The Menopause Doctor: This Diet Delays Menopause! They're Lying To You About Menopause! Menopause Is Shrinking Your Brain! - Dr Lisa Mosconi

Meet the woman behind the scientific research revolution that could change the lives of 50% of the world’s population Dr Lisa Mosconi is the associate professor of neurology and radiology at Weill Cornell Medicine and director of Women’s Brain Initiative and Alzheimer’s Prevention Program. She is also the author of the books, ‘The XX Brain’, ‘Brain Food’, and ‘The Menopause Brain’. In this conversation Lisa and Steven discuss topics such as, how the menopause impacts the brain, the link between menopause and Alzheimer’s, why sex hormones are essential for brain health, and the truth about hormone therapy. 00:00 Intro 01:05 Why People Should Listen To This Conversation 03:10 What People Need To Know About Menopause And The Impact On The Brain 05:21 Who Is Lisa Misconi? 07:08 Why Hasn't There Been Research And Investment Into Menopause? 13:28 What Is Menopause And Signs 14:54 Menopause Stages Start Before You Think! 18:07 What's The Youngest Person With Menopause 21:35 Perimenopause Transition 28:54 Menopause Brain Scans 32:09 Some Women Have More Shocking Brain Scans Than Others 33:28 Behavioural Changes From Menopause 37:05 How Many Women Experience Brain Fog? 38:53 Menopause Rewires The Brain 40:11 Symptoms As A Result Of Brain Change 42:57 Isn't The Cure Simple? 50:50 What Age Should We Think About Treating/Preventing Symptoms 51:50 Going Deeper Into The Stages Of Menopause 57:34 Link Between Suicides And Menopause In Women 01:01:55 Brain Fog Over Time With Menopause 01:06:28 The Benefits Of Exercise 01:10:04 Link Between Exercise And Alzheimer's 01:13:11 Caffeine, Sleep And Menopause 01:17:08 Is Alcohol Bad For Menopause? 01:19:52 What Toxins Should We Be Aware Of? 01:21:40 Specific Foods That Help Stave Off The Menopause 01:24:42 Are Supplements Needed In Our Diet? 01:29:06 What Is The Evolutionary Reason For Menopause? 01:36:14 Does Menopause Make You Sad? 01:39:11 Surgical Menopause 01:44:17 Isn't It Just Ageing? 01:52:07 When Will I Go Through Menopause? 01:55:48 Last Guest Question You can get in contact with Lisa’s team to discuss enrolling in her studies, here: https://neurology.weill.cornell.edu/research/womens-brain-initiative You can access the results from Lisa’s research on brain changes during the menopause, here: http://drlisamosconi.tiiny.co/ You can access a time lapse video of changes to the menopause brain, here: http://brain-shrinking-video.tiiny.co/ You purchase Lisa's most recent book, ‘The Menopause Brain: The New Science Empowering Women to Navigate Midlife with Knowledge and Confidence’, here: https://amzn.to/3VncZgS Follow Lisa: Twitter - https://bit.ly/3XeTpWM Instagram - https://bit.ly/4ek0Ulh Watch the episodes on Youtube - https://g2ul0.app.link/3kxINCANKsb My new book! 'The 33 Laws Of Business & Life' is out now - https://smarturl.it/DOACbook Follow me: https://beacons.ai/diaryofaceo Learn more about your ad choices. Visit megaphone.fm/adchoices

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

• 0:00Speaker 00

  This is evidence of what women have been saying all along. Menopause changes the functionality of your brain.

• 0:06Steven Bartlett?

  It looked there like the brain was basically shrinking.

• 0:08Speaker 00

  Yes, and there are two reasons why this is very important. Number one, and this is something that impacts not all women, but also all men.

• 0:17Speaker 02

  Dr. Lisa Misconi is a neuroscientist

• 0:20Speaker 03

  whose groundbreaking research has discovered and revolutionized our understanding of the menopause

• 0:25Speaker 02

  and the adoptions that can be made in order to thrive during this time of life.

• 0:28Speaker 00

  This is new research looking at brain changes during the different phases of menopause, a process that can take years. So this is before menopause, this is after.

• 0:38Steven Bartlett?

  Wow.

• 0:38Speaker 00

  And this shows a 30% drop in brain energy levels. So when women say that they're having hot flashes, insomnia, depression, two-thirds of all women experience brain fog. Those are brain symptoms, not recognized in medicine. In fact, we know that black and Hispanic women may experience more severe symptoms. And women have been portrayed as mentally unstable in medicine for a really long time. We need to change that. But on top of doing the research, I am actively doing a number of lifestyle adjustments that are known to have a positive effect on menopause.

• 1:13Steven Bartlett?

  So let's have a look at these things then.

• 1:15Speaker 00

  Okay, the first thing I do is...

• 1:17Steven Bartlett?

  Dr. Lisa, one of the things I found fascinating is I read that there was a miracle food for delaying menopause.

• 1:23Speaker 00

  A diet rich in... had been linked with a later onset of menopause.

• 1:28Steven Bartlett?

  By how much?

• 1:28Speaker 00

  Three years.

• 1:35Steven Bartlett?

  Dr. Lisa,

• 1:38Steven Bartlett?

  there's a high chance many millions of people have clicked on this conversation for whatever reason. Men, women of all ages. What is the reason that all of those individuals need to listen to this conversation about the menopause brain?

• 1:57Speaker 00

  I think the main reason is that women are important and women's health matters. And women's health has not been taken seriously in society and in medicine for hundreds of years. And this is time to really change the conversation and help and support women throughout an interesting and complicated transition that all women go through, because this will make us all better. This is important for society as a whole.

• 2:23Steven Bartlett?

  Why should men listen?

• 2:25Speaker 00

  Men should listen because, number one, it's really important to understand what happens to your spouse, to your friend, to your mother, to your aunt. And all women go through menopause. So this is something that impacts not all women, but also all men, really. And I find this so interesting and so, really so heartwarming when I receive emails from men, and they do a lot, like daily. And they're saying to me, like, you know, thank you, you really helped me understand my wife better, or you really helped me understand my mother, or my sister, my daughter. And now as a family, we're making different decisions, or we're having different conversations, and everything's just better. It's also really

• 3:09Speaker 00

  important to understand how humans actually work, you know, physiologically, medically. And there's so much in society that has been done against women, or to help women, but that didn't quite work out. And we're now understanding what's really important to do and not to do to support women's health.

• 3:29Steven Bartlett?

  I've had conversations about menopause before. I've had a few conversations on this podcast with friends, with one of my friends, Davina McCall, about menopause. And it's really opened my eyes. Oh, you know her?

• 3:38Speaker 00

  Yes, yes, yes, she's wonderful.

• 3:39Steven Bartlett?

  Fantastic. Absolute shining light in my life. And she's talked to me about the menopause. But very few people, if, I would say, and nobody's talked to me about this extra word that appears on the front of your book, which is the word brain. I didn't realise that there was any impacts on a woman's brain when she goes through menopause. But that seems to be what you focused much of your work, especially in this book, to identify and to illuminate. What do we need to know, from a very top line perspective, about the impacts of menopause on the brain?

• 4:16Speaker 00

  What we need to know is that as a society, we tend to really focus on only half of what menopause is all about, which is fertility. And as we were talking about before, most people are aware that at some point for the other in a woman's life, fertility ends, usually around midlife. And that's the end of your menstrual cycle and the end of your ability to have children. But what the vast majority of people do not realize is that menopause also impacts the brain in a very significant way. They were only starting to gather real data about. So the research is ongoing. And what we and others have shown is that

• 4:57Speaker 00

  menopause is actually a renovation project on the brain. And the vast majority of women will experience brain symptoms or neurological symptoms during menopause. So when women say that they're having hot flashes, night sweats, insomnia, anxiety, depression, brain fog, two thirds of all women going through menopause experience brain fog and memory lapses. And those symptoms, yes, they are related to menopause, but they have nothing to do with the ovaries. Those are brain symptoms. They are neurological symptoms that come from the ways that menopause changes the brain.

• 5:42Steven Bartlett?

  I want to get into how you know this and the work that you've done. But first, I've got to ask, who are you?

• 5:50Speaker 00

  I am Dr. Lisa Moscone, and I have a PhD in neuroscience and nuclear medicine, which is a branch of radiology where we use brain imaging techniques to study the functionality of the brain, the biochemistry of the brain, and we can really deeply explore how the brain changes at different times in a person's life. And the reason I am here is that I am the director of the Women's Brain Initiative, a Wellcome at Medicine New York Presbyterian in New York City, where I also lead the Alzheimer's Prevention Program.

• 6:29Speaker 00

  And I believe it's fair to say that our team is at the forefront of reproductive neuroscience or gender neurology, which is the study of how brain health plays out differently in women than in men.

• 6:47Steven Bartlett?

  I heard you've published over one hundred and fifty medical journals.

• 6:50Speaker 00

  Yes, yeah, yeah, over one hundred and fifty scientific papers.

• 6:55Steven Bartlett?

  To summarize, because I did quite an extensive piece of research here. You're basically leading the way as it relates to understanding a woman's brain, especially as it relates to menopause, the changes. Because I was reading that you did the first brain scans on a woman's brain to compare what a woman's brain looks like before and after menopause, and also before and after surgical menopause, which is the removal of the ovaries.

• 7:23Speaker 00

  Yes.

• 7:23Steven Bartlett?

  And you actually have those scans, which we'll talk about later. But you have some of those scans to show me today, but you were the first person to do that.

• 7:29Speaker 00

  To my knowledge.

• 7:30Steven Bartlett?

  Super interesting. Why hasn't anything been done here? Why, just generally on the subject of menopause, why hasn't there been research and investment into this area?

• 7:40Speaker 00

  Such a good question, and it's the question I asked when I started looking at menopause for the first time, that was in twenty fifteen. So my specialty is, used to be at least, Alzheimer's prevention. So I'm really, I've always been really focused on supporting cognitive health and cognitive aging and preventing, or at least reducing the risk of dementia, Alzheimer's disease and dementia. And in twenty fifteen, we had kind of ran out of ideas, especially when it comes to women's brain health. Because what most people don't realize is that Alzheimer's disease affects more women than men.

• 8:21Speaker 00

  So almost two thirds of all Alzheimer's patients are women, particularly post-menopausal women. And this was my question, even for my PhD, at the very beginning of my career. And back then, people would say to me, well, yes, we've known since nineteen ninety four that after aging and getting older itself, being a woman is the most significant risk factor for developing dementia. However.

• 8:55Speaker 00

  The explanation back then was that women live longer than men, and Alzheimer's is a disease of old age. Therefore, at the end of the day, more women than men have Alzheimer's disease. And that never made sense to me, in part because I have a family history of Alzheimer's disease that runs in my family, obviously, and affects the women in my family. And I know that this is very common, where your grandmother has Alzheimer's or dementia. And for me, it was my grandmother and her two sisters, who all developed Alzheimer's disease and died of it. But their brother, who lived exactly to the same age, did not.

• 9:38Speaker 00

  And so my PhD thesis actually was to show that Alzheimer's disease is not a disease of old age. It's actually a disease of midlife with symptoms that start in old age. So what happens is that Alzheimer's starts in the brain with negative changes that take years to reach a certain threshold before the damage is so severe that people start losing their memories, they can't come up with words, they have attention deficits. But in reality, Alzheimer's starts, for many people, in midlife. So that changed my entire question. Right then, the question becomes, okay,

• 10:21Speaker 00

  if Alzheimer's starts in midlife, and more women than men end up with Alzheimer's disease, what happens to women, and not men, in midlife? That could potentially explain the higher lifetime risk of Alzheimer's disease for women. And look, we tried everything. We tried genetics. We looked at medical factors. We looked at diabetes. We looked at high cholesterol levels. We looked at insulin resistance. We looked at obesity. We looked at every single thing we could look at: diet, lifestyle, exercise. And those things certainly matter. But they couldn't quite explain the difference that we were seeing. Because what we were seeing is that already in midlife,

• 11:02Speaker 00

  women show these red flags of Alzheimer's disease in their brains, whereas men do not. And we can see that by doing brain scans and doing brain imaging. And the question was, what is it that really tips the scale? And then one day, my students were doing cognitive testing on one of our participants, a woman in her 40s, and she was having a really hard time just getting through the tests. And she said, "I'm really having a hard time. Can you open the window?" And that doesn't happen very often. My students were like, "The window? Sure, actually, no, because it's a hospital in New York City. You can't open the windows,

• 11:47Speaker 00

  but we can, we can play with the fan perhaps." And she just could not get through the test. And then she had to stop and said, "Look, I'm having hot flashes. I just can't think straight. I have to go." And so she rescheduled, and then she came back later. But my students came to me in a panic. "She says she had hot flashes? What is it? Is she okay?" "Well, we, we had to stop the session. Is, are we in trouble physically?" And I said, "Hot flashes? That's interesting." And so we went back and I explained to them that means that she's going through menopause. And this is a sign, a classic neurological sign of menopause, that we do know can impact concentration and focus.

