No One Talks About This: How a Woman’s Brain Changes Through Every Life Stage | Dr. Sarah Mckay

30:32But her body is changing and she knows her body is changing and she's starting to look at herself differently. She's starting to understand that other people are going to look at her differently in ways she may not want or feel comfortable with. And she's going to be very aware of how she fits in with her social circle. And that's going to increase that risk of anxiety and depression. But it wasn't just the hormones. It's the social context. It's the social context, but it's also her reflection of the social context and her interactions with other people and the meaning that she's making of that.

31:05So all of those factors are contributing to her, say, developing depression or anxiety. more so perhaps than the boy who's experienced puberty early so it's not more so than just the hormones so it's like what i was talking about the male female brain differences at the beginning it's not going to be just one thing when we're looking at a population these statistics are drawn from populations of people we've got lots of pieces that are kind of contributing to that and then these you know we've got the male brain we've got the female brain and they're experiencing and kind of the brain turns on, the testes or the ovaries, they start producing the sex hormones that change the body and then kind of send this brain off through this trajectory of adolescent brain development.

31:53And we see all of the kind of refinement and changes and brain structure and brain function and kind of tracking alongside those changes. We see the development of lots of different kinds of ways of thinking and feeling and behaving. And that's when we do start to see age kind of 14, 15 is when we start to see the emergence of mental health problems. And the biggest risk factor, once you're outside the other side of puberty for developing anxiety or depression is having experienced it before. So it's almost like all of these kind of pieces in a puzzle or building bricks in a wall start to add up.

32:35And that's where we start to see this divergence in these rates of diagnosis. And we've also then got, although it depends where you are in the world around mental health awareness, I suppose, accessibility to being able to get diagnosed, willingness to go and ask for help. And also, I guess, how your parents acknowledge the difference between females and males. I think it's really interesting hearing this. I mean, I know even so much on the lifespan of women, but there is so much social conditioning. I mean, I grew up watching Disney films, kind of thinking that you would get married and have babies and that would be your career.

33:14I guess my mum kind of met my father. They've been married 50 years at 15 and had a baby and got married. I've had a very different life. But it's interesting thinking about maybe people that grew up with maybe strong entrepreneurial parents or the mother that stayed at home. There's so many different scenarios, especially maybe in the millennial generation when things are starting to change a lot more than maybe my parents' generation, like the baby boomers. So it's interesting to kind of think like how these have such a mix. Now I'm thinking about how women's roles are changing. So putting into context everything that you said, which I'm finding really fascinating, maybe kind of dispelling the myth that most of our kind of emotional awareness or distress is maybe not just down to hormones.

34:00it's down to the projections and the social context that we're in. Now women's roles are changing. Women are becoming, more women are finishing university than men with higher results. Women are, I don't know if we're having less children, I don't think we are statistically, but I think women are being more conscious about when they're having children than before. There's less marriages happening. So the kind of social context of society is changing. The man and the women's roles are changing. They're becoming both workers and supporting families more so than ever before. So I'm kind of thinking about this projection in the next 30 years of what you're now telling me, which is making me kind of think, okay, well, I know there's more funding now going into women's health than there was maybe 10 years ago.

34:47Not enough, but a little bit more. There's a bit more awareness. There's more conversation. and the social construct is slightly changing. How do you think that's going to impact how women will look at their hows and how they'll be feeling? Do you think if we are changing the social construct, we're going to be having less PMS symptoms? I don't know. I suppose it depends on the stories that we're going to be telling ourselves. I mean, I think sometimes even with the best of intentions, we still sometimes tell stories that perhaps inadvertently have a negative consequence or outcome. So, I often talk about a lot of these ideas are just based on these stereotypes that just become perpetuated over time, like this idea that we're all just at mercy of our hormones and women are so much more emotional, emotions have so much more variation.

35:35Some of the other research, and I'm sure you've read about it in the book, I talk about these sort of stereotypes that children are raised and when they sort of start to, we start to see, I mean boys, it doesn't matter where in the world you are, boys and men have more self-confidence and belief in themselves. And we start to see that diverge around ages sort of six or seven, at least in the country there's studies have been done whereby it's like, well, who's going to be smart? Who's going to grow up to be a scientist or whatever kind of role model, which is perceived as like kind of smart or intellectual or have a high IQ.

