Women in perimenopause and postmenopause were more likely than premenopausal women to report cognitive symptoms such as brain fog and memory problems, although objective cognitive performance was largely similar across groups, according to a cross-sectional study published in npj Women’s Health.
Researchers analyzed data from 14,234 females aged 45 to 55 years in England participating in a REACT cohort study. Participants were categorized as premenopausal, perimenopausal, or postmenopausal and completed assessments of self-reported cognitive symptoms, psychological and physical symptoms, and objective cognitive performance.
Compared with premenopausal participants, those in perimenopause and postmenopause had higher odds of reporting symptoms such as brain fog and poor memory. They also reported more psychological and physical symptoms, including anxiety, low mood, sleep difficulties, and fatigue, although not all differences were statistically significant.
Differences in objective cognitive performance were minimal. Perimenopausal participants showed slightly higher accuracy than both premenopausal and postmenopausal groups, but the effect size was very small, and there were no meaningful differences in reaction time across groups.
Importantly, subjective cognitive symptoms were only weakly associated with objective cognitive performance but showed moderate associations with psychological symptoms. This suggests that perceived cognitive difficulties during menopause may be more closely related to factors such as mood, sleep, and fatigue than to measurable declines in global cognitive ability.
Lead author Laura F. Naysmith, PhD, of King’s College London, and colleagues noted that these findings highlight a disconnect between women’s reported cognitive symptoms and objective test performance.
The findings also raise the possibility that transient, real-world cognitive lapses—such as forgetfulness or difficulty concentrating—may not be captured by standardized cognitive testing, even though they meaningfully affect daily functioning and quality of life.
The authors noted that the cross-sectional design limits conclusions about causality and emphasized the need for longitudinal studies to better understand how cognitive symptoms and performance may change over time.
Disclosures: The researchers reported no competing interests.
The study was published in npj Women’s Health
