Purpose of Review <p>Cognition is the set of mental processes through which individuals acquire, process, store, and apply information. It encompasses functions such as perception, attention, memory, language, reasoning, and problem-solving, enabling people to interpret their environment, make decisions, and generate knowledge. Perimenopause is accompanied by subjective cognitive complaints, often described as “brain fog,” which can have a significant impact on quality of life and may be associated with greater risk of cognitive impairment in later life. These symptoms are multifactorial, influenced by hormonal changes, psychological status, lifestyle behaviors, and neurobiological mechanisms. This review synthesizes the current research on management of cognitive symptoms in perimenopause through a mechanistic lens.</p> Recent Findings <p>The strongest evidence is for the use of lisdexamphetamine and creatine, though generalizability remain limited by study population characteristics and sample size. Among non-pharmacological approaches, physical activity has the most robust evidence for cognitive benefit.</p> Summary of Findings <p>Further research is needed focusing on the perimenopausal population with a focus on subjective and objective cognitive outcomes as well as long-term efficacy and safety of treatment options.</p>