In this episode we discuss:
- New research revealing reductions in gray matter, white matter hyperintensities, and altered blood flow during menopause
- Core drivers of brain fog – reduced cerebral blood flow, chronic inflammation, and estrogen decline
- The gut-brain-hormone connection and how the estrobolome influences circulating estrogen
- Strategies for supporting brain health, including a nutrient-dense diet, physical activity, stress management, and sleep.
- Which nutrients, foods, and botanicals may help support brain health during menopause
Show notes:
- “Nigella sativa seeds ease severity of premenstrual syndrome in women: A randomized, double-blinded, placebo-controlled study” by Afrin, F., et al.
- “Menopause effects on verbal memory: Findings from a longitudinal community cohort” by Epperson, C.N., Sammel, M.D., & Freeman, E.W.
- “Fecal microbial determinants of fecal and systemic estrogens and estrogen metabolite concentrations in postmenopausal women” by Flores, R., et al.
- “Effect of an ashwagandha (Withania somnifera) root extract on climacteric symptoms in women during perimenopause: A randomized, double-blind, placebo-controlled study” by Gopal, S., et al.
- “The effects of a saffron extract (Affron®) on menopausal symptoms in women during perimenopause: A randomised, double-blind, placebo-controlled study” by Lopresti, A & Smith, S.J.
- “Omega-3 fatty acids, brain health and the menopause” by Minihane, A.M.
- “Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition” by Mosconi, L., et al.
- “Flaxseed: Its bioactive components and their cardiovascular benefits” by Parikh, M., Netticadan, T., & Pierce, G.N.
- “Menopause and brain structural changes: A bibliographic revision” by Rodríguez, A.P., et al.
- “Effects of ashwagandha on reproductive health: A systematic review of sex-specific hormonal and fertility outcomes” by Roy, D., et al.
- The Menopause Society. (2025, October 21). How menopause restructures a woman’s brain [Press release].
- “Cognition and mood in perimenopause: A systematic review and meta-analysis” by Weber, M.T., Maki, P.M., & McDermott, M.P.
- “Beneficial effects of docosahexaenoic acid on cognition in age-related cognitive decline” by Yurko-Mauro, K., et al
- Learn more about the Adapt Naturals Core Plus bundle, Bio-Avail Omega+, Biome Protect, Steady Spirit, Luminous Mind, or take our quiz to see which products best suit your needs
- If you’d like to ask a question for Chris to answer in a future episode, submit it here
- Follow Chris on Twitter/X, Instagram, or Facebook
Hey everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. If you’re a woman in your 40s or 50s, or you know someone who is, you’ve probably heard about brain fog during menopause. Maybe you’ve experienced it yourself. You walk into a room and forget why you’re there. You struggle to find the right word in a conversation. You read the same paragraph three times and still don’t remember what it said. It’s frustrating, it’s unsettling, and for many women, it’s been incredibly isolating because for years, these symptoms were dismissed or minimized by healthcare providers.
New research presented just last month at The Menopause Society’s annual meeting confirms what women have been saying all along. Menopause brain fog is real. It’s not all in your head. It’s not just stress or aging. It’s not something you should just accept and live with. This research shows actual, measurable structural changes in the brain during menopause – changes in gray matter volume, blood flow, in white matter of the brain, and we can see it on brain scans. By understanding the mechanisms behind brain fog [and] what’s actually happening in the brain, we can develop better, more targeted interventions. We can address the root causes instead of just suppressing symptoms with medications that often don’t work and come with significant side effects.
In this episode, I’m going to walk you through what this new research found, explain the three main mechanisms that contribute to brain fog during menopause, talk about a connection between your gut health and your hormone levels, and share evidence-based strategies you can use to support your brain health during this transition. By the end of the episode, you’ll understand why brain fog happens, and you’ll have a roadmap for what you can do about it. Let’s dive in.
The Research – Brain Fog is Real
Let’s start with the science. In October 2025, researchers from Ponce Health Sciences University in Puerto Rico presented a comprehensive review at the Menopause Society’s annual meeting. They analyzed recent studies looking at brain structural changes during menopause. First, they documented consistent reductions in gray matter volume in key regions of the brain. We’re talking about the frontal cortex, which is involved in executive function and decision making, the temporal cortex, which plays a role in language and memory processing, and the hippocampus, which is critical for memory consolidation. These are exactly the areas you’d expect to see affected if someone is experiencing forgetfulness, trouble concentrating, and difficulty with word-finding. These volumetric losses or reductions in gray matter were directly correlated with declines in cognitive performance. Women in these studies scored lower on tests measuring verbal memory and visuospatial memory. So we’re not just seeing changes on a brain scan, we’re seeing functional impacts on the cognitive abilities women report struggling with.
