What Midlife Women Need to Know About Estriol, Brain Fog, and Hormone Therapy: A Neurologist’s Perspective
Women Mastering Midlife Podcast Episode 61 Recap
Estriol and Brain Fog: The Hormone Midlife Women Aren’t Hearing About
Brain fog in perimenopause and menopause is one of the most frustrating and frightening symptoms women face. And yet, it’s often dismissed, minimized, or misdiagnosed. If you’ve ever forgotten a word mid-sentence, struggled to retain information, or worried that your memory lapses might be early signs of dementia - you're not imagining things.
As part of the Women Mastering Midlife podcast, I interviewed Dr. Rhonda Voskuhl, neurologist, researcher, and faculty member at UCLA, who is leading a powerful movement to address cognitive changes in midlife women with a safe, estrogen-based protocol that’s backed by decades of science.
Here’s what every woman over 40 should know.
The Connection Between Estrogen and Brain Health
Research consistently shows that estrogens are neuroprotective, helping to preserve cognitive function and reduce inflammation in the brain. During pregnancy, estrogen levels skyrocket, especially a lesser-known form called estriol; and women with conditions like multiple sclerosis (MS) often experience a dramatic improvement in symptoms during this time.
Dr. Voskuhl’s research took a closer look at this connection and found that:
Estriol is associated with better verbal memory and concentration
Cognitive symptoms often worsen after menopause, when estrogen levels drop
Brain scans of untreated menopausal women show measurable atrophy in key areas like the hippocampus
These changes aren’t “just in your head” they’re visible on MRI.
Estriol vs. Estradiol: What’s the Difference?
Most hormone replacement therapy (HRT) in the U.S. uses estradiol, which is effective for hot flashes but binds strongly to estrogen receptors in breast tissue raising concern about breast cancer risk. This is why estradiol is typically prescribed at the lowest dose for the shortest time possible.
Estriol, on the other hand:
Binds weakly to estrogen receptor alpha (in breast tissue)
Binds strongly to receptor beta (in the brain) which supports cognition
Has been used safely in Europe for over 40 years
Does not convert to estrone, reducing blood clot risk when taken orally
In short, estriol offers brain benefits without overstimulating breast tissue—a safer option for long-term use.
Introducing Cleopatra RX and the PearlPak Protocol
Dr. Voskuhl’s research laid the foundation for Cleopatra RX, a personalized hormone therapy program focused on cognitive health and symptom relief.
Key features of the PearlPak protocol include:
A blister pack design for easy AM/PM dosing
A combination of estriol and micronized progesterone (Prometrium)
A national network of nurses and prescribers who monitor symptoms and adjust doses
An option to take a brain fog symptom quiz to assess your candidacy
Rather than a one-size-fits-all approach, Cleopatra RX tailors treatment based on your symptoms and goals, whether it’s brain fog, hot flashes, or sleep issues.
Addressing Safety and FDA Approval
Estriol is not currently FDA-approved in the U.S., but that doesn’t mean it’s unsafe. It’s bioidentical, well-studied, and widely available through reputable compounding pharmacies. Cleopatra RX works only with licensed national pharmacies that:
Follow strict safety and compounding protocols
Use research-backed dosing models
Avoid mixing estriol and estradiol (which have different safety profiles)
If you’re concerned about breast cancer, clotting, or long-term hormone use, Cleopatra RX uses exclusion criteria to screen candidates appropriately and minimize risk.
Could Estriol Help Prevent Alzheimer’s?
While we don’t have definitive proof that treating menopause-related brain fog will prevent dementia, Dr. Voskuhl emphasizes the need for early intervention. Cognitive changes in menopause often precede mild cognitive impairment by a decade or more, and women make up nearly two-thirds of all Alzheimer’s diagnoses.
We may not know the full causal link yet, but research shows the same brain areas affected in menopause are also affected early in Alzheimer’s. That’s a compelling reason to take cognitive changes seriously.
How to Get Started
If you’re curious about whether Cleopatra RX could be a good fit for your menopause journey:
Visit www.cleopatraRX.com
Take the Brain Fog Symptom Questionnaire
Schedule a free consultation with a nurse
Receive a custom hormone protocol shipped directly to your home
Final Thoughts
As a midlife woman, pharmacist, and menopause coach, I know how easy it is to feel dismissed, misinformed, or overwhelmed by conflicting hormone advice. Dr. Voskuhl’s research offers a refreshing combination of safety, science, and simplicity.
You don’t have to accept brain fog as your new normal.
If you’re struggling with perimenopause or menopause symptoms and want personalized support, I offer 1:1 coaching and Midlife Mastery Clarity Sessions. Click here to learn more.
