Supporting the Perimenopausal Brain

Many women notice changes in memory, concentration and mental clarity during perimenopause. For some, it can feel deeply unsettling. Highly capable professionals who have always relied on their ability to think quickly, stay organised and juggle competing demands suddenly find themselves struggling to recall familiar words, losing their train of thought, or forgetting why they walked into a room.

While these experiences are common, they are often misunderstood. The good news is that research is helping us better understand what is happening in the brain during the menopausal transition, and why the picture is far more nuanced (and more hopeful) than many women fear.

What Does the Research Show?

A 2025 systematic review and meta-analysis published in Psychology and Aging examined data from 26 studies involving more than 9,400 women across the menopausal transition. The researchers found that women in perimenopause demonstrated modest reductions in cognitive performance compared with premenopausal women, particularly in attention and working memory (Bangle et al., 2025).

Importantly, these differences were most consistently observed in studies that used standardised reproductive staging criteria. This suggests that some of the conflicting findings reported in earlier research may reflect differences in how menopause stages were defined rather than differences in the underlying biology itself (Bangle et al., 2025).

In other words, the cognitive changes many women experience during perimenopause are real, measurable and increasingly recognised within the scientific literature.

What Is Happening in the Brain?

Perimenopause is not a single hormonal event. It is a gradual neurological and reproductive transition that can span several years.

During this time, levels of oestradiol, the most biologically active form of oestrogen, fluctuate significantly before eventually declining. Oestradiol receptors are found throughout the brain, including areas involved in memory, attention, learning and executive function. As hormone levels change, so too do processes involved in brain energy metabolism, neurotransmitter activity and neuroplasticity (Maki & Henderson, 2016).

Although objective cognitive changes can be detected during perimenopause, performance typically remains within normal functional ranges. Current evidence suggests these changes reflect a period of neurological adaptation rather than progressive cognitive decline (Maki & Henderson, 2016).

This distinction matters.

Many women find the symptoms themselves frustrating, but often what creates the greatest distress is the fear that something more serious is happening. Understanding that these experiences are a recognised feature of the menopausal transition can be both validating and reassuring.

The Missing Piece: Sleep

Sleep may be one of the most important drivers of cognitive symptoms during perimenopause.

Night sweats, hot flushes, anxiety, early morning waking and changes in sleep architecture can all contribute to fragmented sleep. Poor sleep is well known to impair attention, working memory, emotional regulation and decision-making, regardless of hormone status (Maki & Jaff, 2022).

In practice, it can be difficult to separate the effects of hormonal fluctuations from the effects of chronic sleep disruption because the two frequently occur together.

When you're waking repeatedly at 3am and struggling to get back to sleep, your brain is not operating under optimal conditions. For many women, improving sleep quality can have a significant positive impact on cognitive function.

Is Brain Fog Permanent?

Fortunately, the evidence suggests that for most women, it's not.

Findings from the Study of Women's Health Across the Nation (SWAN) indicate that some aspects of cognitive performance, particularly processing speed and verbal memory, may decline temporarily during the menopausal transition. However, these changes are generally modest and do not appear to represent ongoing deterioration (Greendale et al., 2020).

For many women, symptoms improve as hormonal fluctuations stabilise following menopause (Greendale et al., 2020).

The menopausal transition can be challenging, but it is not typically a permanent state of cognitive decline.

Supporting Brain Health During Perimenopause

While there is no single solution for brain fog, research points towards several evidence-based strategies that may help support cognitive health during this transition.

Prioritise Sleep

If there is one intervention with the potential to deliver the greatest return on investment, it is sleep.

Addressing sleep disruption through consistent sleep habits, temperature management, stress reduction strategies and appropriate medical support can improve both cognitive performance and overall wellbeing.

Sleep is not simply a recovery tool. It is one of the brain's primary maintenance systems.

Move Regularly

Regular physical activity is one of the most consistently supported lifestyle strategies for maintaining cognitive health throughout midlife and beyond.

Research suggests aerobic and resistance exercise may support executive function, attention and memory through improvements in cerebral blood flow, neuroplasticity and inflammatory regulation (Maki & Henderson, 2016).

Although research specifically examining exercise and cognition in perimenopausal women is still developing, movement remains one of the most promising non-pharmacological interventions available.

For most women, a combination of aerobic exercise and strength training performed consistently throughout the week is likely to provide the greatest overall benefit.

Focus on Overall Dietary Quality

Nutrition also plays an important role in long-term brain health.

Nutrients such as omega-3 fatty acids, B vitamins and vitamin D have received considerable research attention in relation to cognitive function. However, evidence supporting supplementation alone remains mixed (Maki & Henderson, 2016).

Current evidence generally favours a Mediterranean-style dietary pattern rich in vegetables, beans, pulses, whole grains, fish, olive oil, nuts and other minimally processed foods.

Rather than focusing on individual nutrients in isolation, the overall quality and consistency of the dietary pattern appears to matter most.

Manage Stress

Chronic stress can amplify many of the symptoms women experience during perimenopause, including forgetfulness, poor concentration and mental fatigue.

Stress management strategies such as mindfulness, relaxation techniques, regular physical activity, cognitive behavioural approaches and social connection may help reduce the cognitive burden associated with prolonged stress exposure.

When to Seek Further Support

Although brain fog is a common experience during perimenopause, it is important to remember that not every cognitive symptom should automatically be attributed to hormonal changes. If symptoms are becoming progressively worse, interfering with daily life, affecting your confidence or safety, or continuing despite improvements in sleep and lifestyle factors, it is worth having a conversation with your GP or healthcare professional. Significant changes in mood, or any concerns about an underlying neurological condition, should also be explored. Seeking support is not overreacting; it is a proactive step towards understanding what your brain and body need during this transition.

A Different Way to Think About Perimenopause

Perimenopause is often discussed as a reproductive transition. In reality, it is also a neurological transition.

Understanding this can help shift the conversation away from self-doubt and towards self-support.

The cognitive changes experienced during perimenopause are real. They deserve recognition, understanding and evidence-informed care. Yet they do not mean the brain is failing.

For many women, recognising that the brain is adapting to a period of significant biological change may be one of the most empowering reframes available.

References:

Bangle, A., Williams, D., Walters, J., & Nguyen, L. (2025). Cognitive functioning in perimenopause: An updated systematic review and meta-analysis. Psychology and Aging. Advance online publication.

Greendale, G. A., Karlamangla, A. S., & Maki, P. M. (2020). The menopause transition and cognition. JAMA, 323(15), 1495–1496.

Maki, P. M., & Henderson, V. W. (2016). Cognition and the menopause transition. Menopause, 23(7), 803–805.

Maki, P. M., & Joffe, H. (2022). Brain fog in menopause: A health-care professional's guide for decision-making and counseling on cognition. Climacteric, 25(6), 570–578.