36:15And boys everywhere in the world kind of think, well, that'll be me. And girls sort of start to lose that belief kind of in their primary school years. At least some of them will sort of start to doubt themselves. And there's nothing sort of biological happening there. But there's some really interesting research that's looking at this idea of the implicit messaging that kids are still picking up about gendered stereotypes or occupations or intelligence and we use language and I even caught myself yesterday when I was out with my husband and brother and sister-in-law and I said we can't say well girls are good at maths too or girls can also be scientists because even that girls are scientists the implicit message in there is that this is this boy thing that girls are opting into like the boys are the norm but girls also can instead of saying girls and boys have equal ability at maths men and women are equally capable scientists men and women you know boys and girls can grow up to be scientists not like girls can too by saying girls can too we're kind of giving this message that maybe that maybe someone thinks we can't but the boys are going to so we're kind of jumping in on their parade world so i i think sometimes even when we have good intentions it's unconscious isn't it yeah so i mean kids just you know swim in swim in the world you know what's the idea if you're a fish in a bowl you don't know what that you're swimming in water i can't remember the sort of analogy there and i think sometimes we can, with the best of intentions, create experiences for little people that are giving them messages that we don't want them to receive.

37:57So how are those messages going to change? And it's very hard for me to kind of untangle my experiences out of it as well, because I grew up not even thinking about the fact that I was a girl who could or couldn't do things based on my sex. I just never considered sex and gender until perhaps the last 10 years. It never occurred to me not to go to university and study science. I just thought it was cool and interesting and off I went. And perhaps because I went into the neurosciences and there's always been gender equity in neuroscience, it's perhaps more like the sort of the psychological or biological or medical sciences.

38:43There's always been gender parity. It wasn't like I was going off to study maths or physics or engineering where it was apparent. So it never occurred to me at any time in my academic or education to not do something because I just never... Because you're a girl. I just didn't even think about it. I honestly never considered it. See, I find it interesting because I don't think that my time at school was because of my sex differences. I think it's because I was an undiagnosed dyslexic. And so I just didn't like school. But then what, this is something I find really interesting. So I was then scouted as a model when I was 15.

39:20Now, the modeling industry is unlike any other industry out there. For one big reason that you might not realize, women have a higher hierarchy than men. They get paid more than men. They're wanted more than men. They're in more demand. So, men are kind of second to women in this and it's all about women are bigger consumers, they buy more. So, a lot of money is filtered to paying more for women models. It's kind of more of their industry. So, from a very young age of 16, the women had the power more than the men. I say that in such a kind of derogative way, but I guess coming out of that industry where women, which is very different to I think the outer world of the pay system with men versus women.

40:06Men have always been known to be paid more, have more of the CEO jobs. But I went into an industry where women kind of held that. So for me, it was quite an empowering that when I was coming out of it, I was really seeing the difference between men and women. Interesting. Interesting. And yeah, and it's very hard not to have your own personal lens and bias on this. And I try very hard to when I'm doing the work that I'm doing, but I mean, I'm sure it inadvertently comes in. I guess I just kind of lucked out with the upbringing I had and just kind of the path that I followed. And it's only been more recently.

40:40I've come to, well, not everyone has the same experiences and the same, I just have had a lot of good luck come my way. So I'm now becoming more aware, let's just say, of the inequalities that are out there, which is is still huge i suppose like just to kind of because i mean i can't comment on i mean that's not really my sort of jam just to sort of talk about like bring bring it back to the science and think about the gender inequalities or at least the non-recognition of women's health and biological sex as a variable i think what's really cool is that i have this optimism bias i always to look at the strengths.

