Menopause Brain Fog Is Real: 7 Science-Backed Ways To Clear It | Dr. Jolene Brighten

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Perimenopause is a neurological transition as much as it is a reproductive and hormonal one. And today we're breaking down why brain fog, memory slips, focus issues, maybe why you feel like you have a DHD and all of the brain symptoms that many of us experience in perimenopause and menopause actually happen.

And we're gonna talk about what you can do about it so that you can feel clearer and calmer and like you're more in charge of your brain rather than your brain has exited the building.

But listen, this is relevant to lots of women. So if you have primary ovarian insufficiency, you're using Lupron or other medications that shut down your ovaries for endometriosis or adenomyosis management. If you've had a hysterectomy or you've lost your hormones for any reason you need this episode.

'cause we're gonna also talk about what happens when we lose our hormones too soon in life.

So here's where we're gonna go into today's podcast [00:01:00] episode. We're gonna talk about how changing hormones change your brain chemistry and the way that your brain is functioning. We're gonna talk about why you struggle with brain fog, why you're losing words mid-sentence, and why you feel like you've lost your mental edge or your ability to be as productive, whether that is at work or home life like you once were.

We are gonna talk about exciting new supplement ingredients and a formula that's showing big promise in clinical trials. I will help you parse out why, why do some women feel like they have a DHD, and is it actually a DHD? I'll be sharing a bit of my own personal journey because losing my hormones and losing my mind, this is something that's hitting really close to home. And listen, if you're watching on YouTube, I'll be putting key studies and graphics to help you further understand this topic. And if you're not watching on YouTube, you might wanna pop over there, to see the graphics that I'm providing.

And I put the studies [00:02:00] on the screen. But as always, the studies will be in the show notes at drbrighten.com, D-R-B-R-I-G-H-T-E n.com, and the graphics and the studies showing up on YouTube videos, that's something new we're trying. So if you like it, definitely let me know. If it's helpful, I'd love to hear more about it. . If you're new here or you're joining again, welcome. This is the Dr. Brighten Show, and I'm your host, Dr. Jolene Brighten. I'm board certified in naturopathic endocrinology, which means I'm an integrative hormone doctor. I'm a nutrition scientist, a bestselling author of several books, and your friendly translator between hormones and real life.

If you enjoy this podcast, please consider taking just a minute to leave a review. I know it seems like this really small thing, but I promise you it's huge for a podcast that's hosted by a woman who is trying to rise above the noise in the podcast and the the overall internet space and ensure that women's voices are heard and [00:03:00] centered in topics of women's health.

If you're on YouTube, hit the subscribe button. Let's hang out because we do the show twice weekly, and as always, your feedback guides the conversation. So leave me a comment, let me know what do you wanna hear more of? What helped you? Where do we need to go in a deeper dive? So with all of that said, let's dive in.

Perimenopause is a significant phase of a woman's life. It's a multi-year phase. New estimates say seven to 10 years. For some it could be 15 years before your final period happens. So when we are in perimenopause, estrogen is fluctuating wild, lame, and progesterone is on its slow decline. You may still be cycling, but estradiol is not predictable and progesterone is going low, making it harder for you to feel calm, get good sleep, uh, maybe not say the, the things you think in your head, um, the things you shouldn't say out loud.

Maybe you're [00:04:00] saying them out loud, and we'll talk about why progesterone declining does that to your brain. , but what you need to know is that all of this is a perfect storm for symptoms that you start noticing in terms of your brain's function. Now, I want to go through a quick brain chemistry tour from the perspective of hormones so that we're all on the same page.

I just said estradiol. That is your predominant estrogen while you're still cycling. It is a powerful neuromodulator. It helps tune dopamine, which is focus and motivation. It helps with serotonin, which is our mood, and also plays a role in resilience. It's involved with acetylcholine, which is helping our learning and our working memory.

So when estradiol swings attention and word finding and executive functions, we're, we're gonna talk a little bit more about those can start to falter. Now, estrogen's gonna be going up and down [00:05:00] until you get into the late phase of perimenopause. At which point it's going to be dropping, dropping, dropping.

You stop having periods when we count 12 months and on month 12, happy anniversary of no periods, you're in menopause. The next day you're postmenopausal. At that point, your estrogen is gone. And so in this phase of estrogen being sporadic. Your brain function becomes unpredictable as it declines. We're gonna get more into what the research says about how that affects your brain energy and your brain function overall.

But I wanna talk about progesterone and testosterone because estrogen is like having its moment, and that's great. Love that for estrogen, but we can't forget about these other hormones that our ovaries are producing as well.

Now, the only way that you make progesterone from your ovaries is following ovulation. It is only present in sufficient amounts. During the luteal phase, you must ovulate make a corpus lium that [00:06:00] makes progesterone. So in mi menopause, when you're running out of eggs, you're ovulating a whole lot less frequently.

Or even when you ovulate that corpus lium is a little weak in its job, you don't manufacture progesterone. Now progesterone gets converted in the body to allopregnanolone, which we lovingly call allo Allo acts on the GABA receptors in your brain, which is the calm down system. When progesterone and aloe are dropping, dropping, dropping, you're gonna feel edgy, less stress resilient for sure, and sleep can suffer.

And what we can see is that as we feel less chill, less calm, we become more reactive. That can activate the HPA access. So hypothalamic pituitary adrenal access is your stress system. I will link to episodes about cortisol and about insulin that I've done. These are two very important hormones in the brain discussion, but today I wanna focus specifically on what's happening in the ovaries.

Testosterone. [00:07:00] Yes. Women make it, I don't care what the FDA says, but testosterone declines gradually that's gonna start, you know, it could start as early as our twenties, but definitely our thirties. And yes, it influences our sexual motivation, but it also influences our energy, our boundary setting. It plays a lot of roles in our brain as well.

In midlife, we see a drop in testosterone plus estradiol changes, and that's affecting our libido, but also our get up and go and feeling like we have enough energy in the day. Also, um, starting and following through on projects that can be related to testosterone as well. If you don't know what my reference was to the FDA when I started talking about testosterone, it's this, the FDA has approved testosterone therapy for women, but specifically only for hypoactive sexual desire disorder. You are not in the mood to have sex and it's really stressing you out. They have not approved it for cognition, not for [00:08:00] muscle loss, not for mood changes, but it's wild to me that in 2025, the FDA is still not recognizing the necessity of testosterone for women.

So if you are concerned about your testosterone, this is when we definitely need to test total and free testosterone and a sex hormone binding globulin. Why? Because even once your ovaries call it quits, they retire, your adrenal glands can pump out some DHEA and we can dust that via DHA sulfate or DHAS, and that can get converted into testosterone.

So not everybody loses their testosterone, but if you do, it's a problem. Now, I don't wanna be all doom and gloom. A, a lot of times when we talk about perimenopause and menopause, it's a lot of like, here's all the bad things that happen. Okay, some bad stuff does go down, but preventable in some cases. And what I wanna focus on.

Is telling you the truth of the science and what to expect and what like [00:09:00] our grandmothers should have told, our mothers should have told us when it comes to this phase of life. But I want you to know that your brain is plastic, not like cheap junk jewelry, plastic, but plastic as in it's adaptable and it can change.

And we will talk about strategies to help support that. Now, there is no doubt that hormone replacement therapy, especially estrogen introduced within the critical window, can help with mitochondrial function. It may help with dementia prevention. It is helping with your brain energy. And so overall, estrogen very good for the brain, but as I just demonstrated, progesterone is as well.

I'm not gonna spend a lot of time today talking about hormone therapy or menopause hormone therapy because we've done it before. And I will link in the episode show notes at drbrighten.com, the episodes that do that because there's a lot other of other things that I wanna talk to you about. And yes, hormone therapy [00:10:00] should be considered, yes, hormone therapy is important, but it's not for everyone.

So we wanna give you other options as well. And as a reminder, as estrogen declines, we become less sensitive to insulin. We can see insulin dysregulation, even insulin resistance, and that can absolutely impact how our brain functions. So I will link to the episodes on perimenopause, weight loss, the insulin episode because those are really important for you to understand as well.

And if you missed it, we did a two part sleep series where you talked about your hormones and your sleep, and that's gonna be important as well. Okay, so I, so I just want people to know this. 'cause if you're like, why is she not covering these really important things? Because we've done it, and I'm gonna, I'm gonna put together like a whole compilation of episodes for you that will make you, um, unstoppable in your brain health because you will have the ability to master your hormones and what it takes to have a healthy brain.

Now, when it comes [00:11:00] to perimenopause, especially the late phase and menopause, women will report things like losing words, especially nouns, walking into a room, completely blanking out, mixing up words, having a slower recall. And I want you to know you're still brilliant. Your brain is just struggling with energy and it's going through a remodeling.

