8 Ways to Beat Menopausal Brain Fog

“This is something that makes caring for perimenopausal women much trickier,” she says. “Not only do hormones go down in perimenopause, but occasionally they go up. It is that instability that is really distressing for a lot of people, and their bodies have trouble handling it. Sometimes their bodies aren’t making any estrogen, and sometimes [they’re making] twice as much as normal.”

Menopause-related brain changes go beyond feeling foggy. Research suggests the brain undergoes distinct structural changes during this time. Multiple studies have documented reductions in gray matter volume in areas critical for memory and executive function. Scientists have also found increased white matter hyperintensities in women’s brains, which, according to the Menopause Society, often indicates damaged tissue, typically because of reduced blood flow.

The good news: Studies have shown that in most brain regions, changes stabilize or rebound in postmenopause.

Lisa Mosconi, director of the Weill Cornell Women’s Brain Initiative in New York City, says that people often think of estrogen primarily as a reproductive hormone. “But it’s actually the ‘master regulator’ of the female brain,” she explains. “It literally pushes neurons to burn glucose to make energy.”

It’s also involved in growth, plasticity and immunity. As a result, it keeps your brain younger and healthier, she says

As estrogen declines with age, Mosconi notes, “your neurons start slowing down and age faster.” This causes not only cognitive changes such as depression, anxiety and trouble concentrating but also other menopause-related symptoms.

“When estrogen doesn’t activate the hypothalamus in the brain, it can’t regulate body temperature, which leads to hot flashes,” Mosconi says. “When it doesn’t activate the part of the brain stem in charge of sleep and wake, we develop insomnia. And when it can’t activate the amygdala, the memory center of the brain, we get depressed, anxious, even forgetful.”

Reducing brain fog

Here are some things women’s health experts say you can do to reduce menopausal brain fog:

1. Prioritize good nutrition

The MIND diet — with its emphasis on whole grains, leafy greens, nuts, beans, berries and fatty fish — has been linked to a reduced risk of cognitive decline in women, according to a 2024 study published in the journal Neurology.

2. Exercise

Multiple studies have found that regular exercise can boost memory and brain function.

“You don’t have to run a marathon — just aim for moderately intensive exercise most days of the week,” Mosconi said. Plus, exercise has also been shown to be protective against menopausal symptoms such as hot flashes, she notes.

“If you can get in good aerobic exercise three to four times a week, that’s terrific. Strength training is also crucial,” Minkin adds.

3. Consider menopausal hormone therapy (HT)

“Estrogen can be very helpful for sleep,” Minkin says. And the delivery methods have improved. For example, there are transdermal estrogen patches for women who are not good candidates for oral estrogen therapy. (See: What You Need to Know About Hormone Therapy.)

4. Birth control pills

“They can be fabulous during perimenopause,” Minkin says. “Your ovaries are making basically no estrogen when you are on a birth control pill, so you see a very constant level from just the pill. So we shut down the craziness in the ovaries, and we get a nice fixed level of estrogen every day. Some people benefit from that very well by sleeping better.”

5. Get a grip on stress

As Mosconi explains, studies show that chronic stress, especially when accompanied by high cortisol levels, accelerates brain shrinkage in midlife and correlates with poor memory. And this is the case for women more than men. Mindfulness techniques such as meditation or yoga may help.

A study published in the Journal of Alzheimer’s Disease found that people ages 55 and older who enrolled in a 12-week program consisting of an hour of a type of meditative yoga once a week, as well as 12 minutes of at-home meditation, had significant improvements in both verbal memory (the ability to remember word lists) and visual-spatial memory (the ability to find and remember locations).

6. Limit alcohol

“Many women say, ‘I can’t sleep so I’m going to have a glass of wine. That will help me.’ But it makes sleep worse, not better,” Minkin says. “The other thing is that red wine makes hot flashes worse.”

7. Exercise your brain

Try word or number puzzles, such as crosswords or sudoku, and games like chess or bridge. Or perform mental math rather than using a calculator. Even memorizing your grocery list can help your brain, according to the National Council on Aging.

8. Get other health conditions under control

If you have high blood pressure or cholesterol, midlife is the time to do something about it, Mosconi says. Women with high blood pressure in their 40s, for example, have an almost 70 percent higher risk for dementia in later years than women with normal blood pressure, according to a 2017 study published in Neurology.

Ultimately, it comes down to taking the time to nurture yourself, Mosconi says. “Midlife is such a big turning point in a woman’s life, especially as they go through menopause. It’s a time when we should be taking extra care of ourselves, rather than less. Our brain health really depends on it.”

Editor’s note: An earlier version of this article was published on AARP.org on Nov. 19, 2021. Hallie Levine contributed to the reporting.