Abstract
The aim of this study is to examine the relationship between hormone contraceptive use and menstruation on cognitive performance in young women. The object array task assessed object memory and a mental rotations test assessed spatial ability in women taking hormone contraceptives and naturally cycling women. Women taking hormone contraceptives were significantly better than naturally cycling women at identifying novel objects on an object array, but not on performance of a mental rotations task. There were also no significant differences in either task between naturally cycling women who were menstruating and those who were not menstruating during testing. The results of this study suggest that women taking hormone contraceptives outperformed naturally cycling women in recalling the identities of objects. The findings from this study help to further demonstrate the relationship between ovarian hormones and cognitive performance and add to the understanding of how hormone contraceptives affect cognition.
Introduction
Interest in the influence of the female sex hormones, estrogen and progesterone, on cognition and the brain has increased significantly during recent decades. Some studies have demonstrated beneficial effects of female sex hormones on the brain (Beltz & Moser, 2020; Woolley, 2007) and on cognitive tasks involving learning and memory (Bianchini, et al., 2018; Felmingham et al., 2012; Maki et al., 2002). These studies report that higher levels of ovarian hormones are related to improved cognitive performance on tasks of fine motor skills, verbal fluency, topographical learning, and memory consolidation. Studies have also investigated using hormone replacement therapy as a pharmaceutical treatment for age-related cognitive decline in postmenopausal women. After menopause, women experience a decline in ovarian hormones. Hormone replacement therapy is designed to increase circulating levels of estrogen and/or progesterone to improve the aging process in women. The Women’s Health Initiative Memory Study aimed to examine the effects of hormone replacement therapy on postmenopausal women between the ages of 50 and 79 (Coker et al., 2010; Shumaker et al., 1998). While the Women’s Health Initiative examined the many effects of hormone replacement therapy, the Memory Study focused on the effects of hormone replacement therapy on memory and examined whether or not hormone replacement therapy can be used to help reduce clinically diagnosed all-cause dementia and Alzheimer’s disease. The study was originally designed to run for eight and a half years; however, it was stopped after 5 years due to there being an unsatisfactory risk-benefit ratio (Coker et al., 2010). Women receiving the hormone replacement therapy experienced significantly more non-cognitive negative effects than women who were receiving the placebo treatment, such as increased risk for heart disease, stroke, pulmonary embolism, and breast cancer. In addition to the negative health-related effects associated to receiving the hormone replacement therapy, the study found no beneficial effect of the hormone replacement therapy on cognition. While the Women’s Health Initiative Memory Study demonstrates the importance of understanding the effects exogenous hormones have on one’s overall health, it is a topic that needs further research. Women who participated in the study were of an older age and younger women were not tested. Cognitive performance declines with age; thus, the women in this study may have been past the age where the potential benefits of hormone therapy can be experienced.
Despite the numerous studies investigating the effects of hormone treatments in old age, relatively few studies have examined how exogenous estrogen and progesterone affect learning and memory in young women. Exogenous hormones are synthetic hormones created to mimic the effects of endogenous hormones which are the hormones naturally secreted by the body. In the United States between 2015–2017, about 12.6% of women between the ages of 15-49 took some form of an oral contraceptive pill containing estrogen and progesterone (Centers for Disease Control and Prevention, 2020). However, there is still a lack of knowledge of some protentional side effects women experience when taking hormone birth control. As taking hormone birth control has become more common, scientists have begun to study the effects of exogenous estrogen and progestogen on cognition. Interestingly, one study found that women who received exogenous hormones, either through hormone contraceptives or hormone replacement therapy, demonstrated improved visuospatial ability as well as speed and flexibility (Egan & Gleason, 2012). However, in this study, women were between the ages of 40 to 65 with a mean age of 52.6. Thus, there are inconsistencies in the literature demonstrating the effects of exogenous hormone use on cognition in older women.
