00:00:00
this is evidence of what women have been saying all along menopause changes the functionality of your brain it looked
00:00:06
there like the brain was basically shrinking yes and there are two reasons why this is very important number
00:00:12
one and this is something that impacts not all women but also all men Dr Lisa
00:00:18
mcone is a neuroscientist whose groundbreaking research has discovered and revolutionized our understanding of
00:00:24
the menopause and the adaptions that can be made in order to thrive during this time of life this is new research
00:00:30
looking at brain changes during the different phases of menopause the process that can take years so this is
00:00:35
before menopause this is after wow and this shows the 30% drop in brain energy
00:00:42
levels so when women say that they're having hot flashes insomnia depression 2third of all women experience brain fog
00:00:49
those are brain symptoms not recognized in medicine in fact we know that Black
00:00:54
and Hispanic women may experience more severe symptoms and women have been portrayed is mentally unstable in
00:01:01
medicine for a really long time we need to change that but on top of doing the research I am actively doing a number of
00:01:09
Lifestyle adjustments that are known to have a positive effect on menopause so let's have a look at these things then
00:01:15
okay the first thing I do is Dr Lisa one of the things I found fascinating is I read that there was a miracle food for
00:01:21
delaying menopause a diet rich in has been linked with the later onset of
00:01:27
menopause by how much 3 years we've just hit 6 million subscribers on
00:01:32
the D Co um so me and my team would like to do something we've never done before as little thank you and we're calling it
00:01:38
The di of a CO subscriber raffle and here is how it works every episode this month we're going to pick three current
00:01:44
subscribers at random and we'll send one of you a 1,000 voucher one of you tickets to come and watch the dire
00:01:50
behind the scenes live with our team and one of you will have a 10-minute phone call with me to discuss whatever you want to talk about if you're a
00:01:56
subscriber you're in the raffle thank you from the bottom of my heart for allowing me to do something that me and
00:02:03
my team love doing so much it is the greatest honor of my lifetime and I hope it I hope it continues uh off into the
00:02:08
Future Let's get to the episode Dr
00:02:16
Lisa there's a high chance many millions of people have clicked on this conversation for
00:02:22
whatever reason men women of all ages what is the reason that all of those
00:02:30
individuals need to listen to this conversation about the menopause brain I think the main reason is that
00:02:37
women are important and Women's Health matters and Women's Health has not been
00:02:42
taken seriously in society and in medicine for hundreds of years and this is time to really change the
00:02:49
conversation and help and support women throughout an interesting and
00:02:54
complicated transition that all women go through because this will make us all better this is important for society as
00:03:01
a whole why should men listen men should listen because number one it's really important to understand what happens to
00:03:09
your spouse to your friend to your mother to your aunt and all women go through menopause
00:03:16
so this is something that impacts not all women but also all men really and I
00:03:22
find this so interesting and so really so heartwarming when I receive emails from men and they do a lot like daily
00:03:29
and they're saying to me like you know thank you you really helped me understand my wife better or you really
00:03:35
helped me understand my mother or my my sister my daughter and now as a family
00:03:41
we're making different decisions or we're having different conversations and everything just better it's also really
00:03:48
important to understand how humans actually work you know physiologically medically and there's so much in society
00:03:55
that has been done against women or to help women but that didn't quite work
00:04:01
out and we're now understanding what's really important to do and not to do to support Women's Health I've had
00:04:08
conversations about menopause before I've had a few conversations on this podcast with friends with one of my friends deina mcco about menopause and
00:04:14
it's really open my eyes oh you know her yes yes yes she wonderful fantastic absolute Shining Light In My Life um and
00:04:22
she's talked to me about the menopause but very few people if I would say and nobody's talked to me about this extra
00:04:29
War word that appears on the front of your book which is the word brain I didn't realize that there was any
00:04:36
impacts on a woman's brain when she goes through menopause but that seems to be
00:04:41
what you focused much of your work especially in this book to identify and to illuminate what do we need to know
00:04:48
from a very Topline perspective about the impacts of menopause on the
00:04:53
brain what we need to know is that as a society we tend to really focus on only
00:05:00
half of what menopause is all about which is fertility and as we were talking about
00:05:06
before most people are aware that at some point or the other in a woman's life fertility ends usually around
00:05:14
midlife and that's the end of your menstrual cycle and the end of your ability to have children but what the
00:05:21
vast majority of people do not realize is that menopause also impacts the brain
00:05:26
in a very significant way they were on starting to gather the real data about
00:05:32
so the research is ongoing and what we and others have shown is that menopause
00:05:37
is actually a renovation project on the brain and the vast majority of women
00:05:44
will experience brain symptoms or neurological symptoms during menopause
00:05:50
so when women say that they're having hot flashes nice sweats insomnia anxiety
00:05:56
depression brain fog 2third of all women going through menopause experience brain
00:06:02
fog and memory lapses and those symptoms yes they are related to menopause but
00:06:09
they have nothing to do with the ovaries those are brain symptoms they are neurological symptoms that come from the
00:06:17
ways the menopause changes the brain I want to get into how you know
00:06:22
this and the work that you've done but but first I've got to ask who are
00:06:27
you I am Dr muscone and I have a PhD in
00:06:33
neuroscience and nuclear medicine which is a branch of radiology where we use
00:06:39
brain Imaging techniques to study the functionality of the brain the biochemistry of the brain and we can
00:06:46
really deeply explore how the brain changes at different times in a person's
00:06:52
life and the reason I am here is that I am the director of the women's brain
00:06:59
initiative live a wildon medicine New York Presbyterian in New York City where I also lead the Alzheimer's prevention
00:07:06
program and I believe it's fair to say that our team is at the Forefront of
00:07:13
reproductive Neuroscience or gender neurology which is the study of how brain health plays
00:07:21
out differently in women than in men I heard you you've published over
00:07:27
150 Medical journals yes yeah yeah over 150 scientific papers in
00:07:34
to summarize because I because I did a quite extensive piece of research here you're basically leading the way as it
00:07:40
relates to understanding a woman's brain
00:07:45
especially as it relates to menopause the changes I because I was reading that you did the first brain scans yes on a
00:07:53
woman's brain to compare what a woman's brain looks like before and after menopause and also before and after
00:07:58
surgical menopause which the remal of the ovaries and you actually have those scans which we'll talk about later but
00:08:04
you have some of those scans to show me today but you the first to do that to my knowledge super interesting why hasn't
00:08:11
anything been done here why just generally on the subject of menopause why hasn't there been research and
00:08:17
investment into this area such a good question and it's the question I asked
00:08:22
when I started looking at menopause for the first time there was in 2015 so my my specialty is used to be at
00:08:32
least Alzheimer's prevention so I'm really I've always been really focused
00:08:37
on supporting cognitive health and cognitive aging and preventing or at
00:08:42
least reducing the risk of dementia Alzheimer disease and dementia and in 2015 we have kind of ran out of ideas
00:08:50
especially when it when it comes to women's brain health because what most people don't realize is that um
00:08:56
Alzheimer's disease affects more women than men so almost 2third of all Alzheimer's
00:09:02
patients are women particularly postmenopausal women and this was my
00:09:09
question even for my PhD at the very beginning of my career and back then
00:09:14
people would say to me well yes we've known since
00:09:20
1994 that after aging and getting older itself being a woman is the most
00:09:26
significant risk factor for devel veloping demential
00:09:32
however the explanation back then was that women live longer than men and
00:09:39
Alzheimer's is a disease of old age therefore at the end of the day more
00:09:44
women than men have Alzheimer's disease and that never made sense to me in part because I have a family history of
00:09:51
Alzheimer's disease that runs in my family obviously and affects the women in my family and I know that this is
00:09:58
very common where your grandmother has Alzheimer's or dementia and for me it
00:10:05
was my grandmother and her two sisters who all developed Alzheimer disease and died of it but their brother who lived
00:10:13
exactly to the same age did not and so my PhD thesis actually was to
00:10:20
show that Alzheimer disease is not a disease of old age it's actually a
00:10:26
disease of midlife with symptoms this start in old age so what happens is that
00:10:32
Alzheimer starts in the brain with negative changes that take years to
00:10:38
reach a certain threshold before the damage is so severe that people start
00:10:43
losing their memories they can't come up with wordss they have attention deficits but in reality Alzheimer starts
00:10:51
for many people in midlife so that changed my entire question right then
00:10:57
the question becomes okay if Alzheimer starts in midlife and more women than
00:11:02
men end up with Alzheimer disease what happens to women and not men in midlife
00:11:09
they could potentially explain the higher lifetime risk of Alzheimer disease for women and look we tried
00:11:16
everything we tried genetics we looked at Medical factors we looked at diabetes we looked at high cholesterol levels we
00:11:23
looked at insulin resistance we looked at obesity we looked at every single thing we could look at diet lifestyle
00:11:30
exercise and those things certainly matter but they couldn't quite explain the difference that we were seeing
00:11:37
because what we were seeing is that already in midlife women show these red
00:11:42
flags of Alzheimer disease in their brains whereas men do not and we can see
00:11:48
that by doing brain scans and doing brain Imaging and the question was what
00:11:54
what is it that really tips the scale and then one day my students were
00:12:01
doing cognitive testing on one of our participants a woman in her 40s and she
00:12:07
was having a really hard time just getting through the tests and she said I
00:12:13
I'm really having a hard time can you open the window and that doesn't happen
00:12:18
very often and my students are like the window sure actually no because it's
00:12:24
Hospital in New York City you can't open the windows but we can we can play with the fan perhaps and she just could not
00:12:30
get through the test and then she had to stop and said look I'm having hot flashes I just can't think straight I
00:12:37
have to go and so she rescheduled and then she came back later but my students came to
00:12:42
me in a panic she said she had half flashes what is it is she okay well we
00:12:48
we had to stop the session is is are we in trouble basically and say half lashes
00:12:54
that's interesting and so we went back and we I explained to them that means that she's going through menopause
00:12:59
and this is a sign a classic neurological sign of menopause that we
00:13:05
do know can impact concentration and focus but back then we didn't know that
00:13:10
it could be a bigger a bigger change in your brain right impacting your your
00:13:16
ability to focus and memorize information and so we went back and we asked all the women in our study about
00:13:24
their menopausal status and their menstrual cycle and their symptoms and then what we found is this then if you
00:13:30
compare a group of premenopausal women to men of the same age and look at their
00:13:36
brain scans there are no differences or very little differences but if you look
00:13:41
at women who are per menopausal and compare them to Men of the same age you
00:13:46
see an increase in the amount of Alzheimer's plaques in the brain already
00:13:52
in midlife in per menopause in Perry so not even in menopause but just starting
00:13:59
to lose your skipping menstrual cycles and when you when your period becomes infrequent and usually the half flashes
00:14:06
start making an appearance in the brain fog as well and then after menopause when we compared postmenopause of women
00:14:13
to men of the same age then the difference was quite striking where men barely had any Alzheimer's plaques and
00:14:21
the women had statistically significantly more red flags for Alzheimer's disease
00:14:28
okay so this is a really naive question but please do explain this to me like
00:14:33
I'm a 10-year-old what is manopause what is menopause so there's a standard
00:14:42
medical textbook definition that is entirely based on the function of the ovaries okay and then there's an updated
