How Menopause Rewires Your Brain and What You Can Do Right Now
Why you can't willpower your way out of a dopamine shortage, what the latest research proves, and one step to reclaim your sanity today..
I went through menopause three times in my 30s. I had stage IV endometriosis, and the OBGYNs were only concerned with my “fertility.”
I fired them all.
I was concerned with chronic pain, being able to think, remember, walk, sleep, hold a conversation, find my car keys (oh, and keep my job, you know, the one I’d already killed myself to get promoted into). Yeah, that.
Because why?
Because I’m a Type A+ over-achieving perfectionist with just enough people-pleasing tendencies that I’ll run myself into the ground before disappointing someone I respect. (Okay, that’s the old me. Just add the word “recovering”.)
I’d been promoted to the senior world and was at my first leadership retreat when I found myself in the ER. That started a wild ride of a diagnosis, deep fatigue, memory glitches, and heavy medication. Then I found a doctor who said, “We can try an off-label prostate cancer chemotherapy to suppress your estrogen and put you into chemical menopause. I think that could help you.”
Wait! What?! Are you for-real?!
The Hormone Roller Coaster
I’m female, and I don’t have the biological parts of male anatomy. Like most females, my estrogen production used to swing wildly. During a normal monthly cycle, estradiol levels can shift by more than 1,000% in just a matter of days. Yep 1,000%.
Stick with me, I swear I have a point to biology lesson.
I want you to reflect on your wildest, and I mean wildest, PMS day.
You know the one I’m talking about: the laugh then ugly cry, then sudden rage at everything moment, even though you just ate a whole pint of Ben & Jerry’s Phish Food and watched a funny rom-com (or in my case, an action movie where they blow things up – don’t judge). Okay, that.
Our culture and society have this expectation of linear, consistent performance. But week to week, our own biological blueprint is surging and crashing. And that PMS week – oh Nelly – it can be doozy depending on your biology.
And when someone enters natural menopause, there is a time called perimenopause, which I always thought sound so “nice” and gentle. It’s the “before” stage. It sounds like it should be a little vacation, but it isn’t.
Natural peri-menopause averages 4 to 8 years. It’s a long, chaotic, multi-year roller coaster where ovarian hormones vary wildly before dropping.
In a normal timeline, the brain at least has years to slowly recalibrate to these changes. I mean, you visit Cuba personally and unexpectedly and have an internal summer in the middle of winter, but your brain eases into…and in hindsight having gone through what I went through I actually now think that’s the more important thing.
Because when I said yes to that prostate cancer chemotherapy (a GnRH agonist called Lupron, which is used as an endometriosis treatment), I shut my estrogen production down overnight. I went into a massive chemical crash. It was a total kill-switch.
The drug aggressively shut down the communication line between my ovaries and my brain. And when estrogen leaves, it takes your dopamine supply line right along with it.
By the way - your brain desperately needs this for your executive functioning!
The Brain Needs Fuel
Estrogen isn’t just a reproductive hormone that runs the show downstairs and then politely retires.
Oh no Janet.
Do you know what I learned rapidly that no one told me?
I learned that I couldn’t remember anything. And I mean anything.
I could write a reminder on a post-it note, have that note right in front of me while staring directly at it, and it was still as if it never happened. My working memory simply wasn’t working.
Estrogen is a massive player in your brain. One of its main jobs is helping to regulate dopamine. That’s the exact neurochemical your brain runs on for focus, working memory, motivation, follow-through, and the general ability to hold a thought long enough to finish it. (Don’t get me started on the fact that NOW I know I’ve lived with ADHD all my life so it was a double whammy to me…but I didn’t know that 17 years ago!)
Now watch what happens in normal perimenopause. Estrogen doesn’t glide gently downhill. It swings erratically and steeply from month to month for years. Every single time it drops, your dopamine supply takes a little hit with it.
For me, that drop happened within hours. That’s not just “getting scattered.” That’s an acute neurochemical shortage.
The keys you can’t find (or, ahem, left in the ignition of your locked Jeep).
The credit card you lost (again).
The meeting you forgot (and you scheduled it)
The name of the person who was just in the meeting (was it Bill…Trudy…the guy in the plaid that just kept talking)
The word that was right on the tip of your tongue and then suddenly wasn’t. (I’d like my coffee on the rocks please)
Your kid’s name, birthday, or soccer event (or the fact that you had a kid and were supposed to pick them up, feed them, or something).
