Figure 3.
Cognitive response to menopause and ET must be considered in the context of the individual. Factors affecting direction and magnitude of ET's effects include circulating estrogen level, neurotransmitter concentrations, stress level, HPA axis sensitivity, and early life experience. Taken together, preclinical and clinical studies suggest that interactions between estrogen and these factors in the PFC determine where on the inverted U‐shaped curve of executive functioning abilities an individual may fall. The grey cross‐hatching indicates the approximate range of optimum executive functioning. The relative magnitude to which each factor affects executive function is not yet known and may vary between individuals. Increases in DA or NE concentrations, estrogen level, and stress can shift PFC function to the right. Whether significant behavioral effects result from such increases and the direction of these effects may be determined by genotype. HPA axis sensitivity, early life experiences affecting stress or estrogen sensitivity, and individual life style choices may also affect an individual's cognitive response to ET. In addition, interactions between each of these factors must also be considered.