00:14:50
definition that I'm trying to promote more and more because I think it's important that really looks a menopause
00:14:56
for what it is from a scientific persp practice I'm going to give you both the
00:15:01
standard definition of menopause is when a woman hasn't had a menstrual cycle for
00:15:07
12 consecutive months there are three phases there's a Prem menopausa phase
00:15:14
when a woman is in her 30s or older and has a regular menstrual cycle
00:15:20
approximately every month and then at some point the frequency and severity
00:15:27
can change so that's when your period becomes more infrequent or there's less
00:15:33
menstrual blood yes usually a combination of the two and what we really focus on clinically is the
00:15:40
frequency okay so when you start skipping your period for more than two three months at a time that is
00:15:47
considered the per menopausal phase which is an in between between having a menstrual cycle and not having a
00:15:53
menstrual cycle so that first stage we were talking about is there a name that's per menopause pre pre PR
00:15:59
menopause preop menopause PR there's per yeah which is in between is that stage
00:16:04
two that's yeah okay stage two so if you you want stage two yes stage usually we
00:16:11
say stage one and two for cancer s malignant oh okay but yes first and
00:16:17
second okay stage um and then at some point you will not have a menstrual
00:16:23
cycle anymore for up to 12 consecutive months and then in retrospect
00:16:29
you go back to the year prior and say okay as of 12 months ago that was your
00:16:37
menopause and you are now postmenopausal in the postmenopausal stage which is the third
00:16:44
phase if you will lasts for the entire remaining of a woman's life so most
00:16:50
women today spend at least 30% if not more of their lives in the
00:16:56
postmenopausal stage so you have this Perry menopause stage which happens in your mid to late 40s typically yes
00:17:04
usually around age 47 that's the average but in reality it can start when you
00:17:10
when you're in your 30s or sometimes in your 50s the average
00:17:15
is 47 and it tends to last about 10 years and this is really when your estrogen levels start to dip that's a
00:17:21
good point so it can usually lasts between two and 10 years if you're lucky let's say four
00:17:28
between four and seven okay this is actually when estrogen levels fluctuate
00:17:33
okay and that's what makes it tricky to diagnose based on blood tests so blood
00:17:38
tests are not that helpful in this respect because one day your estrogen is high and the next day your estrogen is
00:17:45
low and it does start gradually declining overall but it doesn't really
00:17:50
bottom out until your your past the transition and you are effectively in a
00:17:57
postmenopausal state age so yes there is a continuous decline in concentration
00:18:02
but day by day it's a little bit of a roller coaster which is also why women
00:18:08
start having symptoms of menopause the brain symptoms of menopause before the final menstrual period not after and
00:18:16
that's a big misconception in medicine and science that menopause is just one
00:18:22
day on the calendar a little bit like puberty right as a woman once you have your first menstrual period That's aect
00:18:28
effectively your first but in order for you to really have your last menstrual
00:18:35
period That's a process that can take years and that is not captured in the
00:18:40
definition of menopause is one day on the calendar when you stop having your cycle and another misconception is that
00:18:48
menopause happens when you're old and it's really not the case in the United
00:18:53
States but also in Europe the average age is 51 52 but if you look at the
00:18:59
global female population is actually 49 and that is not old by any standards
00:19:07
what's the youngest you've seen menopause which is stage two in that in that process so it depends if we're
00:19:13
looking at spontaneous menopause or induced so women can go through
00:19:19
menopause for a number of different reasons which also again this is another misconception that menopause is the same
00:19:25
for everyone that's absolutely not true but the three main reasons um are aging
00:19:33
just the neuroendocrine aging process that I like to refer to as
00:19:38
spontaneous menopause some people say natural but that to me is misleading
00:19:43
because it makes it sound like the other types are unnatural which is really the last thing anybody needs right it's hard
00:19:50
enough to to go through menopause because of medical reasons rather than as part of the agent process and so the
00:19:57
other two types are induced menopause which can be surgically
00:20:02
induced or medically induced surgically induced is when you have your OV is
00:20:07
removed usually as part of a hysterctomy which is the surgical removal of the
00:20:13
ueros or just the ovaries alone and that's called an ectomy the surgical
00:20:18
removal of the ovaries before obviously before going through menopause but menopause can also occur for medical as
00:20:26
a result of Medical Treatments like therapy for cancer that can induce
00:20:33
menopause sometimes just temporarily and sometimes more more often than not
00:20:38
permanently so the youngest stage is actually puberty because there are transgender individuals who have
00:20:46
their ovaries removed as part of their transition to a different gender so in
00:20:51
that case if you have the the surgery the ectomy and hysterctomy when you are a teenager that's when you go through
00:20:58
menop the spontaneous menopause what's the earliest you've seen or heard
00:21:05
of um 40s early 40s but some
00:21:10
women some women with P PCOS or primary ovarian
00:21:16
insufficiency can develop menopause even earlier than that however in that case
00:21:22
is not part of the aging process is because there's something that needs to
00:21:28
to be further investigated whether it's genetics or an autoimmune disorder or
00:21:33
other causes so just to summarize then there's three stages to menopause there's per menopause which happens mid
00:21:40
to late 40s the average age is 47 years old and this can last typically so you said 2 to 10 years this is when estrogen
00:21:46
levels begin to fluctuate as you said there's menopause which is um when she when a woman has reached one
00:21:53
year since her last period the average age at menopause is 51 to 52 and the menopausal transition can last seven to
00:22:01
14 years and then you have postmenopause which is the rest of the woman's life
00:22:07
when she is without a period just on that then so I I think I I used to think that menopause was the last stage and
00:22:15
then once you're in menopause you're in menopause until yeah see the terminology is also confusing but menopause is
00:22:23
actually just basically a mark on the calendar
00:22:28
there and say as of today you are in menopause but it's not
00:22:34
a stage so what's the difference diagnosis but it says it lasts three stages yeah pre menopause
00:22:41
before okay so there okay three yes so from puberty until you start skipping
00:22:48
periods okay okay then there's Perry yeah second stage when you start
00:22:53
skipping periods and your hormones start fluctuating and then there's post menopause okay so before in the middle
00:23:00
of the transition Peri and then after so that transition period yeah that's the
00:23:06
per menopausal or menopause transition that typically last four to seven years
00:23:12
but it can actually last up to 14 for some women and what's going on in that transition phase there's a lot going on
00:23:19
and we're at least from a brain perspective we're starting to really understand it now and I think what's
00:23:25
important to know to really understand what P menopause is and what's going on
00:23:31
in your brain and your body during that transition is that women are
00:23:36
born with a system called the neuroendocrine system that connects the
00:23:43
brain the neurological system with your ovaries and the rest of the endocrine
00:23:49
system this system you're born with meant to but for women that system is
00:23:55
activated during puberty is overa activated during pregnancy every time a
00:24:02
woman is pregnant is partially turned off during postpartum and I'm hoping we can talk
00:24:09
about that too the mommy brain is really it's really quite a thing and then is
00:24:14
quite dismantled after the transition to menopause so this is a system that is
00:24:21
extremely important because reproduction and fertility are effectively some of
00:24:27
the most important drivers of evolution and that means that a huge part of your
00:24:32
brain is really wired to
00:24:38
respond to your reproductive organs okay so the brain talks to the ovaries and
00:24:44
the ovaries report back to the brain every day of a woman's life for as long
00:24:50
as you have a menstrual cycle and probably also after which is something that most people don't realize there's a
00:24:57
reason to keep your OV is after menopause because they do still have some functionalities now if you think
00:25:04
about it when we look at those graphs that show how the the way that the brain
00:25:09
ages it usually looks like there's a flat line and then after midlife like in
00:25:15
your 60s 70s 80s neuronal density starts going down right there's a everything is
00:25:22
good and all those graphs they usually talk about the way that the brain ages and how neurons age and how we lose
00:25:30
neurons in the brain you know most people are aware that everything goes well until you get a little older and
00:25:37
then you lose a few neurons here and there just so some kind of gentle neuronal loss over time not for women
00:25:45
those graphs are based on men women's Brains change in a way that is quite
00:25:52
complicated where starting a puberty throughout every every single
00:25:59
month when your OV cycle your brain microcycles every single yes every two
00:26:07
weeks there's a little micro cycle what's a micro cycle so um the way that the ovaries in the
00:26:14
brain communicate is by sharing hormones and we'll talk about those hormones as
00:26:20
sex hormones for women these are chiefly estrogen progesterone some testosterone
00:26:27
I think is important but people usually kind of put it to the side and other hormones that are made by the brain they
00:26:33
keep going back and forth from the ovaries to the brain from the brain to the ovaries now these hormones are
00:26:39
called sex hormones mostly by mistake in a way they were discovered in the 1930s
00:26:46
by scientists that were studied reproductive function and they did realize that you needed to to have
00:26:52
certain levels of these hormones for menstruation to happen and for a pregnancy to be established and so they
00:26:59
labeled estrogen progesterone testosterone sex hormones but it took
00:27:05
another 60 years it wasn't until the 1990s the late 1990s the brain
00:27:12
scientists came to the rescue and show that the same sex hormones really serve
00:27:18
a multitude of functionalities they have nothing to do with having children and everything to do with having a healthy
00:27:25
brain an energetically active brain so those hormones that are important for
00:27:31
reproduction are just as important for brain function those are brain hormones
00:27:36
too right so what happens in the brain especially for women's Brains estrogen
00:27:43
is possibly the most important in some ways uh to the point that it's being
00:27:50
referred to as the master regulator of women's Brains why because estrogen is
00:27:56
to your brain as a woman one what fuel is to a car it Powers a lot of different
00:28:04
things that need to happen in the brain so when your estrogen is high your neurons you can see them they they start
00:28:10
sprouting out little branches they're called dandrites and become better interconnected with each other and blood
00:28:17
flow to the brain is higher there's more blood going to your brain which is wonderful because you get all the oxygen
00:28:22
and all the nutrients you have more immuno protection your brain is more protected against insults and things
00:28:29
that can go wrong inside your brain and there's um estrogen is also growth
00:28:36
hormone so it stimulates overall plasticity in the brain which is the brain's way of being resilient and able
00:28:44
to make changes but most importantly estrogen pushes your
00:28:51
neurons to burn glucose to make energy so in a way it's an activator and is
00:28:58
able it's a little bit everywhere it's like this wonderful CEO that knows all
00:29:04
the aspects of the business and can speak to any person who is needed to run the business it's like an Orchestra
00:29:10
conductor they make sure that the symphon is exactly the one that we want
00:29:16
but then what happens in per menopause and then after menopause the estrogen
00:29:22
retires if you will a specific type of estrogen called estradiol which is the most potent form of estrogen is no
00:29:30
longer being produced or just a tiny little bit and so another estrogen takes
00:29:37
over it's called estrone which is wonderful but is not as powerful as estradi is and then the
00:29:46
brain keeps playing the orchestra keeps playing but the tune is not quite the
00:29:53
same got you does it make sense and that happens yeah I'm really trying to understand this the difference between
00:30:00
the menopause phase physiologically and the postmenopause phase because it says it lasts for S to 14 years so I'm asking
00:30:07
myself what's going on for those seven to 14 years in terms of the body some kind of transmission yeah do you want to
00:30:12
see please show me the brain scans I think is the best way look like you mentioned before this is new research
00:30:19
relatively new research it's also the only research still that looks at
