October 7, 2025 • 51 mins
Many women experience brain fog, forgetfulness, and sudden mood changes during midlife. Are these symptoms signs of dementia, ADHD, or are they simply our hormones at work? Dr. Elizabeth 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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Speaker 1 (00:17):
Pushkin. Here's the thing about 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
(00:37):
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 of person who woke up happy,
motivated to face the day. Suddenly I didn't feel joy anymore.
(00:58):
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 depressed surgeon.
I felt like a different person and was totally confused
by the whole thing. I went to the medical literature
looking for answers, but I came up completely empty. I
(01:18):
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 (01:32):
Please welcome doctor Elizabeth Point.
Speaker 1 (01:37):
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 dugs for diabetes can actually impact
a woman's survival when she's been diagnosed with ovarian cancer.
Actor was a pointer. Great to see you, Thank you
so much, and yet I was still in the dark.
(01:59):
It was my mom who actually said to me, you
know what, it's probably your hormones. Turns out she was right.
I was going through perimenopause. Looking back at me perfect sense.
I'd always had mood changes around my period. Of course,
then the biggest hormonal shift in my life would affect
my mind and emotions. What's wild is that none of
(02:22):
my doctors, not my therapist, not a psychiatrist I had
consulted for this issue, not even my medical colleague suggested perimenopause.
Eventually I figured out how to feel better, but the
whole experience served as a big wake up call for me.
So here's my question, where exactly is the information for us,
(02:45):
the women in the middle of our lives, to help
us make the best decisions about our health. I'm doctor
Elizabeth Pointer, 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.
And here's what I've observed, both as a patient and
as a doctor. The information actually is out there, but
(03:09):
it's really hard to find some time times. 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 impossible to understand without a medical degree, and even
most doctors don't have time to do that. Now. Specialists
(03:32):
live in their own subspecialties and struggle to keep up
in OBGI. In 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
women after their reproductive years. And that's why I'm making
this podcast, Decoding Women's Health, a new show from Pushkin
(03:56):
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
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
(04:29):
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
(04:50):
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
(05:11):
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 Monash University. There's
(05:34):
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 (05:48):
Thank you so much, doctor Pointer. It's absolute pleasure to
be here.
Speaker 1 (05:51):
Can you tell us what a neuropsychologist is actually?
Speaker 3 (05:54):
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 entering with when it impacts brain, brain and behavior.
So that's the assessment side, but then neuropsychologists can also
(06:17):
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 (06:36):
How did you get involved with this type of work.
Speaker 3 (06:38):
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 that I really loved science like
I loved chemistry. I loved physiology and learning about the brain.
I was fascinated by how powerful our brains are and
(07:02):
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
(07:24):
of take control and do what we can for preparing
ourselves for great cognitive aging.
Speaker 1 (07:29):
Can you tell me a little bit more about what
you mean taking control and prepare for aging.
Speaker 2 (07:34):
Yeah?
Speaker 3 (07:35):
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 lots
(07:57):
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 (08:14):
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 3 (08:24):
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 estra dial 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
(08:47):
be 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 here cognitive symptoms that
(09:08):
can happen during perimenopause or 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,
(09:30):
difficulties with 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 (09:50):
What percentage of women do you really think are going
through these cognitive changes.
Speaker 3 (09:56):
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.
Speaker 2 (10:14):
And I think it really varies.
Speaker 3 (10:15):
For some people, it's quite subtle and it doesn't have
a huge impact on their life, but for other people
it can be quite significant.
Speaker 1 (10:22):
In your clinical practice, what kind of complaints to midlife
women come to you with or what are their main concerns.
Speaker 3 (10:28):
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
(10:49):
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.
Speaker 2 (11:03):
To focus.
Speaker 3 (11:05):
So they're probably the two biggest clinical questions that people
present with. But the types of symptoms that women present
with mood symptoms, forgetfulness, difficulties with efficiency.
Speaker 2 (11:18):
And time management and multitasking.
Speaker 1 (11:22):
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 (11:39):
Exactly the same. It's quite early.
Speaker 3 (11:40):
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 it impacts their self esteem,
Then they become a bit more anxious than the anxiety
(12:03):
in itself further impacts their ability to perform in the moment.
Speaker 2 (12:09):
So it's this real cycle for people.
