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Welcome to The Modern Midlife Collective—where midlife isn’t a crisis, it’s a rebirth. Hosted by Dr. Ade Akindipe, DNP, and Dr. Jillian Woodruff, MD, this is the podcast for women ready to unapologetically own their power, thrive through the ups and downs of hormones, weight, and self-care, and show the world that thriving at 40 and beyond isn’t just possible—it’s your birthright.
Biweekly, we bring you science-backed insights on hormones, menopause, longevity, and sexual health—real tools to empower women in midlife and beyond. With a fearless blend of functional medicine, real-life wisdom, and no-nonsense empowerment, we’re here to challenge the norms, break through the barriers, and help you step into a life of vitality, confidence, and unstoppable strength.
Ready to rise? Let’s do this.
Jillian Woodruff MD (00:26)
I really loved our last episode where we talked about stress and how it hits differently after 40. And I say 40 just because that's like the number of where the age where midlife begins. But I really just mean in that time of perimenopause, in that time in midlife. And this is how cortisol and hormones and sleep disruption can really push our body into this survival mode.
So today I'm excited to take this conversation one step further and talk about brain fog. Why does this happen? Why is it so common in midlife? And when are hormones part of the story?
Ade Akindipe, DNP, APRN, NP-C (01:05)
Yes, we had a great conversation last time. if you, you know, if you were able to resonate with that and you were like, ⁓ my goodness, that sounds like me, then this episode is for you. Why can't I think like I used to? I remember the first time I experienced that and it can be very frustrating. And we hear this all the time when women just feel like they feel slower. Those words that used to be able to come out very, you know, just.
It just comes right out. You're more forgetful. You walk into a room, you forget why you were there. And you remember moments later, you lose your train of thought in the middle of a sentence, or you're trying to recall something. It's at the tip of your tongue. So it's very unsettling, but many of these women are high functioning. You work in leadership. You're smart. You're capable. You're a stay at home mom, and you're juggling multiple things. You're accomplishing a lot, and suddenly you just don't trust your own brain.
very frustrating.
Jillian Woodruff MD (01:58)
I think there's so many bothersome symptoms of perimenopause, but this is one of the most distressing symptoms that women bring into the exam room. And almost every woman prefaces it with, I don't know if this is normal, but.
You know, they're worried and they wonder about early dementia. They may have dementia in their family and they're thinking, is this happening to me? Is this how it starts? Is something seriously wrong? And often no one's really explained what's happening in the midlife brain. So I know we both thought it would be important to talk about this and about what's driving it and why it's so common. And most importantly, what helps. I certainly have had that feeling.
like wait I just came in here for something what was it or you're speaking and then all of a sudden that train of thought just flees and you're like okay what was I saying okay let's move on and if it happens once or twice you really don't think anything of it you know like oh okay but when it starts to continuously happen that's when people really start to worry like okay I have to pay attention to this something could be really wrong
Ade Akindipe, DNP, APRN, NP-C (02:54)
Yeah.
Absolutely. Yeah, and brain fog is a way of describing that, you know, just feeling like cobwebs. It's like everything just feels fuzzy. So it's not a diagnosis. It's really how women describe this feeling. And sometimes you'll see it on social media. see that brain fog, just feeling like your brain is cloudy. And it can show up in a lot of ways, right? We talked about some of that already. You have difficulty concentrating.
Maybe you're doing something, but your brain is thinking about the next thing that you need to do. ⁓ Just processing things a little bit slower. Just imagine yourself being in a position where you have to make a decision or maybe you're in a boardroom or something. And there are lots of different things coming back at you at the same time can feel overwhelmed, feeling of overwhelm. And sometimes women will describe forgetfulness, word finding difficulty.
⁓ mentally fatigued, just feeling very tired in your brain. Okay, multitasking, not feeling sharp. So what's important to say out loud is this though, when women experience brain fog, you know, they often feel like there is a brain issue, like you mentioned, Dr. Jill, like maybe this is dementia, right? Or neurodisease and they're, you know, refer me to a neurologist. In most cases, this is not what's happening.
So that can be very scary for me, it definitely is. And I can tell when ⁓ this is even getting, it gets worse, you know, when you're very busy, when you're very tired, it's like everything needs to stop. You need to go wind down, you need to get some rest.
