Menopause is a universal experience for all women living into late life. Cognitive complaints associated with menopause are common, though many women report no cognitive difficulties. Similarly, longitudinal studies reliably show small but significant declines in memory performance as women transition through the menopause, but these are average changes and many women show no cognitive declines. A priority in aging research is to understand the factors that influence cognition at midlife. Loss of estrogen is a universal experience in the menopause transition while menopause symptoms, such as hot flashes and sleep disturbance, vary among women. On average hot flashes last for 7.6 years and are known to trigger awakenings. Most awakenings in midlife women, however, occur without an accompanying hot flash. Research studies using wearable devices show that these symptoms are related to worse memory performance, a finding that may explain differences among women in the severity and duration of cognitive symptoms at menopause. Hormone therapy is the gold-standard treatment for hot flashes but it is yet unknown if hormone therapy improves cognition in women with hot flashes. Depressive and anxiety symptoms also influence cognition at midlife. Current guidelines recommend the use of lifestyle interventions for cognitive issues at midlife, recognizing that the treatment of menopausal symptoms can also lead to improved cognition in midlife women.