Overview

• The Neurology analysis used data from 7,251 cognitively healthy postmenopausal participants in the Canadian Longitudinal Study of Aging.
• Transdermal estradiol use was associated with higher episodic memory scores compared with nonuse, while oral pills were associated with higher prospective memory scores.
• Neither therapy route showed differences in executive function, but earlier menopause was linked to lower scores across multiple cognitive domains.
• For executive function, the association with earlier menopause was stronger in people with four or more children and in carriers of the APOE ε4 variant.
• Effects were modest at roughly one-third of a standard deviation, only 4% used transdermal estradiol and 2% used pills, and limited diversity and missing dose, duration, and timing data support the need for randomized, more inclusive studies.