Cognitive performance and severity of menopausal symptoms


Women with severe menopausal symptoms are likely to experience significantly greater cognitive decline than their counterparts with mild menopausal symptoms, according to a cross-sectional study in the journal Menopause.

The authors from Panjab University in Chandigarh, India, noted that menopause is accompanied by unfavorable physical, physiological, and psychological consequences.

The major goal of the study was to assess whether the cognitive performance of women is sensitive to the severity of menopausal symptoms.

The study comprised 404 women, aged 40 to 65 years, from the rural areas of district Rupnagar, Punjab, North India.1

For menopausal symptoms, the Greene Climacteric Scale (GCS) recorded the presence and intensity of 21 menopausal symptoms, whereas a 30-point questionnaire of the Hindi version of the Mini-Mental State Examination (MMSE) gauged global cognitive performance.

Women with severe menopausal symptoms, as reflected by a higher total GCS score, had significantly lower mean values for orientation, registration, and attention, compared to those with mild menopausal symptoms: 8.11 vs 8.90 (P < 0.001); 2.77 vs 2.91 (P < 0.001); and 4.31 vs 4.48 (P < 0.01), respectively.

Also, lower mean values for recall and language/visuospatial skills: 2.26 vs 2.53 (P < 0.05) and 7.13 vs 7.91 (P < 0.001), respectively.

After adjusting for age, marital status, and educational status, the multivariate linear regression model determined that severe depression and greater sexual dysfunction were the 2 factors significantly linked to lower MMSE scores.

Other studies have concluded that the coexistence of anxiety, depression and sexual dysfunction in women can be 1 of the underlying causes of poor or impaired cognitive functioning.

On the other hand, the current study found that severe vasomotor symptoms remained the non-predictor of cognitive performance in all the cognitive domains, except for the attention domain of the MMSE scale.

Several other studies have also reported no significant connection between vasomotor symptoms and memory performance in women, according to the current authors.

“The mechanism associated with cognitive decline among mid-life women experiencing vasomotor symptoms is the increased level of cortisol after the occurrence of hot flashes which leads to decline in memory functions of the brain,” they wrote.

Still, the present study does not allow for the evaluation of the causal relationship between menopausal symptoms and poor cognitive scores in women. In addition, using Stages of Reproductive Aging Workshop criteria would have provided detailed classification criteria for categorizing women into different menopausal stages.

Furthermore, using more specific cognitive evaluation tools would have offered better insight into the cognitive performance of women, according to the authors, as would objectively measuring the number of hot flashes instead of relying on self-reported responses and recall bias.

Hence, the authors advocate large longitudinal and cross-sectional studies to clarify the associations found in their study.

“An increase in longevity has resulted in a substantial proportion of women in their postreproductive phase for an extended period,” wrote the authors. “However, the lack of awareness of menopausal related symptoms, absence of counselling, and adequate medical interventions often deprive them of good quality of life.”

Study results can help rural health services plan specific programs to remedy menopausal-related issues and help many silent sufferers.



  1. Mankamal K, Kaur M, et al. Is cognitive performance of women sensitive to the severity of menopausal symptoms? Menopause. Published online January 10, 2022. doi:10.1097/GME.0000000000001910
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