News this month
Study suggests estrogen may help thinking skills
if timing is right

Can estrogen give menopausal women a boost in declining brainpower? Can it help them remember names, clear their heads of muddled thinking and concentrate? A study from Harvard University suggests the answer could be yes – as long as women take the estrogen close enough to the onset of their menopause.

Hormone use plummets
Hormone therapy (HT) – the use of estrogen and sometimes progestin to replace hormones the body no longer produces after menopause – dropped dramatically after the Women’s Health Initiative (WHI) estrogen-progestin trial came to a halt in 2002. The trial ended when the health risks of this particular type of hormone treatment (daily conjugated equine estrogen, or Premarin®, alone or in combination with daily medroxyprogesterone acetate, Provera®), appeared to outweigh the health benefits associated with such treatment.

Meanwhile, research on the impact of estrogen on brain function in particular has turned up mixed results. The WHI trial found no improvement in cognitive skills, and subjects between the age of 65 and 79 were at a higher risk of dementia when they took hormones. The Harvard study focused on women age 40 to 60. Researchers said their findings suggest a window of opportunity near the onset of menopause when estrogen therapy is most beneficial for the brain.

Study tests cognitive function The study focused on 52 women who were either in the beginning stages of menopause (perimenopausal) or had already gone through menopause. First, subjects were asked to complete tests to determine their baseline levels for various cognitive functions, including memory, learning and executive functioning. They were also assessed on menopausal symptoms such as hot flashes and sleep function. Then half were treated with estrogen patches; the other half were given placebos.

After three months, the women were tested again. While most of the cognitive tests showed no significant changes, researchers noticed a marked difference in one area of verbal recall skills. In this area, the tester read aloud a shopping list of 16 common words, such as apples, banana and chicken, then asked the women to perform a variety of other tests. Asked to recite the words 20 minutes later, women who used the estrogen patches made 43 percent fewer errors than they did the first time they took the test. Those who used placebos had a 9 percent improvement.

Women who had reported experiences with hot flashes in the beginning of the study found they had greater cognitive benefit in this test with estrogen therapy. However, their better verbal memory on estrogen did not seem to be associated with improvement in sleep, leading researchers to suggest that HT works to improve verbal recall directly through the central nervous system, and not indirectly by providing a good night’s sleep.

Five of the women on estrogen therapy and six who had placebos also underwent functional MRI (fMRI) brain scans, which showed those who had used estrogen had greater activation in the parts of the brain associated with complex thinking and decision making.

Muddled thinking still tricky
Scientists still don’t know for sure whether menopause itself causes cognitive decline in some women, and some speculate the complexities of middle-aged life could well be the culprit behind middle-aged muddled thinking.

“There aren’t obvious limitations to the world at large, but the women notice that they’re working harder to organize things and are working harder to get to the same goals,” said Hadine Joffe, assistant professor of psychiatry at Harvard Medical School and lead author of the study. While many women seem to see an improvement with estrogen, it’s possible that taking active steps to improve cognitive function without HT may also help, she said.

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