Millions of women face a troubling scenario: as their careers reach peak earning potential, they encounter forgetfulness, concentration difficulties, and persistent brain fog. Yet when they seek medical help, they often encounter dismissal, misdiagnosis, or the suggestion that no treatment exists. Menopause-related cognitive symptoms remain poorly understood in clinical practice, lack a universally accepted definition, and fall outside the scope of conventional cognitive testing designed to detect such subtle changes.

This gap in women's health represents a broader pattern of medical research historically sidelining female experiences. Cerebella, a UK startup, is working to bridge this divide through Cerebella Foundations, a self-guided programme created by cognitive neuroscientists to help women navigate cognitive health during menopause transition.

When menopause brain fog masks something more serious

CEO Dr Nahid Zokaei brings deep academic credentials to the challenge. She completed her PhD in cognitive neuroscience at UCL in 2014, specialising in dementia, cognitive assessment, and biomarkers. She then spent 12 years at Oxford as a senior research fellow, directing her own laboratory and studying cognitive health in ageing populations while collaborating with neurology and memory clinics.

Zokaei's personal experience crystallised the problem. Towards the end of her Oxford tenure, her mother began experiencing unusual memory symptoms. Repeated GP visits attributed these to menopause, but the true diagnosis came late: brain cancer. This experience revealed how little medicine understands about normal cognitive changes in women during ageing. As Zokaei reflects, "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."

The inverse problem also occurs: menopause symptoms get misdiagnosed as other conditions. Around the same period, Professor Aimee Spector—an internationally recognised dementia researcher and one of the world's leading experts in non-drug psychological interventions for menopause—experienced cognitive difficulties herself. Despite her expertise, she initially feared early-onset dementia. The diagnosis proved to be menopause-related brain fog. Yet even she was told no recommended treatment existed and that reducing her working hours might be necessary.

The career and economic cost of cognitive symptoms

Women navigating menopause typically occupy positions of significant professional responsibility, bringing years of experience and institutional knowledge. When cognitive symptoms impair work capacity, many reduce hours, take leave, or exit employment entirely, generating costs for employers and the broader economy. A Cerebella survey of approximately 1,300 to 1,400 UK women revealed that brain fog correlated strongly with diminished confidence, lower productivity, and intentions to leave work.

Research scope underscores the prevalence. A study published this year examining over 14,000 women found that self-reported cognitive symptoms affect roughly 40–80 per cent during the menopause transition. One large survey identified brain fog as the most frequently reported symptom, cited by 76–84 per cent of respondents.

Brain fog is not a diagnosis

Brain fog lacks any clinical or scientific definition. Zokaei emphasises the conceptual problem: "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." The term encompasses difficulties with attention, verbal memory, concentration, motivation, and other cognitive functions, each potentially arising from different causes but producing similar consequences: eroded confidence, workplace struggles, and a sense of diminished functioning.

Existing menopause questionnaires ask only cursory questions about forgotten words or memory lapses, providing insufficient cognitive detail. Zokaei notes that "more sensitive cognitive tests already exist in academic research." Cerebella is developing and validating assessments capable of identifying specific cognitive difficulties rather than treating brain fog as a uniform symptom.

Working alongside Professor Spector, the team is constructing a non-drug intervention drawing on cognitive stimulation, cognitive strategies, and research conducted with midlife women. The approach targets understanding what drives individual difficulties rather than applying a one-size-fits-all treatment.

How Cerebella works — and what the evidence shows

Cerebella is developing a structured, research-backed programme comprising ten sessions over five weeks, each lasting approximately 25 to 30 minutes. Zokaei explains the design rationale: "We wanted something substantial enough to deliver a meaningful intervention but manageable for busy women in midlife." Sessions blend psychoeducation, cognitive behavioural therapy-based activities, and gamified cognitive exercises targeting memory, attention, concentration, and cognitive flexibility.

The UCL Menopause Mind Lab, directed by Professor Spector and dedicated to understanding menopause's impact on cognition and mental health, has published two randomised feasibility trials investigating a comparable approach. Both studies reported encouraging engagement and retention alongside improvements in quality of life and brain fog measures.

