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Women are works of art.

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On the outside as on the inside.

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I am a neuroscientist,
and I focus on the inside,

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especially on women's brains.

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There are many theories
on how women's brains differ

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from men's brains,

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and I've been looking
at brains for 20 years

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and can guarantee
that there is no such thing

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as a gendered brain.

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Pink and blue, Barbie and Lego,

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those are all inventions
that have nothing to do

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with the way our brains are built.

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That said, women's brains
differ from men's brains

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in some respects.

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And I'm here to talk
about these differences,

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because they actually matter
for our health.

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For example,

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women are more likely than men
to be diagnosed with an anxiety disorder

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or depression,

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not to mention headaches and migraines.

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But also, at the core of my research,

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women are more likely than men
to have Alzheimer's disease.

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Alzheimer's disease
is the most common cause

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of dementia on the planet,

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affecting close to six million people
in the United States alone.

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But almost two thirds of all those people

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are actually women.

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So for every man
suffering from Alzheimer's

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there are two women.

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So why is that overall?

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Is it age?

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Is it lifespan?

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What else could it be?

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A few years ago,

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I launched the Women's Brain Initiative

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at Weill Cornell Medicine
in New York City,

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exactly to answer those questions.

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And tonight, I'm here with some answers.

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So it turns out
our brains age differently,

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and menopause plays
a key role here for women.

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Now most people think of the brain
as a kind of black box,

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isolated from the rest of the body.

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But in reality, our brains
are in constant interaction

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with the rest of us.

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And perhaps surprisingly,

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the interactions
with the reproductive system

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are crucial for brain aging in women.

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These interactions
are mediated by our hormones.

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And we know that hormones differ
between the genders.

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Men have more testosterone,
women have more estrogens.

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But what really matters here

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is that these hormones differ
in their longevity.

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Men's testosterone doesn't run out
until late in life,

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which is a slow and pretty much
symptom-free process, of course.

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(Laughter)

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Women's estrogens, on the other hand,

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start fading in midlife, during menopause,

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which is anything but symptom-free.

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We associate menopause with the ovaries,

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but when women say
that they're having hot flashes,

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night sweats, insomnia,
memory lapses, depression, anxiety,

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those symptoms don't start in the ovaries.

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They start in the brain.

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Those are neurological symptoms.

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We're just not used
to thinking about them as such.

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So why is that?

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Why are our brains impacted by menopause?

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Well, first of all,

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our brains and ovaries are part
of the neuroendocrine system.

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As part of the system,
the brain talks to the ovaries

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and the ovaries talk back to the brain,

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every day of our lives as women.

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So the health of the ovaries
is linked to the health of the brain.

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And the other way around.

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At the same time,

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hormones like estrogen
are not only involved in reproduction,

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but also in brain function.

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And estrogen in particular, or estradiol,

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is really key for energy
production in the brain.

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At the cellular level,

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estrogen literally pushes neurons
to burn glucose to make energy.

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If your estrogen is high,

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your brain energy is high.

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When your estrogen declines though,

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your neurons start slowing down
and age faster.

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And studies have shown that this process

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can even lead to the formation
of amyloid plaques,

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or Alzheimer's plaques,

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which are a hallmark
of Alzheimer's disease.

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These effects are stronger
in specific brain regions,

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starting with the hypothalamus,

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which is in charge of regulating
body temperature.

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When estrogen doesn't activate
the hypothalamus correctly,

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the brain cannot regulate
body temperature correctly.

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So those hot flashes that women get,

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that's the hypothalamus.

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Then there's the brain stem,
in charge of sleep and wake.

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When estrogen doesn't activate
the brain stem correctly,

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we have trouble sleeping.

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Or it's the amygdala,

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the emotional center of the brain,
close to the hippocampus,

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the memory center of the brain.

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When estrogen levels ebb in these regions,

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we start getting mood swings perhaps

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and forget things.

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So this is the brain anatomy
of menopause, if you will.

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But let me show you

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what an actual
woman's brain can look like.

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So this is a kind of brain scan

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called positron emission
tomography or PET.

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It looks at brain energy levels.

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And this is what you want
your brain to look like

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when you're in your 40s.

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Really nice and bright.

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Now this brain belongs to a woman
who was 43 years old

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when she was first scanned,
before menopause.

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And this is the same brain
just eight years later,

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after menopause.

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If we put them side by side,

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I think you can easily see
how the bright yellow

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turned orange, almost purple.

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That's a 30 percent drop
in brain energy levels.

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Now in general,

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this just doesn't seem to happen
to a man of the same age.

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In our studies with hundreds of people,

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we show that middle-aged men
usually have high brain energy levels.

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For women, brain energy
is usually fine before menopause,

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but then it gradually declines
during the transition.

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And this was found independent of age.

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It didn't matter
if the women were 40, 50 or 60.

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What mattered most
was that they were in menopause.

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So of course we need
more research to confirm this,

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but it looks like 
women's brains in midlife

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are more sensitive to hormonal aging

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than just straight up chronological aging.

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And this is important information to have,

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because so many women
can feel these changes.

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So many of our patients have said to me

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that they feel like their minds
are playing tricks on them,

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to put it mildly.

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So I really want to validate this,
because it's real.

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And so just to clarify, if this is you,

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you are not crazy.

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(Laughter)

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(Applause)

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Thank you.

