The Menopause Doctor: This Diet Delays Menopause! They're Lying To You About Menopause! Menopause Is Shrinking Your Brain! - Dr Lisa Mosconi

30:06I keep mentioned before, this is new research, relatively new research. So the only research still that looks a 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, Lisa has brain scans on her iPad in front of me, which is 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.

30:52And 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 to 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 menopause.

31:35No, 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, even 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. Whether it'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.

32:22And very specifically, it changes the functionality of your brain. And now we've done plenty of studies, I'm plenty, 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 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 the before brain, 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.

33:13What is the real world change in my behavior that people would see that I would feel that I'm experienced, that would present? One thing that's important to clarify is that not all women show these changes. So this is one woman, this is actually pretty average in terms of changes. We find that the vast majority of women experience something like this, whether they describe it such or not. Some women do not show any brain changes, are very little brain changes, and some women show much more severe brain changes. So some women's brain changes are much worse than that? Yes, yes, much more marked in many ways.

33:57And we also find changes in connectivity and changes in brain structure and changes in white matter volume and changes in glioses, which is the teeny tiny lido spots, bright spots that we find on DMRI scans as part of aging, but for women that really seems to happen more so during menopause. So how would I change if my brain changes, if I'm that woman, my brain has had those changes, how will I feel different and how will the world experience me different? This is something we're trying to understand a little bit better. These brains can't do not speak to behavior, they speak to biology, and there's never a one -to -one correlation between biology and behavior and goodness.

34:45But what we are starting to show right now, and actually we have a paper on the review that shows that these changes correlate quite strongly with brain fog, which is this feeling of mental exhaustion, where you feel cotton brain, you feel like your brain just won't turn on in some ways. And many women experience, well, 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, not a psychic evaluation, you're still performing within normal values. And this is good and bad, but a number of reasons, number one is that historically women would not be taken seriously.

35:44The overall idea is like, okay, she's going crazy, she's hormonal, she's losing her mind, 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 sinus 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 uterus. Really? Yes, yes, because ever since ancient Greek, ancient Greece, there was this mindset, this framework in medicine, where anything that a woman would report in terms of cognitive disturbances, or mental health issues, or just concerns, were immediately tracked away as there's something wrong with your uterus, and there's this weird connection between the uterus and the brain.

36:51That makes women susceptible, vulnerable to madness, or hysteria, where things like right now, we're aware of that. They were kind of right in one sense. That's the bizarre part. Yes, there is a connection, and yes, that connection can impact your mental health. But there is no reason to be put down, or be patronized, or be dismissed.

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38:40Indeed. higher ed in this harder to think clearly, right? But you know that that's going to come back. Okay. We've brain fog. 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, fog is attention in language as well. Something that's very common is this tip of the tongue. Phenomenal, you just can't come up with words and it's hard to just complete a sentence. It feels almost like aphasia in a way, which is an actual clinical syndrome or a form of dementia, even.

39:25But when you just can't come up with words and you know that you know the word, you just can find it in your head. And I know so many women who really use communication is their superpower. And they need to rely on communication for work and whatnot. 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 patterns? All the symptoms. All the symptoms. Oh yeah, it says 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.

40:06But the idea is that manopause, all the different things that happen during manopause, lead the brain to requiring itself. And there are so many different changes inside the brain that impact very specific brain regions that are important for instance, for thermal regulation, for regulating body temperature. Right. So there's this structure of the brain, which is actually exactly the structure that receives all the information from the ovaries is the first center of communication is called the hypothalamus. And is in charge of regulating body temperature. So when estrogen levels and progesterone levels are fluctuating widely, that means that the hypothalamus, which is dependent on these hormones for regulating its own functionality, will have a hard time regulating body temperature.

41:00And then as a woman, you get half lashes. Why does the brain, because it looked 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 in the ability. So there's this little structure, there are many little structures in the brain and in the rest of the body, mitochondria. And they are responsible for 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 a very interesting brain imaging technique is called 31 phosphorus MIS or magnetic resonance petroscopy.

41:52We have found that there's basically an ATP crisis in a woman's brain as most women go through manopause, but ATP is just not produced as much as it used to or perhaps is used too fast. 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're losing the superpowers of estrogen and all the things that come with it. And is that why the brain looks like the lights are going down? Because of the the loss of estrogen.

42:38MIS likely is a combination of loss of estrogen and also all these rewiring to 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 am 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 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 activity of it seems to drop.

