Many women report cognitive difficulties — forgetfulness, distractibility, feeling foggy — as they enter into the menopause. Looking at sex-related differences in memory, Rentz and colleagues examined 212 men and women between the ages of 45 and 55 years.  Participants completed a battery of cognitive tests and underwent hormonal assessments.

On all measures of cognitive functioning, women outperformed age-matched men. However, the difference largely disappeared after women transitioned into the menopause.  Compared to menopausal women and men, premenopausal and perimenopausal women performed better on  the Face-Name Associative Memory Exam (FNAME) and the Selective Reminding Test (SRT).  In women of all ages, higher estradiol levels were associated with better cognitive performance.

For most people who know or work with menopausal women, these findings are probably not that surprising, but it is important to note that this fairly dramatic transition occurs over a relatively short period of time, typically over the course of several years.  When a functional loss occurs over a longer period of time, one has the time to gradually adapt and to develop new strategies for managing that change in functioning.  A decade ago, when we were  more liberal with the use of hormone replacement treatment in peri- and postmenopausal women, I don’t think we fully appreciated the severity of symptoms these dramatic hormonal shifts can trigger and did not so commonly see women with cognitive complaints.    But at this time, much fewer women use estrogen replacement and we are seeing an increasing number of women with a variety of menopausal symptoms, including depression, anxiety, sleep disturbance and cognitive problems.

While much attention has been devoted to the treatment of vasomotor symptoms, such as hot flashes or night sweats, less attention has focused on the management of the memory difficulties and other cognitive problems many menopausal women may suffer.  It is unfortunate because this decline in cognitive functioning can often be dramatic and may cause significant distress and decline in functioning.  

Early observational studies suggested that postmenopausal treatment with estrogen may improve cognitive functioning; however, studies from the Women’s Health Initiative have shown that estrogen replacement therapy started in postmenopausal women (65 years or older) did not markedly enhance cognitive functioning nor did it decrease the risk of dementia.

In 2011, we reported on the use of atomoxetine or Strattera, a treatment for ADHD, which seemed to help menopausal women with cognitive dysfunction.  A preliminary report also indicated that the stimulant lisdexamfetamine (LDX) – marketed in the US as the ADHD medication Vyvanse – improved attention and concentration, organization, and memory in postmenopausal women.  These studies suggest that stimulants may help many women who experience cognitive difficulties as they enter into the menopause; however, more research is needed to better understand how to treat cognitive complaints in this population.

Ruta Nonacs, MD PhD

 

Rentz DM, Weiss BK, Jacobs EG, Cherkerzian S, Klibanski A, Remington A, Aizley H, Goldstein JM.  Sex differences in episodic memory in early midlife: impact of reproductive aging.  Menopause. 2016 Nov 7. [Epub ahead of print]