Cerebella's own proof-of-concept study of its digital intervention involved three weeks and five sessions. Zokaei reports: "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."

The assessment approach combines standardised cognitive measures used in clinical settings with more sensitive tests developed during Zokaei's academic work. Conventional cognitive tests often lack sensitivity to subtle changes and were frequently developed using populations inadequately representing women. Zokaei illustrates the distinction: "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."

Beyond cognitive test scores, the team measures quality of life, wellbeing, productivity, workplace confidence, and whether participants consider reducing hours or leaving employment. Zokaei articulates the longer-term vision: "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."

Personalising treatment without compromising the science

These structured approaches can define a therapeutic dose despite being non-pharmaceutical. As the app takes shape, the team identifies which activity elements are therapeutically essential and which permit adaptation. The underlying cognitive task may remain fixed while presentation, language, or surrounding content shifts.

Zokaei describes the technical approach: "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."

Future development includes cognitive assessments supporting clinician-facing dashboards, enabling women to share meaningful cognitive functioning information with healthcare professionals. These tools require further validation before clinical deployment.

Why brain health needs a holistic approach

Hormonal changes, stress, anxiety, sleep, and other factors affect cognitive difficulties simultaneously and bidirectionally. Historically, medicine has compartmentalised these issues, separating brain-training apps from mental health applications. Zokaei challenges this fragmentation: "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."

Cerebella targets specific difficulties rather than all situations or medical conditions. Serious concerns receive appropriate clinical assessment and care, with users directed accordingly. For the difficulties Cerebella addresses, Zokaei insists, "a more holistic approach is essential."

Building trust in a crowded menopause market

The menopause marketplace overflows with wellness products, supplements, and apps, complicating women's ability to distinguish evidence-based interventions from marketing. Trust emerges as a central challenge as women's health becomes a commercial frontier. Zokaei observes: "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 realise these ambitions as an early-stage company, the team collaborates with established organisations commanding trust within women's and healthcare communities, including Menopause Mandate, a UK not-for-profit campaign founded by broadcaster Mariella Frostrup advocating for improved menopause healthcare, workplace support, and government policy.

Cerebella recognises that digital health solutions risk placing symptom management responsibility on individual women rather than addressing systemic healthcare shortcomings. Zokaei notes: "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."

The company also prioritises representation gaps, acknowledging that menopause research has historically underrepresented women from different ethnic and cultural backgrounds. Cerebella partners with organisations reaching underserved communities and collaborates with clinical psychologists from diverse backgrounds to review and adapt content, including language, imagery, and psychological intervention delivery. Zokaei states: "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 recognises menopause stigma in some communities, making culturally sensitive communication around cognitive health integral to its strategy.

From menopause brain fog to lifelong women's brain health

A free, lighter version of Cerebella provides education and cognitive activities without collecting sensitive health data. Simultaneously, the startup is piloting commercial partnerships with employers to explore workplace programme delivery. Current priorities include building a content library, establishing personalisation infrastructure, and raising a pre-seed funding round.

Longer-term work encompasses clinical trials, cognitive assessment validation, and the regulatory pathway toward a product potentially recommended or reimbursed through healthcare systems. Zokaei indicates broader research interests: "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."

The company pursues grant applications and collaborations supporting wider scientific work. The fundamental challenge lies in translating research into scalable, accessible tools. Cerebella's overarching interest encompasses women's brain health across the entire lifespan. Zokaei reflects: "We've spent a lot of time talking about living longer. We also need to think about living better."

Women face disproportionate risk for several neurodegenerative and neuropsychiatric conditions. Approximately two-thirds of Alzheimer's disease patients are women. Much remains unknown about how hormonal changes relate to cognition and mental health. As momentum builds around women's health, the imperative extends beyond product development to closing entrenched research and healthcare gaps. Cerebella's ambition is converting decades of cognitive science into accessible, evidence-based support enabling women to sustain confidence, independence, and quality of life through menopause and beyond.

Source: Tech.eu