Is Menopause Causing My Brain Fog?

As a woman in mid-life, you may be finding your body changing in ways that make you feel alone.  Perimenopause and menopause are times of relatively rapid shifts in hormone production that don’t just affect your cycle.  Shifting hormone production also impacts your energy, skin, metabolism, sleep, and, maybe most concerning, brain function.   Many women experience these menopause symptoms, including brain fog, without understanding the reasons behind it.  It can make them feel alone and even a little crazy.  In this article we are going to help you understand those reasons so you can be empowered to care for your body and brain during this new season of life.    

Menopause and Brain Fog: You’re Not Alone 

The symptoms that menopause brings on can have a big impact on your quality of life.  An estimated 1.3 million women enter menopause in the US each year. ¹  Add in women in perimenopause or post-menopause and you have a staggering number of women experiencing the symptoms of the hormone shifts in this stage of life.  As life-expectancy increases, more and more women are spending multiple decades of their lives in the hormonal state associated with menopause.  All of these women are susceptible to the effects these hormonal transitions can have on the brain, so having knowledge and support are vital to navigating it.   

Arguably one of the most concerning symptoms of menopause is brain fog.  You might be wondering exactly what is brain fog? It’s not a distinct diagnosis but a cluster of symptoms that can include: 

• Lack of focus or difficulty concentrating 
• Poor short-term memory
• Forgetfulness 
• Confusion 
• Difficulty with word recall   

Brain fog can be related to stress, medications, nutrient deficiencies, sleep disturbances, blood sugar imbalances and hormonal imbalances.  While this article focuses on the contribution of hormones, specifically estrogen, it’s important to note there could be other contributors as well.  If you’re experiencing any of these symptoms, we encourage you to work with your healthcare provider to determine the cause. 

Brain fog can be intermittent (e.g., when you stay up late and feel a little off the next day).  But it can also become a consistent, long-term symptom.  For women transitioning into menopause this is quite common.  Starting in perimenopause, typically beginning in the mid-40’s, hormones begin to shift.  Straight through menopause and post-menopause, many women still find themselves experiencing brain fog.  While symptoms like difficulty sleeping and night sweats can contribute to that fogginess, they are just part of the reason.  They can have an additive effect combined with the direct neurological effects of hormonal fluctuation.  

But just how do hormones impact our brain function?  New research by leading clinicians like Dr. Lisa Mosconi shows that women’s brains age differently than men’s.  This is largely due to the hormonal changes, especially changes in estrogen levels, that occur with menopause.  Hormones, like estrogen, are not just important for reproduction, but also in brain function.  In fact, energy production in the brain relies on estrogen.  This may partly explain why women have twice the risk of Alzheimer’s. 

Like most women, you’ve likely walked into this phase of life completely unprepared.  It's important to know your experience is valid. You might be worried that you’re losing your mind, but you’re not alone. Remember that your brain is trying to work through a major transition and needs support and time to adjust.  Good news! There is evidence to show that it can adjust to its new normal! ² So read on to understand more details about the causes of this fog, and some tips for setting your brain up to function at its best during this time. 

What’s at the Root of Brain Fog? 

As mentioned above, our brain and reproductive system are constantly communicating with each other.  Perhaps surprisingly, estrogen is not just a necessary signaling molecule for reproductive functions.  It also plays an important role in the function and health of the brain.  Estrogen receptors are found throughout the brain, indicating the vital role estrogen plays in its function.  Estrogen is neuroprotective, influencing memory and cognition, increasing brain resilience, and reducing the risk of neurological diseases, like Alzheimer’s and Parkinson’s. ³  

In menopausal women, brain aging occurs due to dips in energy production and chronic low-grade inflammation.  Estrogen helps to regulate activity of microglia (immune cells that can cause ongoing inflammation in aging brains).4  This regulation provides an anti-inflammatory effect in the brain.  As a neuroprotective hormone, estrogen also pushes neurons to use glucose, their preferred fuel source for making energy. ^2,5 Estrogen helps to give the brain the energy it needs to function properly.  

Another important estrogenic action in the brain is vasodilation (relaxation and widening of blood vessels).  Within the brain, this increases cerebral blood flow, supplying required oxygen and nutrients to keep it running.  It’s no wonder that the rapid reduction in estrogen that occurs with menopause can be at the root of a lot of the brain fog experienced by women in this phase of life. 

Menopausal declines in estrogen are also linked to increased risk of Alzheimer’s and dementia.  To learn more, check out our three-part series on women and brain health here, here, and here.  You can also look into our brain health updates article summarizing more recent advances in this area of research. 

What Can You Do About Brain Fog During Menopause? 

The dramatic change in estrogen levels during menopause is quite consequential.  We’ve already discussed how it can make you vulnerable to brain fog and increase risk for Alzheimer’s disease and dementia.  This means by taking care of yourself during this time, you have a wonderful opportunity to set yourself up for lifelong brain health.   

If you’re already feeling foggy there’s good news! Here are several things you can do to keep your brain healthy and stay sharp: 

Diet 

While there are no specific vitamins for brain fog, the Mediterranean diet is important for aging brains in general. This holds true for women’s health especially.  You can find basic information on the Mediterranean diet and it’s benefits for brain health here.  In addition, there are some specific places to focus as a woman who wants to support your brain before, during and after the menopausal transition.   

