Ummm, what did I want to say again? Ugh, what’s the word for that? Why did I go up the stairs to this room? Ummm, I know I needed to get this for dinner, but can’t remember for the life of me. Or you say refrigerator when you meant to say dishwasher, and so on and so on. Ughhhh…..
Sure, everyone forgets things from time to time, but in perimenopause it seems like it happens WAY more often, and many of us feel it. I’m early into the transition to menopause and boy is brain fog hitting me hard, especially when in meetings for work. Are you also in perimenopause and experiencing this brain fog, the constant brain farts, and feeling of being lost sometimes? This frustrating symptom, often described as mental cloudiness, can seriously impact daily life — our daily lives. Understanding why brain fog and perimenopause show up together and discovering ways to manage it can make this whole transitional phase way more tolerable.
But before we dive in, here are 4 podcast recommendations on….BRAIN FOG, remember?
Key takeaways
- What it is: Research suggests perimenopausal brain fog includes memory lapses, word-finding issues, and attention hiccups, often worsened by sleep disruption and stress.
- Why it happens: Studies indicate fluctuating estrogen and other hormones may influence brain circuits for memory and attention, and can interact with hot flushes/night sweats, mood, and sleep.
- What helps: Lifestyle shifts (nutrition, movement, stress reduction), better sleep (including CBT-I for insomnia), and in some cases, hormone replacement therapy (HRT) may help some symptoms. Timing and type of HRT matter; discuss with your clinician, prepare for appointments, and consider a second opinion.
What is “brain fog” in perimenopause?
Many describe it as “cotton wool” in the head: you’re in the middle of a sentence and… poof. Naturally, this can affect day-to-day function, such as forgetting names, misplacing items, losing your train of thought, or feeling slower to process information. Studies indicate some women notice this more when night sweats, insomnia, anxiety, or low mood are also in the mix.
Why this matters: Understanding the “why” helps you choose strategies that actually move the needle – sleep hygiene, stress care, movement, and, for some, medical options.
Hormones & your brain: what’s going on?
Did you know? Estrogen receptors are concentrated in brain regions linked to memory and attention. During the menopause transition, hormone levels swing, and research suggests these fluctuations can alter the brain’s “fuel use” (glucose metabolism) and activity patterns. The result for some: temporary dips in verbal memory, working memory, attention, and processing speed. Not everyone experiences this to the same degree. Some skills stay steady while others feel off.
Common cognitive symptoms to watch
- Verbal learning/recall: “What’s her name again…?”
- Word-finding: Tip-of-the-tongue moments (so many).
- Attention/processing: Feeling distractible or slower to sort info.
- Sleep & mood links: Studies indicate insomnia, anxiety, and low mood can amplify cognitive complaints, so addressing them can help cognition indirectly.
Lifestyle levers that support brain health
Small, sustainable changes add up. Research suggests these areas can help:
1) A brain-smart diet
Studies indicate patterns rich in colorful plants, omega-3 fats, fiber, and polyphenols support vascular and brain health. Think: vegetables, berries, legumes, nuts/seeds, olive oil, whole grains, and fatty fish. Antioxidants and healthy fats may support neuronal signaling and resilience. Hydration matters too.
Try this: build plates around plants + protein, add an omega-3 source a few times weekly, and limit ultra-processed foods that can nudge inflammation.
2) Regular movement
Physical activity supports mood, sleep, and cardiometabolic health, all of which connect to cognitive function. You don’t need to go extreme: brisk walking, strength work, yoga/pilates, or dance are great ways to start. Aim for most days of the week; sprinkle movement breaks into long sit sessions.
3) Stress reduction (yes, really)
Stress spikes cortisol, which can mess with sleep and focus. Studies indicate mindfulness, breathwork, and relaxation exercises can reduce perceived stress and improve attention. Even 5 minutes counts.
Micro-reset: 4-7-8 breathing (inhale 4, hold 7, exhale 8) x 4 rounds.
Sleep: Your secret cognitive superpower
Sleep issues are common in perimenopause (falling asleep, staying asleep, early wakings). Yet, better sleep quality (when you can get it) often means better next-day thinking.
Sleep upgrades to try:
- Consistent schedule: Same sleep/wake times, even weekends.
