October 7, 2025 • 51 mins
Here’s a preview of a new Pushkin podcast, Decoding Women’s Health. On Decoding Women’s Health, Dr. Elizabeth Poynor makes the science of women’s health accessible—from hormones to metabolism to longevity—so you can thrive at any stage of life. A world-renowned gynecologic oncologist and advanced pelvic surgeon, Dr. Poynor speaks with leading physicians, researchers, and educators to share the latest science on women’s wellness, disease prevention, and what it really means to age on your own terms. Each episode explores a different aspect of how to improve your health during midlife—from heart disease and genetic risks to cognitive health and beyond. Because mid-life isn’t a crisis—it’s an opportunity.In this episode, Dr. Poynor is joined by neuropsychologist Dr. Caroline Gurvich to unpack what’s really happening in the brain during perimenopause and menopause. They explore why more than 60% of women experience cognitive shifts, how estrogen impacts memory and focus, and the roles hormone therapy, lifestyle choices, and even cognitive training can play in keeping your brain sharp.
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Episode Transcript
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Speaker 1 (00:00):
Hey, listeners, I'm doctor Elizabeth Poynter, and I'm dropping into
your feed today to bring you a preview of my
new podcast, Decoding Women's Health. I hope you enjoy it,
and if you do, find Decoding Women's Health with Doctor
Elizabeth Pointer wherever you're listening. Now. Here's the thing about
(00:20):
women's health. We spend the first part of our lives
trying not to get pregnant. We spend the second part
of our lives for many of us, trying to get pregnant,
and then the third part of our lives we're kind
of forgotten about. And this is when we go through
some of our biggest changes. I learned myself the hard
way when I was forty three out of nowhere. I
became significantly depressed and anxious. I'd always been the kind
(00:44):
of person who woke up happy, motivated to face the day.
Suddenly I didn't feel joy anymore. I was consumed by
worry and my confidence was gone. At that time, I
was running a very large surgical practice, and let's face it,
nobody wants an anxious or press surgeon. I felt like
a different person and was totally confused by the whole thing.
(01:05):
I went to the medical literature looking for answers, but
I came up completely empty. I consider myself a pretty
well informed, well educated physician. I've trained at some of
the best institutions in the nation. I've specialized in gynecologic
oncology and surgery, and I've been the expert that news
outlets have turned to for insight.
Speaker 2 (01:25):
Please welcome doctor Elizabeth Poyner.
Speaker 1 (01:30):
I think that's very important that women understand that they
still needed you have their yearly annual consultaneous. One of
the most commonly prescribed rugs for diabetes can actually impact
a woman's survival when she's been diagnosed with ovarian cancer.
Was a pointer.
Speaker 2 (01:44):
Great to see you, Thank you so much.
Speaker 1 (01:49):
And yet I was still in the dark. It was
my mom who actually said to me, you know what,
it's probably your hormones. Turns out she was I was
going through perimenopause. Looking back at made perfect sense. I'd
always had mood changes around my period. Of course, then
the biggest hormonal shift in my life would affect my
(02:10):
mind and emotions. What's wild is that none of my doctors,
not my therapist, not a psychiatrist I had consulted for
this issue, not even my medical colleagues suggested perimenopause. Eventually
I figured out how to feel better, but the whole
experience served as a big wake up call for me.
(02:32):
So here's my question, where exactly is the information for us,
the women in the middle of our lives, to help
us make the best decisions about our health. I'm doctor
Elizabeth Poynter, and I've spent the past forty years working
in women's health. I'm the Chair of Women's Health and
Gynecology at the Atria Health Institute in New York City.
(02:55):
And here's what I've observed, both as a patient and
as a doctor. The information actually is out there, but
it's really hard to find. Sometimes you have to read
across subspecialties. You have to read the neurologic literature, the
cardiology literature, the endocrinology literature. It's dense research that's nearly
(03:17):
impossible to understand without a medical degree, and even most
doctors don't have time to do that. Now. Specialists live
in their own subspecialties and struggle to keep up in
OBGI and training programs. Even the top ones, there's maybe
at best one or two lectures on midlife women's health.
There's no textbook, there's no course, there's no focus on
(03:40):
women after their reproductive years, and that's why I'm making
this podcast, Decoding Women's Health, a new show from Pushkin
Industries and the Atria Health Institute that will elevate the
conversation about women's health and midlife and frankly challenge some
of the status quo information out there, because what I
(04:00):
want for everyone listening, for every patient, every doctor, and
every woman is to feel more informed when it comes
to our health women's health. On today's episode, how to
(04:22):
fluctuating hormones impact the brain, specifically for women in midlife.
Turns out a lot of cognitive changes can happen, and
it can be really frightening. Some women, like me, experience
intense mood shifts. Others may start to wonder if they've
developed ADHD or maybe even dementia, but what they're really
(04:43):
dealing with or temporary memory glitches. We'll talk about what's
going on with these cognitive disruptions, how to manage them
in the moment, and how women can be proactive about
maintaining sharp, healthy minds throughout their lifespans. I am thrilled
to be joined today by doctor Caroline Gervich. Caroline's work
(05:03):
caught my attention because she studies hormones and how the
brain changes through midlife. She's engaged in some really fascinating
research about brain fog, cognitive training, and ADHD. Caroline is
an Associate professor and clinical neuropsychologist. She is also the
Deputy director of the Her Center in Australia and head
of the Cognition and Hormones Group at Monesh University. There's
(05:27):
so much we don't understand about how the brain works,
but Caroline and her team are doing critical work examining
how hormones impact our cognitive health throughout our lives. Caroline,
thank you so much for joining us today and welcome
to the show.
Speaker 2 (05:40):
Thank you so much, doctor Poynter, It's absolute pleasure to
be here.
Speaker 1 (05:43):
Can you tell us what a neuropsychologist is actually?
Speaker 2 (05:46):
Yes, so, at a really basic level, it's brain psychology.
So the neuro is the brain bit and the psychology
is understanding a whole range of mental health symptoms. And
what we do as a profession is we do a
lot of assessments to better understand what different symptoms people
are presenting with. When it impacts brain, brain and behavior,
So that's the assessment side, But then neuropsychologists can also
(06:09):
work at an intervention side, So once we know what's
going on for someone, we can help them with education,
so understanding how a brain relates to our behavior, as
well as different kind of training processes to try and
improve or give people strategies to improve whatever difficulties their
experiencing with their cognition or their thinking skills.
Speaker 1 (06:29):
How did you get involved with this type of work?
Speaker 2 (06:31):
Yeah, so it wasn't that I, as a child always
wanted to be a neuropsychologist. I don't think I really
knew what a neuropsychologist was until I was well into
my training. It was more I didn't actually know what
I wanted to do. But I really love science, Like
I loved chemistry, I loved physiology and learning about the brain.
I was fascinated by how powerful our brains are and
(06:54):
how little we know about how we think. From there,
I started working in older age psychiatry and became interested
in menopause and how little we know about that midlife,
which is really when a lot of the brain changes
start happening, and we can either prepare ourselves as much
as we can for kind of healthy older aging or not.
But it's like this potential window of opportunity to kind
(07:16):
of take control and do what we can for preparing
ourselves for great cognitive aging.
Speaker 1 (07:22):
Can you tell me a little bit more about what
you mean taking control and prepare for aging.
Speaker 2 (07:27):
Yeah, So I think these menopause transition years are transitioning
from our reproductive phase of our life to our postmenopausal
years and our older adult years. So it's just a
great opportunity to reflect on the phase of life you're
at and know that there are so many things you
can do as an individual to promote good health. So
(07:49):
lots of physical exercise and lots of lifestyle factors, like
in terms of your diet, in terms of sleep, in
terms of being socially connected. So there are a lot
of things you can do as an individual to make
the most and to optimize whatever brain health you have.
Speaker 1 (08:06):
So you mentioned that there's a connection between menopause or
perimenopause and cognition. On a basic level, what's going on
in perimenopause and menopause.
Speaker 2 (08:16):
So, perimenopause is a time in a woman's life where
there's hormone changes, So we have fluctuations in one of
our estrogen called estradal, and gradually that hormone declines. Perimenopause
can span four to ten years, so it's not a
short time, it's many years in someone's life that there
are these hormone changes that are happening. Perimenopause can be
(08:40):
associated with a whole range of different symptoms. There can
be no symptoms for some women. There can be the
hallmark of menopause. I guess, the vasomotor symptoms, which are
hot flushes, night sweats. There's a number of women who
experience what is often referred to as as brain fog
in a colloquial way, which are cognitive symptoms that can
(09:00):
happen during perimenopausal years. And these symptoms can include word
finding difficulties, which is that words on the tip of
your tongue not being able to find the right word.
There can be forgetfulness. There can be higher level what
we call executive function symptoms, which is where people have
difficulty juggling lots of things, planning ahead, prioritizing, difficulties with
(09:24):
time management, and higher level organization type skills. So there
can be a whole range of different cognitive symptoms that
people can experience, and they're often subtle, but at a
day jay level or at an individual level, they can
have a really significant impact on people's lives.
Speaker 1 (09:42):
What percentage of women do you really think are going
through these cognitive changes?
Speaker 2 (09:49):
The literature would suggest about sixty percent, It depends on
their kind of community based studies, but about sixty Some
say closer to seventy percent. So somewhere in that vicinity
is the percentage of people who experience some degree of
cognitive symptoms. And I think it really varies. For some people,
it's quite subtle and it doesn't have a huge impact
(10:11):
on their life, but for other people it can be
quite significant.
Speaker 1 (10:14):
In your clinical practice, what kind of complaints to midlife
women come to you with or what are their main concerns.
Speaker 2 (10:21):
So there's often mood symptoms that are present, but not always,
but they tend to come and see me because they're
concerned that one they have dementia. That's one of the
probably the most common concerns that people have. And the
types of symptoms that people talk about is, you know,
I'm forgetting everything. I never used to forget things. I
used to be really efficient in my role, and now
(10:42):
it takes me so long to do things. So that's
one and the other one that's become more common in
recent years is do I have ADHD. I'm really struggling
to manage my time. I'm really struggling to prioritize, to plan,
to organize, to focus. So they're probably the two biggest
clinical questions that people present with. But the types of
(11:03):
symptoms that women present with are mood symptoms, forgetfulness, difficulties
with efficiency and time management and multitasking.
Speaker 1 (11:15):
What ages are you seeing this? You know, we talk
a lot about menopause and the final menstrual period, but
I've kind of noticed in my practice that patients really
present in that early perimenopause time where they might not
be having any menstrual irregularities or might not even know it.
What do you see in your practice.