43:22And it's really the loss of estrogen as the cause or factor of that. So if my local science here, this is science for 10 year olds over here, over this side of the table anyway, I go, okay, well, what we'll do is we'll take some estrogen and ping will inject it. Everything will be fine. The brain will stay nice and illuminated. We'll avoid the brain fog, the hot flashes, the depression, the sleep disruption and everything. We'll just inject some estrogen. Yeah. I don't know how do you administer it. I don't know how do you administer it. We'll eat it. We'll rub it. We'll rub it. We'll rub it. We'll inject it.

43:57We'll put it on top of cereal. We'll do whatever we have to do to keep it up. We'll do facial to estrogen facials. And we'll keep it up. We'll put it in the coffee. Everything. We'll smell it, sniff it. And then everything will be fine. Yeah. That's the end of the podcast then. Bye.

44:15If only it were the simple. 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, estrogen therapy was actually the number one best selling drug in America and many other parts of the world. And most women going through manopause in the 50s and 60s and 70s and whatnot will put on hormones and left on hormones, high doses of hormones for life. And the idea back then is that these hormones will not only reduce the half -flashes and make manopause better and more tolerable, we're just gentler, but would also protect against things like heart disease and dementia.

45:13And 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 half -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.

46:11And everyone panicked and so many women just stopped taking hormones overnight that also obviously kicked off a lot of lawsuits and effectively stopped research on hormones for manopause and prevention of chronic diseases. And it took 15, 20 years for the research to resume if they 10, but really it's taken a lot longer than anyone would have thought. And now we know better. The one thing that everybody says is that that studies called the Women's Health Initiative. 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.

47:02So 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. So today we have different hormones. 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 had different types of progesterone which is another important hormone.

47:48Today we tend to use bioidentical hormones rather than synthetic hormones which we use 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 is showing the hormones work best for the brain if you take them within a 10 -year window or the final menstrual period. And technically you want to start taking them prior to your final menstrual period because what these hormones do is that they stabilize your hormone 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.

48:42So your hormones don't start fluctuating back and forth and hopefully you don't even get the symptoms. They have flashes and I sweat. They're so meony. You mean analogy for that then. So those studies that were done in the 1990s, that was 160 ,000 women took part in that study. Yeah, the women self -tenacious. That's whether the disaster for an analogy. Because they were giving the hormones to women that were in their 70s, 80s. It's effectively like trying to put petrol in a car when the petrol valve is sealed or the car is pretty much. So just pumping it into there when the systems are no longer on, doesn't work.

49:23The 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 you want to just start, you really want to be thinking about taking estrogen when your, when those systems are still on and working so that it can work and sustain the systems. That's right. And the idea is to take hormones when you have the symptoms. It's kind of like a car because if you don't use a car for a long time, it just does, you know, the engine stops working.

49:55Yeah, pretty much. If you left a car for 10 years just on the side and then try to put petrol in, I'm pretty sure it still wouldn't work. There were big glitches at the minimum, right? Yeah, at the minimum. So what age then? Because you know, I've got a partner that's what she's studying 31 years old. That's young. That's young to start. I think once you have, once you start having the symptoms and manopause, so it's the heart flashes. So right now hormone therapy is only approved for viso -modern symptoms, which are heart flashes and night sweats. Okay. It's also used off label for support of sleep, especially when sleep is disrupted by having heart flashes and night.

50:39And it's also used for relief of mild, depressed symptoms that are caused by manopause 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 or cognitive function. And there are a lot of scientists, myself included, who find that a little bit puzzling, but we also agree that what research is needed. So we are trying to do the research and show that. Well, we want to understand if taken hormones can actually support cognitive function.

51:24Because look, when I go through manopause, I want to have all the solutions and options that I can possibly have. So I'm doing the research as well as I can to also help myself and a lot of other women. But right now, if you have brain fog as a manopause of hormone, 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 pillars of lifestyle adjustments for menopause are diet, exercise, sleep hygiene, stress reduction, avoid intoxines, which is where I go a little bit overboard sometimes. Regular medical checkups to make sure that you are in good health overall.

52:07And there's nothing in your medical history that might make your manopause worse. And then I am also looking into pharmaceutical options, which I do not take at this time. But I am deciding whether or not that's an option for me when the time comes. Do you know a prepper? No, 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. They don't even do, but they do other things. Like there's no plastic in my kitchen. No plastic. Okay. So let's have a look at some of these things then, our preparations and why you were choosing to do them.

