Scientific insights into brain fog during the menopausal transition

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 changes in cognitive function [1]. Longitudinal cohort studies suggest a ‘window of vulnerability’ for cognitive difficulties [2,3], particularly memory, beginning in the early menopause transition and apparently ending, at least for most women, in the postmenopause. Changes in sex steroid hormones, particularly 17b-estradiol, which exerts potent effects on the brain, play a key role in memory performance at midlife [4] as do vasomotor symptoms, sleep disturbance, and mood/anxiety [5]. Some studies suggest that longer lifetime exposure to endogenous 17bestradiol may be related to better cognitive processes in older women [6].
There are critical gaps in the knowledge of the neurobiological mechanisms contributing to those declines, the persistence of those declines, the extent to which hormonal changes and menopause symptoms contribute to cognitive declines, potential interventions that might be effective in ameliorating cognitive difficulties, and the long-term clinical significance of midlife cognitive changes. This themed edition of Climacteric focuses on menopause and cognition from a clinical translational perspective and addresses some of these gaps by drawing on both clinical and basic science.

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