Jillian Woodruff MD (04:44)
Well, multitasking, I heard something interesting about that years ago because I always thought multitasking was that we could really just do all of these things or think all of these things at the same time. But then what I learned is multitasking, it's not that you're...
brain is able to think down two paths or three paths at once, you just do this quick switching, the task switching. And so you're quickly able to switch from one thought to a different pathway thought, back and forth, back and forth. And so if this is what multitasking is, then if our processing slows down, your multitasking is not able to happen efficiently. Right. So we have to slow it down as well.
And multitasking really isn't the best way to efficiently handle the workload anyway. We're trying to do so many things, but that's really not how our brain is meant to be working. We are meant to be able to focus down on one task and do that task well. And so if you're going back and forth, you're probably not even, you're not giving all things 100%. There's no way to do that, right? Yeah.
Ade Akindipe, DNP, APRN, NP-C (05:52)
There's no way. Absolutely. Yeah.
Jillian Woodruff MD (05:55)
So clinically brain fog reflects changes in how the brain is being fueled, how it's being protected, and how it's being signaled. The brain is really metabolically demanding. know, our brain and our heart need glucose, oxygen, blood flow, neurotransmitter balance, hormonal support. Neurotransmitters handle your moment-to-moment messaging, affecting how clearly the brain...
the brain fires, like right now. I'm sending this message and how fast can I send that message to complete a task? Hormones set the overall conditions those messages have to work in. So that's very important to hear. You need them both. You need fast messaging and you need good conditions for those messages to be sent. So when any one of those symptoms or systems, excuse me, when any one of the systems are off, even just a little bit, you feel it.
cognitively and in midlife multiple systems are shifting at the same time. So I'll start with estrogen. Estrogen plays a major role in brain function. We've discussed this before. It's a regulator in the brain, helps boost the production of the key neurotransmitters, the things sending those messages. It slows the breakdown of the neurotransmitters. So they are there to those messages.
are there for a longer amount of time. And estrogen makes the brain cells more responsive to those messages. So if you're thinking about your teenager and the teenager listening to you versus not, are they getting the message? That message needs to be there a longer amount of time. So if you're sending that text, you don't want them to delete your text because they're going to need to refer back to that text of what they need to do because they're probably not going to do it the first time.
and then maybe they need some estrogen so their brain cells will be more responsive and actually carry through with the task. So estrogen also affects serotonin for mood. It affects your dopamine levels for focus and motivation. It affects your acetylcholine levels for your memory and your processing speed. Estrogen also supports the blood flow to the brain. I I said that. The brain cells use of glucose.
⁓ efficiently as fuel, right? We've got to bring glucose into the cells to be used to provide fuel and then the brain cells ability to communicate so that's the responsiveness. It needs to communicate, adapt to different situations, be able to form connections, and helps your brain to stay flexible and responsive just like it actually does in your your blood vessels. It makes those blood vessels flexible and responsive.
So when estrogen becomes erratic in midlife and perimenopause, the brain feels unstable. The signals don't fire smoothly, energy delivery becomes less predictable, focus feels harder to maintain, brain fog sets in. And this actually happens before you have period changes many times. So before your period stops, before menopause.
It's not about low estrogen, it's really about the unpredictable nature of estrogen.
Ade Akindipe, DNP, APRN, NP-C (08:59)
Yeah, and progesterone definitely matters here too. Because, you know, like you talked about, estrogen goes up and down. It's not predictable. So progesterone also can be an issue because progesterone is our, I call it the anti-anxiety medication that we make naturally. It calms you. It's a, what we call GABA supportive effects in the brain. So this is the part where
as your progesterone starts to drop, women will notice. And it's very common that women will say they have more anxiety. Their sleep is not as great or maybe they're sleeping, but then they're waking up in the middle of the night and just feeling very mentally unrested. Like it's just restless. And then they'll say, I can't shut. It's, have trouble shutting my brain down at night. And that can be.
