Initiation of HT prior to final menstrual period showed beneficial effect on cognition

The initiation of hormone therapy prior to a woman’s final menstrual period had a beneficial effect on cognitive performance compared with initiation of HT after the final menstrual period, which had a detrimental effect.

"The study shows that women who are in the perimenopausal stages of the menopause transition experienced transient, subtle difficulties with memory. These difficulties disappeared when women reach postmenopause," Gail Greendale, MD, of the department of medicine, general internal medicine at the Iris-Cantor UCLA Women's Health Center, told Endocrine Today.

Researchers examined data for 2,362 women aged 42 to 52 years included in the Study of Women’s Health Across the Nation (SWAN) study for four years. Major exposures were time spent in menopause transition stages, hormone use prior to the final menstrual period and postmenopausal current hormone use. Outcome measures were longitudinal performance in processing speed, verbal memory and working memory.

At baseline, the majority of women were perimenopausal (49%); 8% were premenopausal, 12% were late perimenopausal, 27% were postmenopausal and not taking hormones and 4% were postmenopausal and currently taking hormones.

Although scores for late perimenopausal women did not improve during the study period, premenopausal, early perimenopausal and postmenopausal women scored higher on cognitive processing speed tests (P≤.0008).

Hispanic and black women scored worse on the cognitive processing speed test compared with white women. When compared with non-English test-takers, English test-takers had better cognitive processing speed test scores (P=.02), but worse working memory scores (P=.0001).

\During premenopause and postmenopause, verbal memory scores increased (P≤.0008); however, scores did not increase during early or late perimenopause (P≤.14). The verbal memory benefits among women with prior hormone exposure “completely dissipated with time,” according to the researchers.

"The major use of these results is to provide women with information," Greendale said. "Women who are experiencing memory difficulties during their menopause transition often find this experience frightening. They do not know what to expect, if their memory will worsen over time, etc. The SWAN results provide women with frame of reference." – by Jennifer Southall

Greendale. Neurology. 2009;72:1850-1857.

This certainly validates that women in perimenopause on HT have improvement in memory, and resonates with what we see clinically. Perimenopause is the time of the greatest complaints with respect to memory loss and mood issues. The exact mechanisms unclear, but may be in part due to vasomotor symptoms. However, this is an observational study which did not address this. This study also suggests that there may be a window of opportunity for observing this improvement as women who stated hormones later showed deterioration.

– Michelle P. Warren, MD

Endocrine Today Editorial Board member