How to manage brain fog in perimenopause

If you've found yourself walking into a room and forgetting why, losing your train of thought mid-sentence, or struggling to recall a word that's usually on the tip of your tongue, you're not alone.

A survey from Menopause Mandate found that 86% of women struggled with brain fog during perimenopause – a highly impactful symptom in the workplace. Given that perimenopause has likely arrived just as we hit big, important roles at work with more demands, plus a time of life when family demands on our time and mental load are peaking, this makes for a heady mix. 

The impact of symptoms like brain fog can stop women progressing in their careers, consider reducing their hours to cope, employing masking strategies to try and compensate (with the added risk of burnout), and in the worst cases, leaving the workplace entirely.

So what’s happening?

Oestrogen plays a much bigger role in our brain function than many of us realise. There are oestrogen receptors throughout the brain, particularly in regions linked to memory, decision-making, reasoning and stress control. These receptors have been used to provide plentiful supplies of the hormone throughout our reproductive years, and oestrogen helps support brain cell protection, repair, growth, neuroplasticity and communication pathways.

When oestrogen levels start fluctuating in perimenopause, those processes get disrupted. Verbal learning and working memory tend to take the biggest hit. Hormonal shifts can also affect sleep, temperature regulation, mood and anxiety, all of which feed into brain fog and make it feel worse.

The reassuring news? Research by Dr Lisa Mosconi has shown that brain fog is transient, and for the vast majority of us, it resolves post-menopause.

It's not just hormones

Other factors that can cause or exacerbate brain fog:

• Sleep deprivation – whether from hormones, stress, a snoring partner, or children can have a huge impact.
• Physical inactivity – you might not be feeling like exercising if perimenopause is getting the better of you, but exercise helps with brain health, not just physical health.
• Chronic stress – stress over a prolonged period of time can make brain fog feel worse.
• Nutrition – particularly diets high in refined sugars, or low in B12 or iron.
• Alcohol consumption – midlife is often a crunch point for rethinking our relationship with alcohol as a coping mechanism.
• Other health and life factors – thyroid disorders, chronic illness, and grief can also play a role.

Ways to manage brain fog during perimenopause

The good news is that there are factors we can influence.

Here are a few things that help:

Sleep hygiene

Prioritising good sleep habits, such as keeping a consistent routine and limiting screen time before bed, can help support better sleep quality and focus.

Stay active

Regular exercise leaves you feeling more alert and energised. Even shorter sessions of 10-15 minutes are better than nothing. Start small if you need to, and build in something that is sustainable for where you are right now.

Diet

Focus on a diet rich in polyphenols, lean proteins, fibre, unsaturated fats, Omega-3 and magnesium.

Stay hydrated

Yep, pretty basic, but if you feel thirsty, you're already dehydrated, and our thirst cues diminish with age.

Stress management

What's in your stress-busting toolkit? Develop stress management techniques that don't involve food or alcohol, and schedule downtime for physical, mental and emotional recovery.

Technology support

Technology can be a huge support. Diary reminders for recurring tasks, AI notetakers so you can focus on meetings, knowing notes and actions are captured. Apps like Todoist for capturing to-dos on the go, syncing between devices, and tracking deadlines are also helpful, as well as dictation tools like Wispr Flow for turning speech into reliable text.

Manage your energy

Plan challenging tasks for when your energy is highest, and focus on one thing at a time. Multi-tasking tends to make overwhelm worse, not better.

Try mindfulness techniques

Even a short guided meditation or breathing exercise session can be surprisingly effective at clearing the mental cobwebs.

Explore treatment options

HRT is not for everyone, but for many women it can help resolve or at least improve brain fog.

Brain fog can feel deeply unsettling, particularly when it shows up in your professional life or in moments where you need to be sharp. But it isn't a sign that something is wrong with you, and it isn't permanent. Understanding why it's happening and taking small, consistent steps to support your brain can make a real difference.

Coaching, whether 1-1 or in a group setting, can be an important source of support, particularly for things like confidence, which often takes a dip, overwhelm, managing workloads, or navigating our changing sense of identity.