Objective To assess the efficacy of an integrated approach of yoga therapy (IAYT) on cognitive abilities in climacteric syndrome.Design A randomised control study wherein the participants were divided into experimental and control groups.Settings Fourteen centres of Swami Vivekananda Yoga Research Foundation, Bangalore, India.Sample One hundred and eight perimenopausal women between 40 and 55 years with follicle-stimulating hormone level equal to or greater than 15 miu/ml. One hundred and twenty perimenopausal women were randomly allotted into the yoga and the control groups.Methods The yoga group practised a module comprising breathing practices, sun salutation and cyclic meditation, whereas the control group practised a set of simple physical exercises, under supervision (1 hour/day, 5 days/week for 8 weeks).Main outcome measures Assessments were made by vasomotor symptom checklist, six-letter cancellation test (SLCT) for attention and concentration and Punit Govil Intelligence Memory Scale (PGIMS) with ten subtests.Results The Wilcoxon test showed significant (P < 0.001) reduction in hot flushes, night sweats and sleep disturbance in yoga group, with a trend of significant difference between groups at P = 0.06 on Mann-Whitney test in night sweats. There was no change within or between groups in the control group. The SLCT score and the PGIMS showed significant improvement in eight of ten subtests in the yoga group and six of ten subtests in the control group. The yoga group performed significantly better (P < 0.001) with higher effect sizes in SLCT and seven tests of PGIMS compared with the control group.Conclusions Integrated approach of yoga therapy can improve hot flushes and night sweats. It also can improve cognitive functions such as remote memory, mental balance, attention and concentration, delayed and immediate recall, verbal retention and recognition tests.