41:24We know there's a gap, right? We talk endlessly about this gap. It's almost getting a little bit boring to talk about the gap because what is good is that we are filling the gap with data. We're trying really, really hard. And there are some extraordinary scientists out there, and many of them are women. I call them the women of steel. Lots of them are Gen X, call out to my girls, who are, like, you know, they've stuck at it. I didn't. They have stuck at it and they're like at the point now where they can ask the questions get the research funding in the little bit of research funding that's out there they're doing their best with it and getting the answers to fill these gaps and that has come about because especially in the neuroscience space there are like so many women in there now that are high enough up that ranking to be able to start asking questions that the guys never really thought about and that's what's been like wild as in the last sort of since I really started writing about women's health from a neuroscience perspective in 2015 to see how much that has shifted in the last 10 years it is wild but it is crazy that the research has only started to emerge but also selfishly I then get to like watch watch it and talk about it if it came out 30 years ago it would be old news well you wrote your first book, Women's Brain, in 2018, but you're just about to do the second edition now.

42:49It's just coming out, literally, probably as this episode drops. So I really wanted to know, like, even in that, I mean, say it's a short space of time, it's not, but, you know, it's under 10 years. What was kind of the biggest change or revelation that you saw that you think is so important for women to know? Because it's changing so rapidly and so quickly. Well, I think what's important to know is that we know that there's a gap and there's lots of amazing people doing really good work to fill it. I think technology is also kind of tracked alongside the research coming in, the questions, and then the answers.

43:22And we're starting to understand that power comes from numbers, right? Like just to be a total nerdy scientist, like we just need more data, but we've got some cool new ways to get data, which I love. So we've got what we told kids in primary school to do, and maybe it's taken the women to lead the way to share and it used to be very much that each lab was siloed and you didn't really share the research information or data with anyone else particularly raw data and now we've got data sharing we've got biobanks we've got collaborations so instead of you know 10 people in this lab being studied and 10 people in another lab being studied on the other side of the world and 15 over there now we can pull all that together the data is being shared there is power in numbers.

44:07What was the most surprising part of that that you saw there? Like when you were writing the second edition were you like I wish, wow I didn't think I'd write about this? I just think that and it sounds so nerdy but just the fact that we are starting to see signals emerge from the data that we couldn't see before because we didn't have enough of it. So and we've now got technology like machine learning and AI that can analyze that data and can start to pick up signals that perhaps we couldn't necessarily see before. And so I've included a lot of that data in the book. So I mean, like to just kind of think off the top of my head, what would have been...

44:45So there was this one study, which I haven't talked about a lot, that comes out of work from a woman, Pauline Mackey, a neuroscientist, psychiatrist, women's health researcher, who's looked at brain fog during menopause. And this is like this big topic. And again, if you're told you get to 48 and you're going to get brain fog, you're going to experience it. Like we do create our own realities, but also it is real and it is measurable, but not in everyone all of the time. So they had a cohort. It was a small longitudinal study whereby they looked at a group of women and followed them the whole way through perimenopause and menopause and kind of out the other side and did tons of different cognitive tests on them at multiple times all the way through this sort of perimenopause.

45:29was transition. And the cognitive tests were designed to pick up different aspects of kind of memory and attention and thinking. All the sorts of functions that our brain does that we might feel aren't working as well when we say we have brain fog. And brain fog's a very big umbrella word, like a constellation of symptoms, a bit like baby brain where we might just like, my brain isn't working. But like people who haven't slept much might say they have brain fog or perhaps people with depression might have brain fog or you know we use it quite loosely and it turns out that not every woman shows cognitive decline across this time course machine learning was able to analyze this data and kind of come up with these like kind of four subgroups or buckets of women showing these different kind of trajectories across the menopause transition some women their cognition stayed the same.

46:25They did all these tests the whole way through and they just sort of stayed the same as they were. There was one small group of women who showed a slight reduction in some of their test scores across that menopause transition and they were much more likely to have poor levels of education, have terrible sleep and to also have lots of other kind of constellation of symptoms going through menopause. But then there was two groups of women who actually showed improvements in their test scores. Through menopause. And in a way that might not, well, probably shouldn't necessarily come as a surprise. Not every test score, but some tests of memory and some tests of attention actually improved.

