Speaker 1: Pushkin. Here's the thing about women's health. We spend the
Speaker 1: first part of our lives trying not to get pregnant.
Speaker 1: We spend the second part of our lives for many
Speaker 1: of us, trying to get pregnant, and then the third
Speaker 1: part of our lives we're kind of forgotten about. And
Speaker 1: this is when we go through some of our biggest changes.
Speaker 1: I learned myself the hard way when I was forty three,
Speaker 1: out of nowhere. I became significantly depressed and anxious. I'd
Speaker 1: always been the kind of person who woke up happy,
Speaker 1: motivated to face the day. Suddenly I didn't feel joy anymore.
Speaker 1: I was consumed by worry and my confidence was gone.
Speaker 1: At that time, I was running a very large surgical practice,
Speaker 1: and let's face it, nobody wants an anxious or depressed surgeon.
Speaker 1: I felt like a different person and was totally confused
Speaker 1: by the whole thing. I went to the medical literature
Speaker 1: looking for answers, but I came up completely empty. I
Speaker 1: consider myself a pretty well informed, well educated physician. I've
Speaker 1: trained at some of the best institutions in the nation.
Speaker 1: I've specialized in gynecologic oncology and surgery, and I've been
Speaker 1: the expert that news outlets have turned to for insight.
Speaker 2: Please welcome doctor Elizabeth Point.
Speaker 1: I think that's very important that women understand that they
Speaker 1: still needed you have their yearly annual consultaneous. One of
Speaker 1: the most commonly prescribed dugs for diabetes can actually impact
Speaker 1: a woman's survival when she's been diagnosed with ovarian cancer.
Speaker 1: Actor was a pointer.
Speaker 2: Great to see you, Thank you so much.
Speaker 1: And yet I was still in the dark. It was
Speaker 1: my mom who actually said to me, you know what,
Speaker 1: it's probably your hormones. Turns out she was right. I
Speaker 1: was going through perimenopause. Looking back at me perfect sense.
Speaker 1: I'd always had mood changes around my period. Of course,
Speaker 1: then the biggest hormonal shift in my life would affect
Speaker 1: my mind and emotions. What's wild is that none of
Speaker 1: my doctors, not my therapist, not a psychiatrist I had
Speaker 1: consulted for this issue, not even my medical colleague suggested perimenopause.
Speaker 1: Eventually I figured out how to feel better, but the
Speaker 1: whole experience served as a big wake up call for me.
Speaker 1: So here's my question, where exactly is the information for us,
Speaker 1: the women in the middle of our lives, to help
Speaker 1: us make the best decisions about our health. I'm doctor
Speaker 1: Elizabeth Pointer, and I've spent the past forty years working
Speaker 1: in women's health. I'm the Chair of Women's Health and
Speaker 1: Gynecology at the Atria Health Institute in New York City.
Speaker 1: And here's what I've observed, both as a patient and
Speaker 1: as a doctor. The information actually is out there, but
Speaker 1: it's really hard to find some time times. You have
Speaker 1: to read across subspecialties. You have to read the neurologic literature,
Speaker 1: the cardiology literature, the endocrinology literature. It's dense research that's
Speaker 1: nearly impossible to understand without a medical degree, and even
Speaker 1: most doctors don't have time to do that. Now. Specialists
Speaker 1: live in their own subspecialties and struggle to keep up
Speaker 1: in OBGI. In training programs, even the top ones, there's
Speaker 1: maybe at best one or two lectures on midlife women's health.
Speaker 1: There's no textbook, there's no course, there's no focus on
Speaker 1: women after their reproductive years. And that's why I'm making
Speaker 1: this podcast, Decoding Women's Health, a new show from Pushkin
Speaker 1: Industries and the Atria Health Institute that will elevate the
Speaker 1: conversation about women's health and midlife and frankly challenge some
Speaker 1: of the status quo information out there, because what I
Speaker 1: want for everyone listening, for every patient, every doctor, and
Speaker 1: every woman is to feel more informed when it comes
Speaker 1: to our health women's health. On today's episode, how to
Speaker 1: fluctuating hormones impact the brain specifically for women in midlife.
Speaker 1: Turns out a lot of cognitive changes can happen, and
Speaker 1: it can be really frightening. Some women, like me, experience
Speaker 1: intense mood shifts. Others may start to wonder if they've
Speaker 1: developed ADHD or maybe even dementia, but what they're really
Speaker 1: dealing with or temporary memory glitches. We'll talk about what's
Speaker 1: going on with these cognitive disruptions, how to manage them
Speaker 1: in the moment, and how women can be proactive about
Speaker 1: maintaining sharp, healthy minds throughout their lifespans. I am thrilled
Speaker 1: to be joined today by doctor Caroline Gervich. Caroline's work
Speaker 1: caught my attention because she studies hormones and how the
Speaker 1: brain changes through midlife. She's engaged in some really fascinating
Speaker 1: research about brain fog, cognitive training, and ADHD. Caroline is
Speaker 1: an associate professor and clinical neuropsychologist. She is also the
Speaker 1: Deputy director of the Her Center in Australia and head
Speaker 1: of the Cognition and Hormones Group at Monash University. There's
Speaker 1: so much we don't understand about how the brain works,
Speaker 1: but Caroline and her team are doing critical work examining
Speaker 1: how hormones impact our cognitive health throughout our lives. Caroline,
Speaker 1: thank you so much for joining us today and welcome
Speaker 1: to the show.
Speaker 2: Thank you so much, doctor Pointer. It's absolute pleasure to
Speaker 2: be here.
Speaker 1: Can you tell us what a neuropsychologist is actually?
Speaker 3: Yes, so, at a really basic level, it's brain psychology.
Speaker 3: So the neuro is the brain bit and the psychology
Speaker 3: is understanding a whole range of mental health symptoms. And
Speaker 3: what we do as a profession is we do a
Speaker 3: lot of assessments to better understand what different symptoms people
Speaker 3: are entering with when it impacts brain, brain and behavior.
Speaker 3: So that's the assessment side, but then neuropsychologists can also
Speaker 3: work at an intervention side, so once we know what's
Speaker 3: going on for someone, we can help them with education,
Speaker 3: so understanding how a brain relates to our behavior, as
Speaker 3: well as different kind of training processes to try and
Speaker 3: improve or give people strategies to improve whatever difficulties their
Speaker 3: experiencing with their cognition or their thinking skills.
Speaker 1: How did you get involved with this type of work.
Speaker 3: Yeah, so it wasn't that I, as a child always
Speaker 3: wanted to be a neuropsychologist. I don't think I really
Speaker 3: knew what a neuropsychologist was until I was well into
Speaker 3: my training. It was more I didn't actually know what
Speaker 3: I wanted to do that I really loved science like
Speaker 3: I loved chemistry. I loved physiology and learning about the brain.