52:44Before we do that, I just wanted to for people that don't know the full range of symptoms. And when they're symptoms, the phasing of manopause 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 symptoms. 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. Yep. Right. So most women in their 30s have a regular menstrual cycle. As soon as you hit 40, fish, ballpark, you still have a regular menstrual cycle, but you may start seeing changes.

53:27Some 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 pre -menopause stage and when you are about to enter the perimenopause stage, which is more complex than just one, two or three stages. So once you have a regular menstrual cycle is the pre -menopause 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.

54:11Then it starts changing a little bit, maybe just a couple of days, maybe a little bit earlier, a little bit later, lighter, heavier, but still very regular. That's the late pre -menopause stage. At that point, you may start skipping periods, but maybe you just skip you one month and then it's back. At some point, you skip you for two months and then it's back and it's regular. That's the early perimenopause stage. At that point, the most common complaint is difficulty sleeping, it's poor sleep. When women start having a hard time, not just falling asleep but staying asleep. That's usually because progesterone is going down.

54:54It's unusual to have 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, in my last just a couple of hours, perhaps less a day, but it's sent into pay attention to because that could be a preview to the menopausal transition. Then you start skipping periods and then you start skipping more periods. At some point, your periods will be more than three months apart. You have one today, nothing for three months. You're not pregnant.

55:35You will come back, but the frequency is going to diminish. You're going to get fewer and fewer periods, space the part more and more. That's the late period menopausal stage where the symptoms really creep in. 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 getfulness. It's important to know that as disruptive as that might be, it's actually not uncommon.

56:19I can't say normal because it does not feel normal for sure, but it's expected for many women. I saw in your book, you said things like vaginal dryness. Yes, that's not the brain symptom. It's 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 tensions and aches? Yeah. Look, there's a whole range of symptoms. Weight terms. Yeah, well, you can have tinnitus. Tinnitus, which is that bringing in the... Yes, or electroshox sensations. Panic attack.

57:01Please do keep going with your, that was very helpful. You're going through the phases and overlapping them with the symptoms. Yes, the delayed paramanopause stage, which is defined as not having your period for three months or more at the time, is when the symptoms really kick hard. Then, at some point, you just stop having your period for good. So, what age does the symptoms start kicking hard, typically, on average? 47. 47. 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, black and Hispanic women may experience more severe symptoms than menopause, which is something that we should really talk about, because there's hardly any research down in this.

57:59And it's completely unfair. I was reading a stat that really shocked me about suicidality. Yes, it tends to increase for women in midlife, and it tends to be at least a cartilage of going through menopause. Also, the rate of divorce is significantly higher as women transition to menopause. 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 it. So, let me get through the, so there's the late period of menopause stage. Then you heat menopause, which is a diagnosis.

58:49And then you start the early postmenopause phase. That says hard as the late period of menopause stage. So, the four years around the final menstrual period in either direction, both directions, are the hardest. So, the few years, the last three to four years before the final menstrual period and the three, four years right after the final menstrual period. Those are the worst by all accounts. This is when most women really have a hard time. 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 unacceptable and is really not okay.

59:40If you think about pregnancy, right? So, this is what I wanted to tell you before.

59:50And then menopause is that menopause is a neuroendocrine transition, specific to women that ends with reproductive senescence, 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 just getting older and cannot be compared to having a disease. 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 period menopause, right?

1:00:38Now, 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, teachers, and if you're having a hard time, everybody's very compassionate and supportive and tries to make you feel better.

1:01:22So, you're saying you're having a menopause party? Yes, I'm so little at seven men, but also I want vocabulary, because we know that, for example, with pregnancy and postpartum, 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 depression symptoms, some women have baby blues, some women have postpartum 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 in this common, and there's a range, we have a framework to address it.

1:02:05So, once you have a baby and you go to the pediatrician for the baby, you mother get a screening for depression at the pediatrician, you don't have to go to a psychiatrist, they do it right there and then, you are effectively screened the monitor to make sure that you're fine. If you have postpartum depression, we now have therapies that 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.

1:02:40You'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? No, very little. So, it's one in five OBGYN residents. What's the OBGYN for anybody that's obstetrics 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 curriculum, it's more like six, maybe eight hours in total of training throughout the entire residency program.

1:03:24So, it's not much. It's really not much. So, I would say the vast majority of specialists are not OBGYN specialists are not actually menopause 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 is 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 that even the best OBGYN specialist is not a brain specialist.

