Perimenopause at Work: What Every Woman Should Know About Brain Fog, Fatigue and Anxiety

by Violeta Mincu

Have you found yourself reading the same line five times and still unable to process the information? Or forgotten a word you use every day and wondered what was going on?

If you’re a woman in your late 30s to early 50s, you’re not alone.

During this time women experience symptoms that seem to appear out of nowhere: brain fog, fatigue, anxiety, disrupted sleep, memory lapses, and even a surprising loss of confidence.

Yet nearly half (46%) of women around the globe are unaware of perimenopause and the impact it can have on their daily lives.

As a senior manager with over 15 years of experience in corporate organizations, I’m going through these changes myself. I researched what this will mean in my career and I want to share my findings with you.

Women in the workplace rarely talk about the challenges of perimenopause, yet millions of us experience them while balancing careers, family, and everyday life.

What Is Perimenopause, Exactly?

Perimenopause is the transition leading up to menopause. While many women assume it starts in their 50s, symptoms can begin in the late 30s or early 40s, and this phase can last several years before menopause officially occurs.

Understanding the hormones involved:

• Estrogen – helps regulate memory, mood, sleep, body temperature. During perimenopause, estrogen levels fluctuate, which contribute to symptoms such as brain fog, anxiety and sleep issues.

• Progesterone – has a calming effect on the brain. Declining progesterone can contribute to poor sleep, and increased anxiety.

• Testosterone – women produce testosterone too. It supports energy, motivation, muscle strength, and libido.

• Cortisol – known as the stress hormone. Poor sleep and hormonal changes can make the body more sensitive to stress, leaving you feeling overwhelmed more easily.

Signs of Perimenopause

1. Brain fog

2. Sleep disruption

3. Mood changes

4. Anxiety

5. Lack of confidence

You may experience one of these symptoms or several at the same time.

Understanding what is happening is the first step toward regaining control of your health and wellbeing.

1. Brain Fog

• Losing your train of thought mid-sentence
• Forgetting familiar words
• Difficulty concentrating: reading the same note multiple times

Estrogen plays an important role in memory, attention, and verbal fluency.

During perimenopause, estrogen levels fluctuate unpredictably. These hormonal changes can temporarily affect cognitive performance, making previously easy tasks feel more difficult.

What you can do

• Externalise memory with notes, reminders, and checklists. This reduces the mental load
• Build in short pauses before high-stakes conversations to mentally re-anchor
• Use a notepad or notes app in every meeting, even short ones
• Include enough protein and healthy fats to support brain health and cognitive function. Protein provides amino acids needed to make neurotransmitters, while healthy fats, especially omega-3 fatty acids, support brain cell structure and function

The Menopause Society reports that roughly 40 to 60 percent of midlife women experience some form of cognitive symptoms during the menopause transition. That mental effort is invisible to everyone but you. Systems reduce mental load and allow your brain to focus on higher-value work.

The most important thing to remember is this: brain fog feels frightening, but for most women it is temporary.

2. Sleep Disruption

• Even when you spend enough hours in bed, you wake up tired
• Struggling to focus in the afternoon
• Leads to lower patience and emotional resilience

Sleep disruption is one of the most underestimated aspects of perimenopause, and one of the most consequential.

Hormonal fluctuations can affect the body’s temperature regulation and sleep cycles.

Night sweats, waking up during the night, and difficulty falling back asleep are common during perimenopause.

Research suggests that 70–80% of women experience some form of sleep disruption during the menopause transition.

What you can do

• Keep your bedroom cool
• Reduce evening alcohol consumption
• Create a consistent bedtime routine
• Limit screen exposure before bed
• Speak with a healthcare professional if symptoms persist

Protect your sleep like your career depends on it, because it does. I write more about sleep and performance, here: Sleep Deprivation and Work Performance.

3. Mood Changes

• Feeling overwhelmed by situations that normally wouldn’t bother you
• Becoming impatient more easily
• Increased emotional sensitivity
• Frustration that seems disproportionate with the events

Up to 70% of women experience mood disturbances during perimenopause, including irritability, anxiety, and depressive episodes. Fluctuating estrogen affects neurotransmitters involved in mood regulation, including serotonin – a neurotransmitter involved in mood and sleep.

Combined with poor sleep and everyday stress, these hormonal changes can increase emotional volatility.

What you can do

• Build short recovery breaks into your day
• Take a pause before responding when emotions run high
• Move your body, preferably outdoors

4. Anxiety

• Excessive worrying
• Increased stress before meetings and presentations

Hormonal changes can affect the nervous system and increase sensitivity to stress. Even women who have never experienced anxiety before, may notice it during perimenopause.

What you can do

• Practice slow breathing exercises
• Reduce unnecessary commitments (say No more often)
• Talk openly with a healthcare provider

A simple breathing pattern of 4 seconds in and 6 seconds out repeated five times can help calm the nervous system within minutes.

Do you feel like some of these symptoms sound familiar? Download the [FREE] Perimenopause at Work Survival Guide for symptom tracker, and strategies you can start using today.

5. Lack of confidence

• Second-guessing decisions
• Questioning your abilities despite a strong track record

Yes, this comes on top of imposter syndrome, as if that wasn’t enough.

