Effects of conjugated equine estrogens on cognition and affect in postmenopausal women with prior hysterectomy

Abstract

Context: Different menopausal hormone therapies may have varied effects on specific cognitive functions. We previously reported that conjugated equine estrogens (CEE) with medroxyprogesterone acetate had a negative impact on verbal memory but tended to impact figural memory positively over time in older postmenopausal women. Objective: The objective of the study was to determine the effects of unopposed CEE on changes in domain-specific cognitive function and affect in older postmenopausal women with prior hysterectomy. Design: This was a randomized, double blind, placebo-controlled clinical trial. Setting: The study was conducted at 14 of 40 Women's Health Initiative (WHI) clinical centers. Participants: Participants were 886 postmenopausal women with prior hysterectomy, aged 65 yr and older (mean 74 yr), free of probable dementia, and enrolled in the WHI and WHI MemoryStudy (WHIMS) CEE-Alone trial for a mean of 3 yr and followed up for a mean of 2.70 yr. Intervention: Intervention was 0.625 mg of CEE daily or placebo. Main Outcome Measures: Annual rates of change in specific cognitive functions and affect, adjusted for time since randomization, were measured. Results: Compared with placebo, unopposed CEE was associated with lower spatial rotational ability (P < 0.01) at initial assessment (after 3 yr of treatment), a difference that diminished over 2.7 yr of continuedtreatment. CEE did not significantly influence change in other cognitive functions and affect. Conclusions: CEE did not improve cognitive functioning in postmenopausal women with prior hysterectomy. CEE was associated with lower spatial rotational performance after an average of 3 yr of treatment. Overall, CEE does not appear to have enduring effectsonrates of domain-specific cognitive change in older postmenopausal women. Copyright © 2009 by The Endocrine Society.