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Is menopause to blame for increased forgetfulness and lack of attention?

If you're a bit more forgetful or having more difficulty processing complex concepts than in the past, the problem may be your menopause stage. A new study claims that menopause stage is a key determinant of cognition and, contrary to previous studies, shows that certain cognitive declines may continue into the postmenopause period. 

It's commonly assumed that people's memories decline with age, as does their ability to learn new things and grasp challenging concepts. But multiple large-scale studies have suggested that menopause is a sex-specific risk factor for cognitive dysfunction independent of aging and menopause symptoms such as depression, anxiety, and hot flashes.

Many of these previous studies, however, did not characterize the duration of cognitive changes taking place between premenopause and perimenopause but suggested that difficulties in memory and processing may resolve in the postmenopause period. A new study involving more than 440 primarily low-income women of color, including women with HIV, concluded that menopause stage is a key determinant of cognition but that clinically significant cognitive declines/cognitive impairment persist into postmenopause, affecting primarily learning and memory. Subtler declines in attention were additionally found to continue into the postmenopause period.

Researchers theorized that the difference in results relative to the duration of cognitive decline could be explained by the fact that this newer study included more low-income women with multiple risk factors for cognitive dysfunction, including the presence of HIV. Previous studies have confirmed that cognitive function is compromised by an array of risk factors, including HIV, poverty, low education, substance abuse, high levels of stress, limited access to quality healthcare, mental health problems, and medical comorbidities.

The new study is the first known study to assess changes in cognitive performance across menopause stages. It specifically showed cognitive declines over time in learning, memory, and attention from premenopause to early perimenopause and from premenopause to postmenopause. Many of these changes were documented to reach a clinically significant level of cognitive impairment.


Objective: To assess longitudinal changes in cognitive performance across menopause stages in a sample comprised primarily of low-income women of color, including women with HIV (WWH).

Methods: A total of 443 women (291 WWH; 69% African American; 18% Hispanic; median age = 42 y) from the Women's Interagency HIV Study completed tests of verbal learning and memory, attention/working memory, processing speed, verbal fluency, motor skills, and executive function first at an index premenopausal visit and thereafter once every 2 years for up to six visits (mean follow-up = 5.7 y). General linear-mixed effects regression models were run to estimate associations between menopause stages and cognition, in the overall sample and in WWH. We examined both continuous scores and categorical scores of cognitive impairment (yes/no >1 standard deviation below the mean).

Results: Adjusting for age and relevant covariates, the overall sample and WWH showed longitudinal declines in continuous measures of learning, memory, and attention/working memory domains from the premenopause to the early perimenopause and from the premenopause to the postmenopause, Ps < 0.05 to < 0.001. Effects on those same domains were also evident in categorical scores of cognitive impairment, with the increased odds of impairment ranging from 41% to 215%, Ps < 0.05 to < 0.001. The increase in predicted probability of impairment by menopausal stage (% affected) ranged from 4% to 13%.

Conclusions: Menopause stage was a key determinant of cognition in a sample of low-income women of color, including WWH. Many of these changes reached a clinically significant level of cognitive impairment.


Pauline M Maki 1, Gayle Springer, Kathryn Anastos, Deborah R Gustafson, Kathleen Weber, David Vance, Derek Dykxhoorn, Joel Milam, Adaora A Adimora, Seble G Kassaye, Drenna Waldrop, Leah H Rubin. Cognitive changes during the menopausal transition: a longitudinal study in women with and without HIV. Menopause. 2021 Jan 11;Publish Ahead of Print. doi: 10.1097/GME.0000000000001725. Online ahead of print.

Content created 13 Jan 2021

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