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Speaker 1: Pushkin. Here's the thing about women's health. We spend the

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Speaker 1: first part of our lives trying not to get pregnant.

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Speaker 1: We spend the second part of our lives for many

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Speaker 1: of us, trying to get pregnant, and then the third

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Speaker 1: part of our lives we're kind of forgotten about. And

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Speaker 1: this is when we go through some of our biggest changes.

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Speaker 1: I learned myself the hard way when I was forty three,

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Speaker 1: out of nowhere. I became significantly depressed and anxious. I'd

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Speaker 1: always been the kind of person who woke up happy,

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Speaker 1: motivated to face the day. Suddenly I didn't feel joy anymore.

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Speaker 1: I was consumed by worry and my confidence was gone.

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Speaker 1: At that time, I was running a very large surgical practice,

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Speaker 1: and let's face it, nobody wants an anxious or depressed surgeon.

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Speaker 1: I felt like a different person and was totally confused

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Speaker 1: by the whole thing. I went to the medical literature

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Speaker 1: looking for answers, but I came up completely empty. I

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Speaker 1: consider myself a pretty well informed, well educated physician. I've

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Speaker 1: trained at some of the best institutions in the nation.

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Speaker 1: I've specialized in gynecologic oncology and surgery, and I've been

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Speaker 1: the expert that news outlets have turned to for insight.

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Speaker 2: Please welcome doctor Elizabeth Point.

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Speaker 1: I think that's very important that women understand that they

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Speaker 1: still needed you have their yearly annual consultaneous. One of

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Speaker 1: the most commonly prescribed dugs for diabetes can actually impact

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Speaker 1: a woman's survival when she's been diagnosed with ovarian cancer.

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Speaker 1: Actor was a pointer.

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Speaker 2: Great to see you, Thank you so much.

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Speaker 1: And yet I was still in the dark. It was

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Speaker 1: my mom who actually said to me, you know what,

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Speaker 1: it's probably your hormones. Turns out she was right. I

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Speaker 1: was going through perimenopause. Looking back at me perfect sense.

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Speaker 1: I'd always had mood changes around my period. Of course,

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Speaker 1: then the biggest hormonal shift in my life would affect

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Speaker 1: my mind and emotions. What's wild is that none of

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Speaker 1: my doctors, not my therapist, not a psychiatrist I had

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Speaker 1: consulted for this issue, not even my medical colleague suggested perimenopause.

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Speaker 1: Eventually I figured out how to feel better, but the

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Speaker 1: whole experience served as a big wake up call for me.

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Speaker 1: So here's my question, where exactly is the information for us,

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Speaker 1: the women in the middle of our lives, to help

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Speaker 1: us make the best decisions about our health. I'm doctor

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Speaker 1: Elizabeth Pointer, and I've spent the past forty years working

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Speaker 1: in women's health. I'm the Chair of Women's Health and

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Speaker 1: Gynecology at the Atria Health Institute in New York City.

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Speaker 1: And here's what I've observed, both as a patient and

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Speaker 1: as a doctor. The information actually is out there, but

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Speaker 1: it's really hard to find some time times. You have

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Speaker 1: to read across subspecialties. You have to read the neurologic literature,

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Speaker 1: the cardiology literature, the endocrinology literature. It's dense research that's

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Speaker 1: nearly impossible to understand without a medical degree, and even

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Speaker 1: most doctors don't have time to do that. Now. Specialists

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Speaker 1: live in their own subspecialties and struggle to keep up

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Speaker 1: in OBGI. In training programs, even the top ones, there's

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Speaker 1: maybe at best one or two lectures on midlife women's health.

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Speaker 1: There's no textbook, there's no course, there's no focus on

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Speaker 1: women after their reproductive years. And that's why I'm making

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Speaker 1: this podcast, Decoding Women's Health, a new show from Pushkin

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Speaker 1: Industries and the Atria Health Institute that will elevate the

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Speaker 1: conversation about women's health and midlife and frankly challenge some

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Speaker 1: of the status quo information out there, because what I

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Speaker 1: want for everyone listening, for every patient, every doctor, and

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Speaker 1: every woman is to feel more informed when it comes

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Speaker 1: to our health women's health. On today's episode, how to

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Speaker 1: fluctuating hormones impact the brain specifically for women in midlife.

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Speaker 1: Turns out a lot of cognitive changes can happen, and

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Speaker 1: it can be really frightening. Some women, like me, experience

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Speaker 1: intense mood shifts. Others may start to wonder if they've

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Speaker 1: developed ADHD or maybe even dementia, but what they're really

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Speaker 1: dealing with or temporary memory glitches. We'll talk about what's

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Speaker 1: going on with these cognitive disruptions, how to manage them

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Speaker 1: in the moment, and how women can be proactive about

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Speaker 1: maintaining sharp, healthy minds throughout their lifespans. I am thrilled

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Speaker 1: to be joined today by doctor Caroline Gervich. Caroline's work

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Speaker 1: caught my attention because she studies hormones and how the

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Speaker 1: brain changes through midlife. She's engaged in some really fascinating

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Speaker 1: research about brain fog, cognitive training, and ADHD. Caroline is

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Speaker 1: an associate professor and clinical neuropsychologist. She is also the

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Speaker 1: Deputy director of the Her Center in Australia and head

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Speaker 1: of the Cognition and Hormones Group at Monash University. There's

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Speaker 1: so much we don't understand about how the brain works,

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Speaker 1: but Caroline and her team are doing critical work examining

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Speaker 1: how hormones impact our cognitive health throughout our lives. Caroline,

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Speaker 1: thank you so much for joining us today and welcome

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Speaker 1: to the show.

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Speaker 2: Thank you so much, doctor Pointer. It's absolute pleasure to

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Speaker 2: be here.

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Speaker 1: Can you tell us what a neuropsychologist is actually?

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Speaker 3: Yes, so, at a really basic level, it's brain psychology.

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Speaker 3: So the neuro is the brain bit and the psychology

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Speaker 3: is understanding a whole range of mental health symptoms. And

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Speaker 3: what we do as a profession is we do a

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Speaker 3: lot of assessments to better understand what different symptoms people

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Speaker 3: are entering with when it impacts brain, brain and behavior.

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Speaker 3: So that's the assessment side, but then neuropsychologists can also

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Speaker 3: work at an intervention side, so once we know what's

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Speaker 3: going on for someone, we can help them with education,

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Speaker 3: so understanding how a brain relates to our behavior, as

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Speaker 3: well as different kind of training processes to try and

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Speaker 3: improve or give people strategies to improve whatever difficulties their

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Speaker 3: experiencing with their cognition or their thinking skills.

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Speaker 1: How did you get involved with this type of work.

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Speaker 3: Yeah, so it wasn't that I, as a child always

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Speaker 3: wanted to be a neuropsychologist. I don't think I really

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Speaker 3: knew what a neuropsychologist was until I was well into

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Speaker 3: my training. It was more I didn't actually know what

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Speaker 3: I wanted to do that I really loved science like

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Speaker 3: I loved chemistry. I loved physiology and learning about the brain.

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Speaker 3: I was fascinated by how powerful our brains are and

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Speaker 3: how little we know about how we think. From there,

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Speaker 3: I started working in older age psychiatry and became interested

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Speaker 3: in menopause and how little we know about that midlife,

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Speaker 3: which is really when a lot of the brain changes

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Speaker 3: start happening, and we can either prepare ourselves as much

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Speaker 3: as we can for kind of healthy older aging or not.

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Speaker 3: But it's like this potential window of opportunity to kind

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Speaker 3: of take control and do what we can for preparing

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Speaker 3: ourselves for great cognitive aging.

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Speaker 1: Can you tell me a little bit more about what

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Speaker 1: you mean taking control and prepare for aging.

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Speaker 2: Yeah?

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Speaker 3: So I think these menopause transition years are transitioning from

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Speaker 3: our reproductive phase of our life to our postmenopausal years

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Speaker 3: and our older adult years. So it's just a great

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Speaker 3: opportunity to reflect on the phase of life you're at

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Speaker 3: and know that there are so many things you can

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Speaker 3: do as an individual to promote good health. So lots

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Speaker 3: of physical exercise and lots of lifestyle factors, like in

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Speaker 3: terms of your diet, in terms of sleep, in terms

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Speaker 3: of being socially connected. So there are a lot of

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Speaker 3: things you can do as an individual to make the

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Speaker 3: most and to optimize whatever brain health you have.

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Speaker 1: So you mentioned that there's a connection between menopause or

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Speaker 1: perimenopause and cognition on a basic level, what's going on

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Speaker 1: in perimenopause and menopause.

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Speaker 3: So, perimenopause is a time in a woman's life where

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Speaker 3: there's hormone changes. So we have fluctuations in one of

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Speaker 3: our estrogen called estra dial and gradually that hormone declines.

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Speaker 3: Perimenopause can span four to ten years, so it's not

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Speaker 3: a short time. It's many years in someone's life that

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Speaker 3: there are these hormone changes that are happening. Perimenopause can

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Speaker 3: be associated with a whole range of different symptoms. There

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Speaker 3: can be no symptoms for some women. There can be

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Speaker 3: the hallmark of menopause, I guess, the vasomotor symptoms, which

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Speaker 3: are hot flushes, night sweats. There's a number of women

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Speaker 3: who experience what is often referred to as as brain

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Speaker 3: fog in a colloquial way, which here cognitive symptoms that

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Speaker 3: can happen during perimenopause or years. And these symptoms can

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Speaker 3: include word finding difficulties, which is that words on the

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Speaker 3: tip of your tongue, not being able to find the

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Speaker 3: right word. There can be forgetfulness. There can be higher

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Speaker 3: level what we call executive function symptoms, which is where

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Speaker 3: people have difficulty juggling lots of things, planning ahead, prioritizing,

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Speaker 3: difficulties with time management, and higher level organization type skills.