• 12:29Speaker 00

  But back then, we didn't know that it could be a bigger, a bigger change in your brain, by impacting your, your ability to focus and memorize information. And so we went back and we asked all the women in our study about their menopausal status and their menstrual cycle and their symptoms. And then what we found is this, then, if you compare a group of pre-menopausal women to men of the same age and look at their brain scans, there are no differences, very little differences. But if you look at women who are perimenopausal and compare them to men of the same age,

• 13:08Speaker 00

  you see an increase in the amount of Alzheimer's plaques in the brain already in midlife.

• 13:15Steven Bartlett?

  In perimenopausal women?

• 13:16Speaker 00

  In peri, so not even in menopause, but just starting to lose your skipping menstrual cycles and when your, when your period becomes infrequent. And usually the hot flashes start making an appearance and the brain fog as well. And then after menopause, when we compared post-menopausal women to men of the same age, then the difference was quite striking, where men barely had any Alzheimer's plaques and the women had statistically significantly more.

• 13:47Speaker 00

  Red flags for Alzheimer's disease.

• 13:50Steven Bartlett?

  Okay, so this is a really naive question. But please do explain this to me like I'm a ten year old. What is menopause?

• 14:00Speaker 00

  What is menopause? So there's a standard medical textbook definition that is entirely based on the function of the ovaries.

• 14:09Steven Bartlett?

  Okay.

• 14:09Speaker 00

  And then there's an updated definition that I'm trying to promote more and more because I think it's important. That really looks at menopause for what it is from a scientific perspective. So I'm going to give you both. The standard definition of menopause is when a woman hasn't had a menstrual cycle for 12 consecutive months. There are three phases. There's a pre-menopausal phase when a woman is in her thirties or older and has a regular menstrual cycle approximately every month. And then at some point, the frequency and severity can change.

• 14:50Steven Bartlett?

  So that's when your period becomes more infrequent?

• 14:52Speaker 00

  Irregular.

• 14:53Steven Bartlett?

  Or there's less menstrual blood?

• 14:56Speaker 00

  Yes, usually a combination of the two. And what we really focus on clinically is the frequency.

• 15:02Steven Bartlett?

  Okay.

• 15:03Speaker 00

  So when you start skipping your period for more than two or three months at a time, that is considered the peri-menopausal phase, which is an in-between between having a menstrual cycle and not having a menstrual cycle.

• 15:16Steven Bartlett?

  So that first stage we were talking about, is there a name that's peri-menopause?

• 15:19Speaker 00

  Pre.

• 15:20Steven Bartlett?

  Pre-menopause?

• 15:21Speaker 00

  Yeah.

• 15:21Steven Bartlett?

  Pre-menopause?

• 15:22Speaker 00

  Before menopause.

• 15:22Steven Bartlett?

  Pre-menopause?

• 15:23Speaker 00

  Then there's peri.

• 15:24Steven Bartlett?

  Yeah.

• 15:24Speaker 00

  Which is in-between.

• 15:25Steven Bartlett?

  Is that stage two?

• 15:26Speaker 00

  That's, yeah.

• 15:27Steven Bartlett?

  Okay, stage two. So.

• 15:30Speaker 00

  If you want, stage two, yes.

• 15:32Steven Bartlett?

  Yeah.

• 15:32Speaker 00

  Stage, usually we say stage one and two for cancer is anti-malignant.

• 15:36Steven Bartlett?

  Oh, okay.

• 15:37Speaker 00

  Yes, first and second.

• 15:39Steven Bartlett?

  Okay.

• 15:40Speaker 00

  Stage. And then at some point, you will not have a menstrual cycle anymore for up to 12 consecutive months. And then in retrospect, you go back to the year prior and say, okay, as of 12 months ago, that was your menopause? And you are now postmenopausal. In the postmenopausal stage, which is the third phase, if you will, lasts for the entire remaining of a woman's life. So most women today spend at least thirty percent, if not more, of their lives in the postmenopausal stage.

• 16:20Steven Bartlett?

  So you have this peri-menopause stage, which happens in your mid to late forties typically?

• 16:26Speaker 00

  Yes, usually around age forty seven. That's the average. But in reality, it can start when you're in your thirties or sometimes in your fifties. The average is forty seven.

• 16:38Steven Bartlett?

  And it tends to last about ten years? And this is really when your estrogen levels start to dip?

• 16:42Speaker 00

  Hmm, that's a good point. So it can usually last between two and ten years. If you're lucky, let's say four, between four and seven. This is actually when estrogen levels fluctuate.

• 16:54Steven Bartlett?

  Okay.

• 16:55Speaker 00

  And that's what makes it tricky to diagnose based on blood tests. So blood tests are not that helpful in this respect because one day your estrogen is high and the next day your estrogen is low. And it does start gradually declining overall, but it doesn't really bottom out until you're past the transition and you are effectively in a postmenopausal stage. So yes, there is a continuous decline in concentration, but day by day, it's a little bit of a roller coaster, which is also why women start having symptoms of menopause, the brain symptoms of menopause, before the final menstrual period, not after.

• 17:37Speaker 00

  And that's a big misconception in medicine and science that menopause is just one day on the calendar, a little bit like puberty, right? As a woman, once you have your first menstrual period, that's effectively your first. But in order for you

• 17:55Speaker 00

  To really have your last menstrual period, that's a process that can take years. And that is not captured in the definition of menopause. It's one day on the calendar when you stop having your cycle. And another misconception is that menopause happens when you're old. And it's really not the case. In the United States, but also in Europe, the average age is fifty-one, fifty-two. But if you look at the global female population, it's actually forty-nine. And that is not old by any standards.

• 18:28Steven Bartlett?

  What's the youngest you've seen menopause, which is stage two in that process?

• 18:33Speaker 00

  So it depends if we're looking at spontaneous menopause or induced. So women can go through menopause for a number of different reasons, which also, again, this is another misconception, that menopause is the same for everyone. That's absolutely not true. But the three main reasons are aging, just the neuroendocrine aging process that I like to refer to as spontaneous menopause. Some people say natural. But that, to me, is misleading because it makes it sound like the other types are unnatural, which is really the last thing anybody needs. Right? It's hard enough to go through menopause because of medical reasons rather than as part of the aging process.

• 19:18Speaker 00

  And so the other two types are induced menopause, which can be surgically induced or medically induced. Surgically induced is when you have your ovaries removed, usually as part of a hysterectomy, which is the surgical removal of the uterus, or just the ovaries alone. And that's called an oophorectomy, the surgical removal of the ovaries, before, obviously, before going through menopause. But menopause can also occur for medical, as a result of medical treatments like chemotherapy for cancer. That can induce menopause, sometimes just temporarily and sometimes, more often than not, permanently. So the youngest age is actually puberty,

• 20:04Speaker 00

  because there are

• 20:06Speaker 00

  Transgendered individuals who have their ovaries removed as part of their transition to a different gender. So in that case, if you have the surgery, the oophorectomy and hysterectomy when you are a teenager, that's when you go through menopause.

• 20:20Steven Bartlett?

  The spontaneous menopause, what's the earliest you've seen or heard of?

• 20:27Speaker 00

  Um, forties, early forties.

• 20:30Steven Bartlett?

  Right.

• 20:30Speaker 00

  But some women, some women with PCOS or primary ovarian insufficiency can develop menopause even earlier than that. However, in that case, it's not part of the aging process is because there's something that needs to be further investigated, whether it's genetics or an autoimmune disorder or other causes.

• 20:56Steven Bartlett?

  So just to summarize then, there's three stages to menopause. There's perimenopause, which happens mid to late forties. The average age is forty seven years old and this can last typically, what you said, two to ten years. This is when estrogen levels begin to fluctuate, as you said. There's menopause, which is um, when she, when a woman has reached one year since her last period, the average age at menopause is fifty one to fifty two, and the menopausal transition can last seven to fourteen years. And then you have post-menopause, which is the rest of the woman's life when she is without a period. Just on that then, so I, I think, I, I used to think that menopause was the last stage. And then, once you're in menopause, you're in menopause until?

• 21:39Speaker 00

  Yeah, see, the terminology is also confusing, but menopause is actually just basically a mark on the calendar and say, as of today, you are in menopause, but it's not a stage.

• 21:57Steven Bartlett?

  So what's the difference?

• 21:57Speaker 00

  It's a diagnosis.

• 21:58Steven Bartlett?

  But it says it lasts seven to fourteen years.

• 22:01Speaker 00

  So there's three stages.

• 22:02Steven Bartlett?

  Yeah.

• 22:02Speaker 00

  Pre-menopause, before.

• 22:04Steven Bartlett?

  Okay, so there's, okay, three.

• 22:05Speaker 00

  Yes.

• 22:06Steven Bartlett?

  So there's four then?

• 22:06Speaker 00

  Which is from puberty. Until you start skipping periods.

• 22:10Steven Bartlett?

  Okay.

• 22:10Speaker 00

  Okay, then there's peri.

• 22:12Steven Bartlett?

  Yeah.

• 22:13Speaker 00

  Second stage, when you start skipping periods and your hormones start fluctuating. And then there's post-menopause.

• 22:20Steven Bartlett?

  Okay.

• 22:20Speaker 00

  So before, in the middle of the transition peri, and then after.

• 22:24Steven Bartlett?

  So that transition period.

• 22:26Speaker 00

  Yeah, that's the peri-menopausal or menopause transition. That typically lasts four to seven years, but it can actually last up to fourteen for some women.

• 22:37Steven Bartlett?

  And what's going on in that transition phase?

• 22:39Speaker 00

  There's a lot going on and we're, at least from a brain perspective, we're starting to really understand it now. And I think what's important to know, to really understand what peri-menopause is and what's going on in your brain and your body during that transition is that women are born with a system called the neuroendocrine system that connects the brain, the neurological system, with your ovaries and the rest of the endocrine system. This system you're born with, meant to, but for women, that system is activated during puberty, is overactivated during pregnancy.

• 23:22Speaker 00

  Every time a woman is pregnant, is partially turned off during postpartum. And I'm hoping we can talk about that too, the mommy brain. It's really, it's really quite a thing. And then it's quite dismantled after the transition to menopause. So this is a system that is extremely important because reproduction and fertility are effectively some of the most important drivers of evolution. And that means that a huge part of your brain is really wired to respond.

• 24:01Speaker 00

  To your reproductive organs. Okay. So the brain talks to the ovaries and the ovaries report back to the brain every day of a woman's life, for as long as you have a menstrual cycle, and probably also after, which is something that most people don't realize. There's a reason to keep your ovaries after menopause, because they do still have some functionalities. Now, if you think about it, when we look at this graph that show how the way that the brain ages, it usually looks like there's a flat line. And then after midlife, like in your 60s, 70s, 80s, neuronal density starts going down, right? There's a, everything is good until, all those graphs, they usually

• 24:46Speaker 00

  talk about the way that the brain ages and how neurons age. Okay. And how we lose neurons in the brain. You know, most people are aware that everything goes well until you get a little older, and then you lose a few neurons here and there, just so some kind of gentle neuronal loss over time.

• 25:06Speaker 00

  Now for women, those graphs are based on men. Women's brains change in a way that is quite complicated, where starting at puberty, throughout every single month, when your ovaries cycle, your brain microcycles. Every single, yes, every two weeks, there's a little microcycle. What's a microcycle? So, the way that the ovaries and the brain communicate is by sharing hormones. And we'll talk about those hormones as sex hormones. For women, these are chiefly estrogen, progesterone, some testosterone, I think is important, but people usually can do.

• 25:51Speaker 00

  Put it to the side. And other hormones that are made by the brain. They keep going back and forth from the ovaries to the brain, from the brain to the ovaries. Now, these hormones are called sex hormones, mostly by mistake, in a way. They were discovered in the 1930s by scientists that were studying reproductive function. And they did realize that you needed to have certain levels of these hormones for menstruation to happen and for a pregnancy to be established. And so they labeled estrogen, progesterone, testosterone, sex hormones. But it took another 60 years. It wasn't until the 1990s, the late 1990s, the brain scientists came to the rescue

• 26:36Speaker 00

  and showed that the same sex hormones really serve a multitude of functionalities. They have nothing to do with having children and everything to do with having a healthy brain, an energetically active brain. So those hormones that are important for reproduction are just as important for brain function. Those are brain hormones too, right? So what happens in the brain, especially for women's brains, estrogen is possibly the most important in some ways, to the point that it's being referred to as the master regulator of women's brains. Why?

