Cognition and mental health in menopause: a review

Abstract Cognitive and mood changes are frequently mentioned as complaints before, during and after menopausal transition. There is substantial biological evidence for such associations to occur, as there are many mechanisms through which estrogens can affect the brain, by regulating metabolism, increasing cerebral blood flow and dendritic outgrowth, by acting on nerve growth factors through co-localisation of receptors, via neurotransmitters synthesis and turn-over and many more. However, the evidence for objective and longer term changes in cognitive function and mental health over the menopausal transition and beyond is less clear. While hormone treatment including estrogens could potentially reverse these psychological issues, the evidence of long-term benefit is also inconclusive. However, for women with severe menopausal complaints, and particularly for those who undergo early menopause, including women with Premature Ovarian Insufficiency, personalised hormone treatment at least up to the natural age of menopause around 50 should be considered, which is probably safe up to 10 years of treatment, unless contraindicated. This paper reviews the evidence for changes in psychological health related to menopausal transition and hormone treatments.