Word-finding difficulty — the tip-of-the-tongue phenomenon happening constantly and in the middle of normal sentences — is one of the most commonly reported cognitive symptoms of perimenopause. It is alarming when it happens because language is so central to how we function and how we present ourselves, but it does not indicate dementia or serious neurological disease.

Oestrogen has direct effects on the hippocampus and the language areas of the prefrontal cortex, which govern verbal memory and retrieval. When oestrogen fluctuates, these functions are temporarily disrupted. The word is still there — it is not lost — but the retrieval pathway doesn’t fire reliably. This is exactly what the tip-of-the-tongue phenomenon is, and it is happening more because the hormonal environment supporting those neural pathways has become less stable.

For most women, this improves after menopause when hormone levels stabilise.

In the meantime, there are practical steps worth taking. Ask your doctor for a blood test for vitamin B12 — deficiency is common (especially in vegetarians, and in women on metformin or long-term antacids) and causes exactly this kind of verbal retrieval difficulty. Also check thyroid (TSH + fT4), ferritin, and vitamin D. These are all common in the 40s and all treatable.

Prioritise sleep — memory consolidation and language retrieval both require adequate sleep, and poor sleep worsens word-finding significantly. Reduce or eliminate alcohol, which further disrupts these processes.

If word-finding difficulty is accompanied by any other neurological symptoms — weakness in one side of the body, visual changes, severe or sudden headaches, confusion — please see a doctor urgently. For word-finding alone without other symptoms, perimenopause is the most likely and most benign explanation.