Women's Brain Health: Environment, Hormones, Menopause & Neuronal Pruning with Dr. Sarah McKay

Dr. Sarah McKay, a brilliant neuroscientist, takes us on a thrilling adventure into the intricate dance between hormones and the female brain during menopause. She shares her personal quest to unravel how those mischievous hormonal shifts tweak women's brains from 40 onwards, revealing the fascinating secrets of neuronal 'pruning and tuning.' Dr. McKay also shines a spotlight on the superstars estrogen, dopamine, and serotonin, and uncovers how our social circles and daily choices play a massive role in brain health. With sparkling discussions on metabolic health and the wider ripple effect of menopause, this episode is a must-listen for any woman eager to keep her brain sparkling and sharp! To view full show notes, more information on our guests, resources mentioned in the episode, discount codes, transcripts, and more, visit https://drmindypelz.com/ep311 Dr. Sarah McKay is a neuroscientist and science communicator who makes brain science practical and accessible for better health, wellbeing, and performance. She holds an MSc and PhD from Oxford and spent five years researching spinal cord injury before founding Think Brain, her science education company. Sarah's appeared on ABC's Catalyst, The Mel Robbins Podcast, SBS Insight, and has been featured in The Wall Street Journal, The Guardian, and Australian Women's Weekly. She's the author of The Women's Brain Book, Baby Brain, and Brain Health for Dummies, all exploring how understanding the brain can help us live and feel better. Check out our fasting membership at https://esetacademy.drmindypelz.com https://resetacademy.drmindypelz.com/. Please note our medical disclaimer https://drmindypelz.com/medical-disclaimer/.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:02Mindy Pelz?

  On this episode of the Resetter Podcast, I bring you Dr. Sarah McKay. Woo, you ready for some neuroscience? This is so good. And let me just kind of queue up what you're going to hear because I think your mind is going to be blown. First, I have not met another human that loves neuroscience more than I do, but I would say that Dr. Sarah McKay may have 10 times to me. Now, she committed her whole career to this, but if you look at her Instagram, which I highly recommend you go and look at, she has combined neuroscience, she is an official neuroscientist, with women's health.

• 0:45Mindy Pelz?

  And her focus is really helping us all understand the female brain. I love that she has on her Instagram, she calls herself a "science communicator" and she absolutely is that. And she is the author, a three-time author, but the most interesting one that she has brought forward is called "The Women's Brain Book." And she just redid the, she did a second edition with new information in it. So what I wanted to bring Sarah to you all for is to, again, help us understand these brain changes that are going on after 40, as our hormones shift. And you've heard me talk a lot about Lisa Moscone.

• 1:29Mindy Pelz?

  I did an interview with her about a year and a half ago. You've heard me talk about my new book, Age Like a Girl, which is all about the rewiring of your brain for the positive. And now you're going to hear the nerdy scientist, and I promise you, it's going to be entertaining. So in this episode, we talk about this idea that Lisa brought forward, which is the pruning, the pruning of the neurons. What is exactly, does that mean? How does that happen? We then dove into lifestyle tools for things like dementia. This one was really interesting about where does memory loss come from? And is dementia preventable? And you're going to be shocked at what she has to say. I'll give you a little clue.

• 2:13Mindy Pelz?

  She says, based off science, HRT is not proving to prevent dementia. But she does list out about four or five different things that I had never even thought about that can help to keep our neuroplasticity up and prevent things like Alzheimer's and dementia. Of course, we had to talk about metabolic health and how it related to neurons. We dove into neurotransmitters and the whole system of neurotransmitters and how that works in the female brain. It's super interesting and don't be scared by the science. I think we both did a really good job of keeping it applicable. And I made sure that anywhere that she got a little too sciencey that we dove into,

• 2:58Mindy Pelz?

  how do we apply this to our everyday life? So this was probably one of my favorite conversations I've had on my podcast. I love some of the new science she's bringing. I will tell you that one of the conversations I've been wanting to have is around the menopause messaging that is happening out there. I fear that we are putting everybody into this chaotic crisis fear state around menopause. And Sarah really shed some light on that and where she sees the menopause conversation going. She also brought forth some new science that she just received today on the messaging of menopause out in the world.

• 3:43Mindy Pelz?

  So when I say this is a deep conversation, I am not joking. This is a very likeable neuroscientist who is on a mission to help us all understand the female brain. So Dr. Sarah McKay, and we will leave a link for her five day course. You'll hear about it at the end if you're interested in learning more. But as always, I hope this helps. And most importantly, I hope it helps you understand yourself better. Dr. Sarah McKay, enjoy. Welcome to the Resetter Podcast. This podcast is all about empowering you to believe in yourself again. If you have a passion for learning, if you're looking to be in

• 4:24Mindy Pelz?

  control of your health and take your power back, this is the podcast for you.

• 4:36Mindy Pelz?

  Well, first, I just have to start off by welcoming you to my podcast, Sarah. I, you don't know this, but I've been stalking you for several years now, and I only mean that with a loving. It's creepy. I know, I only mean that with a loving. A loving stalk. A loving, I just, I just love neuroscience, and I love what you've been up to with the female brain and educating all of us on it. So this is a real treat for me. So welcome to my podcast. Oh, well, thank you for the invitation. And thank you for stalking me. Yeah, I know. Lovely. It's, it's funny, because it's a term we use a lot in, in my household, because people stalk me. And then when they run into me in public, they're like, oh, my God, oh,

• 5:17Mindy Pelz?

  my God. And I'm like, and I just laugh and I walk away. And I always tell my friends, I'm like, they just, you know, it's a, it's a kind kind of stalking. It's like they dive into your information, but it feels a little stalkery. So anyhow, here's where I want to go with this conversation today. I, I've been on a 10 year quest to understand what is happening to the female brain and body after, after 40. And it started with observing patterns of women in my clinical practice that would come into my office and say, like, I have an amazing house. I have a beautiful husband. My family is incredible. And I think

• 5:59Mindy Pelz?

  I want to kill myself. Or women that would come in and just say, I'm completely become stress intolerant. And I watched this pattern of really healthy, happy women dramatically shift through this process. Well, whereas on the other end of the spectrum, I had a lot of 70 and 80 year olds that seemed happier than ever before. And so fun to be around and calm and nothing ever bothered them. And so I started to really look at like, well, what's happening to the female brain between 40 and 60? There is something we are not talking about.

• 6:38Mindy Pelz?

  So I want to start with that question to you is what is going on with the female brain as our hormones shift?

• 6:47Speaker 01

  My goodness, that's an enormous question. I'll caveat it by saying we don't know quite enough to be able to tell a nice coherent story right now, but there are some amazing scientists who are working very, very hard to fill the gaps. I know it's a bit of a narrative. We don't know much about women's health, particularly within the neuroscience space, but there are amazing neuroscientists around the world who are working, working away, doing the hard work. I just am here to help translate that work for them.

• 7:18Speaker 01

  When we think about the brain, it's a, it's a very big question because when we're thinking about how our brain changes, there are so many ways in. And then when we add hormones in as well, it gets, it gets a whole lot more complicated. So we could start by sort of zooming all of the way in and look at what we know about how hormones, as they ebb and flow, dial up during pregnancy, dial down, ebb and flow across the menstrual cycle and then kind of roller coaster through perimenopause and then fade away. How they change individual neurons and neuron structure and synapses and spines and dendrites on neurons.

• 7:59Speaker 01

  We could zoom out a little bit more and look at how those changes impact brain structure itself. We could look at how brain networks, so little kind of cohorts of neurons, how they network together, what we might call functional connectivity in the brain, how that shifts and shapes and changes across the lifespan and in response to hormones and in response to everything else that's changing around us. And then I suppose we could zoom out even more and look at what do we know about how these changes underpin? What women think and feel and how we might behave and react and respond. So there's lots of, when it comes to the brain, there's lots of different levels.

• 8:42Mindy Pelz?

  Yeah, I can see that.

• 8:44Speaker 01

  We can kind of study, we can study the brain and talk about that. So I don't know where you want to start.

• 8:49Mindy Pelz?

  Yeah, sure.

• 8:50Speaker 01

  You know, like zoom in or zoom out or somewhere in the middle.

• 8:54Mindy Pelz?

  Well, I think I want to start with what Lisa taught me on a podcast interview. And it was this idea that when estrogen starts to decline, there's a pruning process. So that would be going at the level of the neurons, that there's a pruning process that is making way for a new brain to form. That, that concept is.

• 9:17Speaker 01

  That's a, yeah.

• 9:19Mindy Pelz?

  Talk to me about that.

• 9:19Speaker 01

  Cool. Yeah, that's a cool, that's a cool kind of concept and way of thinking about it. And I think we see this, this concept of pruning, I would always say pruning and tuning. Just because that's kind of what neurons, what neurons are doing. We see this at different points through, through the lifespan of all, of all humans. But particularly in females, we see this, a similar process taking place during puberty and adolescence, during pregnancy and early postpartum. And then we think what we're seeing, although we don't yet know as much as what we do in these other life phases, this is what we might be seeing during perimenopause and then perhaps during post, well, those, those post-menopause years. And this word pruning is interesting because we're not here, we're not talking here about

• 10:04Speaker 01

  pruning away of whole parts of the brain or pruning or removal of neurons. We've not got what we would call neural apoptosis, which is the death of, of new neurons and neurons. If, if we were seeing neural death, we'd be in puberty, pregnancy and perimenopause, we'd be in a lot of trouble. When we talk about neural pruning, we're talking about the connections between neurons and how they are being.

• 10:31Speaker 01

  You know, some sometimes flourishing, sometimes being pruned away. And sometimes what I would call being tuned, existing connections being tweaked, maybe being weaker or stronger. And the way I would describe it is if you imagine you've got one neuron and it looks a little bit like a tree. So we've got a cell body and then it has all of these branches coming out of the the cell body, which we call dendrites. And they look like branches on a tree. And then we've got the long axon, which will be connecting to other other neurons or other parts of the brain. The dendrites are like input receivers. And at various stages through the lifespan and even in response to hormones across the menstrual cycle.

• 11:12Speaker 01

  We would see dendrites flourishing, particularly when we've got high levels of estrogen. We typically see dendrites flourishing and little spines on those dendrites, which look very much like buds on a tree branch in spring, we would see them flourish. And then when we've got lower estrogen, they would they would kind of prune away. And so what may be happening, I'm not entirely sure about menopause, but certainly during pregnancy and certainly during puberty. When we've got these massive hormonal shifts, we see the pruning away of the of these little buds and twigs. Which means that we're altering the connections between neurons. A little bit like we see a tree flourish in spring.

• 11:56Speaker 01

  And then perhaps you might prune away the branches and the connections in in the autumn, if you were a gardener. Right. You're not reefing the whole, you're not pulling that whole tree out and throwing it away and planting a new tree in. And that alteration, we would call this synapse plasticity, these connections between neurons. And how they are regulated and shift and change is is kind of adds up to what we might see in terms of structural changes in the whole brain. Um, or and or to in terms of how networks react and respond and connect. So in pregnancy, which, and I'm just talking about this because we're pretty sure we know what is happening here.

