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Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Aug 19, 2021; 11(8): 412-428
Published online Aug 19, 2021. doi: 10.5498/wjp.v11.i8.412
Menopause and cognitive impairment: A narrative review of current knowledge
Délio Marques Conde, Roberto Carmignani Verdade, Ana L R Valadares, Lucas F B Mella, Adriana Orcesi Pedro, Lucia Costa-Paiva
Délio Marques Conde, Department of Gynecology and Obstetrics, Federal University of Goiás, Goiânia 74605-050, Goiás, Brazil
Roberto Carmignani Verdade, Ana L R Valadares, Adriana Orcesi Pedro, Lucia Costa-Paiva, Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas, Campinas 13083-881, São Paulo, Brazil
Lucas F B Mella, Department of Medical Psychology and Psychiatry-Geriatric Psychiatry and Neuropsychiatric Division, State University of Campinas, Campinas 13083-887, São Paulo, Brazil
Author contributions: The authors declare equal contributions to this manuscript.
Supported by National Council for Scientific and Technological Development of Brazil (CNPq), No. 312400/2018-7.
Conflict-of-interest statement: The authors declare no conflicts of interest related to this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lucia Costa-Paiva, MD, PhD, Full Professor, Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas, Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Barão Geraldo, Campinas 13083-881, São Paulo, Brazil. paivaepaiva@uol.com.br
Received: February 15, 2021
Peer-review started: February 15, 2021
First decision: June 24, 2021
Revised: July 5, 2021
Accepted: July 28, 2021
Article in press: July 28, 2021
Published online: August 19, 2021
Abstract

A severe impairment of cognitive function characterizes dementia. Mild cognitive impairment represents a transition between normal cognition and dementia. The frequency of cognitive changes is higher in women than in men. Based on this fact, hormonal factors likely contribute to cognitive decline. In this sense, cognitive complaints are more common near menopause, a phase marked by a decrease in hormone levels, especially estrogen. Additionally, a tendency toward worsened cognitive performance has been reported in women during menopause. Vasomotor symptoms (hot flashes, sweating, and dizziness), vaginal dryness, irritability and forgetfulness are common and associated with a progressive decrease in ovarian function and a subsequent reduction in the serum estrogen concentration. Hormone therapy (HT), based on estrogen with or without progestogen, is the treatment of choice to relieve menopausal symptoms. The studies conducted to date have reported conflicting results regarding the effects of HT on cognition. This article reviews the main aspects of menopause and cognition, including the neuroprotective role of estrogen and the relationship between menopausal symptoms and cognitive function. We present and discuss the findings of the central observational and interventional studies on HT and cognition.

Keywords: Menopause, Cognition, Dementia, Estrogens, Hot flashes, Cognitive decline

Core Tip: Cognitive complaints are more common in postmenopausal women than in premenopausal women. Due to the reduction in ovarian function, a progressive decrease in serum estrogen levels occurs, leading to menopausal symptoms with an emphasis on vasomotor symptoms. In addition to these symptoms, cognitive impairment can affect postmenopausal women to varying degrees. Several aspects of the relationship between menopause and cognitive function were reviewed. We report the latest evidence on the topic. In this sense, considering current knowledge, we do not recommend the prescription of hormone therapy to prevent cognitive decline or dementia in postmenopausal women.