00:30:24
changes in women's Brains as a woman goes through the different phases of menopause okay so just for people that
00:30:31
don't aren't watching on video for whatever reason um Lisa has some brain
00:30:37
scans on her iPad in front of me which she going to explain to me yes so this
00:30:42
is what's happening to this brain as the woman that the brain belongs to is going
00:30:50
from having a menstrual cycle to not having a menstrual cycle and this is going to Loop so this is before
00:30:58
menopause when everything is nice and red and bright and as you can see changing the red is turning yellow and
00:31:05
the yellow is turning green and after menopause the entire brain scan is a lot
00:31:10
greener than before menopause there's a lot less red and yellow and a lot more
00:31:16
green what does that mean because it kind of looks like some of the lights are going off yes no exactly that's a
00:31:21
really good interpretation what that means quantitatively that's a 30% drop in brain energy levels which
00:31:29
means that your neurons are able they have access to the sugar to the glucose
00:31:35
but they're not burning it as fast or perhaps as efficiently as they used to
00:31:42
before going to menop no people don't know this no people don't know this and the reason that this is so important
00:31:49
there are two reasons that I believe this is very important number one this validates what women have been saying
00:31:58
for hundreds if not thousands of years that there's something happening in
00:32:03
their heads that they feel like their brain is changing the feeling of I don't
00:32:09
feel like myself anymore or there's something happening I have the brain fog I have mental fatigue in clinical terms
00:32:17
we say cognitive fatigue mental fatigue and this is actually evidence of what women have been saying
00:32:24
all along that menopause changes your brain as surely as it changes your
00:32:30
ovaries and very specifically changes the functionality of your brain and now
00:32:35
we've done plenty of studies I plenty obvious say I want to do many more but
00:32:41
we've done enough studies to say that menopause also impacts the structure of
00:32:47
the brain the volume of the brain the connectivity of the brain blood flow to
00:32:53
the brain so menopause really is a renovation project on on the brain it's
00:32:59
a neurologically active state that is associated with measurable and
00:33:06
quantifiable changes in a woman's brain if I'm a woman and I'm I'm the before
00:33:13
brain yeah um and then I go through menopause and I'm now the after brain that I just saw there which seems like a
00:33:18
lot of the lights have gone down yeah what is the real world change in my
00:33:24
behavior that people would see that I would feel that I would that would present so one thing that's important to
00:33:31
clarify is that not all women show these changes right so this is one woman this
00:33:38
is actually pretty average in terms of changes we find that the vast majority of women uh experience something like
00:33:45
this whether they describe it as such or not some women do not show any brain
00:33:50
changes they very little brain changes and some women show much more severe
00:33:56
brain changes so some some women's brain changes are much worse than that yes yes
00:34:02
much more uh marked in many ways and we also find changes in connectivity and
00:34:08
changes in brain structure and changes in white matter volume and changes in gliosis which is like this teeny tiny
00:34:16
little uh spots bright spots that we find on dmri scans as part of aging but
00:34:23
for women that really seems to happen more so dur manopause so how would I
00:34:29
change if my brain if my brain changes if I'm that woman my my brain has had
00:34:34
those changes how will I feel different and how will the World Experience me different so this is something we're
00:34:41
trying to understand a little bit better these brain scans do not speak to behavior they speak to biology and
00:34:49
there's never a onetoone correlation between biology and behavior than goodness right but what we are um
00:34:57
starting to show right now and actually we have a paper under review that shows
00:35:05
that this changes correlate quite strongly with brain fog which is this
00:35:12
feeling of mental exhaustion where you feel CAU and
00:35:17
brained you feel like your brain just won't turn on in some ways and many
00:35:23
women experience um what we Define clinically a subjective cognitive decline where you
00:35:30
as a woman are aware that your cognitive performance is not as good as it used to
00:35:36
be but if you go for a standard neuros pyic evaluation you're still performing
00:35:42
within normal values and this is good and bad for a number of reasons number
00:35:47
one is that historically women would not be taken seriously right the overall
00:35:53
idea is like okay she's going crazy she's hormonal she's losing her mind it's it's all in your head I hate that
00:36:00
terminology I got that a lot from even in the scientific community that those
00:36:05
symptoms are kind of made up or a sign of psychological distress some kind of
00:36:11
psycho emotional issue because women have been portrayed as widely emotional
00:36:19
and mentally unstable in medicine forever and ever did you know even the
00:36:25
word hysteria which means Madness comes from Greek and literally means
00:36:31
ueros really yes yes because ever since ancient Greek ancient Greece there was
00:36:39
this mindset this this framework in medicine where anything that the woman would report in terms of cognitive
00:36:46
disturbances or mental health issues or just just concerns were immediately ched
00:36:53
away as there's something wrong with your udus and there's this weird connection between the uterus and the
00:36:59
brain that makes women susceptible or vulnerable to Madness or hysteria where
00:37:05
things like right now we're aware they kind of they were kind of right in one sense you know that's that's the bizarre
00:37:13
part that yes there is a connection and yes that connection can impact your mental health yeah but there's no reason
00:37:20
to be put down or be patronized or be dismissed is actually something that's really worth investigating they didn't
00:37:27
have the science we have now but but you're saying me that they even back then they believe there was a connection
00:37:33
between the utherus in the brain yeah the wom in the brain they I think it's so obvious any woman any woman can tell
00:37:40
you I find a lot of the research that we do is really all about just proving women right just saying okay so you you
00:37:48
we've all been saying this forever nobody took us seriously and now there's actual scientific proof that what women
00:37:55
are saying is scientifically viable and valid is not all in your head I mean it
00:38:00
is all in your head in a way but not the way the people think how many what
00:38:06
percentage of women that go through per menopause and postmenopause struggle
00:38:12
with brain fog 62% up to 62% is almost 2third the
00:38:18
majority of them and and when I I have heard the phrase brain frog B brain fog
00:38:24
but I've never understood what it means is it just like a l uh an inability to think as clearly as you once did I think
00:38:31
it's more than that it's a feeling that something is hijack in your brain and
00:38:37
that no matter what you do your brain won't turn on and it's a very specific symptom that is different from other
00:38:45
things that can impact cognitive performance like when you can't sleep at night you're tired and it's harder to
00:38:51
think clearly right but you know that that's going to come back with fog
00:38:57
there's a there's a little bit of desperation in a way because you feel like you have no control over your
00:39:04
outcomes is it about attention as well as memory It's a combination of things
00:39:09
usually brain fog impacts memory concentration Focus attention and language as well something that's very
00:39:16
common is this tip of the tongue phenomenon where you just can't come up
00:39:21
with words and it's hard to just complete a sentence it feels almost like
00:39:27
fasia in a way which is an actual clinical uh syndrome or a form of
00:39:32
dementia even but when when you just can't come out with words and you know that you know the word and you just
00:39:38
can't find it in your head and I I know so many women who really use
00:39:45
communication is their superpower yeah and they need to rely on communication for work and what not and they really
00:39:52
are miserable are there any symptoms that you believe are a consequence of
00:39:59
the changes in the brain that we see in those the symptoms on the symptoms oh
00:40:04
yes yes we just need to you know when you ask me as a scientist what do the brain scans translate to I need to have
00:40:10
a study that shows you I go from this to this but the idea is that menopause all
00:40:17
the different things that happen during menopause lead the brain to rewiring itself and there are so many different
00:40:24
changes inside the brain that imp impact very specific brain regions that are
00:40:30
important for instance for thermal regulation for regulating body
00:40:36
temperature right so there's the structure of the brain which is actually exactly the structure that receives all
00:40:43
the information from the ovaries is the first um Center of communication it's
00:40:48
called the hypothalamus and is in charge of regulating body temperature so when
00:40:54
estrogen levels and progesterone levels are fluctuating why ly that means that the hypothalamus which is dependent on
00:41:01
these hormones for regulating its own functionality will have a hard time
00:41:06
regulating body temperature and then as a woman you get half lashes why does the
00:41:13
brain CU it looked there like the brain was basically shrinking yes so some
00:41:18
parts of the brain lose volume yeah some parts of the brain become less connected
00:41:23
some other parts become more connected and overall energy metabolic energy is reduced and
00:41:32
the ability um so there's this little stru that are many little structures in the brain and in the rest of the body
00:41:38
mitochondria yeah and they're responsible for uh converting cellular energy into ATP which is a usable form
00:41:46
of energy or the energy currency of all cells and what we have found
00:41:51
using um a very interesting brain Imaging technique is called 31 fos as
00:41:57
for as mrss or magnetic resonance spectroscopy we have found that there's
00:42:03
basically an ATP crisis in a woman's brain as most women go through menopause
00:42:11
where ATP is just not produced as much as it used to or perhaps is used too
00:42:16
fast that the brain just can't quite meet energy demands and so all these different parts of the brain that need
00:42:23
estrogen for support for energy support and for fuel but they also need ATP just
00:42:29
to do things find themselves a little bit at a loss right it's like you you're
00:42:36
losing the superpowers of estrogen and all the things that come with it and is that why the brain is looks like the
00:42:43
lights are going down because of the the loss of estrogen most likely is a combination of loss of estrogen and also
00:42:51
uh all this rewiring that takes place and the fact that some neurons are lost as well in other hormones that okay so
00:43:00
let me get this straight okay so I should be viewing menopause as the physiological reconstruction of the
00:43:06
brain yes really based on the loss of estrogen I and I'm going to try and go a
00:43:12
little bit further here with my science so there's receptors in the brain that estrogen interacts with and as estrogen
00:43:19
doesn't show up those those receptors start to shut down and that's why we're
00:43:24
seeing the brain appear to sort of shrink in volume a little bit but also just the the activity of it seems to
00:43:30
drop and it's really the loss of estrogen as the causal factor of that so if in my mle science here this is you
00:43:37
know science for 10y olds over here over this side of the table anyway um I go okay well what we'll do is we'll Tak
00:43:43
some estrogen and ping we'll inject it everything will be fine the brain will stay nice and illuminated we'll avoid
00:43:49
the brain fog The Hot Flashes the depression um the Sleep disruption and
00:43:54
everything we'll just inject some estrogen yeah I would inject it but yes I don't know how do you how do you administer it by mouth or we'll eat it
00:44:02
we we'll rub it we'll do everything we'll rub it we'll inject it we yes we'll put it on top of cereal we'll do whatever we have to do to keep it up
00:44:09
yeah we'll do facial do estrogen facials and we'll keep it up we'll put in the coffee everything right we'll smell it
00:44:14
sniff it and and then everything will be fine yeah that's the end of the podcast
00:44:20
then that's it bye if only it were that simple mhm so
00:44:28
we do have hormones that are available for treatment I think most people are
00:44:34
familiar with the term hormone replacement therapy or HRT and that option has a strangely
00:44:42
tortured history where in the 1940s um estrogen therapy was actually
00:44:49
the number one best selling drug in America and many other parts of the world and most women going through
00:44:57
menopause in the 50s and 60s and 70s and what not were put on hormones and left
00:45:03
on hormones high doses of hormones for life and the idea back then is that these hormones would not only reduce the
00:45:10
heart flashes and make menopause better and more tolerable or just gentler but
00:45:17
would also protect against things like heart disease and dementia and then in the '90s the
00:45:25
government intervened and said well you can't just do hormones to women without doing clinical trials first even though
00:45:33