The researchers also found something called white matter hyperintensities. These show up as bright spots on MRI scans, and they indicate tissue damage in the white matter of the brain. White matter is like the communication highways in your brain. It connects different regions and allows them to talk to each other. When you have damage to these pathways, it affects thinking, memory, and mood. These white matter hyperintensities were more pronounced in two groups of women: those who went through early menopause, and those who had frequent hot flashes and night sweats. That tells us something important about the mechanisms at play.
Before you start worrying that this is permanent damage, the research also found evidence that gray matter volume may partially recover after menopause. The brain showed signs of adapting and reorganizing itself. This is neuroplasticity in action. Your brain is resilient and it can bounce back. Dr Stephanie Faubion, who’s the medical director of The Menopause Society, emphasized that there’s no evidence that menopause brain fog is associated with later risk of dementia. So if you’re experiencing brain fog during perimenopause or menopause, it doesn’t mean you’re on a path to Alzheimer’s. These are temporary, transitional changes, especially if you get the right support.
The Three Mechanisms
So what’s driving these changes? Based on the research and what we know from functional medicine, there are three main mechanisms at play: reduced blood flow, inflammation, and hormone decline. Let me break each of these down starting with blood flow. Those white matter hyperintensities I mentioned? They’re primarily caused by reduced blood flow to the brain’s white matter. Think of your brain like a city, and the blood vessels are the roads that deliver supplies – oxygen, glucose, and nutrients – to all the neighborhoods. When traffic slows down, certain areas don’t get what they need to function optimally. During menopause, there are changes in cerebrovascular reactivity. That’s a fancy way of saying that the blood vessels in your brain don’t respond as well to the brain’s demands for increased blood flow. This is especially pronounced in women who have frequent hot flashes. Hot flashes aren’t just a temperature regulation problem. They reflect vasomotor instability – dysfunction in how your blood vessels constrict and dilate. And that same instability affects blood flow to the brain. Think of your brain’s blood vessels like adjustable hoses in a garden. Normally, they can widen or narrow based on which parts of the garden need more water. But during menopause, those hoses get a bit stiff. They don’t adjust as readily. So some areas of the garden, or in this case, your brain, don’t get the water they need, especially during times of high demand.
The second mechanism is inflammation. As you probably know by now, inflammation is a normal, healthy response to injury or infection. The problem is when inflammation becomes chronic and widespread, and that’s what happens for many women during the menopause transition. Estrogen has powerful anti-inflammatory effects throughout the body, including in the brain. When estrogen levels decline, you lose some of that natural anti-inflammatory protection. At the same time, many women are dealing with other sources of inflammation [like] poor diet, lack of sleep, chronic stress, gut dysfunction, etc. All of this adds up. Chronic inflammation in the brain doesn’t just damage tissue directly. It also affects the function of neurons. It interferes with neurotransmitter production and signaling. It impairs the brain’s ability to make new connections. And it contributes to that feeling of mental fog, where everything just feels harder and slower than it should be. Think of inflammation like static on a radio station. The signal’s there, but it’s harder to pick up clearly. Your neurons are trying to communicate with each other, but the inflammation creates interference.
The third mechanism is the decline of estrogen itself. Estrogen isn’t just a reproductive hormone. It has receptors throughout the brain and plays crucial roles in brain function. Estrogen boosts the activity of neurotransmitters like serotonin and dopamine, which affect mood and cognition. It supports the energy metabolism of neurons, helping them generate the ATP they need to function. It promotes the growth and branching of neurons, which is essential for learning and memory, and it has neuroprotective effects, defending brain cells against damage. So when estrogen levels plummet during menopause, the brain loses all of these benefits. It’s like removing a key player from a team. The team can still function, but not as smoothly or effectively. You can also think of estrogen as a maintenance crew for your brain. It keeps things running smoothly, repairs damage as it occurs, and ensures all the systems are well supplied. When that maintenance crew suddenly leaves, things start to break down. The backup systems kick in, that’s the adaptive response we see with increased estrogen receptor density, but it takes time for the brain to adjust to this new normal, and it doesn’t always adjust well.
