That Thing on the Thing

Brain Fog is Reall inn Perimenopause

“Hey, you, yes you … right there, you. What’s your name again?” I said.

“Um…. me? Do you mean me? I’m Jay, your husband.” He replies.

I doubt Swifties will want to swap bracelets with me.

I could make brain fog jokes all day, but I know the frustration, fear, and embarrassment of not remembering a common word, forgetting a dear friend’s name, or recollecting what you just learned. It can make us feel shameful when we can’t access the information we know, we know. Brain fog is a common cognitive complaint of a lot of people today, but it’s especially problematic for perimenopausal women.

Settle in; this is going to take a while.

Am I Demented?

Neuroscientists (brain scientists) understand why brain fog is expected during perimenopause. They’ve confirmed what we’ve suspected all along, that we’re not crazy. Fluctuating and declining estrogen are to blame, as well as a busy lifestyle.

Brain fog can be so severe that we question whether we’re developing dementia or early-onset Alzheimer’s, but there are clear differences between perimenopause brain fog and senility/Alzheimer's.¹

Forgotten the name for a fork? Perimenopause brain fog

Forgotten how to use a fork? Senility or Alzheimer’s.

I may sound like a neuroscientist, but I’m not. Please rely on the experts and your doctor if you have a cognitive issue that you are truly concerned about.

Tell Me What You’re Going to Tell Me & Then Tell Me

In this article, I will review:

• What is cognition? – We need to understand what exactly is being affected in order to understand brain fog. The brain is complicated, but I’ll make this simple.

• What does having brain fog feel like?

• Why is brain fog so prevalent among perimenopausal women?

• What can I do to help myself in the short and long term?

I’ve got a lot to review with you. You’re probably struggling with brain fog as you read this. As comedian Nate Bargatze says, “I’m from the 1900s.” And I am, too! For long articles, my brain likes it better to see it on paper that I can read at my own speed. Give it a try … If you’re viewing this on my website on a computer, right-mouse click, hit print [or Ctrl+P]. On a device? I have no idea; ask a Gen Z.

What is cognition?

This article sucks! Well, actually, it doesn’t, but what I just caused your brain to do was make a judgment – is she being funny? Serious? Intentional? And that, my friends, is part of your cognitive skills. You just showed yourself cognition in action. Hooray!

Cognitive function includes “all forms of knowing and awareness, such as perceiving, conceiving, remembering, reasoning, judging, imagining, and problem solving.”² It also includes planning, impulse control, logical analysis, learning, intellectual activities, and understanding. Basically, all of the stuff that we love to do as women.

Your prefrontal cortex (front area of your brain) is responsible for cognition. If you have kids, you may know this area of the brain for controlling executive functioning. As you can imagine, estrogen in women plays a key role in the strength and resilience of our cognitive abilities. Our brains have many estrogen receptors that “soak up” the estrogen and tell the brain cells how to behave.

Outside of cognition, you also have another important area of your brain called the limbic system³, which includes the autonomic nervous system (all the tasks in your body that you don’t have to think about, like cell maintenance, digestion, kidney function, etc.)

It also controls the fight-or-flight response – that screaming response thing that you do when your kids think it would be funny if they jumped out of the closet yelling like banshees just to scare you.

The limbic system is also the emotional and impulse center of the brain. If you’re familiar with the part of the brain called the amygdala or “reptile brain,” this can be found here as well.

It’s important to understand both of these brain functions in order to help yourself with brain fog.

You’ll notice that the limbic system controls body temperature regulation. When I teach you about hot flashes, we’ll discuss the limbic system and the area of the brain in the limbic system that controls body temperature, the hippocampus.

What does having brain fog feel like?

These are some things you might say about brain fog, how it shows up in your life or ways to describe it:

• Name Recall - You bump into a friend at the supermarket and can’t remember her name completely or you second guess yourself on her name.

• Word Recall - You have to ask family members for help remembering words and may call things by not their name, as in “Can you get me that thing on the thing?” Watch Amey from Glow Menopause on IG describe her experience trying to figure out a word. She almost couldn’t host a party lol. According to Felice Gersh, MD, it’s most likely nouns you’ll forget. That’s sort of comforting that it’s not every word.

• General Forgetfulness – You had an appointment and completely forgot about it.

• Memory Lapses – You can’t remember doing something that you just did or you’re unable to remember something that you just read.

• Response Time Delay - Someone asks you a question and you take longer than usual to prepare a response.