A hormonal transition means a brain transition as well. So I want you to think of the hormone influence brain changes more like a software update, not a hardware failure. This is like you're updating your iOS, but it's your brain. And so when you're updating software, right, things can lag, you can get that pinwheel spinning and it takes forever. Um, there you, I have to restart some apps.

And so as we're approaching it this way, we, we wanna think about how we can support the system. So like, sleep movement, protein, fiber, stress, um, [00:12:00] certain cognitive tools. All in order to basically smooth out the performance as the update finishes. Now, unfortunately, this update can last for like five years for some people. So I'm definitely gonna give you some things that you can do today. But I want to get into what is actually happening with your hormones. And we're gonna get really sciencey at times.

And then I'm gonna explain it a little more simply. And then of course in the comments, if you're like, could you break it down more, please tell me. Okay? 'cause I am, I wanna bring you the science, but I also wanna make it something that's accessible for you. Because presumably you're listening to this and you potentially have brain fog and your brain, that that system's running a little bit slower. And that doesn't mean that like you are slow or you're dumb. It doesn't mean that at all. It means that I need to repeat things more often and say them in different ways so that we all are on the same page., I wanna introduce you to a term known as endocrine [00:13:00] aging. And this is where we're looking at your hormones more than your biological age or your birthday, because as I said in perimenopause, there's this system upgrade going on and we are getting a fuel reset as well. And so with endocrine aging for, so let me say this, this is why it's really important you track your symptoms because your endocrine aging, where your hormones are at, what they are doing, how they're changing, this influences your brain health, your cardiovascular health, your bone health.

And so where your hormones stage is at is is more telling than your biological age or your chronological age itself. So we're gonna talk more about like what happens when you lose your hormones too early. But there's a lot of instances where women are not bathing in their own hormones, and that is affecting their endocrine age.

So before I get into like why this all happens and what you can do about it, I think I should share [00:14:00] with you that like I'm not speaking to you just as a clinician or based on my observations or even what I've read in the science. So I have actually gone through these horrible, I'm gonna call it horrible brain changes myself because I was put on Lupron, which is a chemical castration or chemical menopause, and that was a treatment for my endometriosis.

Now, unlike natural menopause where you have perimenopause to transition, there's no perimenopause with Lupron, you inject yourself, you go straight into brain fog, losing words, missing meetings, feeling like you're failing. I felt like I was failing every day. I felt like I was failing at everything and failing as a mother because my brain couldn't keep on top of things.

And in fact, it was so bad. And this was happening around the holidays. I laugh about it now, but it was not a laughing matter at the time. So I had mistakenly purchased multiple Christmas presents, um, [00:15:00] because I couldn't remember. I bought them, like I bought them, wrapped them, had them hidden because I have kids and totally forgot about it.

And, um, the worst of it was is that my son had wanted like this giant Lego set and it was not cheap. And he had asked for it for a very long time. And finally it was like, you're at an age, we're gonna get this for you. I, I bought two and on Christmas morning he's opening up two Lego sets. And let me tell you, that was a very expensive mistake and I was past the return window.

It was hard, and I was so desperate through all of this. I was doing research, I was ordering gobs of supplements. I was taking anything that I thought could help. And I remember one night I was crying to my husband about how I couldn't even keep up with the supplements. Like I could not even remember to take the supplements, even though I knew how they helped when I took them.

And I was just crying and I [00:16:00] was like. I could cry right now thinking about how hard it was. So I was like, why is there not just one supplement for my brain? One supplement is just formulated for a woman who is going through this, who has lost her estrogen, who doesn't have her hormones anymore. And he laughed at me and he's like, you know, that's what you do.

Right? And I just have to laugh because it hit me that my brain was struggling for the lack of hormones so bad that I forgot the, yes, I can be the one that makes that, like I, I formulate supplements for my company, Dr. Brighten Essentials. And so I spent the last year researching clinical trials and finding the most evidence-based ingredients to make our radiant mind.

And I also looked at what I used and what actually helped. And I, you know, I, I look at something like Saffron, um, and I'm gonna talk more about that in this episode, but I was having to take [00:17:00] two capsules of what I was getting because it just wasn't enough. And it's because there wasn't anything made for women and I wanted to actually call this formula focus and mood because that's what I designed it to do. Because on top of all of the brain fog and the, the word missing and the financial mistakes I was making, I also was deeply depressed and struggling with anxiety. And so, you know, I'm getting like kind of on a tangent, the whole point of why I'm telling you this is because I don't want you to feel like you're a failure or like you did something wrong.

If you're struggling with time management, with finding your words, if you're making financial mistakes like I did, like oh my gosh, I really wanna help you because that really hurts. Um, and if you're struggling with things like being able to just plan dinner or any of the day-to-day tasks that become honestly so heavy and hard when we lose our hormones, like.

I have been there [00:18:00] too. And I really regret that it took me being on Lupron to really understand just how hard it is. And I think that's the way it goes sometimes. Like my patients told me it was hard, I believed them, but it was a lot like when I had before I had a baby, and my patients were like, being a mom is hard and childbirth is hard.

And I was like, I believe you. And then I went through it myself and I'm like, oh my gosh. Like I thought I knew, but I really had no idea. And that happens for so many of us. You know, you might be 35 listening to this and being like, yeah, okay, this sounds hard. I, I don't know how to express in words how incredibly difficult it is, how defeating it is, and how awful it is to feel like you are a stranger in your own mind, and that you are trapped by a mood that is, that doesn't feel like you're on, but because it's a biochemical imbalance happening because of the loss of these hormones.

So [00:19:00] I'm very passionate about this, and that is why I wanted to do this episode. Many of you were like, I need this episode. And I'm like, yes, we should do this. So let's get into what is happening with the hormones and get into the science of what you should know, hopefully before you're in perimenopause menopause.

But if you're there already, I got you. Brain networks are remodeling during the menopause transition. I've said this a couple times, so let me break it down on what's going on. There's been imaging studies on menopausal brains that have shown specific changes in structure, connectivity, energy metabolism, especially in regions that are driving our memory and our executive function.

So the executive function is all about that prefrontal cortex. So, executive function, this is something, you know, since I brought it up, I, I wanna say this. So executive function. I've done episodes where I talk all about executive function. I will link to those. [00:20:00] Everyone with A DHD has executive dysfunction, so much so that it impacts their relationships, their school, their work, their day-to-day life.

Not everybody who has executive dysfunction has a DHD. And so there is a term that's going around the internet and it's incorrect. It's called new onset, A DHD, and they're applying it to perimenopause and menopausal women. You can absolutely have brain changes that affect your executive function. So estrogen goes down, mitochondria function goes down, inflammation goes up, and now our executive function is compromised.

You can have that but not have a DHD. If you have a good skill clinician, they will go back through what it looked like when you were a child, what did it look like when you were a teenager, and there is likely [00:21:00] going to be uncovering of issues that you thought were normal, that people ignored, that people told you were lazy, that they told you to suck it up.

And that was a DHD. If you had a DHD as a child and, but you didn't get diagnosed until 45, you've always had a DHD if. Everything was going fine. Okay. And I'm not talking about masking fine. Compensating fine. I'm talking about like you never struggled with significant executive dysfunction that interrupted your day-to-day living, interrupted your ability to be successful in the traditional ways we define success in life, like relationships and uh, school and all of those things.

You never had issues, you never struggled with executive dysfunction. By the way, people with A DHD do get married. They have long relationships. They graduate from school. Okay? So that's not what I'm saying. What I'm saying is that executive dysfunction made it, you had to work harder than any anyone else around you who was neurotypical.

[00:22:00] If you didn't have all of that and now you're experiencing symptoms, what you're having is a decline in estrogen that is affecting your mitochondrial function and is affecting brain inflammation. That is not new onset, A DHD, that is estrogen and other hormones, but primarily estrogen affecting your prefrontal cortex.

Where executive functions are run, executive functions are things like how we manage our time, how we start and finish projects, how we're actually able to look at something really complex, a large project and plan that out and say, okay, I gotta reverse engineer this and, and figure this all out. It is how we are able to put together a grocery list, go to the grocery store, pick up all the items, not get distracted while we're there, um, to my A DHD people, you know, uh, come home, remember that you have those food, follow the recipe.

Executive function is also how we're able to transition from things. So not being hyper-focused, not feeling super enraged. So, you know, it can look a lot like a [00:23:00] DHD, but you need to work with a clinician to rule things out. I get on the internet that diagnosing A DHD is really trendy right now, um, in terms of armchair experts making cute little TikTok clips.