Speaker 3 (12:12):
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 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
(12:33):
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 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 (12:53):
You know, a lot of times we go is dementia
or is it brain fog? Right, and it's like, well,
you know, demension impacks 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 chains.
Speaker 3 (13:12):
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
(13:33):
about 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.
(13:54):
They just 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 more subtle
cognitive symptoms and then the flow 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
(14:19):
workplace settings, 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
(14:40):
knowing that it might be you know, a couple of
years where word finding's 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 (14:57):
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. When you
talk about support structure and that type of thing, what
are you referring to.
Speaker 3 (15:11):
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
(15:32):
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
(15:53):
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
working memory and the juggling and switching between lots of
different tasks.
Speaker 2 (16:11):
And for some people where it's.
Speaker 3 (16:13):
Executive function, 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 (16:34):
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
(17:08):
of leads me into the kind of adhd D 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 (17:26):
Yes?
Speaker 3 (17:27):
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.
Speaker 2 (17:45):
In terms of the diagnostic criteria.
Speaker 3 (17:48):
You 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. So it's that
(18:08):
the sorts of symptoms that fall into that attention D
are things like forgetfulness, difficulties focusing on things, and then
their 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
(18:31):
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, but particularly for women
who also you might be really conscientious and hard working
(18:53):
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,
(19:15):
when eastern 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
(19:35):
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
(19:58):
in menopause where they can no longer kind of mask
or cover up some of the symptoms that they've been experiencing.
Speaker 2 (20:05):
And in our research as.
Speaker 3 (20:06):
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 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
(20:29):
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 (20:43):
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 3 (21:01):
Yeah?
Speaker 2 (21:02):
I think we know the most about estrogen.
Speaker 3 (21:05):
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 be really protective. And so we also know
(21:25):
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 dopamine pathways that are important in ADHD but
(21:47):
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 animal studies, but we kind of extend that,
extrapolate from that and learn from that in terms of
(22:08):
how estrogen might be working in human study.
Speaker 1 (22:11):
Yeah, it's interesting, there's so much to explore when these
cognitive issues are occurring. What's actually going on. Estradiyl 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 3 (22:27):
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,
(22:48):
are used to being stimulated by estradyl, 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.
Speaker 2 (23:04):
But I think there are often lots of other pieces
of the puzzle.
Speaker 3 (23:07):
So I think, you know, while people can experience brainvog
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.
Speaker 2 (23:22):
There's always things underpinning that.
Speaker 3 (23:24):
So I think when we're talking about menopause, we're talking
about hormone changes as being a significant contributing factor, 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
on effects to cognition. They also can impact sleep, so
(23:45):
sleep and a lack of sleep or impaired disruptive sleep
for anyone at any point in your life can 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
(24:05):
pain joint pain and pain can have cognitive symptoms. So
I think there can be lots of actors that 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
(24:27):
often coincides with a really busy time in a lot
of people's lives or often at you know, the 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
(24:50):
important to consider when we think about what's underpinning cognitive symptoms.
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 (25:08):
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 this. 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
(25:31):
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
(25:53):
early perimenopuzzle transition or late perimen a 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 lotos hormone support for them, or
(26:13):
what are your thoughts about that?
Speaker 3 (26:15):
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
(26:36):
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 (26:53):
Why has it been contentious the treatment of cognitive issues
or dementia prevention with estrogen.
Speaker 3 (27:01):
Decades ago, it was kind of accepted and thought that
menopausal hormone therapy or HRT or hormone support was helpful
for reducing dementia ris 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
(27:23):
results 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.
Speaker 2 (27:34):
So probably the.
Speaker 3 (27:35):
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
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
(27:57):
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
balanced evidence. 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
(28:22):
reduced risk of developing dementia later in life, particularly estrogen
only hormone therapy. Yeah.
Speaker 1 (28:28):
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 3 (28:41):
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
(29:02):
type of estrogen in terms of brain health and progesterone
progestine that might be most helpful for brain health.
Speaker 1 (29:08):
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
(29:31):
do you think the answer is?
Speaker 2 (29:32):
We probably need a combination of things.
Speaker 3 (29:34):
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.
Speaker 2 (29:53):
And so I think there's two questions.