Speaker 3: I was fascinated by how powerful our brains are and
Speaker 3: how little we know about how we think. From there,
Speaker 3: I started working in older age psychiatry and became interested
Speaker 3: in menopause and how little we know about that midlife,
Speaker 3: which is really when a lot of the brain changes
Speaker 3: start happening, and we can either prepare ourselves as much
Speaker 3: as we can for kind of healthy older aging or not.
Speaker 3: But it's like this potential window of opportunity to kind
Speaker 3: of take control and do what we can for preparing
Speaker 3: ourselves for great cognitive aging.
Speaker 1: Can you tell me a little bit more about what
Speaker 1: you mean taking control and prepare for aging.
Speaker 2: Yeah?
Speaker 3: So I think these menopause transition years are transitioning from
Speaker 3: our reproductive phase of our life to our postmenopausal years
Speaker 3: and our older adult years. So it's just a great
Speaker 3: opportunity to reflect on the phase of life you're at
Speaker 3: and know that there are so many things you can
Speaker 3: do as an individual to promote good health. So lots
Speaker 3: of physical exercise and lots of lifestyle factors, like in
Speaker 3: terms of your diet, in terms of sleep, in terms
Speaker 3: of being socially connected. So there are a lot of
Speaker 3: things you can do as an individual to make the
Speaker 3: most and to optimize whatever brain health you have.
Speaker 1: So you mentioned that there's a connection between menopause or
Speaker 1: perimenopause and cognition on a basic level, what's going on
Speaker 1: in perimenopause and menopause.
Speaker 3: So, perimenopause is a time in a woman's life where
Speaker 3: there's hormone changes. So we have fluctuations in one of
Speaker 3: our estrogen called estra dial and gradually that hormone declines.
Speaker 3: Perimenopause can span four to ten years, so it's not
Speaker 3: a short time. It's many years in someone's life that
Speaker 3: there are these hormone changes that are happening. Perimenopause can
Speaker 3: be associated with a whole range of different symptoms. There
Speaker 3: can be no symptoms for some women. There can be
Speaker 3: the hallmark of menopause, I guess, the vasomotor symptoms, which
Speaker 3: are hot flushes, night sweats. There's a number of women
Speaker 3: who experience what is often referred to as as brain
Speaker 3: fog in a colloquial way, which here cognitive symptoms that
Speaker 3: can happen during perimenopause or years. And these symptoms can
Speaker 3: include word finding difficulties, which is that words on the
Speaker 3: tip of your tongue, not being able to find the
Speaker 3: right word. There can be forgetfulness. There can be higher
Speaker 3: level what we call executive function symptoms, which is where
Speaker 3: people have difficulty juggling lots of things, planning ahead, prioritizing,
Speaker 3: difficulties with time management, and higher level organization type skills.
Speaker 3: So there can be a whole range of different cognitive
Speaker 3: symptoms that people can experience, and they're often subtle, but
Speaker 3: at a day jay level or at an individual level,
Speaker 3: they can have a really significant impact on people's lives.
Speaker 1: What percentage of women do you really think are going
Speaker 1: through these cognitive changes.
Speaker 3: The literature would suggest about sixty percent. It depends on
Speaker 3: their kind of community based studies, but about sixty some
Speaker 3: say closer to seventy percent. So somewhere in that vicinity
Speaker 3: is the percentage of people who experience some degree of
Speaker 3: cognitive symptoms.
Speaker 2: And I think it really varies.
Speaker 3: For some people, it's quite subtle and it doesn't have
Speaker 3: a huge impact on their life, but for other people
Speaker 3: it can be quite significant.
Speaker 1: In your clinical practice, what kind of complaints to midlife
Speaker 1: women come to you with or what are their main concerns.
Speaker 3: So there's often mood symptoms that are present, but not always,
Speaker 3: but they tend to come and see me because they're
Speaker 3: concerned that one they have dementia. That's one of the
Speaker 3: probably the most common concerns that people have, and the
Speaker 3: types of symptoms that people talk about is you know,
Speaker 3: I'm forgetting everything. I never used to forget things. I
Speaker 3: used to be really efficient in my role, and now
Speaker 3: it takes me so long to do things. So that's
Speaker 3: one and the other one that's become more common in
Speaker 3: recent years is do I have ADHD. I'm really struggling
Speaker 3: to manage my time. I'm really struggling to prioritize, to plan,
Speaker 3: to organize.
Speaker 2: To focus.
Speaker 3: So they're probably the two biggest clinical questions that people
Speaker 3: present with. But the types of symptoms that women present
Speaker 3: with mood symptoms, forgetfulness, difficulties with efficiency.
Speaker 2: And time management and multitasking.
Speaker 1: What ages are you seeing this? You know, we talk
Speaker 1: a lot about menopause and the final menstrual period, but
Speaker 1: I've kind of noticed in my practice that patients really
Speaker 1: present in that early perimenopause time where they might not
Speaker 1: be having any menstrual irregularities or might not even know it.
Speaker 1: What do you see in your practice.
Speaker 2: Exactly the same. It's quite early.
Speaker 3: It's often, as you say, in the early forties, where
Speaker 3: they haven't really necessarily made a connection that this might
Speaker 3: be the start of their perimenopausal journey, and they're just
Speaker 3: concerned about their cognition, their thinking skills, and it has
Speaker 3: this ripple effects, So they start to become a bit
Speaker 3: concerned about their efficiency. Then it impacts their self esteem,
Speaker 3: Then they become a bit more anxious than the anxiety
Speaker 3: in itself further impacts their ability to perform in the moment.
Speaker 2: So it's this real cycle for people.
Speaker 3: I've had patients who have sort of had the conversation
Speaker 3: with their GP, but they haven't been reassured that it
Speaker 3: might not be dementia. So then they've gone ahead and
Speaker 3: contacted people like dementia Australia, like Big Foundations, describe their
Speaker 3: symptoms which can sound a little bit like early stages
Speaker 3: of dementia over the phone, and then they've been reassured
Speaker 3: that yes, it does sound like you might have the
Speaker 3: early stages of dementia and they don't have that at all,
Speaker 3: And they've started to go down that pathway of putting,
Speaker 3: you know, financial things in place and really preparing themselves
Speaker 3: for degenerative process, and that is not what they've got
Speaker 3: at all. So I think it's really important that people
Speaker 3: have a better understanding and follow the right pathways of
Speaker 3: getting the right support.
Speaker 1: You know, a lot of times we go is dementia
Speaker 1: or is it brain fog? Right, and it's like, well,
Speaker 1: you know, demension impacks your quality of life on a
Speaker 1: day to day basis, but I think brain fog probably does,
Speaker 1: especially if you're in the workplace, which brings me into
Speaker 1: how do you help women through the workplace and what
Speaker 1: do you see how are women impacted in their workplace
Speaker 1: by some of these cognitive chains.
