Dr. Lisa Mosconi Links Menopause to Brain Energy Crisis

丽莎·莫斯科尼博士揭示更年期与大脑能量危机的关联 更年期雌激素水平骤降会引发神经元的生物能量危机，导致认知能力下降，而早期的针对性激素干预可以缓解这一状况。 丽莎·莫斯科尼博士（Dr. Lisa Mosconi）展示的研究表明，更年期是一次重大的神经内分泌转变，会重构大脑并减少细胞能量（ATP），从而引发脑雾、潮热和情绪波动等症状。她解释了早期激素替代疗法研究的历史缺陷，强调了现代生物等同性HRT用药时机的优势，并概述了有助于保护认知功能的生活方式支柱——如2区（Zone 2）运动、睡眠卫生和地中海式饮食。此外，本次交流还探讨了生育期后生命的演化目的、手术绝经更高的认知风险，以及脑选择性雌激素（NeuroSERMs）等新兴疗法。 脑部成像研究表明，更年期不仅是卵巢事件，更是中枢神经系统的重大转变；雌激素骤降会导致脑部葡萄糖代谢能量水平下降多达30%，并伴随局部灰质与脑体积萎缩。 (0:00) 高达62%的更年期女性会经历脑雾、注意力涣散以及语言提取困难等认知症状，这对于依赖口语流畅度的职场女性尤其造成深远的情感与专业困扰。 (38:05) 2002年妇女健康倡议（WHI）试验因纳入70至80岁超出最佳治疗窗口的高龄女性，引发了公众长达数十年的恐慌；现代激素替代疗法（HRT）则采用生物同质配方与经皮给药，在绝经10年内的“机会窗口”期使用更为安全有效。 (46:53) Lisa Mosconi博士倡导以五大生活方式支柱应对更年期：富含植物雌激素与抗氧化剂的饮食、规律运动、优化睡眠、避开内分泌干扰毒素以及定期医疗监测。 (51:50) 更年期过渡期存在关键的心理脆弱窗口，女性自杀风险在最后一次月经前后的55岁左右达到峰值，而绝大多数在职妇产科医生仍严重缺乏系统性的更年期医学培训。 (58:34)

Neuroscientist Dr. Lisa Mosconi argues that menopause is fundamentally a neurological transition rather than a localized ovarian event, causing an average 30% drop in brain glucose metabolism, structural remodeling, and cognitive shifts. These neurological changes account for hallmark symptoms like brain fog and hot flashes while establishing a critical midlife biological window that influences long-term Alzheimer's disease risk. Neurological Remodeling and the Bioenergetic Crisis (29:54) Dr. Mosconi explains that estrogens—specifically estradiol—serve as the master regulator of the female brain by promoting synaptic connectivity, blood flow, and mitochondrial ATP production. When estradiol declines during perimenopause, neuroimaging reveals an average 30% drop in cerebral glucose metabolism. Using Phosphorus-31 Magnetic Resonance Spectroscopy, her team observed that estrogen-dependent neurons struggle to meet cellular energy demands, triggering structural volume reduction and altered neural connectivity. This energy shortage manifests in up to 62% of perimenopausal and postmenopausal women as brain fog, typically characterized by verbal retrieval blocks, poor concentration, and subjective cognitive decline. Although standard neuropsychological test scores frequently remain within clinically normal ranges, the bioenergetic slump and concurrent destabilization of the hypothalamic thermostat directly generate symptoms such as hot flashes and cognitive exhaustion. Midlife Alzheimer's Vulnerability and Surgical Menopause (100:11) Almost two-thirds of Alzheimer's patients are women, an imbalance historically attributed to longer female lifespans. However, Dr. Mosconi's research identifies perimenopause as the crucial midlife phase when silent neurodegenerative processes—such as amyloid plaque deposition—often originate. While cognitive performance follows a U-shaped trajectory for many women, dipping during perimenopause and stabilizing postmenopause, a vulnerable subset experiences continuing cognitive decline. This vulnerability is severely exacerbated by surgical menopause resulting from oophorectomy. Serial MRI studies demonstrate widespread gray matter thinning and volume loss within 6 to 12 months following bilateral ovary removal without hormone therapy. Abruptly halting ovarian endocrine signaling increases lifetime risks for Alzheimer's disease, dementia, parkinsonism, stroke, and cardiovascular disease compared to the gradual transition of natural menopause. Modern Hormone Protocols and Brain-Selective Estrogens (46:53) Dr. Mosconi attributes decades of hormone replacement therapy (HRT) reluctance to the 2002 Women's Health Initiative (WHI) trial, which erroneously tested older women in their 70s and 80s using synthetic oral compounds whose liver passage elevated cardiovascular risks. Contemporary protocols emphasize a 'window of opportunity' initiated during perimenopause or within 10 years of the final menstrual period, utilizing lower-dose bioidentical formulations—such as transdermal estradiol and micronized progesterone—to preserve physiological function before neural receptors collapse. Despite estrogen's pronounced impact on brain energetics, regulatory bodies like the FDA approve HRT exclusively for vasomotor symptoms rather than cognitive protection. To provide therapeutic benefits without raising oncological concerns, researchers are testing selective estrogen receptor modulators like NeuroSERM. Developed by Dr. Roberta Diaz Brinton and currently in Phase 2 clinical trials at Weill Cornell Medicine, this 'designer estrogen' is engineered to target brain receptors directly while sparing breast and uterine tissues. Lifestyle Prepping, Glymphatic Sleep, and Timing (82:40) Lifestyle modifications significantly influence symptom severity and the age of menopausal onset. Research cited by Dr. Mosconi indicates that a Mediterranean-style diet centered on legumes and fatty fish is linked to delaying natural menopause by up to 3 years, whereas diets heavy in refined carbohydrates and processed meats correlate with reaching menopause 3 to 4 years earlier. Consistent moderate-intensity cardiovascular exercise ('Zone 2' training) performed 3 to 5 times weekly reduces severe hot flashes by nearly 30% and is associated with a 30% reduction in dementia risk. Sleep quality serves as an essential neurological safeguard because the brain's glymphatic system clears metabolic waste and amyloid fragments primarily during slow-wave deep sleep. Disruptors like caffeine—which carries a 6-hour half-life and requires 12 hours for complete clearance—and dehydrating agents like alcohol interrupt this nocturnal cleansing cycle. Dr. Mosconi also advises eliminating household endocrine disruptors, such as heated plastic food containers, which bioaccumulate in female adipose tissue. Dr. Mosconi emphasizes that although menopause is an evolved biological adaptation—supported by the 'grandmother hypothesis' of evolutionary fitness—medical education severely neglects it, with only one in five OBGYN residents receiving formal instruction. A pressing unresolved priority is completing active, neuroimaging-based clinical trials in perimenopausal women to establish whether targeted hormonal and lifestyle interventions can systematically prevent irreversible cognitive impairment and late-life dementia.

神经科学家Dr. Lisa Mosconi指出，更年期并非局限于卵巢的生殖衰退，而是一场深刻重塑女性大脑结构与能量水平的神经内分泌过渡。在此期间，雌激素剧烈波动与衰退会导致大脑葡萄糖代谢平均骤降约30%，直接诱发脑雾、潮热及情绪波动，并在中年期为女性显著高于男性的阿尔茨海默病患病风险埋下隐患。 更年期本质是大脑神经与代谢重构 (29:54) Mosconi的研究表明，雌激素（特别是雌二醇）是大脑能量代谢与神经可塑性的“主调节器”，负责促进神经元树突生长、增强脑血流并驱动神经元燃烧葡萄糖。PET脑扫描显示，从绝经前过渡到绝经后，女性大脑葡萄糖代谢水平平均下降30%，扫描图像呈现出从高能红黄色向低温绿色的显著转变。通过磷-31磁共振波谱（31P-MRS）检测，线粒体合成三磷酸腺苷（ATP）的产能效率受损，导致雌激素依赖性神经元陷入生物能量危机。 这种中枢神经系统的重构直接表现为外周与认知症状：当下丘脑失去雌激素与孕酮的平稳调节时，其体温调控中枢发生失衡，从而诱发潮热与盗汗；与此同时，高达62%的过渡期女性会出现脑雾。Mosconi指出，脑雾绝非普通的疲劳，而表现为注意力分散、短期记忆受损以及言语检索阻滞（即“舌尖现象”）。尽管这种主观认知衰退在临床标准化神经心理评估中往往仍处于“正常”分数区间，但两者之间的脱节在历史上常导致女性诉求被误判为心理情绪问题。 中年分水岭与手术绝经加剧的认知风险 (8:08) 临床统计显示全球近三分之二的阿尔茨海默病患者为女性。医学界传统观点常将其简单归因于女性平均寿命长于男性，但Mosconi团队的研究反驳了这一推论。脑成像研究证实，阿尔茨海默病的淀粉样蛋白沉积等病理改变在临床症状显现前数十年便已处于无症状期，更年期正是导致女性与男性大脑病理轨迹在中年产生分歧的关键时间点。 这一神经关联在手术绝经（切除子宫伴随双侧卵巢切除术）患者中体现得尤为迅猛。历史数据显示，卵巢切除术常在良性病变手术中被顺带执行。Mosconi团队追踪未接受激素干预的术后患者发现，卵巢切除后仅6个月至1年内，脑部灰质体积便发生广泛而显著的萎缩。同为50岁的女性，绝经前、围绝经期与绝经后的大脑扫描呈现出明显的能量断层，这表明决定大脑结构与代谢老化的核心因素并非实际日历年龄，而是内分泌过渡状态。 激素疗法的认知窗口期与脑特异性药物 (46:53) 针对补充雌激素逆转脑部衰退的设想，Mosconi回顾了激素替代疗法（HRT）的波折历程。2002年美国妇女健康倡议（WHI）试验因初步数据显示乳腺癌、中风与痴呆风险上升而骤停，引发全球停药潮。然而，该试验存在严重的方法学局限：其测试对象主要是70至80岁且已绝经多年的老年女性，其脑部雌激素受体已退化休眠，此时大剂量口服合成激素反而诱发了血管和组织损伤。 现代内分泌医学确立了“机会窗口期”假说，主张在围绝经期或绝经后10年内启动HRT，并采用经皮吸收的微粒化生物等同性激素（如17β-雌二醇与微粒化孕酮），以避开肝脏首过效应引发的血栓风险。目前FDA等机构仅批准HRT用于血管舒缩症状，尚未批准其用于缓解脑雾或保护认知。为解决传统激素对乳腺与子宫的潜在刺激顾虑，Mosconi团队正推进NIH资助的Phase 2临床试验，测试名为NeuroSERM的“大脑特异性设计雌激素”，旨在精准靶向神经元受体以提供代谢保护，同时避免外周致癌风险。 延缓更年期与保护脑功能的生活方式干预 (67:28) Mosconi提出了系统性的“生活方式储备”方案以保护中脑神经元。在运动层面，研究显示身体活动与脑健康呈现倒U型关系，高频次、中等强度的有氧训练（即Zone 2训练）收益最为显著，规律运动的中年女性出现严重潮热的概率降低约30%，老年痴呆风险同样下降30%，而过度剧烈运动可能导致皮质醇激增反噬恢复。在饮食方面，富含豆类与深海多脂鱼类的地中海饮食与更年期推迟长达3年相关；相反，高糖加工的标准美式饮食则与更年期提前3至4年相关。 神经代谢维系同时依赖水合状态与睡眠净化。由于脑组织80%由水构成，2%至4%的脱水即可引发头痛和反应迟钝。同时，环境中的塑料内分泌干扰物易蓄积于女性脂肪组织中。对于更年期高发的睡眠障碍，Mosconi指出咖啡因在体内半衰期约为6小时、完全清除需12小时，午后摄入会严重侵蚀慢波深度睡眠。而慢波睡眠是脑部类淋巴系统（Glymphatic System）启动自清洁机制、冲刷阿尔茨海默病淀粉样蛋白毒性碎片的唯一窗口。 祖母假说、医学教育盲区与去污名化 (93:16) 从演化生物学维度看，在绝大多数动物寿命与生殖期高度吻合的自然界中，人类是极少数雌性在生殖终止后仍能长期生存的物种之一（仅与虎鲸等极少数齿鲸类相似）。“祖母假说”指出，绝经并非演化机制崩溃，而是一种生存策略：远古女性随着年龄增长，继续生育会面临极高的难产死亡率，演化机制驱动其转向终止生殖，转而通过多代看护与资源支持来保障现有子孙的成活率，从而促使长寿基因得以保留。 然而，现代医疗体系对更年期神经生理学的普及严重滞后。Mosconi指出，约80%的妇产科住院医师在规范化培训中仅接受过6至8小时的更年期教学，且传统临床习惯性将更年期限定为卵巢问题，忽视其以神经中枢为起点的生理特征。面对2025年全球将达10亿更年期女性的庞大群体，缺乏精准的医学术语和临床认知不仅加剧了社会污名化，更常导致女性在面临心血管、骨质与认知危机时陷入孤立无援的困境。 Mosconi的研究确立了更年期作为神经生物学重大重塑期的科学定位，指出女性脑雾通常呈现阶段性U型曲线，多数女性在绝经后期认知功能会趋于稳定或部分代偿。然而，针对围绝经期启动脑保护干预的随机临床试验仍然有限，神经特异性激素受体调节剂的长期疗效与安全性尚待临床试验全面验证。

## Background 本期内容由知名播客频道《The Diary Of A CEO》（主持人 Steven Bartlett）于 2024 年 6 月 13 日发布在 YouTube 平台上。视频特邀康奈尔大学医学院神经科学副教授、阿尔茨海默病预防计划主任莉莎·莫斯科尼博士（Dr. Lisa Mosconi），深入剖析更年期对女性大脑的颠覆性重构，并探讨饮食延缓绝经与最新神经科学干预手段。 ## TL;DR 莫斯科尼博士通过开创性的脑部扫描影像证实，更年期绝非单纯的卵巢衰竭，而是一场在中枢神经系统中掀起的大规模“翻修工程”，女性大脑能量代谢在此期间会出现高达 30% 的断崖式下跌，直接诱发脑雾、潮热与抑郁。对话深度剖析了历史上对更年期女性的污名化与医学培训断层，并澄清了激素替代疗法（HRT）的历史争议与关键时间窗理论。最后，莫斯科尼博士提出了涵盖 Zone 2 运动、慢波睡眠与地中海饮食等生活方式干预方案，并介绍了新一代脑靶向“定制雌激素”（NeuroSERM）临床试验的前沿突破。 ## Atmosphere & style 整场对话在科学的严谨客观与深刻的人文关怀之间达到了极佳的平衡，既有严密翔实的神经影像数据论证，又充满对女性长期遭受医学忽视与病痛折磨的由衷同理心。主持人 Bartlett 犀利而富有共情力的追问，与莫斯科尼博士生动直观的比喻（如“汽车加油”与“洗车房”）碰撞出高密度的思想火花。聆听过程从最初揭开大脑能量暴跌真相时的震惊与沉重，逐步走向掌握自主干预路径后的从容与释怀，最终在探讨代际理解与亲情告白的温情氛围中达成充满力量的情感共鸣。 ## Bulletin - [29:54](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=1794s) 脑部成像与波谱研究证实，更年期会导致女性大脑葡萄糖代谢与 ATP 能量水平出现高达 30% 的断崖式下跌，脑雾、潮热与失眠本质上都是中枢神经系统重构引起的神经学症状，而非单纯的卵巢衰退。 - [08:08](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=488s) 阿尔茨海默病确诊患者中近三分之二为女性，其病理斑块早在中年更年期过渡阶段便已开始加速沉积，中年内分泌剧变是打破两性脑健康平衡的关键驱动因素。 - [01:28:22](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=5302s) 饮食与生活方式可直接调节更年期进程：富含豆类与深海鱼的饮食模式可将绝经时间推迟约 3 年，而每周进行 3 至 5 次中等强度运动能使严重潮热发生率降低 30% 并减少晚年痴呆风险。 - [01:50:50](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=6650s) 针对传统激素替代疗法（HRT）对外周组织的促癌担忧，由 NIH 资助的新一代脑靶向选择性调节剂 NeuroSERM 正在开展二期临床试验，旨在精准保护大脑认知同时避免刺激乳腺组织。 ## Key takeaways - [04:10](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=250s) 更年期是大脑经历的一场重大“翻修工程”，潮热、夜汗、顽固失眠、情绪障碍与脑雾等外在表现，本质上均源于下丘脑体温调节中枢受挫及神经内分泌网络失衡。 - [08:08](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=488s) 阿尔茨海默病是一种始于中年、潜伏期长达数十年的退行性疾病，女性更年期雌激素骤降是诱发中枢淀粉样蛋白斑块沉积与患病率远超男性的核心机制。 - [14:28](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=868s) 绝经在临床上仅指连续停经整整 12 个月的特定时间节点，而围绝经期是一个持续 4 至 7 年（甚至长达 14 年）的漫长过渡期；此阶段雌激素剧烈起伏震荡，导致常规单次血液检测难以准确诊断。 - [29:54](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=1794s) 雌激素是大脑神经元燃烧葡萄糖的核心引擎，绝经后雌二醇断崖式退场导致大脑能量水平暴跌 30%，线粒体能量货币 ATP 亏空，使脑部扫描呈现大面积活性变暗。 - [38:05](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=2285s) 高达 62% 的更年期女性深受“脑雾”困扰，典型表现为“舌尖现象”（难以调取熟悉词汇），这种主观认知衰退在常规神经心理学测试中常表现为正常，致使女性诉求长期遭到医学漠视与心理学污名化。 - [46:53](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=2813s) 2002 年妇女健康倡议（WHI）试验因纳入 70 至 80 岁受试者且给药方案陈旧而得出偏颇结论；现代激素替代疗法强调在最后一次月经前后 10 年的黄金窗口期介入，以稳定激素并保护神经代谢。 - [58:00](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=3480s) 末次月经前后各 3 至 4 年（总计 6 至 8 年）是女性更年期症状最严峻的动荡窗口期，55 岁左右更是女性一生中自杀率最高的危险峰值区间。 - [01:04:58](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=3898s) 更年期女性认知表现总体呈现“U型”轨迹，多数人在渡过绝经后晚期后大脑会代偿重组恢复认知；但存在部分认知曲线持续下滑的高危亚群，极易进展为阿尔茨海默病病理前期。 - [01:08:56](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=4136s) 运动干预存在倒 U 型效益曲线，每周 3 至 5 次中等强度（Zone 2）运动即可降低 30% 严重潮热发生率，并促进神经保护肽合成，将晚年认知障碍与痴呆风险降低近三分之一。 - [01:14:11](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=4451s) 咖啡因在体内半衰期约为 6 小时、清除需 12 小时，下午饮用咖啡会严重破坏夜间慢波深度睡眠，掐断脑内“类淋巴系统”对致病性淀粉样蛋白碎片的夜间高压冲洗排毒机制。 - [01:18:52](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=4732s) 仅需 2% 至 4% 的轻度脱水就会显著抑制脑细胞代谢并引发头晕与脑雾；此外塑料中的环境内分泌干扰物极易在女性高脂组织（如乳腺）中发生生物富集，加剧生殖与神经疾病风险。 - [01:28:22](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=5302s) 日常膳食结构直接影响卵巢功能衰退速度：高糖高加工的标准美式饮食使绝经提前 3 至 4 年，而富含豆类与深海鱼的抗炎饮食模式可将绝经时间推迟约 3 年。 - [01:30:40](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=5440s) “祖母假说”阐明了更年期的进化适应意义：远古女性通过提前关闭高死亡率的高龄生育系统，转为以祖母和照护者角色扶持后代，从而大幅提升了家族基因的成活优势。 - [01:37:14](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=5834s) 绝经后大脑对负责负面情绪的杏仁核产生选择性放电下调，使老年期女性的情绪把控力显著超越中年，在 60 岁左右形成生活满意度的“幸福感反弹”。 - [01:40:02](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=6002s) 手术切除双侧卵巢会导致雌激素一夜归零，脑成像证实术后大脑灰质在 1 年内发生大面积萎缩，大幅抬高痴呆、中风与帕金森病风险，历史遗留的预防性卵巢切除做法亟待医学界严格反思。 - [01:53:07](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=6787s) 母亲的绝经年龄和症状是预测女儿更年期时间线的最强遗传指标；破除更年期的社会沉默与耻感，是建立深层家庭支持和改善中年女性身心健康的关键前提。 ## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=0s) 精彩预告：更年期对大脑的颠覆性重塑 长期以来，女性在更年期经历的种种不适往往被轻描淡写，但神经科学的最新证据证实了女性一直以来的切身体会：更年期从根本上改变了大脑的功能运作。脑部扫描成像直观地揭示出，女性大脑在此期间呈现出近乎“萎缩”的形态改变，脑能量水平甚至会骤降 30%。这一转变过程长达数年，其影响不仅关乎所有女性，也深刻波及身边的每一位男性。诸如潮热、盗汗、失眠、抑郁，以及高达三分之二更年期女性所经历的脑雾（Brain Fog），实际上都不是源于生殖器官，而是未被传统医学充分正视的大脑神经系统症状。医学史长期将女性更年期的情绪与认知反应标签化为“精神不稳定”，黑人与拉美裔女性承受的症状往往更为剧烈。 作为神经科学领域的先驱，莉莎·莫斯科尼博士（Dr Lisa Mosconi）指出，更年期绝非不可逆转的衰退，而是可以通过积极的生活方式调整加以应对的重大转折。例如，研究发现某些特定的饮食干预甚至能够将更年期的发病时间延缓长达 3 年。在正片开始前，节目主持人史蒂文·巴特利特（Steven Bartlett）还宣布频道订阅人数刚刚突破 600 万大关，团队为此设立了订阅者抽奖福利，以回馈支持者。 - **脑能量断崖式下跌**：脑成像显示更年期后大脑能量代谢水平出现高达 30% 的显著滑坡。 - **高频认知障碍**：多达三分之二（约 67%）的更年期女性会经历明显的脑雾和记忆力短暂衰退。 - **饮食延缓窗口**：特定富含营养的饮食模式被证实与更年期推迟发生相关联，推迟时间最长可达 3 年。 --- ### [02:14](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=134s) 为什么每个人都应该倾听这场对话 无论点击进来的听众是男性还是女性、正处于何种年龄阶段，这场关于更年期大脑的讨论都至关重要。莫斯科尼博士直言，最根本的原因在于“女性很重要，女性健康至关重要”，然而数百年来，女性健康在社会舆论与主流医学界都未曾得到应有的严肃对待。每一个女性都注定要跨越这一复杂而独特的生理过渡期，提升对这一阶段的科学认知能够让整个社会受益。 对男性而言，理解更年期绝非旁观他人的私事，而是关乎自己的妻子、母亲、姐妹、女儿乃至女性朋友的切实课题。莫斯科尼博士分享道，她每天都会收到大量来自男性的暖心邮件，他们由衷感谢这项研究让他们终于读懂了伴侣或母亲的反常表现，家庭成员之间因此开启了截然不同的沟通方式，做出了更合理的医疗与生活决策。长期以来，社会在对待女性健康上存在太多误解与适得其反的举措，如今正是通过重新认识人体真实的生理机制，彻底消除偏见、给予女性有力支持的关键时刻。 --- ### [04:10](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=250s) 更年期的真相：不仅关乎卵巢，更是大脑的“翻修工程” 大众对更年期的传统认知往往局限于生殖系统的终结，即步入中年后月经停止、生育能力丧失，但这一认知仅涵盖了更年期的“冰山一角”。现代神经科学研究正在揭示更深层的真相：更年期实际上是大脑经历的一场浩大的“翻修工程”（Renovation Project）。在这场巨变中，绝大多数女性所遭遇的生理困扰，其本质都是神经学层面的反应。 ```mermaid flowchart TD accTitle: 更年期神经症状发生机制 accDescr: 展示生殖内分泌变化如何驱动神经中枢产生全身症状 subgraph S1["内分泌转变"] A["中年期卵巢功能衰退"] --> B["雌激素水平波动与下降"] end subgraph S2["大脑神经网络重塑"] B --> C["下丘脑体温调节中枢受扰"] B --> D["脑能量代谢滑坡 (最高达 30%)"] B --> E["睡眠与情绪中枢神经递质失衡"] end subgraph S3["外在神经学症状表征"] C --> F["潮热、夜间盗汗"] D --> G["脑雾、短暂记忆遗忘"] E --> H["顽固性失眠、焦虑抑郁"] end ``` 当女性倾诉自己饱受潮热、盗汗、严重失眠、焦虑、抑郁以及脑雾困扰时，这些问题在解剖学上与卵巢本身并无直接病理关联。下丘脑作为大脑的体温与睡眠调节中枢，在雌激素撤退的冲击下功能失衡，进而诱发了外在的躯体反应。将更年期窄化为妇科问题，导致医学界长期忽视了对其神经生物学机制的探究。 - **核心观点重塑**：更年期症状是“大脑症状”，而非单纯的妇科或卵巢衰竭症状。 - **翻修工程隐喻**：大脑并非单纯衰老退化，而是在经历神经网络连接和能量代谢机制的剧烈调整。 --- ### [06:21](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=381s) 走在生殖神经科学前沿的探索者 在解答这些前沿科学结论从何而来时，莫斯科尼博士介绍了自己的跨学科背景。她拥有神经科学与核医学（放射医学分支）的双重博士学位，专攻利用先进的脑部成像技术，在活体状态下深入探测人脑的功能运作、生物化学代谢以及生命不同发展阶段的结构性重塑。目前，她担任纽约威尔康奈尔医学院与纽约长老会医院“女性大脑倡议”（Women's Brain Initiative）的主任，并负责领导阿尔茨海默病预防计划。 莫斯科尼博士及其团队开创了“生殖神经科学”（Reproductive Neuroscience）与“性别神经病学”（Gender Neurology）这一新兴交叉学科，已在国际主流学术期刊发表了超过 150 篇医学论文。主持人史蒂文特别强调，莫斯科尼博士是全球首位通过脑成像技术对比女性在自然更年期前后，乃至卵巢切除手术前后大脑发生实质性改变的学者，她的开创性扫描图像彻底颠覆了医学界对于更年期中枢神经变化的盲区。 --- ### [08:08](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=488s) 破解阿尔茨海默病的性别谜题：为什么是中年，为什么是女性？ 医学界此前为何对更年期大脑缺乏研究和资金投入？这一空白恰恰是莫斯科尼博士在 2015 年决定全面转向该领域研究的契机。莫斯科尼博士早年的科研重点是阿尔茨海默病与认知功能障碍的预防。长期以来，流行病学数据呈现出一个不容忽视的事实：阿尔茨海默病患者中近三分之二为女性，尤其是绝经后的女性。早自 1994 年起，医学界便明确指出，除了“变老”这一不可抗拒的自然因素之外，“身为女性”本身就是患上认知障碍症的最显著危险因素。 然而，过去几十年医学界对此给出的主流解释却极为草率——“因为女性比男性普遍更长寿，而阿尔茨海默病是老年病，所以最终患病的女性更多”。莫斯科尼博士直言这一归因在科学逻辑上根本站不住脚。她回顾了自己的家族病史：外祖母以及外祖母的两位亲姐妹全都在晚年患上了严重的阿尔茨海默病并因此离世，然而与她们有着几乎相同遗传背景、寿命完全一致的亲兄弟却大脑清醒、终身未患此病。这促使她在博士论文中提出了颠覆性的论点： - **潜伏期漫长**：阿尔茨海默病绝非发生在老年时期的急性疾病，而是一种始于“中年”、在数十年后才显露临床症状的慢性疾病。 - **阈值效应**：大脑内部的病理性损伤与神经退行性改变在中年时期便已悄然生根，历经数年甚至数十年累积越过特定代偿阈值后，患者才会表现出找词困难、注意力缺失和失忆等典型痴呆症状。 - **核心逻辑转变**：既然阿尔茨海默病的病理种子在人生的中年阶段就已经种下，而最终患病的女性又远多于男性，那么问题的焦点必须转移为：**女性在中年时期究竟经历了什么男性完全没有经历的剧变？** 正是这一关键追问，将她的研究焦点直接引向了女性中年阶段的核心生理事件——更年期。 ### [11:16](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=676s) 认知测试中的意外转折：解开中年女性大脑淀粉样斑块之谜 研究团队在探索阿尔茨海默病时，几乎穷尽了所有常规的生物医学指标：基因检测、医疗病史、糖尿病、高胆固醇、胰岛素抵抗、肥胖，乃至于饮食结构与运动习惯。这些生活方式和代谢因素固然至关重要，但无论如何建模，都无法合理解释眼前的惊人发现——中年女性的大脑成像中，早已普遍亮起阿尔茨海默病的“红旗警报”（淀粉样蛋白斑块沉积），而同年龄段的男性大脑中却几乎寻不见这些病理痕迹。究竟是什么在中年期打破了男女之间的平衡？ 真相的揭开纯属一次偶然。一天，Lisa Mosconi 博士的学生们正在为一位四十多岁的女性受试者做常规认知测试。测试进行得异常艰难，那位女性忽然满脸痛苦地请求：“我真的很难受，你们能把窗户打开吗？”学生们面面相觑——这里是纽约市的现代化医院，窗户出于安全考虑是彻底锁死的。他们只能手忙脚乱地寻找风扇，但受试者的状态急转直下，最终不得不终止测试并离场：“抱歉，我正在经历严重潮热（hot flashes），我现在脑子一片空白，根本无法思考，我必须得走了。” 学生们惊恐万分地跑去向 Mosconi 汇报：“她说是潮热，她还好吗？我们把测试搞砸了，是不是惹上大麻烦了？”Mosconi 听到“潮热”时顿时茅塞顿开：潮热不仅是女性迈入更年期的典型神经系统体征，更是直接干扰专注力、记忆力和认知功能的关键信号。在此之前，医学界普遍未曾将更年期与大脑结构深层的病理重塑联系起来。团队随即调取所有女性受试者的更年期进程与月经周期数据进行比对，结果令人震惊： - **绝经前女性（Premenopausal）与同龄男性对比**：大脑扫描几乎看不出任何差异。 - **围绝经期女性（Perimenopausal）与同龄男性对比**：仅仅处于月经周期开始推迟、偶尔跳过经期或出现潮热与脑雾的过渡期，女性大脑中的阿尔茨海默病斑块就已经出现显著增多。 - **绝经后女性（Postmenopausal）与同龄男性对比**：两者的差距呈现断崖式分化，同龄男性脑内几乎见不到淀粉样斑块，而绝经后女性大脑内的阿尔茨海默病病理信号在统计学上呈现极其显著的激增。 ### [14:28](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=868s) 究竟何为更年期：三大阶段与打破“一天”的医学误区 面对主持人“请用解释给十岁小孩听的方式告诉我什么是更年期”的提问，Mosconi 博士指出更年期存在两个维度的定义：一个是完全基于卵巢外周器官功能的传统医学教科书定义，另一个则是她近年来极力倡导的、从神经科学和系统生物学角度审视的现代科学定义。 按照标准妇科定义，临床确诊绝经的硬指标非常机械化：**女性连续整整 12 个月不再有任何月经来潮**。在此演变路径中，生命被划分为前后相继的三部曲： 1. **绝经前阶段（Premenopause）**：从青春期开始，贯穿女性三十余岁及成熟期，月经周期大体维持在每月一次的规律节奏。 2. **围绝经期阶段（Perimenopause）**：月经的频率与经血量发生实质改变。临床上最核心的判断依据是经期的间隔时间——当月经开始出现两到三个月甚至更长时间的停滞时，女性便跨入了围绝经期。这一时期是介于规律排卵与彻底绝经之间的动荡过渡地带。 3. **绝经后阶段（Postmenopause）**：当女性在整整 12 个月内未出现经期后，医学上会回溯到一年前的那一天，判定那一刻即为“绝经点（Menopause）”，自此正式进入绝经后阶段。 在现代社会，女性有超过 30% 甚至更漫长的生命时光是在绝经后度过的。主持人下意识地用“第一阶段、第二阶段”来类比，Mosconi 幽默地纠正道：“通常我们在谈论恶性肿瘤或癌症时才说一期、二期，不过就更年期的演变历程而言，这确实是层层递进的生命阶段。” ```mermaid flowchart LR accTitle: 更年期发展阶段流程 accDescr: 展示从绝经前到围绝经期、绝经点及绝经后阶段的演变过程 subgraph Phase1 ["绝经前 (Premenopause)"] A["规律月经周期<br/>雌激素水平稳定"] end subgraph Phase2 ["围绝经期 (Perimenopause)"] B["月经稀发/跳过经期<br/>雌激素剧烈波动<br/>潮热与脑雾出现"] end subgraph Milestone ["绝经点 (Menopause)"] C["连续停经 12 个月<br/>(回顾性确诊的时间标记点)"] end subgraph Phase3 ["绝经后 (Postmenopause)"] D["卵巢功能退行稳定<br/>占据女性余生 30%+ 岁月"] end A --> B B --> C C --> D ``` ### [17:01](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=1021s) 雌激素的“过山车”：围绝经期为何让血液检测失灵 围绝经期通常发生于四十岁中后期，全人群的平均起始年龄在 47 岁左右。然而这一过程充满了个体差异，部分女性早在 30 多岁或直到 50 岁出头才会显露迹象，持续时间通常在 2 到 10 年之间（平均幸运者约为 4 到 7 年）。 针对主持人关于“围绝经期是否就是雌激素水平开始下降”的直觉理解，Mosconi 作出了关键纠偏：在围绝经期内，雌激素并不是单向平缓下行，而是呈现出极其凶猛的**剧烈波动（roller coaster）**。今天体内的雌激素水平可能冲向峰值，而明天又跌落谷底。这种起伏不定的激素震荡造成了两个直接后果： - **常规抽血检测在此阶段收效甚微**：因为单一时间点的血清雌激素浓度无法反映整体走势，单次血液化验根本无法准确诊断围绝经期。 - **大脑神经症状先于身体停经爆发**：雌激素是维持女性大脑能量代谢与神经递质平稳运作的关键神经营养素。正是由于这种激素过山车式的震颤，潮热、脑雾、注意力涣散等中枢神经系统症状，全都在最后一次月经来临前的数年里就已经集中暴发，而非绝经后才发生。 医学界和公众一直存在两大深重误区：一是误以为更年期只是日历上的某一个具体日子（犹如女性迎来初潮那样是一个单点，但实际上走向绝经是一个历时数年的复杂生物重塑过程）；二是误以为更年期是“衰老老妪”才会遭遇的问题。事实上，即便在欧美发达国家，自然绝经的平均年龄也仅在 51 至 52 岁，全球女性平均绝经年龄更只有 49 岁——这正值女性事业成熟、智识巅峰的中年期，与所谓的“风烛残年”毫无关联。 ### [19:07](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=1147s) 绝经不仅属于衰老：自发绝经、手术切除与最年轻的更年期案例 更年期绝非千人一面的单一样板，导致女性绝经的路径主要可分为三大类： 1. **自发性绝经（Spontaneous Menopause）**：随着神经内分泌老化自然演进的生理过程。Mosconi 强调自己坚持使用“自发”而非大众常用的“自然（natural）”一词，因为将前者称为“自然”，就会无形中将其他因医疗病理导致绝经的女性归类为“不自然（unnatural）”，这给已经遭受身体重创的女性施加了不必要的心理负罪感。 2. **手术诱导绝经（Surgically Induced Menopause）**：通常指在自然绝经之前切除双侧卵巢（卵巢切除术 Oophorectomy），常伴随子宫切除术（Hysterectomy）一并进行。一旦卵巢被摘除，体内的主要雌激素来源瞬间归零，女性会在手术苏醒后立刻跌入绝经状态。 3. **医疗诱导绝经（Medically Induced Menopause）**：多见于恶性肿瘤的放化疗或特定内分泌阻断疗法。这类医疗干预对卵巢功能的抑制有时是暂时的，但在绝大多数情况下是永久性的。 在探讨“经历更年期最年轻的受访案例”时，Mosconi 指出最极端的医源性情况甚至出现在**青春期**——例如部分跨性别男性在十几岁进行性别重置手术切除卵巢时，便已经历了人工绝经。而在非手术的自发性绝经案例中，她见过最早的在四十岁出头；如果年轻女性早在三四十岁甚至更早就丧失卵巢功能，临床上被称为原发性卵巢功能不全（Primary Ovarian Insufficiency, POI）或与多囊卵巢综合征（PCOS）等内分泌异质性疾病相关，这往往涉及深层的遗传突变或自身免疫系统紊乱，不能简单归因于正常的神经内分泌衰老。 ### [21:36](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=1296s) 厘清混乱的医学术语：从绝经前、围绝经期到绝经后 由于大众常将“更年期”笼统代指整个衰老阶段，主持人和大部分公众一样，误以为绝经是漫长人生的终末阶段状态。Mosconi 重新厘清了这套容易产生歧义的专业词汇边界： - **绝经（Menopause）本身不是一个持续的状态区间**，它在临床诊断学中纯粹是**日历上的一个时间刻度（a mark on the calendar）**。它标志着自该节点往前回溯的整整 12 个月里再无月经。 - 真正具有时间跨度的生命阶段应当准确描述为三个部分： - **绝经前（Pre-menopause）**：青春期月经初潮至卵巢周期节律发生实质性动摇前的全部年轻岁月。 - **围绝经期（Peri-menopause）**：平均年龄 47 岁上下展开、跨度 2 至 10 年（常见为 4 至 7 年，部分严重案例持续 7 到 14 年之久）的激烈过渡期，伴随激素剧烈动荡、排卵间隔拉长、脑雾与潮热频发。 - **绝经后（Post-menopause）**：度过“绝经点”之后、无经期状态下的余下全部生命岁月。 通过这套框架，Mosconi 强调科学认知更年期的本质：绝经不是一天的事，更不仅是卵巢退化的妇科事件，而是一场由内分泌波动率先在女性中枢神经系统中掀起的风暴。 ### [23:03](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=1383s) 神经内分泌轴与围绝经期过渡 女性在迈向绝经的过程中，会经历一段被称为围绝经期（Perimenopause）的过渡阶段。这一过程通常持续 4 到 7 年，但对部分女性而言，甚至可能长达 14 年之久。长久以来，人们对这一漫长过渡期内大脑与身体究竟经历了什么知之甚少，而神经科学界的最新研究正在逐步揭开谜底。要理解围绝经期，关键在于认识女性与生俱来的“神经内分泌系统”（Neuroendocrine System）——这是一条将大脑神经系统与卵巢及整个内分泌系统紧密相连的生理通道。 这一系统是人类演化与繁衍的核心驱动力，因此女性大脑有极大一部分区域被专门布线以响应生殖器官。该系统在青春期被正式激活；在女性每次怀孕时被过度激活；在产后阶段被部分关闭（这也是广为人知的“孕傻”或“妈妈脑/Mommy Brain”现象的生理根源）；最终在绝经期过渡后被相当程度地“拆解”。在拥有月经周期的每一天里，大脑都在与卵巢对话，卵巢也在持续向大脑汇报，甚至在绝经之后也是如此——绝经后的卵巢依然保留着部分功能，这也是医学上建议尽量保留卵巢的依据之一。 ```mermaid flowchart TD accTitle: 女性神经内分泌系统的生命周期变化 accDescr: 展示从出生到绝经后神经内分泌系统的激活与拆解过程 subgraph ReproductivePhase ["激活与繁衍阶段"] A["青春期：系统全面激活"] --> B["孕期：系统过度激活"] B --> C["产后：系统部分关闭（妈妈脑）"] end subgraph TransitionPhase ["衰退与重塑阶段"] C --> D["围绝经期（持续 4-14 年）：系统逐步拆解"] D --> E["绝经后：激素转换，大脑进入新稳态"] end ``` ### [25:04](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=1504s) 破除男性视角的衰老曲线与“性激素”的误区 医学教科书和科普图表中关于“大脑衰老”的认知，长期以来建立在一个根本性的偏见之上：图表通常显示一条平缓的横线，直到 60、70 或 80 岁进入老年期后，神经元密度才开始缓慢下滑。然而，丽莎·莫斯科尼（Dr. Lisa Mosconi）博士指出，这些所谓的普遍大脑衰老图表“完全是基于男性数据绘制的”。女性大脑的运作机制远比这复杂得多：从青春期开始，伴随着卵巢每月的周期律动，女性大脑每两周就会经历一次微循环（Microcycle）。 大脑与卵巢之间的双向通信依赖于激素介质，主要是雌激素（Estrogen）、孕激素（Progesterone）以及常被忽视的睾酮（Testosterone）。莫斯科尼博士直言，将它们统称为“性激素”实际上是一个历史性的误读： - **历史局限**：1930 年代，研究人类生殖功能的科学家发现了这些维持月经和妊娠所必需的物质，草率地将其定名为“性激素”。 - **神经科学纠偏**：直到 60 年后的 1990 年代末，脑科学家介入研究才证实，这些激素的作用远远超越了生育繁衍，它们直接掌控着大脑的能量代谢与健康运作，本质上更是不可或缺的“大脑激素”。 在女性大脑中，雌激素堪称“主调控器”（Master Regulator）。莫斯科尼博士用了一个极其生动的比喻：雌激素之于女性大脑，就像“燃油之于汽车”。当雌激素水平充沛时，神经元会积极萌发称为树突（Dendrites）的分支突触，大幅增强神经网络的互联性；脑血流增加，带来充足的氧气与营养；大脑拥有更强的免疫屏障来抵御外来损伤与病变；同时，雌激素作为一种生长激素，还能极大地激发大脑的可塑性与韧性。 - **能量核心驱动**：雌激素最关键的作用，是强力推动神经元燃烧葡萄糖来产生能量。它就像企业中无所不知的高效 CEO，统筹全局；又如交响乐团的指挥家，确保所有声部默契合奏。 - **绝经期的激素交接**：围绝经期与绝经后，强效的雌二醇（Estradiol）近乎“退休”停产，改由效力弱得多的雌酮（Estrone）接替。尽管大脑交响乐仍在演奏，但音色与旋律早已不再如初。 ### [29:54](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=1794s) 脑扫描断层图：能量断崖与女性诉求的实证 当主持人询问围绝经期那 7 至 14 年间身体究竟发生了何种生理转变时，莫斯科尼博士展示了其团队最具突破性的脑部成像研究成果。这是迄今为止全球唯一追踪女性经历绝经各阶段大脑动态变化的科研影像。在 iPad 的动态循环对比图中： - **绝经前**：大脑扫描图呈现出鲜艳饱满的亮红色与黄色，代表着极其旺盛活跃的能量代谢。 - **绝经后**：红色与黄色大面积褪去，整个大脑被大片的绿色所取代。 用主持人直观的感受来说，“就像大脑里的灯一盏盏熄灭了”。莫斯科尼博士证实了这种直觉：在量化指标上，这意味着**大脑能量水平出现了整整 30% 的断崖式下跌**。这并非因为大脑缺乏糖分供应，而是神经元失去了强效雌二醇的驱动，无法再像过去那样快速、高效地燃烧葡萄糖转化为能量。 这一研究具有划时代的双重意义： 1. **历史经验的科学平反**：数百上千年来，无数女性向医生倾诉绝经期间“感觉脑子不对劲”、“我不再是我了”、以及陷入难以名状的“脑雾”（Brain Fog）与“认知疲劳”（Cognitive Fatigue），却常常被当作神经质或情绪问题轻视。脑扫描提供了不容置疑的客观生理铁证，证实绝经改变大脑的确定性与改变卵巢完全一致。 2. **重塑对绝经的认知定位**：绝经不仅仅是生殖系统的落幕，更是对大脑的一场“翻修工程”（Renovation Project）。它是一个神经活跃的重组状态，直接伴随着大脑体积、脑结构、神经网络连接度以及脑血流的真实改变。 在个体差异方面，莫斯科尼博士强调，并非所有女性的大脑变化都如出一辙：展示的病例代表了临床上的平均水平；部分女性的大脑几乎未受影响，而另一些女性的脑改变则剧烈得多，甚至在弥散磁共振（dMRI）上表现出显著的白质病变和更密集的神经胶质增生（Gliosis，即随衰老出现的微小亮斑）。针对主持人关于“生理改变如何投射到现实行为”的追问，莫斯科尼博士指出，生物学特征与具体外在行为之间并不存在简单生硬的单向对应，但她们正在审稿中的最新论文已经证实，这些大脑能量指标与临床症状之间存在着极高的相关性。 ### [35:07](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=2107s) 主观认知下降与医学史上对女性的污名化 更年期带来的核心困扰之一是“脑雾”（brain fog）。这是一种令人陷入极度精神耗竭的状态，整个人感觉像被棉花团包裹住一样浑浑噩噩，仿佛大脑完全无法开机。许多处于该阶段的女性所经历的，在临床上被称为“主观认知下降”（Subjective Cognitive Decline）：女性自身能够非常敏锐地觉察到自己的认知表现大不如前；然而，一旦去接受标准化的神经心理学评估，其测试得分却依然处于正常参考值范围内。 这种“主观能感知、客观测不出”的现状带来了一把双刃剑，最恶劣的影响在于医学史上一贯对女性诉求的漠视与轻视。长期以来，当女性提出这些困扰时，往往会被简单粗暴地打上“她疯了”、“她激素失调了”、“她在无理取闹”的标签，甚至被告知“这纯粹是你想多了/全是你脑子里的臆想”（It's all in your head）。Dr. Lisa Mosconi 直言自己极度痛恨这种说法，哪怕在主流科学界，也有不少人曾经轻蔑地将这些神经症状归咎于心理情绪障碍。回溯医学史，女性始终被塑造成情绪化、心理不稳定的形象。“歇斯底里”（Hysteria）这个词在希腊语中本义就是“子宫”（hystera）。古希腊医学认为，子宫与大脑之间存在着某种诡异的纽带，子宫的病变会导致女性走向癫狂。荒谬的是，现代医学证明他们有一点其实碰巧蒙对了——子宫/卵巢与大脑之间确实存在深切的生理连接，但这种联系绝非女性被傲慢贬低、敷衍对待的理由，而是一项亟需严谨探索的重大科学课题。Lisa 表示，她如今所做的许多神经科学研究，本质上就是在用实打实的证据为千百年来被忽视的女性正名。 - 临床定义：**主观认知下降（Subjective Cognitive Decline）**，即个体明确感知到脑力滑坡，但在常规临床神经心理测试中各项数据仍显示正常。 - 历史渊源：“Hysteria”（歇斯底里）源自古希腊语“Hystera”（子宫），反映了古代将女性一切精神、情绪与神经异常归咎于生殖器官的偏见。 --- ### [38:05](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=2285s) 解构脑雾：高达 62% 的高发率与“话到嘴边”的失语感 在经历围绝经期（Perimenopause）和绝经后期（Postmenopause）的女性群体中，有多达 **62%**（接近三分之二）的人深受脑雾困扰。脑雾绝不仅仅是“思绪不如以前敏捷”那么简单，而是一种大脑被某种不可抗力强行“劫持”的无力感。即便拼尽全力，大脑也像是断了电一样启动不了。它不同于熬夜缺觉引起的疲惫迟钝——因睡眠不足导致的头脑昏沉，你知道补一觉就能恢复；而脑雾却伴随着一种深层的失控感与绝望感。 脑雾是注意力、记忆力、专注力和语言能力的全面受损。其中极具代表性且普遍的症状是**“舌尖现象”（Tip-of-the-tongue phenomenon）**：患者明明对想要表达的词汇心知肚明，但在开口的瞬间，那个词汇就像在大脑中蒸发了一样，无论如何也调取不出来，甚至难以完整说完一句话。这种体验在感官上无限逼近临床上的轻度“失语症”（Aphasia）或某些早发痴呆的语言障碍。对于无数将沟通与表达视为职场立身之本、“核心超能力”的职业女性来说，这种突如其来的认知断层带来了巨大的痛苦与挫败。 ```mermaid flowchart TD accTitle: Menopause Brain Fog Mechanism accDescr: A diagram showing how estrogen fluctuations in menopause cause ATP depletion and lead to cognitive symptoms. subgraph Hormonal_Shift["激素剧烈变动"] E2["雌激素与孕激素波动骤降"] end subgraph Brain_Impact["大脑能量危机与重构"] Mito["线粒体功能受损"] ATP["ATP 细胞能量币暴跌<br>(31P-MRS 证实)"] Hypo["下丘脑体温调节中枢受挫"] Rewire["神经回路重构 & 部分神经元丢失"] end subgraph Clinical_Symptoms["外在典型临床表现"] Fog["脑雾 (记忆/注意力/专注力缺失)"] Aphasia["舌尖现象 (提笔忘字 / 词不达意)"] Flush["血管舒缩症状 (潮热 / 盗汗)"] end E2 --> Mito Mito --> ATP ATP --> Rewire E2 --> Hypo Rewire --> Fog Rewire --> Aphasia Hypo --> Flush ``` --- ### [40:04](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=2404s) 更年期重塑大脑与 31P-MRS 揭示的 ATP 能量危机 更年期在神经生物学层面的本质，是一场**大脑结构的生理性重大重构（Physiological Reconstruction / Rewiring）**。大脑中承受激素剧烈震荡的首当其冲者就是**下丘脑（Hypothalamus）**。下丘脑是中枢神经系统中直接接收来自卵巢激素反馈的枢纽中枢，同时统管着人体的体温调节系统。当雌激素与孕激素水平剧烈起伏时，依赖这些激素正常运转的下丘脑便会功能紊乱，无法稳定调控核心体温，直接诱发了更年期标志性的潮热（Hot flashes）。 在脑结构影像层面，更年期女性的大脑并非单纯衰退，而是呈现出极为复杂的结构变化：部分脑区体积缩水，某些神经通路连接被稀疏化，而另一些脑区连接反而代偿性增强；同时，全脑的代谢能耗水平显著下滑。Dr. Lisa Mosconi 团队利用**磷-31 磁共振波谱成像（31P-MRS，Phosphorus-31 Magnetic Resonance Spectroscopy）**技术，揭示出女性大脑在更年期经历了一场**“ATP 能量危机”**： - 细胞内负责将能量转化为“能量货币”ATP 的线粒体（Mitochondria）功能受阻，ATP 的合成量大幅跌落，或消耗过快入不敷出。 - 雌激素不仅是大脑神经信号传递的调控因子，更是脑细胞汲取葡萄糖与生成代谢燃料的关键后盾。当雌激素这把保护伞被撤走，神经元同时陷入了 ATP 亏空与营养断供的窘境。 - 扫描图像上直观可见的大脑活性暗淡（“像灯光熄灭一样”），正是雌激素撤退、神经回路重组、部分神经元丢失以及细胞能耗衰退共同导致的生物学表征。 --- ### [43:02](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=2582s) 简单补雌激素就能救脑？激素替代疗法（HRT）的曲折历史 面对这种因雌激素受体空置、代谢失调引发的脑萎缩与机能滑坡，主持人 Steven Bartlett 提出了一个看似极具逻辑的常识性质疑：既然核心根源是雌激素匮乏，那我们把雌激素直接补回去不就行了？“哪怕吃下去、抹在脸上、倒进咖啡里、涂在麦片上、甚至吸进去，只要把雌激素补足，让脑子亮起来，是不是就能规避脑雾、潮热、抑郁和失眠？那播客是不是现在就可以结束了？” 然而，Dr. Lisa Mosconi 苦笑着指出：“要是真有这么简单就好了。”现存的医学干预手段即**激素替代疗法（HRT，Hormone Replacement Therapy）**，但这项疗法在现代医学史上经历了一场极其痛苦、颠簸的噩梦： - **1940年代至1970年代**：雌激素疗法一度攀升为全美乃至全球最畅销的处方药物。当时的行医模式是将步入更年期的女性全面且长期（甚至终身）维持在高剂量雌激素状态下。彼时医学界普遍乐观地认为，这不仅能根除潮热等更年期症状，还能长效预防心血管疾病和阿尔茨海默病/痴呆症。 - **1990年代至1993年**：监管机构介入，指出在未进行严谨大规模随机双盲临床试验的情况下，绝不能盲目给全社会女性长期用药。