1:04:10Right? So, menopause has been pigeonholed as an issue with the ovaries, go see an OBGYN specialist where the symptoms and most women actually suffer from a 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 menopause women. Have we finished off with the stages there? So, we were done. Yeah, we're finished off. I mean, no, just one more stage.

1:04:53So, there's the early postmenopause stage. They're 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, there's the late postmenopause stage, which is the stage that a woman will live into for the rest of her life. That stage varies. And that, I find, is really interesting. For many women, the symptoms, they have flashes, the night sweats, the mood changes, the brain fog tend to go away over time. I've got a graph that'll put on the screen that shows how brain footflog changes over time. And as you can see, it's kind of like a U shape.

1:05:36So, it's, there's no brain fog. And then it goes, you have a severe brain fog. And then the brain fog seems to recover, not to the same height as it was before menopause, but postmenopause, which is getting when it gets, getting where it recovers there. This is, yeah, this is possible. Okay. So, this cognitive function, right? It's nice and high before it manopause. 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 premenopause levels, cognitive function. For most women is a little bit lower than it used to be, but still pretty good.

1:06:13This is good news. Yes, that is good news. Absolutely. But for other women, it's 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 cartilage of menopause brain fog. So, as far as I know, this is the first study that shows that there are very specific changes in the brain that's strongly associated with having or not having brain fog.

1:07:04That is the first step to then clarifying why certain women have it and certain women don't have it and how can I make it better? Right. The hormones is some other kind of therapy. How can I reverse it? How can I prevent it? So, this brings us back to this conversation around prepping. You're in this phase of life where you're prepping. What does exercise matter for menopause? So, exercise matters for everything from hormonal health to brain health to heart health because everything is interconnected. We are effectively a system where every part of you needs to be healthy for you to feel healthy as a person.

1:07:44For 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 are also made inside the brain that support neuronal health from growth hormones to very specific peptides that have a boosting functionality. And for menopause in particular, all exercise is good, but cardiovascular activity seems to be especially helpful for the heart flashes and the brain fog. Where strength training seems to be more helpful to preserve metabolic activity in bone mass, but also mood, supports mood. And flexibility exercises and mind -body techniques like yoga, pilates, tai chi, those are helpful not just for flexibility, but also for stress reduction and sleep.

1:08:47So it's good, if possible, to do a little bit of everything and if time is a constraint, then it's helpful to know the different types of exercise, maybe especially helpful for one thing or another. There's a study in your book, I think, in chapter 13, where you case study, I don't think it was a study you did around the Latin women, 3500 Latin women. I mean, but wonderful study, 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, which is a really compelling argument for exercise in that phase of life.

1:09:27And there's some other sort of related information that I read that said that women in their 40s are the highest demographic group to exercise inconsistently or not at all. So we know exercise is great for that phase of life. I know the women have no time. Is that what it is? Is it a timing issue? For most women, it's a combination of factors. I think midlife 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 maybe get a career advancement, you also want to take care of your health, and then boom, you get hormonal changes in menopause.

1:10:11So it is a bit of a, it's a different age to navigate in some ways. And what a lot of women report is that one, they have no time to take care of themselves. And number two, sometimes the reasons are outside of your control, like this fatigue, the so many women report the lack of sleep, or 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 I think it's good to be creative if you can, right? And also realized that you don't have to wear a fancy clothing, you don't have to go to the gym. It's good enough to go through the walk in the park, just keep your body moving.

1:10:56Is there a type of exercise that is too much? Can you, can you do too much exercise? Because 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 have to stay for a minute. I think that's, that's actually what, with people here, when you say exercises really good for you, and they see themselves like, oh my god, I have to join the gym and just work out three hours a day. That's not what the research shows. Is your cortisol levels would go up as well? Yes, it may happen. And also you've recovered at home may increase, especially after menopause.

1:11:31But what studies have shown is that in this case, there's an inverted U shape relationship between intensity of exercise and health gains. And they're not talking about fitness or muscle mass and thinking about overall health, how healthy, actually, are as a whole. And what the research in women, especially women who are recently postmanopause also 50, 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. In the peak of the curve is for a moderate intensity regimen at high frequency, which is you work out in a way that brings some pink -thier chicks.

1:12:20You may have a hard time singing, but you won't have a hard time talking. So your heart rate goes up, but not so high up that you can't breathe, basically, actually. And there's different intensity intervals, of course. Rich Rol called it, he said to me, this is what professional athletes called zone two.

