Perimenopausal brain fog: A nutritionist’s guide to thinking clearly
Prevent brain fog with these tips from nutritionist Sally Duffin, author of Natural Nutrition for Perimenopause: What to eat to feel good and stay sane.
About three weeks ago, I was rolling through my work day, ticking off tasks, and thinking about lunch — when it hit me. I had completely missed a meeting. The meeting had been scheduled well in advance and was logged in my Outlook calendar and handwritten diary (I’m old-school!) but somehow, my perimenopausal brain had completely forgotten about it. Cue quick apologetic emails to colleagues.
Occasional forgetfulness is part of normal life, especially when that life is full and active. But during perimenopause, forgetfulness, poor concentration, and the dreaded brain fog ramp up a gear. One minute you're at the top of your game, juggling the demands of work, family, and social life, and the next it feels like your brain is made of wet cotton wool.
For many women, cognitive changes like brain fog and memory loss are some of the earliest signs of perimenopause. They creep in along with emotional changes like anxiety and mood swings, long before periods begin to stop. As a nutritionist, I've heard from women who fear they are losing their minds and are worried about early onset dementia, when in fact these shifts are all part of the menopausal transition.
What causes perimenopausal brain fog?
Neuroscientist Dr. Lisa Mosconi talks about how menopause begins in the brain. The brain and reproductive organs are in constant communication via the neuroendocrine system. There are estrogen and progesterone receptors throughout the brain, and once our regular hormone levels start to fluctuate during perimenopause, brain function is affected.
Progesterone is usually the first hormone to decline as we have fewer and fewer ovulatory menstrual cycles. Progesterone plays a key role in regulating mood and cognitive function, so as soon as levels drop, we can start to experience mood swings, brain fog, and poor memory. As perimenopause progresses, estrogen starts to decline as well, further impacting brain function.
Does stress worsen brain fog?
These symptoms can also be compounded by stress — and perimenopause is a pretty stressful time! Mental, physical, and emotional stress stimulates the release of cortisol and adrenaline, the two main stress hormones. In the short term, a little stress can increase alertness and sharpen the senses. But over time, chronic stress can impact concentration and memory and affect how the hippocampus works — the part of the brain responsible for short-term memory storage.
Learning ways to handle stress helps alleviate all perimenopausal symptoms, especially brain fog. Gentle exercise and mindful forms of movement like yoga and Tai Chi are fantastic for cognitive health. They enhance blood flow to the brain while downregulating stress hormones — a double win in the fight against brain fog.
Is menopausal memory loss permanent?
Estrogen provides antioxidant protection to brain cells and regulates brain cell energy production. When estrogen levels fall, brain energy declines too, and it takes time for our brains to adjust to this shifting landscape. The cells must switch to other, less efficient ways of producing energy, which can have a knock-on effect on how we feel.
The good news is that given time, our brains can adjust. Perimenopausal brain fog and forgetfulness are not necessarily permanent. Research shows that poor memory and concentration may be worse in the first year after menopause (the first year after your final period) and can improve from then on.
Can certain foods make brain fog worse?
Absolutely! Highly processed foods, refined sugars, and alcohol can worsen brain fog in several ways.
Highly processed foods negatively affect the balance and diversity of the gut microbiome — the billions of bacteria, yeasts, and fungi living in your digestive tract. The gut microbiome communicates with the brain, influencing cognitive function and mental well-being. When the microbiome is out of balance, it can produce harmful metabolites that affect brain function.
Alcohol detoxification in the liver uses up vitamins and minerals that are also needed for brain function. B-vitamins, magnesium, zinc, and vitamin C: these nutrients support brain cell communication and function, and when levels are depleted by alcohol consumption, memory and concentration suffer. Not to mention the all-too-familiar feeling of brain fog that comes with a hangover.
The brain requires plenty of healthy fats for cell-to-cell communication and memory storage, but junk foods are packed with trans fats and highly processed seed oils. These chemically altered fats promote an inflammatory response in the body and affect how brain cells work.
A diet high in sugary processed foods leads to blood sugar dysregulation and eventually, Type II diabetes. High-sugar foods break down quickly in the digestive system, flooding the bloodstream with sugar. Insulin is released to pack sugar away into cells and convert any leftover sugars to fat in the liver. Because insulin acts quickly, blood sugar levels drop triggering mood swings, brain fog, and cravings for more sugar. This “rollercoaster” effect can make menopausal memory problems and brain fog even worse.
What to eat to support mental clarity and concentration during perimenopause and menopause
Whether you’re vegetarian, vegan, flexitarian, or omnivore, there are nutrient-rich foods available to you that support memory and concentration during menopause. But before we dive into the foods themselves, let’s explore two foundational ideas that can make all the difference to your mental clarity.