• 27:17Speaker 00

  Because estrogen is to your brain as a woman what fuel is to a car. It powers a lot of different things that need to happen in the brain. So when your estrogen is high, your neurons, you can see them, they start sprouting out little branches, they're called dendrites, and become better interconnected with each other. And blood flow to the brain is higher. There's more blood going to your brain, which is wonderful because you get all the oxygen and all the nutrients. You have more immunoprotection. Your brain is more protected against insults and things that can go wrong inside your brain. And estrogen is also a growth hormone, so it stimulates overall plasticity in the brain,

• 28:01Speaker 00

  which is the brain's way of being resilient and able to make changes.

• 28:08Speaker 00

  But most importantly, estrogen pushes your neurons to burn glucose to make energy. So in a way, it's an activator. And it's able, it's a little bit everywhere. It's like this wonderful CEO that knows all the aspects of the business and can speak to any person who's needed to run the business. It's like an orchestra conductor that makes sure that the symphony is exactly the one that we want. But then what happens in peri-menopause and then after menopause is that estrogen retires, if you will. A specific type of estrogen called estradiol, which is the most potent form of estrogen,

• 28:51Speaker 00

  is no longer being produced, or just a tiny little bit. And so another estrogen takes over. It's called estrone, which is wonderful, but is not as powerful as estradiol is. And then the brain keeps playing, the orchestra keeps playing, but the tune is not quite the same.

• 29:15Steven Bartlett?

  Got you.

• 29:16Speaker 00

  Does it make sense?

• 29:17Steven Bartlett?

  And that happens, yeah, I'm really trying to understand this, the difference between the menopause phase physiologically and the post-menopause phase, because it says it lasts for seven to 14 years. So I'm asking myself, what's going on for those seven to 14 years in terms of the body? Some kind of transmission?

• 29:33Speaker 00

  Yeah, do you want to see?

• 29:34Steven Bartlett?

  Please, yeah, show me.

• 29:35Speaker 00

  The brain scans, I think is the best way. And look, like you mentioned before, this is new research, relatively new research. So it's the only research still that looks at changes in women's brains as a woman goes through the different phases of menopause.

• 29:51Steven Bartlett?

  Okay, so just for people that don't, aren't watching on video for whatever reason, Lisa has some brain scans on her iPad in front of me, which is gonna explain to me.

• 30:02Speaker 00

  Yes. So this is what's happening to this brain as.

• 30:08Speaker 00

  The woman that the brain belongs to is going from having a menstrual cycle to not having a menstrual cycle. And this is going to loop. So this is before menopause, when everything is nice and red and bright. And as you can see, changing, the red is turning yellow and the yellow is turning green. And after menopause, the entire brain scan is a lot greener than before menopause. There's a lot less red and yellow and a lot more green.

• 30:38Steven Bartlett?

  What does that mean? Because it kind of looks like some of the lights are going off.

• 30:40Speaker 00

  Yes, no, exactly. That's a really good interpretation. What that means quantitatively, that's a 30% drop in brain energy levels, which means that your neurons are able, they have access to the sugar, to the glucose, but they're not burning it as fast or perhaps as efficiently as they used to before going through menopause. No.

• 31:07Steven Bartlett?

  People don't know this?

• 31:07Speaker 00

  No, people don't know this. And the reason that this is so important, there are two reasons that I believe this is very important. Number one, this validates what women have been saying for hundreds, if not thousands of years, that there's something happening in their heads, that they feel like their brain is changing, the feeling of, I don't feel like myself anymore, or there's something happening, I have the brain fog, I have mental fatigue. In clinical terms, we say cognitive fatigue, mental fatigue. And this is actually evidence of what women have been saying all along, that menopause changes your brain as surely as it changes your ovaries.

• 31:52Speaker 00

  And very specifically, it changes the functionality of your brain. And now we've done plenty of studies, plenty, I would say, I want to do many more, but we've done enough studies to say that menopause also impacts the structure of the brain, the volume of the brain, the connectivity of the brain, blood flow to the brain. So menopause really is a renovation project on the brain. It's a neurologically active state that is associated with measurable and quantifiable changes in a woman's brain.

• 32:30Steven Bartlett?

  If I'm a woman and I'm The before brain.

• 32:35Speaker 00

  Yeah.

• 32:36Steven Bartlett?

  And then I go through menopause and I'm now the after brain that I just saw there, which seems like a lot of the lights have gone down.

• 32:42Speaker 00

  Yeah.

• 32:43Steven Bartlett?

  What is the real world change in my behaviour that people would see, that I would feel, that I would experience, that would present?

• 32:51Speaker 00

  So one thing that's important to clarify is that not all women show these changes. Right? So this is one woman. This is actually pretty average in terms of changes. We find that the vast majority of women experience something like this, whether they describe it as such or not. Some women do not show any brain changes, very little brain changes, and some women show much more severe brain changes.

• 33:19Steven Bartlett?

  So some women's brain changes are much worse than that?

• 33:22Speaker 00

  Yes, yes, much more marked in many ways. And we also find changes in connectivity and changes in brain structure and changes in white matter volume and changes in gliosis, which is these tiny, tiny little spots, bright spots that we find on the MRI scans as part of aging. But for women, that really seems to happen more so during menopause.

• 33:50Steven Bartlett?

  So how would I change?

• 33:51Speaker 00

  How would you change?

• 33:52Steven Bartlett?

  If my brain changes, if I'm that woman, my brain has had those changes, how will I feel different and how will the world experience me different?

• 34:02Speaker 00

  So this is something we're trying to understand a little bit better. These brain scans do not speak to behaviour, they speak to biology. And there's never a one-to-one correlation between biology and behaviour, thank goodness, right? But what we are starting to show right now, and actually we have a paper and a review that shows that these changes correlate quite strongly with brain fog, which is this feeling of mental exhaustion.

• 34:38Speaker 00

  Where you feel caught and brained, you feel like your brain just won't turn on in some ways. And many women experience, what we define clinically, a subjective cognitive decline, where you as a woman are aware that your cognitive performance is not as good as it used to be. But if you go for a standard neuropsych evaluation, you're still performing within normal values. And this is good and bad for a number of reasons. Number one is that historically, women would not be taken seriously, right? The overall idea is like, okay, she's going crazy, she's hormonal, she's losing her mind, it's all in your head.

• 35:20Speaker 00

  I hate that terminology, I got that a lot from, even in the scientific community, that those symptoms are kind of made up, or a sign of psychological distress, some kind of psychoemotional issue. Because women have been portrayed as widely emotional and mentally unstable in medicine forever and ever. Did you know even the word hysteria, which means madness, comes from Greek and literally means uterus?

• 35:53Steven Bartlett?

  Really?

• 35:54Speaker 00

  Yes, yes. Because ever since ancient Greek, ancient Greece, there was this mindset, this framework in medicine, where anything that a woman would report in terms of cognitive disturbances or mental health issues or just concerns, were immediately tracked away as there's something wrong with your uterus. And there's this weird connection between the uterus and the brain that makes women susceptible, vulnerable to madness or hysteria. Where things like, right now, we're aware that-

• 36:30Steven Bartlett?

  They were kind of right in one sense.

• 36:33Speaker 00

  You know, that's the bizarre part, that yes, there is a connection, and yes, that connection can impact your mental health. But there is no reason to be put down, or be patronized, or be dismissed. It's actually something that's really worth- Investigating.

• 36:48Steven Bartlett?

  They didn't have the science we have now.

• 36:51Speaker 00

  No.

• 36:51Steven Bartlett?

  But but you're saying to me that they even back then, they believed there was a connection between.

• 36:55Speaker 00

  Hmm. The user is in the brain. Yeah, the woman in the brain. They I think it's so obvious. Any woman, any woman can tell you. I find a lot of the research that we do is really all about just proving women right. Just saying, OK, so you you we've all been saying this forever. Nobody took us seriously. And now there's actual scientific proof that what women are saying is scientifically viable and valid. It's not all in your head. I mean, it is all in your head in a way, but not the way that people think.

• 37:26Steven Bartlett?

  How many, what percentage of women that go through perimenopause and postmenopause struggle with brain fog?

• 37:35Speaker 00

  Hmm. Sixty two percent, up to sixty two percent. It's almost two thirds.

• 37:40Steven Bartlett?

  The majority of them. And I have heard the phrase brain frog, brain fog. But I've never understood what it means. Is it just like a lack, an inability to think as clearly as you once did?

• 37:52Speaker 00

  I think it's more than that. It's a feeling that something is hijacking your brain. And that no matter what you do, your brain won't turn on. And it's a very specific symptom that is different from other things that can impact cognitive performance. Like when you can't sleep at night, you're tired and it's harder to think clearly, right? But you know that that's going to come back. With brain fog, there's a there's a little bit of desperation in a way because you feel like you have no control over your outcomes.

• 38:26Steven Bartlett?

  Is it about attention as well as memory?

• 38:29Speaker 00

  It's a combination of things. Usually, brain fog impacts memory, concentration, focus, attention and language as well. Something that's very common is this tip of the tongue phenomenon where you just can't come up with words. And it's hard to just complete a sentence. It feels almost like aphasia in a way, which is an actual clinical syndrome or a form of dementia even. But when when you just can't come up with words and you know that you know the word, you just can't find it. In your head, and I know so many women who really use communication as their superpower.

• 39:08Steven Bartlett?

  Yeah.

• 39:09Speaker 00

  And they need to rely on communication for work and whatnot, and they really are miserable.

• 39:15Steven Bartlett?

  Are there any symptoms that you believe are a consequence of the changes in the brain that we see in those PET scans?

• 39:24Speaker 00

  All the symptoms, all the symptoms. Oh, yeah, it says, we just need to, you know, when you ask me as a scientist, what do the brain scans translate to? I need to have a study that shows you.

• 39:33Steven Bartlett?

  Yeah.

• 39:34Speaker 00

  I go from this to this. But the idea is that menopause, all the different things that happen during menopause, lead the brain to rewiring itself. And there are so many different changes inside the brain that impact very specific brain regions that are important for instance, for thermoregulation, for regulating body temperature, right? So there's this structure of the brain, which is actually exactly the structure that receives all the information from the ovaries, is the first center of communication, it's called the hypothalamus. And is in charge of regulating body temperature.

• 40:15Speaker 00

  So when estrogen levels and progesterone levels start fluctuating widely, that means that the hypothalamus, which is dependent on these hormones for regulating its own functionality, will have a hard time regulating body temperature. And then as a woman, you get the half lashes.

• 40:33Steven Bartlett?

  Why does the brain? Because it looked there like the brain was basically shrinking.

• 40:38Speaker 00

  Yes, so some parts of the brain lose volume.

• 40:42Steven Bartlett?

  Yeah.

• 40:42Speaker 00

  Some parts of the brain become less connected, some other parts become more connected.

• 40:47Steven Bartlett?

  Okay.

• 40:48Speaker 00

  And overall, energy, metabolic energy is reduced and the ability, so there's this little structure, there are many little structures in the brain and in the rest of the body, the mitochondria.

• 41:01Steven Bartlett?

  Yeah.

• 41:01Speaker 00

  And they're responsible for converting cellular energy into ATP, which is a usable form of energy, or the energy currency of all cells. And what we have found using A very interesting brain imaging technique is called 3D1 phosphorus MRS or magnetic resonance spectroscopy. We have found that there's basically an ATP crisis in a woman's brain, as most women go through menopause. But ATP is just not produced as much as it used to, or perhaps is used too fast. The brain just can't quite meet energy demands. And so all these different parts of the brain,

• 41:44Speaker 00

  they need estrogen for support, for energy support and for fuel. But they also need ATP just to do things, find themselves a little bit at a loss, right? It's like you're losing the superpowers of estrogen and all the things that come with it.

• 42:02Steven Bartlett?

  And is that why the brain is, looks like the lights are going down? Because of the loss of estrogen?

• 42:08Speaker 00

  Most likely it's a combination of loss of estrogen and also all this rewiring that takes place and the fact that some neurons are lost as well in other hormones that...

• 42:21Steven Bartlett?

  Okay, so let me get this straight.

• 42:22Speaker 00

  Okay.

• 42:23Steven Bartlett?

  So I should be viewing menopause as the physiological reconstruction of the brain?

• 42:28Speaker 00

  Yes.

• 42:29Steven Bartlett?

  Really, based on the loss of estrogen? I, and I'm going to try and go a little bit further here with my science. So there's receptors in the brain

• 42:38Speaker 00

  Yes.

• 42:38Steven Bartlett?

  that estrogen interacts with. And as estrogen doesn't show up, those receptors start to shut down. And that's why we're seeing the brain appear to sort of shrink in volume a little bit, but also just the activity of it seems to drop. And it's really the loss of estrogen is the causal factor of that. So if my local science here, this is, you know, science for 10 year olds over here, over this side of the table anyway. I go, okay, well, what we'll do is we'll take some estrogen and ping, we'll inject it. Everything will be fine. The brain will stay nice and illuminated. We'll avoid the brain fog, the hot flashes, the depression, the sleep disruption and everything. We'll just inject some estrogen.

