Age at natural menopause and cognitive aging in U.S. women: Educational attainment as a modifiable resilience factor

While premature menopause is associated with adverse cognitive outcomes, less is known about the impact of late menopause and whether associations vary by socioeconomic status. This study examines the association between the timing of natural menopause and cognitive decline, focusing on the modifying role of education.

The study included 5082 U.S. women from the Health and Retirement Study who had experienced natural menopause by 2008 and were followed through 2020. Age at menopause was self-reported and categorized as <40 (premature), 40-44 (early), 45-49, 50-55, and > 55 (late). Multivariable-adjusted mixed-effects linear regression models estimated associations with baseline cognition and rate of cognitive decline, including interaction terms to assess effect modification by education.

Score on a 27-point cognitive scale that includes word recalls, serial 7 s, and backward counting.

On average, participants were aged 69.9 years and had 12.6 years of education. Compared to those with menopause at 50-55, women with menopause before age 50 had significantly lower baseline cognitive scores. Late menopause was associated with faster cognitive decline (-0.01 standard deviations/year; 95% CI -0.017, -0.002), equivalent to 0.25 years of cognitive aging annually. Each additional year of education reduced this decline by 0.004 standard deviations/year (95% CI 0.001, 0.006), equivalent to 0.1 fewer years of cognitive aging annually.

Earlier menopause was associated with a lower level of cognitive function, and late menopause with faster cognitive decline. Higher education may buffer adverse effects of late menopause. Dementia prevention strategies may need to consider menopause timing, especially for women with lower levels of education.