Cognition and the menopause transition: cross-sectional evidence from a large community cohort

Abstract Subjective cognitive symptoms (brain fog, memory problems) are common in menopause, but whether these self-reported symptoms correspond to measurable deficits in cognition remains unclear. In 14,234 females (aged 45–55) from the REACT-Long Covid Study, we examined self-reported cognitive symptoms and objective cognitive performance in premenopausal, perimenopausal, postmenopausal participants. Global cognitive performance was derived from eight online tasks (‘Cognitron’). Perimenopausal (OR = 1.31 [1.18, 1.35], p = 0.015) and postmenopausal participants (OR = 1.13 [1.08, 1.32], p = 0.014) had higher odds of reporting cognitive symptoms than premenopausal participants. Objective cognitive performance differed minimally across menopause status groups, with perimenopausal participants showing marginally higher accuracy than premenopausal and postmenopausal participants (0.03–0.06 SD, p < 0.023). Across all menopause status groups, cognitive symptoms were weakly associated with objective performance but moderately related to psychological symptoms. These findings underscore recognising cognitive symptoms as a key component of menopausal care and integrating patient-reported outcomes with objective and biological measures of cognitive health.