Speaker 3: I think people who are working in a job that
Speaker 3: does require thinking on the spot. Speaking on the spot
Speaker 3: is often the people I tend to see so high
Speaker 3: functioning professional people because they really feel the subtle cognitive
Speaker 3: changes the word retrieval deficits have a really big impact
Speaker 3: at a day to day level, and people get nervous
Speaker 3: about public speaking, even if it's something they've always done,
Speaker 3: because they're worried they'll experience a word finding difficulties. For
Speaker 3: some people, it can be really problematic. And I've seen
Speaker 3: women who have actually changed their work or drop back
Speaker 3: to part time or left work altogether, which is really
Speaker 3: really sad because they didn't really understand what was going
Speaker 3: on for them. They didn't link it back to their hormones.
Speaker 3: They just felt like they were no longer up to
Speaker 3: whatever their job was. And so I think that's really
Speaker 3: devastating when that's happened. If it's someone who wanted to
Speaker 3: stay in the workforce, but because of their more subtle
Speaker 3: cognitive symptoms and then the flow on impact on self
Speaker 3: esteem and then the increase in anxiety, chain of events
Speaker 3: has led them to leaving the workplace, So it can
Speaker 3: be really detrimental for some women. And then in broader
Speaker 3: workplace settings, I mean, the key thing is just education,
Speaker 3: just knowing that cognitive symptoms can be a part of
Speaker 3: the menopause transition and there are lots of ways to
Speaker 3: manage it. And I think the key factor for women
Speaker 3: to know is that it's not an impact on intellectual
Speaker 3: capacity per se, but they just might need a little
Speaker 3: bit of support and a little bit of knowledge about
Speaker 3: the types of symptoms that they might be experiencing and
Speaker 3: knowing that it might be you know, a couple of
Speaker 3: years where word finding's not great or your learning efficiency
Speaker 3: isn't perfect, but you'll get through, and you just need
Speaker 3: some practical supports to get you through. So women don't
Speaker 3: feel like they're no longer up to it, because that's
Speaker 3: not the case.
Speaker 1: I think that's really important, this whole concept of you know,
Speaker 1: I can still function, I can still work where I
Speaker 1: need to work and be where I need to be
Speaker 1: at the level I need to be at. When you
Speaker 1: talk about support structure and that type of thing, what
Speaker 1: are you referring to.
Speaker 3: Just really practical things like people not shouting out, oh
Speaker 3: can you do this in the corridor, just emailing it
Speaker 3: to people so you've got things written down rather than
Speaker 3: juggling things in your working memory if you're in meetings
Speaker 3: or if you're in a consult with someone to be
Speaker 3: able to take notes or use some sort of recording
Speaker 3: audio to take notes, so you're not again relying on
Speaker 3: your working memory and your attention to hold and juggle
Speaker 3: lots of pieces of information. If you feel like you're
Speaker 3: forgetting a word, it's sometimes easy to say this is
Speaker 3: hard to do this, but don't stress about it because
Speaker 3: it makes it worse. So rather than trying to find
Speaker 3: that word, trying to encourage people just to kind of
Speaker 3: speak around the topic or just own it, say I
Speaker 3: can't think of that word at the moment and move on,
Speaker 3: and no one really cares too much. So I think
Speaker 3: it's just about having some strategies at an individual level
Speaker 3: in place to manage that. So yeah, as I said,
Speaker 3: the key one is really just reducing the demands on
Speaker 3: working memory and the juggling and switching between lots of
Speaker 3: different tasks.
Speaker 2: And for some people where it's.
Speaker 3: Executive function, difficulties are about sort of time management and
Speaker 3: prioritization of tasks, structuring your day so then you've got
Speaker 3: some time blocked out for the last minute things each
Speaker 3: day in case they pop up, but having some sort
Speaker 3: of increased structure to your work date I think can
Speaker 3: be really helpful for people as well.
Speaker 1: Coming up, what does ADHD really look like for women
Speaker 1: in midlife? How can changes an astrogen mimic those symptoms?
Speaker 1: And what does the scientist actually say about whether hormone
Speaker 1: therapy can help not just with focus and memory, but
Speaker 1: maybe even protecting our brains as we age. So that
Speaker 1: kind of leads me into the kind of ADHD component
Speaker 1: of your work, which I think is really interesting because
Speaker 1: I consider my self a pretty educated physician. I'm curious,
Speaker 1: I read, but I know nothing about ADHD and midlife women.
Speaker 1: Can you unpack that a little bit for us and
Speaker 1: also just tell us what ADHD really is?
Speaker 3: Yes, So, and the fact that you haven't read anything
Speaker 3: about ADHD in midlife is because there's really very very
Speaker 3: little published on the topic, So I think there's just
Speaker 3: not much out there. But to come back to what
Speaker 3: ADHD is, so, attention deficit high peractivity disorder is what
Speaker 3: ADHD stands for.
Speaker 2: In terms of the diagnostic criteria.
Speaker 3: You can only now diagnosed ADHD in adults, So it's
Speaker 3: always been considered and still is a neurodevelopmental condition, so
Speaker 3: it's something that your brain is kind of born with
Speaker 3: and you develop as a child. So it can be
Speaker 3: attention deficit and or hyperactivity in attention. So it's that
Speaker 3: the sorts of symptoms that fall into that attention deficet
Speaker 3: are things like forgetfulness, difficulty focusing on things, and then
Speaker 3: their high peractivity impulsivity is just a feeling of being
Speaker 3: on the go all the time, that there's an emotion
Speaker 3: inside you, a drive inside you, and you just need
Speaker 3: to be busy and occupied. The stereotypical picture of ADHD
Speaker 3: is often coming from that hyperactive symptom. You think of
Speaker 3: the hyperactive little boy, and a lot of the diagnostic
Speaker 3: criteria was kind of built around that. But as we're
Speaker 3: learning more, we're seeing for menopausal women it tends to
Speaker 3: be more of the inertention that can be undetected. I
Speaker 3: think in a lot of people, particularly for women who
Speaker 3: also you know, might be really conscientious and hard working
Speaker 3: and perfectionist type people, that inattention and difficulty regulating and
Speaker 3: organizing and structuring your day can often go unnoticed. But
Speaker 3: coming back to your question about sort of the midlife
Speaker 3: and the menopause connection to ADHD. We don't really know
Speaker 3: exactly what's happening. So the theory is that during menopause
Speaker 3: when Eastern changes and impacts dopamine and perhaps uncovers ADHD
Speaker 3: that's always been there. I don't think we fully understand
Speaker 3: whether it's an ADHD presentation appearing at menopause for the
Speaker 3: first time. And for some people, they've got a lot
Speaker 3: of ADHD characteristics, but it's not something that was their
Speaker 3: prior to the age of twelve, which is what we
Speaker 3: need for our diagnostic criteria, that there's evidence that someone's
Speaker 3: had this as a neurodevelopmental condition. So for some people,
Speaker 3: they just present with characteristics of ADHD around menopause, but
Speaker 3: for other people, they've had lots of support or kind
Speaker 3: of scaffolding I guess, throughout their life, and when we
Speaker 3: take a really good history, we can see that they
Speaker 3: have had ADHD always and they've just hit a point
Speaker 3: in menopause where they can no longer kind of mask
Speaker 3: or cover up some of the symptoms that they've been experiencing.