that was the practice for 30 years right and so they launched the largest
00:45:39
clinical trial in history looking at HRT for relief of heart flashes but also for
00:45:45
prevention of heart disease and dementia and that was in 1993 and the study was running and it
00:45:53
was suddenly stopped in 2002 because what they found is that
00:46:00
hormone therapy was actually doing a lot of damage to some of the women in the
00:46:06
study and what the media reported is that the hormone therapy in particular
00:46:12
was increasing the risk of breast cancer while also increasing the risk of heart disease and
00:46:18
dementia and everyone panicked and so many women just stopped
00:46:25
taking hormones overnight it that also obviously kicked off a lot of lawsuits
00:46:31
and effectively stopped research on hormones for menopause and prevention of
00:46:37
chronic diseases and it took 1520 years for the research to
00:46:45
resume say 10 but really it's taking a lot longer than than anyone would have
00:46:50
thought and now we know better so one thing that everybody says is that that study is called the Women's Health
00:46:56
Initiative um they did the best they could with the knowledge they had and the population
00:47:03
they had but the problem is that they were looking at women who were in their 70s and
00:47:09
80s right so if your brain has changed at that point and The receptors are not
00:47:15
there you can't simply put the hormones back in because the system is not there
00:47:20
to use them and what those investigators have found is that actually that can do
00:47:26
more harm than good with the hormones that they were using back then okay
00:47:31
right so today we have different hormones um we use lower doses the
00:47:38
hormones are taken either by mouth or transdermally like the patch through the skin which is gentler on the liver and
00:47:46
reduces the risk of blood clots and other vascular issues we have different
00:47:51
types of progesterone which is another important hormone we today we tend to
00:47:57
use bioidentical hormones rather than synthetic hormones which were used back
00:48:03
then and that overall seems a lot safer and at the same time hormones should be
00:48:09
used for menopause when women are going through menopause not after not after
00:48:16
and a lot of research including my work has shown that hormones work best for the brain if you take them within a
00:48:22
10-year window of the final menstrual period and Tech Al you want to start
00:48:28
taking them prior to your final menstrual period because what these hormones do is that they stabilize your
00:48:35
hormonal concentration so they're not just supplements but the real power the real
00:48:41
magic if you will of hormone therapy at least the way it was intended is that you take it before menopause to really
00:48:49
stabilize things so your hormones don't start fluctuating back and forth and hopefully you don't even get the
00:48:55
symptoms The Hot Flashes the nice wor the insomnia give me an analogy for that then so those studies that were done in
00:49:02
the 1990s there was what 160,000 women took part in that study yeah the Women's
00:49:07
Health Initiative that's was a disaster for an analogy because they were because they were giving the hormones to women
00:49:14
that were in their 70s 80s yeah it's effectively like trying to put Petrol in
00:49:19
a car when the petrol valve is sealed or
00:49:25
the car is Prett much pretty much yes just pumping it into there when the systems are no longer on doesn't work
00:49:31
and the systems are no longer on because they shut down because there was no estrogen yes they didn't those systems
00:49:38
didn't shut down because the person was just old those systems would have carried on working if they were given estrogen is that accurate that's the
00:49:45
idea yes okay so the whole idea you want to just start you really want to be thinking about taking estrogen when
00:49:50
you're when those systems are still on and working so that it can work and sustain the systems that's right and the the idea is to hormones when you have
00:49:58
the symptoms it's kind of like a car cuz if you don't use a car for a long time it just doesn't you know the engine stops working yeah pretty much if you
00:50:05
left a car for 10 years just on the side and then tried to put Petrol in I'm pretty sure it still wouldn't work um
00:50:11
there would be glitches at a minimum right yeah at a minimum so what what age
00:50:16
then because you know I've got a partner that's what she's 30 31 years old that's young that's young to start I think once
00:50:22
you have once you start having the symptoms of menopause the heart flashes so right now hormone therapy is only
00:50:30
approved for vom Mo symptoms which are heart flashes and ey sweats okay it's
00:50:37
also used off label for support of sleep especially when sleep is disrupted
00:50:45
by having hot flashes at night and it's it's also used for relief of mild
00:50:50
depressive symptoms that are caused by menopause and not other reasons we're
00:50:56
doing research now to test whether hormone therapy may be helpful for brain
00:51:02
fog because believe it or not it's not an indication and hormone therapy is not
00:51:09
currently recommended for support of cognitive function and there are a lot of scientists myself included who find
00:51:17
that a little bit puzzling but we also agree that more research is needed so we are trying to
00:51:24
do the research and show that well we want to understand if taking
00:51:29
hormones can can actually support cognitive function because look when I go through menopause I want to have all
00:51:35
the solutions and options that I can possibly have so I'm doing the research as fast as I can to also help myself in
00:51:42
the lot of other women but right now if you have brain fog as a menopausa woman the overall recommendation is kind of
00:51:49
suck it up what would you do you said when you go through menopause what would you do so the the pillars of uh life
00:51:56
style adjustments for menopause are diet exercise sleep hygiene stress reduction
00:52:04
avoiding toxins which is where I go a little bit overboard sometimes regular
00:52:10
medical checkups to make sure that um you are in good health overall and
00:52:16
there's nothing in your medical history that might make your menopause worse and
00:52:22
then I am also looking into phac pharmaceutical options which I do not take at this time but I am I'm deciding
00:52:30
whether or not that's an option for me when the time comes do you know a prepper is it's a term for someone who's
00:52:36
preparing for the end of the world oh goodness and they have like a bunker they have a food supply they're like buying guns that I wouldn't do but they
00:52:44
do other things like um there's no plastic in my kitchen plastic okay so let's have a look at some of these
00:52:50
things then preparations and why you're choosing to do them before we do that I just wanted to to for people that don't
00:52:56
know the full range of symptoms and when those symptoms the phase in of menopause in which those symptoms typically show
00:53:03
up okay are there different symptoms for different phases no they're not they're just a
00:53:10
variety of symp so since you seem to be interested in the stages let's go a little bit deeper okay all right let's
00:53:16
say so your girlfriend is in her 30s yeah right so most women in in in their 30s have a regular menstrual cycle as
00:53:24
soon as you hit 40 ish ballpark you still have a regular
00:53:31
menstrual cycle but you may start seeing changes some months it could be a little
00:53:36
bit shorter some months it could be a little bit longer some months it could be a little bit lighter some other
00:53:42
months it could be a little bit heavier I strongly recommend keeping track because that's very helpful to
00:53:51
realize when you are past the premenopausal stage and when you're
00:53:57
about to enter the per menopausa stage which is more complex than just one two
00:54:02
three stages so once you have a regular menstrual cycle is the Prem menopausa stage and there's actually two separate
00:54:10
phases there's the early phase where your menst cycle is the way it's always
00:54:16
been for women with a very regular menstrual cycle then it starts changing
00:54:21
a little bit maybe just a couple of days maybe a little bit little bit earlier little bit later lighter heavier but
00:54:28
still very regular that's the late premenopausal stage at that point you
00:54:34
may start skipping periods but maybe you just skip it one month and then it's back and then at some point you skip it
00:54:40
for two months and then it's back and is regular that's the early per menopausal
00:54:45
stage at that point the most common complaint is difficulty sleeping it's poor sleep okay when women start having
00:54:53
a hard time not just falling asleep but staying asleep and that's usually
00:55:00
because progesterone is going down it's unusual to have hot flashes at that
00:55:06
point but brain fog may happen especially around your menstrual cycle
00:55:11
when you wake up in the morning you have no energy and just the idea of checking
00:55:16
your email feels like an ordeal it can really happen usually it may last just a
00:55:21
couple of hours perhaps it lasts a day but it's something to pay attention to because because that could be a preview
00:55:28
to the menopausal transition so then you start skipping
00:55:33
periods and then you start skipping more periods and at some point your periods would be more than three months apart so
00:55:40
you have one today nothing for three months you're not pregnant it will come back but you know what I mean so the the
00:55:46
frequency is going to diminish it's get you're going to get fewer and fewer and periods spaced apart more and more
00:55:53
that's the late Pam menopausa stage where the symptoms really creep in so
00:55:59
that's when most women have the half flashes the nice sweats actual insomnia
00:56:05
sometimes mood changes sometimes there's irritability sometimes there can be tearfulness sometimes you cry for no
00:56:12
reason sometimes you just feel really down in the dumps and you don't know why there could be the brain fog there could
00:56:18
be forgetfulness it's important to know that that as disruptive as that might be
00:56:24
it's actually not common I can't say normal because it does not feel normal
00:56:30
for sure but it's expected included in many women I saw in your book you said
00:56:36
things like vaginal dryness yes that's not the brain symptom is a bodily
00:56:41
symptom that can happen earlier weight gain yeah that can happen slow
00:56:46
metabolism and digestive issues overactive bladder yeah that's a little bit later usually more like after
00:56:54
menopause muscle tension and aches yeah look there's a whole range of symptoms
00:57:01
yeah well you can have tinitus tinius which is that bringing in the air yes or electric shock
00:57:07
Sensations panic attack please do keep going with your that was very helpful you're going through the phases and
00:57:12
overlapping them with the symptoms yes so the late per menopausa stage which is
00:57:19
defined as not having your perod for 3 months or more at a time is when the
00:57:25
symptoms really kick hard then at some point you just stop having your period for good sorry what
00:57:32
age does the symptoms start kicking hard typically on average 47 47 you 45 47
00:57:38
okay it's harder on black women and Hispanic women why we don't know but
00:57:46
there are some differences related to race and ethnicity and usually um yeah Black and
00:57:54
Hispanic women may experience more severe symptoms of
00:58:00
menopause which is something that we should really talk about because there's hardly any research done on this and
00:58:07
it's it's completely unfair you know I was reading a stat that really shocked me about suicidality yes yes it tends to
00:58:15
increase for women in in midlife and it tends to be at least a corate of going
00:58:21
through menopause also the rate of divorce is significantly higher
00:58:26
as women transition to manop see that's why it's important for
00:58:31
men to know these things too I read that the time in a woman's life where she's
00:58:38
most likely to die by Suicide is when she's in that sort of 55 years old
00:58:45
region yeah it's right after so let me get through the the so there's the late
00:58:51
per per menopausal stage then you hit menopause which is a DI agnosis right
00:58:57
and then you start the early postmenopausal phase that's as hard as
00:59:03
the late per menopausal stage so the the four years around the final menstral
00:59:10
period in either direction both directions are the hardest right so the few years the the
00:59:16
last three to four years before the final manral period and the 3 four years
00:59:22
right after the final menstral period those are the worst by all accounts this is when most women really have a hard
00:59:28
time uh the women who do have the symptoms as I mentioned there's a whole range of symptoms not just the type of
00:59:36
symptoms the number of symptoms but also the severity of symptoms that is not recognized or formalized in medicine
00:59:43
which I think is is unacceptable and is is really not okay if you think think
00:59:50
about pregnancy right so this is what I wanted to tell you before and I'm going to say now because I think it's
00:59:55
important the modern definition of menopause is that menopause is a neuroendocrine
01:00:02
transition specific to women that ends with reproductive inessence the end of
01:00:08
fertility but also impacts a number of different systems in the body including
01:00:14
the brain and the reason that this is important to realize is that it's a very
01:00:20
specific and unique medical category that cannot be equal to getting older
01:00:27
and cannot be compared to having a disease it's it's a very unique thing