Okay, but that doesn't mean A DHD isn't real, but it also doesn't mean everything is A DHD and that you don't need to rule out other things. You can have post-traumatic stress disorder. You ha can have other issues going on like depression. These can happen with A DHD by the way. You can have these comorbidities or you might have something on its own, but the most important thing is to be holistically evaluated so that we understand is it something else or is it A DHD alone or is it A DHD with other things, because that is the way you get the best treatment for your brain. Now as they go through this science, it's gonna be really easy for you to understand how some doctors are missing. They're not experts in A DHD. Um, so when you see a gynecologist who's like, I think [00:24:00] you have a DHD, that doesn't mean it's a diagnosis. That means that you need a referral. You are gonna see how it's really easy, that it could be mistaken for A DHD, but also why we see such a phenomenon of women in their forties plus getting diagnosed finally with A DHD.

Because with A DHD, you already had executive dysfunction, you already had mitochondria mayhem, and you already had neuroinflammation was up, and you already had problems with brain energy production. So now we put you in perimenopause and hoo, everything just got way, way worse. Now let's go back to the concept of endocrine aging.

So again, more than just chronological aging and it is reflective of the metabolic adaptation that's happening in the brain. So just because you are having these symptoms, I wanna say to you very clearly, that doesn't mean that you have dementia. It isn't cut and dry that you should be on Google being like, oh wow, I'm having these, you know, cognitive changes.

I must have [00:25:00] dementia. You need to see a doctor to make sure that you are working that up. So, while I may say you may just have a brain energy issue, I'm a doctor. I'm not your doctor. You wanna definitely meet with your doctor to understand that.

So

through the lens of endocrine aging, let's look at perimenopause. So our ovaries send uneven amounts of hormones out. The brain signals are becoming, basically your brain starts yelling at your ovaries. Your ovaries are in retirement. They're like, we're on our way out. We don't even care. Like, stop talking to us.

Why are you so loud? So we've got that happening with the ovaries. Then we see that because the estradiol, and progesterone are becoming erratic, unpredictable, um, you can't depend on them. Sometimes your brain circuits that do depend on those hormones, they have to start adapting and changing.

So they're like, we can't count on these hormones. We have to change and get ready for those hormones to no longer be here. Keep in mind that two [00:26:00] women at the same age can have very different endocrine ages, where one can still have stable ovarian function and another can be very deep in the transition.

So if you're 48 and you're like, I'm not having any of this stuff, but my friend who's 45 is talking about it all the time, and it's so horrible, and I don't understand because your chronological age doesn't matter as much as the endocrine age. So your hormone producing glands, those are your endocrine glands.

How advanced are they in aging? And specifically when we talk about the ovaries, it's all about how many eggs were you born with and what environmental impacts have impacted your eggs, and what are your genetics. Now your stage of hormone change will predict brain symptoms. So brain fog, word findings, sleep disturbance, and , that's gonna do it better than your birth certificate age.

And so again, this is why a 43-year-old who's already in [00:27:00] late perimenopause can feel more foggy than a 53-year-old who's passed the transition because their brain has already adopted. And it is, it is steady again.

So we are gonna talk about that. There is some light at the end of the tunnel. Now I mentioned a term metabolic adaptation. This doesn't mean that your brain is dysfunctional or, or damaged in some way, and so you, it has to change and compensate. It means your brain is adjusting to how it uses fuel and how it's responding and interacting with your hormones.

This is why I recommend creatine at least five grams a day, not just for in the gym, 'cause it can help exercise, but also for brain energy. I recommend this to women who have A-D-H-D-I take it myself 'cause I'm A DHD and I'm 44. Um, but also I recommend it for perimenopause and menopausal women.

It is, um, what we hypothesize is that it can be used to build the [00:28:00] energy from the mitochondria. Now what your brain is doing in that late stage perimenopause is it's shifting how efficiently neurons are using glucose. So blood sugar, glucose, your fuel in the brain, and support cells, the GL cells, they help balance energy. There's also a shift in the efficiency of them as well. There's also this, um, retuning of the neurotransmitter system.

So when these hormones start getting all, uh, sporadic, it's like a piano outta tune and your brain's gotta go in and be like, let's retune this whole dopamine, serotonin, GABA system that has been relying on estrogen and progesterone. As you've been cycling, your brain is also rewiring connections. That's the plasticity, so that networks run smooth again, once your hormones settle out. So as your estradiol is fluctuating, that disturbs your memory circuit. So remember we said [00:29:00] estradiol, E two predominant hormone while we are cycling, that is linked to dopamine, serotonin, acetylcholine. And those neurotransmitters, they are dependent on what estradiol is doing. Uh, I like to, you know, she's basically the IT girl and these neurotransmitters follow her around.

So this is impacting your working memory and also your verbal learning. When your estradiol swings in perimenopause, the hippocampus, the prefrontal cortex, their connectivity and their performance will begin to struggle. So that can be seen as small measurable dips in your processing speeds, how quickly your brain is working and in your verbal memory. And that, you know, is linked to word recall. , And if you're with me on YouTube, you're looking at the science right now on the screen that says that.

Now, as I said, women with A DHD may feel this impact the most since there is already an underlying [00:30:00] neurotransmitter dysregulation. There's executive dysfunction and there's energy issues and how they actually are able to run energy in their brain. Now, I mentioned GABA earlier. GABA is the calm down signal, and when that drops, because progesterone and aloe aren't there in the right amounts, we can definitely feel more anxious, have trouble sleeping, much more amped up.

So progesterone is metabolized into the neurosteroid allo, and that is positively modulating GABA receptors. If you're like, no, progesterone doesn't do that for me, I'm gonna link in the show notes to the progesterone intolerance episode. You need to watch that. Now, across reproductive transitions, including menopause, allo dysregulation is linked to mood and cognitive vulnerability.

So keep that in mind. Progesterone changing and not being there. That that [00:31:00] affects the break system. So your brain has a built-in calm break, and that is gaba. That is what GABA is doing. So ideally, we would start women in perimenopause as soon as they start having a loss of that break on progesterone, oral micronized progesterone, because that's what's gonna get metabolized to alle.

Now in perimenopause, there's been scans that suggest that the prefrontal cortex, that the part of it specifically that helps with focus filters, distractions, regulates reactions. So we're not so volatile. It may have less calming GABA signaling. So again, these are some of those executive functions that people with A DHD struggle with that now come up in perimenopause, not because you have A DHD, but because of the changes in your brain.

Not saying you do or don't have a DHD, you have to get that worked up by a provider. But what you should know is that [00:32:00] if you have less reliable, calm break system, your mind is gonna feel noisier. Jumpier more reactive and self-control will take more brain energy. This is why, um. You know, perimenopause, women are like, I just don't care.

I don't give af because their GABA systems are changing. They don't have that stop break. They don't have that filter. That doesn't mean they're not responsible for their actions, and that doesn't mean that something is wrong with them either. Uh, it really is just, honestly, they're, they don't have the energy to keep up the facade of like being a super polite, good girl who gets walked all over every day.

And that I think is something I've always said. I mean, back when I was in my thirties, I was like, I take notes from my 40 plus year old patients who are just like, I set boundaries. I will not be a doormat. I will not people please. And I'm like, we should all embrace that so much sooner. .

but let's talk a little bit [00:33:00] more about what this actually looks like in your day to day when these hormones change, they affect your executive function, your memory, how your brain's operating. So firstly, attention. You're opening up your laptop to write one email. Five tabs later. You can't remember why you started.

Um, slack pings you if you know, you know, or your kids, um, noise yanks your focus instantly. So it's really easy to become distracted. The brain is not focusing, it's not sustaining attention. Again, this is often an issue throughout life if you've had a DHD in some way. But now if you're have a DHD, it is so bad, uh, 'cause perimenopause is so hard for the A DHD brain.

But if you don't have a DHD, you also are experiencing this, but maybe not to the same degree and not for the same duration of over a lifetime. As someone with a DHD. Impulse [00:34:00] control. This is something that is a classic A DHD symptom. So you blurt, you interrupt, you hit bye before you meant to. I'm thinking back in my story of like financial mistakes. This is not a willpower thing by the way. It's your brain's break is lighter. And I think that's important to understand because there's a lot of blame and there's a lot of shame that get put on people for not having impulse control.

So if you were classically always interrupting people mid-sentence because you were afraid you're gonna lose your thought, um, you have, um, you've been seeking novelty and having really poor ink, impulse control with like buying, sometimes drinking alcohol. Uh, you know, just doing all the things your whole life more of an A DHD.

