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Effects of hormonal contraceptives on mental rotation and verbal fluency
Abstract
Cognitive abilities, such as verbal fluency and mental rotation, are most sensitive to changes in sex steroids but poorly studied in the context of hormonal contraceptive usage. Therefore, we investigated the performance of mental rotation and verbal fluency in young (21.5±1.8 years) healthy oral contraceptive (OC) users (23 women) and non-users (20 women) during the follicular, ovulatory and luteal phases of the menstrual cycle. Salivary 17β-estradiol, progesterone and testosterone levels were assayed to evaluate hormonal differences between groups and the phases of the menstrual cycle. To assess the effects of progestins having androgenic/anti-androgenic properties, OC users were subdivided into the third and new generation OC users. In addition, positive and negative affects as factors possibly affecting cognitive performance were evaluated. Salivary 17β-estradiol and progesterone levels were significantly lower in hormonal contraception users. Level of salivary testosterone was slightly lower in the OC users group with significant difference only during ovulatory phase. Naturally cycling women performed better on verbal fluency task as compared to OC users. Subjects who used the third generation (androgenic) OCs generated significantly fewer words as compared to new generation (anti-androgenic) OC users and non-users. The third generation OC users demonstrated significantly longer RT in MRT task as compared to non-users. The MRT, verbal fluency and mood parameters did not…
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“Griksiene and Ruksenas (2011) found verbal and spatial performance differences between women using different types of hormonal birth control”
From Factors Related to Mean Score Group Differences on Cognitive Ability Tests: A Systematic Review (2025) · cites this paper as Griksiene and Ruksenas (2011)
In the citing paper
“several papers detail oral contraceptive use and type influences CAT performance on verbal and spatial task (Griksiene & Ruksenas, 2011;Hampson et al., 2022)”
From Factors Related to Mean Score Group Differences on Cognitive Ability Tests: A Systematic Review (2025) · cites this paper as Griksiene & Ruksenas, 2011
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“However, a recently presented extensive study (160 women and 177 men) demonstrated no relationship between testosterone concentration and spatial performance in young men and women (Puts et al., 2010).”
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Cognition across the Lifespan: Investigating Age, Sex, and Other Sociodemographic Influences
Nichols, E. S., Wild, C. J., Owen, A. M., & Soddu, A. (2021) · Behavioral Sciences · doi:10.3390/bs11040051 · Cited by 25
“Differences in verbal processing have been less clear, with some suggesting that they are due to variability in instruction and strategy [20,21], and others suggesting a hormonal link [22,23].”
BackgroundModeling hormonal contraception in female rats: A framework for studies in behavioral neurobiology
Lacasse, J. M., Gomez‐Perales, E. L., & Brake, W. G. (2022) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2022.101020 · Cited by 29
Hormonal contraceptives, stress, and the brain: The critical need for animal models
Tronson, N. C., & Schuh, K. M. (2022) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2022.101035 · Cited by 25
“When broken down by HC formulation, androgenic HCs were more likely to decrease verbal fluency than anti-androgenic progestins (Griksiene and Ruksenas, 2011).”
BackgroundWhat is there to know about the effects of progestins on the human brain and cognition?
Grikšienė, R., Monciunskaite, R., & Ruksenas, O. (2022) · Frontiers in neuroendocrinology (Print) · doi:10.1016/j.yfrne.2022.101032 · Cited by 23
Self-citationConsidering sex differences in the cognitive controls of feeding
Sample, C. H., & Davidson, T. (2017) · Physiology and Behavior · doi:10.1016/j.physbeh.2017.11.023 · Cited by 22
40 Hz auditory steady-state response in females: When is it better to entrain?
Griškova-Bulanova, I., Grikšienė, R., Korostenskaja, M., & Ruksenas, O. (2014) · Acta Neurobiologiae Experimentalis · doi:10.55782/ane-2014-1975 · Cited by 22
“…concentrations during mid-luteal phase (mean 205.1, SD 134.7) was significantly higher (P=0.013) as compared to early follicular phase (mean 76.5, SD 15.1) and did not differ from the late follicular phase (mean 134.4, SD 64.7) (Celec et al. 2009, Griksiene and Ruksenas 2011, Mumford et al. 2012).”
