Cognitive effects of hormone therapy in early postmenopausal women

Estrogen replacement therapy and cognitive functions in healthy postmenopausal women: a randomized trial

This study aimed to evaluate the effect of estrogen replacement therapy on verbal cognitive performance of middle-aged postmenopausal women. Middle-aged (40 to 59 years) hysterectomized, oligosymptomatic women receiving 0.625 mg/day of conjugated equine estrogens (N = 27) or placebo (N = 32) in a double-blind parallel group design were compared according to their performance on a verbal memory battery before and after six 28-day cycles of treatment. Both groups had similar age and educational level. The estrogen group performed better on digit span-forward and on the recall of the easy stimuli on the verbal-paired associates test regardless of age, education, physical symptoms, number of years of menopause, or blood estradiol levels. However, the small magnitude of difference in the effect on attentional span suggests that the estrogen-related improvement is unlikely to be of clinical relevance. Estrogen replacement therapy did not improve verbal memory in middle-aged, hysterectomized, postmenopausal, asymptomatic women.

Is cognitive functioning detrimentally affected after early, induced menopause?

OBJECTIVE

Investigations into the cognitive effects of surgically and chemically induced menopause are frequently combined with naturally occurring menopause and hormone therapy. However, there is some evidence that women who undergo surgical menopause may experience more cognitive decline post surgery as well as more benefit from subsequent hormone therapy use than women who experience naturally occurring menopause. Little is known about the effects of chemically induced menopause on cognitive function. The aim of this review was to examine whether premature menopause affects cognitive functioning.

DESIGN

PubMed, MEDLINE, and PsychINFO searches of the literature published from 1988 to 2007 pertaining to the understanding of the relationships between induced menopause and cognitive dysfunction were reviewed. Those combining induced menopause with natural menopause, those involving a disease process (eg, dementia), and animal studies were excluded.

RESULTS AND CONCLUSIONS

Although smaller prospective studies have found that surgical menopause is associated with specific deficits in the memory (visual and verbal) and verbal fluency domains, larger randomized, controlled trials have generally found no effect of surgical menopause on cognitive functioning. The effects of chemical menopause are harder to assess as only three prospective trials have explicitly investigated the effect of induced menopause in the context of breast cancer treatment, and the results remain inconclusive. However, as surgical and chemical menopause both comprise the abrupt withdrawal of estrogen, there is the potential that this process may exert neurobiological effects that are different from those occurring with natural menopause and further prospective investigations comprising pre- and postsurgical/chemotherapy neuropsychological assessments are warranted.