Speaker 3: And in our research as well, we've spoken to a
Speaker 3: lot of women with ADHD. These are people who have
Speaker 3: got or already have a diagnose of ADHD, but they
Speaker 3: all worstening of symptoms at menopause, both other menopausal symptoms
Speaker 3: as well as their ADHD symptoms. So there's definitely a
Speaker 3: connection between menopause and ADHD. And we also see a
Speaker 3: similar pattern across a menstrual cycle. So women with ADHD
Speaker 3: report a worsening of their symptoms in that luteal phase
Speaker 3: the second half of their menstrual cycle. And so there's
Speaker 3: clearly a hormonal factor that's driving these changes in symptoms
Speaker 3: across menstrual cycle or during the perimenopausal years.
Speaker 1: You know, it's so interesting because I mean it's like
Speaker 1: menopause and the hormonal fluctuations just uncover issues in the brain, right,
Speaker 1: I mean it's like psychiatric issues get worse at the
Speaker 1: time of perimenopause and menopause, right, Depression can go off
Speaker 1: the rails. How much of this impact do you think
Speaker 1: is due to estrogen? And what is estrogen doing to
Speaker 1: our brains?
Speaker 2: Yeah? I think we know the most about estrogen.
Speaker 3: I think that's why we talk about it the most
Speaker 3: because I think most of the research, most of the
Speaker 3: animal studies has been done looking at estrogen. But we
Speaker 3: know that estrogen plays a neuroprotective role in the brains.
Speaker 3: We know estrogen helps protect our brain against damage, so
Speaker 3: if there's been some sort of insult to the brain,
Speaker 3: estrogen can be really protective. And so we also know
Speaker 3: that there's receptors that respond to estrogen in brain areas
Speaker 3: beyond reproductive function, so in brain areas that are really
Speaker 3: relevant to mood and to cognition. So the front part
Speaker 3: of our brain really important for executive functions. We know
Speaker 3: that estrogen's interacting or modulating a lot of our neurotransmitter pathways,
Speaker 3: so the dopamine pathways that are important in ADHD, but
Speaker 3: also important in motivation, in drive, in regulating our attention.
Speaker 3: More broadly, eachtrogen interacts with serotonin, which is really important
Speaker 3: for mood. So we know that issian's playing a significant
Speaker 3: role in our brain. And yes, most of this research
Speaker 3: is from animal studies, but we kind of extend that,
Speaker 3: extrapolate from that and learn from that in terms of
Speaker 3: how estrogen might be working human studies.
Speaker 1: Yeah, it's interesting, there's so much to explore. So when
Speaker 1: these cognitive issues are occurring, what's actually going on. Estradiyl
Speaker 1: is the main estrogen that the over is produced for women,
Speaker 1: and what is it doing during this time period where
Speaker 1: cognitive issues may occur.
Speaker 3: So it's fluctuating, particularly during those early perimenopausal years, but
Speaker 3: they're also gradually declining, and I think both of those
Speaker 3: factors seem to be related to changes in cognition. So
Speaker 3: if you think about what's actually going on, I think
Speaker 3: there are receptors in our brain that respond to estradyl,
Speaker 3: are used to being stimulated by estradyl, and suddenly there
Speaker 3: it's on off, it's up down, and then it's gradually
Speaker 3: those receptors are less stimulated by estradyl over the years,
Speaker 3: So I think that that's the hormonal factors that are
Speaker 3: underpinning the cognitive symptoms.
Speaker 2: But I think there are often lots of other pieces
Speaker 2: of the puzzle.
Speaker 3: So I think, you know, while people can experience brain
Speaker 3: vogue or cognitive symptoms as the sole symptom of menopause,
Speaker 3: more often than not it's not the case. There's often
Speaker 3: other symptoms going on. So I always think of the
Speaker 3: cognitive symptoms a little bit like the tip of the iceberg.
Speaker 2: There's always things underpinning that.
Speaker 3: So I think when we're talking about menopause, we're talking
Speaker 3: about hormone changes as being a significant contributing factor, but
Speaker 3: also talking about you know, vasomotor symptoms, So there's studies
Speaker 3: that show that these can also have an impact on brain,
Speaker 3: on factors in the brain that might then have flow
Speaker 3: on effects to cognition. They also can impact sleep, So
Speaker 3: sleep and a lack of sleep or impaired disrupted sleep
Speaker 3: for anyone at any point in your life can impact
Speaker 3: your cognition and lead to feeling a bit foggy and
Speaker 3: those kind of cognitive symptoms. And then we've talked a
Speaker 3: bit about mood that can be another contributing factor to
Speaker 3: cognitive symptoms. And some people during menopause might be experiencing
Speaker 3: pain joint pain and pain can have cognitive symptoms.
Speaker 2: So I think there can be lots of factors that.
Speaker 3: Are underlying the presentation of cognitive symptoms, and I definitely
Speaker 3: think hormones are playing a significant role, but I think
Speaker 3: it's important to consider the whole person and everything that's
Speaker 3: going on for them. And the other point is that
Speaker 3: menopause often coincides with a really busy time in a
Speaker 3: lot of people's lives or often at you know, the
Speaker 3: busy time in your career, and elderly parents potentially teenage children,
Speaker 3: managing households, like there's often just a lot going on.
Speaker 3: So I think there's that as well, the fact that
Speaker 3: people are often just stretched and stressed because they're so busy,
Speaker 3: and so I think all of those factors are really
Speaker 3: important to consider when we think about what's underpinning cognitive symptoms.
Speaker 3: But I think, you know, when we're talking about perimenopause,
Speaker 3: we're obviously talking about hormone changes, and hormone changes in
Speaker 3: and of themselves might be enough to drive cognitive symptoms,
Speaker 3: but I just think it's important to consider the whole
Speaker 3: picture as well.
Speaker 1: Yeah, it's kind of a perfect storm, right. I mean,
Speaker 1: you might be going through significant life changes, whether it's
Speaker 1: your job, your family, your partner, and then you put
Speaker 1: on this pressured physiology. I think what a lot of
Speaker 1: people don't realize this. There's estrogen receptors throughout the body
Speaker 1: that are active through the entire body. You talk about pain,
Speaker 1: joint pain, sleep disruption. You know, the holistic approach is
Speaker 1: always or that entire body approach is always so interesting
Speaker 1: in helping women and negotiating those hormone fluctuations. So that
Speaker 1: leads me into what I consider the million dollar question
Speaker 1: right in terms of in terms of hormone therapy, in
Speaker 1: terms of hormonal support for women going through these transitions,
Speaker 1: for even just the cognitive issues around the time of
Speaker 1: early perimen apuzzle transition or late perimen a puzzle transition,
Speaker 1: and then for dementia prevention. You know, professional societies don't
Speaker 1: recommend hormone therapy for dementia prevention or treatment or brain fog.