ResultInfluentialSelf-citationHow hormonal contraceptives shape brain and behavior: A review of preclinical studies
Concas, A., Serra, M., & Porcu, P. (2022) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2022.101017 · Cited by 26
Exploring the sex and gender correlates of cognitive sex differences
Kheloui, S., Brouillard, A., Rossi, M., Marin, M., Mendrek, A., Paquette, D., & Juster, R. (2021) · Acta Psychologica · doi:10.1016/j.actpsy.2021.103452 · Cited by 26
Mackay, K., Gonzalez, C., Zbinden-Foncea, H., & Peñailillo, L. E. (2019) · European Journal of Applied Physiology · doi:10.1007/s00421-019-04254-y · Cited by 20
“Although the use of saliva collection is a valid alternative due to its non-invasive, simple and stress-free methodology (Lu et al. 1999; Liening et al. 2010; Gatti and De Palo 2011; Griksiene and Ruksenas 2011; Hayes et al. 2015), blood samples could have allowed a more precise assessment of specific hormones, and co…”
BackgroundBeltz, A., Loviska, A. M., Kelly, D. P., & Nielson, M. G. (2022) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2021.777911 · Cited by 18
Hormonal Contraception and the Brain: Examining Cognition and Psychiatric Disorders
Laird, S., Ney, L. J., Felmingham, K. L., & Gogos, A. (2019) · Current Psychiatry Research and Reviews · doi:10.2174/1573400515666190521113841 · Cited by 19
Hampson, E., Morley, E. E., Evans, K. L., & Fleury, C. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.888510 · Cited by 17
“Wharton et al (37) result showing lower accuracy on the MRT in Yasmin users (n = 7) was not replicated by Griksiene and Ruksenas (44), who found no differences between 3 (n = 10) and 4 generationOCs (n = 11) on a mental rotation test.”
ResultSex, age, and sex hormones affect recall of words in a directed forgetting paradigm
Kerschbaum, H., Hofbauer, I., Gföllner, A., Ebner, B., Bresgen, N., & Bäuml, K. T. (2016) · Journal of Neuroscience Research · doi:10.1002/jnr.23973 · Cited by 15
“For example, whereas Maki and colleagues describe a positive correlation between estradiol and verbal fluency (Maki et al., 2002), Griksiene and Ruksenas did not find a correlation between estradiol and verbal fluency (Griksiene and Ruksenas, 2011).”
BackgroundQuaiser-Pohl, C., Jansen, P., Lehmann, J., & Kudielka, B. (2016) · Developmental Psychobiology · doi:10.1002/dev.21333 · Cited by 16
Morphologic alterations of the fear circuitry: the role of sex hormones and oral contraceptives
Brouillard, A., Davignon, L., Turcotte, A.-M., & Marin, M. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1228504 · Cited by 21
Methods and considerations for the use of hormonal contraceptives in rat models of neurobehavior.
Hilz, E. N. (2022) · Frontiers in neuroendocrinology (Print) · doi:10.1016/j.yfrne.2022.101011 · Cited by 15
Conducting neuropsychological assessment with transgender individuals
Trittschuh, E. H., Parmenter, B. A., Clausell, E., Mariano, M. J., & Reger, M. A. (2018) · The Clinical Neuropsychologist · doi:10.1080/13854046.2018.1440632 · Cited by 24
“Many of the studies have focused on verbal and visuospatial tasks as these are often found to be the most sensitive to changes in sex hormone levels (for a review, see Griksiene & Ruksenas, 2011).”
BackgroundReproducible stability of verbal and spatial functions along the menstrual cycle
Pletzer, B., Bodenbach, H., Hoehn, M., Hajdari, L., Hausinger, T., Noachtar, I., & Beltz, A. (2024) · Neuropsychopharmacology · doi:10.1038/s41386-023-01789-9 · Cited by 14
Sex and gender correlates of sexually polymorphic cognition
Cartier, L., Guérin, M., Saulnier, F., Cotocea, I., Mohammedi, A., Moussaoui, F., Kheloui, S., & Juster, R. (2024) · Biology of Sex Differences · doi:10.1186/s13293-023-00579-8 · Cited by 19
“Naturally cycling females show stronger performance on verbal fluency task than oral contraceptives users, who present lower estradiol and progesterone levels [81, 82].”
BackgroundScheuringer, A., Harris, T., & Pletzer, B. (2020) · Brain and Language · doi:10.1016/j.bandl.2020.104814 · Cited by 14
Bernal, A., Mateo-Martínez, R., & Paolieri, D. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.104768 · Cited by 13
Boi, L., Petralla, S., Monti, B., Talani, G., Sanna, E., Pisu, M. G., Calderisi, G., Maciocco, E., Serra, M., Concas, A., et al. (2022) · Hormones and Behavior · doi:10.1016/j.yhbeh.2022.105218 · Cited by 17
Noachtar, I., Hidalgo-Lopez, E., & Pletzer, B. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.885617 · Cited by 11
“Users of anti-androgenic OCs generated significantly more words in a verbal fluency task compared to users of androgenic OCs (50).”
BackgroundShirazi, T. N., Levenberg, K., Cunningham, H., Self, H., Dawood, K., Cárdenas, R., Ortiz, T. L., Carré, J. M., Breedlove, S., & Puts, D. A. (2020) · Hormones and Behavior · doi:10.1016/j.yhbeh.2020.104886 · Cited by 11
“, 2016), neither individual differences (Griksiene and Ruksenas, 2011; Puts et al., 2010; Shirazi et al., 2020; Wharton et al., 2008) nor intraindividual fluctuations (Griksiene et al.”
