Mind, Body, & the Pause: Menopause, brain fog, and screening gaps, with Manisha Parulekar, MD, and Jocelyn Carlo, MD, FACOG

In the inaugural episode of Mind, Body, & the Pause: the Perimenopause and Beyond Series, host Soma Mandal, MD, medical director of Women's Health at Hackensack Meridian Jersey Shore University Medical Center, is joined by Jocelyn Carlo, MD, FACOG, director of gynecology at Hackensack Meridian Jersey Shore University Medical Center, and Manisha Parulekar, MD, chief of the Division of Geriatrics and co-director of the Center for Memory Loss and Brain Health at Hackensack Meridian Hackensack University Medical Center and Hackensack Meridian Neuroscience Institute, for a conversation on the perimenopause-to-postmenopause transition.

Carlo opens by clarifying terminology that often confuses patients, explaining that postmenopause is a retrospective diagnosis requiring 12 consecutive months without a period, and distinguishing premature menopause, which occurs before age 40, from the natural transition that typically unfolds between ages 45 and 55, with an average onset around 51. She describes perimenopause as a variable, often years-long process marked by irregular cycles, sleep disruption, night sweats, hot flashes, vaginal dryness, joint pain, and brain fog.

The conversation turns to the neurological side of the transition, with Parulekar noting that while brain fog is a recognized, temporary phenomenon tied to hormonal changes, the link between estrogen deficiency and Alzheimer disease risk remains unresolved, with hormone therapy studies yielding mixed results. Parulekar and Carlo discuss how menopausal brain fog remains stigmatized compared with the more socially accepted "pregnancy brain," and both emphasize lifestyle adjustments, structured diagnostic workups using tools such as the Montreal Cognitive Assessment, and giving patients permission to slow down rather than push through cognitive changes.

The panel also examines how menopause intersects with midlife risk for cardiovascular disease, osteoporosis, and dementia, noting that current screening guidelines, including the US Preventive Services Task Force's age-65 threshold for osteoporosis screening, reflect average risk rather than individualized risk. They discuss the limitations of BMI as a screening tool, particularly for South Asian women with central adiposity, and stress the value of waist and hip measurements, bone density testing, and attention to family history, race, and comorbidities such as thyroid disease. The conversation also touches on underused preventive tools, including the Shingrix vaccine's association with reduced Alzheimer disease risk and expanded cardiovascular risk markers like lipoprotein(a) and ApoB.

Carlo discusses proactively counseling patients before risk-reducing salpingo-oophorectomy or aromatase inhibitor therapy about implications for bone, heart, sexual, and pelvic floor health, along with the lingering influence of the 2002 Women's Health Initiative on patient hesitancy toward hormone therapy and the training gaps many clinicians of her generation faced around prescribing hormones. The episode closes with guidance on identifying knowledgeable, accessible practitioners and the value of multidisciplinary referral among specialists managing menopause care.

Throughout, Mandal, Carlo, and Parulekar underscore that menopause is a multisystemic transition, not a disease, requiring coordinated, preventive, individualized care rather than siloed, single-specialist management, setting the tone for the series' mission of bringing candid, evidence-based guidance to an under-discussed life stage.