• 12:36Speaker 01

  When you're going through the course of your first pregnancy and you've got all these sky high levels of hormones that are made by the placenta, because the placenta is a gland, we're seeing this massive kind of flourishing and pruning and tuning of all of these these connections. And but what we what we end up seeing is that grey matter gets slightly thinner. This might happen during perimenopause as well. Grey matter is getting slightly thinner. Now, this isn't the brain degenerating. It always sounds terrible when you Right, right. part of the brain getting smaller. Yeah. It sounds like degeneration or disaster or catastrophe. It's not, it's the brain streamlining and refining and putting itself in a state of heightened plasticity.

• 13:17Speaker 01

  So that the experiences that we then have can help continue to prune and tune that brain. So what I think might be happening during perimenopause, and we're not sure because we don't have many studies yet. Mm hmm. If we see reductions in grey matter volume, that's not because we've got less neurons. What we're probably seeing is reduction in the numbers of connections between neurons. That doesn't mean they're giving up. Right. That means they're probably doubling down. Let let's just put all of that energy, energy and focus into strengthening the connections that we absolutely need and getting rid of the superfluous ones. I think, I believe what Lisa Moscone's menopause, you know, she's tracked.

• 14:03Speaker 01

  Unfortunately, we haven't got a good longitudinal study. We've got a big group of women. We've tracked them all the way through. Kind of from pre peri peri menopause, post menopause, because that might take like 15 years. It's hard to do. It's hard to to to do good science with longitudinal studies because it takes a long time because it's longitudinal. But she's compared different, you know, cohorts of women. I believe her, her, there's a, there's a figure on one of her papers that shows during perimenopause and grey matter. So that's like the cortex of the brain. That's like. This wrinkly kind of outer covering of the brain. There's a bit of a sort of a dip and then it kind of bounces back up. Postmenopause, which is kind of crazy. So I don't know, maybe that's the downlighting of wisdom.

• 14:48Speaker 01

  I know, who knows? What's underlying that at this specific individual neural level is probably not apoptosis and neurogenesis. So the death of neurons and the birth of new neurons. We don't see that in cortex. What it is probably is the reorganisation of the existing neurons in the networks. So that they become kind of more streamlined. But why would the body do that? Well, the body reacts and responds to all of the experiences that it has. So I always think about, let's imagine kind of the brain. It's receiving a ton of information of what is happening in our body. Not least ebbs and flows of sex hormones, but all the kinds of hormones in our body.

• 15:30Speaker 01

  Everything that is happening in our body is, you know, that that information is making its way up to the brain in various kind of ways, whether it's neural signalling or hormonal signalling or immune signalling. But we've also got what's happening around us, like the sort of the outside in social world. The experiences that we're having. And then we've also got, we're humans. We've got our psychology or our mind, which is also shaping and sculpting the brain. So why would the brain react and respond? Because hormones are, you know, Dip. Roller, roller coastering and then, and then flatlining, although maybe if you're taking HRT, you're perhaps levelling, levelling that out. So the brain simply reacts and responds to the hormonal kind of milieu it's in.

• 16:14Speaker 01

  But it also reacts and responds to everything that it's, all of the data that's making its way into the brain. It's perhaps not. I, I wouldn't like to say it's the loudest voice in the crowd is always hormones. But there's perhaps different points and, and times in the lifespan when that hormonal signal is louder or quieter. And Depending on who you are, we know this, some women like ride this roller coaster of their hormonal fluctuations emotionally, other women just don't even notice a thing.

• 16:46Mindy Pelz?

  Right.

• 16:47Speaker 01

  Their brain is always reacting and responding, and that's simply what it's doing during during the menopause.

• 16:53Mindy Pelz?

  And so in that moment, what I heard and what you're saying is when estrogen is high, we have we have these very active dendrites, we have a very receptive extension of the neuron that's trying to grab information and carry information. But when estrogen goes low, they're not as receptive. And in times of big hormonal swings, like puberty, pregnancy and perimenopause, we are going to see the effects of that more than we typically do.

• 17:25Speaker 01

  Yes, because those are much bigger shifts of hormones. But there's a bit of a U-shaped curve sometimes. So it's not linear, it's not like more and more and more estrogen, more and more and more dendrites. There's, it's because, you know, if we think about it, it's cyclical and it's responsive and it's adaptive. So actually, if you look at increasing the, and studies have been done, looking at this, we can do this in rodents in the research lab, we can do this in humans, but less well, because living human women don't want to give up bits of their hippocampus or bits of their brain for us to look at under the microscope.

• 18:00Mindy Pelz?

  I don't understand, why not?

• 18:02Speaker 01

  But there's actually, there's actually a U-shaped relationship there. So the more, you know, you get across the kind of the course of the menstrual cycle, we'll get kind of flourishing and then pruning and then flourishing and pruning. But in pregnancy, it's something different because we've got like these sky high levels of all of the estrogens, because the placenta is also making them.

• 18:24Mindy Pelz?

  Mm hmm.

• 18:24Speaker 01

  And the kind of the HPO axis is kind of the brakes are off. So that, you know, the ovaries are also pumping a lot out. So we're getting a bigger dose of estrogen across the course of one pregnancy than we would get in the total of the rest of our lifespan. And the kind of the net result of that is actually pruning, because there's a bit of a U-shaped relationship there. So. The brain is never really straightforward. It's always got, there's always a feedback loop in there to kind of throw us into a bit of a loop when we're trying to explain that.

• 18:54Mindy Pelz?

  So then would it be fair to say that there's also this, this, I'm going to call it expansion of the dendrites and contraction of the dendrites throughout the menstrual cycle because of estrogen levels changing?

• 19:07Speaker 01

  Yes, that's partly because of estrogen, but we've also got progesterone in there. So we, we understand this most well and like shout out to, to kind of one of the sort of, you know, the queens of neuroscience research, Catherine Woolley, who was the first person to show that the brain actually reacted and responded to these fluctuations of sex hormones. This is back in the nineties and she got a bit of pushback when she first presented this, this research at a neuroscience research conference. But now it's, I mean, I could, if I was to take my textbook out from underneath my microphone here.

• 19:36Mindy Pelz?

  Don't do that.

• 19:37Speaker 01

  I could show you the pictures in the, in the neuroscience textbook now. So across the course of a menstrual cycle and particularly within the hippocampus of the brain, and we see this in the estrous cycle and, and little mammals that we study in the research lab, where it's far easier, or at least they sacrifice themselves for us to be able to do the, the research in the way that humans aren't going to. Animal, you know, the people have got different thoughts about animal research, but that's where we get most of our data from. So in a particular region of the hippocampus, she was able to see these little neurites flourishing when estrogen went up and then kind of retracting when estrogen went down.

• 20:15Speaker 01

  We, if we do very, very, very careful studies of human brains and brain imaging, we, you know, we put someone on an MRI scanner and then we do precision imaging and we're really only getting to the point where the resolution is enough for us to be able to sort of see, let's look at the hippocampus of living human women across the course of the cycle. We see some parts of the hippocampus kind of getting slightly bigger, probably due to flourishing of neurites and then other parts kind of retracting. And there's a bit of a relationship there between levels of estrogen and levels of progesterone. But it's, it's very kind of, it's very complicated. And we're really only getting to the point where we can map this very.

• 20:59Speaker 01

  Carefully, but still quite roughly, I would say, in human women at the moment. With the technology is going through great leaps and bounds.

• 21:06Mindy Pelz?

  That's beautiful.

• 21:07Speaker 01

  But it's probably only been in the last five years that we've started to get any decent data through from living human women's brains. And because we've got all of these amazing women in the neuroscience kind of space now, who are asking the questions and getting the funding in. And there's some really cool research groups around the world that are driving this research forward and asking these questions.

• 21:27Mindy Pelz?

  So would it be fair to say then, we may have noticed that our brain was working differently when we had a menstrual cycle, but the swings were very subtle. And because the highs and lows of estrogen within twenty eight to thirty two days, it's just not enough for us. I mean, we might be like, I'm not quite myself today. But then five days later, if estrogen's higher, we might feel more in in sync. But since we're not, you know, culturally talking about that brain change, we may not have been aware of it. But once we get to menopause, because estrogen is declining, you know, by a natural, it's natural state, are we noticing it more?

• 22:10Mindy Pelz?

  It's always been there, but we're just noticing it more because of the decline being so consistent and so steep.

• 22:18Speaker 01

  Yeah, I think, well, firstly, I would say different women have very, very different experiences. As I said, across the, you know, if we just look at naturally cycling women across their lifespan, as I said, some women will react incredibly, they're riding the roller coaster. You know, they've got PMS, they've got PMDD, they're really noticing these shifts. Other women are just like, I don't, I'm just carrying on. I don't, don't really notice everything. And then we've got lots of different people sort of in between. Perimenopause is different because we've not necessarily just got declining levels of hormones. We've got roller coastering levels of hormones, particularly in that perimenopause. Because as our ovaries run out of eggs, you know, one month, there may not be a lot of estradiol released from our ovaries.

• 22:59Speaker 01

  So the brain, the hypothalamus and the pituitary are going, hey, next time, louder, more. We can't hear you. And the ovaries go, oh my God, okay. And then there's more estrogen. And then the next month, the brain's going, no, not that much. So we get this real roller coastering. And we've got the ratios between your estrogen and your progesterone are shifting and shaping and changing. We mostly understand from a neurobiological kind of mechanistic perspective, which is what I kind of like, the neuroscience, what is happening in terms of the vasomotor symptoms and how they are a neurological consequence of these changing levels of hormones whereby in our hypothalamus, which is a part of the brain which does things like regulate body temperature and it receives

• 23:41Speaker 01

  information about hormones and, you know, heart rate and blood pressure, et cetera. For some reason, and I'm not entirely sure why Mother Nature had this in mind when, you know, we evolved this way, the hypothalamic thermostat, which regulates our body temperature, is tweaked and set in women by levels of estrogen. And when you've got these roller coastering levels of estrogen, the neurons involved in that thermostat get much more hyper reactive. So it's almost as if the level of the thermostat gets much narrower or the kind of happy, healthy range is much narrower. So your body temperature only needs to rise very slightly for it to kind of hit the top level and your hypothalamus to go, oh my God, it's hot in here, panic stations.

• 24:25Speaker 01

  And it sets off this massive kind of heat dissipation response, which is both physiological and that we sweat, we vasodilate. Part of that is controlled by a sympathetic nervous system. So we get this massive kind of sympathetic nervous system discharge and lots of women can feel that, particularly if you are asleep, you can feel it because your brain might have tried sweating a bit, but you've got your covers on and then the brain's like, girl, we need to wake up to throw the covers off. And you'll get this kind of, you can almost feel like this kind of discharge go through and you kind of wake up. So you've got this massive sympathetic nervous system sort of response, which is an attempt to cool you down because the brain's panicking, thinking

• 25:08Speaker 01

  you were overheated. So we've kind of got the involvement of our autonomic nervous system in there as well. So. Why the estrogen is involved with this process? Yeah, it's a great question. In fact, I would like to know. I'm not entirely sure whether anyone has got there yet, apart from the fact that everything is kind of interrelated. And why that part of the brain is so, takes so long to kind of shift? Because some women can have these vasomotor symptoms for seven, eight, nine, 10 years. Some women don't notice them, some women don't have any, other women do. And why it takes the brain so long to adapt and respond?

