Publisher Summary Cognitive complaints are common in midlife women. Understanding of objective changes in cognitive function across the menopausal transition is limited by the lack of longitudinal studies, although cross-sectional studies suggest no effect. Older women, particularly those with cardiovascular risk factors and cognitive dysfunction, experience a decline in verbal memory and cognitive status with estrogen plus progesterone treatment (EPT). Menopausal hormone therapy (HT) may have beneficial effects on other tasks of memory, including figural memory and possibly working memory. Raloxifene provides cognitive benefits. Neuroimaging studies support the biologic plausibility of beneficial effects of HT and raloxifene on brain regions subserving memory functioning, including the hippocampus and frontal lobes. HT is not approved for the treatment of cognitive complaints or dysfunction in any patient group. It is clinically prudent to caution women who initiate HT for the treatment of menopausal symptoms about the risk of dementia and cognitive decline observed in older women in Women's Health Initiative Memory Study, while recognizing that the absolute risk of dementia in younger women is very low.