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It's important.

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So many women have worried
that they might be losing their minds.

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But the truth is that your brain
might be going through a transition,

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or is going through a transition

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and needs time and support to adjust.

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Also, if anyone is concerned

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that middle-aged women
might be underperformers,

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I'll just quickly add
that we looked at cognitive performance,

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God forbid, right?

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(Laughter)

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Let's not do that.

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But we looked at cognitive performance,

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and we found absolutely no differences
between men and women

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before and after menopause.

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And other studies confirm this.

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So basically, we may be tired,

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but we are just as sharp.

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(Laughter)

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Get that out of the way.

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That all said,

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there is something else more serious
that deserves our attention.

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If you remember,

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I mentioned that estrogen declines
could potentially promote

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the formation of amyloid plaques,
or Alzheimer's plaques.

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But there's another kind of brain scan
that looks exactly at those plaques.

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And we used it to show
that middle-aged men hardly have any,

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which is great.

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But for women,

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there's quite a bit of an increase
during the transition to menopause.

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And I want to be really, really clear here

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that not all women develop the plaques,

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and not all women with the plaques
develop dementia.

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Having the plaques is a risk factor,

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it is not in any way a diagnosis,
especially at this stage.

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But still, it's quite an insight

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to associate Alzheimer's with menopause.

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We think of menopause
as belonging to middle age

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and Alzheimer's as belonging to old age.

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But in reality,

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many studies, including my own work,

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had shown that Alzheimer's disease
starts with negative changes in the brain

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years, if not decades,
prior to clinical symptoms.

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So for women,

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it looks like this process
starts in midlife,

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during menopause.

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Which is important information to have,

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because it gives us a time line
to start looking for those changes.

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So in terms of a time line,

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most women go through menopause
in their early 50s.

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But it can be earlier,

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often because of medical interventions.

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And the common example is a hysterectomy
and/or an oophorectomy,

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which is the surgical
removal of the uterus

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and/or the ovaries.

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And unfortunately, there is evidence

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that having the uterus
and, more so, the ovaries removed

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prior to menopause

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correlates with the higher risk
of dementia in women.

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And I know that this is upsetting news,

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and it's definitely depressing news,

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but we need to talk about it

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because most women
are not aware of this correlation,

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and it seems like very important
information to have.

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Also, no one is suggesting
that women decline these procedures

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if they need them.

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The point here is that we really need
to better understand

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what happens to our brains
as we go through menopause,

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natural or medical,

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and how to protect
our brains in the process.

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So how do we do that?

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How do we protect our brains?

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Should we take hormones?

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That's a fair question,
it's a good question.

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And the shortest possible answer right now

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is that hormonal therapy can be helpful

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to alleviate a number of symptoms,
like hot flashes,

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but it's not currently recommended
for dementia prevention.

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And many of us are working
on testing different formulations

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and different dosages
and different time lines,

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and hopefully, all this work will lead
to a change in recommendations

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in the future.

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Meanwhile, there are other things
that we can do today

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to support our hormones
and their effects on the brain

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that do not require medications

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but do require taking a good look
at our lifestyle.

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That's because the foods we eat,

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how much exercise we get,

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how much sleep we get or don't get,

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how much stress we have in our lives,

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those are all things that can actually
impact our hormones --

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for better and for worse.

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Food, for example.

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There are many diets out there,

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but studies have shown
that the Mediterranean diet in particular

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is supportive of women's health.

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Women on this diet have a much lower risk

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of cognitive decline, of depression,

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of heart disease,
of stroke and of cancer,

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and they also have fewer hot flashes.

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What's interesting about this diet

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is that it's quite rich in foods
that contain estrogens

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in the form of phytoestrogens
or estrogens from plants

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that act like mild estrogens
in our bodies.

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Some phytoestrogens have been linked
to a possible risk of cancer,

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but not the ones in this diet,
which are safe.

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Especially from flax seeds,

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sesame seeds, dried apricots,

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legumes and a number of fruits.

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And for some good news,

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dark chocolate
contains phytoestrogens, too.

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So diet is one way to gain estrogens,

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but it's just as important to avoid things
that suppress our estrogens instead,

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especially stress.

260
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Stress can literally steal your estrogens,

261
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and that's because cortisol,
which is the main stress hormone,

262
00:11:56,833 --> 00:11:59,434
works in balance with our estrogens.

263
00:11:59,458 --> 00:12:02,143
So if cortisol goes up,
your estrogens go down.

264
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If cortisol goes down,
your estrogens go back up.

265
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So reducing stress is really important.

266
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It doesn't just help your day,

267
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it also helps your brain.

268
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So these are just a few things

269
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that we can do to support our brains

270
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and there are more.

271
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But the important thing here

272
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is that changing the way
we understand the female brain

273
00:12:22,000 --> 00:12:25,143
really changes the way
that we care for it,

274
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and the way that we frame women's health.

275
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And the more women
demand this information,

276
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the sooner we'll be able to break
the taboos around menopause,

277
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and also come up with solutions
that actually work,

278
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not just for Alzheimer's disease,

279
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but for women's brain health as a whole.

280
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Brain health is women's health.

281
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Thank you.

282
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(Applause)

283
00:12:47,542 --> 00:12:48,809
Thank you.

284
00:12:48,833 --> 00:12:50,083
Oh, thank you.