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Speaker 3: So there can be a whole range of different cognitive

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Speaker 3: symptoms that people can experience, and they're often subtle, but

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Speaker 3: at a day jay level or at an individual level,

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Speaker 3: they can have a really significant impact on people's lives.

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Speaker 1: What percentage of women do you really think are going

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Speaker 1: through these cognitive changes.

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Speaker 3: The literature would suggest about sixty percent. It depends on

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Speaker 3: their kind of community based studies, but about sixty some

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Speaker 3: say closer to seventy percent. So somewhere in that vicinity

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Speaker 3: is the percentage of people who experience some degree of

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Speaker 3: cognitive symptoms.

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Speaker 2: And I think it really varies.

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Speaker 3: For some people, it's quite subtle and it doesn't have

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Speaker 3: a huge impact on their life, but for other people

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Speaker 3: it can be quite significant.

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Speaker 1: In your clinical practice, what kind of complaints to midlife

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Speaker 1: women come to you with or what are their main concerns.

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Speaker 3: So there's often mood symptoms that are present, but not always,

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Speaker 3: but they tend to come and see me because they're

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Speaker 3: concerned that one they have dementia. That's one of the

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Speaker 3: probably the most common concerns that people have, and the

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Speaker 3: types of symptoms that people talk about is you know,

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Speaker 3: I'm forgetting everything. I never used to forget things. I

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Speaker 3: used to be really efficient in my role, and now

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Speaker 3: it takes me so long to do things. So that's

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Speaker 3: one and the other one that's become more common in

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Speaker 3: recent years is do I have ADHD. I'm really struggling

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Speaker 3: to manage my time. I'm really struggling to prioritize, to plan,

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Speaker 3: to organize.

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Speaker 2: To focus.

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Speaker 3: So they're probably the two biggest clinical questions that people

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Speaker 3: present with. But the types of symptoms that women present

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Speaker 3: with mood symptoms, forgetfulness, difficulties with efficiency.

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Speaker 2: And time management and multitasking.

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Speaker 1: What ages are you seeing this? You know, we talk

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Speaker 1: a lot about menopause and the final menstrual period, but

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Speaker 1: I've kind of noticed in my practice that patients really

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Speaker 1: present in that early perimenopause time where they might not

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Speaker 1: be having any menstrual irregularities or might not even know it.

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Speaker 1: What do you see in your practice.

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Speaker 2: Exactly the same. It's quite early.

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Speaker 3: It's often, as you say, in the early forties, where

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Speaker 3: they haven't really necessarily made a connection that this might

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Speaker 3: be the start of their perimenopausal journey, and they're just

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Speaker 3: concerned about their cognition, their thinking skills, and it has

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Speaker 3: this ripple effects, So they start to become a bit

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Speaker 3: concerned about their efficiency. Then it impacts their self esteem,

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Speaker 3: Then they become a bit more anxious than the anxiety

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Speaker 3: in itself further impacts their ability to perform in the moment.

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Speaker 2: So it's this real cycle for people.

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Speaker 3: I've had patients who have sort of had the conversation

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Speaker 3: with their GP, but they haven't been reassured that it

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Speaker 3: might not be dementia. So then they've gone ahead and

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Speaker 3: contacted people like dementia Australia, like Big Foundations, describe their

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Speaker 3: symptoms which can sound a little bit like early stages

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Speaker 3: of dementia over the phone, and then they've been reassured

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Speaker 3: that yes, it does sound like you might have the

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Speaker 3: early stages of dementia and they don't have that at all,

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Speaker 3: And they've started to go down that pathway of putting,

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Speaker 3: you know, financial things in place and really preparing themselves

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Speaker 3: for degenerative process, and that is not what they've got

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Speaker 3: at all. So I think it's really important that people

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Speaker 3: have a better understanding and follow the right pathways of

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Speaker 3: getting the right support.

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Speaker 1: You know, a lot of times we go is dementia

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Speaker 1: or is it brain fog? Right, and it's like, well,

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Speaker 1: you know, demension impacks your quality of life on a

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Speaker 1: day to day basis, but I think brain fog probably does,

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Speaker 1: especially if you're in the workplace, which brings me into

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Speaker 1: how do you help women through the workplace and what

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Speaker 1: do you see how are women impacted in their workplace

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Speaker 1: by some of these cognitive chains.

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Speaker 3: I think people who are working in a job that

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Speaker 3: does require thinking on the spot. Speaking on the spot

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Speaker 3: is often the people I tend to see so high

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Speaker 3: functioning professional people because they really feel the subtle cognitive

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Speaker 3: changes the word retrieval deficits have a really big impact

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Speaker 3: at a day to day level, and people get nervous

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Speaker 3: about public speaking, even if it's something they've always done,

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Speaker 3: because they're worried they'll experience a word finding difficulties. For

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Speaker 3: some people, it can be really problematic. And I've seen

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Speaker 3: women who have actually changed their work or drop back

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Speaker 3: to part time or left work altogether, which is really

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Speaker 3: really sad because they didn't really understand what was going

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Speaker 3: on for them. They didn't link it back to their hormones.

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Speaker 3: They just felt like they were no longer up to

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Speaker 3: whatever their job was. And so I think that's really

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Speaker 3: devastating when that's happened. If it's someone who wanted to

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Speaker 3: stay in the workforce, but because of their more subtle

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Speaker 3: cognitive symptoms and then the flow on impact on self

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Speaker 3: esteem and then the increase in anxiety, chain of events

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Speaker 3: has led them to leaving the workplace, So it can

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Speaker 3: be really detrimental for some women. And then in broader

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Speaker 3: workplace settings, I mean, the key thing is just education,

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Speaker 3: just knowing that cognitive symptoms can be a part of

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Speaker 3: the menopause transition and there are lots of ways to

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Speaker 3: manage it. And I think the key factor for women

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Speaker 3: to know is that it's not an impact on intellectual

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Speaker 3: capacity per se, but they just might need a little

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Speaker 3: bit of support and a little bit of knowledge about

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Speaker 3: the types of symptoms that they might be experiencing and

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Speaker 3: knowing that it might be you know, a couple of

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Speaker 3: years where word finding's not great or your learning efficiency

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Speaker 3: isn't perfect, but you'll get through, and you just need

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Speaker 3: some practical supports to get you through. So women don't

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Speaker 3: feel like they're no longer up to it, because that's

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Speaker 3: not the case.

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Speaker 1: I think that's really important, this whole concept of you know,

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Speaker 1: I can still function, I can still work where I

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Speaker 1: need to work and be where I need to be

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Speaker 1: at the level I need to be at. When you

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Speaker 1: talk about support structure and that type of thing, what

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Speaker 1: are you referring to.

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Speaker 3: Just really practical things like people not shouting out, oh

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Speaker 3: can you do this in the corridor, just emailing it

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Speaker 3: to people so you've got things written down rather than

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Speaker 3: juggling things in your working memory if you're in meetings

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Speaker 3: or if you're in a consult with someone to be

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Speaker 3: able to take notes or use some sort of recording

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Speaker 3: audio to take notes, so you're not again relying on

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Speaker 3: your working memory and your attention to hold and juggle

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Speaker 3: lots of pieces of information. If you feel like you're

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Speaker 3: forgetting a word, it's sometimes easy to say this is

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Speaker 3: hard to do this, but don't stress about it because

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Speaker 3: it makes it worse. So rather than trying to find

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Speaker 3: that word, trying to encourage people just to kind of

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Speaker 3: speak around the topic or just own it, say I

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Speaker 3: can't think of that word at the moment and move on,

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Speaker 3: and no one really cares too much. So I think

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Speaker 3: it's just about having some strategies at an individual level

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Speaker 3: in place to manage that. So yeah, as I said,

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Speaker 3: the key one is really just reducing the demands on

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Speaker 3: working memory and the juggling and switching between lots of

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Speaker 3: different tasks.

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Speaker 2: And for some people where it's.

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Speaker 3: Executive function, difficulties are about sort of time management and

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Speaker 3: prioritization of tasks, structuring your day so then you've got

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Speaker 3: some time blocked out for the last minute things each

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Speaker 3: day in case they pop up, but having some sort

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Speaker 3: of increased structure to your work date I think can

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Speaker 3: be really helpful for people as well.

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Speaker 1: Coming up, what does ADHD really look like for women

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Speaker 1: in midlife? How can changes an astrogen mimic those symptoms?

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Speaker 1: And what does the scientist actually say about whether hormone

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Speaker 1: therapy can help not just with focus and memory, but

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Speaker 1: maybe even protecting our brains as we age. So that

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Speaker 1: kind of leads me into the kind of ADHD component

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Speaker 1: of your work, which I think is really interesting because

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Speaker 1: I consider my self a pretty educated physician. I'm curious,

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Speaker 1: I read, but I know nothing about ADHD and midlife women.

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Speaker 1: Can you unpack that a little bit for us and

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Speaker 1: also just tell us what ADHD really is?

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Speaker 3: Yes, So, and the fact that you haven't read anything

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Speaker 3: about ADHD in midlife is because there's really very very

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Speaker 3: little published on the topic, So I think there's just

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Speaker 3: not much out there. But to come back to what

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Speaker 3: ADHD is, so, attention deficit high peractivity disorder is what

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Speaker 3: ADHD stands for.

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Speaker 2: In terms of the diagnostic criteria.