1:12:43But if you increase the intensity a lot 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 you can try to shoot for this zone to moderate intensity exercises. 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 that exercise more have less of those Alzheimer's plaques? Yes. Yes, you do have a 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 all day as compared to women who are said in tired in midlife.

1:13:37So 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. Is it my personal trainer? Yes, very right. But the prescription is try to exercise at least moderate intensity level, but do it consistently enough, which means three to five times a week. So let's talk about your diet then. Your diet regime as you prepare for that phase of life. Let's start with caffeine. Oh, yes. I switched to decaf. You don't seem happy about that. Everybody's English in my house. Yes, so you're ready to switch to decaf.

1:14:22Why? Because caffeine is a little bit of a trigger for sleep disturbances for a lot of women. And what people don't realize is that caffeine is not just like a coffee that you drink at the moment, although you do feel a little bit of the energy rash. But what happens is that caffeine 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 give read of all the caffeine from your body and your brain, which also means if you drink a cup of coffee in noon, some of that caffeine is still going to be in your system at 10 p .m.

1:15:13And if you drink a cup of coffee at 2 p .m., half of the caffeine will be in your system by 8 p .m. In 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 nice sleep unless you go to sleep late, which I can't afford because I'm up at 6. So could one also argue then that coffee is going to increase? Could because if coffee is still in our brain, if I have a coffee at 9 p .m., you know people used to have coffees after dinner, it's not mad. They still do that in restaurants.

1:15:51You eat your food and then they come around and ask if you want an espresso. Absolutely psychopaths. I have no idea. It's so crazy. They don't ask as much anymore. That's how they just. This is again, it's the idea of optimizing for one thing without realizing that you're de -optimizing for another. So you improve their just -tune in some ways, but you're disrupting your sleep. Because it's waking your body back up and going, going, yeah, just before you need to sleep. Right. So if I have a coffee, say 6 p .m. 7 p .m. 8 p .m. at night, a midnight, you still have to have a de -caféine. Which means I'm not going to sleep as well, which means my brain isn't going to do its job of clearing things out in restoration.

1:16:30That's exactly why it's going to increase my chance of dementia and Alzheimer's. Yes, because what happens is then 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.

1:17:08So 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 Glimphatic System that gets activated only during slow wave sleep. And it's like a car wash, you know, it's like a dishwasher, just 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 us, unfortunately, tend to wake up in like two or three in the morning when we should be in deep sleep, but we're not because we wake up.

1:17:54And 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 in Alzheimer's as well then. It 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 really make them worse. My biggest concern is that alcohol is a dehydrating substance. It's defunctional, it's one of the main functionality of alcohol is a molecule is dehydrating.

1:18:36And 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. We're even a 2 to 4 % water reduction of water volume loss can prompt neurological symptoms. They 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.

1:19:24But also at any age, it can really have a bad impact on cognitive function. To some studies, they found 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 neuropsych testing and reaction times, computerized tests, then measure your presence is pede. 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. Yeah, I need to start drinking water on this podcast.

1:20:04Yes, and look, yes, you should. And I will also say that water isn't just water. A lot of people drink purified water. That's not water. That's just fluid. So your brain doesn't just want something 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. And one thing that we did at home is that we installed this ginormous filter for the entire house where the water is now filtered in a way that removes all the impurities but preserves all the electrolytes. What else have you done in the shower?

1:20:45Sort of signed to slab of a house that you're building this. You mentioned toxins. I'm a little district. Sounds like it. 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 when you put plastic in the dishwasher, the hot water will make it leak. And then it leaks into your plates and glasses and whatnot. And then you drink it right back or you eat it right back when you put food on a plate.

1:21:27So pollutants in general accumulate in an organism, concentrate in an organism by bio -accumulation, which means that you start to lower doses by the 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 tissues. So they've been linked to an increased risk of reproductive issues, they reproductive infertility and the metriosis, thyroid disease, and more recently to dementia as well.

1:22:11Not plastic in particular, but pollutants in general. Risk cancer? Risk cancer, yeah, reproductive cancer as well. And you could never say it's 100 % these are 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? 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, so it's always been neurochemistry. And I was learning about all these different molecules and all these different chemical reactions that are so important for brain function and neuronal health and whatnot.

1:22:58And 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 our brain health or the opposite and feed our brain garbage that is going to be unfortunately incorporated in the fabric of your brain. And I don't want that. I don't want that for sure. I don't want that for my brain.

1:23:38Exactly.

1:23:42So it's really important to focus on clean foods that are nutrient dense and that prioritized 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 fat inside your brain, which is absolutely not correct. The cholesterol from the diet can never get inside your brain.

