Perimenopause and Brain Fog: Causes, Symptoms, Relief
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When hormones start to go haywire during perimenopause, your memory, focus, and mental energy are likely to take a hit. Not only that, but life probably feels like a three-ring circus of family, work, and other responsibilities most days. With this combo, it’s no wonder you’re feeling scattered. We get it—and we got you. Here’s what you need to know about perimenopause and brain fog, plus some tips for fixing it.
Here’s a weird flex: I’ve gotten extremely good at list-making over the past couple of years. I’ve always been a big proponent of writing down my to-do’s. But lately? Writing things down has become more of a must. It prevents my to-do list from becoming an “oh crap, I forgot” list.
As my 40-something self trudges toward menopause and away from menstruation, a scattered brain has emerged as one of my top symptoms of perimenopause so far. It’s not just a mental thing, though. How well I sleep, how much I exercise, what I eat, and how stressed I am all play a role in how smoothly (or not) my brain seems to operate. Some days I feel mostly normal. Other days I’d really like to speak to the manager about getting a refund because nothing seems to be working properly.
I know I’m not alone in this. Brain fog can happen to anyone for lots of reasons, but the hormonal shifts of perimenopause hit particularly hard when it comes to cognition. In fact, some estimates say 44% to 62% of perimenopausal women experience memory problems or other mild cognitive decline.
Sound like you, too? Let’s get to the bottom of perimenopause and brain fog, and explore simple habits and techniques for reclaiming our mental clarity.
Perimenopause and brain fog: What it is
If your brain seems to be working at half-speed, if words are constantly on the tip of your tongue, or if you’re walking into rooms and forgetting what on earth you’re supposed to be doing there, welcome to the club.
Trouble with memory, learning, attention, and processing speed are all common occurrences for women in perimenopause. And even though perimenopause forgetfulness can be frustrating and even embarrassing (Aubrey’s mom with the blonde hair DOES have a name, I think…), most of the time these brain blips are not cause for alarm.
During this time, it makes sense to seek care from a practitioner who’s experienced in menopause and women’s hormonal health. A foggy brain is just one of many potential symptoms during this transition. Having a provider in your corner can be a big help, as you may need a plan or treatment for symptom management, either now or in the future.
Still, there are some simple habits you can put into place on your own that may help you breathe a little easier and think a little clearer. Let’s dive in.
Does perimenopause cause brain fog?
The short answer? Yes. But how?
To back up a bit: Menopause is really a moment in time, and it’s diagnosed retroactively, because it’s defined as 12 months without a menstrual period. Everything after that is postmenopause, and the timeframe leading up to that point is called perimenopause.
Perimenopause can last a long time—many years, in fact. The peri period usually starts in the late 40s to early 50s, though some women can experience it as early as their mid-30s. And here’s the kicker: perimenopause typically lasts five to 10 years.
During perimenopause, both estrogen and progesterone production start to decline. This hormonal decline has a wide-ranging impact on virtually every nook and cranny of the body, from our brains all the way down to the joints in our toes (women even experience completely bizarre symptoms like itchy ears and “frozen shoulder”).
Fluctuating estrogen levels can influence attention, memory, and processing speed. It’s no wonder, as there are estrogen receptors all over the brain. Plus, estrogen has a regulating effect on the neurotransmitters serotonin and noradrenaline, so it’s not unusual for your mood to nosedive during this time, too.
Other factors that can lead to brain fog are poor sleep, high stress, and dysregulated mental health. During perimenopause, all of these symptoms are often intertwined, with one or more affecting others.
Let’s take a common menopausal experience as one example: night sweats. Imagine waking up in the middle of the night drenched in sweat. If it’s bad enough, you may have to get up and change your pajamas or even your bedding. A good night’s sleep? Not happening.
Now think about that fragmented sleep occurring a few times a week (or more). You’ll be both physically and mentally exhausted while you’re awake. You’ll be more stressed. You may even be anxious about going to bed because you’ll worry about waking up. And so the cycle continues. It’s no wonder we struggle to focus or remember people’s names.
But that’s not all. Estrogen has antioxidant and anti-inflammatory properties, regulates blood flow to the brain, and promotes DNA repair, among other neuroprotective benefits. So when estrogen levels decline, our brain function is directly impacted—beyond just night sweats and bad sleep.
For many women, perimenopause and its myriad of symptoms could not come at a worse time. We may be hitting the peak of our careers, only to feel sidelined by terrible sleep and issues with memory and focus. As “sandwich” adults, we might be trying to support our aging parents while still shuttling our kids to soccer practice. Talk about stress.
“Chronic stress has a strong connection to midlife cognitive symptoms, as it directly impacts memory and concentration through cortisol and other stress hormones,” says Brianna Paruolo, LCMHC, a licensed clinical mental health counselor at On Par Therapy in New York City, who works mostly with high-achieving women.
“During perimenopause, adrenal glands become the main source of hormone production, so chronic stress double-impacts cognitive functioning. Stress in combination with hormonal changes and poor sleep creates a perfect storm for brain fog.”
How common is perimenopause brain fog?