- Wind-down ritual: Dim lights, screens off, calm cue (read, stretch, warm shower).
- Cool, dark, quiet room: Fans, blackout shades, or white noise can help.
- Strategic caffeine & alcohol: Earlier caffeine; go easy on alcohol (it fragments sleep).
- When insomnia sticks: Studies indicate Cognitive Behavioral Therapy for Insomnia (CBT-I) is an effective, first-line, non-drug treatment. Ask your clinician about in-person or digital CBT-I options.
Hormone replacement therapy (HRT): Where it may fit
I’m not a doctor, just sharing what studies indicate so you can discuss it with yours.
- Possible cognitive benefits: Some studies indicate HRT may help certain perimenopausal symptoms and indirectly support cognition via mood/sleep/vasomotor improvement.
- Timing matters: Research suggests starting HRT near the menopause transition is different from starting many years later. Age, time since last period, personal and family history, and type/route/dose of hormones all factor into risks/benefits.
- Individual decision: For some, HRT is appropriate; for others, it isn’t. It’s a shared decision with your clinician.
Getting the most from a medical appointment
Show up prepared – future you will thank present you.
Pack this:
- Symptom diary: When brain fog shows up, what else is happening (sleep, stress, hot flushes)?
- Medication/supplement list: Include doses and timing.
- Medical history + goals: What outcomes matter to you (focus at work, names, fewer 3 a.m. wakeups)?
Ask this:
- “What non-drug options could help my sleep and stress right now?”
- “Would HRT be appropriate for me based on my health history? Which type/route/dose and for how long?”
- “What red flags mean I should stop or adjust treatment?”
And if your gut says the plan doesn’t fit you, seeking a second opinion is totally reasonable.
What’s ahead in research?
Studies continue to explore how modifiable risks (blood pressure, blood sugar, weight, physical activity, sleep) relate to cognition during midlife. Addressing these factors may help protect brain health over time. There’s also ongoing work on how hormonal fluctuations affect brain networks, and how best to personalize care.
Summary
Perimenopausal brain fog is common and (good news) manageable. Hormone fluctuations, sleep disturbance, mood, and stress can all play roles. Sleep quality, stress skills, movement, and nutrition are powerful levers, and that CBT-I helps persistent insomnia. HRT may be helpful for some when appropriately timed and tailored. Prepare for appointments and don’t hesitate to ask questions or get another perspective.
FAQ
What is perimenopausal brain fog?
Research suggests it’s a cluster of cognitive complaints — memory lapses, word-finding issues, and attention blips — linked to hormonal fluctuations and often worsened by poor sleep or high stress.
Does everyone get it?
No. Experiences vary widely; some notice subtle dips, others feel significant fog, and some feel unchanged.
What can I do today?
Prioritize sleep (wind-down, consistent schedule), reduce stress (brief daily practice), move your body (most days), and eat a brain-smart pattern (plants, fiber, omega-3s). If insomnia or symptoms persist, talk with your clinician; CBT-I and, for some, HRT may be options.
Is hormone therapy right for me?
It depends. Research suggests timing, type, dose, and your personal risk profile matter. Discuss pros/cons with your clinician and consider a second opinion if you’re unsure.
Sources:
North American Menopause Society (NAMS) – Mental Health & Menopause pages
https://menopause.org/patient-education/menopause-topics/mental-health
Study of Women’s Health Across the Nation (SWAN) – Cognition
https://www.swanstudy.org/womens-health-info/cognition/
https://www.swanstudy.org/wps/wp-content/uploads/2023/04/SWAN-Fact-Sheets-Cognition.pdf
Weill Cornell imaging study news summary
https://news.weill.cornell.edu/news/2021/06/imaging-study-reveals-brain-changes-during-the-transition-to-menopause
International Menopause Society (IMS) White Paper: Brain Fog in Menopause
https://www.imsociety.org/wp-content/uploads/2022/10/IMS-White-Paper-2022-Brain-fog-in-menopause.pdf
CBT-I evidence in peri/postmenopause
https://pmc.ncbi.nlm.nih.gov/articles/PMC8190071/
Hormone Therapy & cognition—timing/critical window
https://pmc.ncbi.nlm.nih.gov/articles/PMC4935624/
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