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Speaker 3: You can only now diagnosed ADHD in adults, So it's

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Speaker 3: always been considered and still is a neurodevelopmental condition, so

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Speaker 3: it's something that your brain is kind of born with

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Speaker 3: and you develop as a child. So it can be

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Speaker 3: attention deficit and or hyperactivity in attention. So it's that

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Speaker 3: the sorts of symptoms that fall into that attention deficet

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Speaker 3: are things like forgetfulness, difficulty focusing on things, and then

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Speaker 3: their high peractivity impulsivity is just a feeling of being

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Speaker 3: on the go all the time, that there's an emotion

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Speaker 3: inside you, a drive inside you, and you just need

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Speaker 3: to be busy and occupied. The stereotypical picture of ADHD

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Speaker 3: is often coming from that hyperactive symptom. You think of

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Speaker 3: the hyperactive little boy, and a lot of the diagnostic

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Speaker 3: criteria was kind of built around that. But as we're

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Speaker 3: learning more, we're seeing for menopausal women it tends to

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Speaker 3: be more of the inertention that can be undetected. I

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Speaker 3: think in a lot of people, particularly for women who

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Speaker 3: also you know, might be really conscientious and hard working

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Speaker 3: and perfectionist type people, that inattention and difficulty regulating and

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Speaker 3: organizing and structuring your day can often go unnoticed. But

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Speaker 3: coming back to your question about sort of the midlife

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Speaker 3: and the menopause connection to ADHD. We don't really know

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Speaker 3: exactly what's happening. So the theory is that during menopause

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Speaker 3: when Eastern changes and impacts dopamine and perhaps uncovers ADHD

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Speaker 3: that's always been there. I don't think we fully understand

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Speaker 3: whether it's an ADHD presentation appearing at menopause for the

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Speaker 3: first time. And for some people, they've got a lot

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Speaker 3: of ADHD characteristics, but it's not something that was their

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Speaker 3: prior to the age of twelve, which is what we

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Speaker 3: need for our diagnostic criteria, that there's evidence that someone's

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Speaker 3: had this as a neurodevelopmental condition. So for some people,

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Speaker 3: they just present with characteristics of ADHD around menopause, but

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Speaker 3: for other people, they've had lots of support or kind

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Speaker 3: of scaffolding I guess, throughout their life, and when we

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Speaker 3: take a really good history, we can see that they

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Speaker 3: have had ADHD always and they've just hit a point

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Speaker 3: in menopause where they can no longer kind of mask

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Speaker 3: or cover up some of the symptoms that they've been experiencing.

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Speaker 3: And in our research as well, we've spoken to a

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Speaker 3: lot of women with ADHD. These are people who have

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Speaker 3: got or already have a diagnose of ADHD, but they

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Speaker 3: all worstening of symptoms at menopause, both other menopausal symptoms

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Speaker 3: as well as their ADHD symptoms. So there's definitely a

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Speaker 3: connection between menopause and ADHD. And we also see a

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Speaker 3: similar pattern across a menstrual cycle. So women with ADHD

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Speaker 3: report a worsening of their symptoms in that luteal phase

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Speaker 3: the second half of their menstrual cycle. And so there's

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Speaker 3: clearly a hormonal factor that's driving these changes in symptoms

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Speaker 3: across menstrual cycle or during the perimenopausal years.

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Speaker 1: You know, it's so interesting because I mean it's like

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Speaker 1: menopause and the hormonal fluctuations just uncover issues in the brain, right,

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Speaker 1: I mean it's like psychiatric issues get worse at the

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Speaker 1: time of perimenopause and menopause, right, Depression can go off

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Speaker 1: the rails. How much of this impact do you think

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Speaker 1: is due to estrogen? And what is estrogen doing to

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Speaker 1: our brains?

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Speaker 2: Yeah? I think we know the most about estrogen.

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Speaker 3: I think that's why we talk about it the most

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Speaker 3: because I think most of the research, most of the

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Speaker 3: animal studies has been done looking at estrogen. But we

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Speaker 3: know that estrogen plays a neuroprotective role in the brains.

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Speaker 3: We know estrogen helps protect our brain against damage, so

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Speaker 3: if there's been some sort of insult to the brain,

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Speaker 3: estrogen can be really protective. And so we also know

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Speaker 3: that there's receptors that respond to estrogen in brain areas

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Speaker 3: beyond reproductive function, so in brain areas that are really

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Speaker 3: relevant to mood and to cognition. So the front part

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Speaker 3: of our brain really important for executive functions. We know

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Speaker 3: that estrogen's interacting or modulating a lot of our neurotransmitter pathways,

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Speaker 3: so the dopamine pathways that are important in ADHD, but

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Speaker 3: also important in motivation, in drive, in regulating our attention.

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Speaker 3: More broadly, eachtrogen interacts with serotonin, which is really important

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Speaker 3: for mood. So we know that issian's playing a significant

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Speaker 3: role in our brain. And yes, most of this research

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Speaker 3: is from animal studies, but we kind of extend that,

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Speaker 3: extrapolate from that and learn from that in terms of

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Speaker 3: how estrogen might be working human studies.

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Speaker 1: Yeah, it's interesting, there's so much to explore. So when

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Speaker 1: these cognitive issues are occurring, what's actually going on. Estradiyl

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Speaker 1: is the main estrogen that the over is produced for women,

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Speaker 1: and what is it doing during this time period where

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Speaker 1: cognitive issues may occur.

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Speaker 3: So it's fluctuating, particularly during those early perimenopausal years, but

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Speaker 3: they're also gradually declining, and I think both of those

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Speaker 3: factors seem to be related to changes in cognition. So

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Speaker 3: if you think about what's actually going on, I think

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Speaker 3: there are receptors in our brain that respond to estradyl,

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Speaker 3: are used to being stimulated by estradyl, and suddenly there

401
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Speaker 3: it's on off, it's up down, and then it's gradually

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Speaker 3: those receptors are less stimulated by estradyl over the years,

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Speaker 3: So I think that that's the hormonal factors that are

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Speaker 3: underpinning the cognitive symptoms.

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Speaker 2: But I think there are often lots of other pieces

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Speaker 2: of the puzzle.

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Speaker 3: So I think, you know, while people can experience brain

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Speaker 3: vogue or cognitive symptoms as the sole symptom of menopause,

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Speaker 3: more often than not it's not the case. There's often

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Speaker 3: other symptoms going on. So I always think of the

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Speaker 3: cognitive symptoms a little bit like the tip of the iceberg.

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Speaker 2: There's always things underpinning that.

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Speaker 3: So I think when we're talking about menopause, we're talking

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Speaker 3: about hormone changes as being a significant contributing factor, but

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Speaker 3: also talking about you know, vasomotor symptoms, So there's studies

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Speaker 3: that show that these can also have an impact on brain,

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Speaker 3: on factors in the brain that might then have flow

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Speaker 3: on effects to cognition. They also can impact sleep, So

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Speaker 3: sleep and a lack of sleep or impaired disrupted sleep

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Speaker 3: for anyone at any point in your life can impact

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Speaker 3: your cognition and lead to feeling a bit foggy and

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Speaker 3: those kind of cognitive symptoms. And then we've talked a

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Speaker 3: bit about mood that can be another contributing factor to

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Speaker 3: cognitive symptoms. And some people during menopause might be experiencing

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Speaker 3: pain joint pain and pain can have cognitive symptoms.

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Speaker 2: So I think there can be lots of factors that.

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Speaker 3: Are underlying the presentation of cognitive symptoms, and I definitely

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Speaker 3: think hormones are playing a significant role, but I think

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Speaker 3: it's important to consider the whole person and everything that's

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Speaker 3: going on for them. And the other point is that

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Speaker 3: menopause often coincides with a really busy time in a

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Speaker 3: lot of people's lives or often at you know, the

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Speaker 3: busy time in your career, and elderly parents potentially teenage children,

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Speaker 3: managing households, like there's often just a lot going on.

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Speaker 3: So I think there's that as well, the fact that

436
00:24:39,890 --> 00:24:43,330
Speaker 3: people are often just stretched and stressed because they're so busy,

437
00:24:43,850 --> 00:24:46,850
Speaker 3: and so I think all of those factors are really

438
00:24:46,890 --> 00:24:51,210
Speaker 3: important to consider when we think about what's underpinning cognitive symptoms.

439
00:24:51,210 --> 00:24:54,050
Speaker 3: But I think, you know, when we're talking about perimenopause,

440
00:24:54,090 --> 00:24:58,090
Speaker 3: we're obviously talking about hormone changes, and hormone changes in

441
00:24:58,129 --> 00:25:00,730
Speaker 3: and of themselves might be enough to drive cognitive symptoms,

442
00:25:00,770 --> 00:25:03,050
Speaker 3: but I just think it's important to consider the whole

443
00:25:03,050 --> 00:25:03,890
Speaker 3: picture as well.

444
00:25:04,450 --> 00:25:06,850
Speaker 1: Yeah, it's kind of a perfect storm, right. I mean,

445
00:25:06,890 --> 00:25:10,169
Speaker 1: you might be going through significant life changes, whether it's

446
00:25:10,210 --> 00:25:13,130
Speaker 1: your job, your family, your partner, and then you put

447
00:25:13,129 --> 00:25:15,290
Speaker 1: on this pressured physiology. I think what a lot of

448
00:25:15,570 --> 00:25:18,810
Speaker 1: people don't realize this. There's estrogen receptors throughout the body

449
00:25:18,850 --> 00:25:21,850
Speaker 1: that are active through the entire body. You talk about pain,

450
00:25:22,570 --> 00:25:27,609
Speaker 1: joint pain, sleep disruption. You know, the holistic approach is

451
00:25:27,650 --> 00:25:30,490
Speaker 1: always or that entire body approach is always so interesting

452
00:25:30,530 --> 00:25:35,129
Speaker 1: in helping women and negotiating those hormone fluctuations. So that

453
00:25:35,250 --> 00:25:38,609
Speaker 1: leads me into what I consider the million dollar question

454
00:25:38,810 --> 00:25:41,929
Speaker 1: right in terms of in terms of hormone therapy, in

455
00:25:42,010 --> 00:25:46,210
Speaker 1: terms of hormonal support for women going through these transitions,

456
00:25:46,410 --> 00:25:49,249
Speaker 1: for even just the cognitive issues around the time of

457
00:25:49,410 --> 00:25:52,290
Speaker 1: early perimen apuzzle transition or late perimen a puzzle transition,

458
00:25:52,369 --> 00:25:55,770
Speaker 1: and then for dementia prevention. You know, professional societies don't

459
00:25:55,810 --> 00:25:59,170
Speaker 1: recommend hormone therapy for dementia prevention or treatment or brain fog.

