Perimenopause and Executive Function: Why Your Brain May Feel Different

One of the most common concerns I hear from women during perimenopause is, “I don’t feel as sharp as I used to.”

They describe walking into a room and forgetting why they went there. Losing their train of thought in meetings. Struggling to stay organized. Feeling mentally overwhelmed by tasks that once felt manageable.

Many people call this “brain fog,” but there’s another way to understand what’s happening.

Executive functioning refers to the brain skills that help us plan, focus, organize, make decisions, switch between tasks, and hold information in our minds while we use it. These skills rely heavily on the prefrontal cortex, an area of the brain that is influenced by estrogen.

A review published in Human Brain Mapping explains that fluctuations in estrogen during the menopause transition may affect the brain networks involved in executive functioning. The authors also highlight that estrogen does not work in isolation. Its effects interact with stress, neurotransmitters such as dopamine and serotonin, genetics, and individual life experiences, which helps explain why cognitive changes look different from one person to another.

This is an important reminder that cognitive changes during perimenopause are not a reflection of intelligence or capability. They are part of a complex biological transition that can be amplified by poor sleep, chronic stress, caregiving responsibilities, and the many demands that often peak during midlife.

While these changes can be frustrating, they are not a sign that you are “losing your mind.”

Supporting executive functioning often means supporting the whole person. Good sleep, stress management, regular physical activity, cognitive strategies, and, for some individuals, discussions with a healthcare provider about hormone therapy may all play a role. Therapy can also help by reducing cognitive overload, building practical coping skills, and creating space to navigate this life stage with greater self-compassion.

Read more here: https://onlinelibrary.wiley.com/doi/abs/10.1002/hbm.22218