• 43:18Speaker 00

  Yeah, I wouldn't inject it, but yes.

• 43:20Steven Bartlett?

  I don't know, how do you administer it?

• 43:21Speaker 00

  By mouth.

• 43:22Steven Bartlett?

  We'll eat it. We'll rub it, we'll do everything. We'll rub it, we'll inject it.

• 43:27Speaker 00

  Yes.

• 43:27Steven Bartlett?

  We'll put it on top of cereal. We'll do whatever we have to do to keep it up.

• 43:30Speaker 00

  Put it on your face in the morning.

• 43:30Steven Bartlett?

  Yeah, we'll do facial, the estrogen facials. And we'll keep it up. We'll put it in the coffee, everything.

• 43:35Speaker 00

  Right.

• 43:35Steven Bartlett?

  We'll smell it, sniff it. And then everything will be fine.

• 43:39Speaker 00

  Yeah.

• 43:40Steven Bartlett?

  That's the end of the podcast then.

• 43:42Speaker 00

  That's it, bye.

• 43:46Speaker 00

  If only it were that simple. So we do have hormones that are available for treatment. I think most people are familiar with the term hormone replacement therapy or HRT.

• 44:01Speaker 00

  And that option has a strangely tortured history where in the 1940s estrogen therapy was actually the number one best selling drug in America and many other parts of the world. And most women going through menopause in the 50s and 60s and 70s and whatnot were put on hormones and left on hormones, high doses of hormones for life. And the idea back then is that these hormones would not only reduce the heart flashes and make menopause better and more tolerable or just gentler, but would also protect against things like heart disease and dementia.

• 44:44Speaker 00

  And then in the 90s, the government intervened and said, well, you can't just do hormones to women without doing clinical trials first, even though that was the practice for 30 years, right? And so they launched the largest clinical trial in history, looking at HRT for relief of heart flashes, but also for prevention of heart disease and dementia. And that was in 1993 and the study was running and it was suddenly stopped in 2002 because what they found is that hormone therapy was actually doing a lot of damage to some of the women in the study.

• 45:28Speaker 00

  And what the media reported is that the hormone therapy in particular was increasing the risk of breast cancer while also increasing the risk of heart disease and dementia.

• 45:41Speaker 00

  And everyone panicked.

• 45:44Speaker 00

  And so many women just stopped taking hormones overnight. That also obviously kicked off a lot of lawsuits. And effectively stopped research on hormones for menopause and prevention of chronic diseases. And it took fifteen, twenty years for the research to resume. Say ten, but really it's taken a lot longer than than anyone would have thought. And now we know better. The one thing that everybody says is that that study is called the Women's Health Initiative. They did the best they could with the knowledge they had and the population they had.

• 46:25Speaker 00

  But the problem is that they were looking at women who were in their seventies and eighties. Right? So if your brain has changed at that point and the receptors are not there, you can't simply put the hormones back in because the system is not there to use them. And what those investigators have found is that actually that can do more harm than good with the hormones that they were using back then.

• 46:52Steven Bartlett?

  Okay.

• 46:53Speaker 00

  Right? So today we have different hormones. We use lower doses. The hormones are taken either by mouth or transdermally like the patch through the skin, which is gentler on the liver and reduces the risk of blood clots and other vascular issues. We had different types of progesterone, which is another important hormone. We, today we tend to use bio-identical hormones rather than synthetic hormones, which were used back then. And that overall seems a lot safer. And at the same time, hormones should be used for menopause when women are going through menopause.

• 47:36Steven Bartlett?

  Not after.

• 47:36Speaker 00

  Not after. And a lot of research, including my work, has shown that hormones work best for the brain if you take them within a ten-year window or the final menstrual period. And technically, you want to start taking them prior to your final menstrual period. Because what these hormones do is that they stabilize your hormonal concentration. So they're not just supplements. But the real power, the real magic, if you will, of hormone therapy, at least the way it was intended, is that you take it before menopause to really stabilize things. So your hormones don't start fluctuating back and forth. And hopefully, you don't even get the symptoms, the hot flashes, the night sweats, the insomnia.

• 48:19Steven Bartlett?

  Give me an analogy for that then. So those studies that were done in the nineteen nineties. It was what, a hundred and sixty thousand women took part in that study?

• 48:28Speaker 00

  Yeah, the Women's Health Initiative. That's a weather disaster, put an analogy.

• 48:32Steven Bartlett?

  Because they were, because they were giving the hormones to women that were in their seventies, eighties.

• 48:38Speaker 00

  Yeah.

• 48:38Steven Bartlett?

  It's effectively like trying to put petrol in a car when the petrol valve is sealed or the car is off.

• 48:47Speaker 00

  Pretty much, yes.

• 48:49Steven Bartlett?

  So just pumping it into there when the systems are no longer on doesn't work. And the systems are no longer on because they shut down because there was no estrogen.

• 48:58Speaker 00

  Yes.

• 48:59Steven Bartlett?

  They didn't, those systems didn't shut down because the person was just old. Those systems would have carried on working if they were given estrogen. Is that accurate?

• 49:06Speaker 00

  That's the idea, yes.

• 49:07Steven Bartlett?

  Okay, so you wanna just start, you really wanna be thinking about taking estrogen when you're, when those systems are still on and working so that it can work and sustain the systems?

• 49:16Speaker 00

  That's right. And the idea is to take hormones when you have the symptoms.

• 49:20Steven Bartlett?

  It's kind of like a car, because if you don't use a car for a long time, it just doesn't, you know, the engine stops working.

• 49:25Speaker 00

  Yeah, pretty much.

• 49:27Steven Bartlett?

  If you left a car for ten years just on the side and then tried to put petrol in, I'm pretty sure it still wouldn't work.

• 49:33Speaker 00

  There would be glitches at the minimum, right?

• 49:35Steven Bartlett?

  Yeah, at the minimum. So what, what age then? Because, you know, I've got a partner, that's what, she's thirty, thirty-one years old.

• 49:41Speaker 00

  That's young, that's young to start. I think once you have, once you start having the symptoms of menopause, so it's the hot flashes. So right now, hormone therapy is only approved for viso-moder symptoms, which are hot flashes and night sweats.

• 49:57Steven Bartlett?

  Okay.

• 49:58Speaker 00

  It's also used off-label for support of sleep, especially when sleep is disrupted by having hot flashes at night. And it's also used for relief of mild depressive symptoms that are caused by menopause and not other reasons. We're doing research now to test whether hormone therapy may be helpful for brain fog, because, believe it or not, it's not an indication. And hormone therapy is not currently recommended for support of cognitive function. And there are a lot of scientists, myself included, who find that a little bit puzzling.

• 50:41Speaker 00

  But we also agree that more research is needed. So we are trying to do the research and show that. Well, we want to understand if taking hormones can can actually support cognitive function. Because, look, when I go through menopause, I want to have all the solutions and options that I can possibly have. So I'm doing the research as fast as I can to also help myself and a lot of other women. But right now, if you have brain fog as a menopausal woman, the overall recommendation is kind of suck it up.

• 51:12Steven Bartlett?

  What would you do? You said, when you go through menopause, what would you do?

• 51:15Speaker 00

  So the pillars of lifestyle adjustments for menopause are diet, exercise, sleep hygiene, stress reduction, avoiding toxins, which is where I go a little bit overboard sometimes. Regular medical checkups to make sure that you are in good health overall and there's nothing in your medical history that might make your menopause worse. And then I am also looking into pharmaceutical options, which I do not take at this time. But I am deciding whether or not that's an option for me when the time comes.

• 51:55Steven Bartlett?

  Do you know what a prepper is?

• 51:56Speaker 00

  No.

• 51:57Steven Bartlett?

  It's a term for someone who's preparing for the end of the world.

• 51:59Speaker 00

  Oh, goodness.

• 52:00Steven Bartlett?

  And they have like a bunker, they have a food supply, they're like buying guns.

• 52:04Speaker 00

  That I wouldn't do, but I do other things like there's no plastic in my kitchen.

• 52:09Steven Bartlett?

  No plastic, okay. So let's have a look at some of these things then.

• 52:12Speaker 00

  Okay.

• 52:12Steven Bartlett?

  Preparations and why you're choosing to do them. Before we do that, I just wanted to, for people that don't know the full range of symptoms and when those symptoms, the phase of menopause in which those symptoms typically show up.

• 52:25Speaker 00

  Okay.

• 52:26Steven Bartlett?

  Are there different symptoms for different phases?

• 52:29Speaker 00

  No.

• 52:30Steven Bartlett?

  They're not, they're just a variety of symptoms.

• 52:32Speaker 00

  Since you seem to be interested in the stages, let's go a little bit deeper.

• 52:37Steven Bartlett?

  Okay.

• 52:37Speaker 00

  All right, let's say, so your girlfriend is in her 30s.

• 52:41Steven Bartlett?

  Yep.

• 52:41Speaker 00

  Right? So most women in their 30s have a regular menstrual cycle. As soon as you hit 40 ish ballpark, you still have a regular menstrual cycle, but you may start seeing changes. Some months it could be a little bit shorter, some months it could be a little bit longer, some months it could be a little bit lighter, some other months it could be a little bit heavier. I strongly recommend keeping track because that's very helpful to realize when you are past the pre-menopausal stage and when you're about to enter the perimenopausal stage, which is more complex than just one, two, three stages.

• 53:25Speaker 00

  So once you have a regular menstrual cycle is the pre-menopausal stage and there's actually two separate phases. There's the early phase where your menstrual cycle is the way it's always been

• 53:39Speaker 00

  for women with a very regular menstrual cycle. Then it starts changing a little bit, maybe just a couple of days, maybe a little bit earlier, a little bit later, lighter, heavier, but still very regular. That's the late pre-menopausal stage. At that point, you may start skipping periods, but maybe you just skip it one month and then it's back. And then at some point, you skip it for two months and then it's back and it's regular. That's the early perimenopausal stage. At that point, the most common complaint is difficulty sleeping, is poor sleep.

• 54:13Steven Bartlett?

  Okay.

• 54:14Speaker 00

  When women start having a hard time not just falling asleep, but staying asleep. And that's usually because progesterone is going down. It's unusual to have hot flashes at that point, but brain fog may happen, especially around your menstrual cycle. When you wake up in the morning and you have no energy and just the idea of checking your email feels like an ordeal. It can really happen. Usually it may last just a couple of hours, perhaps it lasts a day. But it's something to pay attention to because that could be a preview to the menopausal transition. So then you start skipping periods and then you start skipping more periods.

• 54:58Speaker 00

  And at some point, your periods will be more than three months apart. So you have one today, nothing for three months. You're not pregnant. It will come back. But you know what I mean? So the frequency is going to diminish. It's get, you're going to get fewer and fewer periods spaced apart more and more. That's the late perimenopausal stage where the symptoms really creeping. So that's when most women have the hot flashes, the night sweats, actual insomnia sometimes, mood changes. Sometimes there's irritability. Sometimes there can be tearfulness. Sometimes you cry for no reason. Sometimes you just feel really down in the dumps and you don't know why. There could be the brain fog. There could be forgetfulness.

• 55:41Speaker 00

  It's important to know that that, as disruptive as that might be, it's actually not uncommon. I can't say normal because it does not feel normal for sure, but it's expected for many women.

• 55:56Steven Bartlett?

  I saw in your book, you said things like vaginal dryness.

• 56:00Speaker 00

  Yes, that's not a brain symptom. It's a bodily symptom. That can happen earlier.

• 56:05Steven Bartlett?

  Weight gain?

• 56:07Speaker 00

  Yeah, that can happen.

• 56:08Steven Bartlett?

  Slow metabolism and digestive issues. Overactive bladder?

• 56:11Speaker 00

  Yeah, that's a little bit later usually, more like after menopause.

• 56:17Steven Bartlett?

  Muscle tensions and aches?

• 56:18Speaker 00

  Yeah. Look, there's a whole range of symptoms. Yeah, well, you can have tinnitus.

• 56:25Steven Bartlett?

  Tinnitus, which is that ringing in the ear?

• 56:26Speaker 00

  Yes, or electric shock sensations, panic attack.

• 56:31Steven Bartlett?

  Please do keep going with your, that was very helpful. You're going through the phases and overlapping them with the symptoms.

• 56:35Speaker 00

  Yes, so the late perimenopausal stage, which is defined as not having your period for three months or more at a time, is when the symptoms really kick hard. Then at some point, you just stop having your period for good.

• 56:53Steven Bartlett?

  Sorry, what age does the symptom start kicking hard typically on average?

• 56:56Speaker 00

  Forty seven.

• 56:57Steven Bartlett?

  Forty seven.

• 56:57Speaker 00

  Forty five, forty seven.

• 56:59Steven Bartlett?

  Okay.

• 57:01Speaker 00

  It's harder on black women and Hispanic women.