01:00:32
that happens in medicine that only has three entries in this category of
01:00:38
neuroendocrine transition brain hormone transition there's puberty there's pregnancy and there's per menopause
01:00:46
right now what happens with puberty and pregnancy let's talk about just pregnancy what happens with pregnancy is
01:00:51
that we all know that many pregnant women experience changes in mood for example changes in
01:00:59
attention changes in focus and concentration brain fog also 30% of pregnant women have half flashes it's
01:01:07
just something we never talk about so the symptoms are not that different from
01:01:12
menopause we've seen them before only when you're pregnant everything is
01:01:17
gorgeous Everything Is Beautiful there's baby showers there's parties people take
01:01:23
pictures and if you're having a hard time everybody's very compassionate and supportive and tries to make you feel
01:01:30
better so you're saying we need to have a manopause party yes little but also I want vocabulary because we know that for
01:01:39
example with pregnancy post parm it is understood that this transformation is
01:01:46
not just that you're having a baby your body is changing and so is your brain some women have no depressive symptoms
01:01:52
some women have baby blues some women have post depression and some women have postpartum
01:01:59
psychosis right yeah it can happen it's rare but it can happen and it's a range
01:02:04
and now that we understand that number one it's important and it's common and
01:02:09
there's a range we have a framework to address it so once you have a baby and
01:02:15
you go to the pediatrician for the baby you mother get a screening for depression and the pediatrician you
01:02:21
don't have to go to a psychiatrist they do it right there and then you are effectively screened and
01:02:26
monitor it to make sure that you're fine if you have postpartum depression we now have therapies the very specifically
01:02:34
work for that type of depression that is different from other types of depression
01:02:39
you know what I mean there's no such thing for menopause there's no system in place where you can even describe your
01:02:46
symptoms to a provider because the language is in there you're going to have to say I have brain fog and nobody
01:02:51
knows what brain fog is because it's not a clinically meaningful category how much education do doctors get on medical
01:02:59
very little so it's one in five OBGYN residents what's an OBGYN for anybody
01:03:05
that's in Europe athetics and Gynecology okay person is the person that you go to
01:03:11
for menstrual cycles and pregnancy and then menopause okay and anything related
01:03:17
to fertility or the function of your reproductive organs they don't know about menopause one in five does but in
01:03:23
reality when you look at the curric ulum is more like six maybe eight hours in
01:03:28
total of training throughout the entire Residency program so it's it's not much it's really not much so I would say that
01:03:35
the vast majority of Specialists are not OBGYN Specialists are not actually
01:03:42
manopause Specialists and even those who are don't
01:03:47
receive a lot of training so in school at least so it's really important to go
01:03:52
see a specialist who number one is a certified menopause specialist you can find it on the internet and number two
01:04:00
somebody who has personal experience because at this point you really have to to gain your own experience and the
01:04:07
thing that is very upsetting to many professionals is then even the best
01:04:14
OBGYN specialist is not a brain specialist right so menopause has been
01:04:20
pigeon hold as an issue with the ovaries go see an obig Wayan specialist
01:04:26
where the symptoms that most women actually suffer from are neurological in nature and the specialist you go to is
01:04:34
not trained to manage or diagnose anything brain related they're not
01:04:39
supposed to right it's a complete different organ instead of skills so we're trying to change this framework so
01:04:47
the brain Specialists can be involved in the medical evaluations and
01:04:53
treatment of menopausa women have we finished off with the stages there so we were yes we finished off no
01:05:00
just one more just one more stage so there's the early post menopausa stage that is still a little bit like a
01:05:05
tornado it can be a tornado with a lot of symptoms but then six years after the
01:05:11
final menstrual period That's the late post menopausa stage which is the stage that a woman
01:05:19
would live into for the rest of her life that stage varies and that I find
01:05:26
is really interesting for many women the symptoms like hot flashes the night
01:05:31
sweats the mood changes the brain fog tend to go away over time I've got a
01:05:38
graph that I'll put on the screen that shows how brain flog changes over time and as you can see it's kind of like a
01:05:44
u-shape so it's there's no brain fog and then it goes you have severe brain fog
01:05:49
and then the brain fog seems to recover not to the same height as it was um before menopause but postmenopause which
01:05:57
is I'm getting when it guessing where it recovers there this is yeah this is post menopause so this cognitive function
01:06:03
right it's nice and high before it menopause then it takes a dip yeah during the transition then it goes
01:06:09
typically back up for a few women it would be up here so it goes back to premenopausal level levels cognitive
01:06:16
function for most women is a little bit lower than it used to be but still pretty good this is good news yes that
01:06:23
is good news absolutely and but for other women is not it keeps going down it keeps declining and that's why a lot
01:06:30
of women come to us at the Alzheimer's prevention Clinic because they're really scared that that may be a sign of early
01:06:37
dementia is there any reason why some women's brain fog doesn't return back to
01:06:43
normal levels postmenopause we are looking at that right now is this also why you're prepping Yes actually it's
01:06:50
the study that we have under review that I believe is the first to look at brain
01:06:58
Cates of menopausa brain fog so as far as I know this is the first study that
01:07:03
shows that that there are very specific changes in the brain that strongly
01:07:09
associate with having or not having brain fog that is the first step to then
01:07:16
clarifying why certain women have it and certain women don't have it and how how can I make it better right is it
01:07:23
hormones is some other kind of therapy how how can I reverse it how can I prevent it so this brings us back to
01:07:29
this conversation around prepping you you're you're in this phase of life where you're prepping um why does
01:07:34
exercise matter for menopause so exercise matters for everything from hormonal Health to brain health to heart
01:07:41
health because everything is interconnected right we are effectively a system where every part of you needs
01:07:49
to be healthy for you to feel healthy as a person um for both menopause and brain
01:07:54
health we know that physical activity stimulates the production of certain proteins that can travel all the way
01:08:01
inside your brain and they're also made inside the brain that support neuronal Health from growth hormones to very
01:08:08
specific peptides they have um a boosting
01:08:14
functionality and for menopause in particular all exercise is good but
01:08:21
cardiovascular activity seems to be a especially helpful for the Hat flashes in the brain
01:08:29
fog where strength training seems to be more helpful to preserve metabolic
01:08:36
activity and bone mass but also mood it supports mood and um flexibility exercises and
01:08:46
Mind Body techniques like yoga Pilates taichi those are helpful not just for
01:08:52
flexibility but also for stress reduction and sleep so it's good if possible to do a little
01:08:58
bit of everything and if if time is a constraint then it's helpful to know the
01:09:04
different types of exercise may be especially helpful for one thing or another there's a study in your book I
01:09:11
think in Chapter 13 where you where you case study uh I don't think it was a study you did around the Latin women
01:09:16
3,500 Latin women me but wonderful study wasn't it and and it showed that those
01:09:21
who engage in regular to moderate intensity exercise were almost 30% less likely to have severe hot flashes than
01:09:29
those who exercised less yeah which is a really compelling argument for exercise
01:09:34
in that phase of life and there's some other sort of um related information that I read that said that women in
01:09:41
their 40s are the highest demographic group to exercise inconsistently or not at all yeah yeah
01:09:48
so we know exercise is great for that phase of life and we to know that women have no time is that what it is is it a
01:09:55
timing issues typically for most women is a combination of factors I think midlife is a bit of a is a turbulent
01:10:03
time when you're sandwiched in between a lot of different responsibilities if you
01:10:08
have maybe young children and older parents and you're trying to to maybe
01:10:13
get a career advancement and you also want to take care of your health and then boom you get hormonal changes and
01:10:18
menopause so it is a bit of a it's it's a different age to navigate in some way
01:10:25
is and what a lot of women report is that one they have no time to take care
01:10:30
of themselves and number two sometimes that the reasons are outside of your control like this fatigue that so many
01:10:38
women report the lack of sleep or uh that that is a bit of an issue when it
01:10:43
comes to feeling energized enough to also go to the gym so there are some
01:10:49
barriers and um I think it's good to to be creative if you can right and also
01:10:55
realized then you don't have to wear fancy clothing you don't have to go to the gym it's good enough to go for a
01:11:01
walk in the park just keep your body moving is there a certain type of exercise that is um too much can you can
01:11:09
you do too much exercise CU I don't want people that are listening to this now that are in that phase of life to just
01:11:14
suddenly start running marathons every single day or something thinking that they'll be able to save off menopause I think that's that's actually what most
01:11:20
people hear when you say exercise is really good for you and they see themselves like oh my God I have to join
01:11:26
the gymm and just work out three hours a day that's not what the research shows because your cortisol levels would go up
01:11:32
as well yes it may happen and also your recovery time may increase okay
01:11:38
especially after menopause but what Studies have shown is that in this case there's an inverted u-shape relationship
01:11:45
between intensity of exercise and health gains and I'm not talking about Fitness or muscle mass I'm
01:11:52
thinking about overall health how health you how healthy you actually are as a whole and with the research in women
01:12:00
especially women who are recently postmenopausal of 50s 60s what the
01:12:06
research shows that if you don't exercise at all obviously there's no gains but as soon as you start even just
01:12:12
in mild intensity the gains start increasing and the peak of the curve is
01:12:17
for a moderate intensity regimen at high frequency which is which is you work out
01:12:24
in a way way that bring some pink to your cheeks and you may have a hard time
01:12:30
singing but you won't have a hard time talking okay so your heart rate goes up
01:12:35
but not so high up that you can't breathe physically actually and there's different intensity intervals of course
01:12:43
uh Rich Roll called the he said to me this is what professional athletes called zone two okay so Zone to everyone
01:12:51
okay but if you increase the intensity a lot more more the gains actually start
01:12:56
diminishing after menopause which is not Universal there's plenty of women who
01:13:02
can do beautiful things physically but on average what that suggests is that
01:13:09
just do the best that you can try to shoot for this zone two or moderate intensity exercise just do it often
01:13:15
enough that the gains are consistent and as it relates to alzheimer's you talked
01:13:21
about those Alzheimer's plaques in the brain yeah if I exercise more do women in that exercise more have less of those
01:13:26
Alzheimer's plaques yes yes you do have few Alzheimer's plaques and also what the research shows is that women who are
01:13:33
physically fit in midlife have 30% lower
01:13:39
risk of Dementia in old age as compared to women who are sedentary in
01:13:44
midlife so that's also really important to have because if I had a pill that can
01:13:49
reduce your risk of dementia Alzheimer's Disease by 30% I would be rich and
01:13:55
everyone would buy it you should become a personal trainer yes pretty much but the prescription is try to exercise at
01:14:03
least the moderate intensity um level but do it consistently enough which means three to
01:14:10
five times a week so let's talk about your um diet then your diet regime as
01:14:15
you prepare for that phase of life let's start with caffeine oh yes I
01:14:23
switch to decaf You Don't See to everybody's anguish in my house yes
01:14:28
are you already switched to De CF why because caffeine is a little bit of a
01:14:35
trigger for Sleep disturbances for a lot of women and what people don't realize
01:14:40
is the caffeine is not just like the cup of coffee that you drink at the moment although you do feel a little bit of the
01:14:46
energy rush but what happens is that caffeine um stays in your system and in
01:14:52
your brain for a really long time so the half life is six hours which means that
01:14:58
six hours after drinking that cup of coffee half of the caffeine will still be in your
01:15:04