1993年，历史上规模空前的 HRT 临床试验（妇女健康倡议，WHI）正式启动，旨在全面论证激素对缓解潮热及预防心脏病、痴呆的收益。 - **2002年的试验崩盘**：2002年，该项大型研究被紧急强行叫停。试验中期数据显示，特定配方的激素疗法不仅未能提供心脑血管保护，反而在部分受试女性中显著增加了罹患乳腺癌、心脏病以及痴呆的绝对风险。 - **灾难性后果与漫长停滞**：媒体的大肆负面报道引发了全球性恐慌，成千上万的女性在一夜之间擅自停药，海量医疗诉讼随之爆发。整整 15 到 20 年间，绝经期激素疗法的基础与临床研究几乎陷入冰封瘫痪。直到近年来，科学界才逐渐拨开迷雾，认识到给药时机（Timing Hypothesis）、用药人群亚型与激素配方的重要性。 ### [46:53](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=2813s) 剖析 WHI 研究的致命缺陷与现代激素疗法的演进 Lisa Mosconi 博士深入剖析了历史上极具争议的“妇女健康倡议”（Women’s Health Initiative, WHI）研究。该研究当年招募了大约 16 万名女性，却得出了令人恐慌的结论，导致整整一代人对激素替代疗法（HRT）谈虎色变。Mosconi 指出，这项研究最大的硬伤在于受试人群的年龄结构——研究人员招募的是七八十岁的老年女性。当女性绝经多年后，大脑内的雌激素受体已经退化或关闭，身体缺乏能够利用这些激素的生理基础；此时强行注入高剂量激素，结果往往是“弊大于利”。 如今的激素疗法与数十年前相比已发生翻天覆地的变化。现代医学使用的剂量要低得多，给药方式也多样化，例如通过皮肤吸收的经皮贴剂（transdermal patch），不仅能绕过肝脏代谢、对肝脏更温和，还能显著降低血栓及其他心血管并发症的风险。此外，药物成分从过去的合成激素全面转向生物等同性激素（bioidentical hormones），并配合更安全的黄体酮（progesterone）。 更为关键的是用药时机（Timing Hypothesis）。Mosconi 及其团队的研究证实，激素对大脑的保护作用存在一个“关键时间窗”——必须在绝经最后一次月经前后的 10 年窗口期内使用，最好是在绝经到来之前就开始干预。其核心机制在于“稳定”体内波动剧烈的激素浓度，而不是等到内分泌彻底崩塌后才充当事后补丁。提前介入能够平稳过渡，从而预防潮热、盗汗和失眠等痛苦症状的爆发。 --- ### [48:59](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=2939s) 汽车引擎隐喻与激素疗法的适应证现状 Steven Bartlett 提出了一个极具画面感的机械比喻来总结 WHI 研究的荒谬之处：这就像试图给一辆油阀已被彻底封死、或在路边废弃了整整十年的老旧汽车加油，发动机系统早已下线停摆，硬往里面灌汽油不仅无法让车重新跑起来，反而会导致机械故障。Mosconi 对这个比喻深表赞同，强调神经系统受体如果长期缺乏雌激素刺激就会彻底停机，因此必须在系统仍在运转时供给燃料，才能维持其长期活力。 两人随即转向激素疗法在当代医学中的实际应用范围。目前，官方获批的激素疗法适应证极其狭窄，仅被批准用于治疗“血管舒缩症状”（vasomotor symptoms），即典型的潮热（hot flashes）与夜汗（night sweats）。在临床实践中，它偶尔会被超说明书（off-label）用于缓解因夜间潮热引发的严重睡眠障碍，或是改善由绝经本身引发的轻度抑郁情绪。 令人费解的是，广大女性呼声最高的“脑雾”（brain fog）和认知衰退，目前并未被列为激素疗法的正式适应证，医学指南也不推荐使用激素来保护认知功能。Mosconi 直言这种现状让包括她在内的很多神经科学家感到不可思议。现实中，面对绝经期思维迟钝、记忆受挫的女性，主流医疗建议往往只能是让人无奈的“咬牙硬挺”（suck it up）。Mosconi 表示，她之所以分秒必争地加快临床研究，不仅是为了帮助千千万万的女性，也是为了在自己未来跨入更年期时能有科学、合法的医疗选择。 ```mermaid flowchart TD accTitle: 激素疗法临床应用现状 accDescr: 区分当前官方批准的适应证、超说明书应用与目前仍在临床研究中的脑雾适应证 subgraph Approved["官方正式获批适应证"] VMS["血管舒缩症状 (Vasomotor Symptoms)<br/>• 潮热 (Hot Flashes)<br/>• 夜汗 (Night Sweats)"] end subgraph OffLabel["超说明书常用范围 (Off-label)"] Sleep["潮热继发的睡眠障碍"] Mood["绝经直接诱发的轻度抑郁"] end subgraph UnderResearch["前沿临床攻关阶段"] BrainFog["脑雾 (Brain Fog)<br/>与认知功能保护支持"] end Approved -.-> OffLabel OffLabel -.-> UnderResearch ``` --- ### [51:50](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=3110s) 生活方式干预五大支柱与“绝经生存狂” 在谈到如果自己步入更年期会采取什么措施时，Mosconi 梳理了应对更年期的五大核心生活方式支柱： - **精准膳食调节**（Diet）：为大脑代谢提供抗炎与抗氧化营养支持。 - **规律体育锻炼**（Exercise）：强化心血管与线粒体活性。 - **严苛的睡眠卫生**（Sleep Hygiene）：保证深睡期以促进脑内代谢废物清除。 - **主动压力管理**（Stress Reduction）：抑制皮质醇飙升对内分泌的干扰。 - **极力规避环境毒素**（Avoiding Toxins）：远离内分泌干扰物与塑料微粒。 此外，她强调必须保持严密的定期体检，排除任何可能加剧更年期反应的潜在器质性病变；对于药物治疗方案，她目前虽未服用，但正在基于最新科学证据审慎评估其作为未来备选方案的可行性。 聊到避免环境毒素时，Steven 调侃 Mosconi 的准备状态简直像末日防灾的“生存狂”（Prepper）——那些在地下挖防空洞、囤积粮食甚至购置枪支准备迎接世界末日的人。Mosconi 听后大笑，坦言自己虽然不囤枪支弹药，但在生活细节上的严谨确实有点“走极端”，最典型的举动就是她的厨房里实行完全的“无塑料化”，坚决杜绝任何塑料制品接触食物和饮水。 --- ### [52:50](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=3170s) 围绝经期阶段拆解：生理周期变化与症状级联爆发 为了让公众更清晰地掌握更年期的时间线，Mosconi 详细拆解了从育龄期迈入绝经的渐进过程。大部分女性在 30 多岁时生理周期相当规律；而一旦跨过 40 岁门槛，绝经前期（Premenopause）便悄然拉开序幕。早期阶段月经依然如常，随后进入晚期阶段，周期开始发生数天的微小波动——有的月份稍微提前，有的推迟几天，经血量也可能变多或变少。Mosconi 强烈建议 40 岁以上的女性密切记录经期动态，因为这是察觉身体滑向围绝经期的首要晴雨表。 随后到来的是真正的围绝经期（Perimenopause），其生理演变表现出鲜明的阶段性递进特征： ```mermaid flowchart LR accTitle: 绝经前期至围绝经期的阶段演进 accDescr: 展示从40岁绝经前期到围绝经期早晚期的月经与典型症状变化 A["绝经前期 (约40岁)<br/>月经周期细微变动<br/>天数微调/血量微调"] --> B["围绝经期早期<br/>偶尔跳过1-2个月经期<br/>黄体酮下降/入睡及维持困难/晨起脑雾"] B --> C["围绝经期晚期 (平均45-47岁)<br/>停经间隔达3个月以上<br/>潮热盗汗爆发/情绪崩溃/躯体症状"] C --> D["绝经 (Menopause)<br/>连续12个月完全无月经"] ``` - **围绝经期早期（Early Perimenopause）**：主要特征是开始出现跳过月经的现象，比如缺席一个月后又恢复正常，随后可能连续缺席两个月。此时最普遍的临床抱怨是睡眠质量严重下滑——女性不仅难以入睡，更容易在半夜惊醒且无法继续入眠，这主要是黄体酮（孕激素）水平急剧下滑造成的。在此阶段，潮热尚不普遍，但周期性脑雾开始显现：尤其在经期前后，女性早晨醒来常感到精疲力竭，甚至连“打开邮箱查看工作邮件”这种微小任务都会让人产生宛如浩劫般的巨大抗拒感。这种状态可能持续数小时或一整天，是更年期全面降临的“预告片”。 - **围绝经期晚期（Late Perimenopause）**：临床定义为月经连续推迟停滞达 3 个月以上。女性通常在 45 岁至 47 岁左右遭遇这一重创阶段，也是各类典型症状集中暴发的剧烈期。此时体内雌激素剧烈起伏崩落，潮热、夜间盗汗和真正的顽固失眠集中肆虐；心理情绪方面则会出现毫无缘由的易怒、悲伤欲绝的哭泣失控、极度消沉（down in the dumps）以及令人恐惧的健忘与脑雾。 除了神经大脑层面的震荡，机体还会出现一系列伴生症状：阴道干涩、代谢放缓导致的体重莫名激增、胃肠道消化不良、肌肉高度紧张与全身钝痛；晚期或绝经后还会出现膀胱过度活动症（频繁起夜失禁）。更有女性会出现耳鸣（tinnitus）、全身窜行的“触电感”（electric shock sensations）以及突发的惊恐发作（panic attacks）。Mosconi 特别指出，流行病学数据显示黑人女性与西班牙裔女性往往在围绝经期承受着更为剧烈、痛苦且持久的重度症状，尽管背后的种族与表观遗传机制仍有待现代医学进一步探明。 ### [58:00](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=3480s) 更年期危机：飙升的自杀率、破裂的婚姻与最艰难的八年窗口 更年期长期处于科研投入不足的盲区，但其引发的现实后果却极为惊心动魄。主持人和 Lisa Mosconi 博士谈及一项令人震惊的统计数据：女性在步入中年后，自杀倾向和自杀率显著上升，这与经历更年期转变有着直接关联。不仅如此，女性在这一生理过渡阶段的离婚率也大幅激增。主持人特别指出，数据显示女性一生中自杀风险最高的时期正是在 55 岁左右。 Lisa Mosconi 博士随后系统拆解了绝经期前后最凶险的时间段。更年期并非一个模糊的漫长过程，而是有着明确的分期：在围绝经期晚期（Late Perimenopause）之后，女性迎来绝经（Menopause，在临床上为一个明确的诊断节点），随后进入绝经后早期（Early Postmenopause）。在末次月经（Final Menstrual Period）前后的各个方向延伸 3 到 4 年——即整整持续 6 到 8 年的“过渡窗口期”，是绝大多数女性经历症状折磨最深、日子最难熬的阶段。然而，医学界至今仍未对更年期症状的种类、复合数量以及严重程度建立起正式的标准化分类与评估机制，这种系统性忽视是完全不可接受的。 - **高危年龄段**：55 岁前后是女性一生中自杀率最高的危险峰值区间。 - **关键动荡期**：以末次月经为基准，前 3 至 4 年加后 3 至 4 年，构成最艰难的 6 至 8 年症状风暴期。 - **现实冲击**：除了精神健康危机，伴随更年期过渡的家庭破裂与离婚率也显著增加。 ```mermaid flowchart LR accTitle: 更年期过渡阶段与症状高峰 accDescr: 展示以末次月经为中心的症状高发过渡窗口 subgraph Window["核心动荡窗口期（症状最严重）"] A["围绝经期晚期<br/>（末次月经前 3-4 年）"] --> B["绝经诊断节点<br/>（末次月经 FMP）"] B --> C["绝经后早期<br/>（末次月经后 3-4 年）"] end C --> D["绝经后晚期<br/>（末次月经 6 年之后）"] ``` --- ### [59:56](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=3596s) 重新定义更年期：独特的神经内分泌转变与医学词汇的缺失 更年期在现代医学中亟需重新正名。Lisa Mosconi 强调，更年期的现代科学定义是“女性特有的神经内分泌转变（Neuroendocrine Transition）”。它不仅以生殖衰老和生育能力终止为标志，更深刻冲击着包括大脑在内的整个人体机能网络。这一转变具有独一无二的医学属性，绝不能简单等同于“变老”，更不能被视为一种疾病。在整个医学体系中，能够被归为“神经内分泌重大过渡”的生命阶段仅有三个：青春期（Puberty）、怀孕期（Pregnancy）以及围绝经期（Perimenopause）。 怀孕与更年期在神经和生理机制上有着惊人的重叠：许多孕妇同样会经历情绪大起大落、注意力与专注力涣散、脑雾，甚至有高达 30% 的孕妇同样饱受潮热困扰。然而，社会与医学对待两者的态度却有天壤之别。怀孕被赋予了无限美好：有迎婴派对、亲友道贺、公众拍照祝福，孕妇遭遇情绪不适会获得由衷的同情与照护；更重要的是，医学界为妊娠期建立了完善的话语体系与筛查网络。产后女性从“产后心绪不良（Baby Blues）”、产后抑郁到罕见的产后精神病（Postpartum Psychosis），有着分门别类的诊断词汇。儿科医生在为新生儿做常规体检时，就能当场为母亲完成抑郁筛查，并给予针对性的产后抑郁特异性疗法。 反观更年期，目前却几乎处于“词汇真空”状态。女性甚至无法向医生准确描摹自己的痛苦。当女性诉说自己有“脑雾（Brain Fog）”时，医生往往无所适从，因为在现行的临床诊断体系中根本没有脑雾的标准化病理定义，更缺乏对应的支持与分级诊疗流程。 --- ### [01:02:56](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=3776s) 医疗培训断层：当神经学症状遇到只懂卵巢的妇产科 更年期女性求医无门的根源在于传统医疗教育的制度性缺陷。当主持人询问医学院对更年期知识的教学比重时，Lisa Mosconi 给出的答案令人咋舌：在妇产科（OBGYN）住院医师规培中，仅有五分之一的人接受过相关培训；纵观他们漫长的全部住院医规培周期，更年期培训的累计课时竟然只有区区 6 到 8 小时。这意味着绝大多数妇产科医生从未接受过系统性的更年期医学专科训练。 更深层的结构性矛盾在于学科划分与病理本质的错配。妇产科长期以来被定位为负责月经周期、妊娠、生育及生殖器官病变的学科，更年期因而被狭隘地禁锢在“卵巢功能减退”的单一框架内。然而，绝大多数更年期女性真正痛苦不堪的核心症状——潮热、情绪波动、睡眠剥夺、脑雾与认知衰退——本质上全部都是“神经系统问题”。妇产科医生并未接受过大脑神经病理的诊疗训练，也没有掌握管理大脑机能的专业技术；而神经科专家又极少参与到更年期患者的初级评估中。Lisa Mosconi 与其团队正在竭力打破这一学科壁垒，推动将脑神经专家正式纳入更年期综合评估与多学科干预方案中。 - **极低课时占比**：整套妇产科住院医师规培中，更年期相关课程总计仅约 6 至 8 小时。 - **专科比例失衡**：仅有 1/5 的妇产科规培医生接受过更年期培训，真正持有认证的更年期专科医师（Certified Menopause Specialist）极度匮乏。 - **器官错位诊疗**：主要临床表现属于中枢神经学范畴，却被推给主攻下腹盆腔生殖系统的科室诊疗。 --- ### [01:04:58](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=3898s) 脑雾的“U型”复苏曲线与阿尔茨海默病的隐忧 在梳理完前述阶段后，Lisa Mosconi 补充了更年期的终章——绝经后晚期（Late Postmenopausal Stage）。该阶段通常在末次月经发生 6 年后确立，并将伴随女性度过余生。在此阶段，绝经早期的“风暴”逐渐平息，许多困扰女性的潮热、盗汗、情绪动荡以及脑雾现象会随时间推移逐渐消退。 针对女性最担忧的脑力衰退问题，Lisa Mosconi 解析了认知表现呈现出的“U型轨迹”。在绝经前，女性的认知功能处于稳定高位；进入围绝经期后，认知评分出现明显下挫，脑雾频繁发作；但渡过转变期进入绝经后晚期时，大脑会展现出适应与代偿能力，认知功能曲线重新回升。少数女性甚至能完全恢复到绝经前水平，而多数人虽略低于年轻巅峰期，但整体仍维持在良好水平。 然而，令人担忧的是另一部分女性：她们的认知曲线并未反弹，而是呈现持续单向恶化。这也是大批中年女性涌入 Lisa Mosconi 主管的阿尔茨海默病预防诊所（Alzheimer’s Prevention Program）的原因——她们极度恐惧更年期的严重脑雾正是早期痴呆的先兆。针对这一差异，Lisa 团队一项正处于同行评审阶段的开创性研究，首次揭示了更年期脑雾与特定大脑器质性改变之间的直接对应关联。这项研究为厘清“为何部分人能够代偿复原、而另一些人持续恶化”，以及探寻激素替代或新型治疗手段提供了首个生物学靶标。 | 发展阶段 | 典型时间节点 | 神经/认知特征表现 | |:--- |:--- |:--- | | **围绝经期前** | 40 岁左右及更早 | 神经内分泌稳定，认知功能处于个人高位，无明显脑雾 | | **围绝经期至绝经后早期** | 末次月经前后 3~4 年 | 激素震荡剧烈，神经元能量代谢紊乱，认知曲线出现深幅“U型探底”，脑雾与潮热高发 | | **绝经后晚期（典型多数）** | 末次月经 6 年之后 | 神经系统重新布线代偿，认知功能回升接近基准水平，脑雾逐渐自行消退 | | **持续下滑亚群（高危风险）** | 末次月经 6 年之后 | 认知曲线未出现 U 型反弹而是持续恶化，存在进展为阿尔茨海默病病理前驱期的潜在风险 | --- ### [01:07:28](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=4048s) 运动处方：有氧、力量与身心训练对大脑与激素的协同挽救 面对更年期带来的神经与代谢震荡，积极的预防性筹备（Prep）不可或缺，其中最核心的支柱便是运动干预。Lisa Mosconi 从系统生物学角度阐释道，人体各个器官高度互联，身体任何局部的健康都是维持整体生命活力的基石。体育锻炼之所以能直接保护更年期女性的大脑，是因为肌肉收缩与身体运动会激活并促使体内合成一系列保护性蛋白、肽类物质与生长激素。这些分子能够跨越血脑屏障穿透至大脑内部，在大脑局部被诱导生成，直接滋养并支撑神经元健康。 针对更年期的多系统症状，不同形式的运动有着精确的分工与协同价值： - **心血管有氧运动（Cardiovascular Activity）**：对于缓解下丘脑温控失调引发的“潮热（Hot Flashes）”以及改善“脑雾”展现出极为卓越的针对性效果。 - **力量训练与抗阻运动（Strength Training）**：是维持更年期代谢活性、逆转肌肉流失、防止骨质疏松的基石，同时对提振情绪、抗击抑郁具有关键神经生物学支持作用。 - **身心综合训练（Mind-Body Techniques）**：包括瑜伽（Yoga）、普拉提（Pilates）以及太极（Tai Chi），不仅有助于保持关节柔韧度，更能有效下调皮质醇水平、减轻压力负担并直接改善更年期睡眠障碍。 ### [01:08:56](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=4136s) 运动与更年期症状：打破“没时间”的恶性循环与倒U型曲线 在探讨围绝经期的生活方式调整时，主持人提到丽莎·莫斯考尼（Dr. Lisa Mosconi）书中引用的拉丁美洲女性研究：一项针对约 3,500 名女性的调查显示，坚持规律中等强度运动的女性，遭遇严重潮热的概率比缺乏运动者低了近 30%。然而极具讽刺意味的现实是，40多岁的中年女性恰恰是所有人群中运动最不规律、甚至完全不运动比例最高的群体。莫斯考尼解释道，这并非女性缺乏自律，而是她们正处于人生的“三明治夹心层”——上有年迈父母需要照料，下有年幼子女需要抚育，职场上正处于冲刺晋升的关键期，身体还要承受体内激素剧烈波动的断崖式冲击。持续的慢性疲劳与睡眠匮乏构成了现实阻碍，让许多女性根本没有精力踏入健身房。 针对这种困境，莫斯考尼强调不必把运动神圣化或复杂化。运动不需要昂贵的专业装备，也不必非去健身房，去公园散步、让身体持续动起来就足以产生积极影响。面对“是否会因过度运动反而适得其反”的顾虑，莫斯考尼明确指出，运动强度与整体健康收益之间存在一条经典的“倒U型曲线”（inverted U-shape curve）。对于绝经前后的女性而言，极端高强度的剧烈训练（如盲目挑战每日马拉松）不仅可能导致皮质醇水平飙升、绝经后身体恢复期大幅延长，更会使健康收益递减。 ```mermaid flowchart TD accTitle: 绝经期女性运动强度与健康收益关系 accDescr: 展示久坐、中等强度运动（第二区间）与过度高强度运动对应的健康收益倒U型变化曲线。 subgraph Low["低运动量阶段"] A["久坐不动 / 几乎不运动"] -->|"无健康增益"| B["症状发生率高 / 潮热风险加剧"] end subgraph Optimal["最佳效益区间（倒U型顶点）"] C["中等强度 / Zone 2 训练"] -->|"高频次每周 3-5 次"| D["面颊微红、能说话但无法唱歌"] D --> E["潮热风险下降 30% / 促脑健康"] end subgraph High["过度负荷阶段"] F["超高强度 / 极端剧烈训练"] -->|"皮质醇升高 / 恢复期延长"| G["综合健康收益递减"] end B --> C E --> F ``` 莫斯考尼提倡的最佳运动状态是耐力运动员常说的“第二区间”（Zone 2）——即中等强度、高频次运动。其体感特征非常直观：“面颊微微泛红，虽然说话不费力，但若是想唱歌就会感到吃力”，心率有所提升但绝不会喘不过气。只要坚持这种适度负荷，身体便能获得最稳定、最持久的抗衰与代谢平衡收益。 - **拉丁女性群体研究**：坚持规律进行中等强度运动的女性，严重潮热发生率下降近 30%。 - **中年女性的现实困境**：多重责任夹击（子女教育、赡养老人、职业瓶颈）叠加激素减退带来的疲劳与失眠，构成巨大的运动门槛。 - **倒U型运动效益法则**：从轻度运动起步即可见效，中等强度（Zone 2）达到收益峰值；盲目加大强度会导致皮质醇异常升高并延长肌肉修复周期。 --- ### [01:13:20](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=4400s) 运动对抗阿尔茨海默病：降低30%认知障碍风险的天然处方 运动对大脑结构的深远重塑，直接体现在神经退行性病变的生物标记物上。当主持人询问增加运动是否能减少脑内的阿尔茨海默病淀粉样蛋白斑块时，莫斯考尼给出了斩钉截铁的肯定回答。大量临床神经影像与流行病学证据表明，坚持规律运动的女性大脑中异常蛋白沉积显著减少。 更关键的长期追踪数据显示，中年时期保持良好身体机能与心肺耐力的女性，步入老年后罹患痴呆症（包括阿尔茨海默病）的风险比久坐不动的同龄人低整整 30%。莫斯考尼感慨道：“如果我手里有一款能将阿尔茨海默病和痴呆风险直降 30% 的药丸，我早就富可敌国了，全世界都会抢着买。”但现实中这个最强效的神经保护剂不需要高昂花费，只需要落实为具体的行为处方：每周进行 3 至 5 次中等强度的规律运动。 - **阿尔茨海默病斑块清除**：规律运动能有效减少大脑中淀粉样蛋白斑块的沉淀累积。 - **降低 30% 痴呆风险**：中年期身体活跃、机能良好的女性，晚年认知障碍与痴呆发病率降低约三分之一。 - **运动处方建议**：每周维持 3 到 5 次的中等强度有氧运动。 --- ### [01:14:11](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=4451s) 咖啡因的代谢陷阱：长达12小时的体内残留与睡眠干扰 在日常饮食与更年期调理的讨论中，莫斯考尼透露自己已经彻底改喝无咖啡因咖啡（decaf），虽然这引起了全家人的哀鸣。咖啡因是许多更年期女性睡眠障碍的核心诱发源，但绝大多数人严重低估了它在体内的代谢滞留时间。人们往往以为咖啡因带来的兴奋感只是喝下那一刻的提神体验，却忽视了其漫长而隐蔽的生化代谢周期。 莫斯考尼详细拆解了咖啡因的代谢药代动力学：咖啡因在人体内的半衰期约为 6 小时，这意味着饮用 6 小时后，依然有一半的有效成分在大脑和血液中活跃回荡；而将其彻底代谢清除则需要大约 12 个小时的完整周期。 | 饮用时间点 | 晚上 8:00 体内残留 | 晚上 10:00 体内残留 | 对就寝的实际生理影响 | |:--- |:--- |:--- |:--- | | **中午 12:00** | 大部分已代谢 | 仍有少量残留微量循环 | 影响相对可控，但敏感体质仍会受扰 | | **下午 2:00** | 约残留 50% 咖啡因 | 仍有高达 25% 咖啡因在脑内循环 | 中枢神经过度警觉，直接破坏深度睡眠结构 | | **晚餐后（如 18:00-20:00）** | 处于吸收或峰值期 | 几乎全部或绝大部分未代谢 | 神经系统被强行激活，造成入睡困难与夜醒 | 两人调侃起餐厅在丰盛晚餐后主动端上意式浓缩咖啡（espresso）的传统，主持人笑称这种做法简直是“彻头彻尾的疯子行径”。莫斯考尼指出，这正是典型的“单点优化反致全局崩溃”——人们本想借咖啡因刺激肠胃蠕动促进消化，却在就寝前夕强行唤醒了中枢神经，彻底摧毁了当晚的修复性睡眠。 - **咖啡因代谢时长**：体内半衰期为 6 小时，完全代谢清除周期约为 12 小时。 - **晚间残留效应**：下午 2 点摄入的一杯咖啡，直到夜间 10 点仍有四分之一的咖啡因在脑部神经中枢中持续循环。 - **对大脑自我清理的连锁破坏**：由于咖啡因残存导致深睡受阻，大脑将失去夜间清除代谢废物与毒素的关键窗口期。 --- ### [01:16:43](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=4603s) 深度慢波睡眠与类淋巴系统：大脑的夜间“全自动洗车房” 睡眠缺乏与阿尔茨海默病之间的强相关性，本质上是由脑部微观物理排毒机制所决定的。莫斯考尼解释，人类睡眠包含多种不同节律的阶段，其中最核心的是“慢波睡眠”（slow-wave sleep），即深度睡眠阶段。这是整个人体大脑专属的“独处自我修复时间”（me time）。在其他睡眠阶段，肌肉虽然松弛，但身体仍可能发生抽动与体位翻转，这意味着大脑皮层必须保留部分活性以维持最基本的运动监控；唯有在深度慢波睡眠期间，整个身体陷入彻底静止，大脑才能卸下所有对外监控职责，全神贯注地开展由内而外的自我大扫除。 在此期间，脑内一套名为“类淋巴系统”（glymphatic system）的排毒管道网络才会被激活。莫斯考尼形象地将其比作一台“全自动洗车房”或“洗碗机”：脑脊液像高压水柱一样强力冲刷穿透整个脑组织间隙，将日间神经元高强度代谢产生的垃圾、有害毒素、生化副产物以及阿尔茨海默病的关键致病碎片（如β-淀粉样蛋白碎片）通通卷走排空。 然而，更年期女性频繁面临的夜间潮热或神经兴奋，往往让她们在凌晨两三点被迫惊醒。一旦在这个本该处于慢波排毒的高峰节点醒来，整个清洁周期就会被生生掐断。当人体再次入眠时，脑电波节律只能从第一阶段重新轮转，错失的排毒窗口无法弥补。长期剥夺慢波睡眠，会导致神经毒性蛋白在大脑中日积月累，大幅抬高阿尔茨海默病的远期发病几率。 - **类淋巴系统排毒机制**：唯有在慢波深度睡眠状态下被触发，犹如“洗车房”喷射流体彻底冲洗脑组织。 - **身体彻底静止的必要性**：慢波期是全身肌肉唯一绝对静止的阶段，使大脑无需分心操控运动，专心进行内部代谢废物清理。 - **半夜惊醒的结构性破坏**：更年期女性常在凌晨 2 至 3 点醒来，直接阻断排毒循环；再次入睡只能从浅睡期重新开始，导致脑部垃圾持续堆积。 --- ### [01:18:23](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=4703s) 酒精对更年期的负面影响：脱水与症状加剧 除了咖啡因，酒精是另一个严重加剧更年期身心负担的常见诱因。莫斯考尼直言，酒精会显著激化潮热、盗汗等围绝经期反应，令身体不适雪上加霜。从生物化学与生理学机理来看，莫斯考尼最为担忧的核心威胁在于酒精的强脱水属性——导致机体与脑组织脱水是乙醇分子最基础的生理功能之一。 由于健康的大脑组织有高达 80% 的成分由水构成，脑部对水分含量的微妙失衡有着极高的敏感性。细胞外液与神经元水分的流失会直接削弱脑内生化代谢环境、降低毒素转运效率，并进一步扰乱体温调节中枢与认知功能，对本就处于剧烈激素波动中的女性大脑构成隐秘而沉重的代谢打击。 - **症状诱发放大器**：酒精摄入会直接促发并加重更年期的潮热与神经系统不稳定。 - **强脱水分子特性**：酒精以其明确的利尿脱水功能，直接剥夺全身特别是脑细胞的必要水分。 - **高水敏感器官**：大脑组织含水量高达 80%，微小的脱水状态即会对神经元生理活性与毒素清理造成实质性干扰。 ### [01:18:52](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=4732s) 大脑脱水与认知表现 水是大脑中一切化学和细胞反应的核心媒介，因而大脑是对脱水极其敏感的器官。哪怕体液流失仅仅导致 2% 到 4% 的水分体积减少，就会迅速引发神经系统症状，例如头痛、偏头痛、头晕以及脑雾。酒精在体内分解缓慢且极易造成中枢神经系统脱水，不仅会加重更年期的典型症状，在任何年龄段都会对认知功能造成损害。 Dr. Lisa Mosconi 提到了一项关于补水与认知表现的对照实验：两组受试者在接受神经心理学测试、反应时间及计算机化处理速度测试前，其中一组喝下一到两杯水，另一组则完全不喝水。测试结果显示，事先饮水的受试者在认知表现上比未饮水组整整高出 15%。主持人听后打趣道，自己必须在录播客时立刻开始喝水。 ```mermaid flowchart TD accTitle: 补水状态对大脑功能的影响路径 accDescr: 对比脱水引发的神经症状与科学补水带来的认知提升 subgraph Dehydration["脱水状态（如饮酒、缺水）"] D1["体内水分流失 2% - 4%"] --> D2["阻碍脑内化学与细胞反应"] D2 --> D3["诱发偏头痛、头晕与严重脑雾"] end subgraph OptimalHydration["科学补水（含电解质与矿物质）"] H1["摄入含电解质洁净水"] --> H2["优化脑细胞电化学传导"] H2 --> H3["认知与反应速度提升 15%"] end ``` - **脱水对大脑的阈值影响**：仅需 2%–4% 的体液减少，即可触发头痛、偏头痛、眩晕与脑雾等神经学症状。 - **补水实验表现差异**：测试前饮用 1–2 杯水的受试者，在反应时间和信息处理速度测试中，成绩高出 15%。 - **“水不仅是水”**：纯净水（纯水）只是单纯的液体；大脑真正需要的是富含电解质、矿物质和无机盐的水，以维持细胞间的电信号转导与神经代谢平衡。自来水只要洁净即可，Dr. Lisa Mosconi 家中安装了巨型全屋中央净水系统，在彻底滤除杂质的同时完整保留了电解质。 --- ### [01:20:52](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=4852s) 生活毒素与塑料制品对女性健康的威胁 在家庭环境安全上，Dr. Lisa Mosconi 表现出严谨且略显严苛的态度——她的厨房里完全杜绝塑料，所有器皿全部采用玻璃。塑料是一种极普遍的污染物，加热后其微粒与增塑剂极易溶出并渗入食品与饮料中；即使将塑料餐具放入洗碗机，热水循环也会加速化学物质释出，污染后续同批洗涤的碗碟杯具。 这些环境污染物会通过“生物富集”（Bioaccumulation）在体内长期蓄积，即使摄入剂量极低，也会随时间在组织内不断叠加。这对于女性和儿童的危害尤为严重。女性天生体脂比例高于男性，而脂溶性污染物倾向于蓄积在脂肪组织中，特别是乳腺组织。研究已证实，环境污染物与不孕不育、子宫内膜异位症、甲状腺疾病、乳腺癌以及近年来受广泛关注的痴呆症之间存在显著关联。尽管无法将单一疾病归咎于某一种塑料成分，但这种强相关性足以让人坚决远离塑料制品。 - **生物富集机制**：低剂量环境毒素进入机体后极难代谢排出，会长期储存在脂肪组织中逐渐浓缩累加。 - **女性高风险成因**：由于女性生理上体脂率更高，乳腺等脂肪富集区容易成为内分泌干扰物和环境毒素的沉积温床。 - **相关疾病谱**：污染物已在多项研究中被关联至女性生殖障碍、甲状腺功能失调、乳腺癌、生殖系统癌症以及神经退行性痴呆。 --- ### [01:22:40](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=4960s) 大脑真正需要的营养与地中海饮食 大脑的物理结构完全由日常摄入的营养素所构筑。Dr. Lisa Mosconi 回忆自己在学习神经化学时意识到，课堂上反复推导的钾、钠、镁、Omega-3 脂肪酸、优质蛋白质与葡萄糖，本质上就是食物中的营养素。人每天在三餐中所做的每一次食物选择，都在决定是用支持脑健康的优质原料塑造大脑，还是用垃圾食品将劣质分子缝入神经元网络。 Dr. Lisa Mosconi 破除了一项流传甚广的误区：“大脑主要由脂肪和胆固醇组成，因此需要多吃高胆固醇食物来滋补大脑”。事实恰恰相反，饮食中的外源性胆固醇根本无法穿透血脑屏障进入脑实质。大脑需要的核心营养包括抗氧化剂（维生素 C、维生素 E、硒、β-胡萝卜素，富含于蔬菜、水果、坚果和种子）、提供必需氨基酸的优质精瘦蛋白，以及多不饱和脂肪酸（PUFAs）。总体而言，富含上述成分的地中海式饮食模式在临床研究中与更好的女性健康结局高度相关。 --- ### [01:25:42](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=5142s) 膳食补充剂的取舍与植物精粹 关于补充剂，Dr. Lisa Mosconi 指出其角色只能是“辅助”（Supplement）而非“替代”日常饮食。当前市面上普遍存在盲目推荐超大剂量补充剂的现象，但医学共识表明，补充剂仅在人体存在临床或亚临床缺乏时才真正起效。超量的营养素大脑根本无法利用，不仅会被直接经由尿液排出，还可能在身体其他部位产生不必要的蓄积。 对于公众热议的脑健康补充剂 Omega-3，研究表明大脑维持正常功能每日需要约 3 至 6 克 Omega-3 多不饱和脂肪酸；如果日常饮食无法达标，补充剂确实有益。在个人习惯上，Dr. Lisa Mosconi 坦言自己讨厌吞服药丸——常年在医院工作的经历让她本能地将药丸与“生病”联系在一起，因此她更倾向于通过天然植物提取物、浓缩汁来获取抗氧化剂与植物营养素。 - **晨起日常**：醒来先喝一杯水，随后饮用诺丽果汁（Noni juice）与蓝莓汁混合饮品。 - **诺丽果汁的益处**：产自太平洋岛屿，带有标志性的微苦风味；苦味物质可促进消化酶分泌、改善肠道微生态，进而通过“肠-脑轴”利于中枢神经系统的废物清除与代谢平衡，且其自身富含多种维生素、矿物质与植物营养素。 --- ### [01:28:22](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=5302s) 豆类与深海鱼延缓更年期的科学实证 关于饮食对更年期具体年龄的影响，Dr. Lisa Mosconi 的著作《更年期大脑》（*The Menopause Brain*）第 14 章引用了震撼的实证研究：饮食结构直接关乎卵巢机能与更年期到来的时间窗口。 | 饮食类型 | 主要特征食物 | 对更年期到来的影响 | |:--- |:--- |:--- | | **富含豆类与油性鱼类的饮食** | 豆类（豆科植物）、富含脂肪的深海鱼（富含 Omega-3） | **绝经时间平均推迟约 3 年** | | **标准美式饮食（SAD）** | 含糖饮料、精加工食品、包装加工肉制品 | **绝经时间平均提前约 3 至 4 年** | 过早进入更年期意味着女性身体和大脑更早失去雌激素的神经与心血管保护机制。因此，多摄入豆类和富含 Omega-3 的鱼类，减少精制糖和深度加工食品，是延长卵巢与中枢神经系统年轻态最直接、低成本的干预方式。此外，摄入充足的 Omega-3 亦在临床中被证实与缓解女性经痛具有显著联系。 ### [01:29:28](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=5368s) 饮食与绝经期症状及进化的终极困惑 在继续探讨饮食干预时，研究表明欧米伽-3脂肪酸（Omega-3 fatty acids）的摄入与女性更年期复发性抑郁症状的降低显著相关，同时对改善整体生育力也有积极作用；抗氧化剂（Antioxidants）同样被证实能带来更平缓温和的更年期过渡过程，减少痛经、经期痉挛以及降低经前期综合征（PMS）的发生风险。 然而，这一切促使主持人提出了一个更深层次的根本性困惑：如果按照进化论的逻辑，人体经过漫长演化变得极为精密，所有生理机制理应服务于明确的生存与繁衍优势。可绝经（Menopause）的出现似乎令人费解——为什么女性体内的雌激素不能像男性维持睾酮水平那样终生稳定？为什么女性在生命走到尽头之前，会提前几十年彻底关闭生育系统？这在进化论上到底有何依据？ - **Omega-3 脂肪酸的作用**：显著降低更年期复发性抑郁风险，并有益于提升生育力和生殖健康。 - **抗氧化剂的保护效应**：减轻经期痉挛与疼痛，缓解经前期综合征，带来更平稳的围绝经期体验。 - **进化的逻辑矛盾**：人类大多数器官旨在维持生命机能直至死亡，女性生育系统却在中年提前“停摆”。 --- ### [01:30:40](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=5440s) 达尔文视角的局限与“祖母假说” 面对主持人的提问，Lisa Mosconi 博士半开玩笑地指出，提出进化论的查尔斯·达尔文（Charles Darwin）在理论构建上其实“并不太关注女性”。经典的达尔文进化论从男性视角看十分顺理成章：生物活着的首要目标就是把自身基因传递给下一代。按照这个逻辑，女性中年停止生育却依然能长期存活，完全违背了传统进化论的推演。在绝大多数动物物种中，雌性的寿命与生殖寿命完全匹配，一旦丧失繁殖能力便会很快死去。 在地球上，能在绝经后继续长期生存的动物少之又少，只有虎鲸（Killer whales）、某些大象、长颈鹿以及极少数昆虫。针对人类女性绝经后的长寿，演化生物学主要有两种对立的理论解释： ```mermaid flowchart TD accTitle: 更年期进化的两种理论解释 accDescr: 对比传统达尔文主义的人类偶然长寿假说与支持代际育儿生存优势的祖母假说。 subgraph Theory1["观点一：达尔文式传统视角"] A["传统进化论"] --> B["物种寿命应等于生殖寿命"] B --> C["更年期后存活纯属医学发展与人造环境的偶然现象"] end subgraph Theory2["观点二：祖母假说 (Grandmother Hypothesis)"] D["高龄生育风险极高"] --> E["演化出主动终止生殖机制"] E --> F["开启长寿基因并重构身体"] F --> G["转向'祖母与抚养者'角色"] G --> H["保障极度依赖抚育的人类后代生存率"] end ``` 针对所谓的“现代寿命延长论”（即过去人均寿命仅三四十岁，绝经是长寿后的副产品），Mosconi 博士指出古代女性只要挺过年轻阶段，同样有绝经并继续生存的记录。更合乎逻辑的解释是**祖母假说（Grandmother Hypothesis）**： 1. **生育风险的权衡**：随着年龄增长，女性妊娠和分娩的死亡风险急剧飙升，胎儿出现先天缺陷或夭折的概率也大增。 2. **人类幼崽的极端脆弱性**：与生下来就能自理的动物不同，人类婴儿在出生后多年内都处于极度无助的状态，极度依赖整个家庭网络的长期供给。 3. **适应性突变与长寿基因**：远古时期经受住多次生育考验的最强壮女性，其体内激活了长寿基因突变。她们停止继续亲自冒险生育，转而以“祖母”和“照顾者”的身份守护子女和孙辈，大幅提升家族后代的成活率。 正如 Mosconi 博士所言，临床脑影像也证实，女性的大脑和身体在绝经期发生的大规模重构与重新布线（rewiring），正是机体进行积极**进化适应（adaptation）**的铁证，而非简单的器官衰老损坏。 --- ### [01:36:14](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=5774s) 赞助商插播：完美特德抹茶能量饮 主持人随后分享了一个录制现场的幕后花絮：他在播客录制时一直使用的标志性杯子中，装的正是他在英国投资真人秀《龙穴》（Dragon's Den）中注资的品牌 PerfectTed。 他介绍称，PerfectTed 现已成为英国增长最快的抹茶能量饮料品牌。与喝完容易产生心慌、发抖或能量断崖式骤降（Crash）的普通高糖能量饮料不同，抹茶能够提供一整天平稳、持久的专注力与能量，非常适合应对长达数小时的高强度深度访谈、舞台演讲或董事会会议。在 Tesco 或 Waitrose 线下超市以及线上均有售，结算时输入优惠码“DIARY10”可享 10% 折扣。 --- ### [01:37:14](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=5834s) 绝经后的大脑重构与情绪“U型曲线” 随着话题重新转入更年期的心理与神经变化，主持人提到在 Mosconi 博士的研究中，女性在绝经后期往往呈现出前所未有的幸福感，甚至戏谑这是否是因为许多女性在此时期经历了离婚、摆脱了糟糕的关系。主持人观察到，许多女性在中年阶段对自我需求的认知更加清晰，离婚率也随之攀升。 Mosconi 博士证实了这一现象背后的神经生物学机制： - **杏仁核（Amygdala）的选择性下调**：杏仁核是大脑的情绪中枢。神经科学研究显示，绝经后的大脑会对杏仁核进行极具针对性的选择性“重塑”——当面对消极、悲伤或愤怒的负面刺激时，杏仁核的神经放电活跃度显著减弱，不再产生过去那样强烈的神经电荷；相反，当遇到积极正向的愉快事件时，杏仁核依然能保持同样强度的兴奋放电。 - **情绪控制与超越**：这种生理变化让绝经后的女性具备了更强大的情绪把控力，能够更好地维持内心的喜悦、从容与满足感。用 Mosconi 博士身边朋友们的口头禅来说，这就是一种“对无关紧要的破事越来越不在乎（giving fewer F-words）”的从容境界。 随后，现场调出了一张女性幸福感随更年期演变的曲线图。Mosconi 博士解释说，虽然个体差异确实存在，但统计平均数据呈现出一条非常典型的 **U 型曲线**： 1. **基线期（绝经前期）**：心理满意度处于相对平稳的基线状态。 2. **低谷期（围绝经过渡期）**：生活满意度出现明显下滑，伴随剧烈的荷尔蒙波动与脑神经调整，这是许多女性经历焦虑、抑郁与身心不适的艰难阶段。 3. **适应与回升期（绝经后3至6年）**：身体与神经逐渐适应新的无雌激素环境，幸福感开始触底反弹。 4. **高峰期（晚期绝经后阶段，60岁左右）**：神经回路重构完成，许多女性在这一阶段迎来了整个人生中生活满意度和幸福感的高光时刻。 ### [01:40:02](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=6002s) 被忽视的“手术绝经”与卵巢切除的历史惯性 随着自然绝经的过渡期结束，许多女性的身体不适会逐步消退，重新找回自我，对生活的满意度也会随之回升。然而，医学界鲜少公开探讨另一种更为激进的情况——**手术绝经（Surgical Menopause）**。在临床中，因子宫肌瘤、子宫内膜异位症等良性疾病或恶性肿瘤，大量尚未绝经的女性接受了子宫切除术（Hysterectomy）。在美国，子宫切除术是仅次于剖宫产（C-section）的第二大常见女性手术，约每 8 至 9 位女性中就有一人经历过该手术。 令人震惊的是历史遗留的医疗惯性。直到 2008 年以前，主流医学协会的专业指南甚至常规建议：在切除子宫的同时切除两侧卵巢（Oophorectomy）。外科医生的普遍逻辑是，只要患者完成了生育，卵巢就成了“多余的备件”；顺手切除不仅使手术更彻底简便，还能预防未来发生卵巢癌的可能。数据统计显示，仅在 2004 年全美超过 300 万例切除子宫的手术中，有一半以上在毫无恶性肿瘤医学指征的情况下被顺带切除了卵巢。然而，对于没有遗传高风险或强家族史的女性，卵巢癌的发病率其实相对较低，为了规避这一风险而切除健康器官付出了极其沉重的代价。 ```mermaid flowchart TD accTitle: 手术绝经对全身及大脑的级联影响 accDescr: 展示卵巢切除导致体内激素断崖式下跌，引发脑部退行性病变和全身系统性疾病的流程图。 subgraph Surg["外科手术干预"] A["双侧卵巢切除术<br/>(Oophorectomy)"] --> B["雌激素水平一夜骤降<br/>(断崖式突变)"] end subgraph BrainImpact["脑部及神经退行性病变"] B --> C["认知能力下降与痴呆风险增加"] B --> D["帕金森综合征与中风发生率上升"] B --> E["严重焦虑、抑郁等心理危机"] end subgraph BodyImpact["全身系统性风险"] B --> F["骨质疏松症加速恶化"] B --> G["心血管疾病发病率上升"] end ``` - **第二大手术**：子宫切除术在美国女性手术量中稳居第二，仅次于剖腹产。 - **2004 年历史数据**：全美逾 300 万例切除子宫的手术中，超过 50% 伴随了无明确病理指征的卵巢预防性切除。 - **2008 年指南转向**：美国妇产科医师学会（ACOG）在 2008 年修订了建议，明确呼吁尽可能保留健康卵巢。但该条款仅为“建议”而非强制规范，至今仍有部分医生因操作便利劝说患者切除健康卵巢。 - **倡导充分知情**：并非主张盲目拒绝医生建议，而是女性应在术前主动质询：“为什么现在要切除卵巢？术后会有什么后果？如果切除，后续该如何干预和弥补？” --- ### [01:44:37](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=6277s) 首创脑成像追踪：卵巢切除前后的大脑萎缩 自然绝经是一个历时数年的渐进衰退过程，而手术绝经则是让尚有月经周期的女性在“一夜之间”被强行推入绝经状态。其对中枢神经系统的冲击远比自然衰老残酷。以往的研究大多停留在临床流行病学层面，证实卵巢切除与认知衰退、阿尔茨海默病、中风、情绪障碍等直接相关；而丽莎·莫斯科尼（Dr. Lisa Mosconi）团队则开创性地使用高分辨率脑部扫描，直观呈现了卵巢切除前后大脑内部的实质变化。 莫斯科尼博士展示了一位未接受激素替代治疗的女性在切除双侧卵巢全过程中的连续脑部扫描图（术前数周、术后 6 个月、术后 1 年）。结果清晰显示，在统计学显著的脑图谱上，代表大脑灰质（Gray Matter）萎缩的“蓝色斑块”从术后 6 个月开始显现，到了术后 1 年已大范围蔓延。由于卵巢被强行剥离，失去了雌激素神经保护作用的脑区灰质体积显著萎缩、皮层大幅变薄。这一极其直接的纵向影像证据，无可辩驳地揭示了卵巢功能与脑健康之间密不可分的中枢生理联系。 --- ### [01:47:15](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=6435s) “这只是变老”？同龄对照实验推翻陈旧偏见 长期以来，科学界与公众舆论对莫斯科尼团队的研究存在一股巨大的阻力，许多质疑者试图用一句轻巧的“这不过是大脑正常老化的表现”来抹杀绝经对大脑的特异性损伤。为了彻底击破这种偏见，团队设计了极为严谨的横向同龄对比：选取了 3 位生理年龄完全相同（均为 50 岁）但处于不同生殖阶段的女性进行脑部代谢扫描。 三张扫描图像的差异震撼了现场： 1. **绝经前期（Premenopause）**：月经规律，大脑图像极其明亮，代谢活动活跃，神经连接能量充沛。 2. **围绝经期（Perimenopause）**：月经紊乱，脑能量代谢水平明显出现波折与局部衰退。 3. **绝经后期（Postmenopause）**：完全停经，其脑扫描图宛如“被人关掉了吊灯”，呈现大面积晦暗与能量低落。 即使生理年龄毫无二致，绝经状态的不同却直接决定了大脑神经元的能量图景。面对主持人“看到世人还在坚持错误叙事时作何感想”的提问，莫斯科尼博士表示，作为科学家必须尊重实证研究的复现流程，但眼睁睁看着数以百万计的女性因为误解而在痛苦中挣扎，推动更大样本量（从数百人拓展到数千人、跨不同国家与种族）的研究来确证这一真理，显得刻不容缓。 | 对比维度 | 绝经前期女性（50岁） | 围绝经期女性（50岁） | 绝经后期女性（50岁） | |:--- |:--- |:--- |:--- | | **月经状态** | 规律月经周期 | 月经不规则（过渡期） | 完全闭经（绝经后） | | **大脑代谢表象** | 图像明亮、神经元代谢旺盛 | 能量代谢显现波动与局部暗淡 | 犹如“灯火熄灭”，全局代谢显著低落 | | **病理驱动因素** | 正常的卵巢内分泌支持 | 激素水平剧烈震荡 | 雌激素中枢神经营养支持长期缺失 | --- ### [01:49:11](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=6551s) 激素疗法的盲区与新型“设计雌激素”临床试验 当主持人追问绝经后女性如果使用激素替代疗法（HRT）是否能点亮大脑时，莫斯科尼博士指出了一个令人极其沮丧的科学现状：过去所有探究激素疗法对认知功能与脑结构影响的临床试验，无一例外全都是针对**已经绝经数年乃至数十年的老年女性**进行的。医学界此前居然从未开展过任何一项利用脑部扫描来系统检验 HRT 对**围绝经期（Perimenopausal）女性**脑保护有效性的临床试验。 这种科研阶段的错位令人匪夷所思——女性大脑在围绝经期承受着最剧烈的内分泌震荡与灰质流失，这恰恰是临床干预的黄金窗口期。此外，受到以往历史研究对乳腺癌风险过度夸大的影响，大量女性对传统激素疗法抱有根深蒂固的恐惧，即使权威医学机构已澄清这一风险概率极低，心结依然难以解开。为此，莫斯科尼团队正在主导一项全新的前沿临床试验：跳过传统外源性激素，研发并评估一种被称为“设计雌激素”（Designer Estrogen）的靶向分子化合物，旨在避开对外周组织（如乳腺、子宫）的潜在致癌刺激，精准靶向中枢神经系统，在绝经过渡期为女性大脑提供代谢庇护。 ### [01:50:50](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=6650s) 新一代脑靶向雌激素：NeuroSERM 临床试验 莫斯科尼博士（Dr. Lisa Mosconi）非常兴奋地介绍了一种正在研发的新一代激素疗法——选择性雌激素受体调节剂（Selective Estrogen Receptor Modulators，简称 SERMs），也被称为“定制雌激素”（designer estrogens）。目前她们团队正在测试的一款被称为“NeuroSERM”。这是一种专门针对大脑开发的雌激素调节剂，由亚利桑那大学的罗伯塔·迪亚兹·布林顿博士（Dr. Roberta Diaz Brinton）研发。布林顿博士从 1990 年代起就深耕大脑雌激素领域，堪称该学科首屈一指的领军人物。许多女性由于担心雌激素与乳腺癌之间的关联而抗拒激素替代疗法，布林顿博士对此感到厌倦，决心从零开始重返实验室。历经 15 年的潜心研发，她终于研制出了这种全新的配方。 这种新型制剂更像是一种补充剂而非传统药物，它具备精准的“大脑 GPS 导向”特性：能够径直穿透进入大脑发挥神经保护作用，同时完全绕开乳房和卵巢等生殖系统组织。这意味着它在选择性改善大脑功能的同时，对乳腺和生殖组织毫无不良刺激，不仅不会增加癌症风险，甚至可能降低患癌概率。目前，莫斯科尼博士团队正在开展由美国国家卫生研究院（NIH）资助的二期随机双盲对照临床试验（Phase 2 randomized placebo-controlled clinical trial），通过脑部扫描、认知测试和全方位评估来验证其疗效。团队正面向纽约市积极招募受试者，重点寻找每天经历 7 次及以上潮热发作的围绝经期和绝经后女性。 ```mermaid flowchart TD accTitle: NeuroSERM的作用机制对比 accDescr: 对比传统激素疗法与新一代脑靶向SERM在乳腺组织与大脑组织上的不同作用途径 subgraph TRAD["传统雌激素疗法"] direction TB T1["全身广泛分布"] --> T2["大脑改善潮热"] T1 --> T3["刺激乳腺/子宫组织\n(潜在促癌隐患)"] end subgraph NEURO["新一代 NeuroSERM (设计雌激素)"] direction TB N1["精准脑靶向定位 (脑部GPS)"] --> N2["选择性激活神经受体\n提升认知/缓解潮热"] N1 -.->|不刺激| N3["避开乳腺与生殖组织\n(无致癌风险或降低风险)"] end ``` - **研发背景**：由亚利桑那大学罗伯塔·布林顿博士历时 15 年研发，旨在解决传统 HRT 带来的乳腺癌担忧。 - **作用机制**：具备组织特异性，靶向作用于大脑中枢神经系统，对乳腺和生殖器官无不良刺激。 - **临床试验规格**：由美国国家卫生研究院（NIH）资助的 Phase 2 随机安慰剂对照双盲试验，配套高精度脑部扫描与全面认知评估。 - **招募对象**：常驻或可前往纽约市、每日发作 7 次以上潮热的围绝经期或绝经后女性。 --- ### [01:53:07](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=6787s) 如何预测绝经期：母亲的经历与生理线索 史蒂芬·巴特利特（Steven Bartlett）翻看莫斯科尼博士的著作，分享了其中关于“如何预测绝经期”的精彩见解：预测女性绝经年龄以及症状表现的最强预测指标，正是其亲生母亲经历绝经的年龄与过程。此外，女性在青春期和怀孕期间的体验也是极具价值的参照系，例如在青春期经期或妊娠期容易出现情绪障碍的女性，在更年期遭遇情绪波动和心理困扰的概率也显著更高。 莫斯科尼博士对此完全赞同，并强烈建议女性应当尽早主动与母亲展开深入交流。她指出，除了遗传基准线外，个人生活方式与医疗史也会对时间节点产生调节作用：例如吸烟会显著提前绝经年龄；不良的饮食习惯以及完全缺乏体力活动，同样会促使更年期更早来临。莫斯科尼博士感叹道，在母亲那一辈人中，绝经期完全是一个禁忌话题，母亲会自然地同女儿交代月经初潮和生理期，却从不对绝经只字不提，直到莫斯科尼博士主动开口询问。因此，母女之间提前开启这项对话，能为女性预留充裕的生理与心理准备期。 - **核心遗传指标**：母亲绝经的年龄和症状体验，是女儿最直接的预测依据。 - **生理史联动**：青春期或孕期有情绪障碍史的女性，更年期发生严重情绪波动的概率更高。 - **提前绝经的生活方式风险**：吸烟、长期不健康饮食、久坐缺乏锻炼均会导致绝经年龄提前。 --- ### [01:55:04](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=6904s) 破除更年期沉默：认知、同理心与社会支持 史蒂芬感慨这项研究对于大众认知的巨大启蒙意义。据预测，到 2025 年全球将有约 10 亿女性正在经历或已经度过更年期，相当于全球人口的八分之一至九分之一。这意味着每个人的生命中都会有至关重要的女性（母亲、伴侣、女儿或同事）正在承受这段剧烈变化。掌握这些关于大脑重塑与激素波动的知识，不仅能让伴侣和家属学会如何提供切实的支撑，更能让人们摆脱误解、充满同理心。 史蒂芬反思道，过去许多人面对 50 多岁女性突然出现的行为变化或情绪异样，往往只会觉得她们“行为古怪”甚至敬而远之，这种孤立与不解正是导致 55 岁以上女性群体自杀率居高不下的重要原因之一。当女性自身得不到答案、周围人也充满困惑与排斥时，绝望感便油然而生。莫斯科尼博士的研究不仅揭示了更年期是大脑在经历深刻的生理转变，更是首次通过直观的脑部成像让这套隐秘机制大白于天下。 - **全球患病/过渡规模**：预计到 2025 年，全球绝经及绝经后女性数量将达到 10 亿人。 - **心理危机与社会误解**：由于医学知识普及匮乏，处于围绝经期的女性常被误解、排斥与孤立，这与该年龄段女性的高自杀倾向存在紧密联系。 - **家庭与伴侣的角色**：从神经生物学角度理解情绪起伏与认知脑雾，是打破家庭隔阂、建立深层同理心支持的关键基础。 --- ### [01:56:48](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=7008s) 终极追问：对父母的最后告白与节目结语 按照《首席执行官日记》（The Diary Of A CEO）的惯例，上一位神秘嘉宾为莫斯科尼博士留下了一个盲盒问题：“如果你能与父母进行最后一次对话，你会对他们说什么？”莫斯科尼博士动情地表示，她的父母此刻就陪伴在录音现场。如果要做出最后的告白，她唯一想表达的就是最由衷的感谢。 她深情地回顾，父母是她人生中百分之百的坚强后盾。无论是在经济上、法律上、身体上还是精神上，父母都为她构筑了一张从未动摇过的安全网，让她从小到大从未经历过无处可去的恐惧与孤独。年轻时或许未能完全领悟这种庇护的可贵，而如今人到中年，她无比感激这份毫无保留的爱，并幽默地对现场的父母说道：“非常抱歉我在青春期时曾经那么叛逆难管，不过我觉得我现在已经将功补过了。” 史蒂芬最后引用了频道往期绝经期节目下最令人动容的两条高赞评论作为总结。第一条评论写道：“如果不是看到这些科普视频，我真的确信自己快要死了——心悸、偏头痛、皮肤发痒、失眠、暴怒、突如其来的嚎啕大哭……我才 43 岁，我甚至完全认不出镜子里的自己。”另一条高赞评论则写道：“出汗和潮热我都能忍受，但我真正无法承受的，是那种瘫痪般的恐惧、极度焦虑、抑郁以及深入骨髓的疲惫感。”这生动地证明了普及更年期大脑知识、推进去污名化以及研发定制雌激素药物具有何等深远的现实意义。在互道感谢与珍重中，全场对谈圆满结束。 ## Notable quotes > [11:16](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=676s) 抱歉，我正在经历严重潮热（hot flashes），我现在脑子一片空白，根本无法思考，我必须得走了。 — 受试女性 > [11:16](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=676s) 她说是潮热，她还好吗？我们把测试搞砸了，是不是惹上大麻烦了？ — Lisa Mosconi 的学生 > [14:28](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=868s) 通常我们在谈论恶性肿瘤或癌症时才说一期、二期，不过就更年期的演变历程而言，这确实是层层递进的生命阶段。 — Lisa Mosconi > [29:54](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=1794s) 就像大脑里的灯一盏盏熄灭了 — Steven Bartlett > [35:07](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=2107s) 这纯粹是你想多了/全是你脑子里的臆想（It's all in your head） — 传统医疗界对女性的评价 > [43:02](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=2582s) 要是真有这么简单就好了。 — Lisa Mosconi > [01:13:20](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=4400s) 如果我手里有一款能将阿尔茨海默病和痴呆风险直降 30% 的药丸，我早就富可敌国了，全世界都会抢着买。 — Lisa Mosconi > [01:37:14](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=5834s) 对无关紧要的破事越来越不在乎（giving fewer F-words） — Lisa Mosconi 的朋友们 > [01:40:02](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=6002s) 为什么现在要切除卵巢？