• 57:05Steven Bartlett?

  Why?

• 57:06Speaker 00

  We don't know, but there are some differences related to race and ethnicity. And usually, um, yeah, black and Hispanic women may experience more severe symptoms of menopause, which is something that we should really talk about because there's hardly any research done on this. And it's, it's completely unfair, you know?

• 57:32Steven Bartlett?

  I was reading a stat that really shocked me about suicidality.

• 57:35Speaker 00

  Yes, yes, it tends to increase for women in, in midlife. And it tends to be at least a correlate of going through menopause. Also, the rate of divorce is significantly higher as women transition to menopause. See, that's why it's important for men to know these things too.

• 57:56Steven Bartlett?

  I, I read that the time in a woman's life where she's most likely to die by suicide is when she's in that sort of fifty five years old region.

• 58:07Speaker 00

  Yeah. It's right after. So let me get through the, the, so there's the late peri-menopausal stage. Then you hit menopause, which is a diagnosis, right? And then you start the early post-menopausal phase. That's as hard as the late peri-menopausal stage. So the, the four years around the final menstrual period in either direction, both directions are the hardest. Right? So the few years, the, the last three to four years before the final menstrual period and the three, four years right after the final menstrual period. Those are the worst by all accounts. This is when most women really have a hard time.

• 58:51Speaker 00

  Uh, the women who do have the symptoms. As I mentioned, there's a whole range of symptoms, not just the type of symptoms, the number of symptoms, but also the severity of symptoms that is not recognized or formalized in medicine, which I think is, is unacceptable and is, is really not okay. If you think. Think about pregnancy, right? So this is what I wanted to tell you before, and I'm going to say now because I think it's important. The modern definition of menopause is that menopause is a neuroendocrine transition specific to women that ends with reproductive senescence, the end of fertility, but also

• 59:31Speaker 00

  impacts a number of different systems in the body, including the brain. And the reason that this is important to realize is that it's a very specific and unique medical category that cannot be equal to just getting older and cannot be compared to having a disease. It's a very unique thing that happens in medicine that only has three entries in this category of neuroendocrine transition, brain hormone transition. There's puberty, there's pregnancy, and there's perimenopause, right? Now, what happens with puberty and pregnancy, let's talk about just pregnancy.

• 1:00:12Speaker 00

  What happens with pregnancy is that we all know that many pregnant women experience changes in mood, for example, changes in attention, changes in focus and concentration, brain fog. Also, 30% of pregnant women have hot flashes. It's just something we never talk about. So the symptoms are not that different from menopause. We've seen them before. Only when you're pregnant, everything is gorgeous, everything is beautiful, there's baby showers, there's parties, people take pictures, and if you're having a hard time, everybody's very compassionate and supportive and tries to make you feel better.

• 1:00:52Steven Bartlett?

  So you're saying we need to have a menopause party?

• 1:00:54Speaker 00

  Yes, absolutely, but also one vocabulary, because we know that, for example...

• 1:01:02Speaker 00

  With pregnancy and postpartum, it is understood that this transformation is not just that you're having a baby, it's that your body is changing and so is your brain. Some women have no depressive symptoms. Some women have baby blues. Some women have postpartum depression and some women have postpartum psychosis. Right? Yeah, it can happen. It's rare, but it can happen. And it's a range. And now that we understand that, number one, it's important and it's common and there's a range, we have a framework to address it. So, once you have a baby and you go to the pediatrician for the baby, you, mother, get a screening for depression at the pediatrician. You don't have to go to a psychiatrist. They do it right there and then.

• 1:01:46Speaker 00

  You are effectively screened and monitored to make sure that you're fine. If you have postpartum depression, what we now have therapy is the very specifically work for that type of depression that is different from other types of depression. You know what I mean? There's no such thing for menopause. There's no system in place where you can even describe your symptoms to a provider because the language isn't there. You're gonna have to say, "I have brain fog." And nobody knows what brain fog is because it's not a clinically meaningful category.

• 1:02:17Steven Bartlett?

  How much education do doctors get on menopause?

• 1:02:20Speaker 00

  None, very little. So, it's one in five OB-GYN residents.

• 1:02:25Steven Bartlett?

  What's an OB-GYN for anybody that's in Europe?

• 1:02:28Speaker 00

  Obstetrics and gynecology.

• 1:02:30Steven Bartlett?

  Okay.

• 1:02:30Speaker 00

  Person, is the person that you go to for menstrual cycles and pregnancy and then menopause.

• 1:02:37Steven Bartlett?

  Okay.

• 1:02:37Speaker 00

  And anything related to fertility or the function of your reproductive organs.

• 1:02:41Steven Bartlett?

  They don't know about menopause?

• 1:02:43Speaker 00

  One in five does. But in reality, when you look at the curriculum, it's more like six, maybe eight hours in total of training throughout the entire residency program. So, it's not much, it's really not much. So, I would say that the vast majority of specialists are not OB-GYN specialists, are not actually menopause specialists.

• 1:03:06Speaker 00

  And even those who are, don't receive a lot of training, so in school at least. So it's really important to go see a specialist who, number one, is a certified menopause specialist. You can find it on the internet. And number two, somebody who has personal experience, because at this point you really have to, to gain your own experience. And the thing then is very upsetting to many professionals is that even the best OB-GYN specialist is not a brain specialist.

• 1:03:40Speaker 00

  Right? So menopause has been pigeonholed as an issue with the ovaries. Go see an OB-GYN specialist. Where the symptoms that most women actually suffer from are neurological in nature. And the specialist you go to is not trained to manage or diagnose anything brain related. They're not supposed to, right? It's a completely different organ instead of skills. So we're trying to change this framework so the brain specialist can be involved in the medical evaluations and treatment of menopausal women.

• 1:04:18Steven Bartlett?

  Have we finished off with the stages there?

• 1:04:19Speaker 00

  Yes, we've finished off.

• 1:04:21Steven Bartlett?

  We're finished.

• 1:04:21Speaker 00

  No, just one more, just one more stage. So there's the early post-menopausal stage that is still a little bit like a tornado. It can be a tornado with a lot of symptoms. But then six years after the final menstrual period, that's the late post-menopausal stage, which is the stage that a woman will live into for the rest of her life. That stage varies. And that I find is really interesting. For many women, the symptoms, like heart flashes, the night sweats, the mood changes, the brain fog tend to go away over time.

• 1:04:59Steven Bartlett?

  I've got a graph that I'll put on the screen that shows how brain fog changes over time. And as you can see, it's kind of like a U shape. So. It's, there's no brain fog and then it goes, you have a severe brain fog. And then the brain fog seems to recover, not to the same height as it was before menopause, but post-menopause, which is I'm guessing where it recovers there.

• 1:05:21Speaker 00

  This is, yeah, this is possible.

• 1:05:23Steven Bartlett?

  Okay.

• 1:05:23Speaker 00

  So this cognitive function, right? It's nice and high before menopause, then it takes a dip.

• 1:05:28Steven Bartlett?

  Yeah.

• 1:05:29Speaker 00

  During the transition, then it goes typically back up. For a few women, it would be up here. So it goes back to pre-menopausal levels, cognitive function. For most women, it's a little bit lower than it used to be, but still pretty good.

• 1:05:43Steven Bartlett?

  This is good news?

• 1:05:44Speaker 00

  Yes, that is good news, absolutely. And but for other women, it's not, it keeps going down.

• 1:05:49Steven Bartlett?

  Oh, really?

• 1:05:49Speaker 00

  It keeps declining. And that's why a lot of women come to us at the Alzheimer's Prevention Clinic, because they're really scared that that may be a sign of early dementia.

• 1:06:00Steven Bartlett?

  Is there any reason why some women's brain fog doesn't return back to normal levels post-menopause?

• 1:06:06Speaker 00

  We are looking at that right now.

• 1:06:08Steven Bartlett?

  Is this also why you're prepping?

• 1:06:10Speaker 00

  Yes. Actually, the study that we have under review, that I believe is the first to look at brain correlates of menopausal brain fog. So as far as I know, this is the first study that shows that there are very specific changes in the brain that strongly associate with having or not having brain fog. That is the first step to then clarifying why certain women have it and certain women don't have it and how can I make it better, right? Is it hormones? Is some other kind of therapy? How can I reverse it? How can I prevent it?

• 1:06:50Steven Bartlett?

  So this brings us back to this conversation around prepping. You're in this phase of life where you're prepping. Why does exercise matter for menopause?

• 1:06:57Speaker 00

  So exercise matters for everything, from hormonal health to brain health to heart health, because everything is interconnected, right? We are effectively a system where every part of you needs to be healthy for you to feel healthy as a person. For both menopause and brain health, we know that physical activity stimulates the production of certain proteins that can travel all the way inside your brain and are also made inside the brain that support neuronal health, from growth hormones to very specific peptides. They have a Boosting functionality.

• 1:07:37Speaker 00

  And for menopause in particular, all exercise is good, but cardiovascular activity seems to be especially helpful for the hot flashes and the brain fog. Where strength, training seems to be more helpful to preserve metabolic activity and bone mass, but also mood, it supports mood. And flexibility exercises and mind body techniques like yoga, Pilates, Tai Chi, those are helpful not just for flexibility, but also for stress reduction and sleep. So it's good, if possible, to do a little bit of everything.

• 1:08:20Speaker 00

  And if if time is a constraint, then it's helpful to know the different types of exercise may be especially helpful for one thing or another.

• 1:08:31Steven Bartlett?

  There's a study in your book, I think in chapter thirteen, where you where you case study a, I don't think it was a study you did, around the Latin women, three thousand five hundred Latin women.

• 1:08:40Speaker 00

  I mean, but wonderful study, wasn't it?

• 1:08:42Steven Bartlett?

  And and it showed that those who engage in regular to moderate intensity exercise were almost thirty percent less likely to have severe hot flashes than those who exercised less.

• 1:08:53Speaker 00

  Yeah.

• 1:08:53Steven Bartlett?

  Which is a really compelling argument for exercise in that phase of life. And there's some other sort of related information that I read that said that women in their forties are the highest demographic group to exercise inconsistently or not at all.

• 1:09:08Speaker 00

  Yeah, yeah.

• 1:09:10Steven Bartlett?

  So we know exercise is great for that phase of life.

• 1:09:13Speaker 00

  And we also know that women have no time.

• 1:09:15Steven Bartlett?

  Is that what it is? Is it a timing issue typically?

• 1:09:17Speaker 00

  If for most women, it's a combination of factors. I think midlife is a bit of a, is a turbulent time when you're sandwiched in between a lot of different responsibilities. If you have maybe young children and older parents and you're trying to to maybe get a career advancement, you also want to take care of your health and then boom, you get hormonal changes and menopause. So it is a bit of a. It's a different age to navigate in some ways. And what a lot of women report is that, one, they have no time to take care of themselves. And number two, sometimes the reasons are outside of your control, like this fatigue.

• 1:09:59Speaker 00

  There's so many women report the lack of sleep or that that is a bit of an issue when it comes to feeling energized enough to also go to the gym. So there are some barriers and I think it's good to be creative if you can, right? And also realize then you don't have to wear fancy clothing. You don't have to go to the gym. It's good enough to go for a walk in the park. Just keep your body moving.

• 1:10:26Steven Bartlett?

  Is there a certain type of exercise that is too much? Can you do too much exercise? Because I don't want people that are listening to this now that are in that phase of life to just suddenly start running marathons every single day or something, thinking that they'll be able to stave off menopause.

• 1:10:40Speaker 00

  I think that's that's actually what most people hear. When you say exercise is really good for you and they see themselves like, oh my God, I have to join the gym and just work out three hours a day. That's not what the research shows.

• 1:10:53Steven Bartlett?

  Because your cortisol levels would go up as well.

• 1:10:55Speaker 00

  Yes, it may happen. And also your recovery time may increase, especially after menopause. But what studies have shown is that in this case, there's an inverted U shape relationship between intensity of exercise and health gains. And I'm not talking about fitness or muscle mass. I'm thinking about overall health, how healthy you actually are as a whole. And what the research in women, especially women who are recently post-menopausal, so 50s, 60s, what the research shows that if you don't exercise at all, obviously there's no gains. But as soon as you start, even just in mild intensity, the gains start increasing. And the peak.

• 1:11:38Speaker 00

  But the curve is for a moderate intensity regimen at high frequency.

• 1:11:43Steven Bartlett?

  Which is?

• 1:11:44Speaker 00

  Which is you work out in a way that brings some pink to your cheeks. You may have a hard time singing, but you won't have a hard time talking.

• 1:11:55Steven Bartlett?

  Okay.

• 1:11:55Speaker 00

  So your heart rate goes up, but not so high up that you can't breathe, basically, actually. And there's different intensity intervals, of course. Rich Roll called the, he said to me, this is what professional athletes call zone two.

• 1:12:10Steven Bartlett?