460
00:25:59,210 --> 00:26:02,410
Speaker 1: But do you think that there's any role for if

461
00:26:02,410 --> 00:26:04,649
Speaker 1: somebody is very distressed and it's really impacting their quality

462
00:26:04,650 --> 00:26:07,609
Speaker 1: of life, maybe starting estrogen at this time, for adding

463
00:26:07,609 --> 00:26:09,929
Speaker 1: a little bit of lotus hormone support for them, or

464
00:26:09,930 --> 00:26:10,929
Speaker 1: what are your thoughts about that?

465
00:26:11,570 --> 00:26:14,570
Speaker 3: So I have seen plenty of women at an individual

466
00:26:14,690 --> 00:26:17,410
Speaker 3: level who have shown a huge benefit from the right

467
00:26:17,770 --> 00:26:22,689
Speaker 3: combination of hormones optimization or hormone therapy. So yes, I

468
00:26:22,730 --> 00:26:26,929
Speaker 3: know that professional guidelines don't recommend or advocate for using

469
00:26:27,090 --> 00:26:29,930
Speaker 3: hormone therapy for either cognitive symptoms or as you say,

470
00:26:29,930 --> 00:26:33,210
Speaker 3: prevention of later life cognitive decline. But I think at

471
00:26:33,210 --> 00:26:35,810
Speaker 3: an individual level, I always tell people go and chat

472
00:26:35,850 --> 00:26:37,770
Speaker 3: to your health professional who's working with you in terms

473
00:26:37,770 --> 00:26:41,010
Speaker 3: of menopause. Chat to them about different options for hormone

474
00:26:41,010 --> 00:26:43,889
Speaker 3: therapy because I have seen so many women who have

475
00:26:44,210 --> 00:26:48,090
Speaker 3: been transformed in a beneficial way because of the right

476
00:26:48,129 --> 00:26:49,369
Speaker 3: combination of hormones.

477
00:26:49,530 --> 00:26:54,370
Speaker 1: Why has it been contentious the treatment of cognitive issues

478
00:26:54,450 --> 00:26:57,210
Speaker 1: or dementia prevention with estrogen.

479
00:26:57,730 --> 00:27:01,370
Speaker 3: Decades ago, it was kind of accepted and thought that

480
00:27:01,450 --> 00:27:06,210
Speaker 3: menopausal hormone therapy or HIT or hormone support was helpful

481
00:27:06,290 --> 00:27:09,290
Speaker 3: for reducing dementia risks from a lot of observational studies,

482
00:27:09,810 --> 00:27:13,290
Speaker 3: and then the Women's Health Initiative came along. The largest

483
00:27:13,690 --> 00:27:19,409
Speaker 3: randomized control trial that was early two thousands, and the

484
00:27:19,490 --> 00:27:22,689
Speaker 3: results showed that it was associated with an increase in

485
00:27:22,730 --> 00:27:26,929
Speaker 3: dementia risk. However, there has been a lot of debate,

486
00:27:27,010 --> 00:27:30,050
Speaker 3: a lot of discussion, and a lot of issues with

487
00:27:30,369 --> 00:27:32,890
Speaker 3: that study. So probably the two key ones in terms

488
00:27:32,930 --> 00:27:35,889
Speaker 3: of dementia risk was one all the participants in that

489
00:27:35,930 --> 00:27:39,010
Speaker 3: study were all on average over the age of sixty

490
00:27:39,050 --> 00:27:41,850
Speaker 3: five and more than ten years postmenopause, so a lot

491
00:27:41,850 --> 00:27:46,129
Speaker 3: of them initiated hormones not close to going through the

492
00:27:46,170 --> 00:27:49,929
Speaker 3: menopause transition years, so that was one factor. And the

493
00:27:49,970 --> 00:27:52,330
Speaker 3: other factor was the types of hormones that we used

494
00:27:52,369 --> 00:27:56,409
Speaker 3: in that particular study. Were potentially less beneficial for brain

495
00:27:56,490 --> 00:28:00,490
Speaker 3: health and for cognition, and so when that study came out,

496
00:28:00,530 --> 00:28:02,409
Speaker 3: I think it just scared a lot of people, and

497
00:28:02,490 --> 00:28:05,530
Speaker 3: since then there have been not enough studies to start

498
00:28:05,570 --> 00:28:08,090
Speaker 3: to build a more balanced evidence base. There was a

499
00:28:08,129 --> 00:28:11,489
Speaker 3: meta analysis that was published last year and that showed

500
00:28:11,570 --> 00:28:17,050
Speaker 3: that if hormone therapy was initiated close to menopause, then

501
00:28:17,290 --> 00:28:20,570
Speaker 3: it was associated with a reduced risk of developing dementia

502
00:28:20,690 --> 00:28:24,210
Speaker 3: later in life, particularly estrogen only hormone therapy.

503
00:28:24,650 --> 00:28:26,730
Speaker 1: Yeah. I think that what we call it the critical

504
00:28:26,770 --> 00:28:31,649
Speaker 1: window hypothesis, right, that if you get estrogen support or

505
00:28:31,650 --> 00:28:35,929
Speaker 1: have estrogen support within the first few years of menopause,

506
00:28:35,970 --> 00:28:37,090
Speaker 1: you may get some protection.

507
00:28:37,730 --> 00:28:40,170
Speaker 3: So I think the two key factors are that critical

508
00:28:40,210 --> 00:28:44,970
Speaker 3: window hypothesis or theory that we have to use estrogen

509
00:28:45,010 --> 00:28:48,850
Speaker 3: therapy very close to menopause to see benefits. But yes,

510
00:28:49,010 --> 00:28:53,050
Speaker 3: if it's not initiated during that time, and initiated you know,

511
00:28:53,090 --> 00:28:56,170
Speaker 3: more than ten years postmenopause, yes it might be harmful.

512
00:28:56,650 --> 00:28:58,650
Speaker 3: And I think the other factor is thinking about the

513
00:28:58,730 --> 00:29:01,650
Speaker 3: type of estrogen in terms of brain health and progesterone

514
00:29:01,770 --> 00:29:05,210
Speaker 3: progestine that might be most helpful for brain health.

515
00:29:05,290 --> 00:29:06,810
Speaker 1: And what do you think the answer to this is

516
00:29:06,850 --> 00:29:08,890
Speaker 1: in terms of getting the data? I mean, are we

517
00:29:08,930 --> 00:29:10,650
Speaker 1: going to have to settle for lesser data, are we

518
00:29:10,650 --> 00:29:13,970
Speaker 1: going to have to look for what we call biomarkers

519
00:29:14,130 --> 00:29:16,690
Speaker 1: or what is the answer to this? Because you and

520
00:29:16,690 --> 00:29:18,890
Speaker 1: I have both said that we see people who do

521
00:29:19,010 --> 00:29:22,970
Speaker 1: improve actually and there is compelling data that's out there

522
00:29:23,490 --> 00:29:28,050
Speaker 1: about prevention of dementia and treatment of cognitive issues. What

523
00:29:28,090 --> 00:29:28,970
Speaker 1: do you think the answer is?

524
00:29:29,170 --> 00:29:30,850
Speaker 2: We probably need a combination of things.

525
00:29:30,970 --> 00:29:33,690
Speaker 3: I don't think there's one specific trial that's going to

526
00:29:33,690 --> 00:29:37,210
Speaker 3: give us the perfect answer to that question. And when

527
00:29:37,250 --> 00:29:40,450
Speaker 3: we're talking about something like dementia, you're talking about a

528
00:29:40,570 --> 00:29:43,810
Speaker 3: thirty year period from when the pathology begins in the

529
00:29:43,810 --> 00:29:46,530
Speaker 3: brain to when the symptoms might manifest, or twenty to

530
00:29:46,530 --> 00:29:49,810
Speaker 3: thirty years, So that's a really long time frame. And

531
00:29:49,930 --> 00:29:53,930
Speaker 3: so I think there's two questions. One is, does hormone

532
00:29:53,970 --> 00:29:56,490
Speaker 3: therapy help in the short term for people with cognitive

533
00:29:56,490 --> 00:30:01,250
Speaker 3: symptoms in the moment when they're going through perimenopausal transition years.

534
00:30:01,290 --> 00:30:03,690
Speaker 2: And does hormone therapy help people.

535
00:30:03,410 --> 00:30:06,530
Speaker 3: In the early postmenopausal years if they've still got cognitive symptoms.

536
00:30:06,770 --> 00:30:08,730
Speaker 3: And then what are the flow and effects. Twenty years

537
00:30:08,770 --> 00:30:12,290
Speaker 3: down the track, is there a change in risk for

538
00:30:12,730 --> 00:30:16,970
Speaker 3: developing neurodegenerative processes lack dementia and so I think we

539
00:30:17,090 --> 00:30:19,770
Speaker 3: just need to keep doing more research and keep putting

540
00:30:19,810 --> 00:30:23,890
Speaker 3: the pieces of puzzles together, keeping the research flowing so

541
00:30:23,930 --> 00:30:26,410
Speaker 3: we can gradually build on it and learn more.

542
00:30:27,970 --> 00:30:29,650
Speaker 1: Just the other day, I was talking with a patient

543
00:30:29,650 --> 00:30:33,650
Speaker 1: who started hormone support for something completely unrelated to cognitive health.

