Brain Fog and Brain Health in Perimenopause

Jul 25, 2023
Brain Fog and Brain Health in Perimenopause
Do you have trouble focusing on a task, remembering why you walked into a room, or lose your train of thought? If you are in your 40s and 50s and have started to experience this type of fuzzy thinking we know as brain fog, you are not alone.

Perimenopause brain fog is a symptom of the hormone changes that happen during perimenopause, the transition years to menopause. The good news is that these symptoms often diminish as your brain recalibrates to the new hormonal landscape in menopause.

Brain fog makes everyday life more challenging, but many lifestyle and integrative medicine tools support brain health during perimenopause. Keep reading to learn more about:

  • How perimenopausal hormonal changes affect the brain
  • Brain-related symptoms of perimenopause
  • How brain fog symptoms differ from dementia risk
  • How to clear your perimenopausal mind with lifestyle tools

Brain Changes in Perimenopause – Estrogen and Brain Health

During the reproductive years, estrogen levels rise and fall in a predictable pattern in the menstrual cycle. Total estrogen levels rise in puberty, hit their highest peaks during pregnancy, and then begin to trend downward in perimenopause.

The brain has a lot of estrogen receptors, specifically for estradiol, the primary estrogen produced by the ovaries. The receptors concentrate in the brain areas related to memory, cognition, temperature regulation, and more.

These brain regions are used to having a lot of estrogens around to stimulate various brain functions. However, the brain must adapt to the new hormonal landscape when estrogen levels decline in perimenopause. During this adaptation and recalibration process, it’s very common to experience brain fog and other brain-related symptoms.

Perimenopause Brain Fog and Other Brain-Related Symptoms

Perimenopause brain fog is a collection of cognitive symptoms experienced during perimenopause that include:

  • Memory difficulty
  • Attention difficulty
  • Forgetfulness
  • Difficulty focusing

Beyond brain fog, many common perimenopausal symptoms originate in the brain in response to changes in estrogen levels. These include:

  • Hot flashes
  • Night sweats
  • Sleep disturbances
  • Mood swings
  • Depression
  • Anxiety

Poor sleep, a processed food diet, a sedentary lifestyle, and other lifestyle factors may exacerbate brain symptoms.

Women’s Dementia Risk

Women who go through menopause before the age of 45, deemed early menopause, have a 30% increased risk of dementia before age 65 compared to women who go through menopause around the average age of 50. (Menopause is the one-year mark without a period).

This statistic suggests that the longer your brain is exposed to higher levels of estrogen, the more protective it is. Two-thirds of those diagnosed with Alzheimer’s disease, the most common form of dementia, are women. And we know that the risk for dementia, heart disease, osteoporosis, and other chronic conditions increases for women after menopause.

Given all this information, it can feel scary to experience brain fog and cognitive changes during perimenopause. You may wonder if what you are experiencing is normal or the early signs of dementia. However, it’s important to note that it is rare to have dementia in your 40s or 50s; most cases occur after the age of 65. Brain changes that arise during perimenopause often resolve after menopause or with some of the interventions discussed next.

Still, it’s always a good idea to check in with your TaraMD provider if you are experiencing any new symptoms or your intuition alerts you that something isn’t right.

How to Have a Clear Mind in Perimenopause

Perimenopause is an incredible opportunity to improve your health for decades. It’s a window of time where your body adjusts to new hormonal levels, and a healthy diet and lifestyle change are profoundly supportive. Here are some ways to support brain health in perimenopause and beyond:

  • Increase brain-supportive nutrients. Use food as medicine to provide optimal omega-3 fats, choline, vitamin B12, magnesium, antioxidants, and other nutrients to your brain. You’ll find these in whole foods such as:
    • Fatty fish like wild salmon and sardines
    • Blueberries and other berries
    • Walnuts and other nuts
    • Pumpkin seeds, sunflower seeds, and other seeds
    • Leafy green veggies
    • Broccoli and other cruciferous vegetables
    • Eggs and high-quality animal protein
    • Turmeric and other spices
    • Rosemary and other herbs
    • Dark chocolate and raw cacao
    • Fermented foods, including yogurt, sauerkraut, tempeh, and miso
    • Green tea
  • Eat balanced meals for balanced blood sugar. Choose whole, unprocessed food and include protein, healthy fats, and fiber-rich carbohydrates at meals to promote balanced blood sugar. When you improve metabolic health, you also improve brain health and help prevent dementia.


  • Move your body regularly. We all know exercise is good for your body, including your muscles, bones, and body composition. But it’s also critical for brain health. The most overlooked benefits of exercise are to cognition and mental health.


  • Zap stress. Reducing and managing stress is often easier said than done, but your brain may be more susceptible to the harmful effects of stress during perimenopause. Many women report increased perimenopause symptoms when stress levels are higher. Some ideas for managing stress include walking in the forest, breathing exercises, meditation, asking for help, and prioritizing self-care.


  • Discuss menopausal hormone therapy (MHT) with your provider. At TaraMD, we offer our patients MHT using bioidentical (body-identical) hormones to help manage perimenopausal symptoms, including brain fog. The benefits go beyond symptom management and may produce long-term brain benefits that we are still learning about.

While there is still some fear among women leftover from the Women’s Health Initiative trials, we now have more data, use bioidentical (body-identical) hormones, and see the benefits for more women than ever. It’s at least worth a conversation with your provider and one we’d love to have with you.

To learn more about new thinking about MHT and hormone replacement, please read Menopause, the Women’s Health Initiative, and Hormone Replacement Therapy.

While we can’t promise a symptom-free perimenopause, there are many supportive ways to feel more at ease through this transition. For some women, a commitment to lifestyle habits makes all the difference in the world, and others will also benefit from MHT. Either way, we are here to support you through perimenopause and beyond with a listening ear and integrative medicine. If you are ready to say goodbye to brain fog, give us a call!