Aimee Spector

Importance: Women in the menopause transition (MT) commonly experience mood disturbances, anxiety, cognitive complaints, and reduced quality of life (QoL). Yet access to pharmacological or psychological treatments may be limited or unsuitable for some. Identifying and accessing non-pharmacological interventions is therefore an important clinical and public health priority. Objective: To synthesize evidence from randomized controlled trials (RCT) evaluating the effectiveness of physical activity (PA) interventions for improving depression, anxiety, mood, cognition, stress, and QoL in women during the MT. Evidence Review: A systematic search of Medline, PsycINFO, Web of Science, Cochrane Library, and CINAHL was conducted from inception to April 2025. RCTs including women aged 40-65 years in peri and early postmenopause were eligible. PA interventions were compared with alternative PA or treatment as usual. Outcomes were pooled using random-effects meta-analysis, with subgroup analyses by menopausal stage (peri and early postmenopause) and intervention types (aerobic-based [ABI] and mind-body [MBI]). Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Findings: Twelve RCTs involving 1,003 women were included. PA significantly improved depression (g=−1.37, 95% CI [−1.96 to −0.79], mood (g= 0.84, 95% CI [0.40-1.29]), psychological QoL (g=0.66, 95% CI [0.19-1.13]), and overall QoL (g=1.10, 95% CI [0.32-1.88]). Significant reductions in depression were found in both perimenopause (g=−1.57, 95% CI [−2.58 to −0.56]) and early postmenopause (g=−1.14, 95% CI [−1.48 to −0.79]), with other outcomes improving in early postmenopausal women. ABIs improved (g=−1.07, 95% CI [−1.35 to −0.78]), mood (g=1.05, 95% CI [0.52-1.58]), and overall QoL (g=1.41, 95% CI [0.12-2.69]), whereas MBIs improved psychological QoL (g=0.80, 95% CI [0.43-1.16]). Sensitivity analyses largely supported these findings. Conclusions and Relevance: PA may seem to improve depression, mood, and QoL in women in the MT. Both ABIs and MBIs may be beneficial, supporting the integration of PA into clinical care for menopausal women. Further high-quality trials with clearer menopause staging are needed to strengthen the evidence base. Key points

The objective of this review was to explore the effect of testosterone therapy on objective and subjective cognition during the menopause transition and postmenopause through a systematic review and meta-analysis. A systematic search was conducted in PsycINFO, MEDLINE, Embase, Web of Science and the Cochrane Library from database inception to March 2025 using predefined eligibility criteria. A total of 3,880 records were identified. After screening, five studies were eligible for inclusion. Three studies including 244 postmenopausal participants were included in a random-effects meta-analysis to estimate pooled effects. Three cognitive domains were covered: executive function, verbal learning and memory and visuospatial learning and memory. Studies excluded from the meta-analysis were reported narratively. The meta-analysis found no statistically significant pooled effects of testosterone therapy across the cognitive domains analysed, with effect sizes mostly close to zero. No studies explored the effect of testosterone therapy on subjective cognition or during perimenopause. The findings should be interpreted as insufficient to establish an effect rather than as evidence of no effect, given the small number of available studies and their limited sample sizes. Further adequately powered trials are needed to investigate the effects of testosterone therapy on cognition, particularly during the menopause transition, the period in which cognitive problems appear to be most pronounced. Lay summary: Menopause is a stage of life that can affect thinking and memory, often colloquially referred to as ‘brain fog’. Brain fog can affect daily life and relationships. Hormone treatments are often used to manage symptoms, but it is still unclear how well they work. Testosterone is sometimes prescribed for low sex drive, but its effects on thinking and memory remain unclear. This study reviews the existing evidence. Five studies were identified. These studies examined different areas of thinking and memory, including attention, planning, decision-making and learning. We found no clear evidence that testosterone affects thinking and memory. However, only a few small studies were available, so the results need to be interpreted carefully. This research highlights a knowledge gap. Further studies are needed on testosterone to guide effective treatment and support women to make informed decisions about their health.

The menopause transition represents a significant biological and psychosocial transition in a woman’s life and is defined by permanent cessation of the menstrual cycle. A common and widespread symp...

1. It has been estimated that approximately 13 million women, or one-third of the female population in the UK, are peri- or post-menopausal [1]. Between 50-75% of women experience symptoms during m...

Cognitive symptoms during the menopause, often described as ‘brain fog’, are increasingly recognised as a common but under-addressed aspect of midlife women’s health. These symptoms can include dif...

Objective: The menopause transition (MT) can present with a range of biopsychosocial challenges, including peaks in anxiety and depression. Compassionate Mind Training (CMT), a psychological intervention focused on improving distress and wellbeing, has shown promising results in supporting depression in clinical populations. This study examined the feasibility and preliminary effects of a six-session online CMT group intervention for women in MT, with mild to moderate anxiety and/or mild to moderately severe depression. Methods: This was a mixed-methods feasibility study. 38 participants were randomized to either CMT plus treatment as usual (TAU) or TAU alone. Feasibility and acceptability outcomes included recruitment, retention, attendance, and measure completion. Exploratory analyses examined changes in psychological outcomes. Qualitative interviews ( n =16) were analyzed thematically to explore participant experiences. Results: Recruitment targets were met, with retention rates of 89.5% for CMT, and 73.7% for TAU. Attendance was high, and outcome measures showed 100% completion among those at follow-up. Exploratory analyses suggested improvements following CMT for depression (Patient Health Questionnaire-9, d =0.73), anxiety (Generalized Anxiety Disorder-7, d =0.53), and anxiety/depressive symptoms (Women's Health Questionnaire, d =1.12), alongside reductions in fears of compassion and self-criticism. Thematic analysis generated five themes: motivation and engagement, perceptions of trial processes, structure, support, and group experience, intervention content and skill-building, and personal outcomes, impact, and the future. Conclusions: The study supports the feasibility and acceptability of CMT for women in MT. Quantitative and qualitative findings suggest potential benefits for mental health and quality of life, warranting a fully powered trial of effectiveness and cost-effectiveness.