544
00:30:34,210 --> 00:30:36,530
Speaker 1: When I asked how she was feeling, she said, you

545
00:30:36,530 --> 00:30:39,050
Speaker 1: know what, My brain fog got better. I can think

546
00:30:39,050 --> 00:30:42,250
Speaker 1: more clearly now. We hadn't even spoken about brain fog

547
00:30:42,330 --> 00:30:45,810
Speaker 1: before that, and it's remarkable how quickly these changes can

548
00:30:45,810 --> 00:30:49,570
Speaker 1: take effect. When I started on hormone therapy after I

549
00:30:49,610 --> 00:30:52,570
Speaker 1: finally figured out I was im perimenopause, it only took

550
00:30:52,610 --> 00:30:55,130
Speaker 1: about two weeks before my mood started to improve and

551
00:30:55,170 --> 00:30:57,970
Speaker 1: I started to feel like my old self again. Now

552
00:30:57,970 --> 00:30:59,930
Speaker 1: that's not to say that hormone therapy is a cure

553
00:30:59,890 --> 00:31:03,810
Speaker 1: all for every perimenopausal symptom, but for many women it

554
00:31:03,810 --> 00:31:08,210
Speaker 1: can play a really important role in feeling better. Coming up,

555
00:31:08,410 --> 00:31:11,210
Speaker 1: doctor Gervirich and I discussed some additional tools to support

556
00:31:11,250 --> 00:31:15,650
Speaker 1: your cognitive help from brain training, exercises to lifestyle changes,

557
00:31:16,090 --> 00:31:41,210
Speaker 1: decoding women's health will be right back. You know, we've

558
00:31:41,250 --> 00:31:43,690
Speaker 1: spoken about kind of you know, what happens to the brain,

559
00:31:43,890 --> 00:31:47,850
Speaker 1: and hormone support may be helpful, but talk to me

560
00:31:48,010 --> 00:31:52,610
Speaker 1: about cognitive training, cognitive reserve and what are those concepts

561
00:31:52,610 --> 00:31:53,650
Speaker 1: and how do they help women.

562
00:31:54,570 --> 00:31:59,290
Speaker 3: Yeah, I think in the absence of anything that's currently

563
00:31:59,770 --> 00:32:03,570
Speaker 3: clearly indicated that people can take for cognition, I think

564
00:32:03,570 --> 00:32:05,610
Speaker 3: it's really important to think about what else can we do.

565
00:32:06,130 --> 00:32:08,410
Speaker 3: And I think there's definitely a role for hormonal support

566
00:32:08,490 --> 00:32:11,570
Speaker 3: or hormonal therapy that needs to be explored in a

567
00:32:11,570 --> 00:32:14,690
Speaker 3: lot more detail. But as you said, our brains keep

568
00:32:14,770 --> 00:32:17,530
Speaker 3: changing depending on how we stimulate them and which pathways

569
00:32:17,530 --> 00:32:21,050
Speaker 3: we're using and encouraging and growing, and so there is

570
00:32:21,170 --> 00:32:24,050
Speaker 3: room to retrain our brains and to get better at

571
00:32:24,090 --> 00:32:27,810
Speaker 3: different things all the time. And so we did a

572
00:32:27,850 --> 00:32:31,010
Speaker 3: review initially of cognitive training in midlife, so we're talking

573
00:32:31,050 --> 00:32:35,010
Speaker 3: about cognitive training to boost cognitive functions broadly in everyone

574
00:32:35,210 --> 00:32:39,090
Speaker 3: in the midlife. And then from there we specifically tried

575
00:32:39,090 --> 00:32:41,490
Speaker 3: to focus on the few studies that had either reported

576
00:32:41,530 --> 00:32:45,610
Speaker 3: the results of females specifically or had looked specifically at menopause,

577
00:32:45,970 --> 00:32:47,610
Speaker 3: and so to just kind of pull out what we

578
00:32:47,690 --> 00:32:53,570
Speaker 3: found in menopause, the most beneficial areas were to use

579
00:32:54,010 --> 00:32:57,850
Speaker 3: a strategy based training, So that's teaching people new strategies

580
00:32:57,890 --> 00:33:02,010
Speaker 3: to approach difficulties that they're having or to enhance or

581
00:33:02,050 --> 00:33:06,890
Speaker 3: optimize their cognitive performance. Psycho Education, like explaining to people

582
00:33:06,930 --> 00:33:10,290
Speaker 3: what's going on, can be really helpful as a component

583
00:33:10,330 --> 00:33:13,410
Speaker 3: of cognitive training. And so now we're taking this and

584
00:33:13,450 --> 00:33:19,490
Speaker 3: we're building cognitive training programs for women with whatever mental

585
00:33:19,570 --> 00:33:23,210
Speaker 3: health type symptoms they might be experiencing and cognitive symptoms

586
00:33:23,410 --> 00:33:26,570
Speaker 3: combined without or just cognitive symptoms on their own. So

587
00:33:26,690 --> 00:33:30,210
Speaker 3: giving people education about what we're talking about, the role

588
00:33:30,250 --> 00:33:33,370
Speaker 3: of hormones, other symptoms, how all those things work together,

589
00:33:33,690 --> 00:33:38,050
Speaker 3: how cognition works. People knowing that you have capacity to

590
00:33:38,370 --> 00:33:42,090
Speaker 3: improve and optimize your cognitive functioning, So giving people that

591
00:33:42,130 --> 00:33:44,810
Speaker 3: piece of knowledge and that understanding can be really helpful.

592
00:33:45,250 --> 00:33:46,570
Speaker 2: And then training.

593
00:33:46,890 --> 00:33:49,490
Speaker 3: So when we talk about training, some people I think

594
00:33:49,530 --> 00:33:53,290
Speaker 3: probably think of computerized cognitive training or brain training, where

595
00:33:53,330 --> 00:33:55,450
Speaker 3: you repeat one task over and over again and people

596
00:33:55,450 --> 00:33:57,610
Speaker 3: get really good at that task. But most of the

597
00:33:57,650 --> 00:34:01,490
Speaker 3: research shows that that doesn't necessarily generalize to day day life.

598
00:34:01,530 --> 00:34:03,450
Speaker 3: So you just get really good at that one task

599
00:34:03,850 --> 00:34:07,610
Speaker 3: or maybe similar tasks. But what we want people to

600
00:34:07,610 --> 00:34:11,290
Speaker 3: do is get better at thinking and optimizing all of

601
00:34:11,330 --> 00:34:16,450
Speaker 3: their cognitive skills. So by using strategies to help reduce

602
00:34:16,490 --> 00:34:21,090
Speaker 3: your mental load, writing lists, breaking down tasks, prioritizing tasks,

603
00:34:21,090 --> 00:34:24,330
Speaker 3: completing one thing at a time, teaching people to really

604
00:34:24,370 --> 00:34:28,210
Speaker 3: focus their attention and actively attend to whatever tasks they

605
00:34:28,210 --> 00:34:31,490
Speaker 3: want to do, can also really improve your capacity to

606
00:34:31,610 --> 00:34:34,970
Speaker 3: learn and encode that information. Teaching people that when they

607
00:34:35,010 --> 00:34:37,530
Speaker 3: want to learn a new piece of information, if you

608
00:34:37,570 --> 00:34:40,490
Speaker 3: can sort of paraphrase it now ask questions about it,

609
00:34:40,490 --> 00:34:43,450
Speaker 3: it encodes it in a deeper level. So just teaching

610
00:34:43,490 --> 00:34:46,250
Speaker 3: people about how memory works, and how encoding works, and

611
00:34:46,290 --> 00:34:50,090
Speaker 3: how attention works, and giving people strategies to improve and

612
00:34:50,170 --> 00:34:53,490
Speaker 3: optimize all of those different thinking skills, that's the kind

613
00:34:53,490 --> 00:34:56,610
Speaker 3: of cognitive training that seems to be the most beneficial.

614
00:34:57,090 --> 00:35:00,570
Speaker 3: And then we also talk about lifestyle factors that might

615
00:35:00,610 --> 00:35:04,850
Speaker 3: be helpful to again optimize brain health and optimize cognitive health.

616
00:35:05,170 --> 00:35:07,810
Speaker 1: So one of my midlife friends wants to know, is

617
00:35:07,970 --> 00:35:13,330
Speaker 1: word all a form of cognitive train we suspect not

618
00:35:14,330 --> 00:35:17,050
Speaker 1: we suspect that you need to do more than wordle.

619
00:35:17,610 --> 00:35:20,330
Speaker 3: More than word all, but wordle is better than nothing,

620
00:35:20,810 --> 00:35:23,130
Speaker 3: so I think, and if you love wordle, there's no

621
00:35:23,250 --> 00:35:25,770
Speaker 3: reason not to do word all. So I think anything

622
00:35:25,810 --> 00:35:28,370
Speaker 3: that stimulates your brain in a new way is a

623
00:35:28,410 --> 00:35:31,490
Speaker 3: good thing for your brain. Doesn't mean it will necessarily

624
00:35:31,930 --> 00:35:34,450
Speaker 3: generalize to lots of different areas, but I think if

625
00:35:34,490 --> 00:35:35,810
Speaker 3: you're enjoying it, go for it.

626
00:35:36,210 --> 00:35:38,370
Speaker 1: Tell us what kind of nutrition do you recommend, what

627
00:35:38,490 --> 00:35:41,450
Speaker 1: kind of exercise, and why this stuff works? You know,

628
00:35:41,610 --> 00:35:44,810
Speaker 1: I always love the context of why something works because

629
00:35:44,810 --> 00:35:47,090
Speaker 1: I think it helps me understand it better, It helps

630
00:35:47,130 --> 00:35:49,170
Speaker 1: my patience understand why it's so important.