47:05But when you do cognitive testing multiple times, your test scores get better. And we tell this story about brain fog, but that's not everyone's experience all of the time. And it's not until we've got really rigorous data analysis. We've got lots of data points and then we use sophisticated ways to analyze it. We have these new stories starting to emerge that I think show that, again, we're not just reaching this reproductive life transition that automatically equals dysfunction and decline and instability and things going wrong. Brains shift and shape and reorganize and respond. and, you know, be familiar with this word, even just this word brain plasticity, our brains reorganize and react and often show quite a great deal of resilience over time.

48:01But we're just not telling these stories. And I saw similar types of stories emerge when we're talking about pregnancy and motherhood and baby brain and even just aging and memory across the lifespan, data is starting to reveal some really new and interesting stories that aren't always about dysfunction and decline. I think that gives, okay, so there's one study that I read in your book, and I'm going to, I'm jumping in the lifespans here, but listen, stay with me. We're now on menopause. I'm jumping as well. We're going everywhere, but it's, you know, that's the journey of life. menopause so i went to this women's health summit in la and i mean for a woman in her 30s being very much in the sphere i'm informed about menopause now probably petrified at the moment but i'm petrified yeah and i can see these two years ago you wouldn't have went menopause i joke and i say menopause wasn't invented but yes but i also really don't and i want to undermine women that are really struggling.

49:07I actually do have some friends who can call me in tears because they feel like they've completely lost who they are and they feel very alone. And so I guess I'm kind of in the weeds of kind of wanting to understand the science behind this, but I remember sitting in this Women's House conference only a couple of months ago with some incredible scientists and showing the decline of the brain on the screen and going, this is what happens when you hit 35, this is what happens when you hit 45. And the surface of the brain declining. So I'm obviously, naturally, as anyone who listened to the show and anyone who is very deep in the menopause space, pretty scared about what's meant to happen.

49:46And then I read this part in your book, which said the first brain image study tracking women from perimenopause to postmenopause came out in 2021. It showed that some areas of gray matter expanded, especially in the regions of the brain linked to memory and cognition. So I was like, it's not loss, it's adaption. Which I don't think I've had or heard any conversation that said that parts of our memory and cognition can actually expand in menopause. It's not very trendy or sexy to talk about the upsides. That's what we want to talk about. And I think that this is a problem overall with women's health being under-researched is that we really need to focus in on solving problems.

50:37And I understand that and finding solutions for women who are struggling. But again, there's a whole group of women whose brains are adapting and responding and flexing and adjusting. And I mean, the menopause story that's often, and to be clear, we have very few good brain imaging studies looking at how women's brains change across the menopause. And the study that you're talking about was Lisa Moscone's study. And to be clear, this was not a longitudinal study that followed a group of women all the way through. It compared a group of premenopausal women, perimenopausal women, and another group of postmenopausal women, and also men of the same age.

51:15So ideally, we want longitudinal studies. Because then we can see how one woman's brain changes. And look at a thousand women's brains, not get averages and compared between groups. but her study did show that if you looked at say grey matter volume in parts of the cortex you saw like a slight kind of reduction during perimenopause and it kind of bounces back post-menopause it's almost as if it got slightly thicker in some parts which is crazy because that's kind of the opposite of what we see in puberty and pregnancy whereby we see parts of the grey matter of cortex getting slightly thinner and in both those instances that's involved with kind of streamlining and refining and the brain just becoming more efficient.

51:58It appears to kind of, for want of a better word, bounce back slightly going through menopause. But that's just structure actually. I think what's really fascinating is there's some very, very new studies that have come out looking at how brain networks change both over the natural course of aging and across the perimenopause transition as well. And we know during adolescence, brain networks become much more kind of efficient and we've almost got these nodes that become kind of quite refined and good at doing their jobs. They become very kind of segregated and efficient with each different network being responsible for a different kind of role.

