The study, led by Sharron Hinchliff of the University of Sheffield and Kristina Potočnik of the University of Edinburgh, forms part of the MARIE-UK project, a large-scale international research initiative investigating unmet needs across perimenopause, menopause, and post-menopause. The researchers conducted in-depth, semi-structured interviews with 50 women aged between 43 and 67 years, with a mean age of 52.3 years, drawn from a larger cohort of 1,043 UK women who had completed a quantitative survey. Participants were recruited through digital platforms, NHS Trust websites, clinics, and community venues including places of worship, and the sample deliberately captured variation in age, menopausal stage, ethnicity, and employment circumstances.

To analyse the interviews, the team used collaborative reflexive thematic analysis, a rigorous qualitative method in which multiple researchers independently code the same transcripts and then compare interpretations to reach consensus. The analysis produced 13 themes and 46 subthemes, and the researchers interpreted the findings through the lens of Conservation of Resources (COR) theory, a well-established psychological framework which holds that individuals strive to obtain, retain, and protect resources they value, such as time, energy, health, and social support. When demands deplete these resources faster than they can be replenished, a loss spiral begins: each loss makes people more vulnerable to further losses, compounding strain and diminishing wellbeing.

Applied to menopause, COR theory reframes the transition not simply as a biological event but as a demand that drains the very resources women need to function and thrive at work. The majority of participants in the study reported cognitive changes, particularly difficulties with working, short-term, and episodic memory, alongside the phenomenon popularly known as brain fog, characterized by trouble focusing on tasks, following instructions, or retrieving words. These difficulties struck many women with startling speed and severity. One participant, given the pseudonym Bree, described how after more than two decades in her job she had been the colleague everyone consulted for policy knowledge, yet suddenly found herself unable to work out how to resize her computer screen. The abruptness of the change, she said, made her feel as though she had almost shrunk as a person.

The consequences rippled far beyond day-to-day task performance. Women described their brains filling up too quickly, forcing them to write everything down, and several reported forgetting what they were saying mid-sentence or retracing their steps to check whether tasks had been completed. This perceived decline in efficiency fed directly into career decisions: some participants declined promotions because they no longer felt competent enough to take them on, despite years of accumulated expertise. Others described a vicious cycle in which forgetting triggered worry about forgetting, which in turn dominated their thoughts and deepened their anxiety. Several women articulated a striking sense of imposter syndrome, feeling like frauds in roles they were demonstrably qualified to hold, a perception that chipped away at confidence and professional self-concept.

Perhaps the most emotionally resonant finding concerned identity. Many participants said they no longer recognized themselves, and one described the experience as being like a bereavement, a loss of the self accompanied by a thousand and one emotions. The researchers note that this profound alteration in professional identity, closely tied to cognitive changes, represents a gap in the existing literature, which has documented the impact of menopausal symptoms on quality of life but rarely explored how cognitive disruption intersects with identity reconstruction in occupational settings. Thirty-six of the participants reported feeling overwhelmed at work, and the mental health toll was measurable: at the time of interview, 39 women reported depression and/or anxiety as menopause symptoms, compared with only 12 who reported such conditions before their menopausal transition.

The study also revealed how the personal and professional domains of women’s lives became intertwined in a reciprocal relationship. Sleep disruption associated with menopausal symptoms contributed to fatigue, which participants believed impaired their memory and concentration, with knock-on effects on work performance. Workplace stress, in turn, intensified symptoms that did not simply switch off when women moved between the office and home. Many participants first noticed their cognitive symptoms during the COVID-19 pandemic, and they reflected that lockdowns, staffing shortages, and pervasive uncertainty had likely exacerbated the effects, a compounding factor the researchers argue has been overlooked in existing pandemic preparedness frameworks.

Faced with declining performance, many women adopted masking strategies, deliberately concealing their difficulties from line managers to avoid being seen as less competent. One participant, Rachel, noted that no one had brought her declining performance to her attention because she had managed to fool them into thinking she was still functioning properly, even though she knew she was not. Masking sometimes worked, but the effort of maintaining the facade was itself deeply stressful, and the persistent fear of being found out carried tangible risks, including demotion or enforced reductions in working hours, threats that loom especially large for women approaching the later stages of their careers and concerned about financial security before retirement.

Workplace support emerged as the critical variable determining whether women remained trapped in the resource loss spiral or escaped it. Those with flexible hours, empathetic line managers, colleagues experiencing similar symptoms, or the option to work from home reported better coping and a regained sense of control. One participant described a manager who granted her a paid wellbeing day to attend a menopause retreat. Yet support was far from universal, and shared demographics offered no guarantee of understanding. One woman, Isabelle, whose line manager was of a similar age, requested an Occupational Health referral to explore available support, only to have the referral submitted with poor performance listed as the reason, despite no performance conversation ever having taken place. The manager also suggested a demotion, an outcome Isabelle found deeply distressing. The researchers conclude that limited awareness of the diversity of menopausal experiences, rather than a lack of shared characteristics, drives unsupportive responses.

The findings arrive at a pivotal moment for UK policy. Women’s employment rates have risen steadily, with 68.6 percent of women aged 50 to 64 now employed, an increase of more than 20 percent since 1992, and menopause symptoms typically begin in a woman’s forties. The UK Employment Rights Act 2025 introduced a mechanism through which large employers, those with at least 250 employees, may be required to publish equality action plans addressing the gender pay gap and support for employees experiencing menopause, with voluntary publication possible since April 2026 and mandatory publication intended from spring 2027, subject to secondary legislation. The researchers argue that legal frameworks should go further, mandating employer education, enforcing compliance with menopause policies, and incentivizing evidence-based interventions such as cognitive screening, mental health support, managerial training, and resources like the Menopause Information Pack for Organizations. They caution against framing hormone replacement therapy as a panacea for cognitive health, noting that some participants using HRT still reported substantial cognitive challenges. As the proportion of menopausal women in paid employment continues to grow, the study’s central message is unambiguous: menopausal cognitive changes are legitimate occupational health concerns, and workplaces that fail to recognize them risk perpetuating gender inequalities, losing skilled workers, and compounding the mental health burdens that women already carry through one of the most demanding transitions of their lives.

Subject of Research: Cognitive changes at menopause and their impact on women's workplace performance, identity, and mental health

Article Title: Understanding the interplay between cognitive changes at menopause, the workplace, and mental health: qualitative findings from the MARIE-UK (WP2a) project

Article References: Hinchliff, S., Potočnik, K., Delanerolle, G., Taylor, J., Elliot, K., Fontana, D., Saraswat, L., Panay, N., Talaulikar, V., Atkinson, C., Kemp, H. F., Kurmi, O., Rathnayake, N., Al-Kharusi, L., Pathiraja, V., Al-Riyami, N., Palanisamy, R., Eleje, G. U., & Phiri, P. (2026). Understanding the interplay between cognitive changes at menopause, the workplace, and mental health: qualitative findings from the MARIE-UK (WP2a) project. Frontiers in Global Women's Health, 7, Article 1878423. https://doi.org/10.3389/fgwh.2026.1878423

Image Credits: AI Generated

DOI: 10.3389/fgwh.2026.1878423

Keywords: menopause, brain fog, cognitive changes, workplace, mental health, Conservation of Resources theory, qualitative research, women's health, occupational health, MARIE-UK, gender inequality, UK policy