Brain Fog in Your 40s? Perimenopause Headaches 101

There are a lot of really cool things about hitting your 40s. Almost overnight, it’s like you’ve finally mellowed out over all the (unimportant) things that monopolized your brain throughout your 20s and 30s. In essence, you’ve stopped sweating the small stuff, and it feels amazing.

That is, until you suddenly can’t remember why you opened the refrigerator door. Or why you’ve gained weight despite eating healthy and exercising regularly. Or why you can’t sleep. Or why one day you’re raging at the world and the next, you’re a sobbing mess.

In other words, welcome to perimenopause.

This transitional period leading up to menopause — which is when you permanently stop having a menstrual cycle — can last, on average, 8 to 10 years. During this time, you may experience a wide range of symptoms, including brain fog (e.g., forgetting why you entered a room or losing your train of thought).

According to a recent survey conducted by Alloy Health, the top three symptoms affecting people in perimenopause are weight gain, sleep disturbances, and anxiety/mood swings. So we at Rescripted are here to help you understand why these particularly annoying perimenopause symptoms occur, and what treatment options are available.

Read on for our expert insights, as well as how Alloy Health can provide the support system you need to navigate everything from brain fog to sleep problems.

What’s up with the brain fog? I’m only in my 40s!

No, you’re not suddenly developing dementia because you forgot where you put your car keys. But what is happening is that your estrogen levels are starting to fluctuate — and these changes can affect your memory. “During perimenopause and menopause, the reduction and variability in estrogen levels can lead to changes in memory, attention, and executive function. In real life, these things are often described as ‘brain fog,’” explains board-certified OB-GYN Caledonia Buckheit, M.D.

You may be more prone to forgetting basic things because, continues Dr. Buckheit, “estrogen is particularly active in the brain.” As it turns out, this hormone “plays a role in synaptic plasticity, neurotransmitter synthesis, cerebral blood flow, and energy metabolism.”

So when estrogen levels drop, you might notice your memory is less sharp than it once was, or that you’re having trouble concentrating. While brain fog is usually temporary, it’s important to see your healthcare provider if you feel it’s affecting your day-to-day life.

Weight gain, sleep deprivation, and anxiety/mood swings… Why am I such a hot mess?

In addition to brain fog, Dr. Buckheit confirms that sleep disturbances and mood changes like depression and anxiety “are all well-documented symptoms associated with perimenopause and menopause.”

• Sleep disturbances: While hot flashes and night sweats are often the cause of perimenopausal and menopausal sleep issues, this isn’t always the case. You can still experience changes in sleep patterns in perimenopause, even if you aren’t overheating at night.
• Anxiety/mood swings: It’s not all in your head: about four in 10 women experience symptoms similar to premenstrual syndrome (PMS) during perimenopause. This includes irritability and low energy. Some experience feelings of anxiety during perimenopause, too, where you’re constantly in a state of worry, and may feel muscle tension, sweating, or nausea. Depression is also common during perimenopause: you may want to cry more than usual, or you may be experiencing feelings of hopelessness or worthlessness.
• Weight gain: Staying at your usual weight becomes more challenging as you age, so it’s common for people to experience weight gain during perimenopause. This can continue at about the rate of 1.5 pounds each year throughout your 50s. While hormone changes are one of the reasons behind perimenopausal weight gain, straight-up aging is also a factor. It becomes easier to put on weight as you get older because muscle mass typically goes down with age, while fat increases due to your body’s slowed metabolism. For these reasons, it’s a good idea to adopt a healthy diet and an exercise routine.

Most perimenopause symptoms are more irritating and uncomfortable than cause for concern. However, warns Dr. Buckheit, “abnormal bleeding should not be ignored.” While she acknowledges that “menstrual cycle changes may be simply due to perimenopause,” don’t automatically assume this to be the case. ”Endometrial cancer is common and increases in prevalence with age. The most common presenting symptom of endometrial pre-cancer or cancer is irregular or heavy menstrual bleeding.”

Hormone therapy as a treatment option

Since hormone levels are the root cause of many perimenopause symptoms, Menopausal Hormone Therapy (MHT) “can be very helpful in the perimenopause years,” says Dr. Buckheit. “Adding back estrogen and progesterone, in whatever form this is done (such as low-dose hormonal birth control or estrogen replenishment), can create a steady state for these hormones that would otherwise be on a rollercoaster.”

Dr. Buckheit highlights the “variable, and ultimately declining levels, of estrogen and progesterone” as the cause of “many of the mood and cognitive issues during perimenopause” (e.g., mood swings, brain fog, etc.). Therefore, it’s worth discussing options with your healthcare provider, as “hormone therapy creates a steady state of estrogen/progesterone [that] can often improve or resolve symptoms.”

If you have additional questions and are considering a personalized, perimenopause treatment plan, Alloy Health can help. Alloy has several different types of Menopausal Hormone Therapy (MHT), considered to be the most effective at managing perimenopausal symptoms. These systemic hormonal treatments include estradiol pills, estradiol patches, estradiol sprays, estradiol gels, progesterone, low-dose birth control pills, and estradiol vaginal cream. Alloy offers non-hormonal options as well.

With Alloy, you also have the option of talking to a board-certified, menopause-expert physician who can help you determine which type of treatment is right for your symptoms.

All your perimenopause questions answered. Consult an expert physician at MyAlloy.com with code RESCRIPTED20.

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Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist dedicated to reporting on women's health, parenting, mental health, TV, and pop culture. Her work has appeared in HuffPost, Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. Subscribe to her Substack, the Critical Communicator, and follow her on Instagram, BlueSky, or Threads.