• 25:50Speaker 01

  Because sometimes the brain adapts and responds quite quickly and, and you know, it will adapt. And within a year, you'll find others, it takes a much longer time. I'm not entirely sure what's going on here. There's probably loads of different components. So we understand that quite well. That those vasomotor symptoms can have knock on effects, both physiologically, neurologically, and also psychologically. Particularly if they are responsible for waking you up multiple times a night. Right. There's a neuroscience researcher, Pauline McKay, you should totally get her on your podcast. She has tracked how many times, if we're getting vasomotor hot flashes overnight, how many times a woman waking up? You know, how many are getting at night, how many are you getting during the day?

• 26:33Speaker 01

  And we know that, you know, if you go through the course of a night and you're, you're healthy and well, you've got this beautiful sleep architecture where you go into deep sleep and up again and down, back down into deep sleep. And you go through all of those cycles and stages of sleep. Vasomotor symptoms are completely disrupting that, whether you remember waking up or not. Oh, interesting. We've kind of got that. So we've got this massively disrupted sleep architecture, whether or not you remember waking up. On top of that, and this is, there are not very many research labs studying this around the place. Perhaps one or two, one I know is in Santiago in Chile, that interested in this autonomic nervous system response.

• 27:16Speaker 01

  Because we tend to focus in on the brain, but we've got a brain and nervous system. If you are repeatedly activating your sympathetic nervous system over and over and over again to cool you down. Well, we start becoming, we get more, and there's less parasympathetic nervous system kind of bringing you kind of back to baseline. The parasympathetic and the sympathetic nervous system are always kind of working kind of in harmony together. You're repeatedly activating your sympathetic nervous system. Well, then you kind of become hypervigilant and wired. Right, right. And you start noticing, oh, I'm kind of waking up with a fright, like, what's going on? And I don't know about you, but if you get woken up at night and you can't get back to sleep, it doesn't take very long to find something to just worry about. Oh, it's the worst.

• 28:01Speaker 01

  You sit there and go, cool, I'm just gonna lie here and think about awesome, fun stuff. It's horrible. Immediately go directly to the catastrophe, whether that be, you know, thinking about, and I've got teenage sons and I've got Oh, God. parents and, you know, whether it's immediately what's in front of you or whether it's that silly thing you said when you're in high school, it will be something. And because we're kind of hypervigilant, our brain's going, oh, well, we're feeling anxious for some reason, like we must fill in the gaps. So we've kind of got that playing out as well.

• 28:33Speaker 01

  That happens, imagine, that happens one night. Imagine if it's happening days or weeks or months. Oh, yeah. And we're not finding any way to kind of modify or react or respond or adapt.

• 28:42Speaker 01

  It's almost inevitable that some people are gonna start feeling anxious and lots of women might say that these kind of growing levels of anx- feelings of anxiety, not necessarily clinical anxiety, but feeling anxious might be one of the earliest signs of, of going through perimenopause. We've also got, you know, some women, you know, it's a, it's a kind of a, a window of kind of vulnerability for women starting to experience depression. Particularly women who have had prior experiences of depression. It's a really, particularly if, you know, they, they were the women who had PMS or they were the women who struggled postnatally, or, you know, they kind of feel like they know they're hormonally sensitive. This might be another window of vulnerability to experience depression.

• 29:25Speaker 01

  Occasionally you'll get women where it's first time, they've, they've experienced depression, but most commonly it's women with these prior experiences. So we've kind of got this perfect storm. Right. Unpacking what's underlying all of these negative neurological symptoms.

• 29:41Speaker 01

  You know, we're not quite there yet. Is it directly due to how estrogens acting on neurons in the brain? Or is it like we've got these dominos lined up, you know, with the vasomotor symptoms and the sleep and perhaps a bit of anxiety and perhaps depression? And then have we got some knock on effects in terms of overall metabolic health, overall immune health, overall cardiovascular health? Because if you're not sleeping and then you, it's much harder to exercise the next day and manage your diet well. And perhaps you've got, you know, a lot of social, you know, concerns, you know, you've got chaos in your family or something. We've got all these dominos. So what's like the first domino to fall?

• 30:20Mindy Pelz?

  Yeah, right.

• 30:21Speaker 01

  It's a, it's a bit of, it's a bit of a perfect storm time. And it's so, it's hardly surprising. Lots of women struggle when we go through this phase of life. And I am fifty. So I can kind of put my hands up and say, I, I kind of, I, I do my damnedest to do all of the things, but I'm familiar with how it feels.

• 30:40Mindy Pelz?

  Yeah. Which is beautiful. You teach it from that, from that place, which is so helpful. I, the, the two in the morning wake up, I used to call it, I would do a worry scan. It was like, I would wake up and then my brain would be like, okay, which topic do you want to try to fix right now?

• 30:57Speaker 01

  It's, yeah, it's a bit like that. And I think, you know, this, we, we haven't talked about how we can kind of manage this, but there's hormone therapies, et cetera. You know, pick or choose what you're going to use here. But cognitive behavioural therapy for insomnia is, you know, a, a really great kind of holistic, kind of, I call it bottom up outside and top down, or bio psych, a social way to help address this because we need to get to the point where we're just not kind of giving in and going, well, I've woken up at night, therefore I will worry. It can become very habitual. What techniques and tools do you have? That you can kind of intervene and convince yourself to not worry and be able to go back. Just like, sounds easier said than done.

• 31:42Speaker 01

  But there are resources and tools and support out there. If this is the kind of situation you find yourself in. Because it can become, it's a very, it's a very easy feedback loop to, to kind of lean into.

• 31:53Mindy Pelz?

  Right.

• 31:53Speaker 01

  Particularly, particularly because you've got this autonomic nervous system involvement as well as your mind.

• 32:01Mindy Pelz?

  Right, right, yeah.

• 32:02Speaker 01

  Once those two start, that's, and that's kind of how we end up with people with kind of anxiety and or depression. We need to kind of roll, roll that back and kind of intervene as early as possible. And protecting sleep is one of the most important ways to do that.

• 32:15Mindy Pelz?

  Of course, yeah. And that's what I always hear when, when they're like, here are the lifestyle tools you should do as you go through perimenopause. And one of them is like, get a good night's sleep. And I think whoever created that list never went through perimenopause because it's not the easiest. Yeah, it's a great idea if you knew how to, if you knew how to do it.

• 32:35Speaker 01

  Yeah, but we do have tools and resources there for, for, for people. So I think cognitive behavioural therapy.

• 32:42Mindy Pelz?

  I've heard that.

• 32:43Speaker 01

  With an I at the end is that's, that's, that's your goal.

• 32:47Mindy Pelz?

  Well, let's go back to the metabolic piece of this because, you know, one of the things that Lisa and I geeked out on is that the brain is less receptive to glucose. As it goes through this experience and, you know, my, my following and, and my background is in teaching fasting for women. And how you can use a tool like fasting to balance your hormones. And I've watched everything from somebody getting their metabolic health in order and all of a sudden they get pregnant. I've watched depression and anxiety go away and I've watched all the hot flashes, the sleep, all of that change. And so I'm wondering if the brain is less sensitive to glucose.

• 33:31Mindy Pelz?

  Does, is that playing, playing in to this brain function that you're talking about as far as raising temperature and trouble sleeping?

• 33:41Speaker 01

  Yeah, hundred, hundred percent. And this may be part of what is happening in the hypothalamus in terms of this kind of glucose insensitivity. And the brain reacts and responds and kind of tries its best to compensate for that. And also, it's not just cells in the brain, it's just neurons in the brain, it's every cell in our body become, and people, some people, not everyone, can become more kind of insulin resistant and, you know, kind of metabolise and process glucose and make ATP and all of that in the same way. And I'm not, no expert on cellular metabolism, just kind of makes me want to shut my eyes and have a nap. But that's, that's my, that's, that's my TED talk on that. But we see this in every cell in the body, right? You haven't been up late- You'll be familiar with that.

• 34:24Speaker 01

  Yeah, you haven't been up late at night studying the Krebs cycle? I don't understand. Oh gosh, no, I'm sure there's a textbook around here somewhere with the, with the diagrams. And I think I actually tagged a good diagram the other day that I saw on, on somewhere on social media. I should save that to revise and then I never did. But we see the brain and the cells in the brain react and respond in the same way that cells in the brain do everywhere. We've got, and, and I, and it's hard to kind of tease out, you know, all of these different body systems, because they're all, all interconnected and the brains and the nervous system aren't separate from the rest of the body. And I often, we can talk about metabolic health. So we've got neurons in the brain perhaps finding it harder to do the job that they used to. But luckily,

• 35:07Speaker 01

  the brain adapts, if it is healthy, adapts and reacts and responds. And we sort of see this. And I believe some of Lisa Moscone's work has shown that, I mean, we're in such early stages of imaging menopause in women's, in women's brains. But she has shown that adaptation and that response to, and we've got, you know, different people have got different kind of health profiles and genetic profiles and susceptibility, et cetera, underlying that. But the brain does have to work harder as to other cells in our body when metabolism kind of shifts. I think what we know about the brain as the brain gets older, regardless, sort of menopause aside, if

• 35:50Speaker 01

  we just look at all humans as we get older, as the brain starts to perhaps- Struggle metabolically, what it starts to do is it kind of recruits more neurons on board to get the job done. Hmm. So what may have been quite a specific, well-defined, well-functioning, efficient network that was required perhaps just on one side of the brain to solve a problem. And we can image people doing different types of problem solving, say in the FMRI scanner. The brain will start to recruit more neurons and more networks to get that job done. So the brain's pretty cool in that it goes from being, having these very well-defined, quite segregated networks.

• 36:31Speaker 01

  And as you age, we know that sometimes those networks get what we would call more integrated or they kind of tend to cooperate. And we might go from having one side of the brain doing the job to both, or perhaps more brain activated to get the job done. Hmm. So, you know, the brain's adapting and reacting and responding in its own way. Yeah. To find kind of workarounds to get the same solution. That process of peri-menopause perhaps speeds that process up. It speeds up that kind of, I suppose, I don't want to say it speeds up aging, but it does alter, the brain's metabolism does alter over this point in time.

• 37:10Speaker 01

  And it's possible that the shifts that we are seeing and that they're feelings of, part of the feeling of brain fog, and me in particular, because my sleep is pretty well managed, asked my husband, he's just like, I did 10 hours the other night and didn't weight. Whoa. Got like a 93 score on my Fitbit. Oh my god. My husband is just like always, he's like the one lying awake every night. I'm like just asleep for 10 hours. Wow. Um, but I still, so I feel pretty good, but my, my words, like man, I'm like, you replacing, I will just say stupid things, like one of the kids walked in the other day with a cap on and I went, you've got a nice lid. And I was like, no, I mean hat.

