Understanding “Peri-Brain” and What You Can Do About It

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Perimenopause, the transition period leading up to menopause, is known for a variety of physical symptoms, like hot flashes and irregular periods. However, many women also experience a lesser-known aspect of this hormonal shift: cognitive effects that are often referred to as “peri-brain.” This term encompasses brain fog, memory problems, problems with concentration and decision-making, and other cognitive symptoms that can significantly affect your daily life. Understanding these symptoms, their causes, and potential management strategies is crucial for women navigating this challenging phase.

Peri-brain is a colloquial term used to describe a range of cognitive difficulties experienced by women during perimenopause. Studies show that up to one-half of all women in perimenopause experience symptoms of peri-brain. Here are some of the most common symptoms of peri-brain.

Brain fog

One of the most common manifestations of peri-brain is a feeling of mental cloudiness and lack of clarity, known as brain fog. Women may struggle to concentrate or pay attention, forget words mid-sentence, or experience difficulty recalling information they typically remember easily. Mental fatigue and sleepiness are also common. 

Brain fog can also manifest as a general sense of being mentally “sluggish.”

Memory problems

Short-term memory issues are common, including losing train of thought while reading or conversing,  misplacing your keys, or forgetting names or words, appointments, and even why you entered a room.

The brain fog and memory lapses can be frustrating and even alarming, leading some women to fear the onset of more serious cognitive impairments such as Alzheimer’s or dementia.

Difficulty with multitasking

Executive function tasks that once seemed effortless, like planning, problem-solving, and managing multiple responsibilities at once, can start to feel overwhelming.

Slower cognitive processing

Tasks that require quick thinking or problem-solving may take longer and feel more difficult.

Other symptoms

Other symptoms common to peri-brain include: 

• Mood changes like anxiety and depression
• Lack of motivation
• Lack of confidence
• Feeling frazzled

Peri-brain can severely impact daily functioning, confidence, relationships, and work performance for many women.

An important note: While some degree of brain fog is common during perimenopause, severe or sudden cognitive changes warrant medical attention, as they could indicate an underlying condition.

The primary cause of peri-brain is believed to be the hormonal fluctuations that occur during perimenopause. Estrogen, a hormone that fluctuates – and usually drops -- significantly during this time, plays a vital role in cognitive function.

As estrogen levels decline during perimenopause, research shows that the brain’s ability to process information and form new memories can be compromised. This hormonal shift can also impact attention, concentration, and decision-making abilities, contributing to the cognitive difficulties experienced by many women.

Specifically, estrogen influences:

• Neurotransmitter regulation: Estrogen helps regulate the production and activity of neurotransmitters like serotonin and dopamine, which are crucial for mood and cognition.
• Neuroprotection: Estrogen has neuroprotective properties, shielding the brain from inflammation and oxidative stress.
• Synaptic plasticity: Estrogen is involved in forming and maintaining synapses, the connections between neurons that facilitate learning and memory.

Peri-brain is a common experience during perimenopause, but the severity and specific cognitive challenges can vary from one woman to another. Factors such as genetics, lifestyle, and overall health can influence an individual’s susceptibility to cognitive changes during this transition.

Specifically, women with a history of depression, anxiety, or other mental health conditions may be more vulnerable to cognitive difficulties during perimenopause. Additionally, factors like stress, sleep disturbances, and other medical conditions and hormonal imbalances – including hypothyroidism – can worsen peri-brain.

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In addition to hormonal changes, other factors that are common during perimenopause can exacerbate the cognitive symptoms of peri-bran.

Stress

The perimenopausal transition often coincides with other midlife stressors, such as career pressures, aging parents, and children leaving home. Chronic stress can impair cognitive function by increasing levels of cortisol, a stress hormone that, in high amounts, can damage the hippocampus—the brain region essential for memory and learning.

Sleep

Many women experience sleep problems during perimenopause, including insomnia and night sweats. Poor sleep quality can severely impact cognitive function, leading to increased forgetfulness, difficulty concentrating, and slower mental processing.

The Study of Women’s Health Across the Nation (SWAN) followed a diverse group of women over several years to track their health during the menopausal transition. SWAN found that women in perimenopause reported more cognitive complaints and performed worse on tests of verbal memory and processing speed compared to women before perimenopause.

Another recent study examined the effects of hormonal changes on brain function. Researchers found that declines in estrogen were associated with altered functions in brain regions related to cognitive function and working memory.

Perimenopause is also a time when women are more likely to be diagnosed with hypothyroidism, an underactive thyroid. Hypothyroid patients often experience brain fog symptoms like fatigue, forgetfulness, and cognitive issues, which are associated with fluctuations in thyroid hormone levels.

