You walk into a room and forget why. You’re mid-sentence and the word just isn’t there anymore. You reread the same paragraph three times and none of it lands. If this has been happening more than usual, you’re not losing your mind, and you’re not alone. Research suggests somewhere between 40 and 60 percent of women experience this kind of cognitive fog at some point during perimenopause and menopause.
That range alone tells you something. This isn’t a rare, unlucky symptom. It’s closer to the norm.
It’s also worth saying plainly: this is not a sign that something is seriously wrong with your brain. It’s common for women going through this to worry they’re developing dementia, doctors report hearing that fear often. Menopause-related brain fog and dementia are not the same thing, and for most women, this kind of fog improves as the transition progresses. That said, if what you’re noticing feels persistent, progressive, or is interfering with daily life, that’s worth mentioning to a doctor, not because it’s likely to be something serious, but because ruling things out brings peace of mind.
What’s happening in your brain
The mainstream explanation is real, and it matters: estrogen does far more than regulate your cycle. It supports memory formation, keeps neurons firing efficiently, and helps your brain cells communicate with each other. When estrogen drops and fluctuates during perimenopause and menopause, your brain is running on a different fuel supply than it used to. That’s not a metaphor, researchers have found measurable changes in how the brain uses energy during this transition.
So when you feel foggier, slower, less sharp, that’s not in your head. It’s happening in your head, in a measurable way.
The piece almost nobody connects
Here’s what most articles on this topic leave out entirely: your gut plays a role in regulating those same hormones.
There’s a specific term for it, the estrobolome, a collection of gut bacteria that produces an enzyme controlling how much estrogen stays in circulation in your body versus gets cleared out. Research shows that greater gut microbial diversity is associated with better estrogen regulation, while a less diverse, less balanced gut can disrupt that process further, right at the exact moment your hormones are already in flux.
In other words, gut health and hormone health aren’t two separate conversations. They’re feeding into the same system. And the most effective, most overlooked way to support that gut diversity isn’t a supplement or a trendy tonic. It’s fiber, which most women aren’t getting enough of. If you want the full picture on that, I’ve written about it here.
If you’ve been chasing brain fog with everything except your gut, this is worth a second look.
Curious what this could look like for you? I’m only taking 3 when the waitlist opens. Join the waitlist and I’ll be in touch when spots open.
The lever you can pull
Hormones are only one piece of this, and a blog post can’t tell you what’s right for your body. Some women find hormone therapy helps, and that’s a conversation for you and your doctor. But it isn’t the only lever. How you move, what you eat, how well you sleep, and how much stress you’re carrying all shape how foggy or clear you feel, and you have a say in every one of those.
The one I know the most about is movement, and there’s good research behind it.
A growing body of research on postmenopausal women shows that regular exercise, particularly a mix of aerobic movement and resistance training, is associated with improvements in memory, focus, attention, and executive function, the exact areas brain fog hits hardest. Pilates can be part of that, especially when it includes resistance. The Pilates-specific research is smaller, but in one randomized trial, women over 60 who did Pilates twice a week for 12 weeks improved their executive function and verbal fluency compared with women who didn’t exercise. Pilates also asks you to coordinate breath, focus, and precise movement all at once, which is a different kind of mental work than a treadmill or a set of squats. Since a lot of Pilates happens lying down, heavier loading plays its own role in bone density, something I’ve written about here.
The mechanisms behind exercise’s cognitive benefits are becoming clearer too: movement supports blood flow to the brain, and it appears to support the brain’s ability to form new connections over time. It also helps regulate several of the hormones in play during this transition. Exercise isn’t going to bring your estrogen back up, but the right kind of exercise does help balance cortisol, the stress hormone that makes fog worse when it stays elevated (overdoing intensity can push it the other way), and insulin, which affects your energy and how steady your focus feels through the day. It’s not a cure, and it’s not instant. But it’s one of the better-supported non-drug strategies for cognitive health, and it works alongside whatever else you’re doing, not instead of it.
Two things you can do something about
Hormones are the backdrop. You didn’t choose this transition and you can’t control its timeline. But gut health and movement are two things you have influence over, and now you know they’re not separate side projects, they’re both feeding into the same system that’s affecting how foggy or clear you feel.
That’s the whole idea behind how I coach, too. Not a fix for your hormones, I’m not offering that, and not a miracle either. Just consistent, well-chosen movement that supports what your body is dealing with, week by week.
Where I come in
I’m not a doctor. What I do is get women moving in ways that can help ease brain fog, and build that movement into a life that’s already full, without adding one more overwhelming thing to manage.
I keep my roster small on purpose. Real personalization doesn’t scale. When the waitlist opens, I’m only taking 3.
Join the waitlist and I’ll be in touch when spots open.
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Melissa Van is a Pilates teacher, retreat leader, and writer based between the US and Europe. After 20+ years of teaching, she created travilates, which offers 1:1 online Pilates coaching for women 45 and up. She leads lively retreats that bring movement and travel together, open to women at any stage of life. She also writes Notes from the Road, a weekly Substack on staying steady in midlife, one city at a time.