  Okay.

• 1:12:10Speaker 00

  So zone two, everyone.

• 1:12:12Steven Bartlett?

  Okay.

• 1:12:13Speaker 00

  But if you increase the intensity a lot more, the gains actually start diminishing after menopause, which is not universal. There's plenty of women who can do beautiful things physically. But on average, what that suggests is that just do the best that you can. Try to shoot for this zone two or moderate intensity exercise. Just do it often enough that the gains are consistent.

• 1:12:41Steven Bartlett?

  And as it relates to Alzheimer's, you talked about those Alzheimer's plaques in the brain.

• 1:12:44Speaker 00

  Yeah.

• 1:12:45Steven Bartlett?

  If I exercise more, do women that exercise more have less of those Alzheimer's plaques?

• 1:12:49Speaker 00

  Yes, yes, you do have fewer Alzheimer's plaques. And also what the research shows is that women who are physically fit in midlife have thirty percent lower risk of dementia in old age as compared to women who are sedentary in midlife. So that's also really important to have, because if I had a pill that can reduce your risk of dementia, Alzheimer's disease by thirty percent, I would be rich and everyone would buy it.

• 1:13:18Steven Bartlett?

  You should become a personal trainer.

• 1:13:20Speaker 00

  Yes, pretty much. But the prescription is try to exercise at least a moderate intensity level, but do it consistently enough, which means three to five times a week.

• 1:13:33Steven Bartlett?

  So let's talk about your diet then, your diet regime as you prepare for that phase of life.

• 1:13:41Steven Bartlett?

  Let's start with caffeine.

• 1:13:43Speaker 00

  Oh, yes, I switched to decaf.

• 1:13:46Steven Bartlett?

  You don't seem happy about that.

• 1:13:47Speaker 00

  To everybody's anguish in my house. Yeah, so you've already switched to decaf.

• 1:13:52Steven Bartlett?

  Why?

• 1:13:53Speaker 00

  Because caffeine is a little bit of a trigger for sleep disturbances for a lot of women. And what people don't realise is that caffeine is not just like a cup of coffee that you drink at the moment, although you do feel a little bit of the energy rush. But what happens is that caffeine stays in your system and in your brain for a really long time. So the half-life is six hours, which means that six hours after drinking that cup of coffee, half of the caffeine will still be in your system. And the full life is 12 hours. So it effectively takes 12 hours to get rid of all the caffeine from your body and your brain.

• 1:14:36Speaker 00

  Which also means if you drink a cup of coffee at noon, some of that caffeine is still going to be in your system at 10pm, right? And if you drink a cup of coffee at 2pm, half of the caffeine will be in your system by 8pm. And a quarter of the caffeine will still be circulating everywhere in your body and brain at 10pm. So you can't just have a cup of coffee at 2pm and then hope for a good night's sleep, unless you go to sleep late, which I can't afford because I'm up at 6.

• 1:15:07Steven Bartlett?

  So could one also argue then that coffee is going to increase? Because if coffee is still in our brain, and if I have a coffee at 9pm, you know, people used to have coffees after dinner. Isn't that mad?

• 1:15:19Speaker 00

  Yeah.

• 1:15:19Steven Bartlett?

  They still do that in restaurants. You eat your food and then they come around and ask if you want an espresso. Absolute psychopaths. I've no idea. It's so crazy. They don't ask as much anymore.

• 1:15:28Speaker 00

  Helps you digest. See, this is again, is the idea of optimising for one thing without realising that you're de-optimising for another. So you improve digestion in some ways, but you're disrupting your sleep.

• 1:15:40Steven Bartlett?

  Because it's waking your body back up and going, go on.

• 1:15:42Speaker 00

  Yeah.

• 1:15:43Steven Bartlett?

  Just before you need to sleep.

• 1:15:44Speaker 00

  Right.

• 1:15:45Steven Bartlett?

  So if I have a coffee, say, 6pm, 7pm, 8pm at night.

• 1:15:49Speaker 00

  At midnight, you still have to have the caffeine.

• 1:15:52Steven Bartlett?

  Which means I'm not going to sleep as well, which means my brain isn't going to do its job of clearing things out and restoration.

• 1:15:59Speaker 00

  That's exactly why I switched.

• 1:16:01Steven Bartlett?

  Which is going to increase my chance of dementia and Alzheimer's.

• 1:16:03Speaker 00

  Yes. Yes, because what happens is then... Um. The brain needs to go through certain stages of sleep. And there's one stage of sleep that is called a slow wave or deep sleep, which is really the only chance that the brain has to clean itself up. It's like your brain's me time, where the rest of the body is completely still, which is really important because even when we're sleeping during the other stages of sleep, the body can still move. And that means that the brain needs to be partially active to control that movement and initiate that movement. So deep sleep is really the only chance that your brain has to take care of itself from the inside out. And there's a system inside the brain that's called the glymphatic system

• 1:16:48Speaker 00

  that gets activated only during slow wave sleep. And it's like a car wash, you know, it's like a dishwasher, just like jets of fluid that goes everywhere inside the brain and clean it up and remove all the waste materials, so all the toxins, the byproducts, the waste products, the Alzheimer's fragments. They get cleared during that stage of sleep. So if you miss out on that window, which is most people tend to do, because a lot of us unfortunately tend to wake up at like two or three in the morning, when we should be in deep sleep, but we're not because we wake up. And then you miss out on that cycle because the brain starts again from cycle one, from stage one.

• 1:17:30Steven Bartlett?

  So sleep is super critical here.

• 1:17:31Speaker 00

  It is really important.

• 1:17:33Steven Bartlett?

  There must be a pretty strong link between people who don't sleep much and Alzheimer's as well then.

• 1:17:37Speaker 00

  There is a link, yes, it's been explored and it seems to be consistently significant across studies.

• 1:17:43Steven Bartlett?

  And is there a relationship with alcohol and menopause?

• 1:17:46Speaker 00

  Yes, alcohol unfortunately is a trigger for some of the symptoms of menopause. It can make, it can really make them worse. My biggest concern is that alcohol is a dehydrating substance. It's de-functional, it's one of the main functionality of alcohol is a molecule is dehydrating. And dehydration is a problem for brain health. So the brain is eighty percent water, which is more than everywhere else in the brain. And water is crucial for every single chemical and cellular reaction to take place inside the brain.

• 1:18:24Speaker 00

  So the brain is the one organ that is especially sensitive to the effects of dehydration, where even a two to four percent water reduction of water volume loss can prompt neurological symptoms, the headaches and migraines and dizziness and brain fog. So actually, alcohol by dehydrating your brain and those that sticks around in your brain for a long time can make some of the symptoms of menopause worse, but also at any age, it can really have a bad impact on cognitive function. There's some studies that I found very interesting where people studied the effect of hydration on cognitive performance.

• 1:19:07Speaker 00

  And they showed that if you have two groups of people who need to do sort of mental tasks, like neuropsych testing and reaction times, computerized tests that measure your processes speed. And if you give one group a glass of water or a couple of glasses of water before taking the test, they actually perform fifteen percent better than the group of people who didn't drink any water prior.

• 1:19:31Steven Bartlett?

  Damn, I need to start drinking water on this podcast.

• 1:19:33Speaker 00

  Yes, and look, yes, you should. And I will also say that water isn't just water, right? A lot of people drink purified water. That's not water, that's just fluid. So your brain doesn't just want something wet. It wants water with electrolytes and minerals and salts, because it's the combination of these factors that really supports hydration. So tap water is fine as long as it's clean, right? And one thing that we did at home is that we installed this ginormous filter for the entire house, where the water is now filtered in a way that removes removes all the impurities but preserves all the electrolytes.

• 1:20:13Steven Bartlett?

  What else have you done in that house? Sort of scientist lab of a house that you're building this, you mentioned toxins.

• 1:20:18Speaker 00

  I'm a little bit strict.

• 1:20:20Steven Bartlett?

  Sounds like it.

• 1:20:21Speaker 00

  And yes, so there's no plastic in my kitchen, not at all. Everything's just glass.

• 1:20:26Steven Bartlett?

  Why?

• 1:20:27Speaker 00

  Because plastic is really an issue, is a very, very common contaminant and pollutant. And what happens is that when you heat it, the particles can penetrate into your food and drinks and beverages, but also when you put plastic in the dishwasher, the hot water will make it leak. And then it leaks into your plates and glasses and whatnot, and then you drink it right back or you eat it right back when you put plate, food on a plate. So pollutants in general accumulates in an organism, concentrate in an organism by bioaccumulation, which means that you start at lower doses, but they stick around for

• 1:21:10Speaker 00

  a really long time. So they keep piling up over time. And that's especially an issue for women and for children, but for women in particular, because we have more body fat than men, for instance, and pollutants tend to accumulate in body fat, especially breast tissues. So they're being linked to an increased risk of reproductive issues, reproductive infertility, endometriosis, thyroid disease, and more recently to dementia as well. Not plastic in particular, but pollutants in general.

• 1:21:43Steven Bartlett?

  Breast cancer?

• 1:21:44Speaker 00

  Breast cancer, yeah, reproductive cancers as well. You could never say it's 100% this or that, but the fact that there is a strong association is reason enough for me to stay away from plastic.

• 1:21:56Steven Bartlett?

  And what else, what do you put in your mouth in terms of food?

• 1:22:00Speaker 00

  So there's plenty of research showing that the brain really wants and needs very specific nutrients to function at its best. Because the reality is, so when I was studying, my favorite class has always been neurochemistry. And I was learning about this, all these different molecules and all these different chemical reactions that are so important for brain function and neuronal health and whatnot. And then I realized, well, we're really looking at potassium and sodium and magnesium and omega-3 fatty acids and protein and glucose, and those are nutrients. So the nutrients that we obtain from the foods

• 1:22:41Speaker 00

  that we eat literally become part of the fabric of our brains. So every day, we have a number of opportunities, breakfast, lunch, and dinner, to either make a smart choice that supports our brain health, or the opposite and feed our brain garbage that is going to be unfortunately incorporated in the fabric of your brain. And I don't want that for my brain, for sure.

• 1:23:07Steven Bartlett?

  I don't want that for my brain.

• 1:23:08Speaker 00

  Exactly.

• 1:23:12Speaker 00

  So it's really important to focus on clean foods that are nutrient dense and that prioritize the nutrients that your brain wants. The brain is not a sponge. I keep saying that because I think there's some confusion in the world where people think that whatever you eat can have a direct impact on brain health. For instance, I learned that individuals who really are interested in brain health would say things like the brain is mostly fat, has a lot of cholesterol, which is true. Therefore, you need to eat a lot of cholesterol to support the fat inside your brain, which is absolutely not correct.

• 1:23:54Speaker 00

  The cholesterol from the diet can never get inside your brain. There's no way for that substance to actually get inside your head. I mean, your head, yes, but not inside your brain. So eating cholesterol-rich foods will not help your brain at all. Eating antioxidant-rich foods will. So the nutrients that your brain really relies on are antioxidants, like vitamin C, vitamin E, selenium, betacarotene, things that you find in fruits and veggies, basically, and some nuts and seeds, preferentially. Lean proteins, so amino acids, the essential amino acids,

• 1:24:32Speaker 00

  and polyunsaturated fatty acids, which can be from plant-based sources or animal sources. But they really have to be the polyunsaturated fatty acids that the brain really wants and needs and need to be replenished consistently.

• 1:24:49Steven Bartlett?

  You're saying if I'm on, if I'm struggling with menopause, then I should be aiming at the Mediterranean diet?

• 1:24:53Speaker 00

  Pretty much, yes, thank you. That's the bottom line. So a Mediterranean-style pattern seems to be correlated, or at least associated with better outcomes overall for women's health.

• 1:25:04Steven Bartlett?

  What about supplements?

• 1:25:06Speaker 00

  Supplements are typically used to supplement a healthy diet, not to replace it. And I think that's important because at least here, there's a tendency to recommend really high doses of supplements to everyone across the board. But we do know that supplements only work if you have a deficiency, or at least a subclinical deficiencies. Whereas giving high doses of something that your body, or let's say the brain at least, they just stay in my lane. High doses of something that your brain doesn't want or need are not going to be very helpful. You're just going to either pee them out, or they're just going to accumulate in other parts of the body, so they're not as helpful.

• 1:25:48Steven Bartlett?

  Because everyone that talks to me about the brain talks to me about omega-3 as a supplement that I should take for... Every time I take omega-3, I think I'm doing my little brain a favor.

• 1:25:56Speaker 00

  You may or may not. So the research shows that the brain seems to need a certain amount of omega-3 fatty acids that are between three and six grams per day. Now, if you're able to obtain that from a diet, then maybe supplements are not necessary. But if you're not, then supplements may be helpful. Omega-3s, yes, those are the polyunsaturated fatty acids that the brain really needs. Antioxidants as well. I take vitamin C.

