Cognitive Function Assessment

The goal of this clinical trial is to learn whether it is feasible to conduct a larger study comparing transdermal menopausal hormone therapy (MHT) versus no hormone therapy in menopausal women with vasomotor symptoms (hot flashes and night sweats) and at least one cardiovascular risk factor. The main questions it aims to answer are: * What proportion of eligible women agree to be randomly assigned to either receive MHT or not? * How many participants complete the 12-month follow-up, including repeat heart imaging? * Does transdermal MHT affect early changes in heart muscle tissue as measured by cardiac MRI? Researchers will compare immediate initiation of transdermal estradiol (a skin gel or patch) to a no-hormone therapy strategy to see if MHT influences early cardiovascular and brain-vascular changes over 12 months. Participants will: * Be randomly assigned to start transdermal MHT within 2 weeks, or to use no hormone therapy for at least the first 3 months * Undergo a cardiac MRI and retinal eye imaging at the start of the study and again at 12 months * Complete cognitive testing and questionnaires about symptoms, sleep, and stress at both visits * Provide a blood sample for storage and future analysis of heart and brain health markers * Receive follow-up phone calls at 3, 6, and 9 months to review symptoms, medications, and any health changes

This study aims to evaluate a new artificial intelligence (AI)-based method for measuring cognitive function using speech recordings. Participants will complete a short storytelling task in which they describe a story based on an image while their voice is recorded using a computer or mobile device. The speech recordings will be analyzed using AI technology to identify patterns in speech that may be related to cognitive function. The system will then estimate scores that correspond to commonly used cognitive tests. To evaluate the accuracy of this method, the AI-generated scores will be compared with results from standard cognitive assessments administered by trained researchers. These assessments may include tests commonly used to measure memory, attention, and other cognitive abilities. The goal of this study is to determine whether speech analysis using AI can provide a convenient and efficient approach for cognitive assessment. If successful, this technology may help support early detection of cognitive decline and provide a practical tool for large-scale or remote cognitive screening.