Other recent studies have reported that ovarian hormones influence learning, memory, and overall cognitive performance in young women (Bianchini, et al., 2018; Felmingham et al., 2012; Maki et al., 2002). Ovarian hormones fluctuate in women throughout the natural menstrual cycle. The natural menstrual cycle can be divided into two general phases, the follicular phase (1st-14th days after onset of the menses) and the luteal phase (15th–28th days after the onset of the menses) (Maki et al., 2002). Cognitive performance in naturally cycling women is most often assessed during the early follicular phase (2nd-8th days after the onset of the menses) and the mid-luteal phase (19th–25th days after the onset of the menses) to examine how the change in ovarian hormone levels during the menstrual cycle affect cognition (Beltz et al., 2015; Bianchini et al., 2018; Felmingham et al., 2012; Maki et al., 2002). During the early follicular phase, levels of ovarian hormones in the blood are lower than during the mid-luteal phase when blood ovarian hormones are at their highest concentration (Bianchini et al., 2018; Maki et al., 2002). Numerous studies have examined how different circulating levels of ovarian hormones impact memory, learning, and overall cognitive performance in naturally cycling women (Beltz & Moser, 2020; Bianchini et al., 2018; Nielsen et al., 2011). Interestingly, higher circulating levels of ovarian hormones in women during the mid-luteal phase are associated with enhanced verbal learning and memory (Hampson, 1990; Felmingham et al., 2012; Gogos, 2013). Further, higher levels of ovarian hormones tend to increase performance on skills which often have a female advantage, such as immediate and delayed memory, and verbal fluency (Hampson, 1990; Gogos, 2013). Previous research has also demonstrated that high levels of progesterone can have a beneficial effect on memory recall in naturally cycling women (Felmingham et al., 2012). However, it has previously been reported that high levels of ovarian hormones can impair mental rotation and fine motor skills, which are known to typically have a male advantage (Maki et al., 2002; Peragine et al., 2020). Together, these studies demonstrate the effects of varying levels of endogenous ovarian hormones on cognition in young women.
Indeed, a study by Peters and colleagues examined sex differences and menstrual cycle on a mental rotations test, a test of spatial ability (Peters et al., 1995). Female subjects were asked if they experienced regular periods, what day of their cycle they were currently on, and if they were currently taking any contraceptive pills. Participants were then given a 24-item mental rotations test, and after completion of the mental rotations test, participants were given a card rotation and picture folding test. Peters and colleagues found that males performed significantly better than females on the mental rotations test. It was predicted that 25% of females would perform better on the mental rotations test than the mean score of male performance. However, they found that only 15% of females had scores higher than the mean male score, which implies that women on average perform worse on mental rotation tasks than men. The study also found that there was no significant effect of menstrual cycle phase on performance on the mental rotations test. Further, the study found that women taking contraceptive pills scored slightly higher than naturally cycling women on the mental rotations test; however, this difference was very small and only accounted for 3% of the variance in scores. Interestingly, other studies have found that women performed better on tests of mental rotations during the follicular phase of their menstrual cycle when compared to performance during the luteal phase of their menstrual cycle (Maki et al., 2002; Peragine et al., 2020). The results from these studies suggest that lower levels of ovarian hormones are associated with improved ability of mental rotations; however, this contradicts the findings from the study by Peters and colleagues. The effects of menstrual cycle phase and ovarian hormones on the mental rotations test should be examined again due to contrasting results in this study and in others (Maki et al., 2002; Peragine et al., 2020; Peters et al., 1995).
In recent years, numerous studies have begun to examine the effects of exogenous ovarian hormones on cognition in women. In these studies, exogenous hormones are most often administered through hormone contraceptives (Beltz et al., 2015; Bianchini et al., 2018; Gogos, 2013; Maki et al., 2002; Nielsen et al., 2011). These studies have found that women who are taking a form of hormone contraceptives and have a higher blood concentration of estrogen, tend to perform better on tests of cognition compared to women not taking hormone contraceptives and who have lower blood concentrations of estrogen (Beltz & Moser, 2020; Bianchini et al., 2018; Gogos, 2013; Nielsen et al., 2011). One study also reported that long-term use of hormone contraceptives (15 years or longer) was associated with improved visuospatial ability (Egan & Gleason 2012) compared to women who had not taken hormone contraceptives for as long.
