Addressing Cognitive Symptoms and Transitioning from MHT to Non-Hormonal Therapy for VMS

In this episode, "Addressing Cognitive Symptoms and Transitioning from MHT to Non-Hormonal Therapy for VMS," two menopause experts explore the clinical and societal burden of cognitive dysfunction in menopausal women, and the decision-making process around transitioning from hormonal to non-hormonal therapy. The experts note that cognitive concerns — including difficulty concentrating and word-finding difficulties — are among the most frequently reported symptoms in clinical practice, and carry particularly high stakes for women at the peak of their professional careers. They highlight that menopause-related cognitive decline and reduced workplace productivity cost the U.S. economy an estimated $1.8 billion annually, underscoring the urgency of timely and effective intervention.

The discussion also touches on the fear many women carry around cognitive decline, particularly those who have witnessed dementia in aging parents and are aware that dementia rates are disproportionately higher in women — a population that the experts note was significantly underserved in the wake of WHI misinformation. The experts emphasize that even when hormonal therapy is off the table, non-hormonal treatment options targeting sleep and cognition can provide meaningful relief and serve as a foundation for broader symptom management.

The conversation then shifts to the factors that drive the decision to transition from MHT to non-hormonal therapy, with the experts centering patient preference, comfort, and trust as the primary drivers. They stress that if a patient is not ready to revisit hormonal options, that boundary must be respected — and that building rapport over time often creates the opening for a more nuanced conversation about alternative hormonal formulations. The experts close by noting that different progestogens carry distinct side effect profiles, and that a prior adverse experience with one formulation should not foreclose the possibility of trying another.

The next episode in this series, "Evaluating Newer Non-Hormonal Therapies for VMS," features the panelists examining the mechanisms of action, key clinical trial findings, and safety profiles of fezolinetant and elinzanetant, highlighting the factors that guide treatment selection for a patient with persistent VMS and significant cognitive and sleep concerns.