WEBVTT 00:00:01.286 --> 00:00:03.825 Women are works of art. 00:00:03.849 --> 00:00:06.381 On the outside as on the inside. 00:00:06.405 --> 00:00:09.823 I am a neuroscientist and I focus on the inside, 00:00:09.847 --> 00:00:11.950 especially on women's brains. NOTE Paragraph 00:00:12.403 --> 00:00:15.266 There are many theories on how women's brains differ 00:00:15.290 --> 00:00:16.482 from men's brains, 00:00:16.506 --> 00:00:18.680 and I've been looking at brains for 20 years 00:00:18.704 --> 00:00:21.681 and can guarantee that there is no such thing 00:00:21.705 --> 00:00:23.196 as a gendered brain. 00:00:23.807 --> 00:00:26.109 Pink and blue, Barbie and Lego, 00:00:26.133 --> 00:00:28.809 those are all inventions that have nothing to do 00:00:28.833 --> 00:00:31.100 with the way our brains are built. 00:00:32.115 --> 00:00:35.242 That said, women's brains differ from men's brains 00:00:35.266 --> 00:00:36.623 in some respects. 00:00:36.647 --> 00:00:38.880 And I'm here to talk about these differences 00:00:38.904 --> 00:00:41.904 because they actually matter for our health. NOTE Paragraph 00:00:42.244 --> 00:00:43.402 For example, 00:00:43.426 --> 00:00:47.323 women are more likely than men to be diagnosed with an anxiety disorder 00:00:47.347 --> 00:00:48.712 or depression, 00:00:48.736 --> 00:00:51.458 not to mention headaches and migraines. 00:00:51.482 --> 00:00:53.986 But also, [unclear] my research, 00:00:54.010 --> 00:00:57.402 women are more likely than men to have Alzheimer's disease. 00:00:57.760 --> 00:01:00.029 Alzheimer's disease is the most common cause 00:01:00.053 --> 00:01:02.196 of dementia on the planet, 00:01:02.220 --> 00:01:07.290 affecting close to six million people in the United States alone. 00:01:07.790 --> 00:01:11.316 But almost two thirds of all those people 00:01:11.340 --> 00:01:13.210 are actually women. 00:01:13.234 --> 00:01:16.020 So for every man suffering from Alzheimer's 00:01:16.044 --> 00:01:17.624 there are two women. 00:01:17.648 --> 00:01:20.649 So why is that overall? 00:01:20.673 --> 00:01:22.029 Is it age? 00:01:22.053 --> 00:01:23.418 Is it lifespan? 00:01:23.442 --> 00:01:24.909 What else could it be? NOTE Paragraph 00:01:25.644 --> 00:01:26.970 A few years ago, 00:01:26.994 --> 00:01:28.938 I launched the Women's Brain Initiative 00:01:28.962 --> 00:01:31.216 at Weill Cornell Medicine in New York City, 00:01:31.240 --> 00:01:33.597 exactly to answer those questions. 00:01:33.621 --> 00:01:36.676 And tonight, I'm here with some answers. 00:01:37.752 --> 00:01:42.458 So it turns out our brains age differently, 00:01:42.482 --> 00:01:46.202 and menopause plays a key role here for women. 00:01:47.252 --> 00:01:50.472 Now most people think of the brain as a kind of black box, 00:01:50.496 --> 00:01:52.490 isolated from the rest of the body. 00:01:52.514 --> 00:01:55.611 But in reality, our brains are in constant interaction 00:01:55.635 --> 00:01:56.823 with the rest of us. 00:01:56.847 --> 00:01:58.412 And perhaps surprisingly, 00:01:58.436 --> 00:02:02.009 the interactions with the reproductive system 00:02:02.033 --> 00:02:05.302 are crucial for brain aging in women. 00:02:05.882 --> 00:02:08.652 These interactions are mediated by our hormones. 00:02:08.676 --> 00:02:12.040 And we know that hormones differ between the genders. 