Struggling with mental “fuzziness” during perimenopause or menopause? You’re not alone. This episode explains what’s happening in your brain, why it’s not a sign of dementia, and the evidence-based steps you can take to regain clarity, memory, and focus. #RHRpodcast #menopause #ChrisKresser
The Gut-Hormone Connection
There’s a connection between your gut health and your hormone levels that doesn’t get talked about enough in mainstream medicine. It involves what we call the estrobolome. The estrobolome is the collection of gut bacteria that are capable of metabolizing estrogen. These bacteria produce an enzyme called beta-glucuronidase, which can reactivate estrogen that the body was trying to eliminate. When your body is done using estrogen, your liver packages it up for elimination. It attaches a molecule called glucuronic acid to the estrogen, which makes it water-soluble so it can be excreted in urine or stool. This process is called conjugation. The conjugated estrogen gets sent to your intestines to be eliminated, but the gut bacteria come in. If you have certain types of bacteria in your gut, they produce beta-glucuronidase, which can detach that glucuronic acid molecule. This reactivates the estrogen, allowing it to be reabsorbed back into circulation instead of being eliminated. So the composition of your gut microbiome – which bacteria are present, and in what quantities – can significantly influence your estrogen levels. If you have gut dysfunction, if you have the wrong balance of bacteria, or if you have damage to your gut lining, this can affect how much estrogen is reabsorbed versus eliminated.
This is part of what I call the gut-brain-hormone axis. Your gut health affects your hormone levels. Your hormone levels affect your brain function, and your brain function affects everything else. It’s all connected. This is also why some of the foundational lifestyle interventions I’m going to talk about are so important. When you support gut health, you’re not just helping your digestion, you’re potentially influencing your hormone balance, which in turn affects your brain.
What You Can Do About It
Now that we understand the mechanisms, let’s talk about solutions. In functional medicine, we always look for ways to address root causes rather than just suppressing symptoms. And when it comes to menopause brain fog, there are evidence-based interventions that can make a real difference. I organize these into what I call the four pillars: diet, physical activity, stress management and sleep. These are foundational. They’re not optional, and they’re essential for supporting brain health during the menopause transition.
Let’s start with diet. An anti-inflammatory, nutrient-dense whole foods diet is crucial. You want to emphasize foods that support both brain health and hormone balance. That means plenty of meats, organ meats, vegetables, especially leafy greens and colorful vegetables rich in antioxidants, wild-caught fatty fish and seafood for omega-3s, pasture-raised eggs, nuts and seeds, some fruit, especially berries, and healthy fats like olive oil and avocado. You also want to minimize foods that promote inflammation and disrupt blood sugar balance. This means cutting back on refined carbohydrates, processed foods, industrial seed oils and excess sugar. These foods don’t just cause inflammation throughout the body, they also disrupt gut health, which, as we just discussed, can affect hormone levels.
Regular physical activity is another non-negotiable. Exercise has multiple benefits for brain health. It increases blood flow to the brain, which, as we discussed earlier, can be impaired in women with menopause. It reduces inflammation. It stimulates the production of BDNF, or brain-derived neurotropic factor, which promotes the growth of new neurons and connections between neurons. And it improves insulin sensitivity and metabolic health, which are important for brain function. You don’t need to become a marathon runner. We’re talking about 150 minutes per week of moderate activity, which could be brisk walking, yoga, swimming, cycling, [or] strength training, punctuated ideally by some periods of more intense activity [like] sprints, weight training, or more intense glycolytic activity. The key is consistency, and finding something you enjoy to stick with.
Stress management is critical because chronic stress amplifies all the mechanisms we talked about. It increases inflammation, it impairs blood flow to the brain, and it can disrupt hormone balance even further. There are many effective stress management techniques, meditation and mindfulness practices have good evidence behind them, deep breathing exercises, time in nature, meaningful social connections, the specific technique matters less than finding something that works for you and doing it regularly.
Sleep is critical. This is often the hardest one during menopause because hot flashes and night sweats disrupt sleep. But sleep is when your brain does its housekeeping. It clears out metabolic waste products, it consolidates memories, [and] it repairs damage. When you don’t sleep well, cognitive function suffers. Prioritize sleep hygiene. Keep your bedroom cool and dark, maintain a consistent sleep schedule, [and] limit screen time before bed. If hot flashes are disrupting your sleep, that’s something you need to address, whether through lifestyle interventions, natural compounds, or if needed, hormone therapy.
