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