00:02:12.649 --> 00:02:16.228 Men have more testosterone, women have more estrogens. 00:02:16.252 --> 00:02:17.696 But what really matters here 00:02:17.720 --> 00:02:20.968 is that these hormones differ in their longevity. 00:02:21.420 --> 00:02:24.619 Men's testosterone doesn't run out until late in life, 00:02:24.643 --> 00:02:29.074 which is a slow and pretty much symptom-free process, of course. NOTE Paragraph 00:02:29.508 --> 00:02:33.006 (Laughter) NOTE Paragraph 00:02:33.030 --> 00:02:35.419 Women's estrogens, on the other hand, 00:02:35.443 --> 00:02:38.450 start fading in midlife, during menopause, 00:02:38.474 --> 00:02:41.497 which is anything but symptom-free. 00:02:42.101 --> 00:02:44.998 We associate menopause with the ovaries, 00:02:45.022 --> 00:02:47.842 but when women say that they're having hot flashes, 00:02:47.866 --> 00:02:51.793 night sweats, insomnia, memory lapses, depression, anxiety, 00:02:51.817 --> 00:02:54.166 those symptoms don't start in the ovaries. 00:02:54.190 --> 00:02:56.436 They start in the brain. 00:02:56.794 --> 00:02:58.895 Those are neurological symptoms. 00:02:58.919 --> 00:03:02.299 We're just not used to thinking about them as such. 00:03:02.323 --> 00:03:03.649 So why is that? 00:03:03.673 --> 00:03:06.902 Why are our brains impacted by menopause? NOTE Paragraph 00:03:07.419 --> 00:03:08.577 Well, first of all, 00:03:08.601 --> 00:03:12.800 our brains and ovaries are part of the neuro-endocrine system. 00:03:12.824 --> 00:03:15.336 As part of the system, the brain talks to the ovaries 00:03:15.360 --> 00:03:17.232 and the ovaries talk back to the brain, 00:03:17.256 --> 00:03:20.348 every day of our lives as women. 00:03:20.372 --> 00:03:24.276 So the health of the ovaries is linked to the health of the brain. 00:03:24.300 --> 00:03:25.967 And the other way around. 00:03:26.316 --> 00:03:27.656 At the same time, 00:03:27.680 --> 00:03:31.323 hormones like estrogen are not only involved in reproduction, 00:03:31.347 --> 00:03:33.680 but also in brain function. 00:03:33.998 --> 00:03:36.545 And estrogen in particular, or estradiol, 00:03:36.569 --> 00:03:40.347 is really key for energy production in the brain. NOTE Paragraph 00:03:40.768 --> 00:03:42.291 At the cellular level, 00:03:42.315 --> 00:03:46.302 estrogen literally pushes neurons to burn glucose to make energy. 00:03:46.326 --> 00:03:47.769 If your estrogen is high, 00:03:47.793 --> 00:03:49.881 your brain energy is high. 00:03:49.905 --> 00:03:52.182 When your estrogen declines though, 00:03:52.206 --> 00:03:56.109 your neurons start slowing down and age faster, 00:03:56.133 --> 00:03:58.204 And studies have shown that this process 00:03:58.228 --> 00:04:01.593 can even lead to the formation of amyloid plaques, 00:04:01.617 --> 00:04:03.172 or Alzheimer's plaques, 00:04:03.196 --> 00:04:06.013 which are a hallmark of Alzheimer's disease. NOTE Paragraph 00:04:06.323 --> 00:04:09.124 These effects are stronger in specific brain regions, 00:04:09.148 --> 00:04:11.070 starting with the hypothalamus, 00:04:11.094 --> 00:04:13.823 which is in charge of regulating body temperature. 00:04:14.212 --> 00:04:17.283 When estrogen doesn't active the hypothalamus correctly, 00:04:17.307 --> 00:04:21.006 the brain cannot regulate body temperature correctly. 00:04:21.030 --> 00:04:23.426 So those hot flashes that women get, 00:04:23.450 --> 00:04:25.050 that's the hypothalamus. 