631
00:35:51,050 --> 00:35:55,450
Speaker 3: So the lifestyle recommendations for cognitive health are exactly the

632
00:35:55,490 --> 00:35:59,530
Speaker 3: same as the lifestyle recommendations for brain health, which are

633
00:35:59,530 --> 00:36:02,490
Speaker 3: the same as the lifestyle recommendations for heart health. So

634
00:36:02,570 --> 00:36:04,770
Speaker 3: I feel like everyone is on the same page. That

635
00:36:04,810 --> 00:36:08,770
Speaker 3: people need to do their best to exercise and to

636
00:36:08,890 --> 00:36:11,890
Speaker 3: eat well, and to make sure they can opt their sleep,

637
00:36:12,010 --> 00:36:15,930
Speaker 3: minimize their stress, maintain social connections, so all of those

638
00:36:15,970 --> 00:36:19,650
Speaker 3: things are really important. My personal motto when I see

639
00:36:19,690 --> 00:36:22,210
Speaker 3: people is just for people to try their best. So

640
00:36:22,250 --> 00:36:25,250
Speaker 3: I just think for people at an individual level to

641
00:36:25,370 --> 00:36:28,810
Speaker 3: find a type of exercise that they enjoy and then

642
00:36:28,850 --> 00:36:31,850
Speaker 3: to keep building on that. And you know, the guidelines

643
00:36:31,890 --> 00:36:34,930
Speaker 3: would suggest that you have both strength based training as

644
00:36:34,930 --> 00:36:37,370
Speaker 3: well as cardio and you kind of mix it all up.

645
00:36:37,370 --> 00:36:39,290
Speaker 3: But I just think a little bit of exercise is

646
00:36:39,330 --> 00:36:42,050
Speaker 3: better than nothing. So whatever people can do to exercise

647
00:36:42,610 --> 00:36:45,050
Speaker 3: is going to help people's mental health and their brain

648
00:36:45,090 --> 00:36:46,410
Speaker 3: health and their cognitive health.

649
00:36:46,610 --> 00:36:48,370
Speaker 2: In terms of nutrition, it's.

650
00:36:48,210 --> 00:36:52,170
Speaker 3: About people working toward the best diet they can in

651
00:36:52,210 --> 00:36:56,890
Speaker 3: their lives. And you know, minimizing process food and trying

652
00:36:56,890 --> 00:37:00,489
Speaker 3: to build up a healthy, balanced diet is the most

653
00:37:00,490 --> 00:37:03,410
Speaker 3: important thing. But if they want to adopt the diet

654
00:37:03,450 --> 00:37:05,810
Speaker 3: that has the best evidence base for cognitive health and

655
00:37:06,730 --> 00:37:09,810
Speaker 3: longevity in terms of brain health, it's the Mediterranean diet.

656
00:37:10,370 --> 00:37:13,210
Speaker 3: In terms of sleep, and it's often hard to do this,

657
00:37:13,330 --> 00:37:15,890
Speaker 3: but people shouldn't put up with bad sleep. They should

658
00:37:15,890 --> 00:37:18,970
Speaker 3: speak to their physicians whoever they're working with about different

659
00:37:19,010 --> 00:37:22,290
Speaker 3: sleep interventions. But there's a lot of evidence for CBT,

660
00:37:22,490 --> 00:37:27,330
Speaker 3: so cognitive behavioral therapy I so CBT for insomnia, and

661
00:37:27,370 --> 00:37:29,930
Speaker 3: there are free programs online that people can log in

662
00:37:30,050 --> 00:37:33,770
Speaker 3: and do four to six sessions and this can really

663
00:37:33,810 --> 00:37:37,770
Speaker 3: help some people with their sleep. So I think encouraging

664
00:37:37,810 --> 00:37:42,130
Speaker 3: people to maximize their sleep, their diet, their exercise, for

665
00:37:42,210 --> 00:37:44,250
Speaker 3: people to engage socially.

666
00:37:44,930 --> 00:37:45,570
Speaker 2: There's a lot of.

667
00:37:45,490 --> 00:37:49,810
Speaker 3: Evidence that's emerged to show the importance of social connections

668
00:37:50,330 --> 00:37:54,210
Speaker 3: and the negative effects of being lonely, so in terms

669
00:37:54,210 --> 00:37:57,090
Speaker 3: of mental health, in terms of cognitive health. So encouraging

670
00:37:57,130 --> 00:38:02,130
Speaker 3: people to prioritize socializing because it's fun, it's nice, and

671
00:38:02,170 --> 00:38:04,850
Speaker 3: it also protects your brain and your mental health later

672
00:38:04,890 --> 00:38:06,730
Speaker 3: in life, so that's also important.

673
00:38:07,170 --> 00:38:09,170
Speaker 2: And then minimizing stress.

674
00:38:09,370 --> 00:38:12,810
Speaker 3: So there's a lot of evidence for meditation being beneficial

675
00:38:12,930 --> 00:38:16,290
Speaker 3: for brain health, for cognition in the short term and

676
00:38:16,330 --> 00:38:19,610
Speaker 3: the long term. So if people can incorporate some type

677
00:38:19,650 --> 00:38:23,490
Speaker 3: of meditation, and you know, meditation isn't for everyone. Some

678
00:38:23,530 --> 00:38:26,410
Speaker 3: people need to do more of like a mindfulness based

679
00:38:26,410 --> 00:38:29,050
Speaker 3: practice where you're just present in whatever you're doing. So

680
00:38:29,090 --> 00:38:32,210
Speaker 3: it might be movement based. Some people talk about being

681
00:38:32,250 --> 00:38:35,690
Speaker 3: mindful while they're surfing, or mindful while they're walking, or

682
00:38:35,730 --> 00:38:37,930
Speaker 3: mindful while they're doing yoga. It's just kind of being

683
00:38:38,010 --> 00:38:42,610
Speaker 3: present and it might not be, you know, exactly a

684
00:38:42,690 --> 00:38:46,610
Speaker 3: meditation practice, but some form of mindfulness embedded in people's

685
00:38:46,690 --> 00:38:50,610
Speaker 3: lives is really important to help minimize stress, and it

686
00:38:50,650 --> 00:38:53,650
Speaker 3: can also have flow and effects to promoting brain health.

687
00:38:54,250 --> 00:38:56,850
Speaker 3: So in terms of lifestyle factors, they're kind of the

688
00:38:57,210 --> 00:39:00,770
Speaker 3: key ones. And also talking to people, particularly in midlife

689
00:39:00,770 --> 00:39:04,050
Speaker 3: about minimizing alcohol. There's a lot of negative effects from

690
00:39:04,130 --> 00:39:06,730
Speaker 3: excessive drinking and a lot of people do turn to

691
00:39:06,810 --> 00:39:10,370
Speaker 3: alcohol as a short term coping strategy, and so it's

692
00:39:10,410 --> 00:39:14,930
Speaker 3: important understand that alcohol can have lots of negative effects

693
00:39:14,930 --> 00:39:18,490
Speaker 3: on the brain if people use alcohol excessively. So we

694
00:39:18,570 --> 00:39:20,930
Speaker 3: often have a conversation about how much alcohol people are

695
00:39:20,970 --> 00:39:24,370
Speaker 3: drinking and what that might be doing to their brain

696
00:39:24,450 --> 00:39:26,090
Speaker 3: health in the long term as well.

697
00:39:27,170 --> 00:39:28,770
Speaker 1: So I'm going to go backwards. I'm going to go

698
00:39:28,810 --> 00:39:30,570
Speaker 1: back and touch on each one of those again in

699
00:39:30,610 --> 00:39:32,170
Speaker 1: a little bit more detail. But I want to start

700
00:39:32,170 --> 00:39:34,930
Speaker 1: with alcohol because that's a big one, right And also

701
00:39:34,930 --> 00:39:37,010
Speaker 1: thing is really important to realize too that alcohol is

702
00:39:37,010 --> 00:39:39,970
Speaker 1: to sleep disruption and can worsen there's a motor symptoms

703
00:39:40,010 --> 00:39:42,930
Speaker 1: or heart flashes. Do you think that there is any

704
00:39:43,010 --> 00:39:45,810
Speaker 1: level of I mean, I think of alcohols and neurotoxin,

705
00:39:46,210 --> 00:39:48,650
Speaker 1: So do you think that there is any level of

706
00:39:48,690 --> 00:39:52,250
Speaker 1: alcohol which is safe for women to consume in terms

707
00:39:52,290 --> 00:39:53,930
Speaker 1: of cognitive health.

708
00:39:54,050 --> 00:39:59,330
Speaker 3: Yeah, So I think overall there's no real benefits of

709
00:39:59,530 --> 00:40:02,210
Speaker 3: alcohol in terms of brain health, in terms of sleep,

710
00:40:02,250 --> 00:40:04,810
Speaker 3: in terms of mood. Maybe in the very short term

711
00:40:04,810 --> 00:40:07,170
Speaker 3: as people have a drink, they might feel good temporarily,

712
00:40:07,250 --> 00:40:10,450
Speaker 3: but overall, no, we don't advocate for alcohol, and the

713
00:40:10,490 --> 00:40:13,490
Speaker 3: scientific literature does not support the use of alcohol in

714
00:40:13,570 --> 00:40:16,450
Speaker 3: any way in terms of brain health. But it is

715
00:40:16,490 --> 00:40:20,170
Speaker 3: a big part of society, so it exists and it's there.

716
00:40:20,330 --> 00:40:23,770
Speaker 3: While in the perfect world we wouldn't have alcohol, the

717
00:40:23,850 --> 00:40:26,450
Speaker 3: evidence would suggest that, yes, it's neurotoxic and it's not

718
00:40:26,530 --> 00:40:29,490
Speaker 3: beneficial for brain health. But on the flip side, I

719
00:40:29,490 --> 00:40:32,810
Speaker 3: think sometimes having that conversation isn't going to lead to

720
00:40:32,810 --> 00:40:37,050
Speaker 3: behavior change where people completely stop drinking alcohol. So instead

721
00:40:37,090 --> 00:40:40,210
Speaker 3: talking about adverse effects short term and longer term can

722
00:40:40,290 --> 00:40:43,250
Speaker 3: just help people understand what's going on and what role

723
00:40:43,290 --> 00:40:44,290
Speaker 3: el cool might be playing.

724
00:40:44,730 --> 00:40:47,210
Speaker 1: Yeah, I think that context is really important. Why is

725
00:40:47,290 --> 00:40:50,490
Speaker 1: exercise good for us? Like, how does that work? How

726
00:40:50,490 --> 00:40:51,610
Speaker 1: does that impact the brain?