Maybe you do have a lot of things going on, but naturally you should be coming to a point where you're able to just rest your brain, your brain is relaxed and you're falling asleep and staying asleep, right? So testosterone also play a role too. Testosterone we absolutely need plays a role in focusing, in motivation, right? Mental stamina.
making decisions, so declining levels in that hormone as well can contribute to not, you know, just that flat feeling, even to a point where if you go to the doctor, it may mimic maybe depression because some of those symptoms overlap with that and maybe you're prescribed antidepressants for that, but maybe it's just a hormonal thing. So brain fog is often hormonal, but also,
I think compounded with our lifestyle of multitasking, doing everything and not delegating. So it's hormonal, but it's not always entirely hormonal. So we always have to make sure that we're looking at how we're living. Are you practicing really good sleep hygiene so that your brain can mentally shut off and not replaying everything that's happened during the day, right?
Jillian Woodruff MD (10:44)
Hmm?
Absolutely, absolutely.
yeah, I think we do. We try to do so much. We try to fit so much into our days. And sometimes it's not us. It's just there's so many demands on our time and on our attention. And we feel like we have to do it all or if we don't, who is going to do it? So it is difficult. And I think sometimes we're pulled to do things that, you know, we may not necessarily want to do. It may not necessarily need to be done, but we feel.
like we should and I think sometimes we do have to start saying, you know, no, that's not where my priorities lie right now.
Ade Akindipe, DNP, APRN, NP-C (11:38)
Absolutely, I'm prioritizing that more often now and saying, no, not one more thing to my plate. But we did have to get up at 6 a.m. for this recording.
Jillian Woodruff MD (11:48)
Yes,
we did, right? Well, we prioritized our sleep, I guess, last night. Yes, you know I am not a morning person, so.
Ade Akindipe, DNP, APRN, NP-C (11:51)
It's prioritization. We slept first.
I'm surprised
you are here today. I'm very impressed.
Jillian Woodruff MD (12:01)
I'm
impressed with myself as well. But yeah, I think this is important to us and so we didn't make this a priority. we have lost sleep over it, but then there are some other things that I've been asked to do or recommended, hey, you should do this. And I think about it, I'm like, is that really going to lend itself to, like is that a part of my goals right now? And no, it's just a draw on my time.
Ade Akindipe, DNP, APRN, NP-C (12:17)
Yeah.
Jillian Woodruff MD (12:26)
And you know, everybody's trying to reach their own goals and you could be part of those goals, but if they're not yours, maybe they're not meant to be. You should say no to it. And this really isn't just a midlife thing. This is, we just happen to need to do this more at this point, but it would have been great if I'd learned this 20 years ago.
Ade Akindipe, DNP, APRN, NP-C (12:44)
Yeah, all these high performing women wanting to juggle all kinds of things.
Jillian Woodruff MD (12:48)
Right. So then,
you know, we talked about cortisol last time and stress and how we're not doing ourselves a service to juggle these things because it does increase our stress mentally, physically, you know, emotionally, and then it increases cortisol, increases our weight around the midsection and really leads to this chronically elevated level of cortisol and this dysregulation of our stress response system. So
Ade Akindipe, DNP, APRN, NP-C (12:58)
Mm-mm.
Jillian Woodruff MD (13:14)
Then if you have this issue going on where you have dysregulated stress response but you want your brain to be able to recall words and to focus and to have a better short-term memory because that's mostly the issue. The long-term memory, remembering facts from 20 years ago is fine, but it's that short-term recall of words that is suffering. Something has to give. So if we want that to work, we have to...
Ade Akindipe, DNP, APRN, NP-C (13:38)
Everything has to do.
Jillian Woodruff MD (13:41)
give our brain a break in other ways. We talked about being tired but wired. We talked about sleep. We talked about during sleep at night, your brain needs that time to fully reset so that it can participate in these high mental load tasks that we're putting on it each day.
Ade Akindipe, DNP, APRN, NP-C (13:43)
Mm.
Yeah, yeah, you mentioned midsection weight gain. That is such a common thing. And women will say that they've been trying everything that they can to lose the weight. But even if they do lose the weight, that belly fat kind of sticks around. And this is part of the big issue that you mentioned was that cortisol in the picture. You know, when you're not sleeping well and you have all these hormonal imbalances going on and then you add added stress on top of that.
it's really hard for you to lose that belly fat. So, and then that leads into the blood sugar variability issue. We talked about this before. The brain really relies on glucose, right, for energy. So when you're having blood sugar swings, and this is why I always emphasize the need to be very careful how you manage all kinds of, you know, there's lots of advice out there about diets, especially about fasting. So women will often,
reach for fasting because they're trying to lose that weight or belly fat. you're fasting for long periods of time during a very high stressful period and then you've got your hormones out of whack, you know, that wreaks havoc on your system. So this is the time when if you are going through a stressful period, maybe you do need to nourish your body more instead of fasting. It's probably not the best time to fast, especially those prolonged fasts specifically.