Speaker 1: But do you think that there's any role for if
Speaker 1: somebody is very distressed and it's really impacting their quality
Speaker 1: of life, maybe starting estrogen at this time, for adding
Speaker 1: a little bit of lotus hormone support for them, or
Speaker 1: what are your thoughts about that?
Speaker 3: So I have seen plenty of women at an individual
Speaker 3: level who have shown a huge benefit from the right
Speaker 3: combination of hormones optimization or hormone therapy. So yes, I
Speaker 3: know that professional guidelines don't recommend or advocate for using
Speaker 3: hormone therapy for either cognitive symptoms or as you say,
Speaker 3: prevention of later life cognitive decline. But I think at
Speaker 3: an individual level, I always tell people go and chat
Speaker 3: to your health professional who's working with you in terms
Speaker 3: of menopause. Chat to them about different options for hormone
Speaker 3: therapy because I have seen so many women who have
Speaker 3: been transformed in a beneficial way because of the right
Speaker 3: combination of hormones.
Speaker 1: Why has it been contentious the treatment of cognitive issues
Speaker 1: or dementia prevention with estrogen.
Speaker 3: Decades ago, it was kind of accepted and thought that
Speaker 3: menopausal hormone therapy or HIT or hormone support was helpful
Speaker 3: for reducing dementia risks from a lot of observational studies,
Speaker 3: and then the Women's Health Initiative came along. The largest
Speaker 3: randomized control trial that was early two thousands, and the
Speaker 3: results showed that it was associated with an increase in
Speaker 3: dementia risk. However, there has been a lot of debate,
Speaker 3: a lot of discussion, and a lot of issues with
Speaker 3: that study. So probably the two key ones in terms
Speaker 3: of dementia risk was one all the participants in that
Speaker 3: study were all on average over the age of sixty
Speaker 3: five and more than ten years postmenopause, so a lot
Speaker 3: of them initiated hormones not close to going through the
Speaker 3: menopause transition years, so that was one factor. And the
Speaker 3: other factor was the types of hormones that we used
Speaker 3: in that particular study. Were potentially less beneficial for brain
Speaker 3: health and for cognition, and so when that study came out,
Speaker 3: I think it just scared a lot of people, and
Speaker 3: since then there have been not enough studies to start
Speaker 3: to build a more balanced evidence base. There was a
Speaker 3: meta analysis that was published last year and that showed
Speaker 3: that if hormone therapy was initiated close to menopause, then
Speaker 3: it was associated with a reduced risk of developing dementia
Speaker 3: later in life, particularly estrogen only hormone therapy.
Speaker 1: Yeah. I think that what we call it the critical
Speaker 1: window hypothesis, right, that if you get estrogen support or
Speaker 1: have estrogen support within the first few years of menopause,
Speaker 1: you may get some protection.
Speaker 3: So I think the two key factors are that critical
Speaker 3: window hypothesis or theory that we have to use estrogen
Speaker 3: therapy very close to menopause to see benefits. But yes,
Speaker 3: if it's not initiated during that time, and initiated you know,
Speaker 3: more than ten years postmenopause, yes it might be harmful.
Speaker 3: And I think the other factor is thinking about the
Speaker 3: type of estrogen in terms of brain health and progesterone
Speaker 3: progestine that might be most helpful for brain health.
Speaker 1: And what do you think the answer to this is
Speaker 1: in terms of getting the data? I mean, are we
Speaker 1: going to have to settle for lesser data, are we
Speaker 1: going to have to look for what we call biomarkers
Speaker 1: or what is the answer to this? Because you and
Speaker 1: I have both said that we see people who do
Speaker 1: improve actually and there is compelling data that's out there
Speaker 1: about prevention of dementia and treatment of cognitive issues. What
Speaker 1: do you think the answer is?
Speaker 2: We probably need a combination of things.
Speaker 3: I don't think there's one specific trial that's going to
Speaker 3: give us the perfect answer to that question. And when
Speaker 3: we're talking about something like dementia, you're talking about a
Speaker 3: thirty year period from when the pathology begins in the
Speaker 3: brain to when the symptoms might manifest, or twenty to
Speaker 3: thirty years, So that's a really long time frame. And
Speaker 3: so I think there's two questions. One is, does hormone
Speaker 3: therapy help in the short term for people with cognitive
Speaker 3: symptoms in the moment when they're going through perimenopausal transition years.
Speaker 2: And does hormone therapy help people.
Speaker 3: In the early postmenopausal years if they've still got cognitive symptoms.
Speaker 3: And then what are the flow and effects. Twenty years
Speaker 3: down the track, is there a change in risk for
Speaker 3: developing neurodegenerative processes lack dementia and so I think we
Speaker 3: just need to keep doing more research and keep putting
Speaker 3: the pieces of puzzles together, keeping the research flowing so
Speaker 3: we can gradually build on it and learn more.
Speaker 1: Just the other day, I was talking with a patient
Speaker 1: who started hormone support for something completely unrelated to cognitive health.
Speaker 1: When I asked how she was feeling, she said, you
Speaker 1: know what, My brain fog got better. I can think
Speaker 1: more clearly now. We hadn't even spoken about brain fog
Speaker 1: before that, and it's remarkable how quickly these changes can
Speaker 1: take effect. When I started on hormone therapy after I
Speaker 1: finally figured out I was im perimenopause, it only took
Speaker 1: about two weeks before my mood started to improve and
Speaker 1: I started to feel like my old self again. Now
Speaker 1: that's not to say that hormone therapy is a cure
Speaker 1: all for every perimenopausal symptom, but for many women it
Speaker 1: can play a really important role in feeling better. Coming up,
Speaker 1: doctor Gervirich and I discussed some additional tools to support
Speaker 1: your cognitive help from brain training, exercises to lifestyle changes,
Speaker 1: decoding women's health will be right back. You know, we've
Speaker 1: spoken about kind of you know, what happens to the brain,
Speaker 1: and hormone support may be helpful, but talk to me
Speaker 1: about cognitive training, cognitive reserve and what are those concepts
Speaker 1: and how do they help women.
Speaker 3: Yeah, I think in the absence of anything that's currently
Speaker 3: clearly indicated that people can take for cognition, I think
Speaker 3: it's really important to think about what else can we do.