Exogenous ovarian hormones may also affect mental rotations test performance. As explained previously, the effects of ovarian hormones on the mental rotations test are unclear. Interestingly, most studies suggest that lower circulating levels of ovarian hormones are associated with improved performance on a mental rotations test compared to higher circulating levels of ovarian hormones (Maki et al., 2002; Peragine et al., 2020). However, one study found that women who were taking hormone contraceptives performed better than naturally cycling women on a mental rotations test (Peters et al., 1995), while another study reported no effect of hormone contraceptive use mental rotations test performance (Beltz et al., 2015). The findings from these studies agree, however, that men outperform women on mental rotations tests (Beltz et al., 2015; Peters et al., 1995). The male advantage on this task has led researchers to assume that higher circulating levels of ovarian hormones, as in women taking hormone contraceptives, would be associated with impaired performance on a mental rotations test. However, because Peters and colleagues found that hormone contraceptive use was related to improved mental rotations test performance (Peters et al., 1995), this topic needs to be further examined.
Interestingly, Bianchini and colleagues performed a study where women were given a different spatial ability task, the Walking Corsi Test, during both the mid-luteal phase (when ovarian hormone levels are at their highest concentration) and again during the early follicular phase (when ovarian hormones levels are at their lowest concentration) (Bianchini et al., 2018). Spatial performance of naturally cycling women were compared to oral contraceptive users. Bianchini and colleagues found that women taking oral contraceptives learned the Walking Corsi Test pattern in fewer trials than naturally cycling women during both menstrual phases. The results of this study suggest that oral contraceptives may have a beneficial impact on topographical learning skills.
On the other hand, another study reported that use of exogenous estrogen and androgen, either alone or in combination, did not influence verbal memory performance in premenopausal women who had their uterus and ovaries removed due to benign disease (Sherwin, 2005). However, women who had their uterus and ovaries removed and who had been randomly assigned to receive the placebo experienced a significant decrease on their performance on tasks of verbal memory. The results therefore demonstrate that while exogenous estrogen and androgens may not specifically improve verbal memory, hormone treatment may help prevent the loss of verbal memory skills after uterus and ovary removal.
Although most research on the behavioral effects of ovarian hormones has focused on the impact of estrogen on cognition, progesterone may also influence cognitive functioning in women. However, there are inconsistencies in the literature such that progesterone has been reported to have both beneficial and negative effects on memory. One study reported that women with high levels of progesterone in saliva samples displayed increased memory recall during a stressful situation compared to women who had low levels of progesterone in saliva samples (Felmingham et al., 2012). In contrast, other studies report that high doses of exogenous progesterone may have negative effects on memory and overall health (Coker et al., 2010; Roozbehi et al., 2017).
Thus, research examining the effects of exogenous ovarian hormones in young women is limited and the topic needs to be further examined. This study aims to determine whether exogenous hormone use, through hormonal contraceptives, affects object memory and mental rotation in young women. It was hypothesized that women taking hormone contraceptives would perform better on tasks of object memory compared to naturally cycling women and that naturally cycling women would perform better on the mental rotations test compared to women taking hormone contraceptives. This study also compared object memory and mental rotation ability in women who were menstruating and women who were not menstruating. Menstruating women were expected to have worse object memory and mental rotation ability compared to non-menstruating women.
Methods
Participants
Frequency of Type of Hormone Contraceptive.
Procedure
After informed consent was obtained, participants completed a personal information questionnaire which requested their age, race, SAT/ACT scores, sex, and whether they were assigned male or female at birth. Participants were also asked about their menstrual cycle including questions on the date of their last menstrual period, if they were currently menstruating, if they experienced regular menstrual cycles, or if they were pregnant. Women were also asked if they were taking exogenous hormones (e.g., hormone contraceptives/birth control) and to write down the type and brand of exogenous hormones that they were taking. Participants then received verbal and written instructions on how to perform each of the following tasks: an object array task and a mental rotations task. Participants first completed the first two parts of the object array task, then they completed the mental rotations task, and finally completed the last part of the object array task.
Object Array Task
An object array task was used to assess object memory as previously described (Levy et al., 2005). Participants were shown an array of black-and-white line drawings of 31 recognizable objects which had been printed onto an 8 ½ x 11″ piece of paper. Participants were asked to study the array for 1 minute. After 1 minute, the first array was removed and they were then handed a new array and asked to circle any new objects that they believed had moved positions on the array. The new array contained all the same objects from the original array except for seven pairs of objects which had exchanged positions. After 1 minute, the participants were given a third array and again asked to circle any objects that they believed moved positions on the array compared to the original array. On this third array, 14 objects had been moved to positions that were previously unoccupied in the original array. Participants were given 1 minute to circle objects on the third array. Once this minute was over, participants took a break from the object array task and completed the mental rotations task for about 20 minutes. Once the mental rotations task was completed, participants were shown a fourth array which contained 17 objects from the original array and 14 new objects. Participants were given 1 minute and asked to circle any new objects. Object array score was calculated as the number of objects correctly circled minus the number of objects incorrectly circled. Participants earned up to 14 points for each array, 1 point for each correctly circled object.
