Henderson Victor W, Sherwin Barbara B
Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA 94305, USA.
Menopause. 2007 May-Jun;14(3 Pt 2):572-9. doi: 10.1097/gme.0b013e31803df49c.
Women who undergo both natural and surgical menopause experience the loss of cyclic ovarian production of estrogen, but hormonal and demographic differences distinguish these two groups of women. Our objective was to review published evidence on whether the premature cessation of endogenous estrogen production in women who underwent a surgical menopause has deleterious consequences for cognitive aging and to determine whether consequences differ for women if they undergo natural menopause. Studies of estrogen-containing hormone therapy are relevant to this issue.
We reviewed evidence-based research, including the systematic identification of randomized clinical trials of hormone therapy with cognitive outcomes that included an objective measure of episodic memory.
As inferred from very small, short-term, randomized, controlled trials of high-dose estrogen treatment, surgical menopause may be accompanied by cognitive impairment that primarily affects verbal episodic memory. Observational evidence suggests that the natural menopausal transition is not accompanied by substantial changes in cognitive abilities. For initiation of hormone therapy during perimenopause or early postmenopause when the ovaries are intact, limited clinical trial data provide no consistent evidence of short-term benefit or harm. There is stronger clinical trial evidence that initiation of hormone therapy in late postmenopause does not benefit episodic memory or other cognitive skills.
Further research is needed on the long-term cognitive consequences of surgical menopause and long-term cognitive consequences of hormone therapy initiated near the time of surgical or natural menopause. A potential short-term cognitive benefit might be weighed when a premenopausal woman considers initiation of estrogen therapy at the time of, or soon after, hysterectomy and oophorectomy for benign conditions, although data are still quite limited and estrogen is not approved for this indication. Older postmenopausal women should not initiate hormone therapy to improve or maintain cognitive skills.
经历自然绝经和手术绝经的女性都会失去卵巢周期性产生雌激素的功能，但这两组女性在激素和人口统计学方面存在差异。我们的目的是回顾已发表的证据，以确定经历手术绝经的女性内源性雌激素产生过早停止是否会对认知衰老产生有害影响，并确定对于经历自然绝经的女性，其影响是否有所不同。含雌激素的激素治疗研究与这个问题相关。
我们回顾了基于证据的研究，包括系统识别激素治疗的随机临床试验，这些试验的认知结果包括情景记忆的客观测量。
从非常小的、短期的、高剂量雌激素治疗的随机对照试验推断，手术绝经可能伴有认知障碍，主要影响言语情景记忆。观察性证据表明，自然绝经过渡期间认知能力没有实质性变化。对于围绝经期或绝经后早期卵巢完好时开始激素治疗，有限的临床试验数据没有提供短期获益或有害的一致证据。有更强的临床试验证据表明，绝经后期开始激素治疗对情景记忆或其他认知技能没有益处。
需要进一步研究手术绝经的长期认知后果以及在手术绝经或自然绝经时附近开始激素治疗的长期认知后果。当绝经前女性考虑在因良性疾病进行子宫切除术和卵巢切除术时或之后不久开始雌激素治疗时，可能需要权衡潜在的短期认知益处，尽管数据仍然非常有限且雌激素未被批准用于此适应症。老年绝经后女性不应开始激素治疗以改善或维持认知技能。