术后会有什么后果？如果切除，后续该如何干预和弥补？ — Lisa Mosconi 建议患者提出的问题 > [01:56:48](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=7008s) 非常抱歉我在青春期时曾经那么叛逆难管，不过我觉得我现在已经将功补过了。 — Lisa Mosconi > [01:56:48](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=7008s) 如果不是看到这些科普视频，我真的确信自己快要死了——心悸、偏头痛、皮肤发痒、失眠、暴怒、突如其来的嚎啕大哭……我才 43 岁，我甚至完全认不出镜子里的自己。 — 播客高赞评论观众 > [01:56:48](https://www.youtube.com/watch?v=Cgo2mD4Pc54&t=7008s) 出汗和潮热我都能忍受，但我真正无法承受的，是那种瘫痪般的恐惧、极度焦虑、抑郁以及深入骨髓的疲惫感。 — 播客高赞评论观众 ## Mentioned Lisa Mosconi, Steven Bartlett, The Diary Of A CEO, 威尔康奈尔医学院 (Weill Cornell Medicine), 纽约长老会医院 (NewYork-Presbyterian Hospital), 女性大脑倡议 (Women's Brain Initiative), 阿尔茨海默病预防计划 (Alzheimer’s Prevention Program), 妇女健康倡议 (Women’s Health Initiative, WHI), 美国妇产科医师学会 (ACOG), 美国国家卫生研究院 (NIH), Roberta Diaz Brinton, 亚利桑那大学 (University of Arizona), NeuroSERM, 《更年期大脑》(The Menopause Brain), 《XX脑》(The XX Brain), 《脑力食物》(Brain Food), 查尔斯·达尔文 (Charles Darwin), 祖母假说 (Grandmother Hypothesis), PerfectTed, Dragon's Den, Tesco, Waitrose ## Video description 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’. 00:00 Intro 02:14 Why People Should Listen To This Conversation 04:10 What People Need To Know About Menopause And The Impact On The Brain 06:21 Who Is Lisa Misconi? 08:08 Why Hasn't There Been Research And Investment Into Menopause? 14:28 What Is Menopause And Signs 15:54 Menopause Stages Start Before You Think! 19:07 What's The Youngest Person With Menopause 22:35 Perimenopause Transition 29:54 Menopause Brain Scans 33:09 Some Women Have More Shocking Brain Scans Than Others 34:28 Behavioural Changes From Menopause 38:05 How Many Women Experience Brain Fog? 39:53 Menopause Rewires The Brain 41:11 Symptoms As A Result Of Brain Change 43:57 Isn't The Cure Simple? 51:50 What Age Should We Think About Treating/Preventing Symptoms 52:50 Going Deeper Into The Stages Of Menopause 58:34 Link Between Suicides And Menopause In Women 01:02:55 Brain Fog Over Time With Menopause 01:07:28 The Benefits Of Exercise 01:11:04 Link Between Exercise And Alzheimer's 01:14:11 Caffeine, Sleep And Menopause 01:18:08 Is Alcohol Bad For Menopause? 01:20:52 What Toxins Should We Be Aware Of? 01:22:40 Specific Foods That Help Stave Off The Menopause 01:25:42 Are Supplements Needed In Our Diet? 01:30:06 What Is The Evolutionary Reason For Menopause? 01:37:14 Does Menopause Make You Sad? 01:40:11 Surgical Menopause 01:45:17 Isn't It Just Ageing? 01:53:07 When Will I Go Through Menopause? 01:56:48 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/3RlCkXe Follow Lisa: Twitter - https://bit.ly/3XeTpWM Instagram - https://bit.ly/4ek0Ulh Follow me: https://beacons.ai/diaryofaceo Sponsors: PerfectTed - https://www.perfectted.com - Code: DIARY10 at checkout for 10% off [Source](https://www.youtube.com/watch?v=Cgo2mD4Pc54)

[11:16] 受试女性: 抱歉，我正在经历严重潮热（hot flashes），我现在脑子一片空白，根本无法思考，我必须得走了。 [11:16] Lisa Mosconi 的学生: 她说是潮热，她还好吗？我们把测试搞砸了，是不是惹上大麻烦了？ [14:28] Lisa Mosconi: 通常我们在谈论恶性肿瘤或癌症时才说一期、二期，不过就更年期的演变历程而言，这确实是层层递进的生命阶段。 [29:54] Steven Bartlett: 就像大脑里的灯一盏盏熄灭了 [35:07] 传统医疗界对女性的评价: 这纯粹是你想多了/全是你脑子里的臆想（It's all in your head） [43:02] Lisa Mosconi: 要是真有这么简单就好了。 [73:20] Lisa Mosconi: 如果我手里有一款能将阿尔茨海默病和痴呆风险直降 30% 的药丸，我早就富可敌国了，全世界都会抢着买。 [97:14] Lisa Mosconi 的朋友们: 对无关紧要的破事越来越不在乎（giving fewer F-words） [100:02] Lisa Mosconi 建议患者提出的问题: 为什么现在要切除卵巢？术后会有什么后果？如果切除，后续该如何干预和弥补？ [116:48] Lisa Mosconi: 非常抱歉我在青春期时曾经那么叛逆难管，不过我觉得我现在已经将功补过了。 [116:48] 播客高赞评论观众: 如果不是看到这些科普视频，我真的确信自己快要死了——心悸、偏头痛、皮肤发痒、失眠、暴怒、突如其来的嚎啕大哭……我才 43 岁，我甚至完全认不出镜子里的自己。 [116:48] 播客高赞评论观众: 出汗和潮热我都能忍受，但我真正无法承受的，是那种瘫痪般的恐惧、极度焦虑、抑郁以及深入骨髓的疲惫感。

[43:00] Dr. Lisa Mosconi: If only it were that simple. [39:04] Dr. Lisa Mosconi: I know so many women who really use communication as their superpower... and they really are miserable. [65:38] Steven Bartlett: This cognitive function, right? It's nice and high before menopause, then it takes a dip during the transition, then it goes typically back up... For most women, it is a little bit lower than it used to be, but still pretty good. [71:04] Dr. Lisa Mosconi: You work out in a way that brings some pink to your cheeks and you may have a hard time singing, but you won't have a hard time talking. [100:11] Dr. Lisa Mosconi: Surgical menopause has been linked with an increased risk of cognitive decline and dementia, parkinsonism, stroke, and major anxiety and depression. 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. 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. [116:48] Steven Bartlett: If you could have one last conversation with your parents, what would you say? [116:48] Dr. Lisa Mosconi: I'm sorry that that was difficult when I was a teenager, but I think I redeemed myself

[0:00] this is evidence of what women have been [0:02] saying all along menopause changes the [0:04] functionality of your brain it looked [0:06] there like the brain was basically [0:07] shrinking yes and there are two reasons [0:10] why this is very important number [0:12] one and this is something that impacts [0:15] not all women but also all men Dr Lisa [0:18] mcone is a neuroscientist whose [0:20] groundbreaking research has discovered [0:22] and revolutionized our understanding of [0:24] the menopause and the adaptions that can [0:25] be made in order to thrive during this [0:27] time of life this is new research [0:30] looking at brain changes during the [0:31] different phases of menopause the [0:33] process that can take years so this is [0:35] before menopause this is after wow and [0:39] this shows the 30% drop in brain energy [0:42] levels so when women say that they're [0:44] having hot flashes insomnia depression [0:46] 2third of all women experience brain fog [0:49] those are brain symptoms not recognized [0:52] in medicine in fact we know that Black [0:54] and Hispanic women may experience more [0:57] severe symptoms and women have been [0:59] portrayed is mentally unstable in [1:01] medicine for a really long time we need [1:04] to change that but on top of doing the [1:06] research I am actively doing a number of [1:09] Lifestyle adjustments that are known to [1:11] have a positive effect on menopause so [1:14] let's have a look at these things then [1:15] okay the first thing I do is Dr Lisa one [1:18] of the things I found fascinating is I [1:20] read that there was a miracle food for [1:21] delaying menopause a diet rich in has [1:25] been linked with the later onset of [1:27] menopause by how much 3 years [1:31] we've just hit 6 million subscribers on [1:32] the D Co um so me and my team would like [1:35] to do something we've never done before [1:36] as little thank you and we're calling it [1:38] The di of a CO subscriber raffle and [1:40] here is how it works every episode this [1:42] month we're going to pick three current [1:44] subscribers at random and we'll send one [1:46] of you a 1,000 voucher one of you [1:48] tickets to come and watch the dire [1:50] behind the scenes live with our team and [1:51] one of you will have a 10-minute phone [1:53] call with me to discuss whatever you [1:54] want to talk about if you're a [1:56] subscriber you're in the raffle thank [1:59] you from the bottom of my heart for [2:01] allowing me to do something that me and [2:03] my team love doing so much it is the [2:04] greatest honor of my lifetime and I hope [2:06] it I hope it continues uh off into the [2:08] Future Let's get to the [2:13] episode Dr [2:16] Lisa there's a high [2:18] chance many millions of people have [2:21] clicked on this conversation for [2:22] whatever reason men women of all ages [2:27] what is the reason that all of those [2:30] individuals need to listen to this [2:32] conversation about the menopause [2:34] brain I think the main reason is that [2:37] women are important and Women's Health [2:40] matters and Women's Health has not been [2:42] taken seriously in society and in [2:45] medicine for hundreds of years and this [2:47] is time to really change the [2:49] conversation and help and support women [2:53] throughout an interesting and [2:54] complicated transition that all women go [2:57] through because this will make us all [2:59] better this is important for society as [3:01] a whole why should men listen men should [3:04] listen because number one it's really [3:06] important to understand what happens to [3:09] your spouse to your friend to your [3:10] mother to your [3:12] aunt and all women go through menopause [3:16] so this is something that impacts not [3:18] all women but also all men really and I [3:22] find this so interesting and so really [3:24] so heartwarming when I receive emails [3:26] from men and they do a lot like daily [3:29] and they're saying to me like you know [3:31] thank you you really helped me [3:33] understand my wife better or you really [3:35] helped me understand my mother or my my [3:38] sister my daughter and now as a family [3:41] we're making different decisions or [3:43] we're having different conversations and [3:45] everything just better it's also really [3:48] important to understand how humans [3:50] actually work you know physiologically [3:52] medically and there's so much in society [3:55] that has been done against women or to [3:59] help women but that didn't quite work [4:01] out and we're now understanding what's [4:03] really important to do and not to do to [4:05] support Women's Health I've had [4:08] conversations about menopause before [4:10] I've had a few conversations on this [4:11] podcast with friends with one of my [4:12] friends deina mcco about menopause and [4:14] it's really open my eyes oh you know her [4:17] yes yes yes she wonderful fantastic [4:19] absolute Shining Light In My Life um and [4:22] she's talked to me about the menopause [4:25] but very few people if I would say and [4:27] nobody's talked to me about this extra [4:29] War word that appears on the front of [4:31] your book which is the word brain I [4:33] didn't realize that there was any [4:36] impacts on a woman's brain when she goes [4:39] through menopause but that seems to be [4:41] what you focused much of your work [4:42] especially in this book to identify and [4:45] to illuminate what do we need to know [4:48] from a very Topline perspective about [4:50] the impacts of menopause on the [4:53] brain what we need to know is that as a [4:56] society we tend to really focus on only [5:00] half of what menopause is all about [5:03] which is [5:04] fertility and as we were talking about [5:06] before most people are aware that at [5:09] some point or the other in a woman's [5:11] life fertility ends usually around [5:14] midlife and that's the end of your [5:16] menstrual cycle and the end of your [5:18] ability to have children but what the [5:21] vast majority of people do not realize [5:23] is that menopause also impacts the brain [5:26] in a very significant way they were on [5:29] starting to gather the real data about [5:32] so the research is ongoing and what we [5:34] and others have shown is that menopause [5:37] is actually a renovation project on the [5:41] brain and the vast majority of women [5:44] will experience brain symptoms or [5:47] neurological symptoms during menopause [5:50] so when women say that they're having [5:52] hot flashes nice sweats insomnia anxiety [5:56] depression brain fog 2third of all women [6:00] going through menopause experience brain [6:02] fog and memory lapses and those symptoms [6:05] yes they are related to menopause but [6:09] they have nothing to do with the ovaries [6:12] those are brain symptoms they are [6:14] neurological symptoms that come from the [6:17] ways the menopause changes the [6:20] brain I want to get into how you know [6:22] this and the work that you've done but [6:24] but first I've got to ask who are [6:27] you I am Dr muscone and I have a PhD in [6:33] neuroscience and nuclear medicine which [6:36] is a branch of radiology where we use [6:39] brain Imaging techniques to study the [6:41] functionality of the brain the [6:43] biochemistry of the brain and we can [6:46] really deeply explore how the brain [6:49] changes at different times in a person's [6:52] life and the reason I am here is that I [6:57] am the director of the women's brain [6:59] initiative live a wildon medicine New [7:01] York Presbyterian in New York City where [7:03] I also lead the Alzheimer's prevention [7:06] program and I believe it's fair to say [7:10] that our team is at the Forefront of [7:13] reproductive [7:14] Neuroscience or gender neurology which [7:18] is the study of how brain health plays [7:21] out differently in women than in [7:25] men I heard you you've published over [7:27] 150 Medical journals yes [7:30] yeah yeah over 150 scientific papers in [7:34] to summarize because I because I did a [7:35] quite extensive piece of research here [7:38] you're basically leading the way as it [7:40] relates to understanding a woman's brain [7:45] especially as it relates to menopause [7:49] the changes I because I was reading that [7:50] you did the first brain scans yes on a [7:53] woman's brain to compare what