Dr. Caroline Gervich

So it can fluctuate either daily or if someone still has a menstrual cycle, the cognitive symptoms might fluctuate across the menstrual cycle.

And we also acknowledge in our definition that the cognitive symptoms can cause mild to substantial distress as well as impact quality of life.

But last thing, it doesn't result in a sustained change in someone's capacity to perform their activities of daily living.

So when we do big group studies, we see a subtle decline in areas of learning efficiency.

But on an individual level, we do not see a notable objective decline that is, as you say, it distinguishes this from something like a mild cognitive decline where there is an objective cognitive decline.

So at the moment, there's not really any great treatments or management strategies that have got an evidence base for the cognitive symptoms.

A lot of people might find hormone therapies helpful or different lifestyle strategies helpful, but we don't have a good evidence base.

And I think one of the factors that's hindered our research is because we're using things like a memory task, an objective memory task for a clinical trial, but that isn't what

this is about this is about a subjective experience so I think we really needed to define what the cognitive symptoms are so then we can accept that we need to use a scale that measures that subjective experience and that is what we're trying to improve when we're doing clinical trials or doing research studies trying to improve the cognitive symptoms that people are experiencing.

What's the cause of these symptoms?

I would say it's a lot of different things.

So the most obvious factor is hormone changes because it happens more frequently across the menopause transition or it's identified as being a part of the perimenopausal transition timeframe.

So

During perimenopause, our estrogen progesterone levels, in particular, our estrogen fluctuates and gradually declines.

And there's a huge evidence base, predominantly from animal studies, showing that estrogen can have quite significant impacts within the brain in regions that regulate our cognition, particularly our memory, as well as within the frontal lobes are regulating our ability to plan, to organize, to allocate our attention.

So that provides a bit of a rationale as to where the estrogen receptors are located in the brain and why fluctuations and a decline in estrogen might impact aspects of cognition.

And we also know estrogen works with neurotransmitters like dopamine and serotonin, the GABAergic and glutamatergic system.

These are all neurochemicals that also play a role in our cognition.

So there is that evidence base to show why estrogen decline and fluctuations might impact cognition.

But I think it's also important to remember that perimenopause can come with other symptoms like poor sleep, as well as mood changes.