19: Is It Brain Fog or Is Your Brain Actually Upgrading? The Truth About Memory in Perimenopause

Hey, it’s Megan. Grab your coffee and let’s have a convo.

Part One: The Fear We Don’t Talk About

Our minds are so precious to many of us. The thought of losing it — or it not working the way it used to — brings a sense of dread, a fear that outpaces the fear of losing physical capabilities. Our mind is so intimately tied to the essence of who we are and how we experience the world. Unless you are a professional athlete, chances are your mind is a scarier thing to lose. But what if what feels like decline is actually something else entirely?

Part Two: When the Dots Don’t Get Connected

In early perimenopause it is often when I see this emerge — the changes in memory and focus, the ability to manage stress and streamline your thoughts. I had this happen with a client this week and it broke my heart. She literally thought she was getting dementia or having brain issues. She went to her GYN four times last year for extensive blood work and imaging, got a referral for an endocrinologist, a neurologist, and had advanced testing and imaging done by both. They all gave her a clean bill of health — but since her mom went through menopause at the “classic” point around 50, ruled it out as a possibility. She is 39.

She has very classic signs of low progesterone — heavy periods, longer cycles, poor sleep, cramps, anxiety, poor mood, brain fog, and what she describes as developing ADHD. The challenge is her GYN is looking for late-stage perimenopause symptoms, not early. So it’s wonderful that perimenopause was part of the discussion, but then dismissed because she is “too young” — and based on her labs and symptoms, not someone who should be prescribed estrogen yet. But as we have spoken about many times, progesterone is often the first domino to fall.

She’s our warm and cozy hormone — supporting sleep, helping you self-regulate, bringing down anxiety. She keeps your mood stable, opposes estrogen so you don’t have cramps and heavy bleeding. She is your luteal phase bestie, and if you don’t ovulate — which happens to all women at any age but more frequently during perimenopause — there is no egg released, which means it can’t turn into that beautiful corpus luteum producing all of that wonderful progesterone.

Progesterone is at the center of our Regulate pillar. When progesterone is strong, we don’t have to work as hard to self-regulate — she does that heavy lifting for us. But when she becomes unreliable, because of chronic stress or the beginning of perimenopause, the Regulate pillar becomes a much bigger part of the conversation.

To confirm what I was seeing with this client, we could check a progesterone level at ovulation plus seven days to see if she was releasing an egg — or low-tech, at home, with basal body temperature to see if she was getting a temperature shift after ovulation. If you are new to tracking your cycle, or never have: when you ovulate, your body releases an egg and your temperature rises about one degree to prepare for pregnancy. If the egg is fertilized, your temperature remains elevated. If it’s not, it breaks down and your temperature goes back to baseline.

Part Three: A Story We Need to Stop Telling

I really do not like this cultural carryover of women thinking they are going crazy or losing their minds. This was rooted in much older, worse assumptions about the female body — and in more recent memory, the diagnosis of Hysteria.

Which, by the way, was treated with vibrators and orgasms. But that is a topic for another podcast.

This is a story that has been told about women’s bodies for a very long time. And it’s time we told a different one.

Part Four: What Is Actually Happening

So I want to reframe how we talk and think about this. When you enter early perimenopause, progesterone often steps down first. This hormone plays a very large role in self-regulation. So this is when women may notice their stress tolerance is lower. The threshold to anger — or even rage — may drop. They may get irritated with their families and loved ones more easily. Their sleep is disrupted or not restful, often with 2am–4am wake-ups that make it hard to fall back asleep. Their anxiety might tick up. There is a cortisol picture here too, because low progesterone and higher cortisol travel together in high or chronic stress situations and perimenopause. The exact interaction is still being studied in the human body.

If you had a friend with a brand new baby who was tired, anxious, had low stress tolerance, quick to anger or frustration, forgetting things, having a hard time focusing — would you think this was odd? Probably not. You might even say: that’s just new mom brain, this will pass once the baby sleeps through the night. But the baby is the external cause. It’s clear and visible, and that makes it acceptable — because we can all see the baby.

With perimenopause, we can’t see inside a woman’s body. Our partners or close family are often the only ones who would ever get to see this — the feeling of fraying at the edges, holding on by a thread, “losing our minds.” But in reality, many women are primary caregivers for children, aging parents, partners, communities, and jobs. They power through. They suffer in silence because they think that is what is expected of them. They can’t fall apart — there are people depending on them. So they probably suck it up until it’s too unbearable, and then ask for help. They are often dismissed, given an antidepressant — which can sometimes be appropriate, but is often not addressing the root cause — and sent on their way because their labs are “normal.”