Speaker 3 (29:56):
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 early postmenopausal years if they've still got
cognitive symptoms.
Speaker 2 (30:10):
And then what the flow and effects.
Speaker 3 (30:11):
Twenty years down the track, is there a change in
risk for developing neurodegenerative processes lack dementia 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 (30:31):
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
(30:53):
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 it can
play a really important role in feeling better. Coming up,
doctor Gervirich and I discussed some additional tools to support
(31:14):
your cognitive help from brain training, exercises to lifestyle changes,
decoding women's health will be right back. You know, we've
(31:44):
spoken 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 3 (31:58):
Yeah, I think in the absence of anything that's currently
clearly indicated that people can take for cognition, I think
it's really 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
(32:18):
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
(32:38):
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
(33:01):
to approach difficulties that they're having or to enhance or
optimize their cognitive 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 whatever mental
(33:23):
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
improve and optimize your cognitive functioning, So giving people that
(33:45):
piece of knowledge and that understanding can be really helpful.
Speaker 2 (33:48):
And then training.
Speaker 3 (33:50):
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 to day day life.
So you just get really good at that one task
or maybe similar tasks. But what we want people to
(34:11):
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, teaching people to really
focus their attention and actively attend to whatever tasks they
(34:31):
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, and how encoding works, and
how attention works, and giving people strategies to improve and
(34:53):
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 cognitive health.
Speaker 1 (35:08):
So one of my midlife friends wants to know, is
word all a form of cognitive training? We suspect not
we suspect that you need to do more than wordle.
Speaker 3 (35:21):
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 (35:39):
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 3 (35:54):
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.
Speaker 2 (36:05):
So I feel like everyone is on the same page.
Speaker 3 (36:08):
That people need to do their best to exercise and
to eat well, and to make sure they can optimize
their sleep, 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
(36:28):
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 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.
Speaker 2 (36:50):
In terms of nutrition, it's.
Speaker 3 (36:51):
About people working toward the best diet they can in
their lives, and you know, minimizing process food and trying
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 base for cognitive health and
longevity in terms of brain health, it's the Mediterranean diet.
(37:14):
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
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
(37:37):
help some people with their sleep. So I think encouraging
people to maximize their sleep, their diet, their exercise, for
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,
(37:58):
in terms of cognitive health. So encouraging people to prioritize
socializing because it's fun, it's nice, and it also protects
your brain and your mental health later in life, so
that's also important.
Speaker 2 (38:10):
And then minimizing stress.
Speaker 3 (38:13):
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 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
(38:35):
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 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.
(38:57):
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 and a lot of people do 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.
(39:21):
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 (39:30):
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
things really important to realize too that alcohol is to
sleep disruption and can worsen BEA's a, motor symptoms or
heart flashes. Do you think that there is any level
of I mean, I think of alcohols and neurotoxin, So
do you think that there is any level of alcohol,
(39:52):
which is safe for women to consume in terms of
cognitive health.
Speaker 3 (39:57):
Yeah, so I think overall there's no real benefits of
alcohol in terms of brain health, in terms of sleep,
in terms of mood. Maybe in the very short term
as people have a drink, they might feel good temporarily. Overall, no,
we don't advocate for alcohol, and the scientific literature does
not support the use of alcohol in any way in
(40:18):
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
(40:41):
adverse effects short term and longer term can just help
people understand what's going on and what role Elkol might
be playing.
Speaker 1 (40:48):
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 3 (40:55):
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. So
exercise can have a really big benefit at a physiological level,
(41:16):
just talking about blood flow and changes in 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
(41:39):
super important.
Speaker 2 (41:40):
Otherwise it just won't happen.
Speaker 1 (41:42):
Yeah, I think again that context is so important.
Speaker 3 (41:45):
Right.
Speaker 1 (41:45):
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 caliston next, my irisan
goes up, my VDNF goes up, which are all for
our listeners. Those are things that make your brain grow. Actually,
so pumping iron can make your brain grow. What should
people target? So any movement is good, any exercise is good,
(42:05):
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 3 (42:15):
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. Yeah.
Speaker 1 (42:35):
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 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 our
(42:55):
carbs and increase our protein a little bit for brain
health as the metabolism and the brain changes.
Speaker 3 (43:01):
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,
(43:22):
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 (43:41):
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
(44:03):
as I age. I want a sense of community, Like,
how do you advise your patients?