727
00:40:52,130 --> 00:40:55,650
Speaker 3: So again it comes back to being important for heart

728
00:40:55,690 --> 00:40:59,290
Speaker 3: health and for our physical health and for our mental health.

729
00:40:59,330 --> 00:41:02,970
Speaker 3: So there are studies that show that exercise is almost

730
00:41:03,050 --> 00:41:07,330
Speaker 3: as beneficial as antidepressants for people have mood symptoms, and

731
00:41:07,410 --> 00:41:11,690
Speaker 3: so exercise can have a really big benefit at a

732
00:41:11,690 --> 00:41:15,650
Speaker 3: physiological level, just talking about blood flow and changes in

733
00:41:15,650 --> 00:41:18,570
Speaker 3: the brain, the endorphins, the chemicals that are released while

734
00:41:18,610 --> 00:41:22,450
Speaker 3: we're exercising, and I think people who regularly exercise can

735
00:41:22,490 --> 00:41:23,570
Speaker 3: feel those benefits.

736
00:41:23,810 --> 00:41:25,490
Speaker 2: But I think for people who never.

737
00:41:25,330 --> 00:41:29,330
Speaker 3: Exercise, it is hard for people to start to incorporate

738
00:41:29,410 --> 00:41:31,490
Speaker 3: exercise in their life. So I think kind of starting

739
00:41:31,530 --> 00:41:34,930
Speaker 3: small and finding something that people are really comfortable as

740
00:41:34,970 --> 00:41:36,730
Speaker 3: a starting point is super important.

741
00:41:36,770 --> 00:41:38,210
Speaker 2: Otherwise it just won't happen.

742
00:41:38,890 --> 00:41:41,810
Speaker 1: Yeah, I think again that context is so important. Right.

743
00:41:41,890 --> 00:41:43,570
Speaker 1: I always laugh because I feel bad for the people

744
00:41:43,610 --> 00:41:45,490
Speaker 1: around me because I do my Caliston next every morning,

745
00:41:45,890 --> 00:41:48,770
Speaker 1: and I think, as do my Caliston next, my irisan

746
00:41:48,890 --> 00:41:51,850
Speaker 1: goes up, my VDNF goes up, which are all for

747
00:41:51,970 --> 00:41:54,850
Speaker 1: our listeners. Those are things that make your brain grow. Actually,

748
00:41:55,010 --> 00:41:58,850
Speaker 1: so pumping iron can make your brain grow. What should

749
00:41:58,850 --> 00:42:02,170
Speaker 1: people target? So any movement is good, any exercise is good,

750
00:42:02,250 --> 00:42:05,010
Speaker 1: but there should be a target that people look at

751
00:42:05,090 --> 00:42:07,370
Speaker 1: or can strive to at some point. What should that

752
00:42:07,410 --> 00:42:10,490
Speaker 1: target be in terms of cognitive health? For midlife women.

753
00:42:12,170 --> 00:42:15,410
Speaker 3: So I would say if people can work themselves up

754
00:42:15,450 --> 00:42:18,570
Speaker 3: to five thirty minute sessions a week with a mixture

755
00:42:18,650 --> 00:42:23,330
Speaker 3: of strength training and cardio based training, that would be ideal.

756
00:42:23,730 --> 00:42:26,730
Speaker 3: And also really importantly, just finding an exercise that you

757
00:42:26,810 --> 00:42:29,730
Speaker 3: love so it becomes a passion and a habit is

758
00:42:29,770 --> 00:42:30,410
Speaker 3: really important.

759
00:42:31,250 --> 00:42:33,730
Speaker 1: Yeah, And I think also it's important to realize too

760
00:42:33,770 --> 00:42:35,010
Speaker 1: that you know, you don't have to go to the gym.

761
00:42:35,090 --> 00:42:37,250
Speaker 1: You can do this in your house basically and doesn't

762
00:42:37,250 --> 00:42:41,010
Speaker 1: require that much time necessarily. In terms of nutrition, you

763
00:42:41,090 --> 00:42:43,370
Speaker 1: said the Mediterranean diet. Can you tell us a little

764
00:42:43,370 --> 00:42:45,690
Speaker 1: bit about the Mediterranean diet and are there any tweaks

765
00:42:45,690 --> 00:42:49,170
Speaker 1: for the Mediterranean diet for cognitive health? And do you

766
00:42:49,250 --> 00:42:52,050
Speaker 1: think as midlife women we need to shift and downshift

767
00:42:52,050 --> 00:42:53,930
Speaker 1: our carbs and increase our protein a little bit for

768
00:42:54,010 --> 00:42:57,370
Speaker 1: brain health as the metabolism and the brain changes.

769
00:42:57,890 --> 00:43:00,890
Speaker 3: Yeah, so again there is a bit of literature about that,

770
00:43:00,970 --> 00:43:05,970
Speaker 3: reducing carbs, increasing protein and longevity. In terms of what

771
00:43:06,010 --> 00:43:08,970
Speaker 3: the Mediterranean diet is, making sure you have a lot

772
00:43:08,970 --> 00:43:13,210
Speaker 3: of you know, fresh fruits, fresh fed stables, not process foods,

773
00:43:14,090 --> 00:43:19,090
Speaker 3: fish if you eat fish, and natural oils and nuts

774
00:43:19,170 --> 00:43:22,770
Speaker 3: are all really important. Increasing protein can be important for

775
00:43:23,170 --> 00:43:28,090
Speaker 3: brain health as well, and minimizing carbs, but making sure

776
00:43:28,490 --> 00:43:33,650
Speaker 3: that whatever you're eating is just minimizing the process food

777
00:43:33,690 --> 00:43:36,570
Speaker 3: in terms of brain health, I think is the key message.

778
00:43:37,490 --> 00:43:39,970
Speaker 1: And then in terms of socialization, you know, we counsel

779
00:43:40,010 --> 00:43:43,010
Speaker 1: our patients to socialize, right, but we live in a

780
00:43:43,090 --> 00:43:47,090
Speaker 1: disconnected world for many of us actually, with computers and

781
00:43:47,930 --> 00:43:51,650
Speaker 1: ordering grub hub and Amazon and you never have to

782
00:43:51,650 --> 00:43:53,570
Speaker 1: go outside, right, work at home.

783
00:43:54,210 --> 00:43:55,050
Speaker 2: Do you have any.

784
00:43:54,850 --> 00:43:57,130
Speaker 1: Tips for people in terms of how to get a

785
00:43:57,130 --> 00:43:59,650
Speaker 1: more active social life. That's something I really think about

786
00:43:59,650 --> 00:44:01,730
Speaker 1: as I age. I want a sense of community, Like,

787
00:44:01,770 --> 00:44:03,050
Speaker 1: how do you advise your patients?

788
00:44:03,490 --> 00:44:07,130
Speaker 3: Yeah, so I think again, I always take quite an

789
00:44:07,130 --> 00:44:10,210
Speaker 3: individualized approach, so talking to people about what their social

790
00:44:10,450 --> 00:44:12,969
Speaker 3: situation looks like. Do they have friends that they see

791
00:44:13,010 --> 00:44:16,330
Speaker 3: physically and that they connect with. I agree that we

792
00:44:16,370 --> 00:44:19,490
Speaker 3: live in a very digital global world now and what

793
00:44:19,570 --> 00:44:22,090
Speaker 3: social connection looks like now is quite different to what

794
00:44:22,130 --> 00:44:25,410
Speaker 3: it looks like a decade ago. But I think having

795
00:44:25,410 --> 00:44:28,130
Speaker 3: that sense of belonging, that sense of community, is an

796
00:44:28,210 --> 00:44:31,890
Speaker 3: important part of people feeling like they're socially connected. So

797
00:44:31,970 --> 00:44:35,490
Speaker 3: for some people that is an online community where they

798
00:44:35,730 --> 00:44:38,730
Speaker 3: are connected, But as long as they're kind of real

799
00:44:38,770 --> 00:44:43,090
Speaker 3: people that they actually know and can share their stories

800
00:44:43,090 --> 00:44:46,770
Speaker 3: with and their day with and feel supported by that

801
00:44:47,050 --> 00:44:49,170
Speaker 3: person and someone that they can turn to when they

802
00:44:49,210 --> 00:44:52,810
Speaker 3: need to share bad news with and get support from

803
00:44:52,890 --> 00:44:55,450
Speaker 3: in a social sense, is really important.

804
00:44:55,730 --> 00:44:58,410
Speaker 1: What are you most excited about with the future with

805
00:44:59,250 --> 00:45:01,570
Speaker 1: specifically women's brain health.

806
00:45:02,010 --> 00:45:05,490
Speaker 3: So I think while it is a time of vulnerability,

807
00:45:05,530 --> 00:45:08,570
Speaker 3: there can be lots of negative symptoms that people can

808
00:45:08,650 --> 00:45:13,330
Speaker 3: experience during perimenopause and postmenopause or years, I think it's

809
00:45:13,370 --> 00:45:15,450
Speaker 3: also a time of opportunity. And so if you can

810
00:45:15,490 --> 00:45:18,890
Speaker 3: better understand what's going on and how to optimize brains

811
00:45:19,170 --> 00:45:23,810
Speaker 3: during this time, it is potentially this huge window to

812
00:45:24,210 --> 00:45:28,010
Speaker 3: ensuring that women have much better opportunity to sort of

813
00:45:28,010 --> 00:45:31,490
Speaker 3: minimize the risks of cognitive decline later in life and

814
00:45:32,170 --> 00:45:36,850
Speaker 3: maximize the potential for having good brain health and healthy

815
00:45:36,890 --> 00:45:40,530
Speaker 3: brain aging. And also, I think there's been very little

816
00:45:40,530 --> 00:45:44,250
Speaker 3: research that's really properly been done in perimenopause and early

817
00:45:44,290 --> 00:45:47,010
Speaker 3: perimenopause or years. I think particularly that when we're talking

818
00:45:47,050 --> 00:45:49,770
Speaker 3: about hormone therapy, a lot of the work is done

819
00:45:49,850 --> 00:45:53,290
Speaker 3: in menopause postmenopause or years. But we really don't know

820
00:45:53,450 --> 00:45:56,050
Speaker 3: much in particularly in terms of cognition and mental health

821
00:45:56,170 --> 00:46:00,570
Speaker 3: in terms of perimenopause. So I think uncovering that area

822
00:46:01,610 --> 00:46:03,530
Speaker 3: is something that I'm really excited to learn.

