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← How menopause affects the brain

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Showing Revision 9 created 03/10/2020 by Oliver Friedman.

  1. Women are works of art.
  2. On the outside as on the inside.
  3. I am a neuroscientist,
    and I focus on the inside,
  4. especially on women's brains.
  5. There are many theories
    on how women's brains differ

  6. from men's brains,
  7. and I've been looking
    at brains for 20 years
  8. and can guarantee
    that there is no such thing
  9. as a gendered brain.
  10. Pink and blue, Barbie and Lego,
  11. those are all inventions
    that have nothing to do
  12. with the way our brains are built.
  13. That said, women's brains
    differ from men's brains

  14. in some respects.
  15. And I'm here to talk
    about these differences,
  16. because they actually matter
    for our health.
  17. For example,
  18. women are more likely than men
    to be diagnosed with an anxiety disorder
  19. or depression,
  20. not to mention headaches and migraines.
  21. But also, at the core of my research,
  22. women are more likely than men
    to have Alzheimer's disease.
  23. Alzheimer's disease
    is the most common cause
  24. of dementia on the planet,
  25. affecting close to six million people
    in the United States alone.
  26. But almost two thirds of all those people
  27. are actually women.
  28. So for every man
    suffering from Alzheimer's
  29. there are two women.
  30. So why is that overall?
  31. Is it age?
  32. Is it lifespan?
  33. What else could it be?
  34. A few years ago,

  35. I launched the Women's Brain Initiative
  36. at Weill Cornell Medicine
    in New York City,
  37. exactly to answer those questions.
  38. And tonight, I'm here with some answers.
  39. So it turns out
    our brains age differently,

  40. and menopause plays
    a key role here for women.
  41. Now most people think of the brain
    as a kind of black box,
  42. isolated from the rest of the body.
  43. But in reality, our brains
    are in constant interaction
  44. with the rest of us.
  45. And perhaps surprisingly,
  46. the interactions
    with the reproductive system
  47. are crucial for brain aging in women.
  48. These interactions
    are mediated by our hormones.
  49. And we know that hormones differ
    between the genders.
  50. Men have more testosterone,
    women have more estrogens.

  51. But what really matters here
  52. is that these hormones differ
    in their longevity.
  53. Men's testosterone doesn't run out
    until late in life,
  54. which is a slow and pretty much
    symptom-free process, of course.
  55. (Laughter)

  56. Women's estrogens, on the other hand,

  57. start fading in midlife, during menopause,
  58. which is anything but symptom-free.
  59. We associate menopause with the ovaries,
  60. but when women say
    that they're having hot flashes,
  61. night sweats, insomnia,
    memory lapses, depression, anxiety,
  62. those symptoms don't start in the ovaries.
  63. They start in the brain.
  64. Those are neurological symptoms.
  65. We're just not used
    to thinking about them as such.
  66. So why is that?
  67. Why are our brains impacted by menopause?
  68. Well, first of all,

  69. our brains and ovaries are part
    of the neuroendocrine system.
  70. As part of the system,
    the brain talks to the ovaries
  71. and the ovaries talk back to the brain,
  72. every day of our lives as women.
  73. So the health of the ovaries
    is linked to the health of the brain.
  74. And the other way around.
  75. At the same time,
  76. hormones like estrogen
    are not only involved in reproduction,
  77. but also in brain function.
  78. And estrogen in particular, or estradiol,
  79. is really key for energy
    production in the brain.
  80. At the cellular level,

  81. estrogen literally pushes neurons
    to burn glucose to make energy.
  82. If your estrogen is high,
  83. your brain energy is high.
  84. When your estrogen declines though,
  85. your neurons start slowing down
    and age faster.
  86. And studies have shown that this process
  87. can even lead to the formation
    of amyloid plaques,
  88. or Alzheimer's plaques,
  89. which are a hallmark
    of Alzheimer's disease.
  90. These effects are stronger
    in specific brain regions,

