Ever walked into a room only to forget why you’re there? Or found yourself searching for your glasses – while you’re holding them? Welcome to perimenopausal brain fog, where your once razor-sharp memory suddenly feels like a browser with too many tabs open… and none of them are responding.
For some women, it’s just a little forgetfulness – misplacing keys, losing a train of thought mid-sentence. For others, it can feel like a full-on mental fog, making it hard to focus, process information, or even find the right words. And while it’s completely normal, it can also be hugely frustrating.
Rebecca, 54, says losing her sharpness of mind was one of her worst perimenopause symptoms: ‘At times, I thought I was going mad. I’d start a conversation in a meeting and completely forget what I was going to say, which was highly embarrassing in a room full of business people.’
‘I’d do stupid things like lose my car keys and find them in the fridge or take wrong turns on routes I drive most days, ending up completely lost,’ she recalls. ‘The brain fog was, I believe, made worse because of a lack of sleep. I’d wake up every couple of hours with hot flushes and didn’t get a decent night’s sleep for years.’
Sara, 46, suffered brain fog as a result of long Covid and says it returned with the perimenopause: ‘I find it difficult to get the words out – I know the word, it’s in my head, but it doesn’t come out of my mouth without pause, especially if I’m tired.’
‘Today, an intense period of concentration sent my brain into shutdown mode and I slept for two hours on the sofa,’ she says, adding that it is affecting her ability to look for work. ‘I’ve applied for a few part-time jobs, but I have had second thoughts about the ones that are more demanding concentration-wise – I just can’t guarantee that I’d be able to concentrate.’
What causes perimenopausal brain fog?
Hormonal fluctuations during perimenopause are the main cause of brain fog, and they affect your brain in more ways than one. Oestrogen and progesterone – two key hormones that regulate everything from your mood to your metabolism – play a major role in brain function. When they start declining, the effects trickle down into memory, focus, and mental clarity.
Holly Keen, a nutritional therapist, wellness coach and founder of Flourishment Wellness, says this decline means there are ‘several factors at play with perimenopause brain fog.’
‘These hormones regulate neurotransmitters, influence glucose metabolism, and support brain health,’ she explains. ‘When oestrogen levels drop, it can lead to reduced energy, increased inflammation, and impaired neuroplasticity, while fluctuations in progesterone disrupt sleep, which in turn affects memory.’
Dr. Oksana Melnyk, an obstetrics and gynaecology specialist at Medcare Women & Children Hospital, agrees that hormones play an essential role in cognitive function. She explains that oestrogen helps regulate serotonin and dopamine levels, protects against neuroinflammation, and stabilises cortisol levels, preventing stress from exacerbating brain fog.
‘Conventional treatments often include HRT, which can stabilise estrogen levels and improve cognitive symptoms,’ says Oksana. ‘In some cases, cognitive behavioral therapy (CBT) may help manage associated anxiety and mood disturbances.’
While Hormone Replacement Therapy (HRT) can be highly effective in alleviating perimenopausal symptoms, some women choose not to use it due to personal preference, medical history, or concerns about potential risks. For those with a history of breast cancer, blood clots, or cardiovascular disease, HRT may not be recommended due to its possible link to increased risk of certain conditions. Others worry about side effects, such as weight gain, bloating or mood swings, , or prefer to manage symptoms naturally through lifestyle changes, diet, and alternative therapies.
Positive lifestyle changes
Beyond medical treatments, a functional medicine approach combines hormonal support with nutrition and lifestyle interventions to support brain health naturally. Alternative approaches include supporting brain health with a diet high in omega-3 fatty acids, antioxidants and phytoestrogens, which are found in flaxseeds, soy and legumes; magnesium, vitamin D and B-complex supplements; and adaptogenic herbs, such as ashwagandha and rhodiola rosea to regulate stress responses.
Holly advocates looking around the world for new ways to combat brain fog and other perimenopause symptoms: ‘Explore other cultures, such as Asia, where females consuming a more traditional diet deal with less symptoms due to the high phytoestrogen content consumed – and a Mediterranean diet rich in whole foods is especially beneficial.’
While perimenopausal brain fog can feel overwhelming, lifestyle adjustments can make a significant difference. Experts agree that quality sleep, stress management, and mindful habits play a crucial role in boosting mental clarity and cognitive function.
‘Prioritising sleep is crucial, as disrupted sleep patterns can worsen cognitive symptoms,’ explains Dr. Oksana. ‘In some cases, melatonin supplements may help improve sleep quality.’
‘Establish a bedtime routine, limit screen time before bed and consider natural remedies, like magnesium, salt baths and valerian root for better sleep,’ says Holly. ‘Plus mind-body practices, such as regular yoga, meditation and mindfulness exercises can help reduce stress and improve mental clarity.
Finding the right physical exercise can be another important step in overcoming brain fog.
‘Regular exercise, especially aerobic and resistance training, improves circulation and promotes neurogenesis,’ says Dr. Oksana, while Holly adds that aerobic exercise in particular ‘can boost mood, improve memory and reduce the severity of brain fog.’
Exercising the brain, as well as the body, can make a real difference, says Holly: ‘Engage in activities that challenge the brain, such as puzzles, reading or learning a new skill.’
How can employers support women?
Many women who experience perimenopausal brain fog can struggle in the workplace and feel unsupported. A 2024 Public Health Wales study into perimenopause and menopause experiences for healthcare workers found that some women were reluctant to ask for support at work, even if they thought the workplace would likely be positive. Nearly two-thirds of the women surveyed reported negative effects at work, such as reduced concentration and increased stress.
Holly runs menopause in the workplace workshops as part of her wellbeing practice, and says employers ‘have a vital role in creating a supportive workplace for women navigating perimenopause.’
Her advice for employers includes educating staff to reduce stigma and foster understanding; flexible and remote work options to accommodate fluctuating energy levels; wellbeing initiatives, such as access to nutritional therapy, stress resilience workshops and counselling; workplace adjustments, such as better ventilation and ergonomic equipment to make women more comfortable; and having a menopause champion or HR lead trained to support women and advocate for their needs.
‘By taking these steps, workplaces can retain skilled professionals, while fostering a culture of inclusivity and care,’ says Holly.
‘Employers can play a pivotal role by fostering an open and supportive environment,’ adds Oksana. As well as Holly’s recommendations, she says workplaces should provide ‘quiet spaces for rest or mindfulness during the workday.’
Dubai-based PR agency TishTash for example was one of the first companies to offers employees seven days leave per year for menopause and perimenopause issues, as well as IVF and menstruation.
‘Protocol for this is the same as sick leave, meaning staff do not have to label the leave as ‘menopause’ if they don’t feel comfortable doing so,’ says TishTash founder and CEO, Natasha Hatherall-Shawe. ‘We also provide any staff member going through the menopause with four wellness sessions that will support them in getting back to feeling like themselves again – this could be counselling sessions, alternative therapies or any others that feel right for the individual.’
