Estrogen May Restore Memory in Young Athletes With Amenorrhea

Female sprinter
Female sprinter
Verbal memory and cognitive flexibility improved after 6 months of estrogen replacement therapy.

BOSTON — Six months of estrogen replacement therapy appeared to restore cognitive function in female athletes with amenorrhea, according to a new study.

An estimated 44% of women who exercise experience amenorrhea, or lack of periods. Estrogen deficiency due to amenorrhea may cause forgetfulness and poor concentration, and some studies have found a positive effect of estrogen replacement on mental processes like memory, researchers noted.

“This is the first study, we believe, to assess the impact of estrogen replacement on memory and other cognitive processes in young athletes who lose their periods due to excessive exercise,” Charu Baskaran, MD, the study’s lead investigator and a pediatric endocrinologist at Massachusetts General Hospital for Children, said in a press release. “This information is important because these athletes are in their prime of neurocognitive development.”

The results were presented at ENDO 2016.

Dr Baskaran and her colleagues assigned 29 athletes with amenorrhea aged 14 to 25 to estrogen replacement therapy and compared them with 19 athletes who did not receive estrogen. Athletes in the study either never started their period or stopped having a period for at least 3 months because of too much aerobic physical activity — more than 10 hours a week on average.

Participants were randomly assigned to oral estradiol and progesterone at a dose similar to a birth control pill (n=16), transdermal estradiol at a physiological replacement dose with cyclic progesterone (n=13), or no estrogen (n=19).

All participants underwent cognitive testing before and after treatment that included assessment of their verbal memory and ability to suppress a response. They were also evaluated for cognitive flexibility, switching switch back and forth between different tasks. Researchers then evaluated the change between pre- and posttreatment test scores.

Compared with the control group, the estrogen groups had significantly better verbal memory and cognitive flexibility scores compared with their pretreatment scores at 6 months. Even when researchers controlled for patient age and pretreatment test scores, athletes who received estrogen had greater improvement in both immediate recall of words and cognitive flexibility.

Only athletes who received the transdermal estrogen experienced significantly greater improvement in certain cognitive tests.

The estrogen patch is a more physiologic form of estrogen delivery that isn’t metabolized in the liver like oral estrogen, and that may affect other hormone levels that can affect mental processes, Dr Baskaran said.


  1. Baskaran C, Cunningham B, Plessow F, et al. OR21-1. Does Estrogen Replacement Improve Verbal Memory and Executive Control in Oligo-Amenorrheic Athletes? Presented at: ENDO 2016; April 1-4, 2016; Boston, MA.