• Muddled Thinking/Fuzzy Thinking/Lose of Ability to Think in an Ordered Fashion - Your head is a jumbled mess of information that seems disorganized.

• Difficulty Concentrating – You have to read and re-read something in order to retain it. This can sometimes be enough of an issue to make you think you’ve developed ADHD or another cognitive issue.

• Difficulty with Focus – You aren’t able to keep your attention on what you’re working on.

• Conversation Difficulties - You forget what you were saying or the point you were making. I’ve even forgotten that I was talking while I was talking and will stop in the middle of a sentence while my brain wanders off somewhere else, leaving my family waiting for me to finish.

• Easily Confused - Something might seem new to you like you’ve never done it before or you look at something and think it’s something else. Can you remember what day it is? I’ve looked at words and thought they were spelled wrong or looked funny.

• Spelling Errors - You can’t remember how to spel spelll spell basic words. I was never a very good speller, but now I’m worse. Perimenopause will hit you where it hurts.

• Blank Mind

• Multi-tasking Limitations - You find that you can’t do two things at once anymore. You turn down the radio when you’re trying to find a new address.

• Feeling Mentally Tired - You feel like your brain just can’t take on any more information. I told you to print this earlier in the article :-).

• Everything Everywhere All at Once

Why is brain fog so prevalent among perimenopausal women?

As you know from reading my work, perimenopause is a major transition between the old and the new way of making hormones. It’s driven by the brain, not the uterus. As the brain tries to adapt to your unpredictable hormones, there will be a few hiccups along the way.

As estrogen begins to fluctuate, the brain’s estrogen receptors in the prefrontal cortex, where our cognition lies, don’t receive what they need to do their job correctly.

Furthermore, our body’s goal is survival. When any bodily system starts behaving in unpredictable ways, like in perimenopause, our limbic system interprets it as a threat.

This causes blood and oxygen to pull away from the prefrontal cortex and be redirected to the limbic system to activate our fight or flight response, where it’s needed to deal with the threat. In this case, an internal threat of unpredictable estrogen. Suddenly, the prefrontal cortex and cognition go offline and voila, you have brain fog.⁴

Another issue during perimenopause is an increase in inflammation. Estrogen protects us against inflammation, and when estrogen declines, inflammation will increase, which means in our brains too. This is one reason why lifestyle adjustments are so important at this age. We need to manually reduce inflammation since we can’t rely on estrogen to give us that protection.

It also doesn’t help that we’re constantly distracted and interrupted. This shortens our attention span and trains our brain in negative ways. We could get away with it before we hit perimenopause thanks to estrogen, but now we need to set up boundaries, especially with family members (kids, I’m talking about you!), to reduce these types of demands on our brains.

💠 PeriSquad, new science alert as of June 2024. Lisa Mosconi, PhD, a neuroscientist, just released a 5-year-long groundbreaking study that showed an increase in estrogen receptor density and activity in the brain that occurs in the menopause transition. It was previously thought that the brain’s estrogen receptors shut down following menopause. The study also determined a link between the location of the density and peri/menopause symptoms such as cognitive issues.

My note: It has not yet been determined if the appearance of dense estrogen receptors cause symptoms such as brain fog or vice versa. Dr. Mosconi will continue to study the brain and menopause. She is truly a celebrity in the field of women’s health science.

Before this study, researchers had limited knowledge and had not been able to look at the estrogen receptors in a female adult brain before (alive). She and her team developed a new technique to see the estrogen receptors on a medical brain scan and translate this information to understand what happens to our brains during our perimenopause and menopause experiences. This opens huge doors for us. See the footnote for more and a link to the study. ⁵

We can’t blame the hormonal changes of perimenopause 100% on our brain fog. Like anything, there are multiple reasons that could be causing or increasing brain fog. Some additional reasons are:

1. Not getting enough quality sleep

2. There is way more information than ever now. The world expects us all to be health experts, tech gurus, auto mechanics, plumbers, etc.… This was never the case before, and our brains are struggling to keep up.

