Cognition and mood in perimenopause: A systematic review and meta-analysis

• We performed a meta-analysis of studies of cognition and depression across stages of the menopausal transition.
• Postmenopausal women perform worse than perimenopausal women on phonemic verbal fluency and delayed verbal memory tests.
• Perimenopausal and postmenopausal women are more likely to have significant depressive symptoms compared to premenopausal women.
• Perimenopausal and postmenopausal women are more likely to meet criteria for a diagnosis of Major Depression than premenopausal women.

ObjectiveIt is suggested that declines in estrogen around menopause are associated with declines in cognitive functioning as well as increased risk of depressive symptoms and depressive disorders. Existing studies of objective cognitive function and mood have differed in the criteria used to stage the menopausal transition and in the outcome measures used. The purpose of this review was to synthesize the existing studies of the relationship between menopausal stage and neuropsychological performance and depression.DesignA search of the literature of observational studies was performed using PubMed. Four cross-sectional studies on menopausal transition stage and cognitive function and four longitudinal studies on menopausal transition stage and risk of depression, as measured by symptom inventories and structured clinical interviews, were selected. For the cognitive outcomes, fixed effects models were used to estimate overall standardized effect sizes. For the depression outcomes, the results of group comparisons were summarized using the log odds ratio and its estimated standard error.ResultsPostmenopausal women performed significantly worse than pre- and perimenopausal women on delayed verbal memory tasks, and significantly worse than perimenopausal women on phonemic verbal fluency tasks. Peri- and postmenopausal women were at significantly increased risk of depression, as measured by standard symptom inventories and structured clinical interviews, than premenopausal women.ConclusionsThe menopausal transition is a time of increased vulnerability to cognitive declines and increased risk of depressive symptoms and depressive disorders. However, these results cannot necessarily be generalized beyond the studies included in this review.This article is part of a Special Issue entitled ‘Menopause’.