104. Menopausal Brain Fog

Are you constantly walking into a room only to forget why you're there? Or maybe you’re mid-sentence and suddenly lose your train of thought? If this sounds familiar, you’re not alone—and you’re definitely not losing your mind. In today’s solo episode, I’m diving into a topic that so many of my patients bring up: brain fog during perimenopause and menopause. We’ll explore what’s really behind this frustrating symptom and, most importantly, what you can do to start feeling clearer, calmer, and more capable again.

If you’ve been wondering why your focus feels off or your memory isn’t what it used to be, this episode will help you connect the dots—and find real solutions.

In this episode:

• What brain fog really is (and why it’s not “just in your head”)
• The powerful role estrogen and progesterone play in memory and clarity
• How stress and high cortisol levels make brain fog worse
• Why your sleep quality is directly tied to your cognitive health
• Practical lifestyle changes to support a clearer, sharper mind
• The impact of exercise, healthy fats, and herbal adaptogens like Ashwagandha
• When to consider bioidentical hormone therapy—and why it’s not always the first step

Resources Mentioned:

 🌿 FREE RESOURCE: Download your guide to thriving in midlife: https://risingwomanproject.com

Connect with me, Dr. Sara Poldmae:

Website: https://risingwomanproject.com

Instagram:  https://www.instagram.com/drsarapoldmae

Transcript

Sara Poldmae: 0:01

Sarah, welcome to menopause. Rise and thrive. I am Dr Sarah pulled May, and this podcast is your go to guide for navigating perimenopause and menopause. If you are feeling a little overwhelmed, trust me, you are in great company each week, I'll bring you expert advice, raw, honest conversations and simple tips to help you stay grounded and maybe even find some humor in the process. Let's rise thrive and tackle this wild ride together. Hi there, ladies. Welcome back to menopause. Rise and thrive, where we explore the wisdom, the challenges, the transformation, and basically, like all things midlife, if you're going through perimenopause or menopause, you are in the right place I am. Dr Sarah pulled May, and today is a solo episode, and I wanted to jump on and talk to you about an an issue that so many of my patients bring up in clinic, and that is brain fog during this time of life. You are not imagining it, and know you are not losing your mind. I want to talk about what's really happening, why stress may make it worse, and how your hormones are working behind the scenes, again, to contribute to brain fog. So what is brain fog really? You know, my patients describe the feeling of walking into a room and forgetting why they are there, or losing their train of thought mid sentence. And I wish I could say that I had no idea what my patients are talking about, but I definitely feel this, and I feel it in a really strong way. I have actually suffered from ADHD for most of my life. I am now finally coming into my own with this battle with ADHD, because I feel like I'm finally starting to acknowledge the gifts that that has brought me. But a struggle is real, and so we actually see a lot of women, myself included, where ADHD gets worse during this time of our lives, and unfortunately, brain fog can come along with that. Brain fog can be coexisting with ADHD or can be its own thing. So you don't have to have ADHD to experience brain brain fog. But side note, your brain fog could be even more debilitating if you do have ADHD. So again, what this looks like is we can be struggling to find the right words. We can forget what we were talking about, lose our train of thought. We can forget why we're in a room. Or we can just simply not be able to concentrate on tasks that are in front of us and that can cause real issues, both in family life, personal life, being able to enjoy ourselves and it can also obviously cause problems in our professional lives. So that's what we call brain fog. And brain fog is not a medical diagnosis. It's it's a symptom, just like their cluster of lots of different symptoms in menopause, perimenopause cognitive changes are incredibly common during this time during perimenopause and menopause. So what is behind it? One of the major players in perimenopausal or menopausal brain fog is, of course, your hormones, estrogen in particular, estrogen isn't just a reproductive hormone, it is a reproductive hormone, but it's actually a neuro protective hormone, which means that it plays a critical role in brain function. Estrogen helps to regulate neurotransmitters like serotonin, dopamine, acetylcholine, these chemicals are involved in mood. They are involved in memory, and they are involved in focus. So if estrogen levels, when estrogen levels start to fluctuate and eventually drop, your brain is going to feel it. This may be barely noticeable, but for some women, it is one of the major disrupting symptoms that you can have during this time of life, and that's why, why you may feel foggy, forgetful, or just mentally not as sharp as you used to be. And again, this can be a minor disruption, but oftentimes it can be really scary. So it can be scary when you start to walk into rooms and forget what you came into the room for, especially if it's if it's happening more frequently or really frequently, and you haven't had this particular. Done before, so it can seem super sudden, it can seem super problematic. And then when we think about dementia and Alzheimer's, we can really start to get into our head. And we definitely don't want to discount these things, if it is a radical shift in the way that your brain works. But oftentimes this can just definitely be part of midlife. Unfortunately, progesterone also plays a role. Progesterone is a calming hormone, so when it drops, many women experience more anxiety or difficulty sleeping, both of which can affect your ability to think clearly. So if you aren't sleeping, if you aren't sleeping well, or if you're anxious all the time, you're not going to be of clear mind. You're not going to be able to stay task focused. There's so many reasons why you know these hormone fluctuations really can, can play with your mind. So I'd like to say it's certainly not in your head. Well, it actually is, but it's not your imagination. It is in your head. It's your brain, right? But we really want to pay close attention, and perhaps, if this is becoming a major issue in your life, because we can't maybe rely on our memory all the time at this time of life, it might be a great idea to start that journal and add in. You know, did you feel brain fog today? What are some examples of the brain fog that you felt? How often are you walking into a room and feeling like you can't remember why you're there. Starting to track things is always a good idea when these symptoms start to get scary. So let's, let's add another layer. It's not just hormones, it's stress, right? So clearly, this time of our lives can be stressful. Maybe you're caring for aging parents. Maybe you're raising teens, dealing with your husband