• 37:52Speaker 01

  Or I might, I will use words that are kind of similarly related semantically, but not quite correct. Yeah. Or I'll, I'll say, oh, that, that's, that's a nice soft apple instead of a nice hard crunchy apple. I'm like, what's so soft instead of crunchy? Just stupid things. Interesting. That a little word flips. And maybe, we don't know, maybe this is this process of different networks becoming recruited in this sort of change from pre-menopause to post-menopause, that, that shift may play out in terms of. You know, for me, it's this, this kind of like verbal problems or this verbal recall or sometimes just pulling a complete blank on someone's name. Mm hmm.

• 38:33Speaker 01

  Apparently, and the research shows that lots of women struggle with this during the perimenopause and menopause, and then it kind of recovers, perhaps as the networks react and adjust. Right. But of course, to ensure that happens, you want to be doing all the things that you probably talk about all the time, making sure your metabolic health is right, making sure your cardiovascular health is part of that. And people often think about the heart, but the blood vessels, the vascular part of cardiovascular health is so important because we couldn't do brain imaging studies if we didn't have this massively fine network of brain capillaries, of, of blood vessels in the brain that react and respond to the brain's energy demands, because that's how we do brain imaging.

• 39:16Speaker 01

  And if your capillaries aren't healthy, we know that capillaries are kind of the first things to go. That's why people with metabolic and, you know, cardiovascular problems, their kidneys go because of the fine vasculature, their, their retinas go. Your brain is, is the same. Same thing. That's why the brain is quite vulnerable as well. Like if you've got high, super high blood pressure or heart failure or, you know, type two diabetes, et cetera. Is there a way to increase blood flow to the brain? Well, by being, by, by, by managing your cardiovascular health. Yeah, so just, so like a workout, like a good workout would be. Yeah, yeah, a work, a workout does, but the brain doesn't just get more blood going to it because the heart is pumping faster. Okay.

• 40:01Speaker 01

  Because those, those capillaries react and respond to the neural demands. So brain imaging is like FMRI, a lot of that's of those beautiful, like kind of rainbow images you see where this part of the brain lights up or that part kind of dulls down, comes about via looking at shifts in blood flow, not necessarily shifts in neural activity, we're kind of looking at a proxy. And so that process is very, very tightly regulated and managed by the neural activity. It's like saying, hey, we need more blood here. It's not just like, mate, the. Pump faster and push more blood in, it's much more kind of carefully coordinated.

• 40:37Mindy Pelz?

  Mm hmm.

• 40:37Speaker 01

  Than that, which is why we need to take care of it.

• 40:41Mindy Pelz?

  Right, exactly. Okay, let's talk about, staying at the neuronal level here, let's talk about neurotransmitters. So, one of the studies I saw, this is like seven years ago, was about estrogen's impact on dopamine, serotonin, glutamate, GABA, acetylcholine, oxytocin, BNF, melatonin, like, and all, like, I call, I call, yeah, I call them estrogen's girl gang. I'm like, the first time I read this study, I was like, wait, she had like a gang of, of neurochemicals that helped her do this miraculous job. So if she goes away or she declines, what happens to these neurotransmitters?

• 41:22Mindy Pelz?

  Do we need, do they, like, do what you're talking about where they create an upsurge? So because they're having to compensate for a loss? Or do we need to use our lifestyle to try to coerce these other neurotransmitters to keep home, you know, keep pulsing through our brain?

• 41:41Speaker 01

  Neuro, neurotransmitters and neurotransmitter systems are incredibly complicated. And again, it's very hard to look at this in living humans because most of the information that we would have comes from, from animals in the research lab. And I would say that, that estrogen, all, all hormones are going to, that can cross the blood-brain barrier, of course, and get from the blood into the brain, will react and respond with a, you know, there's, there's receptors for estrogen throughout the brain, but it is localized in certain areas of the brain at higher density. The, the main receptors that we understand for estrogen are actually nuclear receptors, so they're not, um...

• 42:22Speaker 01

  Necessarily working at the level of the synapse where we've got estrogen can make a neuron automatically dial up or dial down the amount of neurotransmitter it's being, is being released. Typically, what we would see would be, it's not so much about the neurotransmitter that's being released, whether that's glutamate or GABA or serotonin or dopamine, it's about the receptor where we're probably going to see most of the action taking place. Right. Because you've got one, each one neuron, tip, almost always just makes one type of neurotransmitter, and it's the next neuron in the chain with the receptors for that neurotransmitter, which determine how the brain will react and respond. And the hormones

• 43:03Speaker 01

  themselves are probably because they go into the nucleus and they act on transcription factors on DNA to kind of promote or speed up or slow down protein synthesis, and that would be the synthesis of different types of receptors. So we're, we're kind of seeing a knock on effect here, not, I would, I think the language I would use myself would be on the neurotransmitter systems versus simply thinking we're going to get more or less. If we haven't got estrogen, we've got, we're getting less serotonin release, for example. What we are probably more likely seeing is shifts over time, and perhaps different shifts in different directions in different parts of the brain in terms of how the receptors

• 43:48Speaker 01

  are reacting and responding to perhaps again, initially that roller coastering level of estrogen, and then the, the lowering levels. Bearing in mind, of course, that estrogen is just one of many thousands of signals that our brain is making meaning of and processing. So, you know, it gets a lot of attention right now, which is, which is cool and good, but there's, you know, there's, there's a lot of other things kind of that the brain is, that, that the brain is making meaning of and is reacting and compensating to over time. Mm hmm. I'm mostly familiar with some of the work that's been done, looking at one at dopamine and two, it's serotonin. And I believe, actually in my woman's brain book.

• 44:32Speaker 01

  Can't remember every word I've written in it.

• 44:34Mindy Pelz?

  Oh, yeah, that happens.

• 44:36Speaker 01

  I was looking at the role of ovarian hormones on serotonin, that serotonin neurotransmitter system, because we have the receptors as well. And you could increase the level of estrogen and in some parts of the brain, you would see that that might dial up certain serotonin receptors. But in another part of the brain, at exactly the same point in time, that might dial it down. So again, it's never linear. Like, and as I said, even when it comes to that, the flourishing and pruning of dendrites, there's a U shaped relationship when we look at levels of estrogen. So it's super complicated.

• 45:19Speaker 01

  Estrogen will be one of the signals that are, that's involved with these, with these neurotransmitters and these signaling. And, and we, and we can see that play out when we zoom out a bit, of course, because we're seeing the networks react and flux and change. I'm not sure whether we've got enough of a clear story there yet.

• 45:36Mindy Pelz?

  Yeah, that makes sense.

• 45:37Speaker 01

  But calling it a girl gang's like, that's, that's kind of, that's fun.

• 45:42Mindy Pelz?

  I, that's what I like to keep it all fun. I actually, the first, the first time about 20 years ago, when I started learning hormones, a friend was, was walking me through a Dutch test, you know, the Dutch test? It's like, it's like a ovarian, it's a urine test. It's a dried urine test to see what your hormones are. And it shows you all the hormonal pathways. And, and I said to her, these pathways are so, these clinical names, nobody's ever going to remember. And she's like, yeah, they should be the names of nail polish, shouldn't they? And I was like.

• 46:13Speaker 01

  I don't know about that.

• 46:15Mindy Pelz?

  I was like, people would know it then, if you gave it a nail polish name.

• 46:20Speaker 01

  I think if we educate people carefully and thoughtfully, we can use the appropriate words. That's what I, I try and do. But, um.

• 46:30Speaker 01

  Colors versus, versus nail polish.

• 46:33Mindy Pelz?

  There we go, there we go, there we go. So I want to go back to what you said, though. You said that estrogen's not the only thing stimulating these neurons. So

• 46:42Speaker 01

  Oh, gosh, no.

• 46:42Mindy Pelz?

  So one of my thoughts, when I saw this study on how estrogen impacted, and I love the way you said, the neurotransmitter system, is, okay, so here we sit, like, I look at my eighty-six-year-old mom, and she'll tell you, she went through menopause with no problems at all. And I would say what I'm witnessing is a very sharp brain. Of course, she had a few moments. So like, what was going on with her lifestyle? Then I look at somebody like my sister, my older sister, who was a couple of years ahead of me, and I can tell you firsthand, she didn't, she didn't make it through menopause as well as she thought she did with her brain, just very quick to react to stress. And I start seeing that

• 47:26Mindy Pelz?

  every woman is having a very different brain experience. And you've mentioned it a couple of times. So

• 47:33Speaker 01

  Yeah, I mean, we're all, we're all different. We all, we all understand that.

• 47:36Mindy Pelz?

  Right.

• 47:36Speaker 01

  Same as pregnancy, right?

• 47:38Mindy Pelz?

  Oh, good point.

• 47:39Speaker 01

  Completely. And we, we can all have wildly different experiences of pregnancy, even if the sort of the biological shifts are the same and between pregnancies.

• 47:48Mindy Pelz?

  Yep.

• 47:48Speaker 01

  You know, you can have two completely different pregnancies yourself. So

• 47:51Mindy Pelz?

  That's true. That's true. So then where do you think lifestyle fits into this? Like, what the, the thing that has been really like weighing heavy on my heart is that the, the main message that's being brought to the public right now is just get on HRT and everything's gonna be okay.

• 48:10Speaker 01

  Yeah. The menopause conversation is wild right now.

• 48:14Mindy Pelz?

  Yes, thank you.

• 48:15Speaker 01

  I have lots I could say about this. Oh, boy, I was even reading a paper this morning that was published from some researchers here in Australia, talking about the, they've surveyed Australian women about their reactions to the massive commercialization

• 48:33Mindy Pelz?

  Yes.

• 48:33Speaker 01

  of menopause and how the conversations are being played out. And it was very interesting to me. And you can get pushback for this. And I've been, you know, there's all kinds of factions at the moment, for want of a better word. There was some lines in this paper, actually, I might even have it up on my computer. It's actually called All About The Money, if you can believe.

• 48:55Mindy Pelz?

  Mmm.

• 48:56Speaker 01

  Women were talking about the catastrophising narratives about menopause whereby commercial actors seek to connect with women and capitalise on their concerns for financial gain. So we're in this particular moment in time right now where the conversations around menopause are an active ingredient.

• 49:18Mindy Pelz?

  Yes.

• 49:19Speaker 01

  And the experiences that we have. And I, when it comes to the brain, the brain isn't prioritising,

• 49:26Speaker 01

  the brain is making sense of information from our biological body and how we, you know, the food we eat and how we sleep and how we exercise and our hormones and a million signals coming in from our body that we're not even aware of, that your brain is making meaning of, but also from the outside world, from what we see and hear, from the rising and setting of the sun to

• 49:47Mindy Pelz?

  Mm hmm.

• 49:48Speaker 01

  the messages that we are getting from our social media feeds as well.

• 49:52Mindy Pelz?

  Right.

• 49:52Speaker 01

  That is also an active ingredient. And I'm really fascinated by these. There's also a really interesting paper as well. I was, I was reading a couple of days ago, looking at the relationship between, I have all these papers.

• 50:06Mindy Pelz?

  I was just gonna say, you're the true scientist over there pulling out.