  91. starting with the hypothalamus,
  92. which is in charge of regulating
    body temperature.
  93. When estrogen doesn't activate
    the hypothalamus correctly,
  94. the brain cannot regulate
    body temperature correctly.
  95. So those hot flashes that women get,
  96. that's the hypothalamus.
  97. Then there's the brain stem,
    in charge of sleep and wake.
  98. When estrogen doesn't activate
    the brain stem correctly,
  99. we have trouble sleeping.
  100. Or it's the amygdala,
  101. the emotional center of the brain,
    close to the hippocampus,
  102. the memory center of the brain.
  103. When estrogen levels ebb in these regions,
  104. we start getting mood swings perhaps
  105. and forget things.
  106. So this is the brain anatomy
    of menopause, if you will.
  107. But let me show you

  108. what an actual
    woman's brain can look like.
  109. So this is a kind of brain scan
  110. called positron emission
    tomography or PET.
  111. It looks at brain energy levels.
  112. And this is what you want
    your brain to look like
  113. when you're in your 40s.
  114. Really nice and bright.
  115. Now this brain belongs to a woman
    who was 43 years old
  116. when she was first scanned,
    before menopause.
  117. And this is the same brain
    just eight years later,
  118. after menopause.
  119. If we put them side by side,
  120. I think you can easily see
    how the bright yellow
  121. turned orange, almost purple.
  122. That's a 30 percent drop
    in brain energy levels.
  123. Now in general,

  124. this just doesn't seem to happen
    to a man of the same age.
  125. In our studies with hundreds of people,
  126. we show that middle-aged men
    usually have high brain energy levels.
  127. For women, brain energy
    is usually fine before menopause,
  128. but then it gradually declines
    during the transition.
  129. And this was found independent of age.
  130. It didn't matter
    if the women were 40, 50 or 60.
  131. What mattered most
    was that they were in menopause.
  132. So of course we need
    more research to confirm this,

  133. but it looks like
    women's brains in midlife
  134. are more sensitive to hormonal aging
  135. than just straight up chronological aging.
  136. And this is important information to have,
  137. because so many women
    can feel these changes.
  138. So many of our patients have said to me
  139. that they feel like their minds
    are playing tricks on them,
  140. to put it mildly.
  141. So I really want to validate this,
    because it's real.
  142. And so just to clarify, if this is you,
  143. you are not crazy.
  144. (Laughter)

  145. (Applause)

  146. Thank you.

  147. It's important.

  148. So many women have worried
    that they might be losing their minds.
  149. But the truth is that your brain
    might be going through a transition,
  150. or is going through a transition
  151. and needs time and support to adjust.
  152. Also, if anyone is concerned
  153. that middle-aged women
    might be underperformers,
  154. I'll just quickly add
    that we looked at cognitive performance,
  155. God forbid, right?
  156. (Laughter)

  157. Let's not do that.

  158. But we looked at cognitive performance,
  159. and we found absolutely no differences
    between men and women
  160. before and after menopause.
  161. And other studies confirm this.
  162. So basically, we may be tired,
  163. but we are just as sharp.
  164. (Laughter)

  165. Get that out of the way.

  166. That all said,

  167. there is something else more serious
    that deserves our attention.
  168. If you remember,
  169. I mentioned that estrogen declines
    could potentially promote
  170. the formation of amyloid plaques,
    or Alzheimer's plaques.
  171. But there's another kind of brain scan
    that looks exactly at those plaques.
  172. And we used it to show
    that middle-aged men hardly have any,
  173. which is great.
  174. But for women,
  175. there's quite a bit of an increase
    during the transition to menopause.
  176. And I want to be really, really clear here
  177. that not all women develop the plaques,
  178. and not all women with the plaques
    develop dementia.
  179. Having the plaques is a risk factor,
  180. it is not in any way a diagnosis,
    especially at this stage.
  181. But still, it's quite an insight

  182. to associate Alzheimer's with menopause.
  183. We think of menopause
    as belonging to middle age
  184. and Alzheimer's as belonging to old age.
  185. But in reality,
  186. many studies, including my own work,
  187. had shown that Alzheimer's disease
    starts with negative changes in the brain
  188. years, if not decades,
    prior to clinical symptoms.
  189. So for women,
  190. it looks like this process
    starts in midlife,
  191. during menopause.
  192. Which is important information to have,
  193. because it gives us a time line
    to start looking for those changes.
  194. So in terms of a time line,