Those moments aren’t evidence about your competence, and they don’t mean you’re losing your edge or your mind. They’re the biological readout of a brain trying to run premium software on a suddenly unreliable power supply. That’s it
The New Science of the Shift
A brand-new study published in June 2026 by researchers Abigail Testo and Julie Dumas sheds some serious light on this. They looked at the brain scans of 151 women in different stages of perimenopause and menopause to see how the brain communicates.
They discovered that menopause is, at its core, a true neurological transition.
All females go through this neurological transition.
I want you to sit with that for a second.
Testo and Dumas (2026) found that women in post-menopause have lower functional connectivity in certain parts of the brain while at rest. The main area that changed was the supramarginal gyrus (okay, I had to go look this up).
Guess what that specific area does? Critical for proper verbal working memory.
When your BS meter gives out at the same time (because holding your tongue also runs on the exact executive function you’re now short on), you find yourself unable to sit politely while the Guy With The Too-Obvious Toupee confidently repeats your exact idea back to the room two minutes after you said it. And you don’t hold your tongue. Your tolerance didn’t get worse. Your neurochemical budget for pretending got cut.
But the researchers found something incredibly empowering, too.
Having lower brain connectivity at rest doesn’t mean your brain is broken!
They explained that the postmenopausal brain might just require less connectivity at rest because resting takes very little cognitive energy.
When it’s actually time to do a hard task, the brain powers up perfectly well to get the job done. Your brain is just optimizing its power settings.
I like that a lot. I’m “optimizing”
Stop Paying the Shame Tax
You cannot willpower your way out of a chemistry problem. Please stop trying.
I have had one too many conversations over the last six months with competent, capable women who are questioning their value, their worth, their competence, and their sanity.
When the cracks start to show, the fear cycles.
The fear doesn’t say, “My estrogen is low.”
It says, “What is wrong with me?”
It says other women seem totally fine.
It says if you were really as sharp as people thought, you’d handle this.
It says, “I used to be able to lose weight and now I can’t, even though I’m not doing anything different. I’m such a loser.”
So you white-knuckle it. You cover. You try to add willpower to a system that is short on the exact neurochemical fuel that willpower requires. That’s like flooring the gas pedal to fix an empty gas tank.
I know, because I ran this exact play in my 30s. And I lost that fight for years, believing that I wasn’t good enough, smart enough, competent enough, or capable enough. Because I was getting signals from my environment that I internalized and I was comparing new self to my old self. My new brain to my old brain…but I didn’t know what was happening and no one was there to help see that I was fighting the wrong opponent
Here is the one should hope you drop today: “If I were really good enough, I should be able to push through this.”
If you feel brain-fog, forgetful, short-fused strain that isn’t proof that something is “wrong with you.” It’s the physical sound of a great brain running low on fuel.
And you can’t willpower estrogen back.
You can stop grading yourself on a rigged exam.
Go get the real picture. There are actual clinical options out there that work. (I couldn’t take HRT due to my medical history, so I don’t know what all of those are; I’m not that kind of doctor, but I hear there are great doctors who can help.)
But where I can help is to show you the science and the system so you stop paying the shame tax on a biological bill that isn’t yours to pay.
P.S. A few ways in, whenever you’re ready
References
Dumas, J. A., & Testo, A. A. (2026). Differences in functional connectivity during midlife between menopause stages. Menopause https://doi.org/10.1097/GME.0000000000002836
Mosconi, L. (2024). The menopause brain: New science for women to navigate midlife and optimize brain health for the rest of their lives. Avery.
Frequently Asked Questions
How does estrogen affect dopamine and working memory?
Estrogen helps regulate dopamine, the key neurotransmitter responsible for focus, working memory, motivation, and executive function. When estrogen swings or drops abruptly during perimenopause, menopause, or chemical suppression, dopamine levels plunge as well. This neurochemical shortage makes it difficult to retain short-term information, track daily tasks, or retrieve words quickly.
Why doesn't willpower work to fix perimenopause brain fog?
Willpower relies on executive function, which requires a stable supply of dopamine to run. Attempting to out-discipline hormonal brain fog is like pressing the gas pedal on an empty gas tank, you are attempting to fuel your focus using the exact neurochemical resource that is currently running low.
Is perimenopause brain fog a sign of permanent cognitive decline?
No. 2026 neuroimaging research by Testo and Dumas reveals that menopause is a natural neurological transition rather than permanent brain damage. While postmenopausal brains show lower functional connectivity at rest in areas like the supramarginal gyrus (which handles verbal working memory), the brain effectively ramps up connectivity when engaging in active, complex tasks.