Speaker 3: And I think there's definitely a role for hormonal support
Speaker 3: or hormonal therapy that needs to be explored in a
Speaker 3: lot more detail. But as you said, our brains keep
Speaker 3: changing depending on how we stimulate them and which pathways
Speaker 3: we're using and encouraging and growing, and so there is
Speaker 3: room to retrain our brains and to get better at
Speaker 3: different things all the time. And so we did a
Speaker 3: review initially of cognitive training in midlife, so we're talking
Speaker 3: about cognitive training to boost cognitive functions broadly in everyone
Speaker 3: in the midlife. And then from there we specifically tried
Speaker 3: to focus on the few studies that had either reported
Speaker 3: the results of females specifically or had looked specifically at menopause,
Speaker 3: and so to just kind of pull out what we
Speaker 3: found in menopause, the most beneficial areas were to use
Speaker 3: a strategy based training, So that's teaching people new strategies
Speaker 3: to approach difficulties that they're having or to enhance or
Speaker 3: optimize their cognitive performance. Psycho Education, like explaining to people
Speaker 3: what's going on, can be really helpful as a component
Speaker 3: of cognitive training. And so now we're taking this and
Speaker 3: we're building cognitive training programs for women with whatever mental
Speaker 3: health type symptoms they might be experiencing and cognitive symptoms
Speaker 3: combined without or just cognitive symptoms on their own. So
Speaker 3: giving people education about what we're talking about, the role
Speaker 3: of hormones, other symptoms, how all those things work together,
Speaker 3: how cognition works. People knowing that you have capacity to
Speaker 3: improve and optimize your cognitive functioning, So giving people that
Speaker 3: piece of knowledge and that understanding can be really helpful.
Speaker 2: And then training.
Speaker 3: So when we talk about training, some people I think
Speaker 3: probably think of computerized cognitive training or brain training, where
Speaker 3: you repeat one task over and over again and people
Speaker 3: get really good at that task. But most of the
Speaker 3: research shows that that doesn't necessarily generalize to day day life.
Speaker 3: So you just get really good at that one task
Speaker 3: or maybe similar tasks. But what we want people to
Speaker 3: do is get better at thinking and optimizing all of
Speaker 3: their cognitive skills. So by using strategies to help reduce
Speaker 3: your mental load, writing lists, breaking down tasks, prioritizing tasks,
Speaker 3: completing one thing at a time, teaching people to really
Speaker 3: focus their attention and actively attend to whatever tasks they
Speaker 3: want to do, can also really improve your capacity to
Speaker 3: learn and encode that information. Teaching people that when they
Speaker 3: want to learn a new piece of information, if you
Speaker 3: can sort of paraphrase it now ask questions about it,
Speaker 3: it encodes it in a deeper level. So just teaching
Speaker 3: people about how memory works, and how encoding works, and
Speaker 3: how attention works, and giving people strategies to improve and
Speaker 3: optimize all of those different thinking skills, that's the kind
Speaker 3: of cognitive training that seems to be the most beneficial.
Speaker 3: And then we also talk about lifestyle factors that might
Speaker 3: be helpful to again optimize brain health and optimize cognitive health.
Speaker 1: So one of my midlife friends wants to know, is
Speaker 1: word all a form of cognitive train we suspect not
Speaker 1: we suspect that you need to do more than wordle.
Speaker 3: More than word all, but wordle is better than nothing,
Speaker 3: so I think, and if you love wordle, there's no
Speaker 3: reason not to do word all. So I think anything
Speaker 3: that stimulates your brain in a new way is a
Speaker 3: good thing for your brain. Doesn't mean it will necessarily
Speaker 3: generalize to lots of different areas, but I think if
Speaker 3: you're enjoying it, go for it.
Speaker 1: Tell us what kind of nutrition do you recommend, what
Speaker 1: kind of exercise, and why this stuff works? You know,
Speaker 1: I always love the context of why something works because
Speaker 1: I think it helps me understand it better, It helps
Speaker 1: my patience understand why it's so important.
Speaker 3: So the lifestyle recommendations for cognitive health are exactly the
Speaker 3: same as the lifestyle recommendations for brain health, which are
Speaker 3: the same as the lifestyle recommendations for heart health. So
Speaker 3: I feel like everyone is on the same page. That
Speaker 3: people need to do their best to exercise and to
Speaker 3: eat well, and to make sure they can opt their sleep,
Speaker 3: minimize their stress, maintain social connections, so all of those
Speaker 3: things are really important. My personal motto when I see
Speaker 3: people is just for people to try their best. So
Speaker 3: I just think for people at an individual level to
Speaker 3: find a type of exercise that they enjoy and then
Speaker 3: to keep building on that. And you know, the guidelines
Speaker 3: would suggest that you have both strength based training as
Speaker 3: well as cardio and you kind of mix it all up.
Speaker 3: But I just think a little bit of exercise is
Speaker 3: better than nothing. So whatever people can do to exercise
Speaker 3: is going to help people's mental health and their brain
Speaker 3: health and their cognitive health.
Speaker 2: In terms of nutrition, it's.
Speaker 3: About people working toward the best diet they can in
Speaker 3: their lives. And you know, minimizing process food and trying
Speaker 3: to build up a healthy, balanced diet is the most
Speaker 3: important thing. But if they want to adopt the diet
Speaker 3: that has the best evidence base for cognitive health and
Speaker 3: longevity in terms of brain health, it's the Mediterranean diet.
Speaker 3: In terms of sleep, and it's often hard to do this,
Speaker 3: but people shouldn't put up with bad sleep. They should
Speaker 3: speak to their physicians whoever they're working with about different
Speaker 3: sleep interventions. But there's a lot of evidence for CBT,
Speaker 3: so cognitive behavioral therapy I so CBT for insomnia, and
Speaker 3: there are free programs online that people can log in
Speaker 3: and do four to six sessions and this can really
Speaker 3: help some people with their sleep. So I think encouraging
Speaker 3: people to maximize their sleep, their diet, their exercise, for
Speaker 3: people to engage socially.
Speaker 2: There's a lot of.
Speaker 3: Evidence that's emerged to show the importance of social connections
Speaker 3: and the negative effects of being lonely, so in terms
Speaker 3: of mental health, in terms of cognitive health. So encouraging
Speaker 3: people to prioritize socializing because it's fun, it's nice, and
Speaker 3: it also protects your brain and your mental health later
Speaker 3: in life, so that's also important.
Speaker 2: And then minimizing stress.
Speaker 3: So there's a lot of evidence for meditation being beneficial
Speaker 3: for brain health, for cognition in the short term and
Speaker 3: the long term. So if people can incorporate some type
Speaker 3: of meditation, and you know, meditation isn't for everyone. Some
Speaker 3: people need to do more of like a mindfulness based
Speaker 3: practice where you're just present in whatever you're doing. So
Speaker 3: it might be movement based. Some people talk about being
Speaker 3: mindful while they're surfing, or mindful while they're walking, or
Speaker 3: mindful while they're doing yoga. It's just kind of being
Speaker 3: present and it might not be, you know, exactly a
Speaker 3: meditation practice, but some form of mindfulness embedded in people's
Speaker 3: lives is really important to help minimize stress, and it
Speaker 3: can also have flow and effects to promoting brain health.