Speaker 2 (11:31):
Exactly the same as quite early. It's often, as you say,
in the early forties, where they haven't really necessarily made
a connection that this might be the start of their
perimenopausal journey, and they're just concerned about their cognition, their
thinking skills, and it has this ripple effects, so they
start to become a bit concerned about their efficiency. Then
(11:51):
it impacts their self esteem, then they become a bit
more anxious. Then the anxiety in itself further impacts their
ability to perform in the moment. So it's this real
cycle for people. I've had patients who have sort of
had the conversation with their GP, but they haven't been
reassured that it might not be dementia. So then they've
(12:12):
gone ahead and contacted people like Dementia Australia like Big Foundations,
describe their symptoms, which can sound a little bit like
early stages of dementia over the phone, and then they've
been reassured that yes, it does sound like you might
have the early stages of dementia and they don't have
that at all, And they've started to go down that
pathway of putting, you know, financial things in place and
(12:33):
really preparing themselves for degenerative process, and that is not
what they've got at all. So I think it's really
important that people have a better understanding and follow the
right pathways of getting the right support.
Speaker 1 (12:45):
You know, a lot of times we go is dementia
or is it brain fog? Right, and it's like, well,
you know, demension packs your quality of life on a
day to day basis but I think brain fog probably does,
especially if you're in the workplace, which brings me into
how do you help women through the workplace and what
do you see? How are women impacted in their workplace
by some of these cognitive changes.
Speaker 2 (13:05):
I think people who are working in a job that
does require thinking on the spot speaking on the spot
is often the people I tend to see so high
functioning professional people because they really feel the subtle cognitive changes.
The word retrieval deficits have a really big impact at
a day to day level, and people get nervous about
(13:26):
public speaking, even if it's something they've always done, because
they're worried they'll experience a word finding difficulties. For some people,
it can be really problematic. And I've seen women who
have actually changed their work or drop back to part
time or left work altogether, which is really really sad
because they didn't really understand what was going on for them.
They didn't link it back to their hormones. They just
(13:47):
felt like they were no longer up to whatever their
job was, and so I think that's really devastating when
that's happened. If it's someone who wanted to stay in
the workforce, but because of their sort more subtle cognitive
symptoms and then the low on impact on self esteem
and then the increase in anxiety, chain of events has
led them to leaving the workplace, So it can be
really detrimental for some women, and then in broader workplace settings.
(14:13):
I mean, the key thing is just education, just knowing
that cognitive symptoms can be a part of the menopause
transition and there are lots of ways to manage it.
And I think the key factor for women to know
is that it's not an impact on intellectual capacity per se,
but they just might need a little bit of support
and a little bit of knowledge about the types of
symptoms that they might be experiencing and knowing that it
(14:34):
might be, you know, a couple of years where word
finding is not great or your learning efficiency isn't perfect,
but you'll get through, and you just need some practical
supports to get you through. So women don't feel like
they're no longer up to it, because that's not the case.
Speaker 1 (14:50):
I think that's really important, this whole concept of you know,
I can still function, I can still work where I
need to work, and be where I need to be
at the level I need to be at. We talk
about support structure and that type of thing. What are
you referring to.
Speaker 2 (15:03):
Just really practical things like people not shouting out, oh
can you do this in the corridor, just emailing it
to people so you've got things written down rather than
juggling things in your working memory if you're in meetings
or if you're in a consult with someone, to be
able to take notes or use some sort of recording
(15:24):
audio to take notes, so you're not again relying on
your working memory and your attention to hold and juggle
lots of pieces of information. If you feel like you're
forgetting a word, it's sometimes easy to say this is
hard to do this, but don't stress about it because
it makes it worse. So rather than trying to find
that word, trying to encourage people just to kind of
speak around the topic or just own it, say I
(15:45):
can't think of that word at the moment and move on,
and no one really cares too much. So I think
it's just about having some strategies at an individual level
in place to manage that. So, yeah, as I said,
the key one is really just reducing the demands on
where memory and the juggling and switching between lots of
different tasks, and for some people where it's executive function,
(16:06):
difficulties are about sort of time management and prioritization of tasks,
structuring your day so then you've got some time blocked
out for the last minute things each day in case
they pop up. But having some sort of increased structure
to your work date I think can be really helpful
for people as well.
Speaker 1 (16:27):
Coming up, what does ADHD really look like for women
in midlife? How can changes an astrogenmmic those symptoms, and
what does the scientist actually say about whether hormone therapy
can help not just with focus and memory, but maybe
even protecting our brains as we age. So that kind
(17:01):
of leads me into the kind of ADHD component of
your work, which I think is really interesting because I
consider myself a pretty educated physician. I'm curious, I read,
but I know nothing about ADHD and midlife women. Can
you unpack that a little bit for us and also
just tell us what ADHD really is?
Speaker 2 (17:19):
Yes, So, and the fact that you haven't read anything
about ADHD in midlife is because there's really very very
little published on the topic. So I think there's just
not much out there. But to come back to what
ADHD is, so attention deficit high peractivity disorder is what
ADHD stands for. In terms of the diagnostic criteria. You
(17:40):
can only now diagnosed ADHD in adults. So it's always
been considered and still is a neurodevelopmental condition. So it's
something that your brain is kind of born with and
you develop as a child. So it can be attention
deficit and or hyperactivity in attention and so it's the
(18:01):
sorts of symptoms that fall into that attention death set
are things like forgetfulness, difficulties focusing on things, and then
the high peractivity impulsivity is just a feeling of being
on the go all the time, that there's an emotion
inside you, a drive inside you, and you just need
to be busy and occupied. The stereotypical picture of ADHD
(18:23):
is often coming from that hyperactive symptom. You think of
the hyperactive little boy, and a lot of the diagnostic
criteria was kind of built around that. But as we're
learning more, we're seeing for menopausal women it tends to
be more of the inattention that can be undetected. I
think in a lot of people, particularly for women who
also you know might be really conscientious and hard working
(18:45):
and perfectionist type people that inattention and difficulty regulating and
organizing and structuring your day can often go unnoticed. But
coming back to your question about sort of the midlife
and the menopause connection to ADHD, we don't really know
exactly what's happening. So the theory is that during menopause,
(19:07):
when estrogen changes, it impacts dopamine and perhaps uncovers ADHD
that's always been there. I don't think we fully understand
whether it's an ADHD presentation appearing at menopause for the
first time. And for some people they've got a lot
of ADHD characteristics, but it's not something that was there
prior to the age of twelve, which is what we
(19:28):
need for our diagnostic criteria, that there's evidence that someone's
had this as a neurodevelopmental condition. So for some people,
they just present with characteristics of ADHD around menopause, but
for other people, they've had lots of support or kind
of scaffolding I guess, throughout their life, and when we
take a really good history, we can see that they
have had ADHD always and they've just hit a point
(19:51):
in menopause where they can no longer kind of mask
or cover up some of the symptoms that they've been experiencing.
And in our research as well, we've spoken to a
lot of women with ADHD. These are people who have
got or already have a diagnose of ADHD, but they
all report a worsening of symptoms at menopause, both other
menopausal symptoms as well as their ADHD symptoms. So there's
(20:12):
definitely a connection between menopause and ADHD. And we also
see a similar pattern across a menstrual cycle. So women
with ADHD report a worsening of their symptoms in that
luteal phase, the second half of their menstrual cycle, and
so there's clearly a hormonal factor that's driving these changes
in symptoms across menstrual cycle or during the perimenopausal years.
Speaker 1 (20:35):
You know, it's so interesting because, I mean, it's like
menopause and the hormonal fluctuations just uncover issues in the brain, right,
I mean, it's like psychiatric issues get worse at the
time of perimenopause and menopause, right, depression can go off
the rails. How much of this impact do you think
is due to estrogen and what is estrogen doing to
our brains?
Speaker 2 (20:54):
Yeah, I think we know the most about estrogen. I
think that's why we talk about it the most because
I think most of the research, most of the animal studies,
has been done looking at estrogen. But we know that
estrogen plays a neuroprotective role in the brains. We know
estrogen helps protect our brain against damage. So if there's
been some sort of insult to the brain, estrogen can
(21:14):
be really protective. And so we also know that there's
receptors that respond to estrogen in brain areas beyond reproductive function,
so in brain areas that are really relevant to mood
and to cognition, So the front part of our brain
really important for executive functions. We know that estrogen's interacting
or modulating a lot of our neurotransmitter pathways, so the
(21:36):
dopamine pathways that are important in ADHD but also important
in motivation, in drive, in regulating our attention. More broadly,
eachtrogen interacts with serotonin, which is really important for mood.
So we know that issian's playing a significant role in
our brain. And yes, most of this research is from
(21:56):
animal studies, but we kind of extend that extrapolate from
that and learn from that in terms of how estrogen
might be working human studies.
Speaker 1 (22:04):
Yeah, it's interesting, there's so much to explore when these
cognitive issues are occurring. What's actually going on. Estradyl is
the main estrogen that the over is produced for women,
and what is it doing during this time period where
cognitive issues may occur.
Speaker 2 (22:20):
So it's fluctuating, particularly during those early perimenopausal years, but
they're also gradually declining, and I think both of those
factors seem to be related to changes in cognition. So
if we think about what's actually going on, I think
there are receptors in our brain that respond to estradyl,
(22:40):
are used to being stimulated by estradyle, and suddenly there
it's on off, it's up down, and then it's gradually
those receptors are less stimulated by estradyl over the years.
So I think that that's the hormonal factors that are
underpinning the cognitive symptoms. But I think there are often
lots of other pieces of the puzzles. So I think,
(23:00):
you know, while people can experience brain fog or cognitive
symptoms as a sole symptom of menopause, more often than not,
it's not the case, there's often other symptoms going on,
so I always think of the cognitive symptoms a little
bit like the tip of the iceberg. There's always things
underpinning that. So I think when we're talking about menopause,
we're talking about hormone changes as being a significant contributing factor,
(23:22):
but also talking about, you know, vasomotor symptoms. So there's
studies that show that these can also have an impact
on brain, on factors in the brain that might then
have flow and effects to cognition. They also can impact sleep,
So sleep and a lack of sleep or impaired disruptive
sleep for anyone at any point in your life can
(23:43):
impact your cognition and lead to feeling a bit foggy
and those kind of cognitive symptoms. And then we've talked
a bit about mood that can be another contributing factor
to cognitive symptoms. And some people during menopause might be
experiencing pain joint pain and pain can have cognitive symptoms.
So I think there can be lots of factors that
(24:04):
are underlying the presentation of cognitive symptoms, and I definitely
think hormones are playing a significant role that I think
it's important to consider the whole person and everything that's
going on for them. And the other point is that
menopause often coincides with a really busy time in a
lot of people's lives or often at you know, the
(24:26):
busy time in your career, and elderly parents, potentially teenage
children managing households, like there's often just a lot going on.
