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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, [unclear] 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 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 a 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 now 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.
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Stress can literally steal your estrogens,
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and that's because cortisol,
which is the main stress hormone,
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works in balance with our estrogens.
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So if cortisol goes up,
your estrogens go down.
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If cortisol goes down,
your estrogens go back up.
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So reducing stress is really important.
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It doesn't just help your day,
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it also helps your brain.
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So these are just a few things
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that we can do to support our brains
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and there are more.
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But the important thing here
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is that changing the way
we understand the female brain
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really changes the way
that we care for it,
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and the way that we frame women's health.
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And the more women
demand this information,
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the sooner we'll be able to break
the taboos around menopause,
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and also come up with solutions
that actually work,
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not just for Alzheimer's disease,
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but for women's brain health as a whole.
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Brain health is women's health.
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Thank you.
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(Applause)
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Thank you.
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Oh, thank you.