Nicole G. Jaff

Women experience menopause around the age of 45-55 years. Cognitive dysfunction is one of the most prevalent menopausal complaints. This focus group study aimed to explore cognitive experiences and management during the menopause transition. Eighteen participants, including 15 women in menopause transition from multi-ethnic backgrounds and three healthcare professionals, were recruited to five focus groups conducted between June and August 2025. Thematic analysis yielded three overarching themes: cognitive changes relevant to the menopause transition; multidimensional impacts of cognitive changes; and holistic management of cognitive changes. From participants' narratives, 12 cognitive domains were affected in the menopause transition. These in turn had psychological, social and behavioral impact, resulting in the need to use various coping strategies. The findings of this study identified cognitive challenges in the menopause transition. Women's current coping with cognitive dysfunction addressed the multidimensionality of menopausal management and highlighted unmet needs regarding cognitive health. The research identified cognitive challenges beyond memory and concentration in the menopause transition. Associations of menopause-related factors, culture and ethnicity with cognitive function warrant further investigation for potential intervention development.

Midlife women commonly experience changes in their cognitive function as they transition through menopause and express concern about whether these changes represent the initial stages of a more serious cognitive disorder. Health-care practitioners play an important role in counseling women on cognitive changes at midlife and normalizing women’s experience. The aim of this commissioned International Menopause Society White Paper on cognition is to provide practitioners with an overview of data informing the clinical care of menopausal women and a framework for clinical counseling and decision-making. Among the topics presented are the specific cognitive changes occurring in menopause, the duration of such changes and their severity. The role of estrogen and menopause symptoms is reviewed. We present talking points for clinical counseling on the effects of hormone therapy on cognition and dementia risk in women, including discussion of absolute risk. Lastly, a brief review of modifiable risk factors for age-related cognitive decline and dementia is presented, with guidance for counseling patients on optimizing their brain health at midlife and beyond.

Life expectancy in sub-Saharan African women is increasing, and by the late 2020s an estimated 76% of postmenopausal women globally will be living in developing countries. Menopause transition has been associated with cognitive decline in a wide range of studies, but data on cognition and reproductive aging are lacking in sub-Saharan African women. Approximately 72 million people in the region are expected to suffer from dementias and neurocognitive decline by 2050. Studies show that compromised cognitive health in low-income countries has significant implications for adult quality of life and socioeconomic development. There is now an urgent need to further examine risk factors for cognitive decline in these aging women and to understand the ability of public health programs to diagnose and treat cognitive dysfunction. This review examines studies assessing cognition and aging in sub-Saharan African adults, while addressing the significant research gaps. It examines data on the association of the menopause transition with cognitive function and describes how validated tools should be available to assess both menopausal stage and symptoms. Culturally appropriate and validated neurocognitive measures are required to better understand the relationship of reproductive aging with cognition. Longitudinal population-based studies are needed to assess the effect of lifestyle interventions, such as diet and exercise, on cognitive health in sub-Saharan African populations, with an emphasis on women as they transition into menopause.

Clinicians and researchers engaged in the field of menopausal health understand that there are myriad physiological and psychological effects associated with the menopausal transition, including ch...

Objective: Studies, conducted largely in North America and Europe, demonstrate that menopausal symptoms and menopausal stage influence cognitive function. Here, we evaluate these associations in a large cohort of sub-Saharan African women, a population where these associations are understudied. We hypothesized that premenopausal women would show better cognitive performance than women later in the transition, and that menopausal symptoms would be inversely related to cognition. Methods: This cross-sectional study included 702 black urban South African women between the ages of 40 and 60 years from the Study of Women Entering and in Endocrine Transition. Participants completed the Symbol Digit Modalities Test, a measure of processing speed and incidental recall. Menopausal stage was ascertained using the Stages of Reproductive Aging Workshop+ 10 criteria and symptoms using the Menopause Rating Scale. Multivariable linear regression analyses were used to examine adjusted associations between menopausal stage and menopausal symptoms on cognitive performance. Results: In adjusted analyses, menopausal stage was not associated with processing speed (p = 0.35) or incidental recall (p = 0.64). However, more severe symptoms of hot flushes and anxiety were associated with slower processing speed (all p < 0.05), and more severe mood symptoms were associated with worse incidental recall (p = 0.008). Conclusion: Menopausal symptoms, but not menopausal stage, were associated with cognitive function in this cross-sectional study of sub-Saharan African women.