If you're just experiencing that noun and you're like, what is this phenomenon? Welcome to perimenopausal changes, Now emotional reactivity. I like, I kind of hate ever talking about [00:35:00] this one because sometimes, um, jerks on the internet use it as fuel against women. And like they don't really hear me when I'm talking about the science of things. But you can be a more emotionally reactive. You small stressors feel really big.

You snap at things and then you feel guilty that happening before your period. That is because of gaba, that's because of the GABA system. And so there's always this characterization of like, oh, perimenopausal women are crazy. They're not crazy. They just don't have the energy and the capacity to deal with BS anymore.

The other thing we should talk about is task switching. So task switching, we should be able to stop one thing smoothly. Just transition into doing another, like going from doing the dishes to bedtime routine. Um, when your executive function is struggling, you don't have the brain fuel.

Ugh, that is really hard. And so this is where, um, I will often recommend things. I'm gonna say a timer, but if you have [00:36:00] a DHD and you're listening to me, I'm not saying you solve your life with a timer, but this is something that, um, so I have a, a preteen boy in my house. He's my son. He has a DHD.

Transitions are really, really hard for him. And this is something I do with him. And I also recommend for patients. So. You set a timer, you're in, you're in, you're hyperfocused, you're like, I'm doing the thing I wanted to do all day. I'm super, super happy. Okay, you're hyperfocused, you're gonna get really angry if somebody interrupts you.

Um, I get really angry when my husband's like, we should go to bed, and it's really abrupt. I'm like, doing something and he's like, we should go to bed. And I'm like, ah. Like I'm, I have such a hard time with that. Like, don't tell me what to do. And also, I can't transition right now. So here, here's what works.

Okay, so setting a timer that's like, you should think about the transition. So we're gonna transition in the next five minutes. So the first timer's like, hi, you're gonna transition in the next five minutes. The next timer goes off. And it's like, okay, it's time to [00:37:00] start your transition. And sometimes you need a third timer that's like, we've transitioned, okay.

The transition has happened. And that allows your brain to get, your brain should have its own little, uh, mechanisms for being like, it's time to transition. Let's go friend. Um, it doesn't have that. So you've gotta put some artificial ones in place to help prompt your brain. I wanna talk about sensory issues, but I want to note that the DSM no longer recognizes emotional dysregulation as an A DHD symptom. And it doesn't recognize that sensory overload sensory sensitivities are specific to A DHD. Lots of people with A DHD reported, uh, it may very well just be, uh, on its own A DHD phenomenon, or it could be other things going on, like a co-occurring autism diagnosis as well.

So what I do wanna say though is that if you're going into like the grocery store and the lighting, the music, the chatter, [00:38:00] the people are making, you feel overwhelmed. That's sensory overload. If you go to a restaurant and you're like, I can't stay here because the people talking, they sat me in a bad chair, people are rushing past me all the time.

Um, if you are, you can't work because your desk is cluttered or a cluttered room feels overwhelming. Those are sensory issues that can come up. And we do see that being a problem. It's more extreme autism and neurodivergent brains, but it can happen in perimenopause. The other thing you might notice is that you're tired but wired in the evening.

You wanna sleep, but your brain will not downshift and you're having 2:00 AM wake up. You wanna see the sleep episode for sure. Sleep fragmentation is super common in perimenopause. I also did a episode on A DHD and sleep issues because you probably had sleep issues your whole life if you have a DHD.

But something that's very unique to perimenopause is having hot flashes and [00:39:00] hormone swings that are slicing up your sleep. And so this sleep that you should be getting is what helps memory stick and helps your focus the next day. But it's getting chopped up because you're having these night wakings and even brief cuts, okay to that deep sleep.

And I realize not everybody can see me doing my hands chopping here, but I'm doing hands chopping. So even just brief night wakings, these brief like cuts that are chopping up your deep sleep and your REM sleep can make you foggy the next day. You also might feel awful like you didn't get rest at all and you can be feeling really sluggish mentally and physically even when like you do a lab test and everything looks normal, it can all go back to your sleep. So the hot flash related night waking, it's an estrogen linked sleep disturbance and that [00:40:00] can fragment your sleep. So it's messing with your slow wave, your deep sleep, your REM sleep. And these are states that are very vital for memory consolidation and for you to have attention the next day. So that will often produce daytime complaints that are disproportionate to these subtle changes and that we can see on objective tests. So recent reviews in menopausal populations highlight this particular sleep disruption to brain dysfunction pathway. So struggling with your brain and sometimes you don't even remember that you are waking up because the hot flash is just like this mini little wake up and you flush and you jolt wake and it's only for a few seconds, but even if you don't remember it, that sleep is still getting chopped up. And that's where wearable technology can be really helpful.

So I wear an AA ring, I also have an Apple watch. It can help you understand are you waking up. There are [00:41:00] certainly times that I will sometimes look at my sleep the next day and I'm like, no, but like I thought I was sleeping. I don't remember like waking up. But I see all these little night wakings that have happened.

This was especially apparent postpartum for me. Um, when I had my second son at 40, oy, I had hot flashes and night sweats in that early postpartum, which is normal because you lost a placenta, which means you lost your estrogen factory. And yeah, it can be disruptive. So I want you to understand that. These fragments in your sleep, these chops, they're, they're hitting you in two places.

So the deep sleep, the slow wave, and that is when your brain and your body repair and, um, you're backing up your hard drive basically. So you're consolidating your memories. So we talked about the deep sleep and we talked about rem. Rem sleep is part of our emotional processing and it's where we're filing memories away.[00:42:00] 

So these, these two particular types of sleep, if we're not hitting them, are gonna have a significant impact on how our brain functions. And the thing that is unique about these estrogen swings is that it not only makes it easier to break these sleep stages, but it also is making it harder to reenter them. So you're getting less continuous deep and REM sleep. And that's even when the total number of hours in bed look okay. So you're like, wait, I went to bed at nine, I didn't wake up till six.

Like, everything should be fine. This is where having wearable technology data, if you can afford that, if you have access to that, can be really helpful to understand what is actually going on with your sleep.

So far, we've talked about the hormonal changes leading to brain remodeling. We've talked about sleep. I wanna just go over um, how not getting enough good sleep might show up for you the next day. So [00:43:00] firstly, your memory slips, names, words don't stick. You reread the same line over and over and you're like, what is it?

What does it even say if you feel like your attention is just not there altogether or it, it's really hard. So small distractions are derailing you. Task switching is really clunky. One of my tips, we'll talk about it today, is not to task switch, is to like actually work in chunks. I actually just said that to my assistant today.

She was like, oh, we have like, you know, you did this set of work this morning, but like, I need you to get me this thing and can you just one off this? And I'm like, that's actually a whole project and I have to record this podcast first and then I can do all of that in a chunk. Other thing you might find is that you're more irritable.

You are feeling like stress is hitting harder and your motivation is dipping. This can all just be a result of really poor sleep and something that [00:44:00] is really apparent that sleep has been a problem for you for a long time and that your adrenal glands and your brain are just getting a divorce it feels like.

Is HPA dysregulation that classic? I'm tired at night. My body's exhausted, but my brain is wired and caffeine is helping less and sugar cravings are crazy and I want salt all the time and I wanna crunch, chew things, uh, really hard that can point to, uh, HPA dysregulation and cortisol issues coming up. Here's another really big one, that late stage perimenopause and menopausal women report, and that is performance mismatch. So you can't perform because tiny interruptions at the wrong moments are just hijacking your brain. You do not feel as mentally sharp and you're like, I feel like I'm sleeping well.

Why am I not able to perform? And if you actually get into the sleep data, [00:45:00] it may be your brain is not getting enough of that restorative time. Sleep is not just when we consolidate memories, by the way, either. It's where we remove metabolic waste. And if we can't remove metabolic waste, like we've, we've got a brain that's really struggling.

Now, the good news about everything that we have talked about thus far is the dip in brain function is usually transient and sometimes reversible. So again, we're thinking of perimenopause like. A long software update. I, I'm, like I said, a software update, but like this is not happening in an hour, right?

So we got the hormones that are changing. It's changing how the brain is functioning. The brain has to adapt, which is pretty phenomenal. When you think about it. You think about the fact that you know your brain is changing throughout your menstrual cycle. Then in perimenopause, you know, it's not just about the ovaries going to retirement, it's also about your brain adaptation.

So you're doing a lot like definitely be gentle with yourself and keep in mind [00:46:00] that in most women, this brain lag, this word recall issues, it's temporary. It's just a phase of the brain changing. So after your hormones settle, so following your final period, um, and now you're going into post menopause, the brain should have brought some of those skills back, hopefully up to baseline.