52:41And then through natural healthy aging, what we start to see is the networks become less segregated and more integrated. It's almost as if they kind of start to cooperate. And as the brain becomes slightly less efficient, perhaps metabolically less efficient, and perhaps is showing some kind of signs of just kind of cellular aging, as every part of our body does, it adapts and responds. And so the networks that used to be very segregated sort of start to integrate a little bit more. It's almost as if instead of, you know, there being lots of little kind of individuals individuals doing their own jobs it's like hey guys let's kind of work together as a team and we see this with the hippocampus and we know that there's kind of hippocampus and both you know there's two hippocampus one and either hemisphere of our brain and that's involved with things like short-term memory and turning short-term memories into long-term memories and typically one side of your hippocampus or the other will be doing jobs related with memory And then as you go through menopause, we start to see both sides being activated together.

53:47Double whammy. Yeah, so it's reacting and responding. It's going, hey, we just need a little bit more brain power here. So how about let's recruit some more parts of the brain together to get the job done. Earlier in development, and as you learn new skills and get better at them, we tend to see less brain activity being required or less parts of the brain being recruited. and then as we age we sort of start to have to recruit brain power back again so the brain realizes and understands hey i've got to like kind of involve more neurons here to get the job done so it can keep on doing the job and we see that happening across menopause as well where we and and there are some studies that are reasonably new whereby we can almost track that with the loss of estrogen so your ovaries are producing less estrogen or rollercoastering through perimenopause and then flatlining post-menopause, we see that those brain networks start to integrate even more as they are kind of responding to the loss of that estrogen.

54:43So that's an interesting question because we haven't spoke about HRT yet and estrogen loss, but these brains that are showing more positive effects, are these the women that have been on HRT? No, these studies that have been done have only looked at women who are not taking HRT. Lisa Moscone's study found it didn't matter. I mean, there's some complexities to that study whereby a lot of those women had APO genes, which predisposed them to Alzheimer's disease, et cetera, and it combined women on HRT and not, and it wasn't longitudinal. So I think what we need is a good, clear longitudinal study that's going to look at this.

55:20But these studies looking at network recruitment and integration across menopause have been done in women, not on HRT. Okay. So that complicates it a bit. But I think what's really cool is we see this throughout healthy aging we see this integration and we see different types of memory emerging and different strengths and different types of memory emerging at different ages but we tend to focus in on that type of memory that quick sharp short problem solving fast you know working memory like the kind of like the stuff that you peek at in your early 20s I know what I was like in my early 20s now I've like I've like to like lose words I'm like at this point I'm like 50 I like just like run out of words sometimes or I just you I just use the wrong words I'll like say lid instead of hat or I don't know sticker instead of plate they're kind of like loosely related there's some semantic mixing going on there I think it's my networks integrating interesting but I have wisdom and I have life experience and I have the ability to connect dots between ideas and I have skills that I didn't have in my early 20s, but we don't tend to honour them and respect them and see them as strengths in the same way that we do with the quick, short, sharp.

56:48We need both. It's the quick and hustle-pustle society. And I wonder, and I'm not sure whether this is the case, but I wonder, and I was speaking to a memory scientist, more in Irish in Sydney recently. And I said, do you think that these skills that we see emerging later in life, the different types of memory strengths are adaptive? It's not just coincidence. Maybe it's adaptive. Like, you know, I'm not having babies anymore. I'm not building a career. I'm not creating and, you know, I'm like kind of settling and making the most and like passing on wisdom perhaps the memory for each life stage is the type of memory that humans as a species need socially perhaps like the wise matriarch you know the older wiser man the guru they're all older wiser slower deeper thinking people who are imparting knowledge on to the younger generations to quickly build something with it i don't know maybe it's adaptive and we don't honor it i don't I think we do because we live in a quicker, more fast-paced society than ever before.

57:54We focus on what we've lost. Yeah. Well, this takes me similar back to the Compassionate Cure 5 questions for Substack, where we spoke about celebrating those wins when they happen and allowing yourself to be in that moment and not just think about the next thing. But I think so many women are going to be screaming at this podcast, going, what about HRT in the brain? Oh, my goodness. Like, what? I'm losing my words. Yeah. I'm literally losing my words. I know what you want to know. There's so many questions that I know women are going to be holding on to their phones or where they're listening saying, but is this good for my brain or not?

