About three weeks ago, I was rolling through my work day, ticking off tasks, and thinking about lunch — when it hit me. I had completely missed a meeting. The meeting had been scheduled well in advance and was logged in my Outlook calendar and handwritten diary (I’m old-school!) but somehow, my perimenopausal brain had completely forgotten about it. Cue quick apologetic emails to colleagues. 

Occasional forgetfulness is part of normal life, especially when that life is full and active. But during perimenopause, forgetfulness, poor concentration, and the dreaded brain fog ramp up a gear. One minute you’re at the top of your game, juggling the demands of work, family, and social life, and the next it feels like your brain is made of wet cotton wool. 

For many women, cognitive changes like brain fog and memory loss are some of the earliest signs of perimenopause. They creep in along with emotional changes like anxiety and mood swings, long before periods begin to stop. As a nutritionist, I’ve heard from women who fear they are losing their minds and are worried about early onset dementia, when in fact these shifts are all part of the menopausal transition.

What causes perimenopausal brain fog?

Neuroscientist Dr. Lisa Mosconi talks about how menopause begins in the brain.  The brain and reproductive organs are in constant communication via the neuroendocrine system. There are estrogen and progesterone receptors throughout the brain, and once our regular hormone levels start to fluctuate during perimenopause, brain function is affected.

Progesterone is usually the first hormone to decline as we have fewer and fewer ovulatory menstrual cycles. Progesterone plays a key role in regulating mood and cognitive function, so as soon as levels drop, we can start to experience mood swings, brain fog, and poor memory. As perimenopause progresses, estrogen starts to decline as well, further impacting brain function.

Does stress worsen brain fog?

These symptoms can also be compounded by stress — and perimenopause is a pretty stressful time! Mental, physical, and emotional stress stimulates the release of cortisol and adrenaline, the two main stress hormones. In the short term, a little stress can increase alertness and sharpen the senses. But over time, chronic stress can impact concentration and memory and affect how the hippocampus works — the part of the brain responsible for short-term memory storage.

Learning ways to handle stress helps alleviate all perimenopausal symptoms, especially brain fog. Gentle exercise and mindful forms of movement like yoga and Tai Chi are fantastic for cognitive health. They enhance blood flow to the brain while downregulating stress hormones — a double win in the fight against brain fog.

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This is just a short slice of the article — read the whole article, including Sally Duffin’s nutrition tips — here on the brand-new Midst Substack.