00:04:25.592 --> 00:04:28.933 Then there's the brain stem, in charge of sleep and wake. 00:04:28.957 --> 00:04:31.655 When estrogen doesn't activate the brain stem correctly, 00:04:31.679 --> 00:04:33.616 we have trouble sleeping. 00:04:33.640 --> 00:04:34.940 Or it's the amygdala, 00:04:34.964 --> 00:04:38.244 the emotional center of the brain, close to the hippocampus, 00:04:38.268 --> 00:04:40.268 the memory center of the brain. 00:04:40.292 --> 00:04:43.148 When estrogen levels [unclear] in these regions, 00:04:43.172 --> 00:04:45.220 we start getting mood swings perhaps 00:04:45.244 --> 00:04:46.529 and forget things. 00:04:46.553 --> 00:04:50.574 So this is the brain anatomy of menopause, if you will. 00:04:50.995 --> 00:04:52.170 But let me show you 00:04:52.194 --> 00:04:54.717 what an actual woman's brain can look like. NOTE Paragraph 00:04:55.249 --> 00:04:56.959 So this is a kind of brain scan 00:04:56.983 --> 00:04:59.735 called positron emission tomography or PET. 00:04:59.759 --> 00:05:01.870 It looks at brain energy levels. 00:05:01.894 --> 00:05:05.504 And this is what you want your brain to look like 00:05:05.528 --> 00:05:07.219 when you're in your 40s. 00:05:07.243 --> 00:05:08.861 Really nice and bright. 00:05:09.314 --> 00:05:12.381 Now this brain belongs to a woman who was 43 years old 00:05:12.405 --> 00:05:15.500 when she was first scanned, before menopause. 00:05:15.524 --> 00:05:20.381 And this is the same brain just eight years later, 00:05:20.405 --> 00:05:22.336 after menopause. 00:05:22.720 --> 00:05:24.514 If we put them side by side, 00:05:24.538 --> 00:05:26.992 I think you can easily see how the bright yellow 00:05:27.016 --> 00:05:29.188 turned orange, almost purple. 00:05:29.776 --> 00:05:34.373 That's a 30 percent drop in brain energy levels. NOTE Paragraph 00:05:35.437 --> 00:05:37.406 Now in general, 00:05:37.430 --> 00:05:42.305 this just doesn't seem to happen to a man of the same age. 00:05:42.786 --> 00:05:44.990 In our studies with hundreds of people, 00:05:45.014 --> 00:05:49.815 we show that middle-aged men usually have high brain-energy levels. 00:05:49.839 --> 00:05:54.023 For women, brain energy is usually fine before menopause 00:05:54.047 --> 00:05:57.491 but then it gradually declines during the transition. 00:05:58.857 --> 00:06:01.751 And this was found independent of age. 00:06:01.775 --> 00:06:04.879 It didn't matter if the women were 40, 50 or 60. 00:06:04.903 --> 00:06:08.847 What mattered most was that they were in menopause. NOTE Paragraph 00:06:09.434 --> 00:06:12.117 So of course we need more research to confirm this, 00:06:12.141 --> 00:06:14.721 but it looks like women's brains midlife 00:06:14.745 --> 00:06:17.403 are more sensitive to hormonal aging 00:06:17.427 --> 00:06:20.022 than just straight up chronological aging. 00:06:20.046 --> 00:06:22.180 And this is important information to have 00:06:22.204 --> 00:06:25.498 because so many women can feel these changes. 00:06:25.522 --> 00:06:27.534 So many of our patients have said to me 00:06:27.558 --> 00:06:30.498 that they feel that their minds play tricks on them, 00:06:30.522 --> 00:06:31.672 to put it mildly. 