1:24:27There's no way for the substance to actually get inside your head. I mean, your head is, 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 antioxidant like vitamin C, vitamin E, selenium, beta -carotene, things that you find in fruits and veggies, basically in some nuts and seeds, preferentially, lean proteins, amino acids, the essential amino acids, and polyensaturated fatty acids, which can be from plant -based sources or animal sources, but they really have to be the polyensaturated fatty acids that the brain really wants and needs and need to be replenished consistently.

1:25:19If I'm struggling with minerals, 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 at least here, there's a tendency to recommend really high doses of supplements to everyone across the board. But we do know that supplements only work if you have a deficiency or at least the sub -cleanical deficiencies.

1:25:59Whereas giving high doses is something that your body or let's say the brain enlist, I just stay in my lane. Well, high doses are something that your brain doesn't want or need. They're not going to be very helpful. You're just going to either pit them out or they're just going to accumulate in other parts of the body so they're not as helpful. Does everyone not talk to me about the brain? Talk to me about omega -3 as a supplement that I should take for it. Every time I take omega -3, 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.

1:26:39Now, 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 -3 is yes. Those are the polyensaturated fatty acids that the brain really needs. Antioxidants as well. I take vitamin C. Okay. So you are on the supplements. You were just trying to keep them all to yourself. No. Okay. Well, you know what I really like is more extracts. Okay. In botanicals. Okay. I'm not take my pill kind of person. I actually get quite annoyed when I need to take pills. I just don't like it. I think because I work in a hospital. So associate that as being sick.

1:27:20I don't like that feeling. But what I really enjoy is to get my nutrients from either extra to concentrates, from plants, imbeciles, 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, I said, sometimes you give me the eye, really. Yeah. Yeah. Yeah. You know what? No, no. No, no, no. And I is a wonderful juice from the Pacific Islands that has a lid of a bitter taste, which is always good because beaders. I really get for digests and get help. And that's important for brain health and elimination as well in clearance.

1:28:01And it's very rich in vitamins and minerals and a lot of phytonutrients. So that's a good concentrate of the source. And this mix with blue beverages. So that's, that's so really good to have. One of the things I found quite fascinating is I read that there was a study done on legumes that proved, yeah. It was in your book. It was in chapter 14 where it says there's a legumes apparently to be, it seemed 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 has been linked with the later onset of menopause. By how much? Three years.

1:28:44Whereas women who follow the standard of the American diet, like they said, diet with more, lots of sugary beverages and processed foods and packaged meats and whatnot, that's been linked with an earlier onset of menopause by about three or 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 women who do consume enough omega -3 may experience different types of menstrual pains and fertility issues and stuff. Yeah. Well, the research shows an association between consumption of omega -3 fatty acids and well, also lower risk of depression and recurrent depressive symptoms in menopause as well as fertility overall.

1:29:41And the same for antioxidants. Antioxidants have also been linked with the gentler menopause overall and fewer menstrual cramps and less pain. And the lower risk of pre -manstual syndrome as well. Okay, 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 a clear and obvious survival benefit and reason. But when I think about menopause, it's hard to see on the surface what the evolutionary reason for such a process is. Why does it happen? Why don't women just, why don't women's estrogen levels just stay the same throughout their life until they die?

1:30:26Because 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 genes on to the next generation. So the fact that women would stop being reproductive in midlife and be able to live after that is clearly against the classic theories of evolution.

1:31:09But I was thinking about this and I was thinking, well, is it not just because in the 1700s, 1800s, the average life expectancy was like 3540? 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 will stop being reproductive and hopefully remain alive. So for, this is what I will tell you that if you're born with ovaries, that manopause seems to be just a factor life. There is an understanding that at some point your ovaries will stop ovulating and you'll go through manopause. But in reality, manopause is a biological puzzle.

1:31:54It's a big question mark because most animal species, in most animal species, females actually die right after manopause. So your lifespan as a female animal tends to match your reproductive span, which is what Darwin was talking about. Now, this theory only makes sense if you are not able to outlive manopause. And there are two different theories when it comes to manopause that are people who, like Darwin, say, well, women should just die. Or women are supposed to die after manopause, like all other animals on the planet, except just a few like killer whales. For example, killer whales are able to live long past manopause.