a woman's [7:55] brain looks like before and after [7:56] menopause and also before and after [7:58] surgical menopause which the remal of [8:00] the ovaries and you actually have those [8:02] scans which we'll talk about later but [8:04] you have some of those scans to show me [8:05] today but you the first to do that to my [8:08] knowledge super interesting why hasn't [8:11] anything been done here why just [8:13] generally on the subject of menopause [8:15] why hasn't there been research and [8:17] investment into this area such a good [8:20] question and it's the question I asked [8:22] when I started looking at menopause for [8:25] the first time there was in [8:26] 2015 so my my specialty is used to be at [8:32] least Alzheimer's prevention so I'm [8:35] really I've always been really focused [8:37] on supporting cognitive health and [8:40] cognitive aging and preventing or at [8:42] least reducing the risk of dementia [8:44] Alzheimer disease and dementia and in [8:47] 2015 we have kind of ran out of ideas [8:50] especially when it when it comes to [8:52] women's brain health because what most [8:54] people don't realize is that um [8:56] Alzheimer's disease affects more women [8:58] than men [8:59] so almost 2third of all Alzheimer's [9:02] patients are women particularly [9:05] postmenopausal women and this was my [9:09] question even for my PhD at the very [9:12] beginning of my career and back then [9:14] people would say to me well yes we've [9:18] known since [9:20] 1994 that after aging and getting older [9:23] itself being a woman is the most [9:26] significant risk factor for devel [9:29] veloping [9:30] demential [9:32] however the explanation back then was [9:36] that women live longer than men and [9:39] Alzheimer's is a disease of old age [9:42] therefore at the end of the day more [9:44] women than men have Alzheimer's disease [9:47] and that never made sense to me in part [9:49] because I have a family history of [9:51] Alzheimer's disease that runs in my [9:52] family obviously and affects the women [9:55] in my family and I know that this is [9:58] very common where your grandmother has [10:02] Alzheimer's or dementia and for me it [10:05] was my grandmother and her two sisters [10:08] who all developed Alzheimer disease and [10:10] died of it but their brother who lived [10:13] exactly to the same age did [10:15] not and so my PhD thesis actually was to [10:20] show that Alzheimer disease is not a [10:23] disease of old age it's actually a [10:26] disease of midlife with symptoms this [10:29] start in old age so what happens is that [10:32] Alzheimer starts in the brain with [10:35] negative changes that take years to [10:38] reach a certain threshold before the [10:41] damage is so severe that people start [10:43] losing their memories they can't come up [10:45] with wordss they have attention [10:47] deficits but in reality Alzheimer starts [10:51] for many people in midlife so that [10:54] changed my entire question right then [10:57] the question becomes okay if Alzheimer [11:00] starts in midlife and more women than [11:02] men end up with Alzheimer disease what [11:05] happens to women and not men in midlife [11:09] they could potentially explain the [11:11] higher lifetime risk of Alzheimer [11:14] disease for women and look we tried [11:16] everything we tried genetics we looked [11:18] at Medical factors we looked at diabetes [11:21] we looked at high cholesterol levels we [11:23] looked at insulin resistance we looked [11:25] at obesity we looked at every single [11:28] thing we could look at diet lifestyle [11:30] exercise and those things certainly [11:32] matter but they couldn't quite explain [11:35] the difference that we were seeing [11:37] because what we were seeing is that [11:38] already in midlife women show these red [11:42] flags of Alzheimer disease in their [11:45] brains whereas men do not and we can see [11:48] that by doing brain scans and doing [11:50] brain Imaging and the question was what [11:54] what is it that really tips the [11:56] scale and then one day my students were [12:01] doing cognitive testing on one of our [12:03] participants a woman in her 40s and she [12:07] was having a really hard time just [12:08] getting through the tests and she said I [12:13] I'm really having a hard time can you [12:14] open the window and that doesn't happen [12:18] very often and my students are like the [12:21] window sure actually no because it's [12:24] Hospital in New York City you can't open [12:25] the windows but we can we can play with [12:28] the fan perhaps and she just could not [12:30] get through the test and then she had to [12:31] stop and said look I'm having hot [12:34] flashes I just can't think straight I [12:37] have to [12:38] go and so she rescheduled and then she [12:41] came back later but my students came to [12:42] me in a panic she said she had half [12:45] flashes what is it is she okay well we [12:48] we had to stop the session is is are we [12:50] in trouble basically and say half lashes [12:54] that's interesting and so we went back [12:55] and we I explained to them that means [12:57] that she's going through menopause [12:59] and this is a sign a classic [13:02] neurological sign of menopause that we [13:05] do know can impact concentration and [13:07] focus but back then we didn't know that [13:10] it could be a bigger a bigger change in [13:14] your brain right impacting your your [13:16] ability to focus and memorize [13:17] information and so we went back and we [13:20] asked all the women in our study about [13:24] their menopausal status and their [13:25] menstrual cycle and their symptoms and [13:27] then what we found is this then if you [13:30] compare a group of premenopausal women [13:33] to men of the same age and look at their [13:36] brain scans there are no differences or [13:38] very little differences but if you look [13:41] at women who are per menopausal and [13:44] compare them to Men of the same age you [13:46] see an increase in the amount of [13:49] Alzheimer's plaques in the brain already [13:52] in midlife in per menopause in Perry so [13:55] not even in menopause but just starting [13:59] to lose your skipping menstrual cycles [14:01] and when you when your period becomes [14:03] infrequent and usually the half flashes [14:06] start making an appearance in the brain [14:07] fog as well and then after menopause [14:11] when we compared postmenopause of women [14:13] to men of the same age then the [14:16] difference was quite striking where men [14:18] barely had any Alzheimer's plaques and [14:21] the women had statistically [14:23] significantly [14:24] more red flags for Alzheimer's disease [14:28] okay so this is a really naive question [14:32] but please do explain this to me like [14:33] I'm a [14:34] 10-year-old what is manopause [14:38] what is menopause so there's a standard [14:42] medical textbook definition that is [14:44] entirely based on the function of the [14:47] ovaries okay and then there's an updated [14:50] definition that I'm trying to promote [14:53] more and more because I think it's [14:54] important that really looks a menopause [14:56] for what it is from a scientific persp [14:59] practice I'm going to give you both the [15:01] standard definition of menopause is when [15:05] a woman hasn't had a menstrual cycle for [15:07] 12 consecutive months there are three [15:10] phases there's a Prem menopausa phase [15:14] when a woman is in her 30s or older and [15:18] has a regular menstrual cycle [15:20] approximately every month and then at [15:23] some point the frequency and severity [15:27] can change so that's when your period [15:29] becomes more infrequent or there's less [15:33] menstrual blood yes usually a [15:35] combination of the two and what we [15:37] really focus on clinically is the [15:40] frequency okay so when you start [15:42] skipping your period for more than two [15:44] three months at a time that is [15:47] considered the per menopausal phase [15:49] which is an in between between having a [15:52] menstrual cycle and not having a [15:53] menstrual cycle so that first stage we [15:56] were talking about is there a name [15:57] that's per menopause pre pre PR [15:59] menopause preop menopause PR there's per [16:02] yeah which is in between is that stage [16:04] two that's yeah okay stage two so if you [16:09] you want stage two yes stage usually we [16:11] say stage one and two for cancer s [16:14] malignant oh okay but yes first and [16:17] second okay stage um and then at some [16:20] point you will not have a menstrual [16:23] cycle anymore for up to 12 consecutive [16:26] months and then in retrospect [16:29] you go back to the year prior and say [16:32] okay as of 12 months ago that was your [16:37] menopause and you are now [16:39] postmenopausal in the [16:41] postmenopausal stage which is the third [16:44] phase if you will lasts for the entire [16:48] remaining of a woman's life so most [16:50] women today spend at least [16:53] 30% if not more of their lives in the [16:56] postmenopausal stage so you have this [16:59] Perry menopause stage which happens in [17:01] your mid to late 40s typically yes [17:04] usually around age 47 that's the average [17:07] but in reality it can start when you [17:10] when you're in your [17:12] 30s or sometimes in your 50s the average [17:15] is 47 and it tends to last about 10 [17:17] years and this is really when your [17:19] estrogen levels start to dip that's a [17:21] good point so it can usually lasts [17:23] between two and 10 [17:25] years if you're lucky let's say four [17:28] between four and seven okay this is [17:30] actually when estrogen levels fluctuate [17:33] okay and that's what makes it tricky to [17:36] diagnose based on blood tests so blood [17:38] tests are not that helpful in this [17:40] respect because one day your estrogen is [17:43] high and the next day your estrogen is [17:45] low and it does start gradually [17:48] declining overall but it doesn't really [17:50] bottom out until your your past the [17:54] transition and you are effectively in a [17:57] postmenopausal state age so yes there is [17:59] a continuous decline in concentration [18:02] but day by day it's a little bit of a [18:05] roller coaster which is also why women [18:08] start having symptoms of menopause the [18:10] brain symptoms of menopause before the [18:13] final menstrual period not after and [18:16] that's a big misconception in medicine [18:19] and science that menopause is just one [18:22] day on the calendar a little bit like [18:24] puberty right as a woman once you have [18:26] your first menstrual period That's aect [18:28] effectively your first but in order for [18:32] you to really have your last menstrual [18:35] period That's a process that can take [18:37] years and that is not captured in the [18:40] definition of menopause is one day on [18:43] the calendar when you stop having your [18:45] cycle and another misconception is that [18:48] menopause happens when you're old and [18:51] it's really not the case in the United [18:53] States but also in Europe the average [18:56] age is 51 52 but if you look at the [18:59] global female population is actually [19:02] 49 and that is not old by any standards [19:07] what's the youngest you've seen [19:09] menopause which is stage two in that in [19:10] that process so it depends if we're [19:13] looking at spontaneous menopause or [19:17] induced so women can go through [19:19] menopause for a number of different [19:21] reasons which also again this is another [19:23] misconception that menopause is the same [19:25] for everyone that's absolutely not true [19:28] but the three main reasons um are aging [19:33] just the neuroendocrine aging [19:35] process that I like to refer to as [19:38] spontaneous menopause some people say [19:41] natural but that to me is misleading [19:43] because it makes it sound like the other [19:45] types are unnatural which is really the [19:47] last thing anybody needs right it's hard [19:50] enough to to go through menopause [19:52] because of medical reasons rather than [19:55] as part of the agent process and so the [19:57] other two types are induced [19:59] menopause which can be surgically [20:02] induced or medically induced surgically [20:05] induced is when you have your OV is [20:07] removed usually as part of a hysterctomy [20:11] which is the surgical removal of the [20:13] ueros or just the ovaries alone and [20:15] that's called an ectomy the surgical [20:18] removal of the ovaries before obviously [20:21] before going through menopause but [20:22] menopause can also occur for medical as [20:26] a result of Medical Treatments like [20:28] therapy for cancer that can induce [20:33] menopause sometimes just temporarily and [20:36] sometimes more more often than not [20:38] permanently so the youngest stage is [20:40] actually puberty because there [20:43] are transgender individuals who have [20:46] their ovaries removed as part of their [20:48] transition to a different gender so in [20:51] that case if you