What are the effects of postmenopausal hormone use on quality of life and cognitive functions, specifically memory and learning?

Quality of life 
Estrogen is prescribed to treat problems associated with menopause such as hot flashes, night sweats, and vaginal dryness. Menopausal hormones have also been thought to improve mood and psychological well-being in women who have hot flashes and sleeplessness during menopause.

However, a recent report from the WHI that focused on the quality of life of women ages 50 through 79 who took estrogen plus progestin indicated no significant effects on their general health, vitality, mental health, depressive symptoms, or sexual satisfaction. Although hormone use was associated with a small benefit in terms of sleep disturbance, physical functioning, and bodily pain after 1 year of use, the effect was too small to be considered clinically significant. At 3 years, there were no benefits in any quality of life issues (4). 

The WHI results may not be relevant for women with severe menopausal symptoms, however. Participants in the WHI study were randomly assigned to receive either hormones or placebo, and those women who had menopausal symptoms reported relief from symptoms with hormone use. Women who felt that they needed menopausal hormones to treat severe symptoms may not have been willing to take the chance of not receiving hormones and may, therefore, have been underrepresented in the study. 

A smaller study of women using estrogen plus progestin found that the effects on quality of life depended on whether or not a woman had menopausal symptoms. Among women experiencing hot flashes, estrogen plus progestin use improved mental health and depressive symptoms. Among those who did not experience hot flashes, however, no emotional benefits were associated with hormone use, and physical functioning (ranging from the ability to dress and bathe to the ability to participate in strenuous sports) was somewhat worse (26). 

Memory and learning
Results from the WHI Memory Study showed that estrogen plus progestin doubled the risk for developing dementia (a decline in mental ability in which the patient can no longer function independently on a day-to-day basis) in postmenopausal women age 65 and older. The risk increased for all types of dementia, including Alzheimer's disease (3). A separate study also showed that estrogen plus progestin adversely affected cognitive function when women on the combination therapy were compared with women age 65 and older on placebo. Generally, the women in the WHI Memory Study age 65 and older did well on cognitive tests during the study, but the women on combination therapy did not do as well (5).

Questions and Answers About Menopausal Hormone Use

• What is menopause?

• What are menopausal hormones and why are they used?

• How do scientists determine the health outcomes associated with hormone use?

• Do the benefits of hormone use after menopause outweigh the risks?

• What are the effects of hormone use on the uterus?

• How does menopausal hormone use affect breast cancer risk and survival?

• How does menopausal hormone use affect the risk of ovarian cancer?

• What are the effects of menopausal hormones on heart disease?

• What are the effects of menopausal hormones on bone health?

• What are the effects of postmenopausal hormone use on quality of life and cognitive functions, specifically memory and learning?

• Are there other benefits or risks associated with menopausal hormone use?

• What are the risks of menopausal hormones for women who have a history of cancer?

• Does the route of administration of hormones make a difference?

• Are there any alternatives for women who choose not to take menopausal hormones?

• What research still needs to be done?