Nearly two-thirds of women have subjective cognitive difficulties, commonly referred to as memory problems, during their menopausal transition. Symptoms also include attention or language deficits.1 The basis for these cognitive symptoms is poorly understood; nonetheless, clinicians should have a conceptual framework to address these concerns when providing care for perimenopausal women. To build a clinically applicable approach, this JAMA Insights article will specify the definition of the menopausal transition (as distinct from postmenopause); review subjective cognitive problems in the context of other, concomitant, and possibly related, menopausal transition symptoms; and describe perceived and objectively measured cognitive function during transition and explain how they are related.