I mean, if you're gonna fast overnight, that's probably a better one, maybe for 12 hours, 13 hours, but those longer fasts, they're supposed to heal, they're very therapeutic, but when it's done in the wrong way, then that can be an issue, right? And then also eating, what are you eating if you are fasting? Are you eating a very healthy meal? Not high refined carbs, that's also going to make your blood sugars.
spike and spikes your insulin and then that adds to the, you know, the belly fat. So what does that look like with blood sugar variations, mental fatigue? This one is very common. I know myself, I used the CGM before and I can tell when my blood sugar is not very stable. I mean, it's normal for it to kind of go up and down, but when it's staying elevated for long periods of time, that means your body's having trouble processing and you know.
Insulin is trying to do its job, bring the sugar in, but then your blood sugar stays so high for a while. And that means that you're probably getting insulin resistant. Irritability, little things bother you. It's just like, get away from me. Difficulty concentrating. You can't concentrate, you can't focus. The crashing, know, brain fog, especially in the afternoon. I know some women will say by the time it's three o'clock, I'm checked out, even if I'm there.
Jillian Woodruff MD (16:19)
Yes.
Ade Akindipe, DNP, APRN, NP-C (16:31)
If I have a meeting, just, I have trouble, you know, concentrating. So protein intake throughout the day or at a particular meal should be taken as priority. The timing of the meal, that can really improve your overall health. So instead of, you know, running on fumes, even if you're not a big breakfast person. And we talked about this, I think, in the last episode too. Dr. Jilly mentioned.
adding some protein and coffee, whatever you can do to make sure that you are not going prolonged times without any kind of nutrition. And that's nourishment for your body can really help get through this brain fog. Because then you don't want to compound hormonal imbalances with poor nutrition and stress, right? Then that's just wreaks havoc on your body.
Jillian Woodruff MD (16:57)
Yes.
We can't forget inflammation. Inflammation also is a key factor in this, right? And glucose, high glucose levels lead to higher inflammation levels. So not only, even though we're hormone advocates, not only does that change in hormone level affect the neurotransmitters signaling in our brain function, but so does chronic low-grade inflammation and...
This is really common at this time and inflammation can be due to poor sleep. That increases your inflammation levels. Chronic stress increases inflammation levels, insulin resistance, high glucose, autoimmune conditions and autoimmune conditions tend to appear in midlife for one reason or another. And then your nutrient deficiencies. ⁓ So the intake of nutrients from food.
even probably environmental factors that are affecting hormone levels or increasing our inflammation as well. but these add up in your talk, you even mentioned compounding and that's what happens is that all of these factors add up. So not one thing is causing anything. They add together, they amplify each other and together they really overwhelm the brain's ability to function smoothly.
People will think, is there a lab that I can do to figure out why brain fog is happening or what we need to do about it? What is the root cause of it? And there's really not. There's not one thing that is going to give you that answer, right? Especially in traditional labs, you're looking for liver disease or thyroid disease or vitamin deficiencies you can check for with that. You can look into metabolic issues, but...
Ade Akindipe, DNP, APRN, NP-C (18:48)
That's right.
Jillian Woodruff MD (19:01)
know, stress and cortisol, you can still have normal lab values and still have symptoms of brain fog.
Ade Akindipe, DNP, APRN, NP-C (19:08)
Absolutely. So here's where we talked about supplements last time too. Supplements can be helpful, but only when layered on top of all the things foundation, right? So some that are more common for brain fog can be magnesium. Magnesium is very helpful for sleep and also calming the nervous system.
⁓ B complex vitamins, particularly B12 and folic acid. Omega-3 fatty acids is really great for brain and also for reducing inflammation. L-theanine, this is Dr. Jill's very, one of her favorites for focus with calm. Creatine, which has emerging evidence for cognitive energy in women, but supplements are great. I always say, but you know,
Jillian Woodruff MD (19:41)
I like it.