It's not always the same for everyone, but I want you to recognize, especially if you're in distress, that this is an adaptation time. It doesn't necessarily mean permanent loss. and there was actually a large study called the SWAN Study that found that there were modest declines in processing speed, in verbal memory that happened during per perimenopause, that even though women were experiencing that, they often found a return to baseline after the transition was done.

So ovaries are done, no more periods, everything's done. And so this [00:47:00] is consistent with the idea that this is a neural adaptation, a brain adaptation, rather than you permanently losing your performance, your edge, your executive function. This also differentiates from A DHD in that you're, you're not gonna just have, you're just not gonna regain your executive function just because now you're in menopause. The question always comes up though, like, how long am I gonna have to deal with this? And I have to say, firstly, everyone's different. But I wanna give you a bit of a helpful roadmap for you to kind of wrap your head around this. So first we have early and mid perimenopause. So foggy days are gonna come and go.

Which might be more tied to poor sleep. Stress might hit you worse. That might really pull on your brain a lot more. You may have heavy irregular cycles, so now you're having iron deficiency possibly coming up that's affecting your brain function. Thyroid issues can come up during this phase, so I don't want you to just assume it's perimenopause.

Okay? [00:48:00] We wanna look at what else is going on. But the biggest thing in that early phase is, oh, everything. We talked about progesterone, so there might be some impulse issues, but there can be a lot of rage, a lot of emotional swings, a lot of anxiety, a lot of sleep disturbance. We then transitioned to late perimenopause, which is, you know, edging towards early menopause diagnosis.

And so this is all happening around the final menstrual period. And this is when the biggest dip in mental speed and word recall happens. So if you're in a place right now where you're like, my brain is really struggling, that, and your periods are like, oh, 60 days or more apart, that is pointing towards you entering into menopause soon.

And that means there's light at the end of the tunnel. 'cause after your periods stop improvement commonly starts within a few months. And, and it's not like a slight switch. Okay. But it, it's a gradual improvement. [00:49:00] Many women start to feel back to their personal normal a couple years after their periods have fully stopped.

And I know you might be like, hold up seven, 10 years of this perimenopause business and then two more years. Like that's a long time. It is. Okay. It is. And we have to acknowledge that. It's why you need to be gentle with yourself. And I'm gonna talk through, I keep saying I'm gonna talk through your solutions.

I swear I am. I promise. I promise. I'm gonna talk to you about some things, but I do have to say this

if your brain fog is getting worse and worse and worse, you are having other symptoms like cold intolerance, hair loss, dry skin, sluggish digestion, they need to check your thyroid. If after your periods stop and things are getting worse, they're not getting better or you're not seeing any improvement at all, you need to ask your clinician to look for contributing factors.

And in fact, there's no reason why we can't rule these out earlier as well in perimenopause. So sleep apnea, insomnia, depression, [00:50:00] anxiety, thyroid, iron issues, certain medications, so, uh, sedating medications, um, antihistamines. Some of these things can definitely contribute. High alcohol use, long COVID, like there can be a lot of reasons why you have brain fog.

So again, I don't want you to just say it's just perimenopause, like always make sure you know it's not just perimenopause because no one said that you only have to have one thing. So now let's get into the tips about what you can do. So if you are noticing you have word slips and you're having slower recall, consider taking breaks during the day.

Your brain needs breaks. So you think about how we exercise, right? I hope you're exercising, we're gonna talk about, that's really important. But okay, you are doing squats. You do a set, right? You do one set and you rest during that exercise, your mitochondria is like, go, go, go. Put out the energy. And then it's like, I, I need some time to recoup.

I gotta, [00:51:00] I gotta pull more, more substrate from the environment. I gotta recoup, I gotta put out this energy. So your brain is very similar. It's not muscle tissue, but it's working in the same way as the muscle. So with that, I want you to consider how you can build in brain breaks. And if you can couple that with going for a walk, oh, that's such a great like stack of a two for one.

It's gonna help with insulin sensitization, it's gonna help with, yeah. Circulation to your brain, and it will ultimately help with your focus. So we gotta take the brain breaks. But you may also want to write key nouns or use prompts. Have 'em in your Apple notes. Um, if you are giving a presentation, use the presenter notes at the bottom. Um, you know, I am someone on my whole life. I have been really bad with names, not because I don't care to learn someone's name.

I can't learn someone's name unless I see it through the conference. If someone has a badge on, I have to like see that and they say their [00:52:00] name and then I'm like, okay, I got it. Um, that is something that I just tell people, Hey, you know, I'm not so good at learning people's names unless I see them. Can I see your badge?

Um, other times I will meet someone, ask them their name, and I try to like exchange a contact early on so I'm writing their name in. So find workarounds and different prompts that help your brain and that you can actually anchor into through this transition period. Now if your problem is that focus is hard 'cause your brain's noisy, the environment's noisy. Everything's noisy, noise canceling headphones. Yes, silence notifications, yes, but also try working in only 20 to 25 minute sprints. So most brains only have the capacity to really focus on something for like 20, 25 minutes.

That gives you an opportunity to have those brain breaks we talked about. But also during those sprints, they're literally sprints. They're, that's all you do. So you're like, 20 minutes, I'm gonna answer emails, nothing else. [00:53:00] Just emails. Or maybe you're someone who's like, okay, 20 minutes, I'm just gonna meal plan for the week.

Like whatever it is you need to focus on, that's all you do in those 20 minutes. You're doing nothing else. I would also encourage you to use body doubling. This is something I am a huge fan of. I know that this is gonna be like a crutch for me in late phase perimenopause. Maybe not. I got my radiant mind on lock, so maybe not.

I'm really hopeful. So just this last week, I was in my luteal phase. So I was just, a few days before my period, I had to make dinner. Nobody was going to eat if my husband did not come and just sit in the room with me. And that's what I said to him, I need you to come in. I need you to, I know you're working.

Sit on your laptop. I just need you to be in the room because I'm so unmotivated, so unfocused. Like I can't work through doing this dinner. Um, and literally no one's going to eat or we're just gonna order takeout. I don't know what it's gonna be. And he was like, sure. And he came and he sat there [00:54:00] and just because his body was there, I was like, okay, I can get this done.

So this is a whole, if you have a DHD, you're like, yeah, I know about this tip. This is the thing though. If you got diagnosed with A DHD before perimenopause, like you have tools, I hate to be the one to tell you that some of those are never, not no longer gonna work. And you have to get more tools, but you do have some of these tools and body doubling is one of those.

So de whether you are phoning a friend that helps for going for walks, uh, when you're like, yeah, I am not up for this. Have a phone call. Oh my gosh, I will literally FaceTime my sister when I need to clean my room. Um, because that then I'm like, oh, well I'm on the phone anyways. Like, I'm just gonna do stuff.

Uh, it works so well.

In this episode I've mentioned several times how important sleep is to your brain function, so although I have a two part sleep episode and then another sleep episode just for a DHD, I do want to talk a little bit about sleep in this episode. 'cause you're here. So why not do it right? If you're struggling with night sweats, 2:00 AM wake [00:55:00] ups, we gotta check your insulin.

You may wanna consider oral micronized progesterone, and if you're candidate for estrogen, we may wanna go to that route as well. 'cause that can really help with you getting good sleep. But outside of that cool bedroom, no late night alcohol. Um, make sure that you are in a relaxed environment, so no stressful tv.

And if you can avoid lights that are blue light emitting like a laptop or um, any screens that can really help with your melatonin. The other thing I would say is fix your wake time first. It is really a struggle in perimenopause when you're just like trying to fight, going to sleep so much like it becomes this bottle.

If you can then instead set a consistent wake time that you wake up within 15 minutes of the same time every day, that can help significantly because what it will do is we'll build sleep pressure during the day. So adenosine will build up that builds sleep [00:56:00] pressure and that will give the signal for you to go to sleep.

And so people usually start to notice things like five to seven days of a consistent wake time that they're like, I am actually getting tired at bedtime. And we love that. So that's a few of my tips for you right away. And again, show notes. I got you covered when it comes to sleep. The other thing that's gonna help your brain a lot is exercise. We wanna get like 150 minutes of aerobic activity a week and two days minimum of strength training. And so that exercise will also, if you do it in the morning, it's gonna help with your sleep. And if you do it in the morning and you get morning sunlight, that's also gonna help with your sleep.

But caveat here, if you're getting less than six hours of sleep, then that morning sunlight can mess with your circadian rhythm. Literally, nobody talks about this, so if you get less than six hours of sleep sunglasses in the morning, you're not gonna get exposed to light because that may mess with your circadian rhythm.