58:32So, this is so complicated because we've got data, we've got clinical practice guidelines, and we've kind of got lots of different ways in which we can go through menopause. most of the information there is there is different information and guidelines based on different sources of evidence for women who perhaps experience early menopause say between the age 40 before the age of 40 or perhaps say they have their ovaries removed so they have cancer or a full hysterectomy before the age of 45 where there is different advice given to women going through, say, natural menopause at, say, 51 or whatever.

59:13And women have been taking different types of HRT or menopause hormone therapy over sort of different amounts of time in different generations. And so the data has got quite mixed and muddly. And that has meant that we can't always make these clear, definitive statements. Say we were looking at the best indication that we have, the clearest sort of little biological mechanism, which I can explain to you, is taking hormone replacement therapy, estrogen, progesterone, because you've got vasomotor symptoms or hot flashes. And we understand very clearly the biological mechanism there. And I don't want to talk about it.

59:59Isn't that one of like the smallest kind of physical symptoms? Well, it's not the smallest physical symptom. It's not one of the main. It can be very disruptive. and it is a neurological symptom because it comes from your hypothalamus. Your hypothalamus deep in your brain does all kinds of things, including regulating hormones, but it does things like heart rate and blood pressure and also body temperature. And lack of estrogen or rollercoastering estrogen alters the hypothalamus thermostat. So the top goes down, the bottom goes up. It takes a very little shift in body temperature, particularly to kind of hit that upper level whereby your brain thinks oh my goodness it's really hot in this body we need to call it down emergency situation it's like overheating whereas when you're younger that shift in body temperature isn't going to go above the top level of the thermostat and we know estrogen tweaks that because when you put it back in with HRT it resets the thermostat back to normal levels.

1:01:00And so what happens is it might just feel like you're hot and sweaty during the day and it can be annoying, but it can have a whole host of other knock-on effects. One of those is disrupting your sleep at night. And we know about 70 % of hot flashes experienced at night wake women up. And sometimes that's just because they're hot and sweaty and uncomfortable, but sometimes it's because they might be deeply asleep and the hypothalamus is going we don't we don't want to just have a physiological calling response we need to call we need to behave in a way to call ourselves down but you are asleep so I need to wake you up so you throw the covers off and so it sends out kind of this sympathetic nervous system response and if you have ever had one at night as a new new and I didn't put up with this for too long don't worry about that started to experience it almost feels like you've been given a fright because you have this burst of rush of adrenaline kind of through your body and you feel like you've got a fright and it wakes you up enough to throw the covers off.

1:01:58And then if you're waking up with fright, it's hard to get back to sleep anyway. And then you get cold and then you fall asleep and you're cold and you wake up, put the covers back up. It just mucks up your sleep. So even if you are not waking up, it's still disrupting that nice healthy sleep architecture because we know that sleep architecture and body temperature are really intimately entwined. So imagine if that's just one night that I've described. So that's going to be affecting the brain overall because we know poor sleep also really affects poor brain health. And then, yep, so we've got hormones, thermoregulation, sleep, what happens with disrupted sleep, brain fog, emotional instability, depression, anxiety.

1:02:35On top of that, there are a whole lot of nervous system and cardiovascular effects of having this repeated sympathetic nervous system activation over and over again. and we're a little bit unclear about the exact link in mechanisms by which it may be contributing to poor cardiovascular health. And we don't know whether it's because of the hot flashes are sort of sitting in there in between or there's another biological mechanism. We're not quite sure what's kind of the chicken and egg scenario there or the first domino to fall, but there's definitely this kind of web of effects in there. And often that's why we see these kind of clusters or constellations of symptoms.

1:03:14so even if it is simply just due to the hot flashes they are going to have a whole lot of different types of consequences and we need more research and there's people in there you know sort of trying to untangle that web and there are some new drugs which are being developed so you want to treat your hot flashes but you don't want to or you can't take hormones if we treat the hot flashes with a non-hormonal therapy do we see improvements in sleep do we see improvements in brain fog if the brain fog's a consequence of bad sleep so you can kind of see how it gets pretty complicated in there so i would never dismiss them as being a small symptom that is the best definitely not a small symptom i just want to make sure that the listeners think this is what it meant that i think most people related menopause just to hot flushes yes and they're saying that's not the the number one symptom of everyone who has menopause that That was more of my kind of stretching of the question.