BackgroundResultInfluentialIt takes a neural village: Circuit-based approaches for estrogenic regulation of episodic memory
Schwabe, M. R., Taxier, L. R., & Frick, K. M. (2020) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2020.100860 · Cited by 15
“, hormonal contraceptives, menopausal hormone therapy), and thus, appreciating how estrogens affect global brain function may provide insights into effects of these treatments on cognition (Griksiene and Ruksenas, 2011; Peragine et al., 2019).”
BackgroundSex Hormones and Cognitive Functions: Current Data
Bulgakova, S. V., & Romanchuk, N. (2020) · Bulletin of Science and Practice · doi:10.33619/2414-2948/52/09 · Cited by 15
Progesterone and Mental Rotation Task: Is There Any Effect?
Noreika, D., Griškova-Bulanova, I., Alaburda, A., Baranauskas, M., & Grikšienė, R. (2014) · BioMed Research International · doi:10.1155/2014/741758 · Cited by 12
“However, in our recent study we demonstrated that performance of MRT in hormonal contraceptive users depends on the characteristics of synthetic progestins in contraceptive pills [24].”
BackgroundResultKowalczyk, M., Kornacka, M., Wisiecka, K., Młyniec, A., Redeł, A., Szwykowska-Ziemniak, M., & Krejtz, I. (2023) · European Psychologist · doi:10.1027/1016-9040/a000514 · Cited by 7
Davignon, L., Brouillard, A., Juster, R., & Marin, M.-F. (2023) · Hormones and Behavior · doi:10.1016/j.yhbeh.2023.105454 · Cited by 7
“…comparing OC users (regardless of specific OC formulations) to NC women have reported no significant difference in their 3D MRT performance (Beltz et al., 2015; Griksiene and Ruksenas, 2011; Jensen et al., 2023; Moody, 1997; Mordecai et al., 2008; Rosenberg and Park, 2002; Wharton et al., 2008).”
BackgroundResultInfluentialJensen, A., Thériault, K., Yılmaz, E., Pon, E., & Davidson, P. S. R. (2023) · Neurobiology of Learning and Memory · doi:10.1016/j.nlm.2023.107720 · Cited by 9
Sex, menstrual cycle, and hormonal contraceptives influences on global-local processing.
Marful, A., Paolieri, D., & Bernal, A. (2021) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2021.105430 · Cited by 7
“In this context, previous studies examining spatial ability have observed a behavior-modulating role of the ethinyl estradiol (Beltz et al., 2015), and of the androgenicity of the synthetic progestins contained in the HC (Griksiene and Ruksenas, 2011; Wharton et al., 2008).”
BackgroundNwakanma, A., Ekanem, T., Eluwa, M., Elemuo, C., & Ekong, M. (2021) · Acta Medica Bulgarica · doi:10.2478/amb-2021-0024 · Cited by 7
An evaluation of visuospatial skills using hands-on tasks
Ramirez, D. E. A., Blinch, J., & Gonzalez, C. L. R. (2020) · Experimental Brain Research · doi:10.1007/s00221-020-05894-9 · Cited by 10
Vocal Range in the Speech of Users of Low-Dose Oral Contraceptives
Meurer, E. M., Moura, A. D., Rechenberg, L., Corleta, H. V. E., & Capp, E. (2016) · Journal of Voice · doi:10.1016/j.jvoice.2016.09.027 · Cited by 7
“OC use has also been associated with vocal stability,(27,28) changes in verbal fluency and memory, fine motor control, and speech perception, among other processes.(19) Pregnant women have shown reduced phonation time.”
BackgroundFlaherty, C. V., Kraft, J. N., Brothers, A. F., Harrison, M. A., Legro, R. S., Manni, A., Yang, C., Simmons, Z., & for the VALUES Consortium (2016) · Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration · doi:10.1080/21678421.2016.1249487 · Cited by 9
“Thus, oestrogen mitigation potentially results in relative preservation of executive and salience networks associated fluency and concept formation abilities (30,36).”
BackgroundAttentional Networks during the Menstrual Cycle
Cohen, Z. Z., Gotlieb, N., Erez, O., Wiznitzer, A., Arbel, O., Matas, D., Lee, K.-R., & Henik, A. (2019) · bioRxiv · doi:10.1101/717264 · Cited by 5
Moróte, J., Tabernero, Á., Álvarez-Ossorio, J. L., Ciria, J. P., Domínguez-Escrig, J., Vazquez, F., Angulo, J., López, F., Iglesia, R. D. L., Romero, J., et al. (2017) · Actas Urológicas Españolas · doi:10.1016/j.acuro.2017.04.007 · Cited by 4
Cognitive performance across the menstrual cycle
Barel, E., Krispil, M., & Yaari, I. (2019) · Journal of Psychology and Cognition · doi:10.35841/psychology-cognition.4.3.41-47 · Cited by 4
Hormonal intrauterine device use is related to mental rotations but not verbal memory skills.