have the the surgery [20:54] the ectomy and hysterctomy when you are [20:56] a teenager that's when you go through [20:58] menop [20:59] the spontaneous menopause what's the [21:01] earliest you've [21:02] seen or heard [21:05] of um 40s early 40s but some [21:10] women some women with P PCOS or primary [21:14] ovarian [21:16] insufficiency can develop menopause even [21:19] earlier than that however in that case [21:22] is not part of the aging process is [21:25] because there's something that needs to [21:28] to be further investigated whether it's [21:30] genetics or an autoimmune disorder or [21:33] other causes so just to summarize then [21:36] there's three stages to menopause [21:38] there's per menopause which happens mid [21:40] to late 40s the average age is 47 years [21:42] old and this can last typically so you [21:44] said 2 to 10 years this is when estrogen [21:46] levels begin to fluctuate as you said [21:48] there's menopause which is [21:50] um when she when a woman has reached one [21:53] year since her last period the average [21:55] age at menopause is 51 to 52 and the [21:58] menopausal transition can last seven to [22:01] 14 [22:02] years and then you have postmenopause [22:05] which is the rest of the woman's life [22:07] when she is without a period just on [22:10] that then so I I think I I used to think [22:12] that menopause was the last stage and [22:15] then once you're in menopause you're in [22:16] menopause until yeah see the terminology [22:19] is also confusing but menopause is [22:23] actually [22:25] just basically a mark on the calendar [22:28] there and say as of [22:31] today you are in menopause but it's not [22:34] a stage so what's the difference [22:36] diagnosis but it says it [22:38] lasts three stages yeah pre menopause [22:41] before okay so there okay three yes so [22:45] from puberty until you start skipping [22:48] periods okay okay then there's Perry [22:51] yeah second stage when you start [22:53] skipping periods and your hormones start [22:55] fluctuating and then there's post [22:57] menopause okay so before in the middle [23:00] of the transition Peri and then after so [23:03] that transition period yeah that's the [23:06] per menopausal or menopause transition [23:09] that typically last four to seven years [23:12] but it can actually last up to 14 for [23:14] some women and what's going on in that [23:16] transition phase there's a lot going on [23:19] and we're at least from a brain [23:21] perspective we're starting to really [23:23] understand it now and I think what's [23:25] important to know to really understand [23:28] what P menopause is and what's going on [23:31] in your brain and your body during that [23:33] transition is that women are [23:36] born with a system called the [23:40] neuroendocrine system that connects the [23:43] brain the neurological system with your [23:46] ovaries and the rest of the endocrine [23:49] system this system you're born with [23:51] meant to but for women that system is [23:55] activated during puberty is overa [23:58] activated during pregnancy every time a [24:02] woman is pregnant is partially turned [24:05] off during [24:07] postpartum and I'm hoping we can talk [24:09] about that too the mommy brain is really [24:12] it's really quite a thing and then is [24:14] quite dismantled after the transition to [24:18] menopause so this is a system that is [24:21] extremely important because reproduction [24:24] and fertility are effectively some of [24:27] the most important drivers of evolution [24:29] and that means that a huge part of your [24:32] brain is really wired to [24:38] respond to your reproductive organs okay [24:41] so the brain talks to the ovaries and [24:44] the ovaries report back to the brain [24:47] every day of a woman's life for as long [24:50] as you have a menstrual cycle and [24:52] probably also after which is something [24:55] that most people don't realize there's a [24:57] reason to keep your OV is after [24:59] menopause because they do still have [25:01] some functionalities now if you think [25:04] about it when we look at those graphs [25:07] that show how the the way that the brain [25:09] ages it usually looks like there's a [25:12] flat line and then after midlife like in [25:15] your 60s 70s 80s neuronal density starts [25:19] going down right there's a everything is [25:22] good and all those graphs they usually [25:25] talk about the way that the brain ages [25:27] and how neurons age and how we lose [25:30] neurons in the brain you know most [25:32] people are aware that everything goes [25:34] well until you get a little older and [25:37] then you lose a few neurons here and [25:39] there just so some kind of gentle [25:41] neuronal loss over time not for women [25:45] those graphs are based on men women's [25:49] Brains change in a way that is quite [25:52] complicated where starting a [25:56] puberty throughout every every single [25:59] month when your OV cycle your brain [26:03] microcycles every single yes every two [26:07] weeks there's a little micro cycle [26:09] what's a micro cycle [26:11] so um the way that the ovaries in the [26:14] brain communicate is by sharing hormones [26:18] and we'll talk about those hormones as [26:20] sex hormones for women these are chiefly [26:23] estrogen progesterone some testosterone [26:27] I think is important but people usually [26:29] kind of put it to the side and other [26:32] hormones that are made by the brain they [26:33] keep going back and forth from the [26:35] ovaries to the brain from the brain to [26:37] the ovaries now these hormones are [26:39] called sex hormones mostly by mistake in [26:43] a way they were discovered in the 1930s [26:46] by scientists that were studied [26:48] reproductive function and they did [26:50] realize that you needed to to have [26:52] certain levels of these hormones for [26:54] menstruation to happen and for a [26:56] pregnancy to be established and so they [26:59] labeled estrogen progesterone [27:01] testosterone sex hormones but it took [27:05] another 60 years it wasn't until the [27:08] 1990s the late 1990s the brain [27:12] scientists came to the rescue and show [27:15] that the same sex hormones really serve [27:18] a multitude of functionalities they have [27:20] nothing to do with having children and [27:23] everything to do with having a healthy [27:25] brain an energetically active brain so [27:28] those hormones that are important for [27:31] reproduction are just as important for [27:33] brain function those are brain hormones [27:36] too right so what happens in the brain [27:40] especially for women's Brains estrogen [27:43] is possibly the most important in some [27:48] ways uh to the point that it's being [27:50] referred to as the master regulator of [27:53] women's Brains why because estrogen is [27:56] to your brain as a woman one what fuel [28:00] is to a car it Powers a lot of different [28:04] things that need to happen in the brain [28:06] so when your estrogen is high your [28:08] neurons you can see them they they start [28:10] sprouting out little branches they're [28:12] called dandrites and become better [28:14] interconnected with each other and blood [28:17] flow to the brain is higher there's more [28:19] blood going to your brain which is [28:21] wonderful because you get all the oxygen [28:22] and all the nutrients you have more [28:25] immuno protection your brain is more [28:27] protected against insults and things [28:29] that can go wrong inside your brain and [28:33] there's um estrogen is also growth [28:36] hormone so it stimulates overall [28:38] plasticity in the brain which is the [28:40] brain's way of being resilient and able [28:44] to make [28:45] changes but most importantly [28:49] estrogen pushes your [28:51] neurons to burn glucose to make energy [28:55] so in a way it's an activator and is [28:58] able it's a little bit everywhere it's [29:01] like this wonderful CEO that knows all [29:04] the aspects of the business and can [29:06] speak to any person who is needed to run [29:09] the business it's like an Orchestra [29:10] conductor they make sure that the [29:12] symphon is exactly the one that we want [29:16] but then what happens in per menopause [29:19] and then after menopause the estrogen [29:22] retires if you will a specific type of [29:25] estrogen called estradiol which is the [29:27] most potent form of estrogen is no [29:30] longer being produced or just a tiny [29:32] little bit and so another estrogen takes [29:37] over it's called [29:38] estrone which is wonderful but is not as [29:41] powerful as estradi is and then the [29:46] brain keeps playing the orchestra keeps [29:49] playing but the tune is not quite the [29:53] same got you does it make sense and that [29:55] happens yeah I'm really trying to [29:57] understand this the difference between [30:00] the menopause phase physiologically and [30:03] the postmenopause phase because it says [30:04] it lasts for S to 14 years so I'm asking [30:07] myself what's going on for those seven [30:08] to 14 years in terms of the body some [30:10] kind of transmission yeah do you want to [30:12] see please show me the brain scans I [30:14] think is the best way look like you [30:16] mentioned before this is new research [30:19] relatively new research it's also the [30:21] only research still that looks at [30:24] changes in women's Brains as a woman [30:27] goes through the different phases of [30:29] menopause okay so just for people that [30:31] don't aren't watching on video for [30:34] whatever reason um Lisa has some brain [30:37] scans on her iPad in front of me which [30:39] she going to explain to me yes so this [30:42] is what's happening to this brain as the [30:47] woman that the brain belongs to is going [30:50] from having a menstrual cycle to not [30:52] having a menstrual cycle and this is [30:54] going to Loop so this is before [30:58] menopause when everything is nice and [31:00] red and bright and as you can see [31:02] changing the red is turning yellow and [31:05] the yellow is turning green and after [31:07] menopause the entire brain scan is a lot [31:10] greener than before menopause there's a [31:13] lot less red and yellow and a lot more [31:16] green what does that mean because it [31:17] kind of looks like some of the lights [31:18] are going off yes no exactly that's a [31:21] really good interpretation what that [31:23] means quantitatively that's a [31:25] 30% drop in brain energy levels which [31:29] means that your neurons are able they [31:33] have access to the sugar to the glucose [31:35] but they're not burning it as fast or [31:38] perhaps as efficiently as they used to [31:42] before going to menop no people don't [31:45] know this no people don't know this and [31:47] the reason that this is so important [31:49] there are two reasons that I believe [31:51] this is very important number one this [31:54] validates what women have been saying [31:58] for hundreds if not thousands of years [32:01] that there's something happening in [32:03] their heads that they feel like their [32:06] brain is changing the feeling of I don't [32:09] feel like myself anymore or there's [32:12] something happening I have the brain fog [32:14] I have mental fatigue in clinical terms [32:17] we say cognitive fatigue mental fatigue [32:20] and this is actually [32:22] evidence of what women have been saying [32:24] all along that menopause changes your [32:27] brain as surely as it changes your [32:30] ovaries and very specifically changes [32:33] the functionality of your brain and now [32:35] we've done plenty of studies I plenty [32:39] obvious say I want to do many more but [32:41] we've done enough studies to say that [32:44] menopause also impacts the structure of [32:47] the brain the volume of the brain the [32:50] connectivity of the brain blood flow to [32:53] the brain so menopause really is a [32:56] renovation project on on the brain it's [32:59] a neurologically active state that is [33:03] associated with measurable and [33:06] quantifiable changes in a woman's brain [33:09] if I'm a woman and I'm I'm the before [33:13] brain yeah um and then I go through [33:15] menopause and I'm now the after brain [33:17] that I just saw there which seems like a [33:18] lot of the lights have gone down yeah [33:21] what is the real world change in my [33:24] behavior that people would see that I [33:26] would feel that I would that would [33:28] present so one thing that's important to [33:31] clarify is that not all women show these [33:35] changes right so this is one woman this [33:38] is actually pretty average in terms of [33:40] changes we find that the vast majority [33:42] of women uh experience something like [33:45] this whether they describe it as such or [33:48] not some women do not show any brain [33:50] changes they very little brain changes [33:53] and some women show much more severe [33:56] brain changes so some some women's brain [33:58] changes are much worse than that yes yes [34:02] much more uh marked in many ways and we [34:06] also find changes in connectivity and [34:08] changes in brain structure and changes [34:10] in white matter volume and changes in [34:13] gliosis which is like this teeny tiny [34:16] little uh spots bright spots that we [34:19] find on dmri scans as part of aging but [34:23] for women that really seems to happen [34:27] more so dur manopause so how would I [34:29] change if my brain if my brain changes [34:32] if I'm that woman my my brain has had [34:34] those changes how will I feel different [34:38] and how will the World Experience me [34:39] different so this is something we're [34:41] trying to understand a little bit better [34:44] these brain scans do not speak to [34:46] behavior they speak to biology and [34:49] there's never a onetoone correlation [34:51] between biology and behavior than [34:53] goodness right but what we are um [34:57] starting to show right now and actually [35:01] we have a paper under review that shows [35:05] that this changes correlate quite [35:07] strongly with brain fog which is this [35:12] feeling of mental [35:15] exhaustion where you feel CAU and [35:17] brained you feel like your brain just [35:19] won't turn on in some ways and many [35:23] women [35:24] experience um what we Define clinically [35:27] a subjective cognitive decline where you [35:30] as a woman are aware that your cognitive [35:34] performance is not as good as it used to [35:36] be but if you go for a standard neuros [35:39] pyic evaluation you're still performing [35:42] within normal values and this is good [35:45] and bad for a number of reasons number [35:47] one is that historically women would not [35:50] be taken seriously right the overall [35:53] idea is like okay she's going crazy [35:55] she's hormonal she's losing her mind [35:57] it's it's all in your head I hate that [36:00] terminology I got that a lot from even [36:03] in the scientific community that those [36:05] symptoms are kind of made up or a sign [36:08] of psychological distress some kind of [36:11] psycho emotional issue because women [36:14] have been portrayed as widely emotional [36:19] and mentally unstable in medicine [36:22] forever and ever did you know even the [36:25] word hysteria which means Madness comes [36:28] from Greek and literally means [36:31] ueros really yes yes because ever since [36:36] ancient Greek ancient Greece there was [36:39] this mindset this this framework in [36:41] medicine where anything that the woman [36:43] would report in terms of cognitive [36:46] disturbances or mental health issues or [36:50] just just concerns were immediately ched [36:53] away as there's something wrong with [36:55] your udus and there's this weird [36:57] connection between the uterus and the [36:59] brain that makes women susceptible or [37:02] vulnerable to Madness or hysteria where [37:05] things like right now we're aware they [37:08] kind of they were kind of right in one [37:10] sense you know that's that's the bizarre [37:13] part that yes there is a connection and [37:15] yes that connection can impact your [37:17] mental health yeah but there's no reason [37:20] to be put down or be patronized or be [37:22] dismissed is actually something that's [37:24] really worth investigating they didn't [37:27] have the science we have now but but [37:30] you're saying me that they even back [37:32] then they believe there was a connection [37:33] between the utherus in the brain yeah [37:35] the wom in the brain they I think it's [37:37] so obvious any woman any woman can tell [37:40] you I find a lot of the research that we [37:42] do is really all about just proving [37:44] women right just saying okay so you you [37:48] we've all been saying this forever [37:50] nobody took us seriously and now there's [37:52] actual scientific proof that what women [37:55] are saying is scientifically viable and [37:57] valid is not all in your head I mean it [38:00] is all in your head in a way but not the [38:03] way the people think how many what [38:06] percentage of women that go through per [38:09] menopause and postmenopause struggle [38:12] with brain fog [38:14] 62% up to 62% is almost 2third the [38:18] majority of them and and when I I have [38:20] heard the phrase brain frog B brain fog [38:24] but I've never understood what it means [38:26] is it just like a l uh an inability to [38:28] think as clearly as you once did I think [38:31] it's more than that it's a feeling that [38:34] something is hijack in your brain and [38:37] that no matter what you do your brain [38:39] won't turn on and it's a very specific [38:42] symptom that is different from other [38:45] things that can impact cognitive [38:46] performance like when you can't sleep at [38:49] night you're tired and it's harder to [38:51] think clearly right but you know that [38:54] that's going to come back with fog [38:57] there's a there's a little bit of [38:59] desperation in a way because you feel [39:01] like you have no control over your [39:04] outcomes is it about attention as well [39:06] as memory It's a combination of things [39:09] usually brain fog impacts memory [39:11] concentration Focus attention and [39:13] language as well something that's very [39:16] common is this tip of the tongue [39:19] phenomenon where you just can't come up [39:21] with words and it's hard to just [39:24] complete a sentence it feels almost like [39:27] fasia in a way which is an actual [39:30] clinical uh syndrome or a form of [39:32] dementia even but when when you just [39:34] can't come out with words and you know [39:36] that you know the word and you just [39:38] can't find it in your head and I I know [39:42] so many women who really use [39:45] communication is their superpower yeah [39:47] and they need to rely on communication [39:49] for work and what not and they really [39:52] are miserable are there any symptoms [39:56] that you believe are a consequence of [39:59] the changes in the brain that we see in [40:01] those the symptoms on the symptoms oh [40:04] yes yes we just need to you know when [40:06] you ask me as a scientist what do the [40:08] brain scans translate to I need to have [40:10] a study that shows you I go from this to [40:13] this but the idea is that menopause all [40:17] the different things that happen during [40:19] menopause lead the brain to rewiring [40:22] itself and there are so many different [40:24] changes inside the brain that imp impact [40:28] very specific brain regions that are [40:30] important for instance for thermal [40:34] regulation for regulating body [40:36] temperature right so there's the [40:38] structure of the brain which is actually [40:41] exactly the structure that receives all [40:43] the information from the ovaries is the [40:45] first um Center of communication it's [40:48] called the [40:49] hypothalamus and is in charge of [40:51] regulating body temperature so when [40:54] estrogen levels and progesterone levels [40:56] are fluctuating why ly that means that [40:58] the hypothalamus which is dependent on [41:01] these hormones for regulating its own [41:04] functionality will have a hard time [41:06] regulating body temperature and then as [41:09] a woman you get half lashes why does the [41:13] brain CU it looked there like the brain [41:15] was basically shrinking yes so some [41:18] parts of the brain lose volume yeah some [41:21] parts of the brain become less connected [41:23] some other parts become more connected [41:26] and overall [41:28] energy metabolic energy is reduced and [41:32] the ability um so there's this little [41:34] stru that are many little structures in [41:36] the brain and in the rest of the body [41:38] mitochondria yeah and they're [41:40] responsible for uh converting cellular [41:43] energy into ATP which is a usable form [41:46] of energy or the energy currency of all [41:48] cells and what we have found [41:51] using um a very interesting brain [41:54] Imaging technique is called 31 fos as [41:57] for as mrss or magnetic resonance [42:00] spectroscopy we have found that there's [42:03] basically an ATP crisis in a woman's [42:07] brain as most women go through menopause [42:11] where ATP is just not produced as much [42:14] as it used to or perhaps is used too [42:16] fast that the brain just can't quite [42:18] meet energy demands and so all these [42:21] different parts of the brain that need [42:23] estrogen for support for energy support [42:26] and for fuel but they also need ATP just [42:29] to do things find themselves a little [42:33] bit at a loss right it's like you you're [42:36] losing the superpowers of estrogen and [42:39] all the things that come with it and is [42:41] that why the brain is looks like the [42:43] lights are going down because of the the [42:45] loss of estrogen most likely is a [42:48] combination of loss of estrogen and also [42:51] uh all this rewiring that takes place [42:54] and the fact that some neurons are lost [42:56] as well in other hormones that okay so [43:00] let me get this straight okay so I [43:02] should be viewing menopause as the [43:05] physiological reconstruction of the [43:06] brain yes really based on the loss of [43:10] estrogen I and I'm going to try and go a [43:12] little bit further here with my science [43:14] so there's receptors in the brain that [43:17] estrogen interacts with and as estrogen [43:19] doesn't show up those those receptors [43:20] start to shut down and that's why we're [43:24] seeing the brain appear to sort of [43:27] shrink in volume a little bit but also [43:28] just the the activity of it seems to [43:30] drop and it's really the loss of [43:32] estrogen as the causal factor of that so [43:34] if in my mle science here this is you [43:37] know science for 10y olds over here over [43:38] this side of the table anyway um I go [43:41] okay well what we'll do is we'll Tak [43:43] some estrogen and ping we'll inject it [43:46] everything will be fine the brain will [43:47] stay nice and illuminated we'll avoid [43:49] the brain fog The Hot Flashes the [43:52] depression um the Sleep disruption and [43:54] everything we'll just inject some [43:56] estrogen yeah I would inject it but yes [43:58] I don't know how do you how do you [43:59] administer it by mouth or we'll eat it [44:02] we we'll rub it we'll do everything [44:03] we'll rub it we'll inject it we yes [44:06] we'll put it on top of cereal we'll do [44:07] whatever we have to do to keep it up [44:09] yeah we'll do facial do estrogen facials [44:12] and we'll keep it up we'll put in the [44:13] coffee everything right we'll smell it [44:14] sniff it and and then everything will be [44:17] fine yeah that's the end of the podcast [44:20] then that's it [44:23] bye if only it were that simple mhm so [44:28] we do have hormones that are available [44:31] for [44:32] treatment I think most people are [44:34] familiar with the term hormone [44:36] replacement therapy or [44:38] HRT and that option has a strangely [44:42] tortured history where in the [44:47] 1940s um estrogen therapy was actually [44:49] the number one best selling drug in [44:52] America and many other parts of the [44:54] world and most women going through [44:57] menopause in the 50s and 60s and 70s and [45:00] what not were put on hormones and left [45:03] on hormones high doses of hormones for [45:05] life and the idea back then is that [45:08] these hormones would not only reduce the [45:10] heart flashes and make menopause better [45:14] and more tolerable or just gentler but [45:17] would also protect against things like [45:20] heart disease and [45:21] dementia and then in the '90s the [45:25] government intervened and said well you [45:27] can't just do hormones to women without [45:30] doing clinical trials first even though [45:33] that was the practice for 30 years right [45:37] and so they launched the largest [45:39] clinical trial in history looking at HRT [45:43] for relief of heart flashes but also for [45:45] prevention of heart disease and dementia [45:48] and that was in [45:50] 1993 and the study was running and it [45:53] was suddenly stopped in [45:57] 2002 because what they found is that [46:00] hormone therapy was actually doing a lot [46:02] of damage to some of the women in the [46:06] study and what the media reported is [46:10] that the hormone therapy in particular [46:12] was increasing the risk of breast cancer [46:15] while also increasing the risk of heart [46:17] disease and [46:18] dementia and everyone [46:22] panicked and so many women just stopped [46:25] taking hormones overnight it that also [46:28] obviously kicked off a lot of lawsuits [46:31] and effectively stopped research on [46:35] hormones for menopause and prevention of [46:37] chronic diseases and it [46:41] took 1520 years for the research to [46:45] resume say 10 but really it's taking a [46:48] lot longer than than anyone would have [46:50] thought and now we know better so one [46:53] thing that everybody says is that that [46:55] study is called the Women's Health [46:56] Initiative [46:58] um they did the best they could with the [47:01] knowledge