But if you get more [00:57:00] than six hours of sleep, then definitely morning sunlight that will help stoke the circadian rhythm to work for you. And if you haven't already grabbed the perimenopause weight loss plan, dr Brighten.com/plan, do that because that's an anti-inflammatory meal plan. Yes, it's targeted towards weight loss, but what helps weight loss is, um, helping your hormones, helping your sleep, helping your stress, and making sure you're eating an anti-inflammatory diet.

We all wanna be doing this anyways, so definitely grab that. Now I wanna talk about some key supplements that I researched in formulating the Radiant Mind and that I personally take for my brain health. And in this, I'm gonna tell you specifically what to look for because I never want you to feel like you have to buy my supplements or like I'm gatekeeping information from you.

If you do choose to purchase the Radiant Mind, there's the Code Pod 15 and you can get 15% off your first purchase. And for a limited time right now we're actually giving a free [00:58:00] bottle of Magnesium Plus with it, which I'm gonna, I'm gonna talk about magnesium as well. Um, because they go together, it works really well. That means if you're listening to this right now, odds are you can get a free 30 days of magnesium glycinate as a bonus. But I want you to know that it's only a limited time. Please don't be mad at me if you procrastinate, because I know that's what your brain is telling you to do. Don't procrastinate.

Okay? Um, maybe that's just me when my hormones are low. Anyhow, let's get into some key supplements that have clinical trials to back them that are showing big promise for brain health, for focus, for mood, for attention. And the very first one is saffron, but just not any saffron Aron specifically with this one, we wanna aim for 30 milligrams a day.

Like I told you before, like I, you know, I was only finding supplements that had 15 milligrams a day, so I was like having to double up on it. 30 milligrams, that's the [00:59:00] sweet spot. At least that's what I found to be the sweet spot. .

Something really cool about Saffron is there have been several human trials, including Aron that I'm talking about specifically, that have shown meaningful improvement in mild depression and anxious symptoms within about four to eight weeks of taking it.

So what people often experience is having a steadier mood that makes attacks starting and follow through a whole lot easier, and they just feel happier. Now, if you remember in this podcast I talked to you about neuroinflammation. So neuroinflammation can rise as estrogen declines or as part of having a DHD. We do see that there is neuroinflammation, and so saffron has carotinoids that can act as antioxidants and immune modulators..

There have been studies, some of which are on lab animals that show a reduction in oxidative stress and inflammatory signaling. So these are some of the factors that can keep the [01:00:00] brain in a noisy state. And so saffron may be able to contribute to calmer biology, that supporting clear thinking. What I think is really cool about saffron is that we've got the inflammation effects, we've got the brain effects, but there's also a sleep effect. So there was a Aron randomized clinical control trial that found better self-reported sleep quality. And remember, this matters because when your sleep is improved, your attention, your working memory is improved the next day.

Now keep in mind that these supplements are not medications, they're not drugs, they're not gonna work overnight and they're not intended to treat or cure disease. So what you can expect with taking something like Aron is that there should be a subtle lift in like your overall outlook in your irritability within a couple of weeks, maybe, you know, two to four weeks.

And then there's a more noticeable mood and [01:01:00] mental ease shift that happens about four to eight weeks. But we do wanna be doing this on top of sleep and protein and movement and fiber and you know, all of the things that supplements, I always say you can't all supplement a poor diet and lifestyle and they really are adding rocket fuel to your lifestyle.

The other one I wanna talk to you about acidic choline specifically. I chose coine for our product and we're looking at 250 milligrams daily for that because that supports executive function and also the speed in which your brain works. And I like to think about CT choline like this premium membrane part for neurons.

It's a really interesting molecule, so there's been human trials in healthy people that show better attention and faster psychomotor speed. And so you can think about like the start button and the mental tempo you need for planning and [01:02:00] prioritizing is supported with this molecule. So if you are the person that has trouble getting started, uh, keeping going on a project, coine is definitely one to be looking at.

The other thing about CT choline as it fits into this conversation of your brain remodeling, you know, through the perimenopause years, is that there's been research showing that it supports the membrane turnover, so the cells that are turning over, and it helps with the signaling specifically in the brain areas that drive executive function.

So it's a really interesting one when you consider that if we, we see perimenopause as this brain remodeling time to bring this in to support remodeling. It's basically like, you know, part of giving your body the building blocks to rebuild. Now from a mood perspective, what we look at is that potentially by stabilizing the frontal lobe and the energy there and the attention citicholine may [01:03:00] reduce the mental drag, that feels kind of overwhelming and that is something that is often felt as low mood in perimenopause.

So with C choline, the mood trials are limited, but what we wanna think about primarily is that it helps with cognitive support, which may help your mood feel lighter, and that's why it's really great molecule to be partnering with Saffron, which we know does have great research supporting its mood effects.

The other thing about Saffron I didn't even mention is that it can help with your libido. If you read, is this normal? I talked about in there how um, sometimes SSRIs can give you a low libido. Saffron can help you overcome that, and that's pretty cool. So with Cyt choline, if you're taking this, we usually see improvement happening about a month.

Some people it takes up to three months for like attention, accuracy, um, mental snap if you will, to, to [01:04:00] really markedly improve. But some measures shift as early as four weeks. But I like to give people like a realistic understanding of like, some things get better in four weeks. Some things take up to, you know, three months.

And so, um, setting realistic expectations of what it will look like to see improvements with Cozine, I think is really important. Now with Bacopa, you, if you have a DHD probably heard about Bacopa 'cause it's like one that like a DHD brains love. And the specific form we're using is bacognize. I hope I'm saying that right. I look it up all the time and I keep finding different ways of saying it, but it'll be in the show notes. with this particular form of a copa, we're looking at 300 milligrams a day, especially when we're wanting to support memory and calm focus. Not like amped up focus, but calm focus. So Bacopa works like a bit of a memory trainer. There's been interesting randomized control trials with a [01:05:00] particular form of bacopa that we're using that show improvements in new memory formation in subjective stress and anxiety.

And with this one it's, it's more like six to 12 weeks of use that we really see improvement.

But bacopa shows promise for supporting memory learning, recall staying on task. So executive functions again, it's also, um, been looked at for brain inflammation and brain health overall.

Bacopa has antioxidant and anti-inflammatory actions that may help protect the synapses in the brain. So that is something that could be really useful when hormonal fluctuations are happening and your networks are retuning, rewiring, you're going through that system update. BACOPA may in fact help with that.

It's something that I'm hoping that we get more research just specific on perimenopause and menopause for these, [01:06:00] um, supplements. But right now, I mean, we have so little funding for that overall. But the randomized control trials, which I will link to in the show notes, have been really promising. And overall, these three supplements that I just discussed with you, they have been generally well tolerated. Um, you know, sometimes there's mild GI upset and that's usually solved with splitting the dose so that you're not taking it all at once.

With Bacopa, like I said, it's about eight to 12 weeks of taking it consistently before you can judge the full effect. That's when typically memory and learning gains are most notable, but they do accrue gradually over time.

It just is something that, it's subtle shifts rather than just like flipping a switch. And as I'm talking about this, I realize like this is a lot of information to take in. I will put a quick cheat sheet in the show notes about these particular ingredients that I'm talking about. Um, [01:07:00] so that you, if you're someone who's right now struggling, 'cause you're not an auditory learner, predominantly, I'll give you to you written as well so that you can see it.

So when we're thinking about executive function, like starting things, planning things, sustaining focus, sit choline can help with attention, uh, controlling your attention and your processing speeds. So how quickly your brain's running thoughts, but COPA looks promising for new memory and having a calmer state of focus, saffron, steadier mood, lower friction to start things, um, you know, promising for neuroinflammation and also helping your libido. And as a reminder, you know, these supplements are in addition to what you're already doing. So we know, you know, things like the Mediterranean diet or Mediterranean leaning diet or an anti-inflammatory diet. These things are really tremendously helpful for brain health. So you don't want to skip the nutrition and [01:08:00] just opt for a supplement alone.

Then of course if you are pregnant, you're on medications, you're managing medical conditions, you always wanna loop in your provider before you start any supplement. I promise we are gonna talk about magnesium, so let's do that because what magnesium does in the brain is pretty awesome. So magnesium, really important molecule, so good to get it from your food, but not all of us can all the time.

I wanna talk about some of the research around it, but you know, I like to think about magnesium is helping like buffer what's happening in the brain. So it naturally is involved with your learning and your memory. It helps prevent over excitation. So that's where I'm talking about that buffering. It supports the GABA related, the calm break that we talked about and it can help with protecting the brain health overall and supporting neuroplasticity.

There's [01:09:00] also been information coming out showing that it can help with brain inflammation. So we know when there's low magnesium that the microglia, that's the brain's immune cells, they can start to ramp up inflammatory messengers and that can, that can lead to what people call leaky brain. So there can be impairment of the blood brain barrier, um, and that can also make it to where it's much harder to focus, much harder to run.