system and the fall life is 12 hours so it effectively takes 12 hours to get rid
01:15:11
of all the caffeine from your body and your brain which also means if you drink
01:15:16
a cup of coffee at noon some of that caffeine is still going to be in your system at 10 p.m. right and if you drink
01:15:23
a cup of coffee at 2 p.m. half of the caffeine will be in your system by 800 p.m. and the quarter of
01:15:30
the caffeine will still be circulating everywhere in your body and brain at 10
01:15:36
p.m. so you can't just have a cup of coffee at 2 p.m. and then hope for a good night sleep unless you go to sleep
01:15:42
late which I can't afford because I'm up at six so could could one also argue then that coffee is going to increase
01:15:50
because if coffee is still in our brain you know if I have a coffee at 9:00 p.m. you know people used to have coffees
01:15:56
after dinner isn't that mad yeah they still do that in restaurants they they you eat your food and then they come around and ask if you want an espresso
01:16:02
absolute Psychopaths I have no idea it's so crazy they don't ask as much anymore but to digest this is again is the idea
01:16:10
of optimizing for one thing without realizing that you're de optimizing for another so you improve digestion in some
01:16:17
ways but you're disrupting your sleep cuz it's waking your body back up and going go on yeah just before you need to
01:16:22
sleep right so if I have a coffee say 600 p.m. 7:00 p.m. 8:00 p.m. at night M and midnight you still have to half at
01:16:29
the caffeine which means I'm not going to sleep as well which means my brain isn't going to um do its job of clearing
01:16:36
things out and restoration that's exactly why which is going to increase my chance of Dimension Alzheimer yes yes
01:16:43
because what happens is then um the brain needs to go through certain stages of sleep and there's one stage of sleep
01:16:49
that is called a slow wave or deep sleep which is really the only chance that the
01:16:55
brain has to clean itself up it's like your brain's me time where the rest of
01:17:01
the body is completely still which is really important because even when we're sleeping during the other stages of
01:17:07
sleep the body can still move and that means that the brain needs to be partially active to control that
01:17:14
movement and initiate that movement so deep sleep is really the only chance that your brain has to take care of
01:17:20
itself from the inside out and there's a system inside the brain that's called the glymphatic system that gets
01:17:27
activated only during slow wave sleep and it's like a car wash in know way
01:17:33
it's like a dishwasher there's like Jets of fluid that goes everywhere inside the brain and clean it up and remove all the
01:17:41
waste material so all the toxins the byproducts the waste products the Alzheimer's
01:17:46
fragments they get cleared during that stage of sleep so if you miss out on
01:17:51
that window which is most people tend to do because a lot of eyes unfortunately tend to wake up at like 2: 3 in the
01:17:57
morning when we should be in deep sleep but we're not because we wake up and
01:18:02
then you miss out on that cycle because the brain starts again from cycle one from stage one so sleep is super
01:18:09
critical here it is really important there must be a pretty strong link between people who don't sleep much and
01:18:14
Alzheimer's as well then there is a link yes it's been explored and it seems to be consistently significant across
01:18:20
studies and is there a relationship with alcohol and menopause yes alcohol unfortunately is a trigger
01:18:28
for some of the symptoms a menopause it can make it can really make them worse my biggest concern is that alcohol is a
01:18:36
dehydrating substance it's def functional is one of the main functionality of alcohol as a
01:18:42
molecule is dehydrating and dehydration is a problem for brain health so the
01:18:48
brain is 80% water which is more than everywhere else in the brain and water
01:18:55
is crucial for every single chemical and cellular reaction to take place inside
01:19:00
the brain so the brain is the one organ that is especially sensitive to the effects
01:19:07
of dehydration where even a two to 4% water reduction of water volume loss can
01:19:16
prompt neurological symptoms the headaches and migraines and dizziness and brain fog so actually
01:19:24
alcohol by dehydrating your brain and those sticks around in your brain for a long time can make some of the symptoms
01:19:31
of menopause worse but also at any age it can really have a bad impact on
01:19:36
cognitive function there's some studies that I find very interesting where people studied the effect of hydration
01:19:44
on cognitive performance and they showed that if you have two groups of people who need to do certain mental tasks like
01:19:51
neury testing and reaction times Compu I tests that measure your pressy speed and
01:19:58
if you give one group a glass of water or a couple of glasses of water before taking the test they actually perform
01:20:05
15% better than the group of people who didn't drink any water prior D I need to
01:20:10
start drinking water on this podcast yes and look yes you should and I will also say that water isn't just water right A
01:20:18
lot of people drink purified water that's not water that's just fluid so
01:20:23
your brain doesn't just want some wet it wants water with electrolytes and
01:20:29
minerals and salts because it's the combination of these factors that really supports hydration so tap water is fine
01:20:36
as long as it's clean right and one thing that we did at home is that we install this ginormous filter for the
01:20:43
entire house where the water is now filtered in a way that removes removes
01:20:48
all the impurities but preserves all the electrolytes what else have you done
01:20:53
sort of scientist slab of a house that you're building this you mentioned toxins I'm a little bit strict sounds
01:20:59
like and yes so there's no plastic in my kitchen not at all everything is just glass why because plastic is really an
01:21:08
issue it's a very very common contaminant and pollutant and what
01:21:13
happens is that when you heat it the particles can penetrate into your food
01:21:19
and drinks and beverages but also in the M also when you put plastic in the dishwasher right the hot water will make
01:21:26
it leak and then it leaks into your plates and glasses and what not and then you drink it right back or you eat it
01:21:32
right back when you put plate food on a plate so pollutants in general
01:21:39
accumulates in an organism concentrate in an organism by
01:21:44
bioaccumulation which means that you start a lower doses by they stick around for a really long time so they keep
01:21:50
piling up over time and that's especially an issue for women and for
01:21:56
children but for women in particular because we have more body fat than men
01:22:02
for instance and pollutants tend to accumulate in body fat especially breast
01:22:07
tissue so they've been linked to an increased risk of reproductive issues
01:22:13
like reproductive infertility endometriosis thyroid disease and more recently to dementia as well not plastic
01:22:19
in particular but pollutants in general breast cancer breast cancer yeah reproductive cancers as well and you
01:22:26
could never say it's 100% this or that but the fact that there is a strong Association is reason enough for me to
01:22:33
stay away from plastic and what else what do you put in your mouth in terms of
01:22:38
food uh so there's plenty of research showing that the brain really wants and
01:22:46
needs very specific nutrients to function at its best because the reality
01:22:51
is that when I was studying my favorite class has always been neurochemistry and I was learning about
01:22:58
this all these different molecules and all these different chemical reactions that are so important for brain function
01:23:04
and neuronal health and whatnot and then I realized well we're really looking at potassium and sodium and magnesium and
01:23:12
omega-3 fatty acids and protein and glucose and those are nutrients so the
01:23:17
nutrients that we obtain from the foods that we eat literally become part of the
01:23:23
fabric of our brains so every day we have a number of opportunities breakfast
01:23:31
lunch and dinner to either make a smart choice that supports her brain health or
01:23:37
the opposite and feed her brain garbage that is going to be unfortunately Incorporated in the fabric of your brain
01:23:43
and I don't want that brain I don't want that for my brain
01:23:49
exactly so it's really important to focus on clean Foods the nutrient dense
01:23:56
and they prioritize the nutrients that your brain wants the brain is not a sponge I keep saying that because I
01:24:02
think there's some confusion in the world where people think that whatever
01:24:07
you eat can have a direct impact on brain health for instance I learned that
01:24:15
individuals who really are interested in brain health would say things like the brain is mostly fat has a lot of
01:24:22
cholesterol which is true therefore you need to eat a lot of cholesterol to
01:24:28
support the fat inside your brain which is absolutely not correct the cholesterol from the diet
01:24:34
can never get inside your brain there's no way for that substance to actually get inside your head I mean your head
01:24:41
yes but not inside your brain so eating cholesterol rich foods will not help your brain at all eating antioxidant
01:24:49
rich foods will so the nutrients that your brain really relies on are anti an
01:24:54
oxidants like vitamin C vitamin E selenium betacarotene um things that you find in
01:25:01
fruits and veggies basically and some nuts and seeds preferentially uh lean protein so amino
01:25:08
acids the essential amino acids and polysaturated fatty acids which can be
01:25:14
from plant-based sources or animal sources but they really have to be the
01:25:20
poly ins saturated fatty acids that the brain really wants and needs and need to be replenished consistently so you're
01:25:27
saying if I'm on if I'm struggling with menopause then I should be aiming at the Mediterranean diet pretty much yes thank
01:25:32
you that's the bottom line so a Mediterranean style pattern seems to be correlated or at least associated with
01:25:39
better outcomes overall for Women's Health what about supplements supplements are typically
01:25:47
used to supplement a healthy diet not to replace it and I think that's important
01:25:53
because the Le here there's a tendency to recommend really high doses as supplements to everyone across the board
01:26:00
but we do know that supplements only work if you have a deficiency or at
01:26:05
least a subclinical deficiencies whereas giving high dose is something that your
01:26:11
body or let's let's say the brain at least I just stay in my Lane but high dose is something that your brain
01:26:17
doesn't want or need they're not going to be very helpful you're just going to either pee them out or do they're just
01:26:23
going to accumulate in other parts of the body so they're not as helpful because everyone that talks to me about the brain talks to me about omega-3 as a
01:26:30
supplement that I should take for every time I take omega3 I think I'm doing my little brain a favor you may or may not
01:26:36
so the research shows that the brain seems to need a certain amount of
01:26:41
omega-3 fatty acids that are between three and six grams per day now if
01:26:47
you're able to obtain that from a diet then maybe supplements are not necessary
01:26:54
but if you're not then supplements may be helpful Omega-3s yes those are the poliner fatty acids that the brain
01:27:01
really needs antioxidants as well I I take vitamin C oh okay so you are on the
01:27:06
supplements you were just trying to keep them all to yourself no I'm joking wasn't well I you know what I really
01:27:12
like is more extracts okay and Botanicals okay I'm not a take my peill
01:27:19
kind of person I I actually get quite annoyed when I need to take pills I just don't like it mhm I think because I work
01:27:24
in a hospital right so I associate that as being sick so I don't like that feeling but what I really enjoy is to
01:27:32
get my nutrients from either extracts or concentrates from plants and veggies and
01:27:38
fruit so in the morning the first thing I do is that I drink water immediately
01:27:43
but also then I have non juice which is a sometimes you give me the eyebrow
01:27:49
you're just yeah yeah yeah no no juice no n o n i a wonderful juice from the
01:27:55
Pacific Islands that has a little bit of a bitter taste which is always good
01:28:01
because beers are really good for digestion and gut health and that's important for brain health and and
01:28:07
elimination as well and clearance and is very rich in vitamins and minerals and a
01:28:14
lot of phytonutrients so that's a good concentrated source and this mixed with blueberry juice so that's that's also
01:28:20
really good to have one of the things I found quite um fascinating is I read that there was a study done on legumes
01:28:27
that proved yeah yeah it was in your book it was in chapter 14 where it says there's a legumes apparently to be seem
01:28:34
to be a bit of a miracle food for delaying menopause yeah so a diet that
01:28:39
is rich in legumes and also fish fatty fish yeah has been linked with the later
01:28:47
onset a menopause by how much 3 years whereas women who
01:28:54
follow the standard American diet like the said diet with more lots of sugary
01:29:01
Beverages and processed foods and package meats and whatnot that's been linked with an earlier onset of
01:29:09
menopause by about three four years and the last thing you want is to go through menopause earlier in life if you don't
01:29:16
have to right I was reading as well in your book that um women who do con
01:29:21
consume enough omega-3 may experience different types of menstrual pains and