1:04:09That is the symptom in which we have the best indication for hormone therapy and what all the clinical practice guidelines would say. Brain fog is kind of confusing and difficult because sometimes studies have been done where women have been treated with hormone replacement therapy and they don't feel their brain fog has improved. And so we're not entirely sure. Or maybe those reorganization of those networks that we're starting to see, perhaps that's kind of contributing to brain fog and putting the hormones back in isn't going to make a difference. I don't know. We've got a lot of complexities in there.

1:04:48The longer term effects, and this is where the data gets mixed and the messages are conflicting, we know that the older you get, the more likely you are to develop Alzheimer's disease and other related dementias. and that women have a higher risk later in life of, at least there's more women alive with Alzheimer's disease than there are men in their 80s and 90s. And part of that is due to living longer. Part of that is due to a whole host of life experiences that we have from rates of childhood education to rates of cardiovascular disease to a whole host of biological sex and gendered factors which are contributing to that difference in risk or at least prevalence.

1:05:32Part of it may be menopause but it's not certainly the only case. If it was as simple as let's put hormones back in with HRT to prevent dementia then the data would show that or it would be very clear. It's not because the gap is there it's because we've looked at that and the data is really conflicting. Some studies show women who are taking HRT, we're seeing an increased risk of dementia and Alzheimer's disease. Some women we're seeing a decreased risk. Some studies are showing, look, it's not really going to make a difference one way or another. And what is causing those conflicting studies is because we've got different types of women who perhaps are starting taking HRT at different points in that kind of menopause transition.

1:06:21Perhaps they're taking different types of kinds of hormone therapies. Women who are in their 80s and 90s now may have started taking hormone therapy in the 1980s or 90s. Which is a very different type of hormone therapy. And it was a different type of hormone therapy than what women are taking now. And there are a lot of contributing factors to Alzheimer's disease risk. We've got some women with a genetic predisposition, other women not. So the data is really mixed. It is certainly not clear enough for any menopause society, and certainly for me as someone who's looked at the data, to say HRT will prevent dementia.

1:07:00It's not going to cause dementia, might be neutral. We don't really know. I think that there are other risk factors which are far clearer and are much louder emerging from the data that are risk factors for Alzheimer's and dementia that we just don't want to talk about because they're really unsexy. things like hearing loss at midlife seven percent of cases of Alzheimer's disease globally could be prevented by treating midlife hearing loss that is just the most boring story no one wants to talk about hearing loss isn't going to drive a social media algorithm lack of education in early childhood five percent of cases perhaps it's the girls lacking the education and perhaps the low middle income countries which are contributing to that risk no one wants to talk about educating girls versus, you know, versus, it's far more kind of glamorous and of the moment.

1:07:49Menopause is having its moment. That is great, but the data is not clear enough to say anything about HRT and dementia. I think the fact that you said that doesn't cause it or is not going to escalate it is maybe really settling for women to hear. And I think it's such a big conversation. As you said, I'm so happy we're having these conversations around women's health. I think women are starting to feel seen after years of not feeling unseen but it is such a confusing wild west out there so much about it is i think everything is so everything is so individual as we were saying in the beginning every brain is mosaic it has its own tapestry of life put together allowing women to maybe try and test something and become connected to how they're feeling i guess is their own case study during this and having a very good physician that will listen to them and understand them.

1:08:39Maybe a woman who is also empathetic to what the other individual is going through. But I do think it's important to say that the science is still hyper unclear in this area. And as a scientist for me, I'm okay with that. But I know that for other people, it's harder to sit with the uncertainties. There are some things that we are certain about. so I guess it's easy for me to kind of say the data is mixed and we don't know but that's not because we're hiding information from people or there's disagreements it's when data is mixed let's be clear about data being mixed and being okay with that and sometimes there are plenty of things that we can do to promote brain health across the lifespan and I've written like books on this well I want you because sadly we're gonna have to get you back on yeah I know we didn't even talk about pregnancy and motherhood.