So I think there's that as well, the fact that
people are often just stretched and stressed because they're so busy,
and so I think all of those factors are really
important to consider when we think about what's underpinning cognitive symptoms.
(24:47):
But I think, you know, when we're talking about perimenopause,
we're obviously talking about hormone changes, and hormone changes in
and of themselves might be enough to drive cognitive symptoms,
but I just think it's important to consider the whole
picture as well.
Speaker 1 (25:00):
Yeah, it's kind of a perfect storm, right. I mean,
you might be going through significant life changes, whether it's
your job, your family, your partner, and then you put
on this pressured physiology. I think what a lot of
people don't realize there's estrogen receptors throughout the body that
are active through the entire body. You talk about pain,
joint pain, sleep disruption. You know, the holistic approach is
(25:23):
always or that entire body approach is always so interesting
in helping women and negotiating those hormone fluctuations. So that
leads me into what I consider the million dollar question
right in terms of in terms of hormone therapy, in
terms of hormonal support for women going through these transitions,
for even just the cognitive issues around the time of
(25:45):
early perimenopuzzle transition or late perimen and puzzle transition, and
then for dementia prevention. You know, professional societies don't recommend
hormone therapy for dementia prevention or treatment or brain fog.
But do you think that there's any role for if
somebody is very distressed and it's really impacting their quality
of life, maybe starting estrogen at this time, for adding
a little bit of lotus hormone support for them, or
(26:06):
what are your thoughts about that?
Speaker 2 (26:07):
So I have seen plenty of women at an individual
level who have shown a huge benefit from the right
combination of hormones optimization or hormone therapy. So yes, I
know that professional guidelines don't recommend or advocate for using
hormone therapy for either cognitive symptoms or as you say,
prevention of later life cognitive decline. But I think at
(26:29):
an individual level, I always tell people go and chat
to your health professional who's working with you in terms
of menopause. Chat to them about different options for hormone
therapy because I have seen so many women who have
been transformed in a beneficial way because of the right
combination of hormones.
Speaker 1 (26:45):
Why has it been contentious the treatment of cognitive issues
or dementia prevention with estrogen.
Speaker 2 (26:53):
Decades ago, it was kind of accepted and thought that
menopausal hormone therapy or HRT hormone support was helpful for
reducing dementia risk from a lot of observational studies, and
then the Women's Health Initiative came along. The largest randomized
control trial that was early two thousands, and the results
(27:16):
showed that it was associated with an increase in dementia risk. However,
there has been a lot of debate, a lot of discussion,
and a lot of issues with that study. So probably
the two key ones in terms of dementia risk was one.
All the participants in that study were all on average
over the age of sixty five and more than ten
years postmenopause, so a lot of them initiated hormones not
(27:41):
close to going through the menopause transition years. So that
was one factor, and the other factor was the types
of hormones that we use in that particular study were
potentially less beneficial for brain health and for cognition. And
so when that study came out, I think it just
scared a lot of people, and since then there have
been not enough studies to start to build a more
(28:02):
balanced evidence base. There was a meta analysis that was
published last year and that showed that if hormone therapy
was initiated close to menopause, then it was associated with
a reduced risk of developing dementia later in life, particularly
estrogen only hormone therapy.
Speaker 1 (28:20):
Yeah, I think that what we call it the critical
window hypothesis, right, that if you get estrogen support or
have estrogen support within the first few years of menopause,
you may get some protection.
Speaker 2 (28:33):
So I think the two key factors are that critical
window hypothesis or theory that we have to use estrogen
therapy very close to menopause to see benefits. But yes,
if it's not initiated during that time and initiated you know,
more than ten years postmenopause. Yes, it might be harmful.
And I think the other factor is thinking about the
(28:54):
type of estrogen in terms of brain health and progesterone
progestine that might be most helpful for brain health.
Speaker 1 (29:01):
And what do you think the answer to this is
in terms of getting the data? I mean, are we
going to have to settle for lesser data, are we
going to have to look for what we call biomarkers
or what is the answer to this? Because you and
I have both said that we see people who do
improve actually and there is compelling data that's out there
about prevention of dementia and treatment of cognitive issues. What
(29:24):
do you think the answer is?
Speaker 2 (29:25):
We probably need a combination of things. I don't think
there's one specific trial that's going to give us the
perfect answer to that question. And when we're talking about
something like dementia, you're talking about a thirty year period
from when the pathology begins in the brain to when
the symptoms might manifest or twenty to thirty years, So
that's a really long time frame. And so I think
(29:47):
there's two questions. One is does hormone therapy help in
the short term for people with cognitive symptoms in the
moment when they're going through perimenopausal transition years. And does
hormone therapy help people in the earth postmenopausal years if
they've still got cognitive symptoms, And then what are the
flow and effects twenty years down the track? Is there
a change in risk for developing neurodegenerative processes lack dementia?
(30:12):
And so I think we just need to keep doing
more research and keep putting the pieces of puzzles together,
keeping the research flowing so we can gradually build on
it and learn more.
Speaker 1 (30:24):
Just the other day, I was talking with a patient
who started hormone support for something completely unrelated to cognitive health.
When I asked how she was feeling, she said, you
know what, My brain fog got better. I can think
more clearly now. We haven't even spoken about brain fog
before that. And it's remarkable how quickly these changes can
take effect. When I started on hormone therapy after I
(30:45):
finally figured out I was in perimenopause, it only took
about two weeks before my mood started to improve and
I started to feel like my old self again. Now
that's not to say that hormone therapy is a cureole
for every perimenopausal symptom, but for many women can play
a really important role in feeling better. Coming up, doctor
Gervit and I discuss some additional tools to support your
(31:07):
cognitive help from brain training exercises to lifestyle changes. Decoding
women's health will be right back. You know, we've spoken
(31:37):
about kind of you know, what happens to the brain,
and hormone support may be helpful, but talk to me
about cognitive training, cognitive reserve and what are those concepts
and how do they help women.
Speaker 2 (31:50):
Yeah, I think in the absence of anything that's currently
clearly indicated that people can take for cognition, I think
it's important to think about what else can we do.
And I think there's definitely a role for hormonal support
or hormonal therapy that needs to be explored in a
lot more detail. But as you said, our brains keep
(32:10):
changing depending on how we stimulate them and which pathways
we're using and encouraging and growing, and so there is
room to retrain our brains and to get better at
different things all the time. And so we did a
review initially of cognitive training in midlife. So we're talking
about cognitive training to boost cognitive functions broadly in everyone
(32:31):
in the midlife. And then from there, we specifically tried
to focus on the few studies that had either reported
the results of females specifically or had looked specifically at menopause,
and so to just kind of pull out what we
found in menopause. The most beneficial areas were to use
a strategy based training, So that's teaching people new strategies
(32:54):
to approach difficulties that they're having or to enhance or
optimize their cognitive for fight performance. Psycho Education like explaining
to people what's going on can be really helpful as
a component of cognitive training. And so now we're taking
this and we're building cognitive training programs for women with
(33:14):
whatever mental health type symptoms they might be experiencing and
cognitive symptoms combined without or just cognitive symptoms on their own.
So giving people education about what we're talking about the
role of hormones, other symptoms, how all those things work together,
how cognition works. People knowing that you have capacity to
(33:34):
improve and optimize your cognitive functioning, So giving people that
piece of knowledge and that understanding can be really helpful.
And then training, So when we talk about training, some
people I think probably think of computerized cognitive training or
brain training, where you repeat one task over and over
again and people get really good at that task. But
most of the research shows that that doesn't necessarily generalize
(33:56):
to day day life. So you just get really good
at that one task or maybe similar tasks. But what
we want people to do is get better at thinking
and optimizing all of their cognitive skills. So by using
strategies to help reduce your mental load, writing lists, breaking
down tasks, prioritizing tasks, completing one thing at a time,
(34:19):
teaching people to really focus their attention and actively attend
to whatever task they want to do, can also really
improve your capacity to learn and encode that information. Teaching
people that when they want to learn a new piece
of information, if you can sort of paraphrase it and
now ask questions about it, it encodes it in a
deeper level. So just teaching people about how memory works,
(34:41):
and how encoding works, and how attention works, and giving
people strategies to improve and optimize all of those different
thinking skills, that's the kind of cognitive training that seems
to be the most beneficial, and then we also talk
about lifestyle factors that might be helpful to again optimize
brain health. And optimize is cognitive health.
Speaker 1 (35:01):
So one of my midlife friends wants to know, is
wordle a form of cognitive training. We suspect not. We
suspect that you need to do more than wordle.
Speaker 2 (35:13):
More than wordle, but wordle is better than nothing, so
I think, And if you love wordle, there's no reason
not to do word all. So I think anything that
stimulates your brain in a new way is a good
thing for your brain. Doesn't mean it will necessarily generalize
to lots of different areas, but I think if you're
enjoying it, go for it.
Speaker 1 (35:32):
Tell us what kind of nutrition do you recommend, what
kind of exercise, and why this stuff works? You know,
I always love the context of why something works because
I think it helps me understand it better. It helps
my patience understand why it's so important.
Speaker 2 (35:47):
So the lifestyle recommendations for cognitive health are exactly the
same as the lifestyle recommendations for brain health, which are
the same as the lifestyle recommendations for heart health. So
I feel like everyone is on the same page. That
people need to do their best to exercise and to
eat well, and to make sure they can optimize their sleep,
(36:08):
minimize their stress, maintain social connections. So all of those
things are really important. My personal motto when I see
people is just for people to try their best. So
I just think for people at an individual level to
find a type of exercise that they enjoy and then
to keep building on that. And you know, the guidelines
would suggest that you have both strength based training as
(36:31):
well as cardio and you kind of mix it all up.
But I just think a little bit of exercise is
better than nothing. So whatever people can do to exercise
is going to help people's mental health and their brain
health and their cognitive health. In terms of nutrition, it's
about people working toward the best diet they can in
their lives, and you know, minimizing process food and trying
(36:53):
to build up a healthy, balanced diet is the most
important thing. But if they want to adopt the diet
that has the best evidence based for cognitive health and
longevity in terms of brain health, it's the Mediterranean diet.
In terms of sleep, and it's often hard to do this,
but people shouldn't put up with bad sleep. They should
speak to their physicians whoever they're working with about different
(37:15):
sleep interventions. But there's a lot of evidence for CBT,
so cognitive behavioral therapy I so CBT for insomnia, and
there are free programs online that people can log in
and do four to six sessions and this can really
help some people with their sleep. So I think encouraging
people to maximize their sleep, their diet, their exercise, for
(37:38):
people to engage socially. There's a lot of evidence that's
emerged to show the importance of social connections and the
negative effects of being lonely, so in terms of mental health,
in terms of cognitive health. So encouraging people to prioritize
socializing because it's fun, it's nice, and it also protects
(37:59):
your brain and your mental health later in life, so
that's also important. And then minimizing stress. So there's a
lot of evidence for meditation being beneficial for brain health,
for cognition in the short term and the long term.
