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Estrogen may improve reading and short-term memory

It is such a very confusing time for women who are trying to make an informed decision about hormone replacement therapy (HRT). The recent research involving very large populations of women on combination estrogen/progestin therapy has called into question many of the benefits long assumed to be associated with HRT.

How each physician translates the global experience of thousands of women chronicled in the research to counsel an individual woman is a very perplexing task. Women are very different in terms of their medical history, their risks for a variety of diseases, their individual lifestyles and the challenges they face in their personal and professional lives. Each woman needs to find out as much as possible about estrogen and its effects, so she can make the best choice for her personal situation.

Estrogen, memory and reading skill
The role of cognitive function and loss of estrogen is not entirely clear. The study published in Neurology is inconclusive. My primary interest is in reading, learning and dyslexia; and our research, recently published in Menopause, has shown midlife menopausal women who receive supplemental estrogen show improved oral reading and verbal memory performance.

Researchers have learned that cognitive function varies across the menstrual cycle, and it varies in women who are on and off estrogen and the variation is not random. We’ve learned when estrogen is highest, before ovulation, there’s an increase in a woman’s verbal function and a decrease in her spatial function. When we talk about verbal function, we’re specifically talking about her verbal fluency, speed of articulation and her working memory.

Two other studies
We studied 60 postmenopausal women, ages 32.8 to 64.9, divided into placebo and estrogen groups. We evaluated their oral reading skills, verbal memory and other cognitive skills and found the estrogen group performed better.

In addition, in an earlier study, we examined brain imaging data generated by functional MRI studies. In performing a cognitive task, such as working memory, blood flow and oxygen concentration are altered in those brain regions engaged by the task, and these changes are detectable in imaging studies. These scans indicated estrogen produces brain activations in the inferior parietal lobule, a region of the brain that is sensitive to phonological demands implicated in reading.

The skills we measured, verbal fluency, speed of articulation and working memory are those that are deficient in people who have reading disorders. All of these skills are dependent on phonologic processing—sounding out a series of letters.

Considering all factors in making a decision about HRT
The improvement in reading skills we reported is an important finding that women need to factor into their decision process about taking HRT, along with many others such as family history and specific risk factors. For some women, this skill is a critical one for professional success and knowing that estrogen might be helpful may be essential for her to make the best decision possible for her at this time.

This is a whole new world for postmenopausal women. For the first time in history we have millions of women who are living for decades after menopause who continue to be fully engaged in challenging pursuits of all kinds, professionally and personally. The quality of life in these postmenopausal years is a high priority for these women.

Scientists need to continue research in this area. It could be that some day pharmaceutical researchers will be able to create designer estrogens that positively impact cognition without other side effects.

Dr. Shaywitz is professor of pediatrics at the Yale School of Medicine, an attending physician at Yale-New Haven Children’s Hospital and author of the recently published book “Overcoming Dyslexia.“

For the 12th year in a row, Yale-New Haven has been highly ranked by U.S. News & World Report for its programs in gynecology.