Both perimenopause and hypothyroidism independently affect areas of the brain involved in memory and cognitive function via different hormonal mechanisms. However, their combined impact can worsen brain fog symptoms for women dealing with both hypothyroidism and the hormonal shifts of perimenopause. Managing both conditions is essential for reducing brain fog severity.

However, it’s easy to overlook symptoms of hypothyroidism during perimenopause because there’s significant overlap. This is why women need to advocate for themselves with their healthcare providers and be aware of the signs and symptoms of both perimenopause and hypothyroidism during this time of life when both are more common.

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While peri-brain can be challenging, some strategies can help manage and mitigate its impact.

Get tested and treated for underlying hypothyroidism

Identifying and treating underlying hypothyroidism is crucial to resolving peri-brain. Hypothyroidism, a condition characterized by low thyroid hormone levels, can significantly contribute to cognitive symptoms like brain fog, fatigue, and difficulty concentrating. These symptoms often overlap with those experienced during perimenopause, making it essential to identify and optimally treat any thyroid imbalances.

Eat a healthy diet

A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support overall brain health. Omega-3 fatty acids, found in fish and flaxseeds, are particularly beneficial for cognitive function. It may also be helpful to moderate caffeine intake.

Get regular, moderate exercise

Physical activity increases blood flow to the brain and stimulates the release of growth factors that promote neural health.

Manage stress

Techniques such as mindfulness meditation, yoga, and deep-breathing exercises can help reduce stress and its negative impact on cognition.

Cognitive training

Engaging in activities that challenge the brain, such as puzzles, reading, and learning new skills, can help maintain cognitive function. Online brain training programs and apps can also provide structured cognitive exercises.

Build a “brain budget”

Budgeting cognitive resources like the ability to focus, make decisions, and use willpower throughout the day can be helpful. This is known as creating a “brain budget.” By planning challenging mental tasks and spacing them throughout the day, you can avoid overtaxing your cognitive capacities. Reserve peak mental energy for the most demanding activities and schedule more manageable tasks during lower energy periods. A brain budget also involves incorporating breaks for mental recovery, such as going for a walk or doing a mindless activity. This approach can help increase productivity, reduce burnout, and improve decision-making during perimenopause.

Medical treatment

For some women, hormone replacement therapy (HRT) can help alleviate cognitive symptoms that are triggered by hormonal symptoms such as hot flashes and sleep disruptions. However, the evidence on the cognitive benefits of HRT during perimenopause is conflicting, and current guidelines do not support its use specifically for cognitive concerns.

In addition, HRT is not suitable for everyone and carries potential risks, so it’s important to discuss this option with a healthcare provider.

Medications typically used for ADHD have shown promise in improving executive function in some women, and research is evaluating whether they can address aspects of peri-brain in perimenopausal women. Some women also have improvements in peri-brain symptoms while taking antidepressants or sleep medications.

In some cases, iron treatment for underlying anemia and corticosteroids or anti-inflammatory drugs for inflammation can help relieve conditions contributing to brain fog and cognitive symptoms.

Sleep hygiene

Aim for 7 to 9 hours of quality sleep per night. Improving sleep quality can have a significant positive impact on cognitive function. Tips for better sleep include maintaining a regular sleep schedule, creating a restful sleep environment, and avoiding caffeine and electronic devices before bedtime.

Social support

Maintaining strong social connections can provide emotional support and cognitive stimulation. Participating in group activities or joining support groups for women going through perimenopause can be particularly beneficial.

Peri-brain, encompassing brain fog, memory problems, and other cognitive symptoms, is a common and often frustrating aspect of perimenopause. These symptoms are primarily driven by hormonal changes, particularly the decline in estrogen, but are also influenced by stress, sleep disturbances, and thyroid function. Understanding the underlying causes and implementing strategies to manage these cognitive challenges can help you navigate perimenopause more effectively. With the proper support and interventions, it’s possible to maintain cognitive function and quality of life during perimenopause.

Paloma Health specializes in comprehensive care for hypothyroidism, perimenopause, and menopause. Paloma members have access to convenient home thyroid test kits and personalized treatment that may include thyroid hormone replacement therapy, HRT, dietary adjustments, lifestyle recommendations, and addressing other underlying conditions contributing to brain fog. Paloma’s team of board-certified physicians and experienced hormonal nutritionists and health coaches provide around-the-clock care, tailored guidance, and support to help manage hypothyroidism and perimenopause, and alleviate brain fog during the perimenopausal transition.