• 50:10Speaker 01

  This is like, this is my life.

• 50:12Mindy Pelz?

  I love it. I wish I was your neighbour.

• 50:15Speaker 01

  This was talking about, although you might not like this one as much, this was talking about nocebo effects and side effect experiences based on the conversations that women have about oral contraceptive use. And that's not to say HRT pro, we should be on the pill, we shouldn't, we should be on HRT, we shouldn't, rather that the conversations that we are having and where our attention goes will also influence the experience that we have.

• 50:45Mindy Pelz?

  Oh my god.

• 50:46Speaker 01

  And we need to also understand that our brain is making, making meaning of these, these signals and where we're getting our information from.

• 50:57Speaker 01

  Can sometimes, it's just, it's so great that we have all of these, you know, opportunities and options and tools available, but to just keep in mind that a conversation can shift a, an experience that you have of your own physiology. No, that's amazing. I've written a whole book called Baby Brain because I was so interested in this kind of social cultural narrative we have. I mean, and honestly, Mindy, I don't know whether you think this, I feel like as soon as a girl hits puberty, the conversation is about her broken female brain, as soon as you add some hormones and it's broken, right? Puberty, puberty blues, you know, baby brain, brain fog. It's all negative. There's never any, there's never any upside. Yep.

• 51:41Speaker 01

  And there's a, and there's this incredibly strong cultural narrative that has also driven the research whereby women are going the end stages of pregnancy, perhaps, or early motherhood, oh, my brain, I have baby brain, mummy brain, my brain isn't working. An identity. I can't do what I want it to do. But what's happened in pregnancy is that it has been reorganised to focus on the baby. Your social cognition networks have been focused, are there to adapt and respond and react to your baby, because that's kind of the mother nature's intention, is that you're, you're focusing on your baby and your memory and your cognitive function depends on your attention. It's what information you take in and what you filter out. We've now got mobile phones, which are almost like a baby as well, sucking our attention. Yeah.

• 52:26Speaker 01

  And so you can't use, possibly, you can't do everything. You're, you're trying, your brain is trying to multitask and task switch and you're, and everything doesn't work as well. It's not, it's not, as I always say, it's not women's brains that are letting them down when it comes to baby brain, but the, the way that women have been primed is like, well, if my brain's not working, something must be wrong with me neurologically. And so then that's driven the research, when it's probably more of a social support issue there for motherhood. So now we've got, we've gone from this pendulum swing from, in the nineties, women were taking hormone therapy to the Women's Health Initiative study, and this has been talked about endlessly. I was working in a breast cancer research centre when that study came out in 2002,

• 53:10Speaker 01

  and it was like, it was kind of like a war room panic station type situation. They were trying to like dampen down the fear around hormone therapy causing cancer. We're seeing a shift back now and in the last few years, this massive shift back. Massive. So menopause is starting at like, I've got friends in their thirties, like, oh, it's perimenopause. And I'm like, you're still breastfeeding. Yes. Maybe it's, maybe it's, maybe every. It's like a trend everybody wants on. And, and I understand that when we have gaps, we have swings and conversations shift to fill that narrative.

• 53:50Speaker 01

  But I think that it's a bit of a, I don't want to use, I'm going to say bull in a china shop. Sometimes the information is not necessarily being imparted thoughtfully and, and the way that we know from public health communications, from health literacy communications, the kind of space I come from. If we've got research, how do we talk about that in a really thoughtful, careful way whereby we communicate absolute risk? We're very cautious and careful, understanding that how we describe something can influence someone's experience. Yeah. And right now, menopause isn't quite. Yeah. Isn't quite in that space. And there are researchers out there that are saying, if we're going to be talking about menopause in the workplace,

• 54:35Speaker 01

  is that going to have knock on effects for gendered ageism perhaps? Mm hmm. Or is that enabling women to be able to talk to their manager in a way without stigma? Yep. We need to be using exactly the same approaches in health, about health communications and risk communication and um, treatment options and tools that we've always done within public health communications. But right now it's glitzy and it's having its moment and all the celebrities are getting on board. And there's a massive, you know, what does that paper say all about the money? So it's just this kind of crazy, perfect storm at the moment. Yep. Which I actually find quite interesting because the brain is going to be. The brain is making meaning of all of this.

• 55:17Mindy Pelz?

  Oh, that's interesting. So yeah, so go back to that because so let's start off with like social media because it's interesting. There's it's like the wild, wild west with when it comes to menopause and social media. And what I'm hearing you say is, so let's use, yeah, do you know about the do not care, we do not care club that has been started on social, yeah, yeah. And that woman is hysterical. Yes. So funny. But what you're saying, if I, if I take that and I put it in, in the context that you're talking about, if I'm watching this woman and I'm laughing and I'm then I'm like, wait a second, I don't care. That's right. I don't care either. So it is it now all

• 55:59Mindy Pelz?

  of a sudden, we get on the bandwagon of what, because the brain is constantly trying to make sense of its environment. And if its environment, it's your brain has been told, oh, you're not supposed to care, then are we really starting a whole generational of women that do not care?

• 56:15Speaker 01

  Right. Yeah. May maybe, maybe. I'm not, I don't think we've been, it's been having its moment just really in the last few years. So I'm not sure whether we can see knock on effects yet.

• 56:26Mindy Pelz?

  Yeah.

• 56:27Speaker 01

  Certainly, like if we looked at like data from the UK, which has looked at prescribing of say hormone therapy, that's kind of gone up and that's tracked alongside, you know, the media and the conversations around this, which is really great for lots of women who need, need that help. But is it, but are there more women perhaps over identifying?

• 56:45Mindy Pelz?

  Yep.

• 56:46Speaker 01

  Um, or attributing other health issues or other issues in their life to their hormone shifts when it might just be, you know, they've got a, you know, a very stressful life. And so the narrow focus in on the hormones being part of the conversation, we're not looking at, you know, this kind of holistic approach to what's happening in our, in our whole life. And so that's where the lifestyle has to come in. And I think genuinely, most people are also, I'm not just saying the only thing you do is take hormone therapy, that you should also address all of these other parts of your life. But to be fair.

• 57:27Speaker 01

  Well, I mean, hormone therapy is kind of the main tool that we've got right now. Hmm. And it's, and if everything, you've only got a hammer, everything looks like a nail, right? That's the, I keep saying that exactly. And all we've, and all we've got, and with, you know, if we look back across like your lifespan, say, and you were naturally cycling, you went on the pill, you didn't have an IUD, you didn't have many pregnancies, you know, your brain learned to react and respond to your ovarian cycles. When you reach perimenopause, all we can do is kind of add an exogenous estrogen and all we can do is just add in a bit more and then add in a bit more. We can never really kind of mimic that. True, yeah.

• 58:07Speaker 01

  Um, which is not necessarily a bad thing or a good thing. It's, it's just, this is the tool that's currently having its moment in the sun, which is excellent, but perhaps we should also be looking at what else is available and what else we can do. And I, but then I also say that with the caveat that I, you know, have, you know, I've had a great education. I live in a very healthy, wealthy part of Australia. It's very easy for me to implement lifestyle change. Hmm. I know how to go about that. There's lots of women in the world that just don't have any access to any of these tools or resources. And it's very easy for us to go, oh, well, you should just exercise more and manage your sleep.

• 58:51Speaker 01

  When, you know, they can't manage to feed their kids a healthy meal. Well said. Pay the power bill, you know, so the, the shiny celebrity messages are great for, you know, healthy, wealthy white women who are living in, you know, was not in poverty and don't have a lot of, you know, might just have a shitty husband. Hmm. But it's not addressing it from a public health perspective. And, and I, and I feel like we need to zoom out a little bit more and kind of look at how can this message land across populations? And that's what public health does. Right now, there's just, it feels like there's a little bit of a clash between. The careful, cautious, thoughtful approach of how can we help everyone and ensure access

• 59:35Speaker 01

  and, you know, justice for all versus take HRT because it'll

• 59:41Mindy Pelz?

  Everything will be better.

• 59:42Speaker 01

  Which it won't, which it won't.

• 59:44Mindy Pelz?

  Ah.

• 59:45Speaker 01

  You know, social media is having its, having its, having its moment. A 90 second reel is very different from a, a broad scale public health campaign that's looking across socio economic kind of strata.

• 59:57Mindy Pelz?

  Yeah, it's really, it's really well said and it's funny because I've been teaching metabolic health and hormonal health on social media for about 15 years now. And I always feel like my job is to bring information and help people make the best decision for them. And the trends in social media have strongly gone towards do this or you will get Alzheimer's. Do this or you will get dementia and that kind of fear mongering is not one that I would like to participate in. So I think what you're saying is the most, the most accurate statement I've heard anybody say, because I think you both, we both agree, like it's a really cool tool, but we've made it the centre of the conversation now.

• 1:00:39Speaker 01

  Yeah.

• 1:00:40Mindy Pelz?

  And it's time to broaden that out.

• 1:00:42Speaker 01

  I think, well, I think, I think it will shift back.

• 1:00:46Mindy Pelz?

  Yeah.

• 1:00:46Speaker 01

  But what I just wish was happening is that the, perhaps this is because of the world I come from and what I've spent years going, talking about and going to conferences too is how we talk about these things really matters in terms of the, the, the decisions that people go on and make the healthcare decisions. And when we talk about, well, this is going to increase your risk or decrease your risk. We don't, what does that even mean? We say, oh, it's got a 30% increased risk. What does that even, no one knows what that means. We've got to talk about absolute risk and absolute numbers and in a woman like you, if you were to take this. Therapy or treatment or not, this is how many more women or how many less women would

• 1:01:26Speaker 01

  go on to develop breast cancer or not develop dementia or would see their hot flashes fade away. We, we need more careful, thoughtful.

• 1:01:35Mindy Pelz?

  Yeah.

• 1:01:36Speaker 01

  And we've got evidence on how to do that, conversations around, around risk. And I mean, I don't know whether we're gonna, have we got time to talk about?

• 1:01:43Mindy Pelz?

  Yeah, yeah.

• 1:01:44Speaker 01

  Hormone therapy and dementia and Alzheimer's disease.

• 1:01:46Mindy Pelz?

  Yeah, no, I was gonna say, I wanna talk about that and then I wanna talk about, yeah, cause you said that and I was like, we need to talk about that. And then I wanna talk about societal stuff here in a moment before.

• 1:01:55Speaker 01

  Oh, yeah.

• 1:01:56Mindy Pelz?

  So, so, okay, so explain why HRT won't prevent dementia.

• 1:02:03Speaker 01

  Because right now, the data is very mixed. So there are lots and lots of different types of studies that have been looking at this over many decades. And some studies are saying, well, it looks like it might slightly increase risk or women who are taking hormone therapies, brains look slightly older than women who don't or have never taken it. Other studies are saying, if we look across a population, we see slight increases in risk. And then we've got a whole lot of other studies are going, look, we're not really seeing anything. Doesn't matter whether you've taken it or not. That's not what's really changing dementia risk profiles in people. It's a whole lot of other risk factors, which we can get into.