Speaker 3 (44:07):
Yeah, so I think again, I always take quite an
indie visualized 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
(44:28):
having 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
(44:50):
that 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.
Speaker 1 (44:59):
What are you most excited about with the future with
specifically women's brain health.
Speaker 3 (45:05):
So I think while it is a time of vulnerability,
there can be lots of symptoms that people can experience
during perimenopause and postmenopause or 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
(45:28):
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.
(45:49):
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.
Speaker 2 (46:07):
What the future will hold.
Speaker 1 (46:09):
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 you know, 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
(46:30):
are three actionable tips that you would give them to
maintain the best brain health possible.
Speaker 3 (46:37):
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 are worried about cognitive symptoms or worried about the
(47:00):
onset of they think they might have dementia, to think
about this might not be that it might just be
part of a hormone or 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,
(47:23):
seeking 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.
Speaker 2 (47:34):
And the third.
Speaker 3 (47:35):
Tip would be just the practical lifestyle things that people
can do, and for people to know that their brains
are constantly 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
(47:56):
to kind of optimize their functioning and as much as
possible thrive during this phase of their life.
Speaker 2 (48:02):
And for some women that's not at all what they're feeling.
Speaker 3 (48:06):
They might be listening to this and 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 (48:22):
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 a success,
to use the ball up correctly.
Speaker 2 (48:36):
Yeah, definitely.
Speaker 1 (48:37):
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 3 (48:45):
Thank you, Elizabeth, It's been absolute pleasure talking to you,
and I've really enjoyed the conversation.
Speaker 1 (48:57):
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. Lifestyle can greatly impact
cognitive function. 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,
(49:21):
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
(49:41):
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
(50:02):
episode of Decoding Women's Health, I'll speak to a world
renowned oncologist about how you can minimize the likelihood of
developing certain types of cancer.
Speaker 2 (50:11):
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 (50:23):
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 Shakergie, additional production support from Kate Furby,
mastering by Sarah Brigaire. Our executive producer is Alexandra Garreton.
(50:43):
Our theme song was composed by Hannes 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 haggidorn
(51:04):
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
(51:26):
doctor Elizabeth Pointer. Thanks for listening. Until next time,
Pushkin. Here's the thing about 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
(00:37):
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 of person who woke up happy,
motivated to face the day. Suddenly I didn't feel joy anymore.
(00:58):
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 depressed surgeon.
I felt like a different person and was totally confused
by the whole thing. I went to the medical literature
looking for answers, but I came up completely empty. I
(01:18):
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 (01:32):
Please welcome doctor Elizabeth Point.
Speaker 1 (01:37):
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 dugs for diabetes can actually impact
a woman's survival when she's been diagnosed with ovarian cancer.
Actor was a pointer. Great to see you, Thank you
so much, and yet I was still in the dark.
(01:59):
It was my mom who actually said to me, you
know what, it's probably your hormones. Turns out she was right.
I was going through perimenopause. Looking back at me perfect sense.
I'd always had mood changes around my period. Of course,
then the biggest hormonal shift in my life would affect
my mind and emotions. What's wild is that none of
(02:22):
my doctors, not my therapist, not a psychiatrist I had
consulted for this issue, not even my medical colleague suggested perimenopause.
Eventually I figured out how to feel better, but the
whole experience served as a big wake up call for me.
So here's my question, where exactly is the information for us,
(02:45):
the women in the middle of our lives, to help
us make the best decisions about our health. I'm doctor
Elizabeth Pointer, 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.
And here's what I've observed, both as a patient and
as a doctor. The information actually is out there, but
(03:09):
it's really hard to find some time times. 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 impossible to understand without a medical degree, and even
most doctors don't have time to do that. Now. Specialists
(03:32):
live in their own subspecialties and struggle to keep up
in OBGI. In 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
women after their reproductive years. And that's why I'm making
this podcast, Decoding Women's Health, a new show from Pushkin
(03:56):
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
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
(04:29):
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
(04:50):
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
(05:11):
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 Monash University. There's
(05:34):
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 (05:48):
Thank you so much, doctor Pointer. It's absolute pleasure to
be here.
Speaker 1 (05:51):
Can you tell us what a neuropsychologist is actually?
