Cognitive Health in the Menopause Transition

It is common for women to complain of cognitive problems in the menopause transition (i.e., ‘perimenopause’), which refers to the five or so years preceding the final menstrual period. Common cognitive complaints include forgetfulness, fuzzy thinking, and poor concentration. However, the few studies which objectively assess cognitive functioning in the perimenopause show a relatively modest association between cognitive performance and reproductive stage when comparing women in the early and late stages of the menopause transition. There is therefore a disconnect between the clinically meaningful problems reported by perimenopausal women and the relatively small effects observed in the scientific literature.

One possible explanation for this disconnect may be related to the ever-changing hormonal environment that characterizes the menopause transition. Previous studies that have measured cognitive performance and hormone levels at a single time-point may therefore not be appropriately designed to capture an effect of reproductive hormones – estrogen, progesterone, testosterone – on cognitive difficulties in the menopause transition. By measuring hormone levels and both self-reported cognitive difficulties and objective performance on cognitive tests multiple times over several months, our research has aimed to clarify the effect of fluctuating hormone levels on cognitive functioning in perimenopausal women.

While this work is still ongoing, some preliminary findings are available: on average, periods of low estrogen are accompanied by temporary reductions in attention and memory among perimenopausal women. However, some women are clearly more sensitive to the cognitive effects of reproductive hormones than others. For example, women who report more life stress may be more likely to experiences attentional difficulties in response to a drop in estrogen levels than women reporting low levels of life stress. These individual differences may help explain why not all women report experiencing cognitive difficulties in the menopause transition to the same degree.

Please check back to learn more as we continue to pursue this important line of research!