The Hormone-Brain Connection: Why Cognitive Changes in Midlife Are Not 'Just in Your Head
By: Jill Chmielewski, April 15, 2025
Estrogen, progesterone, and testosterone modulate different aspects of brain function through several pathways initiated ONLY after hormones bind to receptors on our brain cells.
Hormones affect neurotransmitters in the brain, and they exert anti-inflammatory effects in the brain, enhance blood flow, stimulate neural synapses, and more. Hormones support the volume and plasticity of the hippocampus, the part of our brain that is responsible for our memories, our mood, and so much more. When hormones decline, it affects our hippocampus, causing it to shrink. When the volume or the size of the hippocampus shrinks, we can experience cognitive decline and disorientation.
When hormones decline during perimenopause and menopause (or in surgical menopause when the ovaries are removed), those brain receptors don’t get the hormones they need, which means their messages don’t get communicated. As a result, a woman might experience brain fog, memory issues, and/or difficulty concentrating.
What can we do to reduce brain fog and other cognitive issues?
Nutrition
Incorporate more of the following:
Salmon or other fatty fish/Omega-3s are essential for learning and memory
Antioxidants such as blueberries and broccoli
Coffee/Tea contains both caffeine and antioxidants, increasing alertness, improving mood, and sharpening concentration. Choose organic when possible.
Turmeric is a potent antioxidant and anti-inflammatory that supports memory, boosts serotonin and dopamine, and helps new brain cells grow, potentially delaying mental decline.
Pumpkin Seeds contain zinc (crucial for nerve signaling), magnesium (essential for learning and memory), copper (helps control nerve signals), and iron (low levels can cause brain fog and impaired brain function).
Eggs contain choline, an essential nutrient that our body uses to create acetylcholine, a neurotransmitter that helps regulate mood and memory.
Lifestyle
Movement of any kind helps to improve memory and supports brain health overall.[1]
Strength training/resistance training helps prevent/reverse insulin resistance and increase the neuroprotein BDNF,[2] a neuropeptide that is responsible for growing new neurons and repairing broken ones. The result? Improved cognition and better memory.
Getting consistent, high-quality sleep is critical for brain health.
Reducing alcohol as it impacts brain function.
Playing more word games and other “brain” games improves memory and focus.
Focusing on a single task at a time and avoiding multitasking.
Reducing exposure to toxins that can directly impact our hormones and our neurotransmitters.
Supplements
Resveratrol has been shown to improve verbal memory scores and overall cognitive performance in post-menopausal women.[3]
Omega-3s, especially if you are not eating oily fish and other Omega-3s at least 2x per week.
Hormone Replacement Therapy
Estrogen replacement has been shown to reduce the incidence of Alzheimer’s disease by between 20 and 50%, depending upon the study you look at. Not only that, but estrogen improves blood flow to the brain, stimulates the growth of nerve cells, and reduces the production of beta amyloids (a hallmark of Alzheimer’s disease). (Dr. Avrum Bluming and Dr. Carol Travis wrote an excellent book called “Estrogen Matters” which includes a discussion on estrogen’s role in preventing dementia and cognitive decline. They discuss this information in Dr. Peter Attia’s podcast ~ If you are short on time, you can skip to 1:22:45, where this discussion begins.)
Progesterone replacement has an anti-inflammatory effect and is neuroprotective, meaning it protects the nervous system.
Testosterone replacement is fundamental for psychological, cognitive, and reproductive aspects, and its lack or reduction primarily impacts the quality of life in BOTH males and females.[4]
Final thoughts
Estrogen, progesterone, and testosterone play vital roles in brain function, influencing everything from mood and memory to focus and cognition. These hormones act only after binding to specific receptors in the brain, where they modulate neurotransmitters, reduce inflammation, enhance blood flow, and support the growth and plasticity of neurons, especially in the hippocampus, the brain’s memory and learning center. When hormone levels drop during perimenopause, menopause, or surgical menopause, these brain pathways lose key signals, leading to symptoms like brain fog, forgetfulness, and trouble concentrating.
Supporting brain health during this transition involves a combination of nutrient-rich foods (such as omega-3s, antioxidants, turmeric, pumpkin seeds, and eggs), regular movement and strength training to boost neuroprotective proteins like BDNF, restorative sleep, toxin reduction, and cognitive stimulation. Supplementation with resveratrol and omega-3s can further support cognitive performance. For many women, hormone replacement therapy, especially estrogen, has been shown to significantly reduce Alzheimer’s risk, improve blood flow, and protect nerve cells, while progesterone and testosterone provide additional neuroprotective and mood-supporting effects.
Disclaimer: This article is for educational and informational purposes only and is not intended to replace personalized medical advice or individualized care. It is meant to help you understand your physiology, explore evidence-based options, and make informed choices about your health and wellness. Healthcare should be a partnership, not a permission slip, and proactive care is just as essential as treatment. Use this information to engage in open, collaborative discussions with your provider or to make empowered decisions that align with your own values, goals, and comfort level. You are the ultimate authority on your body.
References
[1] Firth, Joseph et al. “Effect of aerobic exercise on hippocampal volume in humans: A systematic review and meta-analysis.” NeuroImage vol. 166 (2018): 230-238. doi:10.1016/j.neuroimage.2017.11.007
[2] Radak, Zsolt et al. “Exercise plays a preventive role against Alzheimer's disease.” Journal of Alzheimer's disease : JAD vol. 20,3 (2010): 777-83. doi:10.3233/JAD-2010-091531
[3] Evans, Hamish M et al. “Effects of Resveratrol on Cognitive Performance, Mood and Cerebrovascular Function in Post-Menopausal Women; A 14-Week Randomised Placebo-Controlled Intervention Trial.” Nutrients vol. 9,1 27. 3 Jan. 2017, doi:10.3390/nu9010027
[4] Ciocca, Giacomo et al. “Is Testosterone a Food for the Brain?.” Sexual medicine reviews vol. 4,1 (2016): 15-25. doi:10.1016/j.sxmr.2015.10.007