Speaker 3 (05:54):
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 entering with when it impacts brain, brain and behavior.
So that's the assessment side, but then neuropsychologists can also
(06:17):
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 (06:36):
How did you get involved with this type of work.
Speaker 3 (06:38):
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 that I really loved science like
I loved chemistry. I loved physiology and learning about the brain.
I was fascinated by how powerful our brains are and
(07:02):
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
(07:24):
of take control and do what we can for preparing
ourselves for great cognitive aging.
Speaker 1 (07:29):
Can you tell me a little bit more about what
you mean taking control and prepare for aging.
Speaker 2 (07:34):
Yeah?
Speaker 3 (07:35):
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 lots
(07:57):
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 (08:14):
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 3 (08:24):
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 estra dial 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
(08:47):
be 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 here cognitive symptoms that
(09:08):
can happen during perimenopause or 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,
(09:30):
difficulties with 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 (09:50):
What percentage of women do you really think are going
through these cognitive changes.
Speaker 3 (09:56):
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.
Speaker 2 (10:14):
And I think it really varies.
Speaker 3 (10:15):
For some people, it's quite subtle and it doesn't have
a huge impact on their life, but for other people
it can be quite significant.
Speaker 1 (10:22):
In your clinical practice, what kind of complaints to midlife
women come to you with or what are their main concerns.
Speaker 3 (10:28):
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
(10:49):
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.
Speaker 2 (11:03):
To focus.
Speaker 3 (11:05):
So they're probably the two biggest clinical questions that people
present with. But the types of symptoms that women present
with mood symptoms, forgetfulness, difficulties with efficiency.
Speaker 2 (11:18):
And time management and multitasking.
Speaker 1 (11:22):
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 (11:39):
Exactly the same. It's quite early.
Speaker 3 (11:40):
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 it impacts their self esteem,
Then they become a bit more anxious than the anxiety
(12:03):
in itself further impacts their ability to perform in the moment.
Speaker 2 (12:09):
So it's this real cycle for people.
Speaker 3 (12:12):
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 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
(12:33):
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 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 (12:53):
You know, a lot of times we go is dementia
or is it brain fog? Right, and it's like, well,
you know, demension impacks 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 chains.
Speaker 3 (13:12):
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
(13:33):
about 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.
(13:54):
They just 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 more subtle
cognitive symptoms and then the flow 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
(14:19):
workplace settings, 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
(14:40):
knowing that it might be you know, a couple of
years where word finding's 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 (14:57):
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. When you
talk about support structure and that type of thing, what
are you referring to.
Speaker 3 (15:11):
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
(15:32):
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
(15:53):
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
working memory and the juggling and switching between lots of
different tasks.
Speaker 2 (16:11):
And for some people where it's.
Speaker 3 (16:13):
Executive function, 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 (16:34):
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
(17:08):
of leads me into the kind of adhd D 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 (17:26):
Yes?
Speaker 3 (17:27):
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.
Speaker 2 (17:45):
In terms of the diagnostic criteria.
Speaker 3 (17:48):
You 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. So it's that
(18:08):
the sorts of symptoms that fall into that attention D
are things like forgetfulness, difficulties focusing on things, and then
their 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
(18:31):
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, but particularly for women
who also you might be really conscientious and hard working
(18:53):
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,
(19:15):
when eastern 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
(19:35):
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
(19:58):
in menopause where they can no longer kind of mask
or cover up some of the symptoms that they've been experiencing.
Speaker 2 (20:05):
And in our research as.
Speaker 3 (20:06):
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 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
(20:29):
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 (20:43):
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 3 (21:01):
Yeah?
Speaker 2 (21:02):
I think we know the most about estrogen.
Speaker 3 (21:05):
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 be really protective. And so we also know
(21:25):
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 dopamine pathways that are important in ADHD but
(21:47):
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 animal studies, but we kind of extend that,
extrapolate from that and learn from that in terms of
(22:08):
how estrogen might be working in human study.
Speaker 1 (22:11):
Yeah, it's interesting, there's so much to explore when these
cognitive issues are occurring. What's actually going on. Estradiyl 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 3 (22:27):
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,
(22:48):
are used to being stimulated by estradyl, 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.