1. Source your carbs wisely 

No, you don’t have to go keto or low-carb, but the source and quality of the carbs you eat matters!  Vegetables, fruits, root vegetables, whole grains, and legumes all provide quality carbohydrates that will fuel your body and brain with plenty of antioxidants, vitamins, and minerals.  Adding in fermented vegetables, like sauerkraut and kimchi, have the added benefit of providing probiotics as well.    

2. Fiber 

You may not know that fiber is a type of carbohydrate.  It helps to improve energy metabolism, hormonal balance, and feeds the good bacteria of the microbiome.  For women, it’s recommended to get at least 25 grams of fiber per day.  Filling half of your plate with colorful vegetables, especially leafy greens and cruciferous vegetables (e.g., cabbage, broccoli, cauliflower, kale…), will help you get there easily.  

3. Eat healthy fats 

You may remember when fat was the enemy, and low-fat diets were touted everywhere.  Our understanding of fat has changed, and just like carbs, the source matters.  Avoid trans fats and hydrogenated oils found in processed foods, and focus on getting lots of unsaturated fats.  Some of the best for brain health are the omega-3 fatty acids, found in fatty fish like salmon, sardines, and herring.  Monounsaturated fats are also supportive, such as those in olive oil, avocados, nuts, and seeds. 

4. Phyto-estrogens 

These “plant estrogens” are found in certain foods, and have a mild estrogenic effect.  Organic and fermented soy products, like tempeh, miso, and natto, are great options to get isoflavones, a major source of phytoestrogens in food.  Other food sources of phytoestrogens are flaxseeds, nuts and seeds, vegetables and fruits, tea, and legumes.  

5. Hydration 

Although it’s not often thought of in this way, water is an essential nutrient.  Every chemical reaction in our body occurs in this aqueous environment.  Even mild dehydration can impact cognitive function, making you feel sluggish and your brain feel foggy.  So be sure to drink your 8 glasses per day. 

Exercise 

Exercise is one of the most transformative things you can do for brain health.  A single workout immediately increases mood-enhancing neurotransmitters.  It can immediately improve focus and reaction time as well.  Long-term, exercise increases hippocampal prefrontal cortex volume.  This improves long-term memory, attention, and focus.  Increased exercise is neuroprotective, reducing long-term risk of neurodegenerative disease.  Thirty minutes of aerobic exercise 3-4 times per week can be enough to make a difference. ⁶ 

Sleep 

Hormonal changes might make sleep more difficult to come by, but taking steps to get the best quality sleep possible can help with brain fog.  Some simple supports you can use include keeping your room at a comfortable temperature, exercising daily, incorporating a relaxing routine (e.g., stretching, meditation, herbal tea) before bedtime, and avoiding screens close to bed.  

Hormone Replacement Therapy  

You may be asking, “What if I just get hormone replacement therapy (HRT)?  Will that solve the problem?”  The answer is a bit complicated since the data aren’t all there yet.  There are some general patterns in the research that speak to its efficacy and safety. Currently, the evidence suggests that HRT immediately after going into menopause might be helpful in mitigating the effects of low estrogen on the brain.  However, if it has been a while since going through menopause, it may not be effective, and may even be detrimental.  The best thing you can do is speak with your doctor about your individual circumstance regarding HRT, while engaging in brain healthy habits (like above).  

Add Some Nutritional Insurance 

If you aren’t able to eat right all the time, you can add in some nutritional insurance.  RELEVATE provides just that by filling in the gaps with brain fueling nutrients.  In addition to supporting your brain with the nutrition it needs to function well, users tell us that RELEVATE helps them with symptoms of menopause.  Findings of a recent study include: 

• 49% (about half) report improvement in mood and sense of well-being. 
• 42% notice improvements in sleep and energy, or have fewer hot flashes. 
• 65% of RELEVATE users, many of them women,  report improvements in focus and clarity.  

There are many ways to support your body during the major transition of menopause, including diet, exercise, and sleep.  Do your best to bring these in to minimize symptoms of brain fog during menopause.  When you can’t reach those goals, use a support like RELEVATE to fill in nutrient gaps.   

References

1. Peacock, K. & Ketvertis, K. M. Menopause. StatPearls (2022).
2. Mosconi, L. et al. Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Sci. Rep. 11, (2021).
3. Wise, P. M., Dubal, D. B., Wilson, M. E., Rau, S. W. & Böttner, M. Minireview: Neuroprotective Effects of Estrogen—New Insightsinto Mechanisms of Action. Endocrinology 142, 969–973 (2001).
4. Villa, A., Vegeto, E., Poletti, A. & Maggi, A. Estrogens, Neuroinflammation, and Neurodegeneration. Endocr. Rev. 37, 372 (2016).
5. Zárate, S., Stevnsner, T. & Gredilla, R. Role of Estrogen and Other Sex Hormones in Brain Aging. Neuroprotection and DNA Repair. Front. Aging Neurosci. 9, (2017).
6. Basso, J. C. et al. Examining the Effect of Increased Aerobic Exercise in Moderately Fit Adults on Psychological State and Cognitive Function. Front. Hum. Neurosci. 16, (2022).