Blood sugar balance
We’ve looked at the foods that cause blood sugar problems, so what should you eat to support blood sugar balance?
Firstly, look at the quality and portion size of your carbohydrates. We need carbohydrates for energy – especially brain energy. Glucose is the preferred form of fuel for brain cells. But these carbohydrates are best sourced from root vegetables and whole grains like brown rice, quinoa, buckwheat, and wholewheat. And we don't need to eat a lot of them. If roughly one-quarter of your meal plate is complex carbohydrates, that is a good general guide.
Alongside these complex carbohydrates, enjoy a portion of protein. Protein helps to slow down the release of sugars in the bloodstream, providing steadier energy levels for a longer amount of time. Meat, fish, eggs, beans, pulses, nuts, seeds, and dairy products are all sources of protein. This can make up another ¼ of the plate.
Adding a bit of healthy fat to your meal also slows down the sugar release. Drizzling olive, hemp, flax, or avocado oil over salads and cooked vegetables is a great way to enjoy some healthy oils.
Combining complex carbohydrates, protein, and fats in each meal gives a slower, steadier breakdown of sugars and avoids the ‘rollercoaster’ effect that comes from sugary, processed foods.
Eat 30 plant foods every week
Microbiome expert Dr. Tim Spector MD recommends we eat at least 30 different plant foods each week, to support the balance and diversity of our gut bugs. Menopause alters the gut microbiome and it’s particularly important to nourish the beneficial microbes by eating a wide range of different foods.
Plant foods include more than just vegetables. Nuts, seeds, herbs, spices, fruits, dried fruits, beans, lentils — these all count as plant foods, so it’s easier to hit that target of 30 than you might think!
Best foods for memory and concentration
Oily fish supply omega-3 fats that are essential for memory and cognitive function. Salmon, mackerel, anchovy, sardines, and trout are good sources of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), the two omega-3 fats used by the brain. Vegetarians and vegans can source ALA (alpha-linolenic acid), the ‘parent’ fatty acid that can be converted to EPA and DHA in the body, from cold-pressed oils like hemp, flax, pumpkin, and walnut.
Phytoestrogen foods like chickpeas, ground flaxseed, tofu, tempeh, miso, and red clover are rich in compounds that are structurally similar to human estrogen. Phytoestrogens (literally “plant estrogens”) have a modulating effect on our fluctuating hormones during perimenopause and can help support naturally lower levels of estrogen post-menopause. There is a surge of research into the benefits of phytoestrogens for menopausal symptoms, including their effects on cognitive function.
Dark-green leafy vegetables are rich in magnesium and folate, which are essential for brain cell communication and cognitive performance. Kale, arugula, watercress, broccoli, and cabbage are all excellent sources.
Eggs provide the proteins, minerals, and vitamins the body needs to make neurotransmitters – chemical messengers in the brain and central nervous system.
Olive oil is a mainstay of the Mediterranean diet. Rich in healthy monounsaturated fats and antioxidants, olive oil is one of the reasons why the Mediterranean diet is now widely recommended for brain health.
Avocadoes are another source of healthy monounsaturated fats, plus vitamin B6. Vitamin B6 is a key nutrient for energy, hormone balance, and brain health, and works alongside magnesium to produce neurotransmitters in the brain.
Brightly colored fruits and vegetables provide fiber and specialist plant compounds called phytonutrients or phytochemicals. These compounds help support the gut microbiome. The different colors in fruits and vegetables are produced by these phytonutrients, which is why nutritionists are forever encouraging people to 'eat a rainbow'! Eating all the colors of the rainbow means you get the benefits of a wide range of phytonutrients that have been shown to enhance brain function and memory.
Perimenopausal brain fog, memory loss, and concentration can be disturbing and upsetting but are not necessarily permanent symptoms. Given time, our brains can adjust to changing hormone levels. We can help support this process by swapping out refined sugary foods and making more positive food choices, and by giving ourselves time and space for daily relaxation and mindful movement.
Sally Duffin is a UK-based health writer, registered nutritionist/nutritional therapist, and author of Natural Nutrition for Perimenopause: What to Eat to Feel Good and Stay Sane. She has worked in the natural health industry for over 20 years as a nutrition practitioner, writer, and educator, and loves nothing more than empowering people to take charge of their own health. Outside of the nutrition world, Sally enjoys creative writing, making things, and buying more books than she has time to read.
Find her at www.nutritioninyork.co.uk and on Twitter and Instagram @nutritioninyork
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This is so helpful. Thank you!
Plant-based whole foods for the win! :-)