What do we think about cognition and menopause?

What do we think about cognition and menopause? T he recent reappraisal of the effects of hormone therapy in the wake of the publication of the WomenÕs Heath Initiative study has included consideration of the effect of hormone therapy on cognitive function. 1,2 This aspect of the WomenÕs Heath Initiative came via the WomenÕs Health Initiative Memory Study, which included only women aged 65 to 79 years. The negative effects that were demonstrated in this older group stimulated discussion about whether hormone therapy use in the early menopause might have a different effect. The argument is that exposure to estrogen in the early postmenopausal years is likely to have a more positive effect on cognitive function and later dementia that cannot be tested in the WomenÕs Health Initiative Memory Study design. There are a number of reports about the effect of hormone therapy on aspects of cognition, and the results are inconsistent and conflicting. The article by Kok et al 3 published in this issue of Menopause adds to the data on this question, reporting no effect detected, but that is not the main point of the study. The particular importance of this study is the contribution it makes to our understanding of the even more fundamental question of the effect of menopause itself on cognitive function. Menopause is well known to be associated with a range of effects, some of which seriously reduce the quality of life of affected women. Some symptoms are relatively unique to menopause so that the symptom can easily be followed through its course, and appropriate advice can be given and management can be offered. The hot flash is the classic example of this. Urogenital atrophy works on a different time scale, but the same principles apply. With the psychological disturbance that some women experience at menopause, matters are more difficult because the symptoms, including depressed mood, are multifactorial in origin. For any postmenopausal woman reporting psychological symptoms , the clinician may have difficulty assessing the extent to which the symptoms are due to the meno-pausal transition and the extent to which other issues are contributing. Questions around the effect of menopause on cognitive function merge into this area. Clinicians hear from some women at menopause that their mental functioning has deteriorated with the onset of menopause and, as with psychological symptoms, it is difficult to know whether this is a menopausal effect. When one …