823
00:46:04,050 --> 00:46:05,090
Speaker 2: What the future will hold.

824
00:46:05,410 --> 00:46:07,730
Speaker 1: Yeah, I think we have to be super proactive, right,

825
00:46:07,770 --> 00:46:09,570
Speaker 1: I mean, I think that is the future of looking

826
00:46:09,610 --> 00:46:13,650
Speaker 1: at perimenopause or those late reproductive years as an opportunity

827
00:46:13,690 --> 00:46:16,490
Speaker 1: to really shore up health and really pay attention so

828
00:46:16,530 --> 00:46:19,970
Speaker 1: that we don't age passively right and let things happen

829
00:46:20,050 --> 00:46:23,410
Speaker 1: to us, and we can be proactive. What are your

830
00:46:23,530 --> 00:46:27,850
Speaker 1: three take home tips for our listeners? What are three

831
00:46:28,130 --> 00:46:31,650
Speaker 1: actionable tips that you would give them to maintain the

832
00:46:31,650 --> 00:46:33,050
Speaker 1: best brain health possible.

833
00:46:33,570 --> 00:46:35,930
Speaker 3: I would say the first one is just to be aware.

834
00:46:36,370 --> 00:46:39,290
Speaker 3: Be aware of what's happening at a hormone level. And

835
00:46:39,370 --> 00:46:42,490
Speaker 3: while you might not be having lots of menopause symptoms,

836
00:46:42,690 --> 00:46:45,570
Speaker 3: if you're experiencing changes in your mental health and your

837
00:46:45,610 --> 00:46:50,090
Speaker 3: cognitive health or some cognitive symptoms, be aware that it

838
00:46:50,170 --> 00:46:53,010
Speaker 3: might be connected to your hormones. So, I think if

839
00:46:53,050 --> 00:46:57,170
Speaker 3: people are worried about cognitive symptoms or worried about the

840
00:46:57,210 --> 00:47:00,330
Speaker 3: onset of they think they might have dementia, to think

841
00:47:00,370 --> 00:47:03,050
Speaker 3: about this might not be that, it might just be

842
00:47:03,090 --> 00:47:05,690
Speaker 3: part of a hormone or transition period. Maybe this is

843
00:47:05,730 --> 00:47:08,690
Speaker 3: the start of perimenopause, and go and have a chat

844
00:47:08,730 --> 00:47:11,770
Speaker 3: to a health professional to see what can be done.

845
00:47:11,810 --> 00:47:14,330
Speaker 2: So that would tip number one is that awareness.

846
00:47:14,690 --> 00:47:19,290
Speaker 3: Tip number two is for women not to suffer in silence. Again,

847
00:47:19,450 --> 00:47:23,290
Speaker 3: seeking help is so important, having conversations with the right

848
00:47:23,690 --> 00:47:27,210
Speaker 3: practitioner who has an awareness of menopause and awareness of

849
00:47:27,250 --> 00:47:32,250
Speaker 3: the different symptoms that people can experience. And the third

850
00:47:32,290 --> 00:47:36,130
Speaker 3: tip would be just the practical lifestyle things that people

851
00:47:36,130 --> 00:47:40,050
Speaker 3: can do, and for people to know that their brains

852
00:47:40,170 --> 00:47:43,770
Speaker 3: are constantly changing and we're constantly building new pathways in

853
00:47:43,810 --> 00:47:45,930
Speaker 3: our brains, and there's so much we can do to

854
00:47:46,210 --> 00:47:49,490
Speaker 3: build positive pathways. And it's a time that people can

855
00:47:49,530 --> 00:47:53,090
Speaker 3: really seek support and get help and do their best

856
00:47:53,090 --> 00:47:56,610
Speaker 3: to kind of optimize their functioning and as much as

857
00:47:56,650 --> 00:47:58,850
Speaker 3: possible thrive during this phase of their life.

858
00:47:58,930 --> 00:48:02,570
Speaker 2: And for some women that's not at all what they're feeling.

859
00:48:02,610 --> 00:48:04,370
Speaker 3: They might be listening to this and feeling like they're

860
00:48:04,410 --> 00:48:07,490
Speaker 3: so far off thriving. But I think knowing that there

861
00:48:07,530 --> 00:48:11,890
Speaker 3: are pathways to help and to support and to being

862
00:48:11,930 --> 00:48:14,690
Speaker 3: able to be your best version of yourself during this

863
00:48:14,850 --> 00:48:16,970
Speaker 3: time of your life is really important.

864
00:48:18,690 --> 00:48:21,730
Speaker 1: I like to tell my patients, you know, at thirty five,

865
00:48:21,850 --> 00:48:25,250
Speaker 1: forty forty five, how you treat your body today is

866
00:48:25,290 --> 00:48:27,650
Speaker 1: really you're going to feel it when you're seventy or eighty,

867
00:48:27,730 --> 00:48:30,810
Speaker 1: So super important to set yourself up for success.

868
00:48:30,890 --> 00:48:33,170
Speaker 2: To you the ball up correctly, Yeah, definitely.

869
00:48:33,450 --> 00:48:35,730
Speaker 1: Thank you so much for joining me. This has been

870
00:48:35,770 --> 00:48:38,370
Speaker 1: such a real pleasure to speak with you. I really

871
00:48:38,450 --> 00:48:40,930
Speaker 1: look forward to following your work and hearing more from

872
00:48:41,010 --> 00:48:41,690
Speaker 1: you in the future.

873
00:48:42,250 --> 00:48:43,370
Speaker 2: Thank you, Elizabeth.

874
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Speaker 3: It's been absolute pleasure talking to you, and I've really

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Speaker 3: enjoyed the conversation.

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Speaker 1: I see a lot of patients in my practice on

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Speaker 1: a day to day basis who are really concerned about

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Speaker 1: cognitive decline. I want people to really remember that brain

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00:49:01,050 --> 00:49:05,250
Speaker 1: health is not a passive endeavor. Lifestyle can greatly impact

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Speaker 1: cognitive function. There's lots of data that estrogen protects the brain,

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00:49:09,930 --> 00:49:13,210
Speaker 1: and our more modern normal estrogens used in hormone therapies

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00:49:13,210 --> 00:49:16,770
Speaker 1: today may be protective against cognitive decline in the future,

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00:49:17,370 --> 00:49:20,090
Speaker 1: especially if you're at elevated risk based on your family history.

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Speaker 1: I'm grateful for Caroline and researchers like her who are

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00:49:24,450 --> 00:49:26,770
Speaker 1: working to get us more data to help us to

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00:49:26,850 --> 00:49:31,090
Speaker 1: better understand the science behind these issues. For the majority

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Speaker 1: of women, modern transdermal hormone support such as patches, gels,

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00:49:35,370 --> 00:49:38,290
Speaker 1: and rings are safe if started prior to the age

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00:49:38,290 --> 00:49:41,090
Speaker 1: of sixty or within ten years of your last menstrual period,

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Speaker 1: and for brain health sooner maybe even better. Speak to

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Speaker 1: a physician who's knowledgeable and truly engaged in midlife women's

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00:49:48,970 --> 00:49:53,130
Speaker 1: health who can help you decide if menopausal hormone therapy

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Speaker 1: is an option worth exploring. Coming up on the next

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Speaker 1: episode of Decoding Women's Health, I'll speak to a world

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Speaker 1: renowned oncologist about how you can minimize the likelihood of

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Speaker 1: developing certain types of cancer.

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Speaker 2: As we sometimes say, genetics is not destiny. People need

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Speaker 2: to be.

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Speaker 1: Really open minded about the value of genetic testing and

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00:50:14,930 --> 00:50:20,010
Speaker 1: how it can help them mitigate their cancer risk. Decoding

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Speaker 1: Women's Health is a production of Pushkin Industries and the

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Speaker 1: Atria Health and Research Institute. This episode was produced by

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00:50:26,490 --> 00:50:29,610
Speaker 1: Rebecca Lee Douglas and Amy Gaines McQuaid. It was edited

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00:50:29,610 --> 00:50:34,770
Speaker 1: by Karen Shakergie. Additional production support from Kate Furby, mastering

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00:50:34,810 --> 00:50:39,890
Speaker 1: by Sarah Briguaire. Our executive producer is Alexandra Garreton. Our

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00:50:39,930 --> 00:50:43,690
Speaker 1: theme song was composed by Hannes Brown. Concept and creative

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00:50:43,690 --> 00:50:49,050
Speaker 1: development by Shavan O'Connor. Special thanks to Vicki Marrick, Jacob Goldstein,

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00:50:49,370 --> 00:50:55,770
Speaker 1: Kerrie Brodie, Alan Tish, David Saltzman, doctor David Dodick, Theo Bidler,

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00:50:56,210 --> 00:51:02,130
Speaker 1: Sarah Nix, Eric Sandler, Morgan Ratner, Amy Haggadorn, Owen Miller,

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00:51:02,570 --> 00:51:07,850
Speaker 1: Abigail Abrams, Sarah Begley, and Greta Cone. If you have

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00:51:08,010 --> 00:51:11,610
Speaker 1: questions about women's health in midlife and want X advice,

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00:51:12,090 --> 00:51:15,290
Speaker 1: leave us a voicemail at four FI five two O

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Speaker 1: one three three eight five, or send us a message

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Speaker 1: at Decodingwomen's Health at pushkin dot FM. I'm doctor Elizabeth Pointer.

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Speaker 1: Thanks for listening. Until next time,