Mental Rotations Test
A redrawn version of the Vandenberg and Kuse mental rotations test (Peters et al., 1995) was used during the collection of this data. The mental rotations test was used to test spatial ability in participants. Participants were given a 24-question mental rotations test with each question containing a target 3-dimensional black-and-white object on the left and four different 3-dimensional black-and-white objects on the right. Only two of the four objects on the right represented rotated versions of the target object. Participants were asked to mark an “X” over both of the rotated figures in order to get that question correct. Participants were given 4 minutes to complete the first 12 questions, a 4-minute break, and then 4 minutes to complete the last 12 questions. Participants earned up to 24 points, earning 1 point for each correct question.
Results
Fifty-nine women participated in the study. There were 19 women taking hormone contraceptives and 40 women not taking hormone contraceptives. One participant put “prefer not to answer” when asked if currently menstruating and was excluded from the analyses examining the effects of active menstruation on cognitive performance. Of the 39 naturally cycling women who offered information about their menstrual status, 10 women were actively menstruating at the time of their testing and 29 women were not. Only naturally cycling women were used in the analyses examining the effect of menstruation on cognitive performance. This was done so we could examine the effects of active menstruation on cognition without looking at the influence of hormone contraceptives.
Twenty-six participants reported SAT scores, and five participants reported ACT scores. SAT and ACT scores were converted into percentiles and used as one variable for the analyses. The percentiles of SAT/ACT scores of 31 subjects were compared, 19 scores from naturally cycling women and 12 scores from participants taking hormone contraceptives. An independent samples t-test indicates that there were no significant differences in SAT/ACT scores between women taking hormone contraceptives (M = 74.00, SD = 27.60) and naturally cycling women (M = 73.63, SD = 19.22), t(29) = −.04, p = .97.
An independent samples t-test indicates that participants taking hormone contraceptives did not perform significantly differently than naturally cycling women on tasks of object shift (participants taking hormone contraceptives: M = 4.21, SD = 2.72, naturally cycling women: M = 5.40, SD = 2.80), t(57) = 1.54, p = .13; object exchange (participants taking hormone contraceptives: M = 7.47, SD = 2.50, naturally cycling women: M = 6.68, SD = 3.90), t(57) = −.81, p = .42; or on a mental rotations test (participants taking hormone contraceptives: M = 8.47, SD = 2.91, naturally cycling women: M = 9.22, SD = 5.12), t(57) = .59, p = .56. The results demonstrate that women taking hormone contraceptives (M = 11.74, SD = 1.19) performed significantly better than naturally cycling women (M = 10.20, SD = 2.27) on a task of identifying novel objects, t(57) = −2.27, p = .01, d = −.77. Figures 1A and 2A display the average scores for all object array conditions and the mental rotations test of participants taking hormone contraceptives and participants not taking hormone contraceptives. Independent samples t-tests also indicate that naturally cycling women who were menstruating during time of testing did not perform significantly different than naturally cycling women who were not menstruating on tasks of object exchange (menstruating: M = 7.80, SD = 3.29, not menstruating: M = 6.31, SD = 4.11), t(37) = −1.04, p = .31, object shift (menstruating: M = 5.60, SD = 2.01, not menstruating: M = 5.45, SD = 3.02), t(37) = −.15, p = .89; identifying novel objects (menstruating: M = 10.70, SD = 2.31, not menstruating: M = 10.03, SD = 2.31), t(37) = −.79, p = .44; or on a test of mental rotations (menstruating: M = 7.90, SD = 4.28, not menstruating: M = 9.31, SD = 5.08), t(37) = .79, p = .44. Figures 1B and 2B illustrate the average scores for all object array tasks and mental rotations test for naturally cycling women who were actively menstruating and naturally cycling women who were not actively menstruating at the time of testing. Women taking hormone contraceptives were significantly better at identifying objects that were new to the array compared to natural cycling women (Graph A, p < .05 for novel object condition). Active menstruation did not affect object array task performance in naturally cycling women (Graph B, p > .05). Each symbol represents the mean (± SEM) number of correctly circled objects minus the number of incorrectly circled objects. Women taking hormone contraceptives and naturally cycling women performed similarly on the MRT (Graph A, p > .05). Naturally cycling women who were actively menstruating and naturally cycling women who were not actively menstruating also performed similarly on the MRT (Graph B, p > .05). Each bar represents the mean (± SEM) number of correctly answered MRT questions.
