Is cognitive functioning detrimentally affected after early, induced menopause?

Investigations into the cognitive effects of surgically and chemically induced menopause are frequently combined with naturally occurring menopause and hormone therapy. However, there is some evidence that women who undergo surgical menopause may experience more cognitive decline post surgery as well as more benefit from subsequent hormone therapy use than women who experience naturally occurring menopause. Little is known about the effects of chemically induced menopause on cognitive function. The aim of this review was to examine whether premature menopause affects cognitive functioning.

PubMed, MEDLINE, and PsychINFO searches of the literature published from 1988 to 2007 pertaining to the understanding of the relationships between induced menopause and cognitive dysfunction were reviewed. Those combining induced menopause with natural menopause, those involving a disease process (eg, dementia), and animal studies were excluded.

Although smaller prospective studies have found that surgical menopause is associated with specific deficits in the memory (visual and verbal) and verbal fluency domains, larger randomized, controlled trials have generally found no effect of surgical menopause on cognitive functioning. The effects of chemical menopause are harder to assess as only three prospective trials have explicitly investigated the effect of induced menopause in the context of breast cancer treatment, and the results remain inconclusive. However, as surgical and chemical menopause both comprise the abrupt withdrawal of estrogen, there is the potential that this process may exert neurobiological effects that are different from those occurring with natural menopause and further prospective investigations comprising pre- and postsurgical/chemotherapy neuropsychological assessments are warranted.