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A recent publication from the Women’s Health Across the Nation (SWAN) study by Greendale and colleagues has followed 2362 participants for 4 years during the menopause transition [1]. Major exposures were time spent in the menopause transition, hormone use prior to the final menstrual period, and postmenopausal current hormone use. Outcomes were longitudinal performance in three domains: processing speed (Symbol Digit Modalities Test (SDMT), verbal memory (East Boston Memory Test (EBMT) and working memory (Digit Span Backward).

Premenopausal, early perimenopausal and postmenopausal women exhibited learning capacity by scoring higher with repeated SDMT administration (p =0.0008) but scores of late perimenopausal women did not improve over time (p = 0.2). EBMT delayed recall scores climbed during premenopause and postmenopause (p = 0.01) but did not increase during early and late perimenopause (p = 0.14). Scores on the initial SDMT, EBMT-immediate and EBMT-delayed tests were 4–6% higher among prior hormone users (p = 0.001). On the SDMT and EBMT compared to the premenopausal referent, postmenopausal current users demonstrated poorer cognitive performance (p = 0.05) but the performance of postmenopausal non-hormone users was indistinguishable from that of premenopausal women.

The authors conclude that, consistent with transitioning women’s perception of their memory difficulties at this time, perimenopause was associated with a decrement in cognitive performance characterized by women not being able to learn as well as they had during the premenopause. Improvement in learning rebounded to premenopausal levels post menopause, suggesting that menopause transition-related cognitive difficulties may be time-limited. Hormone initiation prior to the final menstrual period had a beneficial effect, whereas initiation after the final menstrual period had a detrimental effect on cognitive performance.


  • Alastair H. MacLennan
    Professor and Head, Discipline of Obstetrics & Gynaecology, University of Adelaide, South Australia
  • Alice MacLennan
    President, Australasian Menopause Society, Honorary Senior Lecturer, Discipline of Obstetrics & Gynaecology, University of Adelaide, South Australia


  1. Greendale GA, Huang MH, Wight RG, et al. Effects of the menopause transition and hormone use on cognitive performance in midlife women. Neurology 2009;72:18507. Published May 26, 2009.
  2. MacLennan AH, Henderson VW, Paine BJ, et al. Hormone therapy, timing of initiation, and cognition in women aged older than 60 years: the REMEMBER pilot study. Menopause 2006;13:2836.
  3. Maki PM, Sundermann E. Hormone therapy and cognitive function. Hum Reprod Update 2009 May 25 [Epub ahead of print].
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