Speaker 3: So in terms of lifestyle factors, they're kind of the
Speaker 3: key ones. And also talking to people, particularly in midlife
Speaker 3: about minimizing alcohol. There's a lot of negative effects from
Speaker 3: excessive drinking and a lot of people do turn to
Speaker 3: alcohol as a short term coping strategy, and so it's
Speaker 3: important understand that alcohol can have lots of negative effects
Speaker 3: on the brain if people use alcohol excessively. So we
Speaker 3: often have a conversation about how much alcohol people are
Speaker 3: drinking and what that might be doing to their brain
Speaker 3: health in the long term as well.
Speaker 1: So I'm going to go backwards. I'm going to go
Speaker 1: back and touch on each one of those again in
Speaker 1: a little bit more detail. But I want to start
Speaker 1: with alcohol because that's a big one, right And also
Speaker 1: thing is really important to realize too that alcohol is
Speaker 1: to sleep disruption and can worsen there's a motor symptoms
Speaker 1: or heart flashes. Do you think that there is any
Speaker 1: level of I mean, I think of alcohols and neurotoxin,
Speaker 1: So do you think that there is any level of
Speaker 1: alcohol which is safe for women to consume in terms
Speaker 1: of cognitive health.
Speaker 3: Yeah, So I think overall there's no real benefits of
Speaker 3: alcohol in terms of brain health, in terms of sleep,
Speaker 3: in terms of mood. Maybe in the very short term
Speaker 3: as people have a drink, they might feel good temporarily,
Speaker 3: but overall, no, we don't advocate for alcohol, and the
Speaker 3: scientific literature does not support the use of alcohol in
Speaker 3: any way in terms of brain health. But it is
Speaker 3: a big part of society, so it exists and it's there.
Speaker 3: While in the perfect world we wouldn't have alcohol, the
Speaker 3: evidence would suggest that, yes, it's neurotoxic and it's not
Speaker 3: beneficial for brain health. But on the flip side, I
Speaker 3: think sometimes having that conversation isn't going to lead to
Speaker 3: behavior change where people completely stop drinking alcohol. So instead
Speaker 3: talking about adverse effects short term and longer term can
Speaker 3: just help people understand what's going on and what role
Speaker 3: el cool might be playing.
Speaker 1: Yeah, I think that context is really important. Why is
Speaker 1: exercise good for us? Like, how does that work? How
Speaker 1: does that impact the brain?
Speaker 3: So again it comes back to being important for heart
Speaker 3: health and for our physical health and for our mental health.
Speaker 3: So there are studies that show that exercise is almost
Speaker 3: as beneficial as antidepressants for people have mood symptoms, and
Speaker 3: so exercise can have a really big benefit at a
Speaker 3: physiological level, just talking about blood flow and changes in
Speaker 3: the brain, the endorphins, the chemicals that are released while
Speaker 3: we're exercising, and I think people who regularly exercise can
Speaker 3: feel those benefits.
Speaker 2: But I think for people who never.
Speaker 3: Exercise, it is hard for people to start to incorporate
Speaker 3: exercise in their life. So I think kind of starting
Speaker 3: small and finding something that people are really comfortable as
Speaker 3: a starting point is super important.
Speaker 2: Otherwise it just won't happen.
Speaker 1: Yeah, I think again that context is so important. Right.
Speaker 1: I always laugh because I feel bad for the people
Speaker 1: around me because I do my Caliston next every morning,
Speaker 1: and I think, as do my Caliston next, my irisan
Speaker 1: goes up, my VDNF goes up, which are all for
Speaker 1: our listeners. Those are things that make your brain grow. Actually,
Speaker 1: so pumping iron can make your brain grow. What should
Speaker 1: people target? So any movement is good, any exercise is good,
Speaker 1: but there should be a target that people look at
Speaker 1: or can strive to at some point. What should that
Speaker 1: target be in terms of cognitive health? For midlife women.
Speaker 3: So I would say if people can work themselves up
Speaker 3: to five thirty minute sessions a week with a mixture
Speaker 3: of strength training and cardio based training, that would be ideal.
Speaker 3: And also really importantly, just finding an exercise that you
Speaker 3: love so it becomes a passion and a habit is
Speaker 3: really important.
Speaker 1: Yeah, And I think also it's important to realize too
Speaker 1: that you know, you don't have to go to the gym.
Speaker 1: You can do this in your house basically and doesn't
Speaker 1: require that much time necessarily. In terms of nutrition, you
Speaker 1: said the Mediterranean diet. Can you tell us a little
Speaker 1: bit about the Mediterranean diet and are there any tweaks
Speaker 1: for the Mediterranean diet for cognitive health? And do you
Speaker 1: think as midlife women we need to shift and downshift
Speaker 1: our carbs and increase our protein a little bit for
Speaker 1: brain health as the metabolism and the brain changes.
Speaker 3: Yeah, so again there is a bit of literature about that,
Speaker 3: reducing carbs, increasing protein and longevity. In terms of what
Speaker 3: the Mediterranean diet is, making sure you have a lot
Speaker 3: of you know, fresh fruits, fresh fed stables, not process foods,
Speaker 3: fish if you eat fish, and natural oils and nuts
Speaker 3: are all really important. Increasing protein can be important for
Speaker 3: brain health as well, and minimizing carbs, but making sure
Speaker 3: that whatever you're eating is just minimizing the process food
Speaker 3: in terms of brain health, I think is the key message.
Speaker 1: And then in terms of socialization, you know, we counsel
Speaker 1: our patients to socialize, right, but we live in a
Speaker 1: disconnected world for many of us actually, with computers and
Speaker 1: ordering grub hub and Amazon and you never have to
Speaker 1: go outside, right, work at home.
Speaker 2: Do you have any.
Speaker 1: Tips for people in terms of how to get a
Speaker 1: more active social life. That's something I really think about
Speaker 1: as I age. I want a sense of community, Like,
Speaker 1: how do you advise your patients?
Speaker 3: Yeah, so I think again, I always take quite an
Speaker 3: individualized approach, so talking to people about what their social
Speaker 3: situation looks like. Do they have friends that they see
Speaker 3: physically and that they connect with. I agree that we
Speaker 3: live in a very digital global world now and what
Speaker 3: social connection looks like now is quite different to what
Speaker 3: it looks like a decade ago. But I think having
Speaker 3: that sense of belonging, that sense of community, is an
Speaker 3: important part of people feeling like they're socially connected. So
Speaker 3: for some people that is an online community where they
Speaker 3: are connected, But as long as they're kind of real
Speaker 3: people that they actually know and can share their stories
Speaker 3: with and their day with and feel supported by that
Speaker 3: person and someone that they can turn to when they
Speaker 3: need to share bad news with and get support from
Speaker 3: in a social sense, is really important.