Feeling foggy and forgetful as you approach The Big M is very common. Research says 44% to 62% of women experience cognitive-specific symptoms of perimenopause, and up to 70% of women experiencing psychogenic symptoms. These are symptoms stemming from psychological causes, like stress or mental health conditions, rather than physical ones and may include anger or irritability, anxiety, depression, loss of concentration, and loss of confidence.
Every woman is different, though, and goes through this transition differently. Some have lots of symptoms, while others skate through pretty easily. Some may have hot flashes, and other women won’t. It’s all up to the “luck” of the draw.
How long does brain fog in perimenopause last?
For most women, symptoms ease once they move into menopause and hormones start to level out. Either way, the memory mishaps and hazy brain won’t last forever, nor does it mean you’re hurtling headfirst into dementia.
“It’s important to remember these temporary cognitive changes are related to hormonal fluctuation, not neurodegenerative disease,” Paruolo says.
Here’s a quick reference chart to determine if your symptoms need more attention.
| Signs of perimenopause brain fog | Signs of possible early dementia |
|---|---|
| You temporarily blank on the name of another mom at your kid’s school, but it comes back to you later. | You can’t remember the names or faces of your spouse, children, or other loved ones. |
| You sometimes forget to put your keys or AirPods in their usual spot, probably because you were distracted or stressed when you walked in the door. | You (or a family member) finds your wallet in a kitchen cabinet, and you have no recollection of putting it there. |
| You toss and turn in bed at night and feel spacey and unfocused the next morning. | You start to become more “out of it” and struggle with simple things, like reading a clock or remembering to take medication. |
Symptoms checklist
Although it’s different for everyone, here are some common symptoms of perimenopause brain fog:
- Perimenopause memory lapses, like losing your train of thought when telling a story or recounting your day to your partner
- Absent-mindedness, such as losing your keys or putting objects in weird places without thinking (like the cereal in the fridge and the milk in the pantry)
- Word-finding problems, like forgetting people’s names or familiar terms. They may feel like they’re right on the tip of your tongue but not quite within reach (I once forgot the word “fork.” Yep. Fork.).
- Slower processing speed makes it harder to get work done, and your brain feels sluggish and fatigued.
- Trouble concentrating, especially when sleep-deprived or stressed.
Daily habits that help
Even if your brain and body feel like they’re no longer under your control, there are actionable steps you can take to feel better. Here’s what Paruolo and research recommend:
- Prioritize sleep: Everything feels harder when you’re wiped out. Maintain a consistent schedule with regular sleep and wake times. Make your bedroom dark and cool, which can improve sleep and prevent night sweats. Reduce your screen time before bed. Avoid caffeine past lunchtime and alcohol later in the evening, as both can trash your sleep.
- Maintain connections: Build and maintain social connections, especially with women who are experiencing the same things for support and validation, Parulo says.
- Create a movement routine: Do whatever works to keep you moving regularly and consistently. That can be tracking your steps, building in walks into your mornings or evenings, or taking fitness classes. Aim for a combination of aerobic exercise and strength training to support sleep, mood, hormone balance, and stress reduction, Paruolo says.
- Work your brain: Skip multitasking for single-tasking. Offload memory tasks to lists and reminders. Do word searches, sudoku, or read a book to keep the mind sharp, Paruolo suggests.
- Manage stress: Research has found meditation, yoga, qi gong, and other mind-body practices can help improve mood, sleep, and fatigue in peri- and postmenopausal women.
- Eat well: Focus on a nutrient-dense diet of lean protein, plenty of plants, and healthy fats, like olive oil. The MIND diet—a mix of the Mediterranean and DASH diets—may help preserve our brain health as we age.
- Try a pick-me-up: When you need to focus and get all the things done, Fixie Dust can give your brain a little extra oomph. It’s filled with fog-lifters like citicoline (CDP-choline), amino acids L-theanine, L-tyrosine, and acetyl L-carnitine, and a smidge of caffeine.
Medical options: HRT and other treatments
Most women—60% to 86%—experience menopausal symptoms challenging enough to seek medical care. But not everyone does. Untreated or undertreated menopausal symptoms are directly tied to lost work productivity and negative impacts on sleep, metabolism, mood, and relationships.
If any mental or physical symptoms of perimenopause are starting to impact your daily life, help is available. This could include hormonal replacement therapy (HRT) or non-hormonal treatments, therapy or counseling, plus tweaks to diet or other lifestyle habits.
- Treat the drivers: Step One is getting to the root of the problem. If night sweats or increased anxiety feel like they make you feel flighty and forgetful, for instance, tackling them may improve the brain haze.
- Hormone therapy: HRT (aka hormone replacement therapy) is usually a combination of estrogen and progesterone, particularly if you still have a uterus. Research has found HRT may improve many of the unpleasant physical manifestations of menopause (like hot flashes and vaginal dryness), as well as cognitive ones. Be sure to talk through the risks and benefits with a clinician.
- Non-hormonal options: If anxiety or depression are present, cognitive behavior therapy (CBT) or antidepressants may improve mood, sleep, libido, and hot flashes—and these benefits could ripple out to the brain. Other non-hormonal treatments include soy and herbal supplements, like black cohosh and evening primrose. The research on these, however, is mixed.