Yan, R., Portengen, C., Yang, T. A., Reece, G. A., Dunnum, Z., Hidalgo-Lopez, E., & Beltz, A. (2025) · Hormones and Behavior · doi:10.1016/j.yhbeh.2025.105804 · Cited by 3
Gaižauskaitė, R., Zelionkaitė, I., & Grikšienė, R. (2025) · Behavioural Brain Research · doi:10.1016/j.bbr.2025.115520 · Cited by 3
Gravelsins, L., Zhao, S., & Einstein, G. (2023) · Frontiers in neuroendocrinology (Print) · doi:10.1016/j.yfrne.2023.101067 · Cited by 3
Evidence for a robust, estradiol-associated sex difference in narrative-writing fluency
Schultheiss, O. C., Köllner, M. G., Busch, H., & Hofer, J. (2020) · Neuropsychology · doi:10.1037/neu0000706 · Cited by 3
“…a profound suppressive effect on naturally occurring estradiol and (b) estrogens are sometimes contained in the contraceptives and may add to, or interact with, endogenous estradiol, influencing cognitive functions in complex ways (Beltz, Hampson, & Berenbaum, 2015; Griksiene & Ruksenas, 2011).”
Yeo, R. A., Ryman, S. G., Thompson, M. E., van den Heuvel, M. P., de Reus, M. A., Pommy, J. M., Seaman, B., & Jung, R. E. (2016) · Personality and Individual Differences · doi:10.1016/j.paid.2016.06.037 · Cited by 4
Effects of Female Reproductive Hormones on Sports Performance
Lebrun, C. M., Joyce, S., & Constantini, N. (2020) · Contemporary Endocrinology · doi:10.1007/978-3-030-33376-8_16 · Cited by 7
Ohlhauser, L., Kwan, H., Casey, H., MacDonald, S. W. S., & Gawryluk, J. R. (2025) · PLoS ONE · doi:10.1371/journal.pone.0334358 · Cited by 2
“For example, contraceptives have been linked with higher performance on verbal and mental rotations tasks [47].”
Früh, D., Mendl-Heinisch, C., Bittner, N., Weis, S., & Caspers, S. (2025) · Human Brain Mapping · doi:10.1002/hbm.70191 · Cited by 2
“…functions and brain features, leading to a less pronounced encoding of language abilities in connectivity data and a stronger association with these other factors (Amunts et al. 2020; Fedorenko and Thompson-Schill 2014; Griksiene and Ruksenas 2011; Guichet et al. 2024; Opdebeeck et al. 2016).”
Martin, D., Bargh, M., & Pennington, K. (2024) · European Journal of Applied Physiology · doi:10.1007/s00421-025-05733-1 · Cited by 2
“Griksiene and Ruksenas (2011) showed that participants using OCs containing third generation progestins ( e.g., gestodene, desogestrel and norgestimate) had poorer verbal fluency compared to newer, less androgenic OCs (e.g., drospirenone).”
BackgroundKuhn, H., & Martini, M. (2022) · Learning and Motivation · doi:10.1016/j.lmot.2022.101821 · Cited by 3
Metadata
- Authors
- Griksiene, R., & Ruksenas, O.
- Venue
- Psychoneuroendocrinology
- Publisher
- Elsevier BV
- Published
- 2011-09
- Volume
- 36
- Issue
- 8
- Pages
- 1239-1248
- ISSN
- 0306-4530 (ISSN-L)
- OpenAlex
- W2011880684
- Cited by
- 128
- References
- 0
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 4 · 2023: 9 · 2022: 16 · 2021: 9 · 2020: 16 · 2019: 9 · 2018: 9 · 2017: 5 · 2016: 10 · 2015: 6 · 2014: 10 · 2013: 9 · 2012: 1
- FWCI
- 6.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychoneuroendocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Endocrinology › Estrogen and related hormone effects
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Spatial Cognition and Navigation
- Keywords
- oral contraceptives, mental rotation, verbal fluency, progestins, androgenic progestins, salivary estradiol, salivary progesterone, salivary testosterone, menstrual cycle phases, cognitive performance, spatial ability, mood, young women
- MeSH terms
- Adult, Affect, Contraceptives, Oral, Hormonal, Female, Humans, Male, Mental Processes, Neuropsychological Tests, Rotation, Space Perception, Task Performance and Analysis, Verbal Behavior, Young Adult
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