1:32:47They do some elephant and some giraffes and some insects, interesting enough. But then there's another theory that says, no, no, no, it's not just medical improvements are supporting women and enabling women to live past manopause. The reality is that manopause makes sense for a number of reasons. And this is called the grandmother hypothesis. And what this hypothesis says is 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 China, you have to grow a child, and there's a strong risk of dying from childbirth, the older you are, and there's also a risk to the offspring, to the children, the older the mother is.

1:33:40Then it makes a lot more sense to stop being reproductive at some point in your life and remain alive to help your dozers and your sons and your grandchildren by providing all the resources that they need for them to outlive, to keep on going and keep having children. So the theory is that 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 pregnancies, the most fit of women at that point, somehow wonder when to desmetations that enabled, or perhaps those were able to activate their longevity genes, where their bodies evolved to be able to outlive manopause by many, many years, if put in the right environment, of course.

1:34:37And 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.

1:35:15So that makes sense for humans, the women would 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 manopause is actually an issue because we're living longer? Yes, I really don't get 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 manopause. Our brains are wired, our bodies are wired. And the idea that there is such a mechanism in place suggests adaptation.

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1:37:14That's true, though, isn't it? A lot of women do go through divorce in that phase of life. It seems that in our divorce is increased exponentially. They just have pointed life. No, they want a little bit more. Yes. I think 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 is not my work, but other people have shown that there's one part to the brain called the amygdala that's in charge of emotional control.

1:37:51It's like the center, the emotional center in the brain. And after Manopause, 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 amygdala 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 wanderer is, if not amplified, is certainly stable. And that's been linked with better emotional control after Manopause. And those emotional transcendence that in the words of many of my friends is really more like given fewer f words.

1:38:44I've actually got a graph that I found in your work that shows that by the time women are in their 60s, 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 functional manopause. And look, we have the graph here. Oh, is that the graph here? Yeah, perfect. So, this is what these studies have shown. And of course, it's not universal. It's never universal. They're women who are miserable before and after Manopause and women are happy all the time. But there seems to be again a little bit of this you curve where life contentment is, whatever it is, is baseline over here.

1:39:23And then it takes a dip during the transition to Manopause when a lot of women just have a hard time. I think it's important to acknowledge that. But then life contentment goes back up. See, that's the window before, I did three to six years after Manopause 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 postmanopause 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 that shows the impact of so you call it a surgical Manopause.

1:40:05Yeah, do you want to see that? Yes, please, yeah. What many people just be honest, nobody talks about surgical Manopause, right? What happens sometimes very often actually is that women need to have their uterus removed with or without the ovaries often enough before Manopause. These are very common surgical procedures. In fact, he's interacting me. 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 nine 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, medical societies, recommended removing the ovaries all the time as part of his rectomy.

1:41:02So 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 the legnutty, but it's more for things like endometriosis or benign reasons. Up until 2008, the surgeon would 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 three million women who had their uterus is removed in America, over half also had their ovaries removed without a medical reason to do so. It was just common practice to say, while I'm in there, let's get rid of the ovaries as well.

1:41:59Why? Because it's as murder, it's a more straightforward surgery, and also that reduces the risk of developing a variant cancer in the future. While that is true, the risk of a variant 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 and women who had a menstrual cycle, would effectively plunge the woman into menopause almost overnight. And the consequences are far more severe than going through menopause as part of the age in process. And the toll on the brain is actually significant because surgical menopause has been linked with an increased risk of cognitive decline in dementia, Parkinsonism, stroke, a major anxiety and depression.

1:42:53So this is something that we need to talk about. In 2008, the American College of Obeginin Surgery changed the recommendations, saying that they now recommend 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, allow the surgeons advise their patients to have the ovaries taken out even when the ovaries are healthy because of surgical considerations without necessarily thoughtfully explaining the possible side effects of that procedure.

1:43:46And look, this is not to say the 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 anopause may be more severe, and we know that there'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.

1:44:23And this is what I wanted to show you, which just ended up studying. I'll say to everybody that's watching the podcast, it's on the screen, but for those that aren't watching the podcast because you're listening and you're walking 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 opherectomy. The evidence that we have so far is more clinical, so we know that we're fractures are associated with all these risks or neurological disorders, but to my knowledge, there are no studies that are really looking at women's brains before and after the surgery.

1:45:14If 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 who's been working with us for over a year and we have 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 will also show in parts of the brain that is losing gray matter and those are shown as blue blobs, I would say, there are blue spots over the brain scans which show the parts of the brain that are losing vomit.