00:06:32.205 --> 00:06:35.403 So I really want to validate this because it's real. 00:06:35.427 --> 00:06:38.823 And so just to clarify, if this is you, 00:06:38.847 --> 00:06:41.082 you are not crazy. NOTE Paragraph 00:06:41.106 --> 00:06:42.858 (Laughter) NOTE Paragraph 00:06:42.882 --> 00:06:44.645 (Applause) NOTE Paragraph 00:06:44.669 --> 00:06:45.819 Thank you. 00:06:46.714 --> 00:06:47.872 It's important. 00:06:47.896 --> 00:06:50.983 So many women have worried that they might be losing their minds. 00:06:51.007 --> 00:06:54.624 But the truth is that your brain might be going through a transition, 00:06:54.648 --> 00:06:56.188 or is going through a transition 00:06:56.212 --> 00:06:58.983 and needs time and support to adjust. 00:06:59.349 --> 00:07:00.896 Also, if anyone is concerned 00:07:00.920 --> 00:07:04.015 that middle-aged women might be underperformers, 00:07:04.039 --> 00:07:07.126 I'll just quickly add that we looked at cognitive performance, 00:07:07.150 --> 00:07:08.476 God forbid, right? NOTE Paragraph 00:07:08.500 --> 00:07:09.934 (Laughter) NOTE Paragraph 00:07:09.958 --> 00:07:11.158 Let's not do that. 00:07:11.720 --> 00:07:13.585 But we looked at cognitive performance, 00:07:13.609 --> 00:07:17.069 and we found absolutely no differences between men and women 00:07:17.093 --> 00:07:19.672 before and after menopause. 00:07:19.696 --> 00:07:21.926 And other studies confirm this. 00:07:21.950 --> 00:07:24.768 So basically, we may be tired, 00:07:24.792 --> 00:07:26.934 but we are just as sharp. NOTE Paragraph 00:07:26.958 --> 00:07:29.331 (Laughter) NOTE Paragraph 00:07:29.355 --> 00:07:30.847 Get that out of the way. NOTE Paragraph 00:07:31.419 --> 00:07:32.601 That all said, 00:07:32.625 --> 00:07:35.680 there is something else more serious that deserves our attention. 00:07:35.704 --> 00:07:36.887 If you remember, 00:07:36.911 --> 00:07:39.744 I mentioned that estrogen declines could potentially promote 00:07:39.768 --> 00:07:42.474 the formation of amyloid plaques, or Alzheimer's plaques. 00:07:42.839 --> 00:07:44.664 But there's another kind of brain scan 00:07:44.688 --> 00:07:46.450 that looks exactly at those plaques. 00:07:46.474 --> 00:07:50.327 And we used it to show that middle-aged men hardly have any, 00:07:50.351 --> 00:07:51.522 which is great. 00:07:51.546 --> 00:07:53.053 But for women 00:07:53.077 --> 00:07:58.255 there's quite a bit of an increase during the transition to menopause. 00:07:58.279 --> 00:08:00.282 And I want to be really, really clear here 00:08:00.306 --> 00:08:02.770 that not all women develop the plaques, 00:08:02.794 --> 00:08:06.001 and not all women with the plaques develop dementia. 00:08:06.025 --> 00:08:08.080 Having the plaques is a risk factor, 00:08:08.104 --> 00:08:11.699 it is not in any way a diagnosis, especially at this stage. NOTE Paragraph 00:08:12.501 --> 00:08:14.786 But still, it's quite an insight 00:08:14.810 --> 00:08:17.444 to associate Alzheimer's with menopause. 00:08:17.468 --> 00:08:19.992 We think of menopause as belonging to middle age, 00:08:20.016 --> 00:08:22.538 and Alzheimer's as belonging to old age. 00:08:22.562 --> 00:08:23.720 But in reality, 00:08:23.744 --> 00:08:25.847 many studies, including my own work, 00:08:25.871 --> 00:08:30.117 had shown that Alzheimer's disease starts with negative changes in the brain 00:08:30.141 --> 00:08:34.335 years if not decades prior to clinical symptoms. 00:08:34.689 --> 00:08:36.006 So for women, 00:08:36.030 --> 00:08:38.966 it looks like this process starts in midlife, 00:08:38.990 --> 00:08:40.402 during menopause. 