• 1:26:27Steven Bartlett?

  Oh, okay. So you are on the supplements, you were just trying to keep them all to yourself?

• 1:26:30Speaker 00

  No.

• 1:26:32Speaker 00

  Well, you know what I really like is more extracts?

• 1:26:36Steven Bartlett?

  Okay.

• 1:26:37Speaker 00

  And botanicals.

• 1:26:38Steven Bartlett?

  Okay.

• 1:26:39Speaker 00

  I'm not a take-my-pill kind of person. I actually get quite annoyed when I need to take pills, I just don't like it. I think because I work in a hospital.

• 1:26:47Steven Bartlett?

  Right.

• 1:26:47Speaker 00

  So I associate that as being sick. So I don't like that feeling. But what I really enjoy is to get my nutrients from either extracts or concentrates, from plants and veggies and fruit. So in the morning, the first thing I do is that I drink water immediately, but also then I have noni juice, which is a... Sometimes you give me the eyebrow.

• 1:27:10Steven Bartlett?

  Yeah, yeah, yeah.

• 1:27:12Speaker 00

  The what?

• 1:27:12Steven Bartlett?

  Noni juice.

• 1:27:13Speaker 00

  Noni, N O N I. It's a wonderful juice from the Pacific Islands that has a little bit of a bitter taste, which is always good because bitter is really good for digestion and gut health. And that's important for brain health and elimination as well and clearance. And it's very rich in vitamins and minerals and a lot of phytonutrients. So that's a good concentrated source. And this mixed with blueberry juice. So that's really good to have.

• 1:27:43Steven Bartlett?

  One of the things I found quite fascinating is I read that there was a study done on legumes that proved.

• 1:27:50Speaker 00

  Yeah.

• 1:27:50Steven Bartlett?

  It was in your book, it was in chapter 14, where it says there's a legumes apparently to be, it seemed to be a bit of a miracle food for delaying menopause.

• 1:27:59Speaker 00

  Yeah, so a diet that is rich in legumes and also fish, fatty fish.

• 1:28:06Steven Bartlett?

  Yeah.

• 1:28:07Speaker 00

  Has been linked with the later onset of menopause.

• 1:28:11Steven Bartlett?

  By how much?

• 1:28:12Speaker 00

  Three years.

• 1:28:14Speaker 00

  Whereas women who follow the standard American diet, like the SAD diet, with more lots of sugary beverages and processed foods and packaged meats and whatnot, that's been linked with an earlier onset of menopause by about three, four years. And the last thing you want is to go through menopause earlier in life if you don't have to, right?

• 1:28:40Steven Bartlett?

  I was reading as well in your book that women who do consume enough omega-3 may experience different types of menstrual pains and fertility issues and stuff. Is that true?

• 1:28:52Speaker 00

  Yeah, well, the research shows an association between consumption of omega-3 fatty acids and well, also lower risk of depression and recurrent depressive symptoms in menopause, as well as better fertility overall. And the same for antioxidants. Antioxidants have also been linked with a gentler menopause overall and fewer menstrual cramps and less pain.

• 1:29:24Speaker 00

  And the low risk premensual syndrome as well.

• 1:29:27Steven Bartlett?

  Okay, all of this begs the question, because it seems that the human body is designed, if you believe the theory of evolution, which I do, to be very smart and to do things for a clear and obvious survival benefit and reason. But when I think about menopause, it's hard to see on the surface what the evolutionary reason for such a process is. Why does it happen? Why don't women's estrogen levels just stay the same throughout their life until they die? Because it seems to be the case that it's not the same for men. So is there an evolutionary basis for everything we've talked about today?

• 1:30:02Speaker 00

  The theory of evolution was developed by Charles Darwin, who did not love women.

• 1:30:08Steven Bartlett?

  Oh, really?

• 1:30:09Speaker 00

  Yes.

• 1:30:10Steven Bartlett?

  Let's move on then.

• 1:30:11Speaker 00

  And the theory makes sense if you're a man, but not if you're a woman, because the theory of evolution says that pretty much the only reason to be alive is to pass your genes on to the next generation. So the fact that women would stop being reproductive in midlife and be able to live after that is clearly against the classic theories of evolution.

• 1:30:39Steven Bartlett?

  But I was thinking about this, and I was thinking, well, is it not just because in the 1700s, 1800s, the average life expectancy was like 35, 40?

• 1:30:50Speaker 00

  Yes, but there was a notion already back then that women who were able to live past that age at some point in their lives would stop being reproductive and hopefully remain alive. So this is what I will tell you, that if you're born with ovaries, that menopause seems to be just a factor of life. There is an understanding that at some point your ovaries will stop ovulating and you'll go through menopause. But in reality, menopause is a biological puzzle, is a big question mark. Because in most animal species, females

• 1:31:33Speaker 00

  actually die right after menopause. So your lifespan as a female animal tends to match your reproductive span, which is what Darwin was talking about.

• 1:31:47Speaker 00

  Now, this theory only makes sense if you are not able to outlive menopause. And there are two different theories when it comes to menopause. There are people who, like Darwin, say, "Well, women should just die." Or, "Women are supposed, were supposed to die after menopause, like all other animals on the planet, except just a few, like killer whales." For example, killer whales are able to live long past menopause. They do some elephants, and some giraffes, and some insects, interestingly enough. But then there's another theory that says, "No, no, no.

• 1:32:25Speaker 00

  It's not just medical improvements are supporting women and enabling women to live past menopause." The reality is that menopause makes sense for a number of reasons. And this is called the grandmother hypothesis. And what this hypothesis says in a nutshell is that evolution is much more complicated than what Darwin was thinking, perhaps. And what makes more sense, if you are a woman, and you have to bear these children, you have to grow a child, and there's a strong risk of dying from childbirth the older you are, and there's also a risk to the offspring, to the children, the older the mother is,

• 1:33:10Speaker 00

  then it makes a lot more sense to stop being reproductive at some point in your life and remain alive to help your daughters, and your sons, and your grandchildren, by providing all the resources that they need for them to outlive, you know, to keep on going and keep having children. So the theory is that at some point in the course of evolution, where our ancestors were still cavemen, that the strongest women who were able to live past multiple pregnancies, the most fit of women at that point, Somehow underwent these mutations that enabled, or perhaps just were able to activate it,

• 1:33:55Speaker 00

  to activate their longevity genes, where their bodies evolved to be able to outlive menopause by many, many years, if put in the right environment, of course. And that means that, yes, you're not passing on your own personal genes to the next generation, but you are effectively stepping into the role of grandmother and caregiver. And that helps your own children have more children. And then you're going to make sure that your grandchildren don't die because you're going to be there to provide for them. This is very important when your babies can't really take care of themselves for a really long time, like human babies can't.

• 1:34:37Speaker 00

  They're basically helpless for many, many years. The parents had to keep providing for them. The grandparents had to keep providing. So that makes sense for humans. The women would stop being reproductive, but would keep being productive and stay alive. And anyone who's ever had a grandmother would know that that's very, very important to have.

• 1:35:00Steven Bartlett?

  So this idea that menopause is actually an issue because we're living longer?

• 1:35:06Speaker 00

  Yes, I really don't get that. Well, some people think it's true, some people think it's not. From what I can see clinically, our bodies have this unique capability to really remodel themselves and change themselves to adapt to menopause. Our brains rewire, our bodies rewire. And the idea that there is such a mechanism in place suggests adaptation.

• 1:35:34Steven Bartlett?

  I think I read in your work that a woman is never happier than in that post-menopausal phase than in any period in her life.

• 1:35:42Speaker 00

  An average.

• 1:35:43Steven Bartlett?

  Maybe because she's dumped him or she's had the divorce. Maybe that's why. That's true, though, isn't it? That a lot of women do go through divorce in that phase of life.

• 1:35:52Speaker 00

  It seems like the number of divorces increase exponentially at that point in life.

• 1:35:56Steven Bartlett?

  No, they want a little bit more.

• 1:35:57Speaker 00

  Yes, I think that, you know, that comes up a lot. Also, in our research, but mostly in psychological research, there's something that seems to happen. In part, it might be aging. In part, you're older, you know better. But there's also something that happens neurologically. Where this is not my work, but other people have shown that there's one part to the brain called the amygdala that's in charge of emotional control. It's like the center, the emotional center in the brain. And after menopause, it gets quite selectively turned off in a very special way where emotions like sadness or anger don't hold quite the same charge.

• 1:36:42Speaker 00

  So your amygdala doesn't quite fire as strongly when something negative happens to you, but it keeps firing just as strongly when something good happens to you. So the ability to sustain joy and potentially contentment and just wonder is, if not amplified, is certainly stable. And that's been linked with better emotional control after menopause. And also emotional transcendence that in the words of many of my friends is really more like giving fewer F words.

• 1:37:17Steven Bartlett?

  I've actually got a graph, graph that I found in your work that shows that by the time women are in their sixties, they're statistically, they've never been happier.

• 1:37:25Speaker 00

  Yes, well, so it depends on the studies, right? And that's always an average. So these studies have measured life contentment as a function of menopause. And look, we have the graph here if you want.

• 1:37:34Steven Bartlett?

  Oh, is that the graph here?

• 1:37:35Speaker 00

  Yeah, perfect. So this is what these studies have shown. And of course, it's not universal, it's never universal. There are women who are miserable before and after menopause and women who are happy all the time. But there seems to be again, a little bit of this U curve.

• 1:37:51Steven Bartlett?

  And then suddenly up.

• 1:37:52Speaker 00

  Where life contentment is, whatever it is, is baseline over here. And then it takes a dip during the transition to menopause, when a lot of women just have a hard time. You know, I think it's, it's important, important to acknowledge that. But then life contentment goes back up. See, that's the window before, like the three to six years after menopause, when things are still not quite perfect, you're still adjusting. But then it looks like it's going back up. And this is the late post-menopausal phase, where usually the symptoms go away and you feel more like yourself again, or you feel better overall. And life contentment tends to increase.

• 1:38:31Steven Bartlett?

  You have some other graphs on there. You have another one that shows the impact of, you call it a surgical menopause?

• 1:38:38Speaker 00

  Yeah, do you want to see that?

• 1:38:39Steven Bartlett?

  Yes, please, yeah.

• 1:38:40Speaker 00

  What many people. Let's just be honest, nobody talks about surgical menopause, right? What happens sometimes, very often actually, is that women need to have their uterus removed with or without the ovaries, often enough before menopause. These are very common surgical procedures. In fact, a hysterectomy, the surgical removal of the uterus, is the second most common surgery for women in the United States after the C-section. That's one in nine women, either one in eight or one in nine, depending on the statistics.

• 1:39:18Speaker 00

  And what happened historically is that until 2008, so very recently, professional guidelines of medical societies recommended removing the ovaries all the time as part of a hysterectomy. So let's say that you go to your surgeon because you need to have the uterus taken out, sometimes it's because of cancer, more often than not is not because of a malignancy, but it's more for things like endometriosis or benign reasons. Up until 2008, the surgeon would say, no matter the woman's age, as long as you're

• 1:40:00Speaker 00

  done having children, the ovaries are redundant, don't really matter, let's just take them out. So in 2004, of the over 3 million women who had their uteruses removed in America, over half also had their ovaries removed without a medical reason to do so. It was just common practice to say, while I'm in there, let's get rid of the ovaries as well. Why? Because it's a smoother, it's a more straightforward surgery, and also that reduces the risk of developing ovarian cancer in the future.

• 1:40:41Speaker 00

  While that is true, the risk of ovarian cancer is relatively low for women who do not have genetic risks or a strong family history. But what people were not realizing is that surgical menopause

• 1:40:56Speaker 00

  This procedure of removing the ovaries in women who had a menstrual cycle would effectively plunge a woman into menopause almost overnight. And the consequences are far more severe than going through menopause as part of the aging process. And the toll on the brain is actually significant because surgical menopause has been linked with an increased risk of cognitive decline and dementia, Parkinsonism, stroke, and major anxiety and depression. So this is something that we need to talk about. In 2008, the American College of Obligating Surgery changed their recommendations, saying

• 1:41:41Speaker 00

  that they now recommend preserving the ovaries whenever possible. Now, this is not a strict medical guideline. It's a recommendation, which means that you've reached different people at different places at different times. And still today, a lot of surgeons advise their patients to have the ovaries taken out even when the ovaries are healthy because of surgical considerations without necessarily thoroughly explaining the possible side effects of that procedure. And look, this is not to say that women should decline medical advice, but it really calls

• 1:42:25Speaker 00

  for an informed conversation where you go to your doctor and say, well, why should I be taking out my ovaries now? And what are the consequences of doing so? And if I do it, what do I do to feel better? Because the symptoms of menopause may be more severe, and we know that that's no picnic. And then we need to consider the increased risk of these other medical complications, like an increased risk of osteoporosis and heart disease and brain and neurological disorders. So this is something that we need to talk about. And this is what I wanted to show you, which we just done this study.