So if people can incorporate some type of meditation, and
you know, meditation isn't for everyone. Some people need to
(38:20):
do more of like a mindfulness based practice where you're
just present in whatever you're doing, so it might be
movement based. Some people talk about being mindful while they're surfing,
or mindful while they're walking, or mindful while they're doing yoga.
It's just kind of being present and it might not be,
you know, exactly a meditation practice, but some form of
(38:41):
mindfulness embedded in people's lives is really important to help
minimize stress, and it can also have flow and effects
to promoting brain health. So in terms of lifestyle factors,
they're kind of the key ones. And also talking to people,
particularly in midlife about minimizing alcohol. There's a lot of
negative effects from excessive drinking. A lot of people do
(39:02):
turn to alcohol as a short term coping strategy, and
so it's important that people understand that alcohol can have
lots of negative effects on the brain if people use
alcohol excessively. So we often have a conversation about how
much alcohol people are drinking and what that might be
doing to their brain health in the long term as well.
Speaker 1 (39:23):
So I'm going to go backwards. I'm going to go
back and touch on each one of those again in
a little bit more detail. But I want to start
with alcohol because that's a big one, right and also
thing is really important to realize too that alcohol is
to sleep disruption and can worsen there's a motor symptoms
or heart flashes. Do you think that there is any
level of I mean, I think of alcoholics and neurotoxin.
So do you think that there is any level of
(39:44):
alcohol which is safe for women to consume in terms
of cognitive health.
Speaker 2 (39:50):
Yeah, so I think overall there's no real benefits of
alcohol in terms of brain health, in terms of sleep,
in terms of moody. In the very short term, as
people have a drink, they might feel good temporarily, but overall, no,
we don't advocate for alcohol, and the scientific literature does
not support the use of alkhol in any way in
(40:10):
terms of brain health. But it is a big part
of society, so it exists and it's there. While in
the perfect world we wouldn't have alcohol, the evidence would
suggest that yes, it's neurotoxic and it's not beneficial for
brain health. But on the flip side, I think sometimes
having that conversation isn't going to lead to behavior change
where people completely stop drinking alcohol. So instead talking about
(40:34):
adverse effects short term and longer term can just help
people understand what's going on and what role elcol might
be playing.
Speaker 1 (40:40):
Yeah, I think that context is really important. Why is
exercise good for us? Like, how does that work? How
does that umpact the brain?
Speaker 2 (40:48):
So again it comes back to being important for heart
health and for our physical health and for our mental health.
So there are studies that show that exercise is almost
as beneficial as antidepressants for people have mood symptoms, and
so exercise can have a really big benefit at a
physiological level, just talking about blood flow and changes in
(41:11):
the brain, the endorphins, the chemicals that are released while
we're exercising, And I think people who regularly exercise can
feel those benefits, but I think for people who never exercise,
it is hard for people to start to incorporate exercise
in their life. So I think kind of starting small
and finding something that people are really comfortable as a
starting point is super important, otherwise it just won't happen.
Speaker 1 (41:35):
Yeah, I think again that context is so important.
Speaker 2 (41:37):
Right.
Speaker 1 (41:38):
I always laugh because I feel bad for the people
around me because I do my calistone next every morning
and I think, as do my calist next, my irisan
goes up, my BDNF goes up, which are all for
our listeners. Those are things that make your brain grow. Actually,
so pumping irons can make your brain grow. What should
people target? So any movement is good, any exercise is good,
(41:58):
but there should be a target that people look at
or can strive to at some point. What should that
target be in terms of cognitive health for midlife women?
Speaker 2 (42:08):
So I would say if people can work themselves up
to five thirty minute sessions a week with a mixture
of strength training and cardio based training, that would be ideal.
And also, really importantly, just finding an exercise that you
love so it becomes a passion and a habit is
really important.
Speaker 1 (42:27):
Yeah. And I think also it's important to realize too
that you know, you don't have to go to the gym.
You can do this in your house basically and doesn't
require that much time necessarily. In terms of nutrition, you
said the Mediterranean diet. Can you tell us a little
bit about the Mediterranean diet and are there any tweaks
for the Mediterranean diet for cognitive health? And do you
think as midlife women we need to shift and downshift
(42:48):
our carbs and increase our protein a little bit for
brain health as the metabolism and the brain changes.
Speaker 2 (42:54):
Yeah, so again there is a bit of literature about that.
Reducing carbs, increasing protein and longevity in terms of what
the Mediterranean diet is, making sure you have a lot
of you know, fresh fruits, fresh vegetables, not process foods.
Fish if you eat fish, and natural oils and nuts
(43:15):
are all really important. Increasing protein can be important for
brain health as well, and minimizing carbs. But making sure
that whatever you're eating is just minimizing the processed food
in terms of brain health, I think is the key message.
Speaker 1 (43:33):
And then in terms of socialization, you know, we counsel
our patients to socialize, right, but we live in a
disconnected world for many of us actually, with computers and
ordering grub hub and Amazon and you never have to
go outside, right, work at home. Do you have any
tips for people in terms of how to get a
more active social life. That's something I really think about
(43:55):
as I age. I want a sense of community, Like,
how do you advise your patients?
Speaker 2 (43:59):
Yeah, so I think again, I always take quite an
individualized approach, so talking to people about what their social
situation looks like, do they have friends that they see
physically and that they connect with. I agree that we
live in a very digital global world now, and what
social connection looks like now is quite different to what
it looks like a decade ago. But I think having
(44:21):
that sense of belonging, that sense of community is an
important part of people feeling like they're socially connected. So
for some people that is an online community where they
are connected, but as long as they're kind of real
people that they actually know and can share their stories
with and their day with and feel supported by that
(44:43):
person and someone that they can turn to when they
need to share bad news with and get support from
in a social sense, is really important. What are you.
Speaker 1 (44:52):
Most excited about with the future with specifically women's brain health.
Speaker 2 (44:58):
So I think while it is a time of vulnerability,
there can be lots of negative symptoms that people can
experience during perimenopause and postmenopausal years, I think it's also
a time of opportunity, and so if you can better
understand what's going on and how to optimize brains during
this time, it is potentially this huge window to ensuring
(45:20):
that women have much better opportunity to sort of minimize
the risks of cognitive decline later in life and maximize
the potential for having good brain health. And healthy brain aging.
And also I think there's been very little research that's
really properly been done in perimenopause and early perimenopause or years.
(45:41):
I think particularly that when we're talking about hormone therapy,
a lot of the work is done in menopause, postmenopause
or years, but we really don't know much in particularly
in terms of cognition and mental health in terms of perimenopause.
So I think uncovering that area is something that I'm
really excited to learn. What the future will hold.
Speaker 1 (46:01):
Yeah, I think we have to be super proactive, right,
I mean, I think that is the future of looking
at perimenopause or those late reproductive years as an opportunity
to really shore up health and really pay attention so
that we don't age passively, right and let things happen
to us, and we can be proactive. What are your
three take home tips for our listeners? What are three
(46:24):
actionable tips that you would give them to maintain the
best brain health possible.
Speaker 2 (46:29):
I would say the first one is just to be aware.
Be aware of what's happening at a hormone level. And
while you might not be having lots of menopause, symptoms.
If you're experiencing changes in your mental health and your
cognitive health or some cognitive symptoms, be aware that it
might be connected to your hormones. So I think if
people worried about cognitive symptoms or worried about the onset
(46:53):
of they think they might have dementia, to think about
this might not be that it might just be part
of a hormone transition period. Maybe this is the start
of perimenopause, and go and have a chat to a
health professional to see what can be done. So that
would tip number one is that awareness. Tip number two
is for women not to suffer in silence. Again, seeking
(47:16):
help is so important, having conversations with the right practitioner
who has an awareness of menopause and awareness of the
different symptoms that people can experience. And the third tip
would be just the practical lifestyle things that people can do,
and for people to know that their brains are constantly
(47:37):
changing and we're constantly building new pathways in our brains,
and there's so much we can do to build positive pathways,
and it's a time that people can really seek support
and get help and do their best to kind of
optimize their functioning and as much as possible thrive during
this phase of their life. And for some women that's
not at all what they're feeling. They might be listening
(47:59):
to this feeling like they're so far off thriving. But
I think knowing that there are pathways to help and
to support and to being able to be your best
version of yourself during this time of your life is
really important.
Speaker 1 (48:14):
I like to tell my patients, you know, at thirty five,
forty forty five, how you treat your body today is
really you're going to feel it when you're seventy or eighty,
so super important to set yourself up for success.
Speaker 2 (48:27):
To you the ball up correctly, Yeah, definitely.
Speaker 1 (48:29):
Thank you so much for joining me. This has been
such a real pleasure to speak with you. I really
look forward to following your work and hearing more from
you in the future.
Speaker 2 (48:38):
Thank you, Elizabeth. It's been absolute pleasure talking to you,
and I've really enjoyed the conversation.
Speaker 1 (48:49):
I see a lot of patients in my practice on
a day to day basis who are really concerned about
cognitive decline. I want people to really remember that brain
health is not a passive endeavor. Style can greatly impact
cognitive function. There's lots of data that estrogen protects the
brain and are more modern transdermal estrogens used in hormone
therapies today may be protective against cognitive decline in the future,
(49:13):
especially if you're at elevated risk based on your family history.
I'm grateful for Caroline and researchers like her who are
working to get us more data to help us to
better understand the science behind these issues. For the majority
of women, modern transdermal hormone support such as patches, gels,
and rings are safe if started prior to the age
(49:34):
of sixty or within ten years of your last menstrual period,
and for brain health sooner maybe even better. Speak to
a physician who's knowledgeable and truly engaged in midlife women's
health who can help you decide if menopausal hormone therapy
is an option worth exploring. Coming up on the next
(49:55):
episode of Decoding Women's Health, I'll speak to a world
renowned oncologist about how how you can minimize the likelihood
of developing certain types of cancer.
Speaker 2 (50:04):
As we sometimes say, genetics is not destiny. People need
to be really open minded about the value of genetic
testing and how it can help them mitigate their cancer risk.
Speaker 1 (50:15):
Decoding Women's Health is a production of Pushkin Industries and
the Atria Health and Research Institute. This episode was produced
by Rebecca Lee Douglas and Amy Gains McQuaid. It was
edited by Karen Chakerjie additional production support from Kate Furby,
mastering by Sarah Brigaire. Our executive producer is Alexandra Garreton.