• 1:02:46Speaker 01

  And then we've got other studies saying, oh, well, actually, if you take it at the right age and you take it in this sort of formulation, it might decrease your risk. So right now, if we look at the consensus, we look at all of the studies that have been done. And I often say, another way to think about risk is, you know, those old fashioned, like weighing scales. And so you want to tip the scales in your favor towards not getting dementia.

• 1:03:10Mindy Pelz?

  Of course.

• 1:03:10Speaker 01

  So what can you do as a preventative? And what can you, you know, what's the kind of the harms and what are the, the kind of actions that we could do to alleviate risk? To tip it in your favor. But sometimes tipping something in your favor doesn't make any difference. I mean, People can get lung cancer if they've never smoked a cigarette, right? Yeah, well said. Right now, we've got all of these little, you know, weights that we can put on the side of prevention and weights that we can put on the side of risk. And hormone therapy, we're like, oh, we don't know whether we're putting it on this side or this side or this side, and how big that weight is. Right now, it's quite tiny. And there's some studies put it on one side of the scales and some studies put it on the other.

• 1:03:50Speaker 01

  So until we've got a clearer story and scenario where we can say, if you are this particular age and this is your particular risk, like this is your kind of current health status, this is perhaps, you know, have you got the, the types of genes that would increase or decrease your risk for Alzheimer's disease, and there's lots of different genes that may be involved. If you start taking hormone therapy at this time for this long and this kind of formulation and combination and method of delivery, then we might see your risk tweak slightly in your favour. Mm hmm. We're, we're not really at that point even yet. Interesting. What, what we know is, what the, and, and I'm not a clinician, so I would just stick

• 1:04:34Speaker 01

  to the clinical practice guidelines because that's where the consensus has, we've looked at all of the studies, we've put all of that together and we've reached a consensus is no menopause society, nor any dementia society or association in the world says, take HRT to prevent dementia, because the data doesn't support that conclusion. Interesting.

• 1:04:53Speaker 01

  And it would be unethical to say that. And that's fine, that's okay, I'm, I'm fine with that because there's a whole host of other things that we know, know absolutely will make more of a difference. But right now, this is the tool that's kind of got the shiny sort of attention. Yeah. What, what are some of those things? There's a whole host of other things. Oh gosh, it depends, we could look across like the lifespan in terms of. Where, where does kind of what was going to increase or decrease your risk? So we, some studies have come out looking and it's somewhere kind of around between forty, fifty ish percent of cases, there are modifiable risk factors and this is across the global population.

• 1:05:34Speaker 01

  If we were to manage all of these, we would see these declining numbers, this declining prevalence and people who are old, but we've got to go all the way back to early life and look at, one of the risk factors is how much education you have during childhood and adolescence. So the more years you stay in formal education, the more exposure you have to complex, enriched and educational environments, that kind of almost builds up what we call kind of brain, kind of reserve. It's almost like then you've got, it's further, further to fall once your brain starts aging. So, and, and if you're talking to women who are fifty, there's not a lot of point in talking about what education, how many years of education they had when they were a kid. Right, they're not thinking like that.

• 1:06:18Speaker 01

  It doesn't seem like a very fun tool to talk about. You can't do much about, you can't say, just put, put, here's, put an education patch on, an increased years of education. But would it be your learning? Right, but it could be there, you're learning, you're learning. So new, new information's coming in. Yeah, so perhaps staying engaged and learning, but the, the risk does, the, the, the risk profile in old age does appear, there's some of that is around early life education. And this is particularly in, in parts of the world where, you know, many girls don't stay in, in school beyond ages twelve, you know, you could stay in education up until your mid twenties if you were doing a PhD. So we've got these, these kind of big gaps there, depending on where you live in the world. Then we can look at midlife and this is where all of the factors

• 1:07:01Speaker 01

  that you kind of work at, work, you know, the space you work in around metabolic health and cardiovascular health and your cholesterol and your blood pressure and, you know, the, the type of lifestyle that reduces your risk of type two diabetes, all of those types of things, like your diet and your exercise and your sleep and your stress, and they all coalesce. But then we've also got factors which are incredibly unsexy, for example, untreated herring loss. I heard this, yeah. Yeah, lots of people have perhaps industrial related herring loss, you know, you worked in a factory or you were a farmer or you were, you know. You're a roadie for, I don't know, Taylor Swift, maybe. You know, your, your, your hearing loss has start, started to be impacted by midlife.

• 1:07:44Speaker 01

  And particularly back in the days when we used to have those massive thing, hearing aids, there was a lot of stigma around that. They're much more discreet now. People weren't getting hearing loss treated. And that's an incredible burden in terms of brain aging and, and risk for dementia because when you can't hear, you can't communicate, you can't interact, you just kind of withdraw from the world. And then your brain isn't in as an enriched, stimulating, engaged environment. You're losing your social connections, you're perhaps losing that ability to stay educated and engaged and in employment, et cetera. So your world shrinks down. And as soon as things happen where your world shrinks,

• 1:08:26Speaker 01

  your brain isn't being, being stimulated. And we see the same later in life with visual loss as well. So I believe around seven percent of cases globally of Alzheimer's disease could be kind of eliminated if everyone in midlife had hearing loss treated. Of course, there's different countries in the world that have got access to this or not. Yeah. Vision loss in late life is the same because again, your world shrinks. Right. And even if you've got your hearing and your vision and all of this, there's a real tendency, I think, like when you go to sort of this, and I've seen this in some people I know who are a bit older, was their world just gets really small. You know, it's almost like they kind of live within the walls of their own house or their own garden. And

• 1:09:06Speaker 01

  the most exciting thing that, that happened was, you know, the neighbour didn't pick up their mail. You know, there's some kind of like, it's a, they've got a very small world and they're not out in the world and get, engaging and reacting and responding and using our brain to, to explore and navigate and Yep. and engage. And all of these things, it's, it's, it's so important. And there were, there's other factors in there like depression, mental health issues, head injuries. And we think a lot about, you know, brain injuries or head injuries when we think about, um, you know, kids playing sport or.

• 1:09:43Speaker 01

  You know rugby players or or hockey, you know, players and head injuries. But there's a there's kind of an uptick in head injuries, particularly around men above the age of sixty who've climbed ladders.

• 1:09:55Mindy Pelz?

  Oh, that's interesting.

• 1:09:57Speaker 01

  Because of course, you know, your balance is a little bit off, but particularly men are still, I'm still going to empty the gutters. I, you know, I'm still capable of doing all of this and they fall off a ladder and hit their head. So we've got, you know, different types of risk factors in here, which go far and above and beyond simply menopause hormone therapy.

• 1:10:16Mindy Pelz?

  Yeah. Oh, my God. Yes. If if if you just listen to that little clip, that exactly is you went, that was so beautiful. And I was, it reminded me of my parents. They were in their early eighties when we went into Covid. And I was really clear that they were my top priority. They lived in the same area as me. And we used to, like, I would have them come into my office. We had everybody masked up and doing all the protocols. Because I was like, you have to get out of the house. You have to come in and get some kind of interaction. We got the nasal swab tests really early on. We were able to get them. And so I would nasal swab everybody and then we would have them come over because, but you could see that they they were incredibly social humans before the pandemic.

• 1:11:01Mindy Pelz?

  And there was a significant brain decline afterwards.

• 1:11:05Speaker 01

  Hundred percent.

• 1:11:06Mindy Pelz?

  Yeah.

• 1:11:07Speaker 01

  We see, and and we can all remember what that was like. It was like, because if it was like, if you leave your house and you see other people, you might kill them.

• 1:11:13Mindy Pelz?

  Right, exactly.

• 1:11:14Speaker 01

  I mean, it was just, it was a very frightening message.

• 1:11:17Mindy Pelz?

  It's so scary.

• 1:11:17Speaker 01

  Well, intent, perhaps it was very well intentioned then, and now we are seeing some of the the consequences. And as you said, for for older people whose worlds shrunk and they haven't been able to kind of grow that world again. And then we saw this with, you know, kids and young people as well, particularly those kids who were a little bit like socially awkward or going through adolescence. And adolescence is a time when the social cognition networks require social experiences to guide and and and wire up appropriately. And and again, they were told, well, if you leave the house or you go to school, you know, terrible things will happen. So the messaging there was incredibly confusing. And when people's worlds shrink, um, there of course, there's going to be knock on consequences. And perhaps in older people, we might see this in terms of brain aging.

• 1:12:01Speaker 01

  And in younger people, we saw this play out in terms of mental health.

• 1:12:04Mindy Pelz?

  Yeah.

• 1:12:05Speaker 01

  Sequences. And I even know myself being very aware of this and and thinking about it.

• 1:12:12Speaker 01

  It felt like your social fitness, you'd lost social fitness.

• 1:12:17Mindy Pelz?

  It's beautiful.

• 1:12:17Speaker 01

  And then it was easier, and I noticed people, it was easier for people to opt out, like you'd organise an event. I remember organising like a book event before Covid and everyone go, I'm coming. And then everyone that said they were going to come along would come along. And then after Covid, people would say they were going to come along and then they just wouldn't. Because people would say, oh, well, they've, they've been, they've been told that they can opt out and they don't need to show up. And so then it would be like this really tiny little event and I'd feel a little bit sad. Because people have lost their social fitness and just go, oh, I'm not going to bother anymore.

• 1:12:46Mindy Pelz?

  Yeah. Still, would it be fair?

• 1:12:48Speaker 01

  Hopefully, hopefully we're seeing that.

• 1:12:50Mindy Pelz?

  Yeah.

• 1:12:51Speaker 01

  It'd be interesting to see what the long term consequences of

• 1:12:53Mindy Pelz?

  I bet.

• 1:12:54Speaker 01

  brain health are going to be like. It'll be, and we'll be able to perhaps look. I mean, maybe you're not, we'll be able to look back and go, well, this state or this city or this part of the world, you know, was more restrictive and this wasn't. And we may be able to see, see that play out. Who knows?

• 1:13:10Mindy Pelz?

  That would be interesting.

• 1:13:10Speaker 01

  I'm sure there's people studying those kinds of things, yeah.

• 1:13:13Mindy Pelz?

  So would it be, would it be fair to say then, one of the key things you want to do with your brain as you age is to put itself in different environments?

• 1:13:22Speaker 01

  Yes, one hundred percent, one hundred percent.

• 1:13:26Mindy Pelz?

  Because each new environment is going to create new neuronal pathways. So this idea of shrinking your world is a, is a, is a classic age problem. You know, oh, I can't go to the gym, I can't do the things, I'm not going to work and your world gets smaller, smaller, smaller. But what I'm hearing

• 1:13:43Speaker 01

  Yeah.

• 1:13:44Mindy Pelz?

  is we need to put the brain in as many different environments, whether you're eighty five or you're twenty five, to keep its neuroplasticity at its best.

• 1:13:54Speaker 01

  Hundred percent, trying to expand your world. And some people may need support to do that.

• 1:13:58Mindy Pelz?

  Yeah.