Discussion
The purpose of the present study was to examine the effects of hormone contraceptives and menstruation on cognitive performance in young women. College-aged women were assessed using the object array task and a mental rotations test. It was hypothesized that women taking hormone contraceptives would perform better on tasks of object memory than naturally cycling women and that naturally cycling women would perform better than women taking hormone contraceptives on tests of mental rotation.
The results of this study demonstrate that women taking hormone contraceptives were significantly better at identifying novel objects on an object array compared to naturally cycling women. Hormone contraceptive use did not significantly impact performance on a mental rotations test or tests of object location memory using the object shift and object exchange arrays. Additionally, women who were menstruating during the time of testing did not perform significantly differently than women who were not menstruating during the time of testing on any of the object array conditions or on the mental rotations test. These results help demonstrate how hormone contraceptives and ovarian hormones may impact cognition.
The findings from the present study are consistent with several prior studies in the field examining this topic. Previous studies have demonstrated that young women taking hormone contraceptives have better performance on tests of cognition compared to young women not taking hormone contraceptives (Bianchini et al., 2018; Gogos, 2013; Nielsen et al., 2011). These studies report that women taking hormone contraceptives tend to outperform naturally cycling women on tasks of immediate and delayed memory, visuospatial ability, attention, and spatial ability. Similarly, this study reports that women taking hormone contraceptives performed significantly better than women not taking hormone contraceptives on a task of identifying novel objects.
Prior studies have also demonstrated that exogenous estrogen and progesterone are related to improved object identity memory in mice (Harburger et al., 2008, 2009), which has now been demonstrated in women in this study. Further, previous studies in women imply that higher levels of ovarian hormones and taking hormone contraceptives that contain exogenous ovarian hormones have beneficial effects on tasks that have a female advantage, such as immediate and delayed memory, but can also impair performance on tasks that have a male advantage, such as a mental rotations test (Hampson, 1990; Maki et al., 2002; Gogos, 2013). Interestingly, the present study found no effect of hormone contraceptives or menstruation on mental rotations test scores. The findings from the present study may differ from prior reports because we used a different test of mental rotation ability. It is possible that the mental rotations test used in this study is less sensitive to cognitive changes associated with hormonal contraceptive use.
Interestingly, previous studies have demonstrated conflicting information on the effects of ovarian hormones on mental rotations tests in young women (Maki et al., 2002; Peragine et al., 2020; Peters et al., 1995). Past studies found that participants performed better on a mental rotations test during the follicular phase of their menstrual cycle, when endogenous ovarian hormone levels are at their lowest, compared to during the luteal phase of their menstrual cycle, and that naturally cycling women who were actively menstruating performed significantly better than naturally cycling women who were not actively menstruating on a test of spatial ability (Hampson, 1990; Maki et al., 2002). However, a different study found that women taking contraceptive pills scored better on a mental rotations test compared to naturally cycling women, which contradicts a prior study reporting that higher ovarian hormone levels impair performance on a mental rotations task (Peters et al., 1995). The present study reports that naturally cycling women performed similar to hormonal contraceptive users on the same mental rotations task. Thus, there are discrepancies in the literature and future studies should examine the effects of ovarian hormones and hormone contraceptives on spatial ability tasks.
It is possible that these studies may have found varying results due to confounding and extraneous variables. Different sample sizes, different tests of cognition, and different types of hormone contraceptives are only some of the variables that can impact the results of a study. By using different tests of cognition, researchers can further generalize the findings of the field; however, it also allows for inconsistencies between studies. Since few studies have examined how hormone contraceptives impact cognition in young women, it is imperative that further studies examine this effect to further the understanding of women’s health.