(50:35):
Our theme song was composed by HANNS. Brown. Concept and
creative development by Shavan O'Connor. Special thanks to Vicki Marrick,
Jacob Goldstein, Kerrie Brodie, Alan Tish, David Saltzman, doctor David Dodick,
Theo Bidler, Sarah Nix, Eric Sandler, Morgan Rattner, Amy Hagadorn,
(50:57):
Owen Miller, Abigail Abrams, Sarah Begley, and Greta Cone. If
you have questions about women's health and midlife and want
expert advice, leave us a voicemail at four FI five
two oh one, three three eight five, or send us
a message at Decodingwomen's Health at Pushkin dot FM. I'm
(51:19):
doctor Elizabeth Pointer. Thanks for listening. Until next time,
Hey, listeners, I'm doctor Elizabeth Poynter, and I'm dropping into
your feed today to bring you a preview of my
new podcast, Decoding Women's Health. I hope you enjoy it,
and if you do, find Decoding Women's Health with Doctor
Elizabeth Pointer wherever you're listening. Now. Here's the thing about
(00:20):
women's health. We spend the first part of our lives
trying not to get pregnant. We spend the second part
of our lives for many of us, trying to get pregnant,
and then the third part of our lives we're kind
of forgotten about. And this is when we go through
some of our biggest changes. I learned myself the hard
way when I was forty three out of nowhere. I
became significantly depressed and anxious. I'd always been the kind
(00:44):
of person who woke up happy, motivated to face the day.
Suddenly I didn't feel joy anymore. I was consumed by
worry and my confidence was gone. At that time, I
was running a very large surgical practice, and let's face it,
nobody wants an anxious or press surgeon. I felt like
a different person and was totally confused by the whole thing.
(01:05):
I went to the medical literature looking for answers, but
I came up completely empty. I consider myself a pretty
well informed, well educated physician. I've trained at some of
the best institutions in the nation. I've specialized in gynecologic
oncology and surgery, and I've been the expert that news
outlets have turned to for insight.
Speaker 2 (01:25):
Please welcome doctor Elizabeth Poyner.
Speaker 1 (01:30):
I think that's very important that women understand that they
still needed you have their yearly annual consultaneous. One of
the most commonly prescribed rugs for diabetes can actually impact
a woman's survival when she's been diagnosed with ovarian cancer.
Was a pointer.
Speaker 2 (01:44):
Great to see you, Thank you so much.
Speaker 1 (01:49):
And yet I was still in the dark. It was
my mom who actually said to me, you know what,
it's probably your hormones. Turns out she was I was
going through perimenopause. Looking back at made perfect sense. I'd
always had mood changes around my period. Of course, then
the biggest hormonal shift in my life would affect my
(02:10):
mind and emotions. What's wild is that none of my doctors,
not my therapist, not a psychiatrist I had consulted for
this issue, not even my medical colleagues suggested perimenopause. Eventually
I figured out how to feel better, but the whole
experience served as a big wake up call for me.
(02:32):
So here's my question, where exactly is the information for us,
the women in the middle of our lives, to help
us make the best decisions about our health. I'm doctor
Elizabeth Poynter, and I've spent the past forty years working
in women's health. I'm the Chair of Women's Health and
Gynecology at the Atria Health Institute in New York City.
(02:55):
And here's what I've observed, both as a patient and
as a doctor. The information actually is out there, but
it's really hard to find. Sometimes you have to read
across subspecialties. You have to read the neurologic literature, the
cardiology literature, the endocrinology literature. It's dense research that's nearly
(03:17):
impossible to understand without a medical degree, and even most
doctors don't have time to do that. Now. Specialists live
in their own subspecialties and struggle to keep up in
OBGI and training programs. Even the top ones, there's maybe
at best one or two lectures on midlife women's health.
There's no textbook, there's no course, there's no focus on
(03:40):
women after their reproductive years, and that's why I'm making
this podcast, Decoding Women's Health, a new show from Pushkin
Industries and the Atria Health Institute that will elevate the
conversation about women's health and midlife and frankly challenge some
of the status quo information out there, because what I
(04:00):
want for everyone listening, for every patient, every doctor, and
every woman is to feel more informed when it comes
to our health women's health. On today's episode, how to
(04:22):
fluctuating hormones impact the brain, specifically for women in midlife.
Turns out a lot of cognitive changes can happen, and
it can be really frightening. Some women, like me, experience
intense mood shifts. Others may start to wonder if they've
developed ADHD or maybe even dementia, but what they're really
(04:43):
dealing with or temporary memory glitches. We'll talk about what's
going on with these cognitive disruptions, how to manage them
in the moment, and how women can be proactive about
maintaining sharp, healthy minds throughout their lifespans. I am thrilled
to be joined today by doctor Caroline Gervich. Caroline's work
(05:03):
caught my attention because she studies hormones and how the
brain changes through midlife. She's engaged in some really fascinating
research about brain fog, cognitive training, and ADHD. Caroline is
an Associate professor and clinical neuropsychologist. She is also the
Deputy director of the Her Center in Australia and head
of the Cognition and Hormones Group at Monesh University. There's
(05:27):
so much we don't understand about how the brain works,
but Caroline and her team are doing critical work examining
how hormones impact our cognitive health throughout our lives. Caroline,
thank you so much for joining us today and welcome
to the show.
Speaker 2 (05:40):
Thank you so much, doctor Poynter, It's absolute pleasure to
be here.
Speaker 1 (05:43):
Can you tell us what a neuropsychologist is actually?
Speaker 2 (05:46):
Yes, so, at a really basic level, it's brain psychology.
So the neuro is the brain bit and the psychology
is understanding a whole range of mental health symptoms. And
what we do as a profession is we do a
lot of assessments to better understand what different symptoms people
are presenting with. When it impacts brain, brain and behavior,
So that's the assessment side, But then neuropsychologists can also
(06:09):
work at an intervention side, So once we know what's
going on for someone, we can help them with education,
so understanding how a brain relates to our behavior, as
well as different kind of training processes to try and
improve or give people strategies to improve whatever difficulties their
experiencing with their cognition or their thinking skills.
Speaker 1 (06:29):
How did you get involved with this type of work?
Speaker 2 (06:31):
Yeah, so it wasn't that I, as a child always
wanted to be a neuropsychologist. I don't think I really
knew what a neuropsychologist was until I was well into
my training. It was more I didn't actually know what
I wanted to do. But I really love science, Like
I loved chemistry, I loved physiology and learning about the brain.
I was fascinated by how powerful our brains are and
(06:54):
how little we know about how we think. From there,
I started working in older age psychiatry and became interested
in menopause and how little we know about that midlife,
which is really when a lot of the brain changes
start happening, and we can either prepare ourselves as much
as we can for kind of healthy older aging or not.
But it's like this potential window of opportunity to kind
(07:16):
of take control and do what we can for preparing
ourselves for great cognitive aging.
Speaker 1 (07:22):
Can you tell me a little bit more about what
you mean taking control and prepare for aging.
Speaker 2 (07:27):
Yeah, So I think these menopause transition years are transitioning
from our reproductive phase of our life to our postmenopausal
years and our older adult years. So it's just a
great opportunity to reflect on the phase of life you're
at and know that there are so many things you
can do as an individual to promote good health. So
(07:49):
lots of physical exercise and lots of lifestyle factors, like
in terms of your diet, in terms of sleep, in
terms of being socially connected. So there are a lot
of things you can do as an individual to make
the most and to optimize whatever brain health you have.
Speaker 1 (08:06):
So you mentioned that there's a connection between menopause or
perimenopause and cognition. On a basic level, what's going on
in perimenopause and menopause.
Speaker 2 (08:16):
So, perimenopause is a time in a woman's life where
there's hormone changes, So we have fluctuations in one of
our estrogen called estradal, and gradually that hormone declines. Perimenopause
can span four to ten years, so it's not a
short time, it's many years in someone's life that there
are these hormone changes that are happening. Perimenopause can be
(08:40):
associated with a whole range of different symptoms. There can
be no symptoms for some women. There can be the
hallmark of menopause. I guess, the vasomotor symptoms, which are
hot flushes, night sweats. There's a number of women who
experience what is often referred to as as brain fog
in a colloquial way, which are cognitive symptoms that can
(09:00):
happen during perimenopausal years. And these symptoms can include word
finding difficulties, which is that words on the tip of
your tongue not being able to find the right word.
There can be forgetfulness. There can be higher level what
we call executive function symptoms, which is where people have
difficulty juggling lots of things, planning ahead, prioritizing, difficulties with
(09:24):
time management, and higher level organization type skills. So there
can be a whole range of different cognitive symptoms that
people can experience, and they're often subtle, but at a
day jay level or at an individual level, they can
have a really significant impact on people's lives.
Speaker 1 (09:42):
What percentage of women do you really think are going
through these cognitive changes?
Speaker 2 (09:49):
The literature would suggest about sixty percent, It depends on
their kind of community based studies, but about sixty Some
say closer to seventy percent. So somewhere in that vicinity
is the percentage of people who experience some degree of
cognitive symptoms. And I think it really varies. For some people,
it's quite subtle and it doesn't have a huge impact
(10:11):
on their life, but for other people it can be
quite significant.
Speaker 1 (10:14):
In your clinical practice, what kind of complaints to midlife
women come to you with or what are their main concerns.
Speaker 2 (10:21):
So there's often mood symptoms that are present, but not always,
but they tend to come and see me because they're
concerned that one they have dementia. That's one of the
probably the most common concerns that people have. And the
types of symptoms that people talk about is, you know,
I'm forgetting everything. I never used to forget things. I
used to be really efficient in my role, and now
(10:42):
it takes me so long to do things. So that's
one and the other one that's become more common in
recent years is do I have ADHD. I'm really struggling
to manage my time. I'm really struggling to prioritize, to plan,
to organize, to focus. So they're probably the two biggest
clinical questions that people present with. But the types of
(11:03):
symptoms that women present with are mood symptoms, forgetfulness, difficulties
with efficiency and time management and multitasking.
Speaker 1 (11:15):
What ages are you seeing this? You know, we talk
a lot about menopause and the final menstrual period, but
I've kind of noticed in my practice that patients really
present in that early perimenopause time where they might not
be having any menstrual irregularities or might not even know it.
What do you see in your practice.
Speaker 2 (11:31):
Exactly the same as quite early. It's often, as you say,
in the early forties, where they haven't really necessarily made
a connection that this might be the start of their
perimenopausal journey, and they're just concerned about their cognition, their
thinking skills, and it has this ripple effects, so they
start to become a bit concerned about their efficiency. Then
(11:51):
it impacts their self esteem, then they become a bit
more anxious. Then the anxiety in itself further impacts their
ability to perform in the moment. So it's this real
cycle for people. I've had patients who have sort of
had the conversation with their GP, but they haven't been
reassured that it might not be dementia. So then they've
(12:12):
gone ahead and contacted people like Dementia Australia like Big Foundations,
describe their symptoms, which can sound a little bit like
early stages of dementia over the phone, and then they've
been reassured that yes, it does sound like you might
have the early stages of dementia and they don't have
that at all, And they've started to go down that
pathway of putting, you know, financial things in place and
(12:33):
really preparing themselves for degenerative process, and that is not
what they've got at all. So I think it's really
important that people have a better understanding and follow the
right pathways of getting the right support.