Beyond these four pillars, there are specific nutrients that can support brain health during menopause. Omega-3 fatty acids, particularly EPA and DHA, are crucial. Your brain is made up of about 60 percent fat, and DHA is one of the most abundant fats in brain tissue. Omega-3 supports healthy inflammatory balance, which is essential given what we know about inflammation’s role in brain fog. They also support cognitive function and mood. Research specifically on menopause and omega-3s is still emerging, but the evidence is promising. Studies show that omega-3 supplementation can improve memory, focus, and overall cognitive function. And in women going through menopause, omega-3s may help with the cognitive symptoms associated with hormonal changes.
Curcumin, the active compound in turmeric, is another nutrient that can help support healthy inflammatory balance. The challenge with curcumin is it’s not well absorbed in standard preparations, so you need a highly bioavailable form to get meaningful benefits. For improving blood flow to the brain, ginkgo biloba has good evidence. Ginkgo contains compounds that boost cerebral circulation, allowing more oxygen and nutrients to reach brain cells. Multiple studies have shown that ginkgo can enhance memory, focus, and overall cognitive performance, particularly in people experiencing age related cognitive changes. Some women will also benefit from natural compounds that promote hormonal balance. Botanicals like black cohosh, red clover, vitex, shatavari, and schisandra have been used traditionally for menopausal symptoms, and there’s research supporting their benefits. For gut health specifically, include fermentable carbohydrates like sweet potatoes and root vegetables that feed beneficial bacteria. Fermented foods like sauerkraut, kimchi, kefir, and yogurt introduce beneficial microbes. Bone broth provides amino acids like glutamine that support the gut lining. And prebiotic-rich foods like garlic, onions, and asparagus nourish the bacteria that help regulate estrogen metabolism.
I want to mention a few products we’ve developed at Adapt Naturals that address these mechanisms. Bio-Avail Omega+ combines ultra pure fish oil with highly bioavailable curcumin, 185 times more bioavailable than standard forms, plus black seed oil or Nigella sativa. Each serving provides about one gram of EPA and DHA to support healthy inflammatory balance, cognitive function, and mood. A 2025 study found that Nigella sativa, which is black seed oil, significantly increased estrogen levels in women and improved hormonal balance. Luminous Mind is our cognitive support formula with ginkgo biloba to promote blood flow to the brain, plus bacopa, lion’s mane, citicoline, and other nutrients that work together to boost focus, memory, and mental clarity. Biome Protect is our four-in-one gut health formula with prebiotics, probiotics, postbiotics, and polyphenols. It contains tributyrin, which is a bioavailable form of butyrate for gut barrier function, bacillus coagulans probiotic, FortiPhage prebiotic, and a polyphenol blend. Since gut health affects hormone metabolism through the estrobolome, supporting your microbiome is an important piece of the puzzle. And last, Steady Spirit is our stress and mood support formula with clinically studied doses of ashwagandha and saffron. Recent research shows both significantly improved psychological symptoms, sleep quality, and cognitive function in perimenopausal women. It also includes L-theanine, lemon balm, and holy basil for complete stress management. You can learn more at AdaptNaturals.com, and check with your healthcare provider to make sure these are appropriate for your particular circumstances.
All right, let’s recap what we’ve covered today. Menopause brain fog is real. It’s not in your head. It’s not something you just have to accept. New research shows measurable structural changes in the brain during menopause, changes in gray matter volume, white matter integrity, and blood flow. These changes are driven by three main mechanisms: reduced blood flow to the brain, increased inflammation, and declining estrogen levels. Your gut health also plays an important role through the estrobolome, which affects how much estrogen is reabsorbed versus eliminated. The good news is the brain is remarkably adaptive. Gray matter volume can partially recover after menopause, and there are evidence based interventions you can use to support your brain during this transition, which we just discussed. Start with the four pillars: an anti-inflammatory diet, regular physical activity, stress management, and prioritizing sleep. For gut health specifically, include those fermented foods, bone broth, etc, to support a healthy microbiome and optimize estrogen metabolism. Then consider targeted nutrients like omega-3s to support healthy inflammatory balance, curcumin for additional support, ginkgo to promote blood flow to the brain, and adaptogens like ashwagandha and saffron for stress, mood, sleep, and cognitive support.
This is not about just accepting brain fog as an inevitable part of aging. It’s about understanding what’s happening in your body and your brain and taking steps to address the root causes. You have more control over this than you might think. If you’re going through perimenopause or menopause and experiencing brain fog, you’re not alone. Millions of women are going through the same thing, and now we have the science to validate what you’ve been experiencing and the tools to help you feel better. Thanks for listening. You can find the show notes and references for this episode at ChrisKresser.com and until next time, be well.