It is possible that we did not find significant differences between naturally cycling women and hormone contraceptive users on the exchange and shift conditions of the object array task because we did not have an equal sample size in both groups. In the sample of 59 women total, only 19 were taking hormone contraceptives. It is possible that the results may have been different had the ratio of hormone contraceptive users to naturally cycling women been more even. It is also important to note that the object exchange and object shift conditions of the object array test for object location memory, which may employ spatial ability skills more than object memory skills. Thus, one may conclude that women taking hormonal contraceptives in the present study had better object memory (in the novel object array condition), but not spatial ability (in the object shift and exchange conditions and on the mental rotations test).
Interestingly, in the present study, naturally cycling women who were menstruating performed better on all object array tasks compared to naturally cycling women who were not menstruating during the time of testing. Though in this study, these results were not significant, it does suggest that there may be an effect of menstruation on object memory and further research should be conducted to examine this question. Prior studies found that naturally cycling women who were not menstruating performed better on the mental rotations test compared to naturally cycling women who were menstruating at the time of testing (Maki et al., 2002; Peragine et al., 2020; Peters et al., 1995).
We should also note that the present study used a personal information questionnaire to collect information about hormone contraceptive use and menstruation. For participants who were not actively menstruating at the time of their testing, we did not know what phase of their menstrual cycle they were in. Ovarian hormone levels fluctuate throughout the different menstrual cycle phases, lower levels are found during the follicular phase (1st-14th days after the onset of the menses) and higher levels are found during the luteal phase (15th-28th days after the onset of the menses). The female menses last for about 7 days; however, the follicular phase of the menstrual cycle lasts for 14 days. Participants could have ended their period recently and still have been in the follicular phase of their menstrual cycle during testing. Identifying which menstrual cycle phase participants were experiencing during their time of testing would have allowed us to examine the subjects in groups specific to their menstrual cycle phase and not just if they were actively menstruating or not. Examining the data by menstrual cycle phase could have offered a better examination of how ovarian hormones impact cognition. Participants were also taking different forms of hormone contraceptives. Different types of hormone contraceptives may have different effects on cognition. By not having participants all take the same form of hormone contraceptives and by examining all hormone contraceptive users together in one group, we may not have found the same impacts on cognition we may have observed had the type of hormone contraceptive been consistent among all participants taking hormone contraceptives.
It should be noted that this study used a between-subjects design. By using this type of study design, there is a possibility that the groups differed in variables that were not analyzed in this study. In order to control for these potential differences, we limited our recruitment to undergraduate students at Purchase College, State University of New York who were between the ages of 18–27. We also compared participants SAT and ACT score percentiles to see if the groups differed significantly using this measure. Although not all participants submitted their scores, we did not see differences in SAT or ACT scores in women taking hormone contraceptives and those not taking hormone contraceptives.
While in recent years, more studies have examined the impact of hormone contraceptives on cognition in young women, it is important that this effect be further investigated. With about 12.6% of women of reproductive age in the United States taking oral contraceptives containing exogenous estrogen and progesterone, it is imperative that the effects be better understood (Centers for Disease Control and Prevention, 2020). Many women begin taking hormone contraceptives during high school and college, times during their lives when it is vital that their cognitive performance be non-impaired. Currently, there are few studies examining the cognitive effects of hormone contraceptives. The present study adds significantly to this limited field. The present findings are consistent with prior reports that women taking hormone contraceptives may have improved performance on cognitive tasks compared to naturally cycling women (Bianchini et al., 2018; Gogos, 2013; Nielsen et al., 2011). Additionally, these finding support that exogenous estrogen and progesterone positively impact object identity memory, which had previously been demonstrated in mice (Harburger et al., 2008, 2009). To our knowledge, this study is the first study to report that hormone contraceptive use may improve object array task performance in women. Future studies should continue to investigate this important topic. By further exploring this subject and gaining a deeper understanding of how hormone contraceptives affect cognition, women will be better able to understand how taking hormone contraceptives could impact their education. Future research should examine how different types of hormone contraceptives can impact cognition so that women can make a more informed decision about whether they take hormone contraceptives and what type they will use.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for this project was supported by Purchase College.
Author Biographies
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