I always prided myself on being detail-oriented. Remembering important events and exactly who was there. Focusing for long hours on a project without losing my place. I can still recall lyrics to an enormous catalog of songs and connect actors to Kevin Bacon in six degrees of separation without breaking a sweat. So when the fog started creeping in, I noticed.
I will walk into a room and completely blank on why I am there. A brief wave of panic hits, I retrace my steps, the memory surfaces, and I am back. I wish I could say it only happened once.
When the Fog Crept In: A Real -Time Example
My friends and I were leaving book club at Disney Springs when a live band started playing a song I immediately recognized from a movie I have watched and loved multiple times. Smiling, I turned to one of my friends and said, “I will always associate this song with the movie…” and then—nothing. A full stop. I could see the scene in my mind’s eye. For the life of me I couldn’t remember the title. I looked at her and tried again: “You know, that movie with…” and OMG…I couldn’t recall the actor’s name either, even though his face was right there in my head. She tried to help and hilariously hit the same wall. Just another day in the life of a midlife woman. (For the record: the song was “Keep Your Head Up” by Andy Grammer, from Pitch Perfect. The scene where Ben Platt is singing it alone in his dorm room before he ever joins The Treblemakers. You’re welcome.)
As funny as that moment was, there is an honest and vulnerable side to this conversation. In midlife, many of us are experiencing what is known as perimenopause brain fog. It can show up at any moment and in different forms. For women who do not know how common it is, it can make us quietly question ourselves. Have I lost my edge? Could this be something more serious, like early dementia or Alzheimer’s?
If you have been feeling forgetful, foggy, or just not as mentally sharp as you used to be, and it’s absolutely frustrating, you are not alone, Sis. Let’s talk about what perimenopause is really doing to your brain.
Is Perimenopause Brain Fog Normal?
Although perimenopause brain fog is not a formal clinical diagnosis, it is a very real and common experience for women in midlife. For many of us it can look like this:
- Walking into a room and forgetting why you went in there
- Trouble finding the right words in conversation
- Forgetting names or appointments
- Difficulty concentrating on tasks that used to feel effortless
- Feeling overwhelmed by things you used to handle with ease
Does any of this hit close to home? Yup, it does for me too. A recent report from UCL and The Lancet found that more than 2 in 3 women experience memory or concentration difficulties during the menopause transition. The reassuring part is that for most women, these symptoms are mild and tend to improve once hormones stabilize after menopause.
What Is Perimenopause Doing to Your Brain?
“Brain fog, referring to menopause-related subjective cognitive difficulties, is common in midlife women. Longitudinal studies find small but reliable declines in objective memory performance as women transition into perimenopause, and these are not explained by advancing age alone.”— Maki & Jaff, Menopause Journal, 2024
Let’s get to the nitty gritty of the matter at hand. Estrogen is not only a reproductive hormone. It is an essential hormone for cognitive function. Estrogen fuels the female brain by regulating the brain chemicals (dopamine and norepinephrine) behind focus, memory, and motivation. During perimenopause, estrogen fluctuates erratically which causes those brain chemicals to dip. This leads to various cognitive symptoms mentioned earlier.
More and more research is being done to bring awareness. The Menopause Society shared a report on how recent MRI research reveals how menopause restructures the female brain. These changes are the measurable proof of common cognitive symptoms we are experiencing. You can learn more about the science in the study in How Menopause Restructures A Woman’s Brain.
This knowledge can feel jarring. However, there is comfort knowing this is not permanent. Our brains are remarkable.
Is It ADHD or Perimenopause?
For some women, these cognitive symptoms can feel similar to ADHD (Attention Deficit Hyperactivity Disorder) which is a common neurodevelopmental disorder that affects how the brain functions. Many women do receive an ADHD diagnosis in their 40s. Perimenopause is often the trigger that reveals what was always there, or simply mimics it.
Perimenopause brain fog typically begins in the late 30s-40s which coincides with common hormonal symptoms like irregular periods, hot flashes, sleep disturbances, mood changes, etc. Brain fog episodes fluctuate from day to day or week to week, and worsen around menstrual cycles. Brain fog can be amplified by sleep deprivation, stress/elevated cortisol levels, anxiety/depression, vitamin deficiencies (B12 and Iron), and blood sugar dysregulation.