or marital issues, managing a career, just in general, rethinking life. Your body is changing, and that can feel overwhelming. When we're under chronic stress, we produce more cortisol, that's your body's main stress hormone, and when cortisol stays high, when we keep pumping it out for longer and longer periods, it disrupts the region of your brain known as the hippocampus, and this part of your brain is responsible for memory. So now in the Imagine that your brain is trying to function with less estrogen or fluctuating levels of estrogen. And I challenge this, this concept that we think of menopause as less estrogen, because there's a great period of time during perimenopause where it's actually fluctuating levels of estrogen. And that can be really, really confusing, because some days you may feel perfectly sharp and mentally focused, and then some days you're like, who am I? Why can't I think that can be the fluctuating levels of estrogen, not just the lack of estrogen. So imagine your brain trying to function with less estrogen, and you're also pumping out a ton of cortisol, but no wonder you feel foggy. So this isn't just about like inconvenience. This is about the fact that all systems, all of our systems, our stress hormones, our reproductive hormones, our blood sugar levels, our insulin, which is a blood sugar hormone, all of these systems are interconnected, and hormonal shifts can make you more sensitive to stress, and stress can make hormonal imbalances worse. And it's just this loop. It's the cycle that you you know, it's a hamster wheel, and it can feel really relentless. So what can we do? What? What can we do to combat brain fog? Well, there's a ton of solutions. And, you know, as a clinician, when I sit down with patients in clinic, there's, you know, I I tell my patients, and I'm going to tell you now that there's good news, brain fog is not permanent, and there are a lot of things that you can do to support your brain during this time, and maybe I'll go off on a tangent here for a second. But even if you aren't having brain fog, there are a lot of things that you you can and should do during this time to support brain health, because brain fog is not super concerning. It's just annoying, but at some point, you know, we could be looking at Alzheimer's or dementia. So we should be, you know, preparing ourselves and making sure that we're protecting our brain in any way, shape or form that we can so but to combat brain fog and to combat many, many different. Um, long term health concerns, sleep is your superpower, protecting your sleep. Protecting your sleep equals protecting your brain. So trying to get seven to nine hours of restful sleep each night is certainly easier said than done, but it's important, and there's actually research coming out that it's not the the amount or total hours of sleep that you get, but the consistency of your going to bed and waking times. So maybe focusing more on the consistency of your bedtime and your waking time and really working on your circadian rhythm. So easier said than done, but considering you know, wind down routines, any herbal support, and working with a practitioner for supporting your sleep could be a value or is of value regardless of whether you have sleep issues, regardless of whether you have brain fog. Sleep is your superpower and support your body in so many different ways. Another thing that you can do for brain fog is to move your body so exercise, especially getting your heart rate up, can really help to improve memory and focus. And exercise can help with brain fog from the angle of stress management. So obviously, exercise helps with managing stress levels. And just, you know, moving your body every day can be a great way to support not only your brain, but also your stress levels. Eating to support your brain. There are so many good brain healthy foods, but healthy fats are one of the big ones. Your brain is actually the brains. Your brain cells are coated with like a healthy lipid layer, right a fat layer. So by eating really healthy fats, you can nourish your brain. Leafy greens, foods rich in omega three fatty acids, can help fuel your brain. Obviously, reducing sugar and processed foods, which can spike inflammation, will help to combat brain fog. Considering herbal or hormonal support, you know, I can throw out adaptogens like Ashwagandha or Rhodiola to help with stress response. But in the ideal world, you could work with a practitioner that can help you to pick out a supplementation that that would be most appropriate for you, not only to address your brain fog, but you as a whole person, bio identical hormone therapy can make a huge difference for brain fog, and I find that women often come in seeking bio identical hormone replacement therapy, and that could be the way to go, but it may not be the first step. We want to make sure that you're supporting your system in a holistic way and not just jumping towards hormones as the first thing. That might be the best thing, but it could be in conjunction with and often in our clinic, it's almost always in conjunction with lifestyle and supplementation and moving your body and getting enough sleep, because we want to look at you holistically, not just put patches on problems, mindfulness, breath work, meditation. They don't just sound good, they are actually great at proving to reduce cortisol spikes and improve cognitive clarity. So just a few things that you can do acupuncture again, can influence stress hormones. So I would take a look at that. If you're not under the care of an acupuncturist, find one such a valuable medicine my first love in the medical world. But, you know, moving on, I really want to just, you know, take a moment to share that you're not alone. This is such a common concern, it is a documented symptom of perimenopause and menopause, and I want you to hear this loud and clear. You are not broken. This is not permanent. You are transitioning, and your brain is literally rewiring itself, and with the right support, you can feel clear, you can feel feel calm, you can feel focused, and you can be capable again. So just be gentle with yourself. You are doing an amazing job in this physically and emotionally demanding phase of your life, and I want to thank you for joining me on my podcast. It's if this episode resonated with you, share it with a friend. I could use the support in growing this podcast. So I thank you for any shares. You know, if your friends are thinking, why can't I. Think straight anymore, or I forget things all the time. Please share this episode with them. I think that they would really appreciate it, and don't forget that I do have a resource on my website, rising woman project.com there is a free resource out there for you, if you are looking for ways to get started in managing this journey through midlife and thank you, thank you. Thank you. Thank you for being here. Thank you for sharing and for taking time for yourself. Stay kind to yourself during this time, give yourself praise. And I look forward to having you tune in next week. You.