Menopause doesn’t have a lasting impact on cognition, study finds

There is no evidence that the transitional symptoms of menopause – such as brain fog and memory problems – have a lasting impact on cognitive performance, a new study finds.

Published in npj Women's Health, 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 a person’s cognitive abilities such as memory, attention, problem-solving, and decision-making.

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.’

Menopause occurs at an average age of 51, and cognitive symptoms such as forgetfulness and brain fog — encompassing memory lapses, mental slowing, and attention difficulties — are reported in 40–80% of women.

The biological basis for these symptoms, however, remains unclear, and there have been contradictory findings on whether cognitive symptoms relate directly to cognitive performance.

In this study, researchers analysed data from 14,234 women aged 45–55 years drawn from the REACT-Long Covid Study, a large community cohort in England.

Participants were split into three groups depending on their menopausal experience (pre-menopause, perimenopause and post-menopause) and self-reported cognitive symptoms of menopause before undertaking eight online tasks designed to test memory and reasoning.

An initial analysis of the data established that overall cognitive performance differed minimally across the three groups, with cognitive symptoms only weakly associated with cognitive performance in the pre-menopause, perimenopause and post-menopausal stages.

While the researchers did find a very weak link between symptoms and abilities, further analysis showed that the experience of cognitive symptoms was more closely correlated with an increased reporting of psychological symptoms, including anxiety and low mood, especially in perimenopausal and post-menopausal participants.

Nevertheless, while the researchers acknowledge that no global cognitive dysfunction was observed, they emphasise that the reported cognitive symptoms still significantly impact quality of life.

Therefore, they underscore the need 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.’