Women with an ADHD diagnosis have typically dealt with symptoms which were present during childhood and went undiagnosed. The symptoms are chronic in nature with a history of procrastination, difficulty finishing tasks, concentrating, or tendency to lose things constantly. Due to the nature of this condition, it is possible for women to experience both perimenopause brain fog and ADHD symptoms simultaneously. Perimenopause amplifies ADHD and brings it to the forefront causing some women to receive an official diagnosis. If you suspect lifelong ADHD, that conversation with your doctor is worth having.
How to Navigate Perimenopause Brain Fog with Grace
There is no clear cut answer to know how long perimenopause brain fog lasts. For most of us, it is temporary and will fluctuate. For others, it may last several years. It is important to handle perimenopause brain fog with grace. In my perimenopause journey, I have incorporated Hormone Replacement Therapy (HRT) to lessen the severity of symptoms. You can read more about my journey in Perimenopause Diaries 1.
When we go through sudden changes in midlife, it is imperative to prioritize and make necessary lifestyle changes to aid ourselves during perimenopause. This is incredibly important as I know many of us are high-functioning women in our homes and careers.
I am not a doctor or hormone specialist. Just a woman who is walking through this season and sharing a few gentle practices I’ve incorporated with the help of my doctors and my own personal research. Here are three pillars to establish while navigating perimenopause brain fog.
1. Calm the Mental Chatter
Mindfulness
When brain fog hits, so does anxiety. This causes my brain to feel scattered and a sense of overwhelm. Mindfulness helps me to quiet the noise in my brain and calms my nervous system. Mindfulness is creating small moments throughout the day to pause. Take the time to breathe, pray, journal or simply notice what is going on around you. At times it is stepping away from screens/devices for a few minutes and stepping outside. These pauses quiet and calm the mental chatter and help me focus with more ease. Think of mindfulness as a brain reset you can do at any time.
2. Feed Your Changing Brain
Nutrition
Our nutrition plays a huge factor for not only perimenopause, but also our brain health. Foods full of protein, leafy greens, berries, extra-virgin olive oil, fatty fish, nuts are ideal. It’s not necessarily restricting your diet but prioritizing foods to benefit cognitive function and help keep blood sugar steady. If your blood sugar is steady, focus and energy feel more balanced. Let’s not forget to stay hydrated as well. I find when I don’t prioritize my nutrition, my focus and energy suffer.
3. Protect Your Sleep
Rest as Self Care
If there is something that makes brain fog worse, it’s poor sleep due to night sweats and insomnia (Ask me how I know). Sleep is when the brain restores, processes and resets. Take measures to protect your sleep by establishing a good nighttime routine to bring your body to a place of rest when it is time to sleep. Here are some key things I do in my night time routine: stepping away from devices after 8pm or 9pm; placing my phone on do not disturb; doing my skin care regimen and reading a book before bed. For pleasant sleep, I make sure the room is cool to my liking. If my mind is active, I can count on some sleep meditations from my Peloton app to help me get to the place of rest. I highly recommend it!
If night sweats, insomnia and other symptoms disrupt your sleep on a consistent basis, consider keeping a symptoms journal and speaking with your healthcare provider. It may be time for HRT or an adjustment to your HRT treatment. It’s worth the conversation for your sleep and overall well being.
One Last Encouragement
Perimenopause brain fog isn’t so much about losing your memory. It’s more like having too many browser tabs open at the same time. The information is all there. Just give us a minute, and we’ll find it.
Book Spotlight: The Menopause Brain by Dr. Lisa Mosconi, PhD is known to be a great resource within the menopause community. She is the Director of the Women’s Brain Initiative at Weill Cornell Medicine. Written for women navigating cognitive changes in perimenopause. It was written as a means to educate and empower women.
Have you been experiencing perimenopause brain fog lately? What was your experience like? Drop a comment below.
The information provided in this post is for educational and informational purposes only and is not intended as medical advice. Always consult with a qualified healthcare professional for any health symptoms you are experiencing.
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