Brain Changes During Perimenopause - and What to Do About It
Brain fog, memory lapses, sleep disturbances, and hot flushes are neurological symptoms of the midlife transition - a time when the brain undergoes real, measurable changes. Just like during other transformative life stages - childhood, puberty, pregnancy, and postpartum - the brain recalibrates itself during perimenopause, the years leading to your final period. Understanding these changes is key to protecting long-term cognitive health.
What Happens to the Brain During Perimenopause?
Perimenopause usually begins in a woman’s 40s but can start earlier. It’s marked by hormonal fluctuations - primarily in oestrogen and progesterone - that directly affect brain function.
The Role of Oestrogen
Oestrogen supports:
Neuroplasticity (how the brain adapts and learns)
Mitochondrial function (how your brain cells produce energy)
Neurotransmitters such as serotonin, dopamine, and acetylcholine (which affect mood, memory, and concentration)
Circadian rhythm (your sleep-wake cycle)
When oestrogen levels swing, women often experience:
Brain fog
Memory lapses
Difficulty focusing
Sleep disruption
Low mood or anxiety
The Role of Progesterone
While oestrogen tends to fluctuate, progesterone usually declines more steadily. It plays a quieter but equally important role in the brain:
Acts on GABA receptors, promoting calm and emotional regulation
Supports deep, restorative sleep
Promotes healthy neurogenesis (growth and development of new nerve cells)
Helps balance oestrogen's stimulating effects on the brain
Falling progesterone levels can lead to:
Heightened anxiety or irritability
Sleep issues, especially trouble falling or staying asleep
Migraines
Feeling emotionally overwhelmed or overstimulated
Together, these hormonal shifts can create a perfect storm of cognitive symptoms. But this isn’t permanent decline - it’s a transition. Once hormone levels stabilise post-menopause, many women regain mental clarity and emotional steadiness. The goal is to support your brain during this in-between phase and prevent issues in later life.
How to Support Brain Health During Midlife
Here are some practical ways to keep your brain sharp and resilient during the hormonal upheaval of perimenopause.
1. Sleep
Both progesterone and oestrogen help regulate sleep. When they drop, sleep quality often crashes — and that affects memory, mood, and thinking speed.
Tips:
Stick to a consistent bedtime and wake-up time
Consider supplements like magnesium glycinate, l-theanine, taurine, and/or personalised herbal remedy
Practice Yoga Nidra
Reduce or quit alcohol
Avoid low-carb diets
2. Exercise
Physical activity boosts brain-derived neurotrophic factor (BDNF), a protein that helps with learning, memory, and neuron repair. Moving your body and building muscle helps reverse insulin resistence and improve brain energy.
Consider:
Regular moderate exercise, e.g. brisk walking, cycling, but also household work or gardening
Resistance training e.g. weights lifting, body-weight exercises, reformer pilates
Body-mind exercise, like yoga or qi gong
3. Eat to Support Brain Function
A Mediterranean-style diet, rich in healthy fats, vegetables, and whole foods, supports cognitive function and reduces inflammation.
Focus on:
Oily fish, flaxseed, walnuts (for omega-3s)
Leafy greens, berries, extra virgin olive oil
Limiting ultra-processed foods and refined sugar
4. Consider Menopause Hormone Therapy (MHT), a.k.a HRT
For some women, MHT can help stabilise symptoms and protect brain health, especially if started early in the transition. While oestrogen gets most of the attention, progesterone (especially micronised progesterone) can significantly improve sleep and reduce anxiety.
Speak with a healthcare professional who understands the nuances of midlife hormone changes. Personal risk factors and timing matter.
5. Manage Stress Proactively
Without progesterone’s calming influence, stress can feel more intense. Chronic stress increases cortisol, which can shrink key brain areas like the hippocampus (involved in memory).
Strategies:
Daily mindfulness or meditation, even 5 minutes
Breathing exercises, yoga, or gentle movement
Spending time outdoors
Setting boundaries and saying no when needed
6. Seek Holistic Support
Midlife is a critical window of opportunity when proper care can dramatically improve your quality of life now and result in better health in later years. I therefore strongly recommend to work with an integrative women’s health specialist who can help optimise your nutrition, lifestyle, and emotional wellbeing, while offering support through minimally invasive therapies.
Consider:
Submitting the New Patient Form to get help at my clinic, or
Working with another qualified holistic medicine practitioner who specialises in women’s health
Conclusion
Perimenopause is a neurological as well as a hormonal transition. Both oestrogen and progesterone affect how your brain changes. The forgetfulness, brain fog, mood swings, migraines and hot flashes are common signs of these neurological change.
With the right support, you can navigate this phase with fewer symptoms and build a strong foundation for long-term brain health. Midlife isn’t cognitive decline - it’s a neurological reset. Take charge, and work with an integrative specialist who understands women’s health. You can emerge from this transition with a renewed, resilient brain - ready to serve your purpose in the next chapter of life.
