Working memory, by coordinating brain network activity, is implicated in mood regulation and may be disrupted in mood disorders, hormonal contraceptive use, and premenstrual symptoms
While cognitive functions like navigation, word generation, arithmetic or face recognition are easily explained, working memory is less self-explanatory. Yet, it underlies all these cognitive functions and guides us through everyday life.
Working memory, in fact, comprises a variety of cognitive functions that determine how we process information received through our senses or retrieve it from long-term memory. Since we can only hold a certain amount of information in working memory at any given time, that includes the updating of information as we receive new input, the active maintenance of information relevant to a certain task, the inhibition of information irrelevant to a certain task, as well as flexibly switching between different processes depending on the task requirements.
Brain networks related to working memory…
Cognitive processes cannot be matched to a single brain network. Nevertheless, each of these processes is supported by certain brain networks more than others (1). For example, the salience network is involved in selecting information. In contrast, the executive control network is involved in inhibiting information, while the default mode network is involved in introspection and memory recall. It is thus not surprising that an imbalance between those brain networks results in impairments in working memory (1).
… are also related to mental health
Curiously, the balance between these brain networks is also what supports our mental health (2). If the balance between the selection and inhibition of information is shifted, this may result in the selective or excessive processing of negative emotional information or increased rumination. These processes do not only take up working memory resources, but may result in mood lability, depression or anxiety. Thus, mood disorders, such as depression and anxiety, have been linked to impairments in working memory (3) on the one hand and altered connectivity between the aforementioned brain networks on the other hand.
… and hormonal contraceptive use in a subgroup of women
This can also be demonstrated during hormonal transitions. Women who report adverse mood reactions to hormonal contraceptives show changes in the connections within and between the salience network, executive control network, and default mode network (4). The changes in these connections can be related to increased mood lability (4).
Importantly, this finding only applies to women who actually do show worsened mood during hormonal contraceptive use. It is currently estimated that 4-10% of women are affected by such a mood worsening (5), whereas other women may profit from a more stable mood during hormonal contraceptive use. We currently do not know how their brain connections change during hormonal contraceptive use and whether network changes related to hormonal contraceptive use are also related to changes in working memory. However, recent evidence from premenstrual syndrome (PMS) highlights the importance of assessing working memory during hormonal transition periods.
Working memory relates to premenstrual symptoms
Premenstrual syndrome refers to the phase-specific increase in a variety of psychological symptoms, including irritability, anxiety, depression, and mood lability during the premenstrual cycle phase. Severe cases may fulfill the criteria for premenstrual dysphoric disorder (PMDD), which affects 3-9% of women (6). It has previously been observed that women with premenstrual syndrome show subtle impaired working memory (7).
Importantly, these alterations in working memory are not specific to the premenstrual phase but remain constant across all cycle phases (8). It is currently unclear whether working memory is the chicken or the egg in this scenario. Are the working memory impairments a cause or a result of the recurrent emergence of adverse mood symptoms during the premenstrual phase? It is possible that they emerge as a chronification of untreated premenstrual symptoms.
In any case, these findings demonstrate the importance of addressing working memory and the underlying brain circuitry in conjunction with mood changes during hormonal transition periods, specifically, also hormonal contraceptive use.
(1) Cai et al. (2021): https://doi.org/10.1038/s41467-021-23509-x
(2) Rubin & Walth (2025): https://doi.org/10.1101/2024.06.16.24309000
(3) Nikolin et al. (2021): https://doi.org/10.1016/j.jad.2021.01.084
(4) Hidalgo-Lopez et al. (2023): https://doi.org/10.1038/s41398-023-02470-x
(5) Sundstrom-Poromaa (2021): https://doi.org/10.1007/978-3-030-70932-7_5
(6) Halbreich et al. (2003): https://doi.org/10.1016/S0306-4530(03)00098-2
(7) Slyepchenko et al. (2017): https://doi.org/10.1016/j.psychres.2017.01.031
(8) Gnaiger et al. (2025): https://doi.org/10.31234/osf.io/3g9su_v1
