Female Reproductive Health and Cognitive Function

Chia-Kuang Tsai, MD, PhD; Yuan-Yuei Chen, MD; Chung-Hsing Chou, MD, PhD; Tung-Wei Kao, MD; Chih-Sung Liang, MD; Fu-Chi Yang, MD, PhD; Chung-Ching Wang, MD; Jiunn-Tay Lee, MD; Wei-Liang Chen, MD, PhD


Menopause. 2020;27(12):1357-1362. 

In This Article

Abstract and Introduction


Objective: The impact of sex hormones milieu on women's cognitive performance at different reproductive stages has caused increased caution. Our research aims to explore whether parity is negatively correlated with cognitive function.

Methods: There were 1,093 postmenopausal participants recruited from the Health and Nutrition Examination Survey dataset. Cognitive functioning was evaluated by digit symbol substitution test (DSST). We performed log transformation to normalize the distributions of the DSST values.

Results: Participants were categorized into tertile groups based on the number of pregnancies. Using the zero to one pregnancy group as the reference, there was a reduced DSST scores with β values of −0.13 (95% confidence interval [CI] −0.23 to −0.03; P = 0.008) in the ≥5 pregnancies group after adjusting for socioeconomic, medical disease, lifestyle, and reproductive components. Moreover, women who had their last pregnancy after 28 years old and education less than 12 years also was correlate with cognitive malfunction after adjusting relevant covariates (both P< 0.001).

Conclusions: Women with at least five pregnancies had poorer cognitive performance. Last pregnancy after 28 years old and education less than 12 years also was associated with poorer DSST scores.

Video Summary: http://links.lww.com/MENO/A634.


The number of aged adults with declining cognitive function or dementia has remarkably increased in recent decades and has become a global health dilemma.[1,2] Heterogeneity between individuals is involved in this progression, possibly indicating a range of genetic influences and environmental and behavioral affects over the life course.[3,4] For instance, estrogens are involved in regulating the nervous system and brain function related to cognitive processes.[5–7] Numerous studies have indicated that there is a higher risk of acquiring dementia and Alzheimer disease (AD) in postmenopausal women than in men, which might be due to the markedly decreased estrogen level that occurs after menopause.[8–10]

The impact of sex hormones on cognition of women at different reproductive life stages has gained increased attention. Reproductive history reflects the dynamic change in reproductive hormones that women undergo between menarche, pregnancy, and menopause.[11,12] The relationship between lifelong estrogen exposure, such as reproductive time and age at first menarche and last pregnancy, and length of breastfeeding has been examined in previous studies.[12–14] However, there are inconsistent conclusions about the impact of the number of pregnancies on cognitive performance in later life (Table 1).[13,15–23] For example, Li et al[19] demonstrated that women having five or more full-term pregnancies exhibited poor cognitive performance than those having fewer full-term pregnancies in a Chinese population. Colucci et al[17] presented the same findings, that is, a higher number of lifetime pregnancies are a hazard factor for developing AD earlier, in a control experiment composed of 400 women from an Italian population. Moreover, Prince et al[20] also reported that a higher number of parities were strongly correlated with a higher risk of dementia in China and Latin American populations. Nevertheless, Rasgon et al,[13] Shimizu et al,[22] and Harville et al[23] demonstrated that multiparity was not strongly associated with cognitive functioning.

The goal of our research was to investigate the relationship between number of pregnancies and cognitive function in postmenopausal women from an American noninstitutionalized civilian population. We also attempted to identify factors that are statistically correlated with better cognitive performance in participants with multiple parities.