Perimenopausal woman with brain fog walking outside

Five Tips for Improving Brain Fog in Perimenopause

Five Tips for Improving Brain Fog in Perimenopause

Perimenopausal woman with brain fog walking outside

In my previous blog, I discussed brain fog and other cognitive changes that many women report during perimenopause, including difficulties with memory, organisation, focus, and concentration. While these changes can significantly impact some women, there’s encouraging news:

1) Brain fog often improves with time, especially as you transition into post-menopause and experience better sleep and reduced stress levels.

2) Brain fog during perimenopause doesn’t indicate a permanent loss of cognitive ability (1,2).

3) Most women successfully adopt memory strategies to manage these changes, allowing overall performance to remain at normal levels (2,3).

Interestingly, recent research shows that women’s cognitive profiles during perimenopause are quite varied—some women demonstrate particular strengths in certain areas, while others experience challenges. Factors like depression, sleep problems, and vasomotor symptoms (such as hot flushes) may also contribute to cognitive difficulties during this time (4). Talking with your GP about brain fog or other related symptoms, should always be your first step towards understanding all the variables that may be at play.

This article provides five key strategies to help optimise brain health and reduce the effects of brain fog. While you may already be familiar with these tips, the real challenge often lies in finding ways to integrate them into your daily life. Remember, everyone’s experience of perimenopause is unique, and symptoms can vary widely, so please use this guide as a general overview, not a substitute for personalised medical care.

Evidence-based strategies for brain health and to improve brain fog:

1. Address sleep problems

Sleep is fundamental to cognitive function. While hormonal therapy can be helpful for many women, there may be additional factors disrupting your sleep. Chronic sleep issues like insomnia require a holistic approach, and interventions such as Cognitive Behavioural Therapy for Insomnia (CBT-I) and mindfulness-based practices have the strongest evidence for improving insomnia. For more details, check out my blogs on CBT-I and mindfulness or mindfulness for sleep.

Quick fixes like sleep medications or herbal remedies often don’t provide long-term benefits. Instead, learning sustainable skills to improve sleep can prevent chronic insomnia from recurring.

If you often experience daytime fatigue or sleepiness, it might be worth considering an overnight sleep study to check for other potential sleep disorders, such as breathing issues like sleep apnea. The prevalence of sleep-disordered breathing increases with age and becomes more common during perimenopause. Research suggests that around 50–70% of postmenopausal women are affected by sleep-disordered breathing (5).

2. Practice stress reduction techniques

Chronic stress contributes significantly to brain fog, as elevated cortisol levels negatively affect brain function. Practices such as mindfulness, meditation, and relaxation techniques like deep breathing or yoga can reduce stress and improve cognitive performance.

Mindfulness enhances concentration, focus, and the ability to manage distractions. It has also been linked to improvements in attention and working memory.

Learn more about mindfulness

3. Stay physically active

Exercise, particularly aerobic activity, boosts blood flow to the brain, enhances neuroplasticity, and releases endorphins, all of which help combat brain fog. For optimal brain health during this stage of life, include four key types of exercise in your routine:

- Strength Training: Build muscle and counteract age-related muscle loss with resistance exercises like weightlifting. This also supports brain health.

- Flexibility: Stretching exercises, such as yoga or Pilates, maintain joint mobility, posture, and circulation while reducing physical stress.

- Cardiovascular Exercise: Activities like walking, swimming, or cycling stimulate the production of brain-derived neurotrophic factor (BDNF), a protein essential for brain repair and growth.

- Balance Training: Activities like tai chi or Pilates improve stability and focus, helping to strengthen neural connections.

Yoga is an excellent way to incorporate many of these elements, but adding a brisk walk or other cardio activities may be necessary to meet your goals.

4. Eat a balanced Mediterranean diet

A Mediterranean diet rich in whole grains (e.g., oats, brown rice, quinoa), lean proteins (e.g., chicken, yogurt), healthy fats (e.g., oily fish), and antioxidant-rich fruits and vegetables (e.g., berries, leafy greens) supports brain health. Maintaining stable blood sugar levels through regular, nutritious meals can help reduce cognitive sluggishness.

5. Address other health related problems

Changes in hormones during perimenopause and menopause can lead to a range of other health related problems, including depression and anxiety which can affect cognition. Seeking support early for these conditions can help protect your overall health and create a smoother transition through menopause. For some women, hormonal therapy may help address these issues by stabilising estrogen and progesterone levels. While the research on the direct effects of hormonal therapy on cognition is mixed, its ability to improve sleep and reduce hot flushes can indirectly enhance cognitive function (4).

6. Use cognitive and organisational strategies

Tools like digital calendars, to-do lists, and reminders can significantly reduce mental load, making it easier to manage your daily tasks. These external aids act as helpful "extensions" of your memory, freeing up mental space for other priorities. In addition to organisational tools, engaging in cognitively stimulating activities is crucial for keeping your brain active and resilient. Activities like solving puzzles, learning a new skill or language, playing musical instruments, or even engaging in meaningful conversations and social activities can help strengthen cognitive pathways and enhance mental flexibility.

Another effective approach is breaking larger tasks into smaller, manageable steps and setting realistic goals for yourself. This not only keeps your cognitive load manageable but also provides a sense of accomplishment as you tick off tasks. Finding opportunities to challenge your brain while still allowing room for rest and recovery is key to maintaining balance.

Incorporating these strategies into your daily routine can help you to support your brain health and reduce the impact of brain fog. Remember, there’s no one-size-fits-all solution, so prioritise the ones that are relevant to you. While perimenopause brings its challenges, it also offers an opportunity to prioritise self-care and make changes that support your well-being for years to come.

References
1) Brunet, H. E., Caldwell, J. Z. K., Brandt, J., & Miller, J. B. (2019). Influence of sex differences in interpreting learning and memory within a clinical sample of older adults. Aging, Neuropsychology, and Cognition, 27(1), 18–39. https://doi.org/10.1080/13825585.2019.1566433

2) McCarrey AC, An Y, Kitner-Triolo MH, Ferrucci L, Resnick SM. (2016) Sex differences in cognitive trajectories in clinically normal older adults. Psychol Aging.Mar;31(2):166-75. doi: 10.1037/pag0000070. Epub 2016 Jan 21. PMID: 26796792; PMCID: PMC4783196.

3) McDougall GJ, Pituch KA, Stanton MP, & Chang W (2014). Memory Performance and Affect: Are there Gender Differences in Community-Residing Older Adults? Issues in Mental Health Nursing, 35(8), 620–627. 10.3109/01612840.2014.895071 [PubMed: 25072215]

4) Metcalf, C, Duffy, K, Page, C & Novick, A. (2023) Cognitive Problems in Perimenopause: A Review of Recent Evidence. Curr Psychiatry Rep. October ; 25(10): 501–511. doi:10.1007/s11920-023-01447-3.

5) Heinzser, R. Marti-Soler, H., Marques-Vidal, P., Tobback, N., Andries, D., Waeber,G., Preisig,M., Vollenweider, P., & Haba-Rubio, J. (2018) Impact of sex and menopausal status on the prevalence, clinical presentation, and comorbidities of sleep-disordered breathing. Sleep Medicine, Volume 51. Pages 29-36,ISSN 1389-9457,https://doi.org/10.1016/j.sleep.2018.04.016

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