• 1:13:59Speaker 01

  Um, you know, and we, and even think about, I had a family member who moved my, she was living with my mum and stepdad for quite a while. And then she moved into an aged care facility and her world opened up and expanded because it's not just like my mum and stepdad going in a couple of times a day to see her. And but she's got all of these different people coming in. And we often see people when they move into aged care, not everyone, you know, they see a bit of an uptick in their health because suddenly they're in a new environment. They're probably being fed. Well. Yeah. Maybe better. You know, there's more people, there's more interactions, there's this whole new environment and so that life has opened up a little bit and you sometimes see a bit of an uptick and and their health for a little while. So our brains evolved because we move and because we navigate through the world.

• 1:14:44Speaker 01

  Mm hmm. There's some really cool research looking at different types of occupations people have. Hmm. And how that provides resilience to aging and resilience to dementias and other types of Alzheimer's disease. And the occupations which provide the most protection are taxi drivers, not Uber drivers with their mobile phone navigation, but like the old style taxi drivers and ambulance drivers. Uh, because they're constantly navigating and decision making and having to make complex cognitive decisions while they move through the world. And then they were like, oh, was it just driving vehicles? So they've like compared them with like pilots who don't have to make the same. Yes. Pilots aren't turning corners up in the sky, right? They're just flying in a straight line. Fascinating.

• 1:15:27Speaker 01

  They'll have to make some adjustments, right? And they will like say a ship's captain. But it's definitely that constant challenging decision making. Say, imagine an ambulance driver, like you watch those TV shows, right? There's a lot of information coming in. That they're like making meaning of very quickly. They're having to kind of think ahead. They're having to, you know, talk to the hospital, they're having to navigate. They're not, they're not going where they've been before, like a bus driver driving back and forward. And, and our brains evolved to navigate and, and find our way through the world. And that's reasonably cognitively demanding. If you, you know, cast back, you want to take an evolutionary perspective. We had to hunt and we had to gather and we had to remember where

• 1:16:12Speaker 01

  the berries were and how to, you know, socially coordinate to hunt down the animals and you know, find our way through the world. And when we stop moving, not only is. You know, the biological consequences of not moving our bodies, but we haven't got that same visual and auditory and sensory input kind of streaming in and challenging our brains.

• 1:16:35Mindy Pelz?

  So this is why I've seen some studies on travel. You know, you go and put yourself in a different country, maybe even with a different language, like the amount of brain energy that is needed is has to be tremendous.

• 1:16:48Speaker 01

  So. And then if you go to a country where the cars drive on the opposite side of the road and the steering wheel is on the opposite side of the car, I think, I do not think that there's anything more cognitively demanding than navigating from the airport, picking up the car hire at the airport to like, you know, your first night stay and like that everything's on the opposite side.

• 1:17:07Mindy Pelz?

  That's crazy.

• 1:17:08Speaker 01

  It's very good, it's very good for you.

• 1:17:09Mindy Pelz?

  Yeah.

• 1:17:10Speaker 01

  Quite stressful though.

• 1:17:11Mindy Pelz?

  I bet.

• 1:17:12Speaker 01

  You have to have a lot of emotional regulation within a family.

• 1:17:15Mindy Pelz?

  True, that's true. So talk to me about societal impact. There was recently, I about a year ago, I'd learned of a woman named Carol Gilligan, and she was a feminist psychologist who studied teenage girls back in the 1980s. And what she discovered there was that before a girl's hormones come in, if you ask a boy and a girl a question, they'll give you very direct answers, like, what do you want to eat at eight or nine, they'll tell you exactly what they want to eat. When you get to about 11, if you ask that same question, the boy will tell you exactly what he wants to eat. By the time the woman, the girl will be like, ah, she'll hesitate a little bit.

• 1:17:58Mindy Pelz?

  By the time you ask that question at 13, at four, 14, the boy will tell you what he wants to eat, but the girl will say to you, I don't know, what are you going to eat? And so what Carol Gilligan came out of that research and said that there was a conditioning of the female brain that occurred because of social messaging. And the social messaging that a lot of girls got was you are worthy if you are selfless. You are worthy if you don't rock the boat. And one of the theories I have.

• 1:18:30Speaker 01

  Goosebumps.

• 1:18:31Mindy Pelz?

  Right? One of the theories I have is that menopause is actually the unwinding of that.

• 1:18:37Speaker 01

  Oh, I like that.

• 1:18:39Mindy Pelz?

  Yeah.

• 1:18:40Speaker 01

  Yeah, I like, I like that.

• 1:18:41Mindy Pelz?

  Give me your neuroscience perspective.

• 1:18:44Speaker 01

  Oh, I'm not sure. I'm not sure, oh gosh, I'm not sure whether I could neuroscience my way through that, but I think it's a cool idea. And I've looked a little bit at the, at what happens to, to girls and boys when they go through puberty, because I think that's, that's really fascinating, because really that's when, you know, we've got the, in utero, the, the brain kind of patterned up, ready to react and respond to the hormones of puberty. And in boys, that's testosterone and in girls, that's estrogen, but also progesterone. And we know that pubertal and adolescent brain development tracks more closely to pubertal stage than chronological age. Um, so, you know, there's a bit of a narrative that, oh, girls' brains

• 1:19:26Speaker 01

  are more developed than boys at the same chronological age. But that's just, on average, the girls have gone through puberty a little bit earlier than the boys.

• 1:19:34Mindy Pelz?

  Yep.

• 1:19:34Speaker 01

  Um, but you could get an early pubertal girl, boy, say, and a late pubertal girl, who's, you know, so the boy's brain would be slightly more further along that developmental track than the girl. So we're, so we're, typically, we're talking about averages, and I think it's always useful to think about individual trajectories.

• 1:19:51Mindy Pelz?

  Mm hmm.

• 1:19:52Speaker 01

  Um, I'm familiar with some research that's come out of work here at Australia, looking at how girls start to react and respond socially and emotionally, both to other people, but also their perceptions of themselves going through puberty based on the social context in which they experience puberty. So we've got girls, perhaps, who, they might get their period at nine or 10, which is early, but it's still on the normal curve, they're not five.

• 1:20:20Mindy Pelz?

  Yeah.

• 1:20:20Speaker 01

  Um, early, so I would say early but normal, because someone's going to be on one side of the distribution curve and someone's, someone's going to be later. And what happens when a girl goes through puberty early? She's going to be, feel very different from her, you know, her, her cohort, her friends around her. She's going to be, one, noticing about how her body has changed in, in comparison to her friends. Other people are going to start reacting and responding to her very, very differently. And then you've got a girl who goes through puberty, you know, she gets a period at 12 and a half, like most of her friends, or on average, and then girl goes through later. So those girls who go through puberty earlier than their friends are much, much more vulnerable, particularly to go on to develop perhaps anxiety and depression through that pubertal

• 1:21:04Mindy Pelz?

  Fascinating.

• 1:21:04Speaker 01

  transition, but also later in life. Now,

• 1:21:08Speaker 01

  Kind of compounding that in some girls, but not all, is what drove that perhaps earlier but normal pubertal transition could perhaps be earlier life stress or trauma or abuse. Not always, some girls are just like on the early, early side of normal, someone has to be first. Right. But those girls are more vulnerable, but it's interesting because if you look at boys going through puberty, depending on, you know, early, average or later, a boy who goes through puberty earlier than his friendship group or what happens to him, it's all big and tall and hairy and his voice drops. And everybody wants to be him. The alpha, alpha in the group. Yeah. And he's almost, and then every, all of the, all the little dudes cluster around him and he's like the alpha. And he's kind of protected in a way.

• 1:21:53Speaker 01

  Now, he might go on and has the, the parts of his brain, and particularly we see this more so in boys, and it's hard to know whether it's testosterone or whether it's society, is it, you know, mother nature or the patriarchy? He will seek out more sensations and do, do kind of risky business, which teenage boys, and I've, I know, I know all about teenage boys, slightly earlier. So he might get up to more mischief with older, older friends. But typically he's going to be less vulnerable to the mental health, you know, issues that feeling like not part of the group versus the little dude who still hadn't grown at 16. And we all remember them from, from school, there would always be someone that was kind of on the far end of the distribution curve.

• 1:22:35Speaker 01

  So we've got here, kids going through puberty at different ages and stages, but the vulnerabilities come about by the social context in which that is happening. So it's not simply just the hormones in the brain interacting, it's the hormones, the brain interacting with the social context. And then, you know, how well supported, like you've got an early pubertal girl, maybe she's got an incredibly supportive, aware, you know, her mum and her dad kind of can see this happening and they provide all of the right supports and nurturing around her and she goes to a great school and she's got good friends and she's just, is going to be okay. But perhaps there's a girl who's just neglected and just really struggles and, you know, she hit puberty early and doesn't really kind of know how to cope. So.

• 1:23:18Speaker 01

  That social cultural context around the biology of puberty is incredibly important. And I did speak to one researcher in my book, Jane Mendel, who's a who researches puberty. And she said, particularly in girls, puberty kind of provides an emotional blueprint for how you will react and respond, particularly in those reproductive transitions later in life. Because one, you've had that psychological experience of perhaps it was just traumatic and horrible. And maybe your first period was a scary frightening experience. So maybe it was like cool and awesome. It could be anywhere in between, right? Um, but girls who go through puberty early often then maybe their brain becomes sensitized. And then they're more likely to have PMS symptoms.

• 1:24:02Speaker 01

  And then maybe then that kind of compounds, they're more likely to develop depression. Then they're going to struggle, you know, perhaps through pregnancy and early motherhood. So we kind of see a snowballing. Right now, I think it's very hard and it would be perhaps unwise of me to say, well, there's a hormonal basis. There's a biological basis. There's always going to be this collision of the biological and the psychological and the social.

• 1:24:26Mindy Pelz?

  So well said. Yeah, and, and you know, it, when I heard about Carol Gilligan's work, I was like, okay, if that's what happens when hormones come in, then is the opposite happening when hormones go out? That was the hypothesis that I was thinking through. I actually tried to even get, get a hold of her to see like, but she only studied teenage girls. But go ahead, what, what are your thoughts on that?

• 1:24:52Speaker 01

  I mean, I guess you get more cranky and irritable when, when your hormones are kind of on the decline. Or some women, you know, don't notice, other women just, you know, feel that very, very deeply. I, I will be fair, I think it's really hard to take, to say, oh, it's just the hormones that are driving perhaps that. I don't care anymore, the I don't care club. Perhaps in Australia, we might use different language. Yeah, I, I, what would you, what would you call it? I'm curious. Perhaps you just give less, the, the give less fucks. Yeah. But how much, it's, it's kind of hard to tease that up because perhaps, you know, and I think about myself. I turned 50 at the beginning of the year.

• 1:25:36Speaker 01

  My oldest son is doing his final high school exam, starting in 10 days. And he's going off to university, you know, going away to college. He's going travelling in Asia over the summer holidays. Then he's going away to university. You know, I've written all of these books and I'm kind of having a year to just kind of suit myself and go to loads of parties. And going with friends around the world and, and, you know, and I, and I turned 50 and I'm, there's, there's so many things going on. Is it just the hormones that have changed? Or is it just as you get older and you're in a different place and space and stage of life?