Thoughts. You feel like you have brain fog. So restoring magnesium can help normalize these pathways, there have been animal studies where they have mimicked low estrogen states and then they used magnesium and they found that magnesium can help reduce the neuroinflammation response that happens in the brain as estrogen declines. And much like exercise influences the BDNF alpha pathways, the brain derived neurotropic factor pathways that help with your neuroplasticity, magnesium does this as [01:10:00] well. And this is very much key for attention and memory, especially as we age. And the other great thing about magnesium is that while it's also supporting brain health, it's also supporting sleep. So magnesium can help with nudging your GABA tone and relaxing the nervous system. It can shorten the time it takes to fall asleep in some people, and it helps promote the type of sleep that supports your next day attention and memory.

Now what's actually been shown in people, this is not just theory, is that if you have a higher dietary magnesium intake that's been associated with larger brain volumes and fewer white matter lesions, when they scan people on an MRI, and in the study I am referencing this, well, firstly it's an observational study, but it was specifically in mid to late adulthood that they were looking at, they actually found that people who had higher magnesium, about 550 [01:11:00] milligrams a day, had younger looking brains than their cohorts who were not taking in as much magnesium.

There was also a 12 week randomized, double-blind, placebo controlled trial of older adults with cognitive complaints,

and magnesium was found to have a notable effect on their executive function. Now, the study was small, but it did have a rigorous design, and it did show that magnesium helped with task switching and with planning. So these are some very key executive functions that we've already discussed in the podcast. As I mentioned before, magnesium can help support sleep. Uh, I love magnesium glycinate for women because that little glycinate molecule can be really helpful for sleep. And there was a study in older adults that found that magnesium reduced sleep onset latency by about 17 minutes, which are modest benefits, but honestly very meaningful.

If [01:12:00] you are somebody who's like, I toss and turn for like 45 minutes, getting like 17 minutes off of that, that's pretty significant for somebody who's having that kind of sleep struggle. Now, there was another recent randomized control trial with magnesium that also showed improved sleep quality and deeper sleep stages in adults who had sleep complaints.

So that is really interesting as well, especially when you consider, I talked about the hot flashes waking you up, the fragmented sleep, disrupting your deep sleep phases. So magnesium may be helpful there. In mild to moderate cases of depression, magnesium supplementation has also been shown to be really helpful in reducing some of those symptoms.

There's another really common symptom in perimenopause that's happening in the brain, affects brain function, affects concentration, and we just don't talk about it enough, and that is migraines. And migraines are definitely [01:13:00] an executive function. Disruptor. Magnesium has been shown to be helpful here, so the American Headache Society recommends 400 to 600 milligrams a day of magnesium.

They're often recommending oxide or citrate. That much citrate might give you diarrhea. Okay? So just be careful. But they're recommending 400 to 600 milligrams a day for prevention, and the overall evidence, I will say is modest, but the safety is really good. And when you start to look at, okay, if you have migraines, we can use magnesium.

Um, as an intervention. I typically use 300 milligrams of magnesium glycinate twice a day, five days before the expected onset of a migraine. Because in women we tend to know it's going to be around ovulation or it's going to be right before menstruation. In perimenopause, it can become more unpredictable because in late face perimenopause, you may throw a migraine anytime because god knows [01:14:00] what estrogen's up to these days, right?

So in those cases, 300 milligrams twice a day, every day is just the way to go. Now why magnesium matters for executive function, brain health, neuroinflammation mood is because if we can stabilize signaling in the brain for like GABA, NMDA, uh, and support BDNF Alpha, I know that's like a whole lot of acronyms, soup, but we can, we can support signaling and plasticity with magnesium.

We can support the brain and how it runs its focus, it's working memory, it's task switching the domains that sometimes make it feel noisy and midlife. We may be potentially able to keep the brain filling and acting younger and we love that. And like I said, you know, if you're taking magnesium citrate, there's a risk of having diarrhea.

If you're taking other forms of magnesium, like magnesium glycinate, three innate less risk of having those, you shouldn't have [01:15:00] them. But you might be the one person who's like, oh, it was me, I, I had it. And keep in mind that higher magnesium intake is tracking with a healthier brain structure measured on an MRI, so you can actually see it. And that is a hint that better magnesium status may protect our tissues over time. Remember I said that getting it from food is also important. So leafy greens, beans, lentils, nuts, seeds, whole grains, chocolates, we always love it when I say chocolate, right? Um, those are great sources of magnesium. Unless you're a migraine person who's has migraines triggered by chocolate, then you hate me.

I'm sorry. That's the worst. Uh, I'm sorry for you. That's, I, if I could take that away, I would. So when we talk about supplementing outside of the migraine conversation with magnesium, the RDA is 320 milligrams a day for women, four 20. If you are a man, um, you know, the [01:16:00] RDA is just the like bare minimum to avoid a deficiency.

So I think we need research to tell us, like, is that actually the best levels to be taking in every day? Especially in the wake of research showing 550 milligrams is associated with a younger brain. So with the RDA, I think it's a good like baseline, but take it with a grain of salt because the RDA is like, we're just doing the minimum to keep you from developing a disease.

It doesn't mean it's optimal. And so what you may need may be different. And I think that it's always important to honor that. I say that as somebody who did the dual track of didactics and nutrition science when I was getting my degree and why I've come to this, this stance here is because of the contradictions that happened when I was in school watching the dietician track say, oh, this is like, this is what's buzz full, [01:17:00] the RDA da da da.

And then being in the scientific track and actually looking at the science and being like the RDA is not so great, not so great sometimes for certain populations. And so that's where I think, um, I think that's like one of the biggest issues with medicine, right? We're not looking at the individual. It's not bio individual.

There's just these blanket statements, recommendations, and then we expect everyone to fit in the box. And when you don't fit in the box, you are the problem, not the box. The box is the problem for some people. As long as I'm talking about magnesium, I also want to note that if you've long-term used A PPI, um, certain diuretics, you might have lower magnesium and you may need to supplement and your provider may not be checking that. You can do a red blood cell and RBC magnesium, see what your magnesium levels are.

But if you're struggling with brain fog, cramps, even heart arrhythmias, you don't wanna just be like, I have a heart arrhythmia. I need magnesium, but you may need magnesium. And I want you to talk to your provider about that. So the bottom line is that as we [01:18:00] age, magnesium is gonna help your brain stay balanced, connected, calmer. It supports executive function, it supports healthy brain tissue. It can help with neuroinflammation. It may help you keep a steadier mood, better sleep, less migraines, less headaches. And we want to always focus on food first because there's a lot more in your food than just the minerals.

And if you're eating the foods and the diversity to get magnesium, you're getting a whole lot of phytonutrients as well. And I have an episode with Dr. Kara, Fitzgerald. I will link to, and you'll know why you, you want all of those. Then we wanna consider supplementation and we wanna tailor the dose for what our goal is, the medical context to what, what health conditions we have if we're actually able to meet the daily requirements through diet.

So I've talked about supplements, but wanna give you some more tips before we wrap up today's episode to help with brain function, especially if you're in the early phase perimenopause. I think this is something you should [01:19:00] start right away and keep this habit going ongoing. And if you haven't started it, today's a great day. The habit is deep breathing and you can do box breathing. Inhale for four, hold for four, exhale four, hold for four, repeat. Or you can do inhale for four. Exhale for six, which is gonna stimulate the parasympathetic nervous system. It's basically what works for you. That longer nudge of exhale helps your nervous system calm down.

Leveraging your breath is a great way to also stimulate the vagus nerve, and that helps with neuroinflammation as well. So deep breathing is more than just you feeling zen and chill. Deep breathing is also going to help with your brain function. So we also know that those who practice mindfulness and meditation do have better cognition and brain function.

[01:20:00] So trying to incorporate that in your day-to-day life. And look, mindfulness can be as simple as paying attention to what you're eating, smelling it, tasting it, chewing it. Please chew, please chew your food. Uh, but you know, we don't have to overcomplicate these things. We can integrate them into our day to day life.

I wanna reiterate that if your brain is already experiencing static, you need noise canceling headphones or earplugs, you need to put your phone on focus mode. You need to, uh, turn off all notifications at work. You could just let people know, Hey, 20 minutes I'm going into a sprint. I just need to focus.

I'm turning off everything. Because the less input you are having into your brain, the more it can use its energy for the task at hand. I would also encourage you to structure a bedtime routine that's nourishing your nervous system. Warm bath and shower, dim lights, screens off before bed. 60 minutes is, you know, if [01:21:00] possible, maybe doing, um, some puzzles, some reading, some things that are, you know, seen as just like frivolous and extra and like who has the time for that are really important to give your brain wind down time and to give time off.