01:29:28
fertility issues and stuff is that true yeah well the research shows an association between consumption of
01:29:35
omega-3 fatty acids and um well also lower risk of
01:29:41
depression in recurrent depressive symptoms in menopause as well as better
01:29:47
fertility overall and the same for antioxidants antioxidants have also been
01:29:53
linked with the gentler menopause overall and fewer
01:29:59
menstrual crms and less pain uh and the lower risk of
01:30:04
premenstrual syndrome as well I all of this begs the question because it seems that the human body is designed if you
01:30:11
believe the theory of evolution which I do to be very smart and to do things for
01:30:17
clear and obvious survival benefit and reason but when I think about menopause
01:30:23
it you know it's hard hard to see on the surface what the evolutionary reason for such a process is why does it happen why
01:30:29
don't women just you know why don't women's estrogen levels just stay the same throughout their life until they die and you know because it seems to be
01:30:35
the case that it's not the same for men so is there an evolutionary basis for everything we've talked about today the theory of evolution was
01:30:42
developed by Charles Darwin who did not love women oh really yes let's move on
01:30:49
then and the theory makes sense if you're a man but not if you're a woman
01:30:55
because the theory of evolution says that pretty much the only reason to be alive is to pass your genes On to the
01:31:02
Next Generation so the fact that women will stop being reproductive in
01:31:09
midlife and be able to live after that is clearly against the classic theories
01:31:16
of evolution but I I was thinking about this and I was thinking well is it is it
01:31:21
not just because in the what 1700s 1800s the average life expectancy was like 35
01:31:28
40 yes but there was a notion already back then that women who were able to
01:31:34
live past that age at some point in their lives would stop being reproductive and hopefully remain alive
01:31:41
so for this is what I will tell you that if
01:31:47
you're born with ovaries that menopause seems to be just a fact of life there is an understanding
01:31:53
that at some point your ovaries will stop ovulating and you'll go through menopause but in reality menopause is a
01:32:01
biological puzzle is a big question mark because most animal species in most
01:32:09
animal species females actually die right after menopause so your life pin
01:32:17
as a female animal tends to match your reproductive pin which is what Darwin
01:32:23
was talking about now this Theory only makes sense
01:32:29
if you are not able to outli menopause and there are two different
01:32:36
theories when it comes to menopause there are people who like Darwin say well women should just die or women
01:32:43
areos were supposed to die after menopause like all other animals on the
01:32:48
planet except just a few like killer whales for example killer whales are able to leave live long past menopause
01:32:56
or do some elephants and some giraffes and some insects interestingly enough
01:33:01
but then there's another theory that says no no no it's not just medical
01:33:06
improvements are supportive women and enabling women to live past menopause
01:33:13
the reality is that menopause makes sense for a number of reasons and this is called the grandmother hypothesis and
01:33:19
what this hypothesis says in a nutshell is that evolution is much more
01:33:25
complicated than what Darwin was thinking perhaps and what makes more sense if you
01:33:31
are a woman and you have to bear this children you have to grow a child and
01:33:38
there's a strong risk of dying from child birth the older you are and
01:33:43
there's also a risk to The Offspring to the children the older the mother is
01:33:48
then it makes a lot more sense to stop being reproductive as simple point in
01:33:54
your life and remain alive to help your daughters and your sons and your
01:33:59
grandchildren by providing all the resources that they need for them to
01:34:05
outlive you know to keep on going and keep having children so the theory is
01:34:10
that there at some point in the course of evolution where our ancestors were still
01:34:15
cavemen that the strongest women who were able to live past multiple pregnanc
01:34:23
is the most fit of women at that point somehow underwent these mutations
01:34:30
that enabled or perhaps that were able to activate it to activate their longevity genes where their bodies
01:34:37
evolved to be able to outlive menopause by many many years if put in the right
01:34:43
environment of course and that means that yes you're not passing on your own
01:34:48
personal genes to the Next Generation but you are effectively stepping into
01:34:54
the role of grandmother and caregiver and that helps
01:34:59
your own children have more children and then you're going to make sure that your grandchildren don't die because you're
01:35:05
going to be there to provide for them this is very important when your babies
01:35:12
can't really take care of themselves for a really long time like human babies can't they're basically helpless for
01:35:18
many many years the parents had to keep providing for them the grandparents had to keep providing so that makes sense
01:35:24
for humans that women will stop being reproductive but will keep being
01:35:31
productive and stay alive and anyone who's ever had a grandmother would know
01:35:36
that that's very very important to have so this idea that menopause is actually an issue because we're living longer yes
01:35:45
I really don't that that well some people think it's true some people think it's not from what I can see clinically
01:35:54
our bodies have this unique capability to really remodel themselves and change
01:36:01
themselves to adapt to menopause our brains rewire our bodies
01:36:07
rewire and the idea that there is such a mechanism in place suggests
01:36:12
adaptation I'm going to let you in on a little secret what is in the DI of a COO
01:36:18
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01:36:23
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01:37:14
I think I read in your work that a woman is never happier than in that postmenopausal phase than in any period
01:37:21
in her life an average Maybe because she's dumped him or she's had the divorce maybe that's why that's true
01:37:28
though isn't it that a lot of women do do go through divorce in that phase of Life they it seems like the number of divorces increase exponentially that
01:37:35
point in life know what they want a little bit more yes I think that you know that comes up a lot also in our
01:37:42
research but mostly in psychological research there's something that seems to happen in part it might be Aging in part
01:37:49
you're older you know better but there's also something that happens neurologically
01:37:54
where this not my work but other people have shown that there's one part to the brain called the amydala that's in
01:38:01
charge of emotional control it's like the center the emotional Center in the brain and after menopause it gets quite
01:38:10
selectively turned off in a very special way where emotions like sadness or anger
01:38:18
don't hold quite the same charge so your amigdala doesn't quite fire as strongly
01:38:24
when something negative happens to you but it keeps firing just as strongly
01:38:29
when something good happens to you so the ability to sustain joy and
01:38:35
potentially contentment and just wonder is if not Amplified is certainly stable
01:38:42
and that's been linked with better emotional control after menopause and
01:38:48
those emotional Transcendence that in the words of many of my friends is
01:38:53
really more like giving fewer F words I've actually got a graph graph that I
01:38:59
found in your work that shows that by the time women are in their 60s they're sta statistically they've never been
01:39:04
happier yes well so it depends on the studies right and that's always an average so these Studies have measured
01:39:10
life contentment as a function of menopause look we have the graph here if you want Oh at the graph yeah yeah yeah
01:39:16
perfect so this is what these Studies have shown and of course it's not Universal it's never Universal there are
01:39:22
women who are miserable before and after menopause and women are happy all the time but there seems to be again a
01:39:28
little bit of this U curve and then suddenly where life contentment is
01:39:34
whatever it is is Baseline over here and then it takes a dip during the transition to menopause when a lot of
01:39:40
women just have a hard time you know I think it's it's import important to acknowledge that but then life
01:39:46
contentment goes back up see that's the window before like the three to six
01:39:51
years after menopause when things are still not quite perfect you're still adjusting but then it looks like it's
01:39:58
going back up and this is the late postmenopausal phase where usually the symptoms go away and you feel more like
01:40:05
yourself again or you feel better overall and life contentment tends to
01:40:10
increase you have some other graphs on there you have another one uh that shows the impact of you call surgical
01:40:17
menopause yeah do you want to see that yes please yeah what many people let's just be honest nobody talks
01:40:24
about surgical menopause right um what happens sometimes very often actually is
01:40:30
that women need to have their uterus removed with or without the
01:40:36
ovaries often enough before menopause these are very common surgical
01:40:41
procedures in fact a hysterctomy the surgical removal of the uterus is the
01:40:47
second most common surgery for women in the United States after the C-section that's one in women either one
01:40:55
in eight or one in nine depending on the statistics and what happened historically is that until 2008 so very
01:41:04
recently professional guidelines of medical societies recommended removing the
01:41:11
ovaries all the time as part of a hysterctomy so let's say that you go to
01:41:17
your surgeon because you need to have the uterus taken out sometimes it's because of cancer more often than not is
01:41:25
not because of a malignancy but it's more for things like
01:41:30
endometriosis or benign reasons up until 2008 the surgeon will say no matter the
01:41:38
woman's age as long as you're done having children the ovaries are
01:41:43
redundant don't really matter let's just take them
01:41:48
out so in 2004 of the over 3 million women who had
01:41:56
their uteruses removed in America over a half also had their ovaries removed
01:42:03
without a medical reason to do so it was just common practice to say well I'm in
01:42:09
there let's get rid of the ovaries as well why because it's a smoother it's a
01:42:14
more straightforward surgery and also that reduces the risk of developing ovarian cancer in the future while that
01:42:21
is true the r risk of ovarian cancer is relatively low for women who do not have
01:42:28
genetic risks or a strong family history but what people were not realizing is
01:42:33
that surgical menopause this procedure of removing the ovaries in women who had a menstrual
01:42:39
cycle would effectively plunge a woman into menopause almost overnight and the
01:42:46
consequences are far more severe than going through menopause as part of the aging process and the tall on the brain
01:42:53
is actually significant because surgical menopause has been linked with an increased risk of cognitive decline and
01:43:00
dementia parkinsonism stroke and major anxiety and depression so this is
01:43:07
something that we need to talk about in 2008 the American College of um Oban
01:43:16
surgery changed their recommendations saying that they now
01:43:22
recommend and preserving the ovaries whenever possible now this is not a strict
01:43:30
medical guideline it's a recommendation which means that you've reached different people at different
01:43:37
places at different times and still today a lot of Surgeons advise their
01:43:45
patients to have the ovaries taken out even when the ovaries are healthy
01:43:50
because of surgical considerations without necessarily thoroughly explaining the
01:43:56
possible side effects of that procedure and look this is not to say that women should decline medical advice but it
01:44:04
really calls for an informed conversation where you go to your doctor and say well why should I be taking out
01:44:10
my ovaries now and what are the consequences of doing so and if I do it
01:44:16
what do I do to feel better because the symptoms of menopause may be more severe
01:44:21
and we know that that's no picnic and then we need to consider the increased risk of these other medical
01:44:27
complications like an increased risk of osteoporosis and heart disease and brain and neurological disorders so this is
01:44:34
something that we need to talk about and this is what I wanted to to show you
01:44:39
which we've just done this study I I'll say to everybody that's watching um the podcast it's on the screen but for those
01:44:45
that aren't watching the podcast because you're listening and you walk in the dog or whatever all of the graphs and images
01:44:51
that we're talking about will be listed in the description below so you can click on them and take a look for yourself so this is something else that
01:44:58
we're doing for the first time as far as I know at least to my knowledge which is to do brain scans in women before and
01:45:07
after an ectomy the evidence that we have so far is more clinical so we know that
01:45:14
ectomies are associated with all these risks or neurological disorders but to
01:45:19
my knowledge there are no studies that are really looking at women's Brains before and after the
01:45:26
surgery if there are any I haven't seen them send them to me I would love it
01:45:31