Speaker 2 (23:04):
But I think there are often lots of other pieces
of the puzzle.
Speaker 3 (23:07):
So I think, you know, while people can experience brainvog
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.
Speaker 2 (23:22):
There's always things underpinning that.
Speaker 3 (23:24):
So I think when we're talking about menopause, we're talking
about hormone changes as being a significant contributing factor, 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
on effects to cognition. They also can impact sleep, so
(23:45):
sleep and a lack of sleep or impaired disruptive sleep
for anyone at any point in your life can 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
(24:05):
pain joint pain and pain can have cognitive symptoms. So
I think there can be lots of actors that 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
(24:27):
often coincides with a really busy time in a lot
of people's lives or often at you know, the 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
(24:50):
important to consider when we think about what's underpinning cognitive symptoms.
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 (25:08):
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 this. 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
(25:31):
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
(25:53):
early perimenopuzzle transition or late perimen a 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 lotos hormone support for them, or
(26:13):
what are your thoughts about that?
Speaker 3 (26:15):
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
(26:36):
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 (26:53):
Why has it been contentious the treatment of cognitive issues
or dementia prevention with estrogen.
Speaker 3 (27:01):
Decades ago, it was kind of accepted and thought that
menopausal hormone therapy or HRT or hormone support was helpful
for reducing dementia ris 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
(27:23):
results 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.
Speaker 2 (27:34):
So probably the.
Speaker 3 (27:35):
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
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
(27:57):
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
balanced evidence. 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
(28:22):
reduced risk of developing dementia later in life, particularly estrogen
only hormone therapy. Yeah.
Speaker 1 (28:28):
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 3 (28:41):
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
(29:02):
type of estrogen in terms of brain health and progesterone
progestine that might be most helpful for brain health.
Speaker 1 (29:08):
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
(29:31):
do you think the answer is?
Speaker 2 (29:32):
We probably need a combination of things.
Speaker 3 (29:34):
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.
Speaker 2 (29:53):
And so I think there's two questions.
Speaker 3 (29:56):
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 early postmenopausal years if they've still got
cognitive symptoms.
Speaker 2 (30:10):
And then what the flow and effects.
Speaker 3 (30:11):
Twenty years down the track, is there a change in
risk for developing neurodegenerative processes lack dementia 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 (30:31):
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
(30:53):
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 it can
play a really important role in feeling better. Coming up,
doctor Gervirich and I discussed some additional tools to support
(31:14):
your cognitive help from brain training, exercises to lifestyle changes,
decoding women's health will be right back. You know, we've
(31:44):
spoken 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 3 (31:58):
Yeah, I think in the absence of anything that's currently
clearly indicated that people can take for cognition, I think
it's really 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
(32:18):
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
(32:38):
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
(33:01):
to approach difficulties that they're having or to enhance or
optimize their cognitive 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 whatever mental
(33:23):
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
improve and optimize your cognitive functioning, So giving people that
(33:45):
piece of knowledge and that understanding can be really helpful.
Speaker 2 (33:48):
And then training.
Speaker 3 (33:50):
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 to day day life.
So you just get really good at that one task
or maybe similar tasks. But what we want people to
(34:11):
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, teaching people to really
focus their attention and actively attend to whatever tasks they
(34:31):
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, and how encoding works, and
how attention works, and giving people strategies to improve and
(34:53):
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 cognitive health.
Speaker 1 (35:08):
So one of my midlife friends wants to know, is
word all a form of cognitive training? We suspect not
we suspect that you need to do more than wordle.
Speaker 3 (35:21):
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 (35:39):
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 3 (35:54):
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.
Speaker 2 (36:05):
So I feel like everyone is on the same page.
Speaker 3 (36:08):
That people need to do their best to exercise and
to eat well, and to make sure they can optimize
their sleep, 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
(36:28):
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 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.
Speaker 2 (36:50):
In terms of nutrition, it's.
Speaker 3 (36:51):
About people working toward the best diet they can in
their lives, and you know, minimizing process food and trying
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 base for cognitive health and
longevity in terms of brain health, it's the Mediterranean diet.
(37:14):
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
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
(37:37):
help some people with their sleep. So I think encouraging
people to maximize their sleep, their diet, their exercise, for
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,
(37:58):
in terms of cognitive health. So encouraging people to prioritize
socializing because it's fun, it's nice, and it also protects
your brain and your mental health later in life, so
that's also important.
