Perimenopause and the Brain: What’s Going On Up There?

In this article with Deirdre Nazareth, Osteopath and Functional Medicine Practitioner, the brain in perimenopause is uncovered in all its glory. It’s not just about hot flushes, brain fog and wonky periods: what about ADHD or Alzheimer’s? Biologically speaking, it’s all connected, and here’s why…

Perimenopause can feel a bit like getting ghosted by your own brain. One minute you’re running on full steam, the next you’re all at sea thinking: “Where the F**k did I put my phone?!”. Why could this be? Take one guess, and we’re pretty sure you're shouting “hormones” very loudly at your laptop screen right now.

Turns out, oestrogen, progesterone, and testosterone aren’t just about what happens in the bedroom. They’re like backstage managers in your brain, running the show on everything from mood to memory to keeping your blood pressure in check. So, when these hormones start doing a bit of improv during perimenopause, they can seriously mess with your brain’s rhythm.

There really is a lot to it, but sit tight, this hormonal hustle-and-bustle can lead to more than just forgetting your best mate’s birthday. 

Perimenopause isn’t just a ‘time of the month’ on steroids (although it can seem like it). It’s a full-on neurological transition that can leave you feeling like your brain’s gone on a bit of a bender. But knowing what’s happening is the first step to taking back a bit of control – or at least realising it’s not just, well, in your head.

In the brain, oestrogen, progesterone, and testosterone:

• Support memory and learning
• Help manage stress and maintain blood pressure and temperature control
• Influence how the brain grows and adapts (neuroplasticity and neurogenesis)
• Affect mood and thinking
• Influence sexual behaviour and movement coordination
• Influence how we experience pain

During perimenopause, hormone levels fluctuate unpredictably. This can disrupt how the brain functions and reduce its natural protection. As a result:

• Memory and cognitive changes can happen
• Risk of anxiety and depression can increase
• Chronic pain conditions may become more likely
• Neurodevelopmental conditions like ADHD can worsen
• Long-term risks for diseases like Alzheimer’s and multiple sclerosis can go up

In short, perimenopause isn’t just about changes in fertility. It’s a neurological transition. Our hormones even help other brain chemicals, known as neurotransmitters and neuropeptides, to work more efficiently. This fine-tuning of brain chemistry sharpens our attention and enhances how we experience and respond to the world around us.

It’s quite easy to focus solely on oestrogen when discussing brain health because it’s the master regulator, and the transition effectively begins with its decline. But, let’s break it down even further:

Oestrogen

• Acts as a master regulator and protector of brain regions involved in learning and memory
• Boosts neuroplasticity, speeds up brain circuitry and supports energy production in the brain
• Its decline during perimenopause can affect cognitive functions and memory

Testosterone

• Often linked with libido, but also sharpens mental clarity and focus
• Improves blood flow to the hippocampus, supporting memory, learning and sleep cycles
• Increases serotonin and dopamine activity, helping mood and motivation
• Supports metabolic health, energy and overall wellbeing

Progesterone

• More than a reproductive hormone; it lowers inflammation and supports immune balance
• Increases metabolic rate and protects heart, bone and breast health
• Calms the brain by stimulating GABA receptors
• Its decline can lead to sleep issues, mood swings and reduced stress resilience

What’s stress got to do with it?

Cortisol, the stress hormone, can spike when oestrogen drops, causing more cravings and constant hunger. At the same time, your thyroid slows down, making it harder to turn food into energy.

What’s muscle mass got to do with it?

Muscle loss makes this worse. Muscles burn more energy even at rest, so less muscle means slower metabolism. Endless cardio won’t fix it. Strength training, on the other hand, builds muscle, supports testosterone and helps insulin work better.

It may seem like it is all doom and gloom but understanding the symptoms that are alarms for greater neurological consequences later can be windows of opportunity to make changes right away. 

Focusing on small changes that have a big impact on multiple systems is the way to ensure you don’t get overwhelmed.

The perimenopausal brain and nutrition

• Prioritise whole foods, focusing on protein and fibre to support recovery and gut health.
• Aim for at least 1g of protein per 1lb of body weight (around 30g per meal).
• Begin your day with protein or fibre-rich foods, not just coffee – this stabilises blood sugar and cortisol.
• Eat within the first hour of waking, including watery foods like tomatoes, cucumbers, parsley, watermelon, and squash. These help circulation and nitric oxide production.
• Include more bitter and colourful foods to support liver health, bile production, and antioxidant levels. Don’t stop at eating your greens, go for the whole rainbow!
• Avoid eating heavy meals too close to bedtime; aim for meals 2 hours or more before sleep. And if you’re going to have a big meal, eat it earlier in the day to avoid disrupting sleep.

Supplements

There are some key supplements that can support brain health in perimenopause. Minerals such as magnesium, zinc, selenium and iron are essential, along with fat-soluble vitamins A, D, E and K, B vitamins and antioxidants like glutathione, vitamin C and CoQ10. 

Cell membrane support from omega fatty acids and phosphatidylcholine can also be helpful. Meanwhile, creatine (around 3 – 5 grams daily) and electrolytes are there to support cellular hydration and brain health.

To make life easier, our Valerie Daily Essential includes a carefully chosen blend of nutrients that are specifically known for supporting your brain health during perimenopause:

• Ashwagandha: calms the nervous system and helps manage stress, supporting better focus and resilience
• Zinc: involved in neurotransmitter function and healthy cognitive processes
• Magnesium: plays a role in memory, learning, and keeping your nervous system balanced
• Curcuminoids: support memory, reduce brain fog and calm inflammation that can impact brain health
• Chromium: helps keep blood sugar stable, which is crucial for steady brain energy
• Selenium: supports thyroid function, essential for mood and brain clarity
• Vitamin C: an antioxidant protector for brain cells, helping you stay sharp
• Vitamin D3: stabilises mood and supports brain health
• Vitamin B6: helps produce neurotransmitters like serotonin and dopamine, vital for mood and clear thinking
• Vitamin B12: essential for nerve health and reducing brain fog and fatigue
• Vitamin K2: helps protect brain cells by regulating calcium in the body

These ingredients work together in our advanced liposomal formula to support memory, focus, and overall brain clarity.

Shop the Valerie Daily Essential today and give your brain the boost it deserves.

Exercise
Build muscle with strength training. Move daily, especially after carb-heavy meals. Even 15 minutes of uphill walking helps circulation and lymph flow. Why not also try group exercise to hit community and connection!  

Sleep
Be in bed by or before 10pm. Early bedtime helps recovery and a healthy circadian rhythm.

Hydration
Drink filtered water with sea salt or electrolytes to stay hydrated and support brain health, especially after a night of mouth breathing.

HRT

If it’s right for your body, work with a professional to give you guidance on the right hormone replacement for you. 

Want to connect with Deirdre?

To learn more or get in touch, you can visit her website at The Functional Osteopath or follow her on Instagram at The Functional Osteopath.