It starts innocently enough: you’re in the middle of a conversation, and suddenly the name of a close friend—someone you’ve known for years—vanishes from your mind. You smile, stall, and hope no one notices. Later, you find yourself standing in the kitchen, unsure why you walked in there. For millions of women, especially those navigating the hormonal shifts of perimenopause and menopause, these moments are not rare glitches but a daily fog that feels both unsettling and exhausting. In response, many people reach for brain games—crosswords, Sudoku, math puzzles, memory apps—hoping to sharpen their minds and push through the haze. But according to Dr. Rhonda Voskuhl, a professor of neurology at UCLA and co-founder of Cleopatra RX in Los Angeles, that approach is often misguided. At the Livelong Women’s Health Summit in New York City in September, Voskuhl offered a clear warning: generic cognitive exercises are not a one-size-fits-all remedy. “You can’t just do random cognitive exercises,” she said. “They’ve got to fit the problem.” Her message is both empowering and liberating: brain fog is real, but it is also specific, and the right kind of mental workout can make a meaningful difference.
To understand why generic brain games so often disappoint, it helps to look at what brain fog actually is—and what it is not. When estrogen levels begin to decline during midlife, many women worry that they are losing their intelligence or slipping toward dementia. Voskuhl is quick to reassure: that fear is not supported by the science. “It’s not a global problem with the brain,” she explained. “It’s not global brain atrophy.” Instead, the changes are localized and specific. Overall intelligence, logic, reasoning, and basic problem-solving abilities remain completely intact. What takes a hit are two distinct cognitive domains: verbal memory and processing speed. Verbal memory is the ability to recall names, words, and language-based information quickly and accurately. Processing speed is the ability to think and react swiftly under pressure, like when you’re put on the spot or asked to make a fast decision. Brain imaging and research studies back this up, showing subtle changes in the hippocampus—the brain’s memory center—including some atrophy and altered functional connectivity. But this is not the same as global cognitive decline. It is a targeted, specific challenge, and it responds best to targeted, specific exercises. That is why doing math puzzles, which rely heavily on logic and numerical reasoning, may leave a woman feeling just as foggy as before. She might be a Sudoku champion and still struggle to remember the name of the actor in her favorite movie. The problem is not her brain’s overall power; it is the particular machinery responsible for word retrieval and quick thinking.
The distinction between encoding and retrieval makes this even clearer. Encoding is the process by which the brain takes in new information and stores it. Retrieval is the process of pulling that stored information back up when it is needed. For most women experiencing menopause-related brain fog, encoding is not the issue. The information—the name, the word, the memory—is still safely stored in the brain, as vivid and accessible as ever. The problem is retrieval. Think of it like a library where every book is on the shelf, perfectly organized, but the search system has suddenly slowed down. The book is there; it just takes longer to find. Or imagine your brain as a search engine that has all the data but is running on a slow connection. You know the answer is in there; you can almost feel it on the tip of your tongue. But the pathway to reaching it feels clogged. This is why brain fog can be so frustrating: it is not a loss of memory, but a delay in access. And this is also why certain exercises are more effective than others. If retrieval is the bottleneck, then the brain needs practice in retrieving words quickly, not in solving equations or recognizing patterns. Voskuhl puts it bluntly: “Doing math is not going to help … You need an exercise that will help you with words.” The good news is that retrieval can be strengthened with the right kind of practice, much like a muscle that grows stronger with targeted resistance training.
So what should a brain workout actually look like? According to Voskuhl, the most effective exercises combine two essential ingredients: word-finding and speed. “It’s basically processing speed,” she said. “So you need an exercise that is going to be something that makes you rush, makes you do it quickly.” The goal is not just to access words, but to access them fast, under a gentle pressure that mimics the demands of real conversation. One excellent example is the timed word game. Set a 60-second timer and challenge yourself to list as many words as possible from a single category—animals, foods, cities, or verbs. The timer creates a sense of urgency, forcing your brain to scan its verbal network quickly and retrieve words before the clock runs out. Another powerful exercise is speed reading with immediate recall. Read a short article, a news story, or even a recipe quickly, then close the text and summarize it out loud in two or three sentences. This pushes you to not only absorb information but also retrieve and express it rapidly, which is exactly what daily life demands. A third option is rapid recall drills using flashcards or picture prompts. Flip through images of common objects, places, or people, and name them as fast as possible without pausing. You can even do this with photos of friends and family, turning a nostalgic trip through your camera roll into a targeted brain workout. The key is to combine verbal output with time pressure, so that your brain becomes more nimble at finding the right word in the moment you need it.
But perhaps the most important lesson from Voskuhl’s advice is that personalization matters more than any single app or puzzle book. Instead of blindly downloading the latest brain-training program, she encourages women to pay close attention to their own lives. Where exactly do they stumble? Is it remembering names at parties? Is it finding the right word when writing an email? Is it responding quickly in meetings or thinking on your feet during conversations? “People know themselves,” Voskuhl said. “What they are bad at or what they used to be good at and now they’re not as good at … Once you know those things, you should think about what kind of games [to play].” This is a deeply human approach: it trusts your own experience and intuition as a guide. You are the expert on your own mind, and you already know where the fog is thickest. The next step is to choose exercises that directly target those specific weak spots. If you struggle with word-finding, choose word-based games. If you struggle with quick responses, choose timed challenges. If you struggle with remembering names, practice naming faces. Voskuhl even encourages experimentation. “You can play around with different games. You can see if it pushes you,” she said. A game that feels too easy is not helping; a game that feels challenging but achievable is likely hitting the right spot. The point is not to become a master puzzle solver, but to build a brain workout that fits your personal cognitive profile.
None of this means that brain fog is all in your head, or that you should simply try harder to think clearly. The hormonal changes of perimenopause and menopause have real, measurable effects on the brain’s structure and function. But understanding those effects can be profoundly reassuring. You are not losing your mind; your brain is just processing words and speed a little differently than it used to. And because the problem is specific, the solution can be specific too. By trading random brain games for targeted, timed, word-based exercises, you can actively work on the very skills that feel most fragile. You might set a timer every morning and list as many animals as you can in one minute. You might read a short article over lunch and summarize it out loud to yourself. You might turn a stack of old photos into a rapid-fire naming drill. These small, simple practices can build real cognitive confidence over time. They remind you that your memory is still rich and full—the words are still there, waiting to be found. With patience, practice, and a little bit of self-compassion, you can sharpen your retrieval pathways and feel more like yourself again. The goal is not to win a trivia contest or achieve a perfect score on a game. The goal is to walk into a room, see a familiar face, and say their name without hesitation. And that is a goal worth working toward.