Ade Akindipe, DNP, APRN, NP-C (19:51)
Food is medicine as well and unfortunately we don't always have access to the healthiest food. But if you can, when you can, supplementing it with really good nutrition is forefront. But supplements can definitely supplement whatever you might be lacking in your diet, but definitely cannot override your sleep, managing stress, and like we talked about, nutrition.
Jillian Woodruff MD (20:15)
Right, more is not better. Cognitive symptoms or perimenopausal symptoms don't mean that you need a long supplement list. Like it is best if you're able to get these things from nutrition, but our food really isn't as nutrient dense as it used to be. And it is very difficult to fit in all of these things that we need. But the best thing would be if you could individualize your supplement list and work with somebody who can really help to find
weak points in your diet and then add in just those things. You're not like having this whole pharmacy that you're taking every day.
Ade Akindipe, DNP, APRN, NP-C (20:51)
Yeah, absolutely. And the good news is our bodies are very resilient, right? So it responds to good things because it gives you the signs that, hey, I need help. Brain fog is one of those signs. So when you fix it by improving your sleep, stabilizing your blood sugar, reducing the overload, saying no, and making sure that you are, you know, winding down and practicing really great sleep hygiene, exercise, exercise is a great way.
Adjusting the intensity of your exercise when your stress load is high. Taking walks, getting outside and getting fresh air can also help. Supporting your hormones when appropriate. Of course, seeking help from someone that is trained to do that. Sometimes the biggest improvements come from doing less and not doing more.
Jillian Woodruff MD (21:36)
That's right, that's right. I hope people are seeing a pattern here because these like not so simple lifestyle changes can have major impacts on us. Less is more, exactly. We have to listen as well to the things that we are saying because it's one thing to know what to do and it's quite another thing to adopt those habits into your actual life.
Ade Akindipe, DNP, APRN, NP-C (21:40)
Less is more.
Jillian Woodruff MD (22:00)
I would like to add morning light. said, you know, taking walks and things. Just getting that exposure to light in the morning, if you don't live in Alaska, is going to be really instrumental in setting your clock, your rhythm, your cortisol rhythm for the day. So I would add that. And then hormone therapy is not a universal solution, but it can be really helpful for a lot of women.
But also best when paired with these lifestyle changes, when paired with your nutrients, increasing your protein, the walking. So all of the lifestyle changes in the sleep, probably is, I think that just becomes far more important as we get older and it gets more elusive, right? It's like, we really need it. When you're young, we say you need to get 10, 12 hours of sleep as a young person, as a kid, and that they can sleep so easily.
And then as we get older, we have less time to sleep. It's more difficult to sleep. And we're like, we actually need more sleep. So that does become difficult, but can be done if we know the steps to take to do so.
Ade Akindipe, DNP, APRN, NP-C (23:06)
Absolutely, if you know the steps to do so, it definitely can be helpful. So if you're listening to this, don't get overwhelmed and try to overhaul everything. Start with one thing. Is it your sleep? Maybe getting more sleep can improve your clarity without having to do anything else. Protect your sleep. Women, protect your sleep. I'm repeating that because it's super important. It's important for me. Fuel your brain with enough protein.
Sometimes women are just not eating enough, as in actually eating enough protein. Reduce the constant mental load where you can. Get outside. Yes, Alaskans, that means you too. Get outside in the sunshine. And if this episode helps you feel less alone, that's great. So share it with someone who's quietly worrying about this too and their brain health.
Jillian Woodruff MD (23:52)
And we are out of time, but we do want to hear from you. If you have some ideas about future episodes, I was thinking perhaps we should be talking about creatine. You brought that up today. That would be something important to talk about. Maybe even, I know in the new year we talked about bringing in guests. So maybe someone who focuses on sleep, maybe even someone who focuses on sleep at midlife would be really helpful to have on the program. Yes.
Ade Akindipe, DNP, APRN, NP-C (24:18)
I totally agree. That's great. Yeah.
Jillian Woodruff MD (24:21)
But send us your thoughts too. So email us connect at modernmidlifecollective.com and we'll be back with even more engaging episodes in 2026. Happy New Year and thank you for listening.
Ade Akindipe, DNP, APRN, NP-C (24:23)
Let us know.
Bye bye, happy new year.
Jillian Woodruff MD (24:35)
Bye.