this is what we are seeing in our own cohort and population so this is one woman uh who's been working with us for
01:45:38
over a year and we had done three sets of brain scans the first brain scan
01:45:43
before the surgery like a couple of weeks prior the second brain scan six
01:45:49
months later and the third brain scan one year after the surgery this woman is
01:45:54
not taking hormones and we are looking at the brain's gray matter right now and when
01:46:02
you see I we're also showing parts of the brain that is losing gray matter and
01:46:09
those are shown as blue blobs I would say there are blue
01:46:15
spots okay over the brain scans which show the parts of the brain that are losing volume so this is the Brain
01:46:22
before for the surgery this is the brain 6 months later and this is the
01:46:28
brain one year later where all these parts in light blue are parts of the
01:46:33
brain that have lost gray matter her ovaries were removed and the gray matter of her brain
01:46:41
shrunk has diminished has it seems to have disappeared in some parts of the brain is thinning quite a bit and these
01:46:48
are statistical maps that I'm showing so these are regions where the change is statistically significant okay but that
01:46:56
you know there's an overall thinning and it just goes to show that that relationship between the ovies in the
01:47:01
brain and this is very direct because one of the things that been happening to
01:47:07
us for a few years now that we studying menopause is that there's push back that what we're seeing is not menopause it's
01:47:14
just aging and look I show you one more thing that we've done to say no it's not
01:47:20
actually just aging it's much more like to be menopaused and aging so now we have women who are exactly the same age
01:47:28
these are all women who are 50 years old one has a regular menstrual cycle one
01:47:33
has irregular menstrual cycle she's in per menopause and this woman is also 50
01:47:39
years old and does not have a menstrual cycle do you see the differences I mean yeah their brains look completely
01:47:45
different thank you and they're all exactly the same age drastically different so the the lady there in
01:47:51
premenopause her brain is really really illuminated um and then the same a
01:47:57
different lady but the same age in post menopause I mean yeah if it looks like
01:48:04
it kind of looks like the lights have gone down you can see this just by eyeballing a brain scan it's crazy and
01:48:09
again these are three cases and we now have more and more women so we're going to do a statistical examination a group
01:48:16
differences but still it you can't tell me how you feel this how do you cuz you
01:48:22
you know you've got the scans you've done the work and then you must look out into the world and see a narrative which
01:48:28
you know is wrong how does it make you feel I mean you know as a scientist that's the whole process you do things
01:48:35
and then you wait for other people to replicate what you have done but you know there's women right now that are
01:48:40
suffering I know that is because they're misunderstood but it's also really important for the research to be
01:48:46
substantial enough to really be sure that this is menopause that
01:48:53
you know we have hundreds of women in the study I would love to have thousands right and the more people look at this
01:49:01
question from different angles in different countries with different populations and they higher our
01:49:07
confidence that what we're seeing is actually menopause and if she had taken in the last graph you showed me in the
01:49:13
last image you showed me with the three women same age different phases of menopause if she on the right who was in
01:49:20
postmenopause had been on hormon on hormones I don't know she's not on hormones that's why I'm showing their
01:49:26
skins but we're also looking at that we're also doing clinical trials to test
01:49:31
whether hormone therapy uh can change this brain scans so this is another
01:49:37
thing that's quite upsetting as a woman and the scientist um the only clinical trials
01:49:45
have have looked at the effect of hormone therapy on cognition or using brain scans
01:49:53
have been focused on women who are past menopause there isn't a single clinical
01:50:00
trial that uses brain scans to test the efficacy of hormone therapy in women who
01:50:06
are per menopausa for example which is bizarre to say the least so we started
01:50:12
we're doing one right now so we have an active clinical trial where so the other
01:50:18
concern is that hormone therapy has this terrible reputation for being linked with the higher risk of breast cancer
01:50:25
right and that's been addressed and professional societies are saying actually whatever risk increases very
01:50:31
small and it's actually a rare occurrence but there's there's history
01:50:37
there's history and a lot of women are just scared of taking hormones and so what we're doing we're working with an
01:50:45
alternative which is an estrogen designer estrogen is a designer estrogen I'm very excited about that so this is
01:50:51
the new generation of hormone options hormonal options and
01:50:57
they're called selective estrogen receptor modulators or serms or designer
01:51:02
estrogens and the one we're testing is called the neuro serm is a serm is an
01:51:07
estrogen for the brain that's been very specifically developed by my colleague
01:51:13
Dr Roberta D Brinton at the University of Arizona she's a genius she's an absolute Rockstar in this field and
01:51:20
she's been studying estrogen in the brain since the 199 is and she's amazing and she was like okay I am tired of
01:51:27
hearing that people won't take hormones because of this this problem with the breast cancer link and the association
01:51:34
we're going to start fresh and she went back to the bench and she worked for 15
01:51:40
years and she came up with this formulation of this new type of estrogen
01:51:46
supplement actually it's more like a supplement than a medication that goes straight up to your brain it's like a
01:51:51
little GPS for your brain and leaves your breast Ries alone so this
01:51:57
selectively improves brain function while having no
01:52:04
impact on your breast and reproductive tissues which means that can either have
01:52:09
no effect on cancer risk or actually reduce the risk of cancer while selectively supporting brain health and
01:52:15
now we're testing it with brain scans we do cognitive testing we do all sort of evaluations and we're actively enrolling
01:52:23
participants so if anyone is interested we're looking for p menopausal and
01:52:28
postmenopausal women with hot flashes specifically women who have at least
01:52:34
seven or more hatot flashes a day who might really benefit from this treatment in a short amount of time who are
01:52:41
willing to work with us in New York City and everything is sponsored by the ni the National Institute on health is a
01:52:49
phase to randomize Placebo control clinical trial which means it's one of
01:52:54
the most thorough clinical trials you'll ever get a headache for us how do they get in touch with you if they want to
01:53:00
take part they can email my team can we share their email yeah yeah we'll put it
01:53:05
on the screen afterwards so everyone can see it while you're finding that I wanted to share something from your book that I found to be quite fascinating
01:53:11
there's a section where you talk about um how to predict when a woman will go through menopause and I pulled out a few
01:53:16
things I found fascinating here which I'll probably be speaking to my my partner about said the best predictor of when a woman will go through menopause
01:53:23
is when her mother went through menopause that's right and the experience of the symptoms of menopause is similar to for mother and for
01:53:29
daughter another indicat is a woman's experience during puberty or pregnancy for instance if they have mood
01:53:34
disturbances during puberty or pregnancy they are likely to have it for menopause that's right so maybe we should be
01:53:41
having conversations with our mothers if we're women um to understand their experience with menopause because it might be the clearest indicator um of
01:53:48
our own potential future experience that's right it gives you a sense of when you might be going through
01:53:54
menopause what kind of symptoms you may be having and then you consider your own medical history so if you ever smoked
01:54:00
cigarettes for instance you may go through menopause a little bit earlier in life than your mom has or if your
01:54:08
diet is not very healthy same considerations or if you don't exercise at all those are all factors that um
01:54:15
reduce the age of onset of menopause so you may go through menopause earlier on but it's always good to talk to your mom
01:54:22
so that's really my my best advice here is ask your mom because mothers just you
01:54:28
know it's really bizarre how very few at least for my mom's generation nobody
01:54:35
would talk about menopause my mom talked to me about puberty and periods of course because you have to be prepared
01:54:41
need to know what to do she never once mentioned menopause until I asked so how
01:54:47
how was it for you what age you know should I should what am I expecting what's going to be in store what what's
01:54:53
in store for me and I think it's a good conversation to have ahead of time so then you have time for you know to
01:55:02
prepare you should talk to your girlfriend I'm going to I mean I had no idea about all of this stuff so it's um
01:55:07
thank you so much for for sharing it in the way that you do and doing the work that you do because you're really shining a light on an uh a very
01:55:14
unilluminated part of life that I think by 2025 they say that a billion women
01:55:19
are going to be experiencing or have gone through manipa which is crazy a billion people that walk amongst us
01:55:25
that's what one one in8 one in N people are currently going through or have been through menopause at that stage and that
01:55:30
that means that someone in your life is going to go through this your mother your partner your your daughter whoever it is so being um armed with this
01:55:37
information helps us to be I think better supporting um acts to those people but it helps us to understand ourselves
01:55:43
better and helps us to be more empathetic and to know how to to show up for those people even if we're not one
01:55:49
of the the people that will be going through menopause ourselves and that's allowed me in my own life to understand people in my life that I maybe didn't
01:55:56
understand before I thought well they're acting strange or their Behavior's weird or they're being a bit weird and you can sometimes isolate those people and the
01:56:02
stats show that you know the suicidality amongst that age group of people that are at sort of 55 plus is probably so
01:56:09
high in part because they're confused they don't have the answers and those around them don't have the answers so
01:56:14
they can be shunn they can be rejected they can be misunderstood and that's exactly what your work confronts and it shines a really important unique light
01:56:20
on the brain which I had absolutely never thought about before never considered never seen the scans and now
01:56:25
I have a better understanding of the full um physiological process that's going on when people go through the
01:56:31
different stages of menopause Dr Lisa thank you so much we have a closing tradition on this podcast
01:56:38
where the last guest leaves a question for the next guest not knowing who they're going to be leaving it
01:56:43
for and the question that has been left for you if you could have one last conversation with your parents what
01:56:50
would you say goodness my parents are here right now oh one last I would just say thank
01:56:57
you thank you for everything thank you for being there for me my entire life and thank you for being my my 100%
01:57:05
backup plan you know I I feel so fortunate that my parents are such good people and they've always been there for
01:57:13
me I never had I never worried about not knowing where to go and when I was
01:57:19
little I didn't fully appreciate that but now I really do I appreciate it so
01:57:25
much that I I never felt on my own I always felt like I had a safety net both
01:57:30
financially legally physically and mentally and it's just it's such a
01:57:36
blessing and I would just say thank you I love you so much and I I'm sorry that that was difficult when I was a teenager
01:57:42
but I think I redeemed myself you certainly have thank you so much for all
01:57:48
the work you're doing and behalf of all the people that I have to say this I amum last had a conversation about menopause
01:57:54
I for people that don't realize how sort of impactful this is the top comment on the video was had I not found these
01:58:00
videos I would have been convinced that I was dying heart palpitations migraines itchy skin insomnia pure rage crying
01:58:07
spells the list goes on I'm 43 and I literally do not recognize myself and
01:58:12
the other top comment was sweating I can deal with hot flashes I can deal with what I can't deal with is the paralyzing
01:58:19
fear anxiety depression and fatigue there the two top comments on the video about menopause and I think that's why
01:58:25
it's so important for us to keep having these conversations to stigmatize it to inform ourselves and then to by doing so
01:58:32
push the research forward push attention push investment forward in this subject it's so wonderful that you're working on
01:58:38
the designer estrogen um because again that if that if that is successful it will help to change even more people's
01:58:43
lives so thank you so much Dr Lisa thank you thank you so much for having me and for doing this really appreciate it
01:58:52
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