1:46:08So this is the brain before the surgery. This is the brain six 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 the minute 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. But there's an overall thinning. And it just goes to show that that relationship between the ovaries and the brain. Yeah, and this is very direct because one of the things that been happening to us for a few years now there were study manopause instead there's pushback that what we're seeing is not manopause is just aging.

1:47:02And look, I'll show you one more thing that we've done to say no, it's not actually just staging. It's much more likely to be menopause in agents. 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 a regular menstrual cycle. She's in peri manopause. 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 lady there in premenopause, her brain is really, really illuminated.

1:47:42And then the same, a different lady but the same age in postmenopause. I mean, yeah, it 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 of group differences. But still, you can't tell me this is your stage. How do you, because you know this, 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, there's the whole process.

1:48:21You do things and then you wait for other people to replicate where 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 the 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 hormones.

1:49:10I don't know. She's not a hormones and the time is showing their scans. But we're also looking at what we're also doing clinical trials to test whether hormone therapy can change these brain scans. So this is another thing that's quite upsetting as a woman and the scientist. The only clinical trials have looked at the effects 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 hormone therapy in women who are pyramidopause, for example, which is bizarre to say the least.

1:49:59So we started, we're doing one right now. So we have an active clinical trial where the other concern is that hormone therapy has this terrible reputation for being linked with a higher risk of breast cancer. Right. And that's been addressed in professional societies are saying actually whatever risk increases very small and it's actually a rare occurrence. But there's history. There's history and a lot of the women are just scared of taking hormones. And so what we're doing we're working with an alternative which is an estrogen. Is a designer estrogen? It's a designer estrogen. I'm very excited about that.

1:50:38So this is the new generation of hormone options, hormonal options. They're called selective estrogen receptor modulators or serms or designer estrogens. And the one we're testing is called the Nuro Serm. It's a serum is an estrogen for the brain. There's been very specifically developed by my colleague Dr. Roberta Diaz -Brington at the University of Arizona. She's a genius. She's an absolute roxer in this field. And she's been studying estrogen in the brain since the 1990s. And she's amazing. And she was like, okay, I am tired of hearing that people want to hormones because of this problem with the breast cancer link and association.

1:51:21We'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, exactly the GPS for your brain and leaves your breast roveries 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 with a cognitive testing, we do all sorts of evaluations and we're actively enrolling participants.

1:52:10So if anyone is interested, we're looking for Pyramenopausal and Postmenopausal Women with Hap Flashes, specifically women who have at least seven or more Hap 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 NIH, the National Institute of Don't Health is a face to randomize placebo control clinical trial, which means it's one of the most thorough clinical trials you'll ever get. How do they get in touch with you if they don't 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 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 partner about, said the best predictor of when a woman will go through menopause is when her mother went through menopause.

1:53:12And the experience of the symptoms of menopause is similar to for mother and for daughter. Another indicator is the 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 to understand their experience with menopause because it might be the clearest indicator 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.

1:53:44And 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 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 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.

1:54:24My mom talked to me about puberty and periods, of course, because you had to be prepared in it to know what to do. She never once mentioned menopause until I asked, how was it for you? What age? You know, should I eat what am I exactly? What's going to be 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 thank you so much for sharing it in the way that you do and doing the work that you do because you're really shining a light on a very unaluminated part of life that I think by 2025, they say that a billion women are going to be experiencing or have gone through menopause, which is crazy.

1:55:10A billion people that walk amongst us, that's what one in eight, one in nine 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 daughter, whoever it is. So being armed with this information helps us to be, I think, better supporting acts to those people, but it helps us to understand ourselves better and helps us to be a 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.

1:55:39And 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 is 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 shunned, they can be rejected, they can be misunderstood. And that's exactly what you're working for.

1:56:05And 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 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, but the last guest leaves the 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?

1:56:38Good news. My parents are here right now. Oh, one last time, 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 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 never felt to my own. I always felt like I had a safety net, both financially, legally, physically and mentally. And it's just such a blessing.

1:57:24And I would just say thank you. Love you so much. And I'm sorry that that was difficult when I was a teenager. I think I redeemed myself. You certainly have. Thank you so much for all the work you're doing. And I have to say this, I am last time I had a conversation about menopause. I the people that don't realize how 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 and so many of pure rage, crying spells, the list goes on, I'm 43 and I literally do not recognise myself. And the other top comment was, sweating I can deal with, hot flashes I can deal with.

1:58:04What I can't deal with is the paralyzing fear, anxiety, depression and fatigue. Those were 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 stigmatise 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. Because again, 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.

1:58:35Really appreciate it.

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