00:08:40.426 --> 00:08:42.300 Which is important information to have, 00:08:42.324 --> 00:08:46.189 because it gives us a time line to start looking for those changes. NOTE Paragraph 00:08:46.602 --> 00:08:48.721 So in terms of a time line, 00:08:48.745 --> 00:08:52.109 most women go through menopause in their early 50s. 00:08:52.133 --> 00:08:53.888 But it can be earlier. 00:08:53.912 --> 00:08:56.512 Often because of medical interventions. 00:08:56.815 --> 00:09:00.728 And the common example is a hysterectomy and/or an oophorectomy, 00:09:00.752 --> 00:09:03.387 which is the surgical removal of the uterus 00:09:03.411 --> 00:09:05.029 and/or the ovaries. 00:09:05.363 --> 00:09:07.871 And unfortunately, there is evidence 00:09:07.895 --> 00:09:11.069 that having the uterus, and more so the uterus removed 00:09:11.093 --> 00:09:12.799 prior to menopause 00:09:12.823 --> 00:09:16.735 correlates with the higher risk of dementia in women. 00:09:17.442 --> 00:09:19.545 And I know that this is upsetting news, 00:09:19.569 --> 00:09:21.696 and it's definitely depressing news, 00:09:21.720 --> 00:09:23.335 but we need to talk about it 00:09:23.359 --> 00:09:26.887 because most women are not aware of this correlation, 00:09:26.911 --> 00:09:30.117 and it seems a very important information to have. NOTE Paragraph 00:09:30.141 --> 00:09:33.179 Also, no one is suggesting that women decline these procedures 00:09:33.203 --> 00:09:34.910 if they need them. 00:09:34.934 --> 00:09:38.586 The point here is that we really need to better understand 00:09:38.610 --> 00:09:42.022 what happens to our brains as we go through menopause, 00:09:42.046 --> 00:09:43.744 natural or medical, 00:09:43.768 --> 00:09:46.834 and how to protect our brains in the process. NOTE Paragraph 00:09:47.196 --> 00:09:48.577 So how do we do that? 00:09:48.601 --> 00:09:49.998 How do we protect our brains? 00:09:50.022 --> 00:09:51.895 Should we take hormones? 00:09:51.919 --> 00:09:54.569 That's a fair question, it's a good question. 00:09:54.593 --> 00:09:57.180 And the shortest possible answer right now 00:09:57.204 --> 00:09:59.680 is that hormonal therapy can be helpful 00:09:59.704 --> 00:10:02.958 to alleviate a number of symptoms like hot flashes, 00:10:02.982 --> 00:10:06.749 but it's not currently recommended for dementia prevention. 00:10:06.773 --> 00:10:10.201 And many of us are working on testing different formulations, 00:10:10.225 --> 00:10:12.749 and different dosages and different time lines, 00:10:12.773 --> 00:10:16.856 and hopefully, all this work will lead to a change in recommendations 00:10:16.880 --> 00:10:18.030 in the future. NOTE Paragraph 00:10:18.807 --> 00:10:22.141 Meanwhile, there are other things that we can do today 00:10:22.165 --> 00:10:24.879 to support our hormones and their effects on the brain 00:10:24.903 --> 00:10:26.981 that do now require medications, 00:10:27.005 --> 00:10:30.500 but do require taking a good look at our lifestyle. 00:10:30.963 --> 00:10:33.217 That's because the foods we eat, 00:10:33.241 --> 00:10:34.947 how much exercise we get, 00:10:34.971 --> 00:10:37.114 how much sleep we get or don't get, 00:10:37.138 --> 00:10:39.098 how much stress we have in our lives, 00:10:39.122 --> 00:10:42.313 those are all things that can actually impact our hormones 00:10:42.337 --> 00:10:44.202 for better and for worse. NOTE Paragraph 00:10:44.694 --> 00:10:46.678 Food, for example. 