Effects of the menopause transition and hormone use on cognitive performance in midlife women

Background: There is almost no longitudinal information about measured cognitive performance during the menopause transition (MT).

Methods: We studied 2,362 participants from the Study of Women's Health Across the Nation for 4 years. Major exposures were time spent in MT stages, hormone use prior to the final menstrual period, and postmenopausal current hormone use. Outcomes were longitudinal performance in three domains: processing speed (Symbol Digit Modalities Test [SDMT]), verbal memory (East Boston Memory Test [EBMT]), and working memory (Digit Span Backward).

Results: Premenopausal, early perimenopausal, and postmenopausal women scored higher with repeated SDMT administration (p ≤ 0.0008), but scores of late perimenopausal women did not improve over time (p = 0.2). EBMT delayed recall scores climbed during premenopause and postmenopause (p ≤ 0.01), but did not increase during early or late perimenopause (p ≥ 0.14). Initial SDMT, EBMT-immediate, and EBMT-delayed tests were 4%–6% higher among prior hormone users (p ≤ 0.001). On the SDMT and EBMT, compared to the premenopausal referent, postmenopausal current hormone users demonstrated poorer cognitive performance (p ≤ 0.05) but performance of postmenopausal nonhormone users was indistinguishable from that of premenopausal women.

Conclusions: Consistent with transitioning women's perceived memory difficulties, perimenopause was associated with a decrement in cognitive performance, characterized by women not being able to learn as well as they had during premenopause. Improvement rebounded to premenopausal levels in postmenopause, suggesting that menopause transition–related cognitive difficulties may be time-limited. Hormone initiation prior to the final menstrual period had a beneficial effect whereas initiation after the final menstrual period had a detrimental effect on cognitive performance.