1:09:29I know, because we've run out of time and it's so sad about this. That's why you need to be a bro podcast so we can go for three and a half hours. I know. We're the anti-bro podcast, this podcast, but we have great conversations. But I do want to leave, like, if you could give women one main tip to take from today to really look after their brain health through their lifespan, what is the one tip that you would give? There are a lot of stories that we tell ourselves that are not necessarily based on good data. And I think sometimes we underestimate the power of expectations. And that is not to dismiss other people's experiences or to say things are all in your head.

1:10:13But our brain is considering all sources of data and information when it creates an experience. there is the data and information that is coming from our bodies there is the information and data making its way in through our senses from the outside world that includes every experience we had as a child growing up education and we've got these like devices that we hold in our hands like a few feet away from our face now that are streaming information from the world into our brain that our brain is considering and making meaning of and then we've got like our top-down thoughts and experiences and expectations and sometimes I think it's kind of good to take as a bit of a scientist's kind of approach or mindset to weighing all of those pieces of information up when we consider our health we tend to as I said just default to thinking that hormones particularly estrogen just this like the you know the scapegoat and blaming them and not understanding that yeah our brains are endocrine organs which react and respond and flex but our brains are social organs which are paying just as much attention to other people around us and you know the stories that they're telling us and that the context is mattering just as much as like this one kind of biological signal and I think right now we're focusing a lot on that, sex hormones or women's health from a biological perspective but we're more complicated than that and we're not always about dysfunction and decline and instability.

1:11:54My brain isn't. Flourishing, thriving and adaption. Yeah, resilient, responsive, flexible. Our brains will often perform well given the right stories. And so the last question I leave you with is, if you can give me one sentence on this, you'll be very good at this. What does live well, be well mean to you? go to bed early and don't take yourself too seriously please i love that going to bed early and not taking yourself too seriously is a great philosophy for life and there is so much more like we could have done like a four-hour episode on this we didn't we didn't cover barely the we barely scratched the surface of the cortex we barely scratched the surface but it just shows you know how much work you've done in this area how much need there is for this conversation and you know we're gonna have to get you back on when you fly back to London or if I come to Australia um because yeah women need to feel more seen than ever before and I'm I'm it's really exciting it was definitely not a conversation that I expected on the fact of our projections as much as I love Lisa Feldman Barrett I didn't think it was going to cross over pollinate into this episode and I'm really yeah surprised I'm just I just which is great I just want there to be some good news stories out there and neuroscience is it's coming up with so many good news stories and we're not hearing about them and it's and it's a shame because we are in this podcast so here I'm telling some so maybe they might start shifting people's perspectives and expectations yeah women to feel more powerful as they grow older and wiser yeah we're awesome yeah I am well everyone must get your next kind of two books your next edition of women's health women's brain book the special the second edition yeah and just quickly say about the new one that's coming out that is the new book that is coming out so the baby isn't there the baby so the surprising neuroscience of how pregnancy and motherhood sculpt our brains and Change Our Minds for the Better came out in 2023.

1:14:13Okay. Brain Health for Dummies, the Four Dummies, Wiley, you know, yellow and black Four Dummies book came out in January 2025. And the second edition of the Women's Brain book, The Neuroscience of Health, Hormones and Happiness, came out or is about to come out in the next month. So you just have too many books. Well, there's three. There's only three. There's only three in two years. That's a lot. There was no, well, because the first book came out in 2018, but there was just so much new neuroscience since 2018. I had to do an update. Love that. Which is amazing. And that makes me so happy that finally we can say there is some new research and funding into women's health.

1:14:54Oh, my God, there's so much. And there's so much more to come. And I just want to, and I don't know whether you're still recording at this point, but I have to just give the shout out to all of the scientists that are doing the work. Okay, go. Because I could not do what I do without their expertise and time and generosity, like doing all of the work and also talking to me and explaining their science and research. And I don't feel that they get enough credit because we keep talking about the gap as if no one's noticed it and no one's doing anything about it. And there is so much good science being done.

1:15:29So let's like. Give them a clap. Applause. Applause. Well, thank you. I'm very excited for this episode to come out and for everyone to hear it.