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Clearing the Fog: Understanding and Managing Cognitive Changes During Perimenopause

The cognitive changes experienced during perimenopause are largely tied to fluctuating hormone levels, particularly estrogen. Estrogen plays a key role in regulating neurotransmitters in the brain and supporting overall brain health. As estrogen levels decrease, so too does the support it provides to cognitive functions like memory and focus.


Other contributing factors may include:

  • Poor Sleep: Sleep disruptions from night sweats or insomnia can lead to fatigue and impair cognitive function.

  • Stress: Increased stress levels during this transitional period can exacerbate brain fog and make it harder to focus.

  • Nutritional Deficiencies: A lack of essential nutrients, like B vitamins and omega-3 fatty acids, can impact brain health.

  • Age-Related Changes: Cognitive shifts during perimenopause often overlap with age-related memory changes, amplifying their effects.


Common Cognitive Symptoms During Perimenopause

  • Difficulty concentrating or focusing

  • Forgetting appointments, names, or everyday tasks

  • Feeling mentally “fuzzy” or slower than usual

  • Struggling with problem-solving or decision-making

  • Difficulty finding the right words during conversations


Strategies to Improve Cognitive Function During Perimenopause

  1. Prioritize SleepSince sleep disturbances can directly impact memory and focus, improving sleep hygiene is crucial. Create a calming bedtime routine, limit screen time before bed, and keep your bedroom cool to help mitigate night sweats. If sleep issues persist, consult a healthcare provider to explore treatment options.

  2. Stay ActiveRegular physical activity is a powerful tool for improving cognitive function. Exercise increases blood flow to the brain, reduces stress, and helps regulate hormone levels. Aim for at least 30 minutes of moderate exercise, like walking, swimming, or yoga, most days of the week.

  3. Feed Your BrainA nutrient-rich diet can go a long way in supporting cognitive health. Focus on foods that are rich in:

    • Omega-3 fatty acids: Found in fish like salmon, walnuts, and flaxseeds, these fats support brain function.

    • Antioxidants: Blueberries, dark leafy greens, and nuts help protect brain cells from damage.

    • B Vitamins: Whole grains, eggs, and leafy greens can help support energy production in the brain.

  4. Practice Stress ManagementChronic stress can wreak havoc on your cognitive health. Incorporate stress-reducing practices like meditation, deep breathing, or journaling into your daily routine. Even 5-10 minutes of mindfulness can help clear mental fog and boost focus.

  5. Train Your BrainEngage in activities that challenge your brain to keep it sharp. Puzzles, reading, learning a new skill, or even playing a musical instrument can help improve memory and cognitive abilities.

  6. Stay Socially ConnectedStrong social connections are linked to better cognitive health. Regular interactions with friends, family, or support groups can provide emotional support and help keep your mind engaged.

  7. Consider Hormone Therapy or SupplementsFor some women, hormone replacement therapy (HRT) may help reduce cognitive symptoms by stabilizing estrogen levels. Speak with your healthcare provider to determine if this is a good option for you. Additionally, supplements like magnesium, vitamin D, and omega-3s may offer added support for brain health.


While brain fog and memory issues during perimenopause are typically mild, they shouldn’t significantly disrupt your daily life. If you’re experiencing severe cognitive symptoms, or if they’re accompanied by other concerning signs, such as depression or extreme fatigue, it’s important to consult a healthcare provider to rule out underlying conditions.

Your mind deserves just as much care as your body—so take a deep breath, and know that you’ve got this.


Want to learn more about navigating perimenopause? Schedule a consultation to get personalized guidance for your journey.

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About Michelle

Michelle is a Doctor of Physical Therapy at Webb Physical Therapy, located in Lawrence, Kansas.  She's worked in PT for close to 10 years, and believes each patient should be treated with a holistic, whole person approach to healing.

She is devoted to helping her patients develop individualized treatment plans to help them achieve their specific goals.

Call (785) 813-1338 for a free 15 minute phone consultation, or email WebbPelvicHealth@gmail.com

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