Hormonal changes during perimenopause and menopause can trigger several cognitive symptoms, including brain fog.
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As the founder and CEO of a successful business and a podcast host, 53-year-old Justine Reichman is used to keeping several balls in the air. But a couple of years ago, things began to change. She’d walk into rooms with absolutely no idea why she was there, blank on names she’d known for years, or pause mid-sentence searching for words that randomly vanished from her vocabulary without leaving a forwarding address. Perplexed, as it was very much out of character for her sharp, quick-witted self, Reichman figured she was likely just overwhelmed or needed more sleep.
“I’d been on the pill for years managing terrible PMS, so I completely missed the perimenopause memo—those symptoms just blended into the background noise,” she says. “It wasn’t until I started learning about perimenopause and menopause that everything clicked.”
Up to 62% of women going through menopausal transition report cognitive challenges like brain fog, memory lapses, and difficulty concentrating.
“Falling estrogen and progesterone levels around menopause significantly affect our brain chemistry and function,” says Dr. Lisa Billars, chief of neurology at Kaiser Permanente, Georgia. Below, three board-certified neurologists break down how these changes may show up and how to support our brain health as we navigate them.
How Menopause Affects Your Brain
Beyond their role in women’s reproductive health, estrogen and progesterone also play a key role in supporting areas of the brain like the hippocampus and prefrontal cortex that are highly involved in learning, memory, and emotional regulation, explains Dr. Beth McQuiston, board-certified neurologist and medical director at Abbott Diagnostics.
Estrogen also helps stimulate neurotransmitters like acetylcholine, serotonin, and dopamine, which are essential for attention, word recall, mood regulation, and working memory, Dr. McQuiston adds.
Similarly, progesterone impacts gamma-aminobutyric acid (GABA) signaling in the brain. GABA is a neurotransmitter that promotes calm and relaxation. Progesterone also affects brain regions that control sleep, such as the hypothalamus, says Dr. Billars.
As a result, when these hormones drop during menopausal transition, we experience cognitive symptoms like brain fog, mood swings, anxiety, depression, and sleep disturbances.
According to Dr. McQuiston, lack of sleep from night sweats or stress can also have a domino effect on memory, mood, and performance.
While these symptoms can be alarming, the good news is, they usually resolve once hormone levels stabilize and your brain and body adjust to the new levels, says Dr. Billars.
It’s also important to note that brain fog doesn’t affect someone’s IQ nor does it span across all cognitive tasks, says Dr. Rhonda Voskuhl, professor of neurology at UCLA and founder of CleopatraRX.
Tips For Supporting Brain Health During Menopause
Here’s how to take care of your brain health during menopause and beyond, according to experts:
- Eat the Mediterranean way: Dr. Billars recommends eating a Mediterranean diet, as it’s linked to delayed cognitive aging, lower risk of depression, and fewer hot flashes. It’s also rich in phytoestrogens, aka plant-derived estrogen, that may help ease menopause symptoms like insomnia.
- Optimize sleep: Practice nighttime habits that support more restful sleep like creating a relaxing bedtime routine, avoiding having caffeine after 4 p.m., and keeping your phone outside the bedroom to avoid doomscrolling, suggests Dr. Sanam Hafeez, a New York-based neuropsychologist.
- Prioritize strength training: Dr. McQuiston recommends regular exercise, particularly strength training, as it’s shown to increase brain-derived neurotrophic factor (BDNF) levels. BDNF is a protein that’s essential for memory, learning, and protecting brain cells.
- Manage stress: Chronic stress disrupts your mood, focus, and sleep—all of which can worsen brain fog. Dr. Hafeez suggests practicing breathing exercises, meditation or yoga to calm the nervous system and support clearer thinking.
- Find your village: Leaning on supportive friends and loved ones can not only reduce stress and lift mood, but may also help you feel seen and discover new coping strategies.
- Consider menopausal hormone therapy: For some, menopausal hormone therapy (MHT) can be helpful, especially when started early and tailored to the individual. “It can help with hot flashes, bone density, sleep, and cognitive symptoms,” says Dr. McQuiston.
- Cut down on alcohol: Avoid alcohol or limit to 1-2 drinks three times a week at most, as it can mess with your sleep and in turn, affect your cognitive performance, says Dr. Voskuhl.
- Quit smoking: Dr. McQuiston suggests quitting smoking as it can disrupt estrogen in your body, potentially worsening cognitive symptoms. A review published in the journal Climacteric found that smoking may also reduce the effectiveness of hormone replacement therapy.
- Challenge your mind: Try things like reading, puzzles, crosswords, or learning a new skill that help keep your brain agile by strengthening existing neural pathways and forming new ones, says Dr. Hafeez.
- Take dietary supplements: Dr. McQuiston says supplements such as creatine, magnesium, or omega-3s may also help ease menopause brain fog symptoms and improve cognitive function. However, she adds that it’s best to check with your primary care physician first to see what’s best for you.
Since menopause affects every woman differently, Dr. Voskuhl recommends all women experiencing cognitive symptoms of menopause discuss them with their ob-gyn. Especially any symptoms beyond cognition, such as tremors or weakness on one side, should be checked immediately as they could suggest a neurological disease, says Dr. Voskuhl.
Those experiencing persistent sleep problems or excessive fatigue should also ask their physician about screening for sleep apnea as the risk of sleep apnea increases in women around menopause, says Dr. Billars. “If left untreated, obstructive sleep apnea can compound many menopause symptoms and increase the risk of weight gain, high blood pressure, and diabetes,” she adds.