Speaker 2 (38:10):
And then minimizing stress.
Speaker 3 (38:13):
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 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
(38:35):
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 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.
(38:57):
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 and a lot of people do 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.
(39:21):
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 (39:30):
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
things really important to realize too that alcohol is to
sleep disruption and can worsen BEA's a, motor symptoms or
heart flashes. Do you think that there is any level
of I mean, I think of alcohols and neurotoxin, So
do you think that there is any level of alcohol,
(39:52):
which is safe for women to consume in terms of
cognitive health.
Speaker 3 (39:57):
Yeah, so I think overall there's no real benefits of
alcohol in terms of brain health, in terms of sleep,
in terms of mood. Maybe in the very short term
as people have a drink, they might feel good temporarily. Overall, no,
we don't advocate for alcohol, and the scientific literature does
not support the use of alcohol in any way in
(40:18):
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
(40:41):
adverse effects short term and longer term can just help
people understand what's going on and what role Elkol might
be playing.
Speaker 1 (40:48):
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 3 (40:55):
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. So
exercise can have a really big benefit at a physiological level,
(41:16):
just talking about blood flow and changes in 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
(41:39):
super important.
Speaker 2 (41:40):
Otherwise it just won't happen.
Speaker 1 (41:42):
Yeah, I think again that context is so important.
Speaker 3 (41:45):
Right.
Speaker 1 (41:45):
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 caliston next, my irisan
goes up, my VDNF goes up, which are all for
our listeners. Those are things that make your brain grow. Actually,
so pumping iron can make your brain grow. What should
people target? So any movement is good, any exercise is good,
(42:05):
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 3 (42:15):
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. Yeah.
Speaker 1 (42:35):
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 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 our
(42:55):
carbs and increase our protein a little bit for brain
health as the metabolism and the brain changes.
Speaker 3 (43:01):
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,
(43:22):
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 (43:41):
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
(44:03):
as I age. I want a sense of community, Like,
how do you advise your patients?
Speaker 3 (44:07):
Yeah, so I think again, I always take quite an
indie visualized 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
(44:28):
having 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
(44:50):
that 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.
Speaker 1 (44:59):
What are you most excited about with the future with
specifically women's brain health.
Speaker 3 (45:05):
So I think while it is a time of vulnerability,
there can be lots of symptoms that people can experience
during perimenopause and postmenopause or 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
(45:28):
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.
(45:49):
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.
Speaker 2 (46:07):
What the future will hold.
Speaker 1 (46:09):
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 you know, 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
(46:30):
are three actionable tips that you would give them to
maintain the best brain health possible.
Speaker 3 (46:37):
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 are worried about cognitive symptoms or worried about the
(47:00):
onset of they think they might have dementia, to think
about this might not be that it might just be
part of a hormone or 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,
(47:23):
seeking 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.
Speaker 2 (47:34):
And the third.
Speaker 3 (47:35):
Tip would be just the practical lifestyle things that people
can do, and for people to know that their brains
are constantly 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
(47:56):
to kind of optimize their functioning and as much as
possible thrive during this phase of their life.
Speaker 2 (48:02):
And for some women that's not at all what they're feeling.
Speaker 3 (48:06):
They might be listening to this and 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 (48:22):
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 a success,
to use the ball up correctly.
Speaker 2 (48:36):
Yeah, definitely.
Speaker 1 (48:37):
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 3 (48:45):
Thank you, Elizabeth, It's been absolute pleasure talking to you,
and I've really enjoyed the conversation.
Speaker 1 (48:57):
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. Lifestyle can greatly impact
cognitive function. 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,
(49:21):
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
(49:41):
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
(50:02):
episode of Decoding Women's Health, I'll speak to a world
renowned oncologist about how you can minimize the likelihood of
developing certain types of cancer.
Speaker 2 (50:11):
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 (50:23):
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 Shakergie, additional production support from Kate Furby,
mastering by Sarah Brigaire. Our executive producer is Alexandra Garreton.
(50:43):
Our theme song was composed by Hannes 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 haggidorn
(51:04):
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
(51:26):
doctor Elizabeth Pointer. Thanks for listening. Until next time,
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