Menopausal ‘brain fog’ is a cluster of cognitive-related symptoms that can be distressing to individuals.Brain fog can occur across the lifespan in both men and women. It is not always hormone rela...

START (STrAtegies for RelaTives) is an evidence-based manualised psychological intervention to improve mood and increase quality of life for family caregivers of people with dementia. A trained facilitator delivers eight sessions to individuals. The contents include psychoeducation, behavioural management, thought analysis, communication, relaxation strategies, planning for the future, and behavioural activation. This study aimed to culturally adapt START, train facilitators, and test its feasibility in India. The adaptation process followed the Medical Research Council guidelines for five phases adaptation of complex interventions. The Cultural Treatment Adaptation Framework (CTAF) was used to analyse professional and caregiver stakeholder qualitative interviews (N = 21) about cultural changes for the intervention. The manual incorporated the changes and was translated into Tamil. The intervention was adapted for virtual delivery using Zoom due to COVID-19. Feasibility was tested through recruitment, retention, attendance, and adverse effects. Modifications informed by stakeholder interviews (N = 21) involved cultural changes in materials, semantics, pictures and vignettes. The manual did not require modification of core therapeutic elements. Twenty-two caregivers were recruited, of whom eighteen completed all sessions. The feedback from the participants on START was positive, reporting that the intervention enabled them to express their emotions and increased their knowledge and skills in caring for people with dementia. START was feasible and acceptable for virtual delivery in India with the potential to improve the well-being of caregivers of people with dementia.

Aim: The aim of this study was to evaluate the feasibility, acceptability, and potential effects of a novel, group-based online intervention for cognition in menopause transition, ‘CST-Meno’, through a feasibility randomised controlled trial. Method: Forty-one women were eligible to participate, with 33 randomised to CST-Meno (n = 17) or treatment as usual (n = 16). CST-Meno was delivered over six weeks within four, two-hour sessions. Feasibility and acceptability outcomes included recruitment, retention, attendance, and measure completion. Exploratory analysis examined changes in subjective and objective cognition, quality of life, vasomotor symptoms, anxiety, and depression. Results: CST-Meno demonstrated acceptability as an intervention, with strong retention, good attendance, and no adverse effects related to content or delivery. With recruitment and retention targets exceeded, willingness to be randomised high, and outcome measures well tolerated, the feasibility and acceptability of the trial design were demonstrated. Exploratory analysis showed small changes in all outcomes, some favouring CST-Meno and others favouring treatment as usual. However, the trial was not powered to detect changes, so these findings were interpreted with extreme caution. Conclusion: CST-Meno is feasible to conduct both as a randomised controlled trial and as an acceptable intervention to participants. This warrants further research with a larger, diverse sample, exploring both effectiveness and cost-effectiveness. Lay summary: Cognitive changes (‘brain fog’) are highly prevalent during menopause transition. However, there are no treatments shown to help. We developed an online, group intervention called ‘CST-Meno’ (four, two-hour sessions), which provides information and management strategies. Thirty-three women were randomly assigned to receive either CST-Meno or usual care. Everyone was given the same tests (including cognition, mood, and quality of life) at the beginning and end of the study. CST-Meno appeared acceptable to participants, with easy recruitment, good attendance, no adverse effects, few dropouts, and most completing outcome measures. There were no notable changes in outcomes between those attending CST-Meno and usual care; however, our sample was too small to detect clinical changes. We concluded that a larger trial with a more diverse sample is needed. This would help us understand whether CST-Meno improves cognition and other outcomes and if it leads to any economic benefits, such as reduced time off work.

Receiving a diagnosis of a physical health condition can present significant psychological challenges. Despite this, structured post-diagnostic support aimed at fostering psychological adjustment remains limited in many clinical settings. This systematic review aimed to identify and synthesise evidence on interventions designed specifically to promote psychological adjustment following such diagnoses, with a focus on evaluating their effectiveness and feasibility. A systematic review of MEDLINE, PsycINFO, Scopus and CINAHL from inception until May 2024. Studies were assessed for quality using the CASP and MMAT, and the impact of the intervention on outcomes of psychological adjustment, emotional adjustment, coping or similar were extracted. This review was PROSPERO registered (CRD42023452369). Forty-five articles were evaluated (n = 4,848). Most reported interventions in cancer (28/45), but other populations were represented including neurodegenerative disease, and neurological brain trauma. Interventions were heterogenous, but Cognitive Behavioural Therapy (CBT) or a Cognitive based psychotherapy were most common (n = 20) and improved psychological adaptation across clinical groups. Examples of other interventions included general psychotherapy (n = 3), Acceptance and Commitment Therapy (ACT; n = 2), and stress management (n = 3). Interventions that incorporated mindfulness were largely successful and were highly acceptable to participants. Multiple evidence-based interventions were identified that promote psychological adjustment. Further research is needed to explore the sustainability, scalability, and economic impact of these interventions across clinical settings.