important part of its approach.
From menopause brain fog to lifelong women's brain health
The free, lighter version of Cerebella focuses on education and some cognitive activities without collecting sensitive health data.
At the same time, the startup is developing commercial pilots with employers to explore how the programme could be offered in workplace settings. It's also building a content library and the underlying structure needed for personalisation and raising a pre-seed funding round.
Longer-term work includes clinical trials, validating our cognitive assessments, and the regulatory pathway toward a product that could eventually be recommended or reimbursed through healthcare systems.
“Hearing is another area we're interested in exploring as part of women's cognitive health. It may eventually become relevant to the app, but we want to develop the research first,” explained Zokaei.
The company is also pursuing grant applications and collaborations that support broader scientific work. The challenge is translating that research into something people can use at scale. From this, Cerebella’s broader interest is women's brain health across the lifespan.
“We've spent a lot of time talking about living longer. We also need to think about living better.”
Women are disproportionately affected by several neurodegenerative and neuropsychiatric conditions. For example, around two-thirds of people living with Alzheimer's disease are women. Much remains unknown about how hormonal changes relate to cognition and mental health.
As the conversation around women's health gains momentum, the challenge is not simply to develop more products, but to close longstanding gaps in research and healthcare. For Cerebella, the ambition is to turn decades of cognitive science into accessible, evidence-based support that helps women maintain their confidence, independence, and quality of life, during menopause and beyond.