The Menopause Doctor: This Diet Delays Menopause! Menopause Is Shrinking Your Brain! Dr Lisa Mosconi

Summary

In 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

00:00

🧠 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.

05:00

👥 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.

10:02

🧬 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.

15:05

🌟 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.

20:05

🔬 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.

25:08

🌿 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.

30:09

🏃‍♀️ 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.

35:12

🥗 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.

40:14

🧘‍♀️ 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.

45:14

🌱 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.

50:17

🌿 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.

55:20

🔍 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.

00:20

👵 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.

05:22

💡 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.

10:22

⚕️ 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.

15:23

🧬 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.

20:25

🚀 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.

25:26

🤔 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.

30:27

🌐 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.

Keywords

💡Menopause

Menopause is a natural biological process marking the end of a woman's menstrual cycles and fertility. Defined medically as the absence of a menstrual period for 12 consecutive months, it is not just a single event but involves a transitional phase with various symptoms. In the video, the discussion revolves around the impact of menopause on the brain and overall health, emphasizing the importance of understanding this transition for both women and men.

💡Neuroscientist

A neuroscientist is a scientist who specializes in the study of the nervous system, including the brain. Dr. Lisa Mosconi, the guest in the video, is a neuroscientist whose research focuses on understanding the changes in the brain during menopause. Her work has contributed to the groundbreaking knowledge about the connection between menopause and cognitive changes, as discussed in the script.

💡Cognitive Fatigue

Cognitive fatigue, also referred to as brain fog in the video, is a non-specific symptom that can impact memory, concentration, and overall mental clarity. It is one of the neurological symptoms experienced by some women during menopause, as validated by the research discussed in the video, which shows a measurable change in brain activity during this phase.

💡Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy, or HRT, is a medical treatment used to help alleviate symptoms of menopause by supplementing the body's declining estrogen levels. The video discusses the history and modern practices of HRT, including the controversy and cautious approach due to concerns about its long-term effects, especially on the risk of breast cancer and heart disease.

💡Neuroendocrine System

The neuroendocrine system is a complex network that integrates the nervous and endocrine systems, allowing for the regulation of various body functions, including the menstrual cycle and response to stress. In the context of the video, the neuroendocrine system is highlighted as a key player in the changes that occur during menopause, particularly in how it affects the brain.

💡Estrogen

Estrogen is a primary sex hormone in women that plays a crucial role in the menstrual cycle and the development of secondary sexual characteristics. In the video, it is emphasized that estrogen is not only essential for reproductive health but also for brain health, acting as a fuel source for neurons and supporting cognitive function. The decline in estrogen levels during menopause is linked to the observed changes in brain function.

💡Brain Fog

Brain fog is a term used to describe a collection of symptoms such as lack of mental clarity, forgetfulness, and difficulty concentrating. In the video, it is mentioned that up to 62% of women going through menopause experience brain fog, which is validated by the research showing a 30% drop in brain energy levels, indicating a significant impact on cognitive function.

💡Alzheimer's Prevention

The video discusses the connection between menopause and the risk of developing Alzheimer's disease. Dr. Mosconi, who leads the Alzheimer's prevention program, emphasizes the importance of understanding the changes in the brain during menopause to potentially reduce the risk of cognitive decline and Alzheimer's in later life.

💡Selective Estrogen Receptor Modulators (SERMs)

Selective Estrogen Receptor Modulators, or SERMs, are a class of drugs that have tissue-specific effects on estrogen receptors in the body. The video mentions a new generation of SERMs, specifically a 'designer estrogen' being developed and tested by Dr. Mosconi's colleague, which aims to support brain health without affecting breast and reproductive tissues, potentially reducing the risk of cancer.

💡Lifestyle Adjustments

Lifestyle adjustments refer to changes in habits and routines that can have a positive impact on health. In the context of menopause, the video discusses various lifestyle adjustments such as diet, exercise, sleep hygiene, and stress reduction that can help alleviate menopausal symptoms and support overall well-being.

💡Brain Energy Levels

Brain energy levels refer to the metabolic activity of the brain, including how efficiently neurons utilize glucose for energy production. The video script reveals that there is a 30% drop in brain energy levels during menopause, which is a significant finding from the research and corresponds to the cognitive symptoms experienced by many women.

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

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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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