• 1:26:16Speaker 01

  And, and some people, I know, but I, I, I think, I feel like I see more people struggling. Or at least people that are struggling are talking about it more. Maybe. And so then maybe then everyone goes, oh, perhaps I should have a terrible time too. So let's get together and moan. Yes. Versus the, the, as if you talk about, there was, there was, there was a, this is this whole, like, the, the conversations that we see around us, how they influence and shape us. There was a menopause kind of inquiry or kind of conversation and, and Parliament here in Australia last year. And one of the parliamentarians who was talking about this said, this isn't about women who've had a, a, a great time. And they've gone through menopause and, and it's been fine. And we're patting them on the back and say, well done you.

• 1:27:01Speaker 01

  This is about the woman who struggled. And I was like, I don't think that we should only ever listen to and describe the stories about the terrible times. Yes, it's. We should also look at, well, hey, what about those women who did have? Yes. Like, instead of patting them on the back and being a bit snarky and going, well done you. How about we go, well, what have you done? Like, is this your mindset? Like, what have you done to have this great time? Yeah. What can we learn from you? Because surely. Yeah. That's what you want. Yeah. How can we, like, learn from the wisdom of those who have gone before us? Um, I think, like I said, I feel like at every reproductive life stage, we have this very strong tendency just to focus on all of the things that go wrong.

• 1:27:44Mindy Pelz?

  Yeah, it's so well said.

• 1:27:45Speaker 01

  I don't think that as our daughters are entering puberty, we are there catastrophising it and, you know, you're going to hemorrhage every month and

• 1:27:53Mindy Pelz?

  Yeah.

• 1:27:53Speaker 01

  you're going to have terrible period pains and it's going to be awful and it's going to be humiliating and people are going to start looking at you, it would hypersexualise you and la, la, la, la, la. We're, we're kind of trying to provide, I don't have daughters, but I imagine that's not the messages that most people give their daughters.

• 1:28:09Mindy Pelz?

  No, not at all.

• 1:28:10Speaker 01

  It's going to be much more positive and empowering.

• 1:28:11Mindy Pelz?

  Yes, of course.

• 1:28:13Speaker 01

  And we're going to be using wisdom to educate. And I would like to think that that was what we were doing at this stage in life, but I just don't feel like all of the conversations are there yet. But I'm very optimistic that they will get there. And I'm very optimistic also that all neuroscience research that comes through that sort of shows the upsides and the benefits and what kind of peaks at midlife and cognitive functions that we see continue to improve into old age, because I feel like all we do is grieve and talk about what we've lost.

• 1:28:49Mindy Pelz?

  So well said.

• 1:28:50Speaker 01

  And not what we're potentially gaining.

• 1:28:52Mindy Pelz?

  Oh, that, that is so beautifully said. And that was actually the whole, a big premise of my book, Age Like a Girl, was to talk about what's right with menopause.

• 1:29:01Speaker 01

  Oh, good.

• 1:29:01Mindy Pelz?

  As opposed to talking about what's wrong with menopause. But what you have offered me is a deeper context today on the environments that we keep putting our brains in are going, could have a direct influence on our experience of menopause. And I, I too have been struggling with the direction the conversation's gone, just because it's so limited. And wanting to open that up a little bit more is, is so important. So, talk about your five day course. I know you are doing incredible work educating and you have a course coming up where everybody can learn from you. So, how do, how do my people find you?

• 1:29:41Speaker 01

  Yeah, I have a suite of professional development courses and applied neuroscience and brain health. So some of them are kind of like the basics of neuroscience and brain health, kind of a one O one type course. And I've also got one around women's brain health across the lifespan. I could say womb to tomb, which is, so it's, it's accredited if people want to get their, you know, professional development hours for their different associations and organisations. And I look through the female lifespan. So in utero, childhood, puberty, menstrual cycle, adolescence, pregnancy. Oh, and then I write, and it kind of tracks along the chapters of my book, The Woman's Brain Book, which I first wrote in 2017,

• 1:30:25Speaker 01

  and I just did a second edition update, which came out this year, because so much has changed even in the last five or six years. It was quite funny though, because when I first put the, the, when I was writing the book, and the, and the, and the course maps along, maps along the chapters of the book through the lifespan. But it was funny because I, I think I went from adolescence, menstrual cycle, I think I had a chapter on anxiety, depression and mental health, and then pregnancy. And then I was like, oh, I forgot the bit about how you get pregnant. So there's also a chapter in there on sex, sex, love and relationships.

• 1:30:57Mindy Pelz?

  Amazing.

• 1:30:57Speaker 01

  I was like, oh, you've got to talk about how.

• 1:31:00Mindy Pelz?

  That's the problem. That, that's the problem with writing a book. It's so, it's so stagnant. It's like you put it there and you can't go change it. And then when you get to change it, you got to, and then watch.

• 1:31:10Speaker 01

  And I was like, oh, need a chapter on how you get pregnant. And, you know, I, I still find that a little bit embarrassing to talk about. And ageing. So the, so the, the course is designed, there's online lectures where I, I kind of teach the basics. There's various kinds of tasks which enable people to take a closer look at various kind of academic articles, or go and listen to webinars, or explore the neuroscience underlying each of these life stages in a little bit more depth. And then we have lots of time for live Q and A. And then it culminates, and this always scares people, but then people end up loving it. Giving a little five minute presentation on a topic of their choice.

• 1:31:49Mindy Pelz?

  Wow.

• 1:31:49Speaker 01

  That's relevant to the work that they do. So I have teachers and I have psychologists and coaches and therapists. And I've had people from so many different professions come in and then they kind of pick one of the topics. And then like, what have I learned about the neuroscience of, maybe, you know, you're, you work in a girl's private school and you want to talk about the neuroscience of puberty. And then they'll give like a little five minute talk, which is fascinating and it's so good for me because that's how you iterate and learn.

• 1:32:15Mindy Pelz?

  Yeah.

• 1:32:16Speaker 01

  Professionally yourself is by how, what meaning has someone made of this neuroscience? And how have they integrated that into, into the work they do? So I've tried, I'm not just teaching theory. I've tried to make it as practical and applied as possible for, for, for lots of people from different kind of professional backgrounds and disciplines. And we have people from all over the world.

• 1:32:35Mindy Pelz?

  I want to join. I'm going to join.

• 1:32:38Speaker 01

  Do it too.

• 1:32:38Mindy Pelz?

  I know, I just, I find.

• 1:32:40Speaker 01

  You think of a little presentation?

• 1:32:41Mindy Pelz?

  I, I'm good. I, I'm happy to. I find neuroscience just fascinating. I've actually thought about going back and getting my PhD in it.

• 1:32:50Speaker 01

  Oh, you should just do one of my courses.

• 1:32:52Mindy Pelz?

  Exactly. That would be a lot more time efficient for me.

• 1:32:54Speaker 01

  Yeah, yeah, yeah. Yeah. So some of them I've got to, I've, I've got a 17 lesson curriculum, which is applied neuroscience and brain health. So we kind of go through, oh, we've been talking about, about neuroplasticity and neurons and synapses and transmitter systems. But we talk about cognition, emotion, motivation, goal setting, brain aging, diet, exercise, you know, sleep, stress, social connection, et cetera. And I teach that across, there's a 10 day intensive. It's like really full on. Or there's a 12 week slow version. And so I just have all of these incredible people from all around the world come and do these courses.

• 1:33:29Mindy Pelz?

  Beautiful.

• 1:33:30Speaker 01

  And for me, that's how I've learned how to teach as well, is by just interact, you, you, you know, you learn to teach well and explain the brain.

• 1:33:41Speaker 01

  By getting feedback from other people about what's landed and what hasn't.

• 1:33:45Mindy Pelz?

  Yeah.

• 1:33:46Speaker 01

  I just. And I mean, my favorite thing in the world is talking about neuroscience to people. This is just.

• 1:33:52Mindy Pelz?

  It's amazing.

• 1:33:53Speaker 01

  It's like a sort of Venn diagram of all my favorite things.

• 1:33:55Mindy Pelz?

  How, how do people sign up for the course? We'll leave a link, but is it, do they just go to your?

• 1:34:00Speaker 01

  Yeah. So Dr. Go to DrSarahMackay.com. And if you sign up to like my newsletter, I have like a little, like kind of mini email course. That'll just get you in the system and then the enrollments for, it's called In Her Head. Actually, I wanted to call this book, The Women's Brain Book, I wanted to call it In Her Head. And the publishers were like, meh, sounds, and this is in twenty seventeen, sixteen, seventeen. They were like, oh, it might, and it, All In Her Head, it might sound like the girl on the train or the woman in the window. They might think it's domestic noir, like a novel, not.

• 1:34:32Mindy Pelz?

  Yeah.

• 1:34:33Speaker 01

  Brain health. And so in Australia, they like what you see, what it says on the can is what's in the can. So it got called The Women's Brain.

• 1:34:42Mindy Pelz?

  Yeah, it says it.

• 1:34:43Speaker 01

  That is what it says.

• 1:34:44Mindy Pelz?

  Yeah.

• 1:34:44Speaker 01

  Um, and then I still really liked All In Her Head, so I called the course.

• 1:34:49Mindy Pelz?

  Good, good.

• 1:34:51Speaker 01

  All in it, in her head.

• 1:34:53Mindy Pelz?

  Yeah.

• 1:34:53Speaker 01

  So yeah, that, that's what the course is called. It's running for the first time. It's been on ice for the last two years and I'm just at a massive update based on the research. But like honestly, there was research that came out, you know, today, research that came out a couple of months ago. I'm constantly iterating and updating.

• 1:35:12Mindy Pelz?

  Amazing.

• 1:35:12Speaker 01

  Cause there is just so much work being done and shout out to all of the scientists who are the ones at the coalface doing all of the hard work. There's some really amazing research groups around the world that are driving this women's brain health.

• 1:35:25Mindy Pelz?

  Yeah.

• 1:35:26Speaker 01

  Field forward. So my, I, I can only do what I do because they're all doing the hard work.

• 1:35:31Mindy Pelz?

  Amazing. Well, Dr. Sarah McKay, this was an incredible conversation. I can see when you're like, I could go three hours. I'm like, I could go three hours, like.

• 1:35:40Speaker 01

  I, we, we've only done menopause like I've got. Yeah.

• 1:35:44Mindy Pelz?

  So we'll bring you back. We'll bring you back to do more. I'm very interested in your course and I just think there's never been a greater time to understand yourself than this moment. And you know, that's what I love about neuroscience is you really start to understand human behavior in a new way. So yeah, thank you.

• 1:36:03Speaker 01

  It's endlessly fascinating. Yeah. Thank you for giving me the opportunity to talk about it.

• 1:36:07Mindy Pelz?

  Of course, of course. And we'll leave all the links and send everybody your way and I'll see you in your course. So, and I'll bring you back. So thank you for your time. I really appreciate it.

• 1:36:18Speaker 01

  Thank you.

• 1:36:20Mindy Pelz?

  Thank you so much for joining me in today's episode. I love bringing thoughtful discussions about all things health to you. If you enjoyed it, we'd love to know about it. So please leave us a review, share it with your friends and let me know what your biggest takeaway is.