This is one of the most well-documented effects of the menopause transition. A 2022 survey by the Fawcett Society found that 52 percent of women reported losing confidence at work during the menopause transition.

What you can do

• Keep a running record of wins and positive feedback to counter the in-the-moment doubt
• Talk to other women going through the same transition, naming it out loud takes away much of its power

You have the track record. The expertise hasn’t gone anywhere. Separate the feeling of low confidence from the fact of your competence, they are not the same thing.

Frequently Asked Questions about Perimenopause

1. What are the first signs of perimenopause?

The earliest signs are the ones women least expect, and least connect to hormones. Irregular periods are the most recognised signal, but women also notice mood changes, unexplained fatigue, slow weight gain and disrupted sleep long before their cycle shifts.

The symptom that tends to catch professional women most off guard is brain fog.

If you are in your late 30s or early 40s and something just feels off, your sleep has changed, your patience is shorter, you feel less like yourself, it is worth paying attention.

2. Can perimenopause cause brain fog and memory problems?

Yes, and this is one of the most important things to understand, because we assume the worst when it happens. Women experience cognitive difficulties during perimenopause, such as memory problems or trouble concentrating, sometimes called brain fog.

Here is the reassurance the research offers: perimenopausal brain fog is usually temporary and reversible with support. The Study of Women Across the Nation, one of the largest longitudinal studies on women’s health ever conducted, found that cognitive changes are largely limited to the perimenopausal transition period.

In practical terms: use your calendar as an external memory system, and protect your sharpest hours of the day for your most cognitively demanding work. The fog lifts. The research is consistent on this.

3. Is perimenopause making me gain weight?

When estrogen levels drop in perimenopause, your body compensates by storing fat, especially around the belly. It is common to gain 1–2 pounds a year up to menopause, even if you have eaten and moved as you always have.

Strength training two to three times per week is the most effective intervention, it preserves muscle mass, boosts metabolism, and directly counteracts the hormonal changes driving weight redistribution. A Mediterranean-style diet, rich in protein, vegetables, legumes, and healthy fats, has the strongest clinical evidence base. And reducing alcohol has a double effect: it reduces calories and reduces symptom severity.

4. Is HRT safe, and should I be considering it?

This is the question with the most misinformation attached to it, and women deserve a straight answer. For many women, HRT – Hormone Replacement Therapy – is now considered a safe and effective treatment for symptoms, especially if started before the age of 60.

The fear around HRT stems largely from a 2002 study that was widely misreported. Subsequent research has significantly rehabilitated its safety profile for most women. Further studies point to the associated link between HRT and a reduction in the risk of type 2 diabetes and osteoporosis, and a lower chance of developing cardiovascular disease if taken within 10 years of the menopause start. More recent evidence found that HRT use lowered the risk of neurodegenerative diseases in women, such as Alzheimer’s disease and dementia.

However, and this is important, HRT is not right for every woman. It depends on your personal health history, your symptoms, and your individual risk profile. What is right for every woman is having an informed conversation with a GP or certified menopause practitioner who takes your symptoms seriously. If you feel your concerns are being dismissed, do not hesitate to seek a second opinion, especially from a provider experienced in perimenopause treatment.

You deserve a healthcare provider who treats your symptoms as the legitimate medical issue they are.

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Final Thoughts

Perimenopause arrives during the years when women carry the greatest responsibilities at work and at home.

It can feel confusing, frustrating, and at times frightening.

But it is not a sign that you are becoming less capable.

It is a temporary biological transition that deserves understanding, support, and proper care.

Women emerge from this phase with greater self-awareness, stronger boundaries, and a healthier relationship with success. 🌸

With the right support, information, and strategies, it is entirely possible to continue thriving.

For a practical summary of the symptoms, health impact, and strategies, download the [FREE] Perimenopause at Work Survival Guide. It’s designed to help busy women understand what’s happening, take meaningful action and support conversations with a healthcare provider.

Books That Will Support You Through Perimenopause

Some links in this section are affiliate links, which means I may earn a small commission if you buy through them at no extra cost to you.

1. The Menopause Brain by Dr. Lisa Mosconi – [Paperback] | [Kindle]
   The neuroscience of the menopausal brain, reassuring, essential.
2. Perimenopause Power by Maisie Hill – [Paperback] | [Kindle]
   Practical, honest, and refreshingly unfiltered. A genuine guide.
3. The New Menopause by Dr. Mary Claire Haver – [Paperback] | [Kindle]
   Evidence-based and empowering. A new standard in the field.
4. The Hormone Cure by Dr. Sara Gottfried – [Paperback] | [Kindle] Dr. Sara Gottfried translates complex hormonal science into something we can all understand and implement in everyday life.

You may also enjoy reading:

• Sleep Deprivation and Work Performance

• Salary Negotiation for Women: How to Get Paid What You’re Worth

Medical Disclaimer

This guide is intended for educational purposes only and should not replace professional medical advice, diagnosis, or treatment.

References

• Study of Women’s Health Across the Nation (SWAN). Fact Sheet: Memory and Cognition During and After the Menopause Transition
• Brain fog in menopause: a health-care professional’s guide for decision-making and counseling on cognition.
• Sleep Disturbance and Perimenopause: A Narrative Review.
• UVA Health / Flo Health Study: Perimenopause symptoms common in women as young as 30.