This is an unfair part of our healthcare system. Your doctor has ten minutes, and unless they specialize in perimenopause and menopause, they may not connect the dots. And even if they have training, many doctors are still not well-versed in how to support early perimenopause driven by low progesterone. This is exactly why I built the Perimenopause Matrix™ — because no single prescription addresses what is happening across all six pillars: Fuel, Move, Recharge, Regulate, Connect, and Clean. This is where adaptogens and HPA axis-supportive supplements can also be helpful.

If you have a friend who has ever said “I think I’m losing my mind” or “I don’t know what’s wrong with me” — please send her this episode. You might be giving her the reframe that changes everything. Just forward it, text her the link, drop it in a group chat. She needs to hear this.

Part Five: The Reframe

But today I want to talk about reframing the forgetfulness and poor memory specifically. When you are tired and stressed, your brain has a harder time with executive function — the brain manager who is in charge of building out the strategy for the day, managing tasks, keeping all the plates spinning. This is the Recharge pillar of the Perimenopause Matrix™ at work — sleep deprivation directly impairs the prefrontal cortex, which is exactly where executive function lives.

Often we forget little things — picking up bread at the store, signing a permission slip, folding the laundry. Often not big things to us, even if they are extremely important to other people. Your child may be very angry if you forget a permission slip. But if your brain is running on very low resources, it may file the permission slip as less important than getting the reporting done for your boss — because your job pays the mortgage and keeps your kid in school to go on the field trip they need that permission slip for. This does not mean you love your child any less, that you are a bad mother, or even that they have become less important to you. This means your brain is sleep-deprived, anxious, dealing with fluctuating hormones, and doing its best to keep you going. So let’s give your brain — and yourself — some grace here. Your brain is remembering things that are high priority. Things that are not are getting lost in the shuffle. That does not make you a bad person. That makes you human.

Ellen Langer explores this beautifully in The Mindful Body. She reframes forgetfulness not as a failure of memory, but as selective attention. Her point is that we don’t remember things we never really encoded as important in the first place — and that is not decline, that is discernment.

I experience this myself — when I decide something is not important, my brain lets it go. That’s not a bug. That might be a feature.

Dr. Lisa Mosconi, a neuroscientist at Weill Cornell, takes this even further. Her neuroimaging research shows that during perimenopause, the brain undergoes a significant metabolic and structural reorganization — it consumes energy differently, rewires how it operates, and shifts its priorities. She frames this not as deterioration, but as adaptation. The brain is literally changing its operating system. If you want to go deeper on this, her book The XX Brain is extraordinary and I’ll link it in the show notes.

Consider the possibility that your forgetfulness is part of that reorganization process. Your brain is changing what it finds important. Perhaps it is easier to remember what is familiar, and what counts as “important” is itself in flux. We generally start to care less what other people think about us at this stage of life. We have more responsibilities than we did in our twenties. What you cared deeply about at 25 may simply carry less weight now — and that shift might be showing up in what sticks and what doesn’t.

Could it be possible that your forgetfulness is part of a brain restructuring process? We can’t change it — but could we reframe how we experience it? Can it be less distressing?

Part Six: Working With Your Brain

So let’s work with your brain, not against it. Here are three ways I support the women I work with inside the Recharge and Regulate pillars of the Perimenopause Matrix™:

Shared lists. Create a running list — paper or on your phone — for low-importance life admin: making appointments, signing paperwork, picking things up at the store. Get it out of your head and onto a page. Your brain will thank you for not making it hold that.

Admin hour. I schedule one hour a week for these tasks and keep a running list on my calendar of everything that needs to happen in that window. Nothing gets lost, and I’m not using admin tasks to procrastinate on bigger priorities — which, I’ll be honest, I have done many times.

Giving away responsibility. Do you have too much on your plate right now? Is it time to delegate? Maybe your kid is old enough to start keeping track of permission slips, and you can designate a time each week for them to come to you with what they need. Maybe your partner can take something off your plate. Maybe you need help outside the family — someone to prep food, clean your house, or act as a personal assistant. There is nothing wrong with asking for help. You probably give it freely whenever the people close to you ask for it. Suffering in silence and doing it all yourself is not a badge of honor. It is a recipe for exhaustion. And you deserve better than that.

Closing

You are not a woman who is losing her mind. You are a woman whose brain is reorganizing — doing exactly what it needs to do to carry you into the next chapter of your life. And the more you understand what is happening inside your body, the less frightening it becomes. That is what the Perimenopause Matrix™ is for. Not to fix you — but to help you work with yourself.

If you are hearing yourself in this episode — the brain fog, the sleep disruption, the anxiety that doesn’t quite make sense — this is exactly what I look at in a Matrix Lab Review. We go through your labs together and I help you understand what they are actually telling you about where you are in the perimenopause transition. The link is in the show notes.