There isn’t a mom who can’t relate to the idea of her brain as a computer with 50 tabs perpetually open, juggling a personal life, kids, activities, career, errands, housework, spouses…the list is endless. And brain fog is real.
It’s not odd for motherhood and its myriad responsibilities to make us feel distracted and forgetful. But if you’re in your late 30’s or 40’s and feeling “off,” these symptoms often point to perimenopause. “It’s an overall sense that you’re not as sharp as you know you can be. You’re just off your game,” says Dr. Jennifer Okwerekwu, a Harvard-trained reproductive psychiatrist who specializes in integrative women’s mental health.
The average age of menopause, defined as one full year without a period, is 51-years old. Dr. Okwerekwu says perimenopause can begin about 8 years before that, sometimes as much as a decade sooner. The accompanying “brain fog” is what Dr. Okwerekwu calls a catchall term for poor cognitive function, like forgetfulness, poor focus, and difficulty remembering names and facts. “Picture going into the kitchen for something but forgetting what it is, or taking a while to remember the name of someone you’ve known for years. You may find usual tasks taking longer, or using extra effort to strategize about your plan for the day.”
The culprit is hormonal; namely, a drop in estrogen. Dr. Okwerekwu explains that “in our brains, estrogen is a key that revs the engines of our brain cells. It helps with cell-to-cell communication and connection. During perimenopause, there are fewer estrogen keys, so it’s harder to ‘unlock’ our usual functions. And the result is brain fog.”
This “key” analogy makes it easy to understand the onslaught of symptoms that perimenopause can trigger: without estrogen “keys” to regulate our body temperature, hot flashes or night sweats can develop. “And with fewer ‘keys’ for emotion, memory regulation and decision-making, we are more susceptible to depression, anxiety, and brain fog,” says Dr. Okwerekwu.
Symptoms of brain fog are often misunderstood and/or confused with ADHD or “mom brain.” Dr. Okwerekwu believes context is the most important factor in finding the root of your symptoms.
ADHD, she explains, is a neurodevelopmental disorder that begins from childhood and doesn’t go away. So while difficulty focusing may get worse with hormonal fluctuations, “you don’t turn 40 and get ADHD. You don’t just develop it; it has always been there.”
“Mom brain”, on the other hand, is more short-lived. Dr. Okwerekwu puts the range for symptoms from a few months up to 3 years. “When you’re pregnant, your body says ‘how do I keep this tiny baby alive? I have to tend to this person’s physical and emotional needs.’ And so our brains become specialized in those activities. You’re not losing IQ points, but remembering to buy milk isn’t as important as keeping babies alive.”
Perimenopause lasts longer-but not forever! Dr. Okwerekwu encourages us to be patient with ourselves because, eventually, our bodies reorganize and learn to depend less on estrogen: “Our brains and bodies acclimate.”
Still, 7 or 8 years can be a long time to struggle so we need action. These are the six steps Dr. Okwerekwu shares for all moms navigating perimenopause and brain fog:
- Connect with a mental health professional.
Manage your mental health and treat any underlying mental health conditions that can zap your cognitive ability. Treating symptoms proactively is like closing tabs in the operating system of our brain. Let’s close the anxiety tab! There are options like medication, therapy, and more…but do something!
- Exercise.
Estrogen has functions all over the body, not just in your reproductive system. It can influence things like weight, cholesterol levels, and more. As estrogen wanes, exercise can counteract some of those effects. It also boosts the function of the hippocampus, which is the headquarters in the brain, for memory and learning. Do moderate exercise at least 3 times a week, where you aim to break a sweat. Balance any cardio with building muscle, so do weight-bearing exercises and resistance training.
- Manage stress.
Mindfulness and meditation help but I’m not suggesting a silent retreat. Take a moment to focus on the present moment. That’s a muscle! The more you practice, the stronger it becomes. There’s real substance to this! When you’re frazzled and your attention is pulled in a thousand directions, of course you forget what you’re doing. Slowing down and breathing helps with neuroplasticity, which is your brain’s ability to grow and form adaptive connections.
- Find new experiences.
Flex your brain muscles! Crossword puzzles, brain games that require thinking or strategy also help stimulate neuroplasticity. We need to stay in a constant state of learning to help us replace what the estrogen used to do for us. Travel to a new part of your neighborhood, or the world. Make pottery, learn a new language-do whatever you find interesting to encourage cognitive growth.
- Optimize your sleep hygiene.
Sleep is a hormonally regulated process and light from nighttime phone and computer use pushes away the calming hormones that we want. So create a wind-down routine. That means stop scrolling! Blue light blocking glasses can help disperse some wavelengths that stimulate alertness in our brain. Ideally, step away from the screens 2-3 hours before bed-or one hour at the very least. Then add something that helps you feel calm: journaling, mindfulness, prayer, reading, and listening to the Calm App or Headspace. Taking a magnesium supplement may help sleep as well.
- Check in with your diet.
The advice we give our kids works so well for us too: eat the colors of the rainbow! I suggest to my patients that they follow a Mediterranean diet that emphasizes nuts, fatty fish, fresh fruits, vegetables, and non-processed foods. Double down on the things that are helpful and do them in an intentional way! But rather than guessing, ask your doctor to run your blood work so you know definitely what your body is lacking. In some cases, B vitamins, omega 3’s, and vitamin D can help with mood and production of neurotransmitters (what brain cells use to communicate).
To learn more about Dr. Jennifer Okwerekwu, visit her website and follow her on Instagram at @drjennifer_o
