Cognitive strategy in verbal fluency: sex differences, menstrual cycle, and menopause effects.

Cognitive sex differences are shaped by hormone effects on brain development, organisation, structure, function, and ageing. In human speech and language, sex differences and hormone effects are typically studied in the form of performance-based differences (via measures of central tendency) with little attention given to underlying cognitive strategy. This study presents data from 126 healthy adults, aged 20-79 years, from three studies of letter based verbal fluency. Comparisons were conducted based on sex, menstrual cycle phase, and menopause stage to examine total words produced, plus switching and clustering strategy use. The investigation probed differences in performance, underlying cognitive strategies, and correlations between performance and strategy. For performance, there were no statistically significant sex or menopause group differences in total words, number of switches and cluster size. Menstrual cycle differences were significant for switches and cluster size, but not total words. However, there were large effect sizes for correlations between total word performance and strategy measures in some groups; these correlations formed patterns which differed as a function of sex, menstrual cycle phase, and menopausal stage. Words produced were highly correlated with switching in younger women at higher hormone menstrual cycle phases. Correlations between total words and both strategies were moderate and equivalent in older premenopausal and perimenopausal women. Postmenopausal women showed a pattern of higher correlation between total words and cluster size which was observed in younger women at the lower hormone cycle phase, and men. This study illustrates the impact of hormones and sex differences on strategy use in verbal fluency-underscoring the value of comparisons in strategy use between women at different reproductive life stages.