I would also recommend to start some brain training apps or doing puzzles or anything that is, uh, especially novel to help your brain be trained and stay sharp. So there are lots of apps that help out there with training your brain, keeping it young, keeping it sharp. We need to be doing those. And if you can pick up a new hobby to support neuroplasticity, to support your brain, I think that's a wonderful thing to do.

Like something like maybe ceramics, something like dancing, something that is physical, that you are moving, that you are using your body with is another way we can really help to [01:22:00] support our brain through the perimenopausal years. And there is so much research out there about, you know, supporting brain health, about preventing Alzheimer's and dementia, but not a lot of it is just focusing on perimenopause and menopause and the struggles that we have.

So we definitely have to go through and, and look at, uh, what the research is saying in terms of promise for preventing some of those conditions and asking could this benefit us? And if it's yes and there's no risk, start implementing these things. And the last thing I wanna say is talk to your clinician about cognitive behavioral therapy. Cognitive behavioral therapy for insomnia. If you're finding you have rumination, if you are finding you have night sweats, hot flashes, and sleep disturbance, that even once you've corrected the underlying issues or maybe start a hormone therapy, your sleep issues persist because this is [01:23:00] something that we don't always talk about.

That just because you fix the underlying issue doesn't mean it fixes the habits and the behaviors that developed from that. Now, before we close out today, I wanna talk about removing the ovaries before natural menopause. And now that raises your risk later in life for cognitive problems. So first thing, if you have your ovaries removed, they should be considering estrogen therapy and continuing that estrogen therapy.

So what the evidence shows is that early loss of ovarian hormones matters greatly. So whether it's a ectomy bilateral, you remove both your ovaries, or maybe they're putting you on Lupron long term, they should not be doing that, but some people do that and I don't like them. Um, or you have, uh, functional, hypothalamic a amenorrhea and you've lost your hormones and no one's giving you hormone replacement therapy.

And, uh, you know, maybe that happened at 35. And then here you are at 45 and now you're going into perimenopause. So [01:24:00] we know these hormones matter greatly. So when it comes specifically to the ectomy, which is the big word for taking your ovaries surgically, we know that if that happens before natural menopause, it is linked to a higher long-term risk of cognitive impairments and possibly dementia as well. And we know that women who lose their ovaries, the younger the surgery is, the greater the risk.

Okay, I'm gonna put this study up so that you can see it. Uh, so what has been found is that premenopausal, bilateral removal of ovaries, those women have higher odds of mild cognitive impairment and poor cognitive test scores 30 years later compared to their peers. So this isn't some short term brain blip.

This is a long term impact on your cognitive health. There was another [01:25:00] study that came out in 2019 that showed that women under age 45, who had surgical menopause that was associated with a higher dementia risk and that surgical menopause at any age was tied to faster decline in verbal memory and processing speed.

 so what brain imaging is showing us is that women who are premenopausal and they have had their ovaries removed, they show reduced white matter integrity years. Years later, which is consistent with long-term brain effects of abrupt estradiol loss. So what is it? The crux of this?

They take your ovaries, your estrogen drops rapidly and you have none. So this is what I was talking about with my Lupron story, and I can't even believe there are doctors who do that to like 20 something year old women for like years. I can't even imagine. I went months and I was losing my mind lo I thought I was gonna lose [01:26:00] like a grasp on my reality and my life altogether.

So the question is, right, does estrogen therapy help? Uh, yeah. So the evidence is looking really good there. So there has been evidence suggesting that if estrogen therapy is started after a premenopausal ectomy and continued, they've looked until about the age of natural menopause. Um, so they've looked at like whatever age you were, they take your ovaries, we start you on estrogen.

And then menopause is on average about 51 years old. Okay? What happens then if we no longer have estrogen? So the excess cognitive risk that we've been talking about has been largely mitigated, uh, when given estrogen, and it's not contraindicated. So this aligns with the idea of the critical window for estrogen's neuro production that you've heard me talk about in other episodes.

So giving estrogen within 10 years of menopause can offer neuroprotection. And it's not that like past 10 years you [01:27:00] get no protection as all. It's just not as good. It's just not as good. And, and it's a missed opportunity. And, um, the Women's Health Initiative did us all dirty. And it is seriously the Women's Health Initiative and what clinical practice became after that was one of the greatest disservices ever done in women's health. But that aside, let me give you some context here. So, hormone therapy is not used to prevent dementia in women who reach menopause at the usual age, but after surgical menopause. Most expert bodies consider hormone therapy to reduce several adverse outcomes like bone loss, cardiovascular disease, urogenital conditions like increased risk of UTIs and pyelonephritis kidney infections, and is very likely based on the research we have that it also can protect your brain.

So what I'm talking about here very specifically is not that you had natural menopause and not what we [01:28:00] talked about the start of this episode. I'm talking about you abruptly lose your ovaries in your thirties. You were never meant to go a couple of decades without having that estrogen. Okay? And that's why we have to consider estrogen hormone therapy here.

And it is a replacement therapy at that point. Now, when it comes to removing just one ovary, there was, it's been found that there's an increased cognitive risk after unilateral or bilateral ectomy if it's done before menopause. Again, younger age, higher risk, but the negative effects is more consistent and abrupt with bilateral removal.

So why I say this is that if your doctor's like, well, we're taking one, we might as well take two. No, no. If there's no reason to take two, leave one in there. Because while you will experience some cognitive decline, in most cases, that one ovary may offer a little bit of protection. And listen, just [01:29:00] because you retain your ovaries doesn't mean you are in the clear. So you may still need to be assessed. You may still need hormone therapy because there have been some studies showing that a hysterectomy, even when you keep your ovaries, is associated with higher risk of dementia in certain age groups.

And so this all underscores that gynecological surgeries and abrupt endocrine changes have major brain repercussions and part of the surgical conversation is we have to be having the conversation about what comes next with hormone therapy. Because if you have your organs removed, you should definitely be offered hormone replacement therapy.

If you're a candidate, even if you retain your ovaries, if they're not functionally optimally, you should still be considered. If you're listening to this right now, I would encourage you to avoid elective ovary removal before age 50. If you're an average risk person, there's [01:30:00] certainly conditions when you might wanna consider it. So you, you know, if the ovaries are being removed 'cause you're high risk with the BRCA gene, there's compelling indications, then you need to discuss hormone therapy, at least until age 50 to 51 and less contraindicated.

But honestly, there's no reason just to stop at 51. We're starting most patients right around that age. So why would we just stop you? We don't need to. But the re the research has shown that like in terms of cognitive health, like if you stop, then not, not as negative effects as if you had never started it altogether.

If you're gonna go in for a surgery, baseline cognition, sleep, mood, cardiometabolic checks, have all of that, all your symptoms tracked, all your labs done, recheck that six to 12 months post-op and make sure that like things are still going well. And if you are someone who has had a hysterectomy, you've had your ovaries removed and you're [01:31:00] listening to this, know that the things that we talked about in this episode can help you too. So the exercise we talked about, the anti-inflammatory way of eating, dr Brighten.com/plan, go grab it. You can start implementing that.

Um, making sure that you are doing something to safeguard your sleep. So I don't want you to feel like, okay, I made a mistake, I had my ovaries removed and it's game over for me, it's not, there's lots of things that you can still do, and it sometimes feels overwhelming, right? Because there's so much that you can do.

But I don't want you to look at it as like, I have to do all the things. It is, what is the thing that I can implement right now that can move the needle most? And listen, before we leave this podcast, I should also just mention again, sleep apnea thyroid iron deficiency, B12 deficiency, uh, long COVID depression, anxiety.

Certain medications can also be contributing to your brain fog. So maybe you had a hysterectomy, but you've got these other factors going on. Make sure you work with a [01:32:00] provider who is working you up thoroughly and can investigate everything that could be the cause of why your brain is struggling. Now as always, thank you so much for being here.

I know this was a long episode and a whole lot of information. Again, if you want to grab the Radiant Mind Pod, POD 15 gets you 15% off and for a limited time, we're throwing in the Magnesium. Plus, as a thank you for trusting in me and my team to bring you the best quality supplements. Always third party tested, always screened, and always making sure that we are using the highest quality sustainable ingredients manufactured in the United States.

If you can take a minute, leave me a review, let me know what was helpful about this episode and what else you would like to hear more on the Dr. Brighten show. Please let me know. 'cause I am always searching for guests and topics that will fill the need of the information gaps that you have and help you live the healthiest life.

So until next time, take care of your [01:33:00] hormones and they will take care of you.