00:10:46.702 --> 00:10:48.591 There are many diets out there, 00:10:48.615 --> 00:10:52.434 but studies have shown that the Mediterranean diet in particular 00:10:52.458 --> 00:10:55.188 is supportive of women's health. 00:10:55.673 --> 00:10:59.089 Women on this diet have a much lower risk 00:10:59.113 --> 00:11:01.634 of cognitive decline, of depression, 00:11:01.658 --> 00:11:04.697 of heart disease, of stroke, and of cancer, 00:11:04.721 --> 00:11:07.530 and they also have fewer hot flashes. 00:11:07.554 --> 00:11:09.847 What's interesting about this diet 00:11:09.871 --> 00:11:13.958 is that it's quite rich in foods that contain estrogens 00:11:13.982 --> 00:11:17.648 in the form of phytoestrogens or estrogens from plants 00:11:17.672 --> 00:11:20.656 that act like mild estrogens in our bodies. 00:11:20.680 --> 00:11:24.125 Some phytoestrogens have been linked to a possible risk of cancer, 00:11:24.149 --> 00:11:27.369 but the ones in this diet, which are safe. 00:11:27.393 --> 00:11:29.956 Especially from flax seeds, 00:11:29.980 --> 00:11:32.964 sesame seeds, dried apricots, 00:11:32.988 --> 00:11:35.544 legumes and a number of fruits. 00:11:35.568 --> 00:11:37.466 And for some good news, 00:11:37.490 --> 00:11:40.878 dark chocolate contains phytoestrogens too. NOTE Paragraph 00:11:41.680 --> 00:11:44.061 So diet is one way to gain estrogens, 00:11:44.085 --> 00:11:48.371 but it's just as important to avoid things that suppress our estrogens instead, 00:11:48.395 --> 00:11:49.978 especially stress. 00:11:50.347 --> 00:11:53.323 Stress can literally steal your estrogens, 00:11:53.347 --> 00:11:56.815 and that's because cortisol, which is the main stress hormone, 00:11:56.839 --> 00:11:59.418 works in balance with our estrogens. 00:11:59.442 --> 00:12:02.149 So if cortisol goes up, your estrogens go down. 00:12:02.173 --> 00:12:05.077 If cortisol goes down, your estrogens go back up. 00:12:05.101 --> 00:12:07.334 So reducing stress is really important. 00:12:07.358 --> 00:12:09.649 It doesn't just help your day, 00:12:09.673 --> 00:12:11.648 it also helps your brain. NOTE Paragraph 00:12:12.427 --> 00:12:13.918 So these are just a few things 00:12:13.942 --> 00:12:15.681 that we can do to support our brains 00:12:15.705 --> 00:12:16.871 and there are more. 00:12:16.895 --> 00:12:18.304 But important thing here 00:12:18.328 --> 00:12:21.981 is that changing the way we understand the female brain 00:12:22.005 --> 00:12:25.148 really changes the way that we care for it, 00:12:25.172 --> 00:12:27.941 and the way that we frame women's health. 00:12:27.965 --> 00:12:30.878 And the more women demand this information, 00:12:30.902 --> 00:12:34.322 the sooner we'll be able to break the taboos around menopause, 00:12:34.346 --> 00:12:37.220 and also come up with solutions that actually work, 00:12:37.244 --> 00:12:38.846 not just for Alzheimer's disease, 00:12:38.870 --> 00:12:41.569 but for women's brain health as a whole. 00:12:41.593 --> 00:12:44.286 Brain health is women's health. NOTE Paragraph 00:12:44.310 --> 00:12:45.475 Thank you. NOTE Paragraph 00:12:45.499 --> 00:12:47.102 (Applause) NOTE Paragraph 00:12:47.540 --> 00:12:48.690 Thank you. 00:12:48.714 --> 00:12:49.864 Oh, thank you.