3. Poor breathing patterns (subscribe for a later article on breathing)

4. Stress, trauma (big T and little t), and mood changes

5. Poor nutrition

6. Aging - boooo!

7. Metabolic changes like insulin sensitivity and glucose metabolism

8. Viruses (i.e. Covid, Epstein-Barr virus initial infection - aka mono - and reactivation)

9. Alcohol and drug use, overusing caffeine, smoking⁶

10. Medical conditions such as thyroid issues and multiple sclerosis

11. Multi-tasking and being on our devices too much

12. Sedentary lifestyle

13. Pregnancy

14. Medications, even some over-the-counter medicine

💖Note: If you’re concerned about your cognitive function at midlife, you’ll want to be careful when taking the antihistamine Benedryl. Benedryl is commonly used by perimenopausal women as a sleep aid. The problem with Benedryl is that it’s anticholeretic (meaning against choline). Choline is an important brain nutrient that we get from food and is made in our body by producing a neurotransmitter, acetylcholine. Its production declines with age. When we take anticholeretic medicines, like Benedryl, it blocks the production of acetylcholine and may make us more brain foggy.⁷

What can I do to help myself in the short and long term?

The key to reducing perimenopausal brain fog is managing the things that drain your mental energy. It could be something mental or physical that is causing your brain to feel spacey, so we need to pay attention to both. If you make space in your nervous system and brain by getting rid of the things that steal your energy, you can allow the brain some room to work as it should.

Our unconscious brains can process 11 million bits of information per second, while our conscious brains can process 40 bits of information per second.⁸ If we can clear the clutter of what our 40 bits are paying attention to, we can help reduce our brain fog.

The two biggest takeaways from The Menopause Society 2024 Annual Meeting were to remain socially active, which has a huge positive impact on our brains, and to do hard things cognitively (like reading this article).

Would you like more tips & tricks for managing brain fog? Consider subscribing. My best tips will be included in your welcome email.

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Although perimenopause brain fog is common, according to neuroscientists and Dr. Louann Brizendine in her book The Upgrade, brain fog is temporary as the body gets through the menopause transition. We “just” need to rely on techniques to adapt and help us support our brains during this time of transition. #noshame

Brain fog affects cognition, but remember that our limbic functions are not affected by brain fog. Brain fog should lift a bit following menopause, especially if we do things to help it out a bit.

Do you have a new appreciation for your brain? I know I do! I still struggle with brain fog, but I’m proof that it doesn’t have to get the best of you. Trust me, I do or did all of the silly things I describe, but I took the time to address it and I am so much better for it. I’ve also noticed that my brain has become better and stronger in other areas, like creativity, intuition, and compassion. I choose to focus on these abilities instead of what I can’t do right now. Mindset is important.

A side note about this article: They do not teach this material in “certified perimenopause educator school.” This is me connecting the dots between what I know through learning about health over 30+ years and what I’ve lived. I have not seen any other article online coupling brain function, stress, brain fog, AND perimenopause. I write what I want to see on the internet.

Be well, stay cool…

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1. “Brain Fog vs. Dementia | OHSU.” www.ohsu.edu, www.ohsu.edu/womens-health/brain-fog-vs-dementia.

2. “American Psychological Association (APA).” Https://Www.apa.org, apa.org.

3. The entire brain is important, complex, and we only understand a limited amount of it. For the purpose of this article, I will only cover cognition and the limbic system.

4. Louann Brizendine, MD . The Upgrade. Harmony, 2022.

5. Mosconi, Lisa, et al. “In Vivo Brain Estrogen Receptor Density by Neuroendocrine Aging and Relationships with Cognition and Symptomatology.” Scientific Reports, vol. 14, no. 1, June 2024, p. 12680, https://doi.org/10.1038/s41598-024-62820-7. Accessed 28 June 2024.

https://www.nature.com/articles/s41598-024-62820-7

!!This is heavy reading, but Dr. Mosconi has been very generous with her time and there are a ton of free interviews she has done online that explains her research. The interview I sat in on live with her was recorded and posted to My Alloy’s IG page. Dr. Mosconi has funded this published study for open access, meaning it’s free for EVERYONE to read. Otherwise, the study would have been behind a paywall or payment system.

Dr. Mosconi also published two books about the female brain. Her most recent book is The Menopause Brain.

Please show interest online in this topic. The more women who talk about it, the more funding will be available for this type of research. Let’s create demand.

6. Campos MW, Serebrisky D, Castaldelli-Maia JM. Smoking and Cognition. Curr Drug Abuse Rev. 2016;9(2):76-79. doi: 10.2174/1874473709666160803101633. PMID: 27492358.

7. Louann Brizendine, MD . The Upgrade. Harmony, 2022. For more information on choline, visit https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/

8. DiSalvo, David. “Your Brain Sees Even When You Don’t.” Forbes, www.forbes.com/sites/daviddisalvo/2013/06/22/your-brain-sees-even-when-you-dont/.