Diagnosis and treatment options
A healthcare professional can help you zero in on what could be causing your brain fog. It could be hormonal, but it could also be caused by depression, anxiety, or stress.
“Hormonal brain fog often correlates with menstrual cycle changes and can accompany other symptoms like hot flashes and sleep disruption, which are common in menopause,” Paruolo says. “Depression-related cognitive issues might include an ongoing persistent sadness, loss of interest, and hopelessness. Stress-related fog improves with stress reduction.”
There’s no single standard lab test to determine whether you’re experiencing perimenopause. A healthcare provider may take an inventory of your symptoms, as well as other health conditions you have or medications and supplements you take. They may do bloodwork to evaluate your hormone levels or check for nutritional deficiencies. Based on the root cause of your perimenopause brain fog, a provider can tailor a program of lifestyle changes and medical treatments that may help.
Working with a healthcare provider
Even though there are steps you can take on your own to try to de-fog your mind, like focusing on sleep or getting more nutrient-dense foods on your plate, it’s never a bad idea to check in with your healthcare provider. They can help put all the pieces of your perimenopause puzzle together, as well as order bloodwork and prescribe medications or other treatments, if needed.
Here’s how to prepare for a convo with your physician about what you’re feeling.
- What to bring: You’ll certainly want to share all medications and supplements you’re taking. Making a list of these so you don’t forget any is smart (because brain fog). You may also want to start tracking your symptoms and your sleep to help paint a picture of what’s going on.
- Questions to ask: Again: Write them down so you don’t forget. Here are some ideas to get you started:
- “What’s driving my brain fog?”
- “Am I a candidate for HRT?”
- “What are non-hormonal options?”
- “What lifestyle changes can help with sleep, mood, and brain fog?”
- Follow-up: Once you start a treatment plan, you’ll want to develop a cadence for check-ins. Continue to keep track of your symptoms so you and your clinician can figure out what parts of the plan are working and what needs to be tweaked a bit.
When to seek care
The rule of thumb is to seek care when symptoms are starting to affect your career, home life, or relationships with others.
“See a clinician when symptoms are significantly impacting your work or daily life, if you have concerns about your safety, or if your symptoms aren’t correlating with hormonal patterns,” Paruolo says.
Don’t wait to get medical attention if you experience any of these symptoms:
- feeling persistently down
- changes to your mood or memory come on suddenly or get worse very quickly
- sharp pain
- weakness
- changes to your speech, vision, or movement
The bottom line
Brain fog is an all-too common occurrence in women going through perimenopause. Everyone experiences it differently, with some struggling to recall names and everyday items while others feel scattered, anxious, or spaced-out. It’s frustrating for sure, but it’s normal.
During this period, declining levels of estrogen and progesterone result in less neuroprotection for the brain, disrupted sleep, and mood changes, which mess with our memory, focus, and processing speed. Thankfully, there are solutions. Lifestyle changes can help, as can treatments that are both hormonal and non-hormonal.
And when you need to do all the things NOW but feel your focus and energy flagging, the nootropics in Fixie Dust can deliver an extra boost to your brain in minutes.
Key takeaways
- Brain fog and other cognitive symptoms affect between 44% and 62% of women in perimenopause.
- Common symptoms include forgetfulness, absentmindedness, sluggish thinking, and mental fatigue.
- Getting better sleep, managing stress, eating a nutrient-dense diet, and exercising regularly can all help with perimenopause brain fog and other symptoms.
- Treatment options are available for perimenopause symptoms, including hormone replacement therapy, non-hormonal treatments, cognitive behavioral therapy, and mind-body practices.
- Seek help from a professional when cognitive symptoms start to impact daily life or if they come on suddenly, worsen quickly, or are accompanied by other physical symptoms, like pain or weakness.
Frequently Asked Questions
Perimenopause is different for everyone. What works for one person might not work for another, so it’s important to talk with a clinician about what’s at the root of your brain fog. Several treatment options are available, including hormone replacement therapy, lifestyle changes, and non-hormonal treatments.
Not everyone experiences brain fog the same way, but it can often look like forgetting people’s names, misplacing items like keys, inability to concentrate on work or other tasks, or feeling mentally tired or generally spacey and out of it.
Declining levels of estrogen and progesterone trigger a cascade of different mental and physical symptoms—many of which overlap. Night sweats can disrupt sleep, which can make you feel foggy, for example. Estrogen also directly protects the brain and affects neurotransmitter action, so when it declines, brain function may also decline.
No. In most people, brain fog related to perimenopause will resolve when hormone levels become more stable.
Foods rich in omega-3 fatty acids, B vitamins, iron, and other vitamins and minerals can support brain health. These include fatty fish, leafy greens, whole grains, berries, nuts, and seeds.
A multivitamin can fill in gaps in nutrition. If you suspect you may be deficient in certain nutrients, your healthcare provider can do bloodwork to check and then recommend other supplementation.
Yes. HRT can improve some menopausal symptoms, but it isn’t guaranteed to knock out all of them. If you still have brain fog while on HRT, ask your healthcare provider about other options that may help.
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