Menopause
Menopause has no lasting impact on cognition, research finds

Common menopause symptoms such as brain fog and memory problems do not appear to have a lasting impact on cognitive performance, a study suggests.
The study found that while brain fog is a real symptom commonly experienced by perimenopausal and post-menopausal women, there is no evidence that it has an ongoing impact on core cognitive abilities such as memory, attention, problem-solving and decision-making.
Menopause usually happens at about 51, and cognitive symptoms such as forgetfulness and brain fog, including memory lapses, mental slowing and attention difficulties, are reported by 40 to 80 per cent of women.
But findings have been mixed on whether those symptoms are directly linked to cognitive performance. Their biological basis also remains unclear.
Dr Laura Naysmith, postdoctoral research associate at King’s College London and the study’s first author, said: “Cognitive symptoms are very real and often quite a distressing aspect of the menopause.”
“While mental effort [may] need to increase to maintain cognitive function due to these symptoms, we hope it is reassuring to those experiencing symptoms that cognitive abilities can be preserved.”
“Our study found that core cognitive abilities are consistent between menopausal stages.”
Researchers analysed data from 14,234 women aged 45 to 55 in the REACT-Long Covid Study, a large community cohort in England.
Participants were divided into three groups by menopausal stage, pre-menopause, perimenopause and post-menopause, and reported cognitive symptoms before completing eight online tasks designed to test memory and reasoning.
The analysis found only minimal differences in overall cognitive performance across the three groups, with cognitive symptoms only weakly linked to performance in pre-menopause, perimenopause and post-menopause.
The researchers did find a very weak link between symptoms and performance, but further analysis suggested that cognitive symptoms were more closely associated with increased reporting of psychological symptoms, including anxiety and low mood, especially among perimenopausal and post-menopausal participants.
The team said no global cognitive dysfunction was seen, but stressed that the reported symptoms can still have a significant effect on quality of life.
They called for more precise measures of subjective cognitive difficulties in future research.
Adam Hampshire, the study’s senior author, said: “Next we will explore the basis of the observed elevation in cognitive symptoms in more detail, including whether specific aspects of cognitive performance, or particular groups of people with certain symptom profiles or HRT [hormone-replacement therapy] use, show clearer differences.”
Menopause
More research needed to understand link between brain fog and menopause, expert says

Brain fog in menopause is common but still poorly understood, with researchers calling for more work to explain the link and how best to support women.
For a new perspective article published in The Lancet Obstetrics, Gynaecology, & Women’s Health, researchers based in the UK and Australia reviewed the evidence on menopause-related cognitive symptoms. They found that symptoms such as forgetfulness, reduced concentration and brain fog are common during the menopause transition, but are still poorly recognised and under-researched.
More than two-thirds of women report difficulties with memory or concentration over the menopause transition. Multiple factors may contribute to these cognitive symptoms, including hormonal changes, sleep disturbances and psychological and psychosocial stress. Yet, because cognitive symptoms are not widely discussed, they can cause considerable worry, with some fearing they are signs of dementia or undiagnosed neurodevelopmental conditions.
The review paper emphasises that overall cognitive performance for women experiencing menopause-related brain fog typically remains within expected ranges and, importantly, that cognitive symptoms are not linked to an increased risk of dementia.
Professor Aimee Spector of UCL Division of Psychology and Language Sciences, co-author on the paper, said: “Cognitive symptoms such as forgetfulness and ‘brain fog’ are incredibly common during menopause, yet they are often overlooked. Our findings highlight just how complex menopause-related cognitive symptoms are, and how much we still don’t know about what drives them. More targeted research is essential if we are to identify which biological, psychological or lifestyle factors contribute most, and what types of support or treatment are likely to be effective.”
The authors argue that clinicians can play a key role in understanding and validating women’s experiences by asking about the duration of cognitive symptoms, impacts on day-to-day functioning and any other medical or psychosocial factors that could be contributing to cognitive symptoms.
The review also discusses a range of approaches that may ease cognitive symptoms, such as improving sleep quality, engaging in regular aerobic exercise and eating a balanced diet. There is also little but promising research into the impact of psychological therapies targeting cognitive symptoms, with a recent meta-analysis of three cognitive behavioural therapy-based studies showing significant improvements in memory and concentration. The evidence is more mixed for the benefits of hormone therapy on cognitive symptoms during menopause.
The authors identify cognitive symptoms as a major area of unmet need in menopause research. They call for a unified definition of menopause-related cognitive changes and for prospective, longitudinal studies that can track women from pre- to post-menopause. Better understanding of the biological, psychological and social factors that contribute to cognitive symptoms will be crucial for developing effective treatments.
Lead researcher Dr Caroline Gurvich of Monash University said: “There’s a lot of pressure to use objective measures of cognitive decline, like a memory test, for example, in a clinical trial, but the key symptom of brain fog is a subjective experience. So having a definition that acknowledges the key cognitive symptom is critical.”
This is not without precedent – we already use subjective or self-report measures for depression, anxiety and other mental health conditions with great success.
Dr Gurvich said the proposed definition would also validate women’s individual experiences while empowering them through the reassurance that any objective decline in their cognitive ability is subtle.
She added: “This is a decrease in cognitive or learning efficiency, not functionality or capacity. For many women, the perception they are losing capacity is what drives them to stop work or lose the confidence to live fulfilling lives during and after menopause. I hear all the time from women who have gone through menopause that validation would have made a significant difference to their resilience and the approach they took to living with menopause.”
Co-author Professor Martha Hickey of the University of Melbourne and Royal Women’s Hospital said: “Our analysis of the best available research shows that many women experience some degree of cognitive symptoms, such as brain fog, during the menopause transition.”
“But there’s a lack of long-term data, which means that there’s a gap in our knowledge about how the brain fog symptom develops and changes from peri-menopause to after menopause ends. It’s a real gap in our understanding.”
Professor Spector added: “We increasingly see women, typically at the peak of their careers, losing confidence in the workplace, often translating to leaving work or reducing work hours. Having simple strategies to support and retain them at work is also a broader economic issue.”
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