Cognitive function in relation to age at menopause: Insights from the English longitudinal study of aging

BACKGROUND: As global aging accelerates, cognitive decline is a major public health concern. Natural menopause, characterized by a sharp decline in endogenous estrogen, is a hypothesized modulator of long-term cognitive health, yet epidemiological evidence remains inconsistent. This study aimed to clarify the cross-sectional and longitudinal associations between age at natural menopause and cognitive function using data from the English Longitudinal Study of Aging (ELSA). METHODS: This study included 3712 postmenopausal women aged ≥50 years from the English Longitudinal Study of Aging Wave 4 (2008-2009), with follow-up until Wave 9. The primary exposure was self-reported age at natural menopause. Cognitive function (memory, executive function, orientation) was synthesized into a global z-score. Multiple linear regression (cross-sectional) and linear mixed-effects models (longitudinal) were employed, with sequential adjustment for sociodemographic, lifestyle, and health-related covariates. RESULTS: In these 3712 postmenopausal women, later age at menopause was consistently associated with better global cognitive function. Cross-sectionally, each additional year was linked to higher cognitive scores (β = 0.058, P < 0.001). Longitudinally, each year was associated with improved cognitive performance (β = 0.008, 95% CI 0.002-0.015, P = 0.014), with the latest menopause quartile (Q4) significantly outperforming the earliest (Q1) (β = 0.100, 95% CI 0.010-0.189, P = 0.030). Subgroup and sensitivity analyses corroborated the robustness of the primary findings. CONCLUSION: This study found that a later age at menopause correlates with improved cognitive abilities.