• 1:43:01Steven Bartlett?

  I'll say to everybody that's watching the podcast, it's on the screen, but for those that aren't watching the podcast because you're listening and you walk in the dog or whatever, all of the graphs and images that we're talking about will be listed in the description below, so you can click on them and take a look for yourself.

• 1:43:16Speaker 00

  So this is something else that we're doing for the first time, as far as I know, at least to my knowledge, which is to do brain scans in women before and after an oophorectomy.

• 1:43:30Speaker 00

  The evidence that we have so far is more clinical, so we know that oophorectomies are associated with all these risks of neurological disorders, but to my knowledge, there are no studies that are really looking at women's brains before and after the surgery. If there are any, I haven't seen them, send them to me, I would love it. This is what we are seeing in our own cohort and population. So this is one woman who's been working with us for over a year, and we had done three sets of brain scans. The first brain scan before the surgery, like a couple of weeks prior, the second brain scan six months later, and the third brain scan one year after the surgery.

• 1:44:14Speaker 00

  This woman is not taking hormones, and we are looking at the brain's gray matter right now. And when you see, we're also showing parts of the brain that is losing gray matter, and those are shown as blue blobs, I would say, there are blue spots over the brain scans, which show the parts of the brain that are losing volume. So this is the brain before the surgery, this is the brain six months later, and this is the brain one year later, where all these parts in light blue are parts of the brain that have lost gray matter.

• 1:44:57Steven Bartlett?

  Her ovaries were removed and the gray matter of her brain shrunk.

• 1:45:02Speaker 00

  Has diminished.

• 1:45:03Steven Bartlett?

  It seems to have disappeared.

• 1:45:05Speaker 00

  In some parts of the brain is thinning quite a bit, and these are statistical maps that I'm showing. So these are regions where the change is statistically significant.

• 1:45:15Steven Bartlett?

  Okay.

• 1:45:15Speaker 00

  But that, you know, there's an overall thinning.

• 1:45:18Steven Bartlett?

  And it just goes to show that that relationship between the ovaries and the brain is pretty significant.

• 1:45:22Speaker 00

  Yes, and this is very direct, because... One of the things that been happening to us for a few years now that we're studying menopause is that there's pushback that what we're seeing is not menopause, it's just aging. And look, I'll show you one more thing that we've done to say, no, it's not actually just aging, it's much more likely to be menopause than aging. So now we have women who are exactly the same age. These are all women who are 50 years old. One has a regular menstrual cycle, one has irregular menstrual cycle, she's in peri-menopause, and this woman is also 50 years old and does not have a menstrual cycle. Do you see the differences?

• 1:46:04Steven Bartlett?

  I mean, yeah, their brains look completely different.

• 1:46:06Speaker 00

  Thank you. And they're all exactly the same age.

• 1:46:08Steven Bartlett?

  Drastically different. So the lady there in pre-menopause, her brain is really, really illuminated. And then the same, a different lady, but the same age in post-menopause, I mean, yeah, if it looks like, it kind of looks like the lights have gone down.

• 1:46:26Speaker 00

  You can see this just by eyeballing a brain scan.

• 1:46:29Steven Bartlett?

  It's crazy.

• 1:46:29Speaker 00

  And again, these are three cases, and we now have more and more women. So we're going to do a statistical examination of group differences. But still, you can't tell me this is just age.

• 1:46:41Steven Bartlett?

  How do you, because you know this, you've got the scans, you've done the work.

• 1:46:44Speaker 00

  Yeah.

• 1:46:45Steven Bartlett?

  And then you must look out into the world and see a narrative which you know is wrong. How does it make you feel?

• 1:46:51Speaker 00

  I mean, you know, as a scientist, that's the whole process. You do things and then you wait for other people to replicate what you have done.

• 1:46:59Steven Bartlett?

  But you know, there's women right now that are suffering.

• 1:47:01Speaker 00

  I know. That is.

• 1:47:02Steven Bartlett?

  Because they're misunderstood.

• 1:47:03Speaker 00

  But it's also really important for the research to be substantial enough to really be sure that this is menopause, that, you know, we have hundreds of women in the study. I would love to have thousands.

• 1:47:18Steven Bartlett?

  Right.

• 1:47:19Speaker 00

  And the more people look at this question from different angles and different countries with different populations, and the higher our confidence that what we're seeing is actually menopause.

• 1:47:30Steven Bartlett?

  And if she had taken, in the last graph you showed me, in the last image you showed me with the three women, same age, different phases of menopause, if she on the right, who was in post-menopause, had been

• 1:47:42Speaker 00

  On hormones?

• 1:47:42Steven Bartlett?

  On hormones.

• 1:47:43Speaker 00

  I don't know. She's not on hormones. That's why I'm showing their scans. But we're also looking at that. We're also doing clinical trials to test whether hormone therapy can change these brain scans. So this is another thing that's quite upsetting as a woman and a scientist. The only clinical trials have looked at the effects of hormone therapy on cognition, or using brain scans, have been focused on women who are past menopause. There isn't a single clinical trial that uses brain scans to test the efficacy of hormone

• 1:48:25Speaker 00

  therapy in women who are perimenopausal, for example, which is bizarre to say the least. So we started, we're doing one right now. So we have an active clinical trial where... So the other concern is that hormone therapy has this terrible reputation for being linked with a higher risk of breast cancer, right? And that's been addressed and professional societies are saying, actually, whatever risk increases is very small and is actually a rare occurrence. But there's, there's history. There's history. And a lot of women are just scared of taking hormones. And so what we're doing, we're working with an alternative, which is an estrogen.

• 1:49:07Steven Bartlett?

  Designer estrogen.

• 1:49:08Speaker 00

  Is a designer estrogen. I'm very excited about that. So this is the new generation of hormone options, hormonal options. And they're called selective estrogen receptor modulators, or SERMs, or designer estrogens. And the one we're testing is called the Nuro SERM. It's a SERM, it's an estrogen for the brain. That's been very specifically developed by my colleague, Dr. Roberta Diaz-Brinton at the University of Arizona. She's a genius. She's an absolute rock star in this field. And she's been studying estrogen in the brain since the 1990s. And she's amazing. And she was like, OK, I am tired of hearing that people won't take hormones

• 1:49:50Speaker 00

  because of this problem with the breast cancer link and association. We're going to start fresh. And she went back to the bench and she worked for 15 years. And she came up with this formulation of this new type of estrogen supplement, actually, it's more like a supplement than a medication, that goes straight up to your brain. It's like a little GPS for your brain and leaves your breasts and ovaries alone. So this selectively improves brain function while having no impact on your breast and reproductive tissues, which means that can either have no effect on cancer risk or actually reduce the risk of cancer while selectively supporting brain health.

• 1:50:35Speaker 00

  And now we're testing it with brain scans. We do cognitive testing. We do all sorts of evaluations and we're actively enrolling participants. So if anyone is interested, we're looking for perimenopausal and postmenopausal women with hot flashes, specifically women who have at least seven or more hot flashes a day, who might really benefit from this treatment in a short amount of time, who are willing to work with us in New York City. And everything is sponsored by the NIH. The National Institute on Health is a phase two randomized placebo-controlled clinical trial, which means it's one of the most thorough clinical trials you'll ever get. It's a bit of a headache for us.

• 1:51:18Steven Bartlett?

  How do they get in touch with you if they want to take part?

• 1:51:20Speaker 00

  They can email my team. Can we share the email?

• 1:51:24Steven Bartlett?

  Yeah, yeah, we'll put it on the screen afterwards so everyone can see it. While you're finding that, I wanted to share something from your book that I found to be quite fascinating. There's a section where you talk about how to predict when a woman will go through menopause. And I pulled out a few things I found fascinating here, which I'll probably be speaking to my partner about. Said the best predictor of when a woman will go through menopause is when her mother went through menopause.

• 1:51:45Speaker 00

  That's right.

• 1:51:45Steven Bartlett?

  And the experience of the symptoms of menopause is similar to for mother and for daughter. Another indicator is a woman's experience during puberty or pregnancy. For instance, if they have mood disturbances during puberty or pregnancy, they are likely to have it for menopause.

• 1:51:59Speaker 00

  That's right.

• 1:52:00Steven Bartlett?

  So maybe we should be having conversations with our mothers, if we're women, to understand their experience with menopause, because it might be the clearest indicator of our own potential future experience.

• 1:52:11Speaker 00

  That's right. It gives you a sense of when you might be going through menopause, what kind of symptoms you may be having. And then you consider your own medical history. So if you ever smoked cigarettes, for instance, you may go through menopause a little bit earlier in life than your mom has. Or if your diet is not very healthy, same considerations. Or if you don't exercise at all, those are all factors that reduce the onset of menopause. So you may go through menopause earlier on. But it's always good to talk to your mom. So that's really my, my best advice here is ask your mom. Because mothers just, you know, it's really bizarre how very few,

• 1:52:52Speaker 00

  at least for my mom's generation, nobody would talk about menopause. My mom talked to me about puberty and periods, of course, because you had to be prepared, you need to know what to do. She never once mentioned menopause until I asked. So how was it for you? What age? You know, should I, should, what am I expecting? What's going to be in store, what's in store for me? And I think it's a good conversation to have ahead of time. So then you have time for, you know, to prepare.

• 1:53:23Speaker 00

  You should talk to your girlfriend.

• 1:53:24Steven Bartlett?

  I'm gonna, I mean, I had no idea about all of this stuff. So it's, um, thank you so much for, for sharing it in the way that you do and doing the work that you do because you're really shining a light on a very unilluminated part of life that I think by 2025, they say that a billion women are going to be experiencing or have gone through menopause, which is crazy. A billion people that walk amongst us, that's what one in eight, one in nine people are currently going through or have been through menopause at that stage. And that, that means that someone in your life is going to go through this, your mother, your partner, your, your daughter, whoever it is. So being armed with this information helps us to be, I think, better supporting acts to those people, but it helps us to understand ourselves better and, and helps us to be more empathetic and to know how to, to show up for those people, even if

• 1:54:09Steven Bartlett?

  we're not one of the, the people that'll be going through menopause ourselves. And that's allowed me in my own life to understand people in my life that I maybe didn't understand before. I thought, wow, they're acting strange or their behavior is weird or they're being a bit weird. And you can sometimes isolate those people. And the stats show that, you know, the suicidality amongst that age group of people that are at sort of 55 and plus is probably so high in part because they're confused. They don't have the answers and those around them don't have the answers. So they can be shunned, they can be rejected, they can be misunderstood. And that's exactly what your work confronts. And it shines a really important, unique light on the brain, which I had absolutely never thought about before, never considered, never seen the scans. And now I have a better understanding of the full physiological process that's going on when people go through the different

• 1:54:52Steven Bartlett?

  stages of menopause. Dr. Lisa, thank you so much. We have a closing tradition on this podcast where the last guest leaves a question for the next guest, not knowing who they're going to be leaving it for. And the question that has been left for you, if you could have one last conversation with your parents, what would you say?

• 1:55:11Speaker 00

  Goodness, my parents are here right now.

• 1:55:15Speaker 00

  Oh, one last thing, I would just say thank you. Thank you for everything. Thank you for being there for me my entire life. And thank you for being my, my 100% backup plan. You know, I, I feel so fortunate that my parents are such good people. And they've always been there for me. I never had, I never worried about not knowing where to go. And when I was little, I didn't fully appreciate that. But now I really do. I appreciate it so much that I never felt on my own. I always felt like I had a safety net, both financially, legally, physically and mentally. And it's just, it's such a blessing. And I would just say, thank you, love you so much.

• 1:55:59Speaker 00

  And I, I'm sorry that that was difficult when I was a teenager. But I think I redeemed myself.

• 1:56:05Steven Bartlett?

  You certainly have. Thank you so much for all the work you're doing and behalf of all the people that. I have to say this, I am, last time I had a conversation about menopause, I. For people that don't realize how sort of impactful this is, the top comment on the video was, had I not found these videos, I would have been convinced that I was dying. Heart palpitations, migraines, itchy skin, insomnia, pure rage, crying spells, the list goes on. I'm 43 and I literally do not recognize myself. And the other top comment was sweating, I can deal with. Hot flashes, I can deal with. What I can't deal with is the paralyzing fear, anxiety, depression and fatigue. Those were the two top comments on the video about menopause. And I think that's why it's so important for us to keep having these conversations,

• 1:56:47Steven Bartlett?

  to destigmatize it, to inform ourselves and then to, by doing so, push the research forward, push attention, push investment forward in this subject. It's so wonderful that you're working on the designer estrogen. Because again, if that, if that is successful, it will help to change even more people's lives. So thank you so much, Dr. Lisa.

• 1:57:05Speaker 00

  Thank you, thank you so much for having me and for doing this. Really appreciate it.