  195. most women go through menopause
    in their early 50s.
  196. But it can be earlier,
  197. often because of medical interventions.
  198. And the common example is a hysterectomy
    and/or an oophorectomy,
  199. which is the surgical
    removal of the uterus
  200. and/or the ovaries.
  201. And unfortunately, there is evidence
  202. that having the uterus
    and, more so, the ovaries removed
  203. prior to menopause
  204. correlates with the higher risk
    of dementia in women.
  205. And I know that this is upsetting news,
  206. and it's definitely depressing news,
  207. but we need to talk about it
  208. because most women
    are not aware of this correlation,
  209. and it seems like very important
    information to have.
  210. Also, no one is suggesting
    that women decline these procedures

  211. if they need them.
  212. The point here is that we really need
    to better understand
  213. what happens to our brains
    as we go through menopause,
  214. natural or medical,
  215. and how to protect
    our brains in the process.
  216. So how do we do that?

  217. How do we protect our brains?
  218. Should we take hormones?
  219. That's a fair question,
    it's a good question.
  220. And the shortest possible answer right now
  221. is that hormonal therapy can be helpful
  222. to alleviate a number of symptoms,
    like hot flashes,
  223. but it's not currently recommended
    for dementia prevention.
  224. And many of us are working
    on testing different formulations
  225. and different dosages
    and different time lines,
  226. and hopefully, all this work will lead
    to a change in recommendations
  227. in the future.
  228. Meanwhile, there are other things
    that we can do today

  229. to support our hormones
    and their effects on the brain
  230. that do not require medications
  231. but do require taking a good look
    at our lifestyle.
  232. That's because the foods we eat,
  233. how much exercise we get,
  234. how much sleep we get or don't get,
  235. how much stress we have in our lives,
  236. those are all things that can actually
    impact our hormones --
  237. for better and for worse.
  238. Food, for example.

  239. There are many diets out there,
  240. but studies have shown
    that the Mediterranean diet in particular
  241. is supportive of women's health.
  242. Women on this diet have a much lower risk
  243. of cognitive decline, of depression,
  244. of heart disease,
    of stroke and of cancer,
  245. and they also have fewer hot flashes.
  246. What's interesting about this diet
  247. is that it's quite rich in foods
    that contain estrogens
  248. in the form of phytoestrogens
    or estrogens from plants
  249. that act like mild estrogens
    in our bodies.
  250. Some phytoestrogens have been linked
    to a possible risk of cancer,
  251. but not the ones in this diet,
    which are safe.
  252. Especially from flax seeds,
  253. sesame seeds, dried apricots,
  254. legumes and a number of fruits.
  255. And for some good news,
  256. dark chocolate
    contains phytoestrogens, too.
  257. So diet is one way to gain estrogens,

  258. but it's just as important to avoid things
    that suppress our estrogens instead,
  259. especially stress.
  260. Stress can literally steal your estrogens,
  261. and that's because cortisol,
    which is the main stress hormone,
  262. works in balance with our estrogens.
  263. So if cortisol goes up,
    your estrogens go down.
  264. If cortisol goes down,
    your estrogens go back up.
  265. So reducing stress is really important.
  266. It doesn't just help your day,
  267. it also helps your brain.
  268. So these are just a few things

  269. that we can do to support our brains
  270. and there are more.
  271. But the important thing here
  272. is that changing the way
    we understand the female brain
  273. really changes the way
    that we care for it,
  274. and the way that we frame women's health.
  275. And the more women
    demand this information,
  276. the sooner we'll be able to break
    the taboos around menopause,
  277. and also come up with solutions
    that actually work,
  278. not just for Alzheimer's disease,
  279. but for women's brain health as a whole.
  280. Brain health is women's health.
  281. Thank you.

  282. (Applause)

  283. Thank you.

  284. Oh, thank you.