Speaker 1 (12:45):
You know, a lot of times we go is dementia
or is it brain fog? Right, and it's like, well,
you know, demension packs your quality of life on a
day to day basis but I think brain fog probably does,
especially if you're in the workplace, which brings me into
how do you help women through the workplace and what
do you see? How are women impacted in their workplace
by some of these cognitive changes.
Speaker 2 (13:05):
I think people who are working in a job that
does require thinking on the spot speaking on the spot
is often the people I tend to see so high
functioning professional people because they really feel the subtle cognitive changes.
The word retrieval deficits have a really big impact at
a day to day level, and people get nervous about
(13:26):
public speaking, even if it's something they've always done, because
they're worried they'll experience a word finding difficulties. For some people,
it can be really problematic. And I've seen women who
have actually changed their work or drop back to part
time or left work altogether, which is really really sad
because they didn't really understand what was going on for them.
They didn't link it back to their hormones. They just
(13:47):
felt like they were no longer up to whatever their
job was, and so I think that's really devastating when
that's happened. If it's someone who wanted to stay in
the workforce, but because of their sort more subtle cognitive
symptoms and then the low on impact on self esteem
and then the increase in anxiety, chain of events has
led them to leaving the workplace, So it can be
really detrimental for some women, and then in broader workplace settings.
(14:13):
I mean, the key thing is just education, just knowing
that cognitive symptoms can be a part of the menopause
transition and there are lots of ways to manage it.
And I think the key factor for women to know
is that it's not an impact on intellectual capacity per se,
but they just might need a little bit of support
and a little bit of knowledge about the types of
symptoms that they might be experiencing and knowing that it
(14:34):
might be, you know, a couple of years where word
finding is not great or your learning efficiency isn't perfect,
but you'll get through, and you just need some practical
supports to get you through. So women don't feel like
they're no longer up to it, because that's not the case.
Speaker 1 (14:50):
I think that's really important, this whole concept of you know,
I can still function, I can still work where I
need to work, and be where I need to be
at the level I need to be at. We talk
about support structure and that type of thing. What are
you referring to.
Speaker 2 (15:03):
Just really practical things like people not shouting out, oh
can you do this in the corridor, just emailing it
to people so you've got things written down rather than
juggling things in your working memory if you're in meetings
or if you're in a consult with someone, to be
able to take notes or use some sort of recording
(15:24):
audio to take notes, so you're not again relying on
your working memory and your attention to hold and juggle
lots of pieces of information. If you feel like you're
forgetting a word, it's sometimes easy to say this is
hard to do this, but don't stress about it because
it makes it worse. So rather than trying to find
that word, trying to encourage people just to kind of
speak around the topic or just own it, say I
(15:45):
can't think of that word at the moment and move on,
and no one really cares too much. So I think
it's just about having some strategies at an individual level
in place to manage that. So, yeah, as I said,
the key one is really just reducing the demands on
where memory and the juggling and switching between lots of
different tasks, and for some people where it's executive function,
(16:06):
difficulties are about sort of time management and prioritization of tasks,
structuring your day so then you've got some time blocked
out for the last minute things each day in case
they pop up. But having some sort of increased structure
to your work date I think can be really helpful
for people as well.
Speaker 1 (16:27):
Coming up, what does ADHD really look like for women
in midlife? How can changes an astrogenmmic those symptoms, and
what does the scientist actually say about whether hormone therapy
can help not just with focus and memory, but maybe
even protecting our brains as we age. So that kind
(17:01):
of leads me into the kind of ADHD component of
your work, which I think is really interesting because I
consider myself a pretty educated physician. I'm curious, I read,
but I know nothing about ADHD and midlife women. Can
you unpack that a little bit for us and also
just tell us what ADHD really is?
Speaker 2 (17:19):
Yes, So, and the fact that you haven't read anything
about ADHD in midlife is because there's really very very
little published on the topic. So I think there's just
not much out there. But to come back to what
ADHD is, so attention deficit high peractivity disorder is what
ADHD stands for. In terms of the diagnostic criteria. You
(17:40):
can only now diagnosed ADHD in adults. So it's always
been considered and still is a neurodevelopmental condition. So it's
something that your brain is kind of born with and
you develop as a child. So it can be attention
deficit and or hyperactivity in attention and so it's the
(18:01):
sorts of symptoms that fall into that attention death set
are things like forgetfulness, difficulties focusing on things, and then
the high peractivity impulsivity is just a feeling of being
on the go all the time, that there's an emotion
inside you, a drive inside you, and you just need
to be busy and occupied. The stereotypical picture of ADHD
(18:23):
is often coming from that hyperactive symptom. You think of
the hyperactive little boy, and a lot of the diagnostic
criteria was kind of built around that. But as we're
learning more, we're seeing for menopausal women it tends to
be more of the inattention that can be undetected. I
think in a lot of people, particularly for women who
also you know might be really conscientious and hard working
(18:45):
and perfectionist type people that inattention and difficulty regulating and
organizing and structuring your day can often go unnoticed. But
coming back to your question about sort of the midlife
and the menopause connection to ADHD, we don't really know
exactly what's happening. So the theory is that during menopause,
(19:07):
when estrogen changes, it impacts dopamine and perhaps uncovers ADHD
that's always been there. I don't think we fully understand
whether it's an ADHD presentation appearing at menopause for the
first time. And for some people they've got a lot
of ADHD characteristics, but it's not something that was there
prior to the age of twelve, which is what we
(19:28):
need for our diagnostic criteria, that there's evidence that someone's
had this as a neurodevelopmental condition. So for some people,
they just present with characteristics of ADHD around menopause, but
for other people, they've had lots of support or kind
of scaffolding I guess, throughout their life, and when we
take a really good history, we can see that they
have had ADHD always and they've just hit a point
(19:51):
in menopause where they can no longer kind of mask
or cover up some of the symptoms that they've been experiencing.
And in our research as well, we've spoken to a
lot of women with ADHD. These are people who have
got or already have a diagnose of ADHD, but they
all report a worsening of symptoms at menopause, both other
menopausal symptoms as well as their ADHD symptoms. So there's
(20:12):
definitely a connection between menopause and ADHD. And we also
see a similar pattern across a menstrual cycle. So women
with ADHD report a worsening of their symptoms in that
luteal phase, the second half of their menstrual cycle, and
so there's clearly a hormonal factor that's driving these changes
in symptoms across menstrual cycle or during the perimenopausal years.
Speaker 1 (20:35):
You know, it's so interesting because, I mean, it's like
menopause and the hormonal fluctuations just uncover issues in the brain, right,
I mean, it's like psychiatric issues get worse at the
time of perimenopause and menopause, right, depression can go off
the rails. How much of this impact do you think
is due to estrogen and what is estrogen doing to
our brains?
Speaker 2 (20:54):
Yeah, I think we know the most about estrogen. I
think that's why we talk about it the most because
I think most of the research, most of the animal studies,
has been done looking at estrogen. But we know that
estrogen plays a neuroprotective role in the brains. We know
estrogen helps protect our brain against damage. So if there's
been some sort of insult to the brain, estrogen can
(21:14):
be really protective. And so we also know that there's
receptors that respond to estrogen in brain areas beyond reproductive function,
so in brain areas that are really relevant to mood
and to cognition, So the front part of our brain
really important for executive functions. We know that estrogen's interacting
or modulating a lot of our neurotransmitter pathways, so the
(21:36):
dopamine pathways that are important in ADHD but also important
in motivation, in drive, in regulating our attention. More broadly,
eachtrogen interacts with serotonin, which is really important for mood.
So we know that issian's playing a significant role in
our brain. And yes, most of this research is from
(21:56):
animal studies, but we kind of extend that extrapolate from
that and learn from that in terms of how estrogen
might be working human studies.
Speaker 1 (22:04):
Yeah, it's interesting, there's so much to explore when these
cognitive issues are occurring. What's actually going on. Estradyl is
the main estrogen that the over is produced for women,
and what is it doing during this time period where
cognitive issues may occur.
Speaker 2 (22:20):
So it's fluctuating, particularly during those early perimenopausal years, but
they're also gradually declining, and I think both of those
factors seem to be related to changes in cognition. So
if we think about what's actually going on, I think
there are receptors in our brain that respond to estradyl,
(22:40):
are used to being stimulated by estradyle, and suddenly there
it's on off, it's up down, and then it's gradually
those receptors are less stimulated by estradyl over the years.
So I think that that's the hormonal factors that are
underpinning the cognitive symptoms. But I think there are often
lots of other pieces of the puzzles. So I think,
(23:00):
you know, while people can experience brain fog or cognitive
symptoms as a sole symptom of menopause, more often than not,
it's not the case, there's often other symptoms going on,
so I always think of the cognitive symptoms a little
bit like the tip of the iceberg. There's always things
underpinning that. So I think when we're talking about menopause,
we're talking about hormone changes as being a significant contributing factor,
(23:22):
but also talking about, you know, vasomotor symptoms. So there's
studies that show that these can also have an impact
on brain, on factors in the brain that might then
have flow and effects to cognition. They also can impact sleep,
So sleep and a lack of sleep or impaired disruptive
sleep for anyone at any point in your life can
(23:43):
impact your cognition and lead to feeling a bit foggy
and those kind of cognitive symptoms. And then we've talked
a bit about mood that can be another contributing factor
to cognitive symptoms. And some people during menopause might be
experiencing pain joint pain and pain can have cognitive symptoms.
So I think there can be lots of factors that
(24:04):
are underlying the presentation of cognitive symptoms, and I definitely
think hormones are playing a significant role that I think
it's important to consider the whole person and everything that's
going on for them. And the other point is that
menopause often coincides with a really busy time in a
lot of people's lives or often at you know, the
(24:26):
busy time in your career, and elderly parents, potentially teenage
children managing households, like there's often just a lot going on.
So I think there's that as well, the fact that
people are often just stretched and stressed because they're so busy,
and so I think all of those factors are really
important to consider when we think about what's underpinning cognitive symptoms.
(24:47):
But I think, you know, when we're talking about perimenopause,
we're obviously talking about hormone changes, and hormone changes in
and of themselves might be enough to drive cognitive symptoms,
but I just think it's important to consider the whole
picture as well.
