2026 ECNP Congress

PS01-1086

Perimenopause is associated with lower cognitive performance and higher depressive symptoms compared to postmenopause

İkbal Sıla Ağar — C. Ozgunduz1,, Ş. Hun Şenol2,, Ş. Yıldız, S. Güler Çekiç, Ö. Takmaz, M. Ceyhan, J. Arnab, S. Balaç, R.N. Babalıoğlu6,, İ.C. Akşahin, Z.İ. Karabal, Z.U. Gürbüz7,, İ. Fettahoğlu, B. Yeşiloğlu, B. Aksoy, A. Eslami Abriz, H.E. Arat Çelik, D. Ceylan · Acıbadem University, School of Medicine, İstanbul, Türkiye

2026 ECNP Congress

Background

Menopause signifies a neuroendocrine aging phase that marks a decline in estrogen levels, correlating with reduced reproductive capacity, alongside various psychiatric symptoms in women, such as hot flashes, sleep disturbances, mood fluctuations, and cognitive issues [1,2]. Perimenopause is characterized by notable menstrual cycle changes and continues until 12 months after the final menstruation period [3]. This phase is associated with increased risk for psychiatric disorders [4,5]. Although the contribution of hormonal changes to these outcomes remains unclear, the levels of reproductive hormones change markedly across perimenopause. This study aims to compare psychiatric symptoms in peri- and postmenopausal women and examined relationships with the changes in reproductive hormone levels.

Methods

The clinical and laboratory data were collected from 29 women -17 in the perimenopausal, and 12 in the postmenopausal periods according to the Stages of Reproductive Aging Workshop criteria [3]- recruited from Obstetrics & Gynecology and Psychiatry outpatient clinics. They completed a clinical case form, Montreal Cognitive Assessment Battery (MoCA) and self-report scales assessing psychiatric, cognitive, menopausal symptoms and lifestyle characteristics. Blood samples (15 cc each) were collected from the participants and FSH, estradiol, progesterone levels were measured. SPSS 28.0 was used for statistical analysis. The normality of the data distribution was assessed using skewness and kurtosis values, continuous variables were compared using Mann-Whitney U test. Spearman correlation and linear regression analysis were performed. The significance level was accepted as p<0.05.

Results

The mean age of the perimenopausal women was 50.24±3.40 and the mean age of the postmenopausal women was 52.25±3.28. The mean body mass index (BMI) of the perimenopausal women was 25.60±4.95 and the mean BMI of the postmenopausal women was 24.94±4.28. The mean total score of Short Multidimensional Inventory Lifestyle Evaluation (SMILE) in the perimenopausal group was 111.82±12.85 and the mean total score of SMILE in the postmenopausal group 108.50±11.90. 23.5% of the perimenopausal and 41.6% of the postmenopausal women were smoking. Groups were not different regarding age, BMI, lifestyle measures, and smoking (p=0.117; p=0.948; p=0.824; p=0.422, respectively). Compared with postmenopausal women, perimenopausal women had lower MoCA, and higher Patient Health Questionnaire (PHQ-9) scores (p=0.018 and p=0.027, respectively). As expected, postmenopausal women had lower estradiol, and conversely, higher FSH levels (p=0.002 and p=0.009, respectively). Menopausal Rating Scale (MRS) scores were positively correlated with PHQ-9 and Mood Disorder Questionnaire scores (r=0.693 and r=0.480, respectively; both p<0.01). In adjusted regression models, perimenopausal status remained associated with lower MoCA scores (B=-2.356, p=0.016) and higher PHQ-9 scores (B=3.571, p=0.035), while higher SMILE and MRS scores were independently associated with lower and higher PHQ-9 scores, respectively (B=-0.140, p=0.039; B=0.351, p<0.001).

Conclusions

Perimenopausal women showed lower cognitive performance and more depressive symptoms than similarly aged postmenopausal women. Depressive symptoms were positively associated with menopausal symptom burden, whereas healthier lifestyle characteristics were associated with lower depressive symptom severity. Future studies with larger sample sizes will shed light on impact of perimenopause on cognition and mood symptoms.

References

  1. Brinton, R. D., Yao, J., Yin, F., Mack, W. J., & Cadenas, E. (2015). Perimenopause as a neurological transition state. Nature reviews. Endocrinology, 11(7), 393-405.
  2. Monteleone, P., Mascagni, G., Giannini, A., Genazzani, A. R., & Simoncini, T. (2018). Symptoms of menopause - global prevalence, physiology and implications. Nature reviews. Endocrinology, 14(4), 199-215.
  3. Soules, M. R., Sherman, S., Parrott, E., Rebar, R., Santoro, N., Utian, W., & Woods, N. (2001). Stages of Reproductive Aging Workshop (STRAW). Journal of women’s health & gender-based medicine, 10(9), 843-848.
  4. Bromberger, J. T., Schott, L. L., Kravitz, H. M., Sowers, M., Avis, N. E., Gold, E. B., Randolph, J. F., & Matthews, K. A. (2010). Longitudinal change in reproductive hormones and depressive symptoms across the menopausal transition: results from the Study of Women’s Health Across the Nation (SWAN). Archives of general psychiatry, 67(6), 598-607.
  5. Maki, P. M., Freeman, E. W., Greendale, G. A., Henderson, V. W., Newhouse, P. A., Schmidt, P. J., Scott, N. F., Shively, C. A., & Soares, C. N. (2010). Summary of the National Institute on Aging-sponsored conference on depressive symptoms and cognitive complaints in the menopausal transition. Menopause (New York, N.Y.), 17(4), 815-822.