Speaker 1: What are you most excited about with the future with
Speaker 1: specifically women's brain health.
Speaker 3: So I think while it is a time of vulnerability,
Speaker 3: there can be lots of negative symptoms that people can
Speaker 3: experience during perimenopause and postmenopause or years, I think it's
Speaker 3: also a time of opportunity. And so if you can
Speaker 3: better understand what's going on and how to optimize brains
Speaker 3: during this time, it is potentially this huge window to
Speaker 3: ensuring that women have much better opportunity to sort of
Speaker 3: minimize the risks of cognitive decline later in life and
Speaker 3: maximize the potential for having good brain health and healthy
Speaker 3: brain aging. And also, I think there's been very little
Speaker 3: research that's really properly been done in perimenopause and early
Speaker 3: perimenopause or years. I think particularly that when we're talking
Speaker 3: about hormone therapy, a lot of the work is done
Speaker 3: in menopause postmenopause or years. But we really don't know
Speaker 3: much in particularly in terms of cognition and mental health
Speaker 3: in terms of perimenopause. So I think uncovering that area
Speaker 3: is something that I'm really excited to learn.
Speaker 2: What the future will hold.
Speaker 1: Yeah, I think we have to be super proactive, right,
Speaker 1: I mean, I think that is the future of looking
Speaker 1: at perimenopause or those late reproductive years as an opportunity
Speaker 1: to really shore up health and really pay attention so
Speaker 1: that we don't age passively right and let things happen
Speaker 1: to us, and we can be proactive. What are your
Speaker 1: three take home tips for our listeners? What are three
Speaker 1: actionable tips that you would give them to maintain the
Speaker 1: best brain health possible.
Speaker 3: I would say the first one is just to be aware.
Speaker 3: Be aware of what's happening at a hormone level. And
Speaker 3: while you might not be having lots of menopause symptoms,
Speaker 3: if you're experiencing changes in your mental health and your
Speaker 3: cognitive health or some cognitive symptoms, be aware that it
Speaker 3: might be connected to your hormones. So, I think if
Speaker 3: people are worried about cognitive symptoms or worried about the
Speaker 3: onset of they think they might have dementia, to think
Speaker 3: about this might not be that, it might just be
Speaker 3: part of a hormone or transition period. Maybe this is
Speaker 3: the start of perimenopause, and go and have a chat
Speaker 3: to a health professional to see what can be done.
Speaker 2: So that would tip number one is that awareness.
Speaker 3: Tip number two is for women not to suffer in silence. Again,
Speaker 3: seeking help is so important, having conversations with the right
Speaker 3: practitioner who has an awareness of menopause and awareness of
Speaker 3: the different symptoms that people can experience. And the third
Speaker 3: tip would be just the practical lifestyle things that people
Speaker 3: can do, and for people to know that their brains
Speaker 3: are constantly changing and we're constantly building new pathways in
Speaker 3: our brains, and there's so much we can do to
Speaker 3: build positive pathways. And it's a time that people can
Speaker 3: really seek support and get help and do their best
Speaker 3: to kind of optimize their functioning and as much as
Speaker 3: possible thrive during this phase of their life.
Speaker 2: And for some women that's not at all what they're feeling.
Speaker 3: They might be listening to this and feeling like they're
Speaker 3: so far off thriving. But I think knowing that there
Speaker 3: are pathways to help and to support and to being
Speaker 3: able to be your best version of yourself during this
Speaker 3: time of your life is really important.
Speaker 1: I like to tell my patients, you know, at thirty five,
Speaker 1: forty forty five, how you treat your body today is
Speaker 1: really you're going to feel it when you're seventy or eighty,
Speaker 1: So super important to set yourself up for success.
Speaker 2: To you the ball up correctly, Yeah, definitely.
Speaker 1: Thank you so much for joining me. This has been
Speaker 1: such a real pleasure to speak with you. I really
Speaker 1: look forward to following your work and hearing more from
Speaker 1: you in the future.
Speaker 2: Thank you, Elizabeth.
Speaker 3: It's been absolute pleasure talking to you, and I've really
Speaker 3: enjoyed the conversation.
Speaker 1: I see a lot of patients in my practice on
Speaker 1: a day to day basis who are really concerned about
Speaker 1: cognitive decline. I want people to really remember that brain
Speaker 1: health is not a passive endeavor. Lifestyle can greatly impact
Speaker 1: cognitive function. There's lots of data that estrogen protects the brain,
Speaker 1: and our more modern normal estrogens used in hormone therapies
Speaker 1: today may be protective against cognitive decline in the future,
Speaker 1: especially if you're at elevated risk based on your family history.
Speaker 1: I'm grateful for Caroline and researchers like her who are
Speaker 1: working to get us more data to help us to
Speaker 1: better understand the science behind these issues. For the majority
Speaker 1: of women, modern transdermal hormone support such as patches, gels,
Speaker 1: and rings are safe if started prior to the age
Speaker 1: of sixty or within ten years of your last menstrual period,
Speaker 1: and for brain health sooner maybe even better. Speak to
Speaker 1: a physician who's knowledgeable and truly engaged in midlife women's
Speaker 1: health who can help you decide if menopausal hormone therapy
Speaker 1: is an option worth exploring. Coming up on the next
Speaker 1: episode of Decoding Women's Health, I'll speak to a world
Speaker 1: renowned oncologist about how you can minimize the likelihood of
Speaker 1: developing certain types of cancer.
Speaker 2: As we sometimes say, genetics is not destiny. People need
Speaker 2: to be.
Speaker 1: Really open minded about the value of genetic testing and
Speaker 1: how it can help them mitigate their cancer risk. Decoding
Speaker 1: Women's Health is a production of Pushkin Industries and the
Speaker 1: Atria Health and Research Institute. This episode was produced by
Speaker 1: Rebecca Lee Douglas and Amy Gaines McQuaid. It was edited
Speaker 1: by Karen Shakergie. Additional production support from Kate Furby, mastering
Speaker 1: by Sarah Briguaire. Our executive producer is Alexandra Garreton. Our
Speaker 1: theme song was composed by Hannes Brown. Concept and creative
Speaker 1: development by Shavan O'Connor. Special thanks to Vicki Marrick, Jacob Goldstein,
Speaker 1: Kerrie Brodie, Alan Tish, David Saltzman, doctor David Dodick, Theo Bidler,
Speaker 1: Sarah Nix, Eric Sandler, Morgan Ratner, Amy Haggadorn, Owen Miller,
Speaker 1: Abigail Abrams, Sarah Begley, and Greta Cone. If you have
Speaker 1: questions about women's health in midlife and want X advice,
Speaker 1: leave us a voicemail at four FI five two O
Speaker 1: one three three eight five, or send us a message
Speaker 1: at Decodingwomen's Health at pushkin dot FM. I'm doctor Elizabeth Pointer.
Speaker 1: Thanks for listening. Until next time,