Speaker 1 (25:00):
Yeah, it's kind of a perfect storm, right. I mean,
you might be going through significant life changes, whether it's
your job, your family, your partner, and then you put
on this pressured physiology. I think what a lot of
people don't realize there's estrogen receptors throughout the body that
are active through the entire body. You talk about pain,
joint pain, sleep disruption. You know, the holistic approach is
(25:23):
always or that entire body approach is always so interesting
in helping women and negotiating those hormone fluctuations. So that
leads me into what I consider the million dollar question
right in terms of in terms of hormone therapy, in
terms of hormonal support for women going through these transitions,
for even just the cognitive issues around the time of
(25:45):
early perimenopuzzle transition or late perimen and puzzle transition, and
then for dementia prevention. You know, professional societies don't recommend
hormone therapy for dementia prevention or treatment or brain fog.
But do you think that there's any role for if
somebody is very distressed and it's really impacting their quality
of life, maybe starting estrogen at this time, for adding
a little bit of lotus hormone support for them, or
(26:06):
what are your thoughts about that?
Speaker 2 (26:07):
So I have seen plenty of women at an individual
level who have shown a huge benefit from the right
combination of hormones optimization or hormone therapy. So yes, I
know that professional guidelines don't recommend or advocate for using
hormone therapy for either cognitive symptoms or as you say,
prevention of later life cognitive decline. But I think at
(26:29):
an individual level, I always tell people go and chat
to your health professional who's working with you in terms
of menopause. Chat to them about different options for hormone
therapy because I have seen so many women who have
been transformed in a beneficial way because of the right
combination of hormones.
Speaker 1 (26:45):
Why has it been contentious the treatment of cognitive issues
or dementia prevention with estrogen.
Speaker 2 (26:53):
Decades ago, it was kind of accepted and thought that
menopausal hormone therapy or HRT hormone support was helpful for
reducing dementia risk from a lot of observational studies, and
then the Women's Health Initiative came along. The largest randomized
control trial that was early two thousands, and the results
(27:16):
showed that it was associated with an increase in dementia risk. However,
there has been a lot of debate, a lot of discussion,
and a lot of issues with that study. So probably
the two key ones in terms of dementia risk was one.
All the participants in that study were all on average
over the age of sixty five and more than ten
years postmenopause, so a lot of them initiated hormones not
(27:41):
close to going through the menopause transition years. So that
was one factor, and the other factor was the types
of hormones that we use in that particular study were
potentially less beneficial for brain health and for cognition. And
so when that study came out, I think it just
scared a lot of people, and since then there have
been not enough studies to start to build a more
(28:02):
balanced evidence base. There was a meta analysis that was
published last year and that showed that if hormone therapy
was initiated close to menopause, then it was associated with
a reduced risk of developing dementia later in life, particularly
estrogen only hormone therapy.
Speaker 1 (28:20):
Yeah, I think that what we call it the critical
window hypothesis, right, that if you get estrogen support or
have estrogen support within the first few years of menopause,
you may get some protection.
Speaker 2 (28:33):
So I think the two key factors are that critical
window hypothesis or theory that we have to use estrogen
therapy very close to menopause to see benefits. But yes,
if it's not initiated during that time and initiated you know,
more than ten years postmenopause. Yes, it might be harmful.
And I think the other factor is thinking about the
(28:54):
type of estrogen in terms of brain health and progesterone
progestine that might be most helpful for brain health.
Speaker 1 (29:01):
And what do you think the answer to this is
in terms of getting the data? I mean, are we
going to have to settle for lesser data, are we
going to have to look for what we call biomarkers
or what is the answer to this? Because you and
I have both said that we see people who do
improve actually and there is compelling data that's out there
about prevention of dementia and treatment of cognitive issues. What
(29:24):
do you think the answer is?
Speaker 2 (29:25):
We probably need a combination of things. I don't think
there's one specific trial that's going to give us the
perfect answer to that question. And when we're talking about
something like dementia, you're talking about a thirty year period
from when the pathology begins in the brain to when
the symptoms might manifest or twenty to thirty years, So
that's a really long time frame. And so I think
(29:47):
there's two questions. One is does hormone therapy help in
the short term for people with cognitive symptoms in the
moment when they're going through perimenopausal transition years. And does
hormone therapy help people in the earth postmenopausal years if
they've still got cognitive symptoms, And then what are the
flow and effects twenty years down the track? Is there
a change in risk for developing neurodegenerative processes lack dementia?
(30:12):
And so I think we just need to keep doing
more research and keep putting the pieces of puzzles together,
keeping the research flowing so we can gradually build on
it and learn more.
Speaker 1 (30:24):
Just the other day, I was talking with a patient
who started hormone support for something completely unrelated to cognitive health.
When I asked how she was feeling, she said, you
know what, My brain fog got better. I can think
more clearly now. We haven't even spoken about brain fog
before that. And it's remarkable how quickly these changes can
take effect. When I started on hormone therapy after I
(30:45):
finally figured out I was in perimenopause, it only took
about two weeks before my mood started to improve and
I started to feel like my old self again. Now
that's not to say that hormone therapy is a cureole
for every perimenopausal symptom, but for many women can play
a really important role in feeling better. Coming up, doctor
Gervit and I discuss some additional tools to support your
(31:07):
cognitive help from brain training exercises to lifestyle changes. Decoding
women's health will be right back. You know, we've spoken
(31:37):
about kind of you know, what happens to the brain,
and hormone support may be helpful, but talk to me
about cognitive training, cognitive reserve and what are those concepts
and how do they help women.
Speaker 2 (31:50):
Yeah, I think in the absence of anything that's currently
clearly indicated that people can take for cognition, I think
it's important to think about what else can we do.
And I think there's definitely a role for hormonal support
or hormonal therapy that needs to be explored in a
lot more detail. But as you said, our brains keep
(32:10):
changing depending on how we stimulate them and which pathways
we're using and encouraging and growing, and so there is
room to retrain our brains and to get better at
different things all the time. And so we did a
review initially of cognitive training in midlife. So we're talking
about cognitive training to boost cognitive functions broadly in everyone
(32:31):
in the midlife. And then from there, we specifically tried
to focus on the few studies that had either reported
the results of females specifically or had looked specifically at menopause,
and so to just kind of pull out what we
found in menopause. The most beneficial areas were to use
a strategy based training, So that's teaching people new strategies
(32:54):
to approach difficulties that they're having or to enhance or
optimize their cognitive for fight performance. Psycho Education like explaining
to people what's going on can be really helpful as
a component of cognitive training. And so now we're taking
this and we're building cognitive training programs for women with
(33:14):
whatever mental health type symptoms they might be experiencing and
cognitive symptoms combined without or just cognitive symptoms on their own.
So giving people education about what we're talking about the
role of hormones, other symptoms, how all those things work together,
how cognition works. People knowing that you have capacity to
(33:34):
improve and optimize your cognitive functioning, So giving people that
piece of knowledge and that understanding can be really helpful.
And then training, So when we talk about training, some
people I think probably think of computerized cognitive training or
brain training, where you repeat one task over and over
again and people get really good at that task. But
most of the research shows that that doesn't necessarily generalize
(33:56):
to day day life. So you just get really good
at that one task or maybe similar tasks. But what
we want people to do is get better at thinking
and optimizing all of their cognitive skills. So by using
strategies to help reduce your mental load, writing lists, breaking
down tasks, prioritizing tasks, completing one thing at a time,
(34:19):
teaching people to really focus their attention and actively attend
to whatever task they want to do, can also really
improve your capacity to learn and encode that information. Teaching
people that when they want to learn a new piece
of information, if you can sort of paraphrase it and
now ask questions about it, it encodes it in a
deeper level. So just teaching people about how memory works,
(34:41):
and how encoding works, and how attention works, and giving
people strategies to improve and optimize all of those different
thinking skills, that's the kind of cognitive training that seems
to be the most beneficial, and then we also talk
about lifestyle factors that might be helpful to again optimize
brain health. And optimize is cognitive health.
Speaker 1 (35:01):
So one of my midlife friends wants to know, is
wordle a form of cognitive training. We suspect not. We
suspect that you need to do more than wordle.
Speaker 2 (35:13):
More than wordle, but wordle is better than nothing, so
I think, And if you love wordle, there's no reason
not to do word all. So I think anything that
stimulates your brain in a new way is a good
thing for your brain. Doesn't mean it will necessarily generalize
to lots of different areas, but I think if you're
enjoying it, go for it.
Speaker 1 (35:32):
Tell us what kind of nutrition do you recommend, what
kind of exercise, and why this stuff works? You know,
I always love the context of why something works because
I think it helps me understand it better. It helps
my patience understand why it's so important.
Speaker 2 (35:47):
So the lifestyle recommendations for cognitive health are exactly the
same as the lifestyle recommendations for brain health, which are
the same as the lifestyle recommendations for heart health. So
I feel like everyone is on the same page. That
people need to do their best to exercise and to
eat well, and to make sure they can optimize their sleep,
(36:08):
minimize their stress, maintain social connections. So all of those
things are really important. My personal motto when I see
people is just for people to try their best. So
I just think for people at an individual level to
find a type of exercise that they enjoy and then
to keep building on that. And you know, the guidelines
would suggest that you have both strength based training as
(36:31):
well as cardio and you kind of mix it all up.
But I just think a little bit of exercise is
better than nothing. So whatever people can do to exercise
is going to help people's mental health and their brain
health and their cognitive health. In terms of nutrition, it's
about people working toward the best diet they can in
their lives, and you know, minimizing process food and trying
(36:53):
to build up a healthy, balanced diet is the most
important thing. But if they want to adopt the diet
that has the best evidence based for cognitive health and
longevity in terms of brain health, it's the Mediterranean diet.
In terms of sleep, and it's often hard to do this,
but people shouldn't put up with bad sleep. They should
speak to their physicians whoever they're working with about different
(37:15):
sleep interventions. But there's a lot of evidence for CBT,
so cognitive behavioral therapy I so CBT for insomnia, and
there are free programs online that people can log in
and do four to six sessions and this can really
help some people with their sleep. So I think encouraging
people to maximize their sleep, their diet, their exercise, for
(37:38):
people to engage socially. There's a lot of evidence that's
emerged to show the importance of social connections and the
negative effects of being lonely, so in terms of mental health,
in terms of cognitive health. So encouraging people to prioritize
socializing because it's fun, it's nice, and it also protects
(37:59):
your brain and your mental health later in life, so
that's also important. And then minimizing stress. So there's a
lot of evidence for meditation being beneficial for brain health,
for cognition in the short term and the long term.
So if people can incorporate some type of meditation, and
you know, meditation isn't for everyone. Some people need to
(38:20):
do more of like a mindfulness based practice where you're
just present in whatever you're doing, so it might be
movement based. Some people talk about being mindful while they're surfing,
or mindful while they're walking, or mindful while they're doing yoga.
It's just kind of being present and it might not be,
you know, exactly a meditation practice, but some form of
(38:41):
mindfulness embedded in people's lives is really important to help
minimize stress, and it can also have flow and effects
to promoting brain health. So in terms of lifestyle factors,
they're kind of the key ones. And also talking to people,
particularly in midlife about minimizing alcohol. There's a lot of
negative effects from excessive drinking. A lot of people do
(39:02):
turn to alcohol as a short term coping strategy, and
so it's important that people understand that alcohol can have
lots of negative effects on the brain if people use
alcohol excessively. So we often have a conversation about how
much alcohol people are drinking and what that might be
doing to their brain health in the long term as well.
Speaker 1 (39:23):
So I'm going to go backwards. I'm going to go
back and touch on each one of those again in
a little bit more detail. But I want to start
with alcohol because that's a big one, right and also
thing is really important to realize too that alcohol is
to sleep disruption and can worsen there's a motor symptoms
or heart flashes. Do you think that there is any
level of I mean, I think of alcoholics and neurotoxin.
So do you think that there is any level of
(39:44):
alcohol which is safe for women to consume in terms
of cognitive health.
Speaker 2 (39:50):
Yeah, so I think overall there's no real benefits of
alcohol in terms of brain health, in terms of sleep,
in terms of moody. In the very short term, as
people have a drink, they might feel good temporarily, but overall, no,
we don't advocate for alcohol, and the scientific literature does
not support the use of alkhol in any way in
(40:10):
terms of brain health. But it is a big part
of society, so it exists and it's there. While in
the perfect world we wouldn't have alcohol, the evidence would
suggest that yes, it's neurotoxic and it's not beneficial for
brain health. But on the flip side, I think sometimes
having that conversation isn't going to lead to behavior change
where people completely stop drinking alcohol. So instead talking about
(40:34):
adverse effects short term and longer term can just help
people understand what's going on and what role elcol might
be playing.
Speaker 1 (40:40):
Yeah, I think that context is really important. Why is
exercise good for us? Like, how does that work? How
does that umpact the brain?
Speaker 2 (40:48):
So again it comes back to being important for heart
health and for our physical health and for our mental health.
So there are studies that show that exercise is almost
as beneficial as antidepressants for people have mood symptoms, and
so exercise can have a really big benefit at a
physiological level, just talking about blood flow and changes in
(41:11):
the brain, the endorphins, the chemicals that are released while
we're exercising, And I think people who regularly exercise can
feel those benefits, but I think for people who never exercise,
it is hard for people to start to incorporate exercise
in their life. So I think kind of starting small
and finding something that people are really comfortable as a
starting point is super important, otherwise it just won't happen.
Speaker 1 (41:35):
Yeah, I think again that context is so important.
Speaker 2 (41:37):
Right.
Speaker 1 (41:38):
I always laugh because I feel bad for the people
around me because I do my calistone next every morning
and I think, as do my calist next, my irisan
goes up, my BDNF goes up, which are all for
our listeners. Those are things that make your brain grow. Actually,
so pumping irons can make your brain grow. What should
people target? So any movement is good, any exercise is good,
(41:58):
but there should be a target that people look at
or can strive to at some point. What should that
target be in terms of cognitive health for midlife women?
Speaker 2 (42:08):
So I would say if people can work themselves up
to five thirty minute sessions a week with a mixture
of strength training and cardio based training, that would be ideal.
And also, really importantly, just finding an exercise that you
love so it becomes a passion and a habit is
really important.
Speaker 1 (42:27):
Yeah. And I think also it's important to realize too
that you know, you don't have to go to the gym.
You can do this in your house basically and doesn't
require that much time necessarily. In terms of nutrition, you
said the Mediterranean diet. Can you tell us a little
bit about the Mediterranean diet and are there any tweaks
for the Mediterranean diet for cognitive health? And do you
think as midlife women we need to shift and downshift
(42:48):
our carbs and increase our protein a little bit for
brain health as the metabolism and the brain changes.
Speaker 2 (42:54):
Yeah, so again there is a bit of literature about that.
Reducing carbs, increasing protein and longevity in terms of what
the Mediterranean diet is, making sure you have a lot
of you know, fresh fruits, fresh vegetables, not process foods.
Fish if you eat fish, and natural oils and nuts
(43:15):
are all really important. Increasing protein can be important for
brain health as well, and minimizing carbs. But making sure
that whatever you're eating is just minimizing the processed food
in terms of brain health, I think is the key message.
Speaker 1 (43:33):
And then in terms of socialization, you know, we counsel
our patients to socialize, right, but we live in a
disconnected world for many of us actually, with computers and
ordering grub hub and Amazon and you never have to
go outside, right, work at home. Do you have any
tips for people in terms of how to get a
more active social life. That's something I really think about
(43:55):
as I age. I want a sense of community, Like,
how do you advise your patients?
Speaker 2 (43:59):
Yeah, so I think again, I always take quite an
individualized approach, so talking to people about what their social
situation looks like, do they have friends that they see
physically and that they connect with. I agree that we
live in a very digital global world now, and what
social connection looks like now is quite different to what
it looks like a decade ago. But I think having
(44:21):
that sense of belonging, that sense of community is an
important part of people feeling like they're socially connected. So
for some people that is an online community where they
are connected, but as long as they're kind of real
people that they actually know and can share their stories
with and their day with and feel supported by that
(44:43):
person and someone that they can turn to when they
need to share bad news with and get support from
in a social sense, is really important. What are you.
Speaker 1 (44:52):
Most excited about with the future with specifically women's brain health.
Speaker 2 (44:58):
So I think while it is a time of vulnerability,
there can be lots of negative symptoms that people can
experience during perimenopause and postmenopausal years, I think it's also
a time of opportunity, and so if you can better
understand what's going on and how to optimize brains during
this time, it is potentially this huge window to ensuring
(45:20):
that women have much better opportunity to sort of minimize
the risks of cognitive decline later in life and maximize
the potential for having good brain health. And healthy brain aging.
And also I think there's been very little research that's
really properly been done in perimenopause and early perimenopause or years.
(45:41):
I think particularly that when we're talking about hormone therapy,
a lot of the work is done in menopause, postmenopause
or years, but we really don't know much in particularly
in terms of cognition and mental health in terms of perimenopause.
So I think uncovering that area is something that I'm
really excited to learn. What the future will hold.
Speaker 1 (46:01):
Yeah, I think we have to be super proactive, right,
I mean, I think that is the future of looking
at perimenopause or those late reproductive years as an opportunity
to really shore up health and really pay attention so
that we don't age passively, right and let things happen
to us, and we can be proactive. What are your
three take home tips for our listeners? What are three
(46:24):
actionable tips that you would give them to maintain the
best brain health possible.
Speaker 2 (46:29):
I would say the first one is just to be aware.
Be aware of what's happening at a hormone level. And
while you might not be having lots of menopause, symptoms.
If you're experiencing changes in your mental health and your
cognitive health or some cognitive symptoms, be aware that it
might be connected to your hormones. So I think if
people worried about cognitive symptoms or worried about the onset
(46:53):
of they think they might have dementia, to think about
this might not be that it might just be part
of a hormone transition period. Maybe this is the start
of perimenopause, and go and have a chat to a
health professional to see what can be done. So that
would tip number one is that awareness. Tip number two
is for women not to suffer in silence. Again, seeking
(47:16):
help is so important, having conversations with the right practitioner
who has an awareness of menopause and awareness of the
different symptoms that people can experience. And the third tip
would be just the practical lifestyle things that people can do,
and for people to know that their brains are constantly
(47:37):
changing and we're constantly building new pathways in our brains,
and there's so much we can do to build positive pathways,
and it's a time that people can really seek support
and get help and do their best to kind of
optimize their functioning and as much as possible thrive during
this phase of their life. And for some women that's
not at all what they're feeling. They might be listening
(47:59):
to this feeling like they're so far off thriving. But
I think knowing that there are pathways to help and
to support and to being able to be your best
version of yourself during this time of your life is
really important.
Speaker 1 (48:14):
I like to tell my patients, you know, at thirty five,
forty forty five, how you treat your body today is
really you're going to feel it when you're seventy or eighty,
so super important to set yourself up for success.
Speaker 2 (48:27):
To you the ball up correctly, Yeah, definitely.
Speaker 1 (48:29):
Thank you so much for joining me. This has been
such a real pleasure to speak with you. I really
look forward to following your work and hearing more from
you in the future.
Speaker 2 (48:38):
Thank you, Elizabeth. It's been absolute pleasure talking to you,
and I've really enjoyed the conversation.
Speaker 1 (48:49):
I see a lot of patients in my practice on
a day to day basis who are really concerned about
cognitive decline. I want people to really remember that brain
health is not a passive endeavor. Style can greatly impact
cognitive function. There's lots of data that estrogen protects the
brain and are more modern transdermal estrogens used in hormone
therapies today may be protective against cognitive decline in the future,
(49:13):
especially if you're at elevated risk based on your family history.
I'm grateful for Caroline and researchers like her who are
working to get us more data to help us to
better understand the science behind these issues. For the majority
of women, modern transdermal hormone support such as patches, gels,
and rings are safe if started prior to the age
(49:34):
of sixty or within ten years of your last menstrual period,
and for brain health sooner maybe even better. Speak to
a physician who's knowledgeable and truly engaged in midlife women's
health who can help you decide if menopausal hormone therapy
is an option worth exploring. Coming up on the next
(49:55):
episode of Decoding Women's Health, I'll speak to a world
renowned oncologist about how how you can minimize the likelihood
of developing certain types of cancer.
Speaker 2 (50:04):
As we sometimes say, genetics is not destiny. People need
to be really open minded about the value of genetic
testing and how it can help them mitigate their cancer risk.
Speaker 1 (50:15):
Decoding Women's Health is a production of Pushkin Industries and
the Atria Health and Research Institute. This episode was produced
by Rebecca Lee Douglas and Amy Gains McQuaid. It was
edited by Karen Chakerjie additional production support from Kate Furby,
mastering by Sarah Brigaire. Our executive producer is Alexandra Garreton.
(50:35):
Our theme song was composed by HANNS. Brown. Concept and
creative development by Shavan O'Connor. Special thanks to Vicki Marrick,
Jacob Goldstein, Kerrie Brodie, Alan Tish, David Saltzman, doctor David Dodick,
Theo Bidler, Sarah Nix, Eric Sandler, Morgan Rattner, Amy Hagadorn,
(50:57):
Owen Miller, Abigail Abrams, Sarah Begley, and Greta Cone. If
you have questions about women's health and midlife and want
expert advice, leave us a voicemail at four FI five
two oh one, three three eight five, or send us
a message at Decodingwomen's Health at Pushkin dot FM. I'm
(51:19):
doctor Elizabeth Pointer. Thanks for listening. Until next time,
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