¹University of Rwanda, Physiology, Kigali, Rwanda, ²Nnamdi Azikiwe University, Obstetrics & Gynecology, Nnewi, Nigeria, ³University of Dar es Salaam -Mbeya College of Health and Allied Sciences, Epidemiology, Mbeya, Tanzania, United Republic of, ⁴Ethos Clinic, Psychology, Milton Keynes, United Kingdom, ⁵University of Rwanda, Psychiatry, Kigali, Rwanda, ⁶University of Rwanda, Clinical Psychology, Kigali, Rwanda, ⁷University of Rwanda, Anatomy, Kigali, Rwanda, ⁸University of Ruhuna, Sri Lanka, Pharmacy, Matara, Sri Lanka, ⁹AuroraOX Discovery Ltd, London, UK, Commercial Enterprising, London, United Kingdom, ¹⁰University College London, London, United Kingdom, Urogynaecology and Uro-neurology, London, United Kingdom, ¹¹University of Southampton, Southampton, United Kingdom, Research & Innovation, Southampton, United Kingdom, ¹²Hampshire and Isle of Wight Healthcare NHS Foundation Trust, Research and Innovation, Southampton, United Kingdom

Background: Cognitive fatigue, characterised by impaired concentration, mental exhaustion and reduced cognitive efficiency, is an increasingly recognised neurocognitive manifestation of the menopausal transition, likely mediated through neuroendocrine and neurotransmitter changes involving oestrogen modulation of fronto-striatal and limbic networks. Evidence from low- and middle-income countries remains limited, symptoms.limiting global understanding of menopausal cognitive morbidity.

Aims & Objectives: To quantify the prevalence and severity of cognitive fatigue across menopausal stages in women from four sub-Saharan African countries and evaluate clinical, hormonal, and contextual determinants after adjustment for socioeconomic factors.

Method: We conducted a pooled secondary analysis of harmonised cross-sectional survey data collected between 2024 and 2025 in Rwanda, Ghana, Nigeria, and Tanzania (N=1,991). Cognitive fatigue was operationalised using a composite score derived from Menopause Rating Scale cognitive items and a burnout concentration item, standardised to a 0–3 severity scale. Moderate–severe cognitive fatigue was defined as a score ≥2. Menopausal stage, demographic variables, hormone therapy use, long-term health conditions and socioeconomic indicators were included as covariates. Multivariable linear and logistic regression models were applied.

Results: Mean cognitive fatigue severity differed significantly across countries, highest in Rwanda (mean 1.40) and Tanzania (1.31), and lowest in Nigeria (0.99). Moderate–severe cognitive fatigue affected 23.3% of women in Rwanda compared with 8.4% in Ghana. Perimenopause was independently associated with higher fatigue severity (β 0.22, 95% CI 0.10–0.34), while premenopause was associated with lower severity. Long-term health conditions (OR 1.91, 95% CI 1.36–2.67) and hormone therapy use (OR 12.03, 6.36–22.77) were strongly associated with clinically significant cognitive fatigue. After adjustment, Rwanda remained associated with elevated odds compared with Ghana.

Discussion & Conclusions: Cognitive fatigue is a prevalent and clinically significant component of menopausal morbidity in sub-Saharan Africa, with marked cross-national heterogeneity. The high burden observed in Rwanda and Tanzania underscores the interaction between neuroendocrine transition, chronic disease and health-system context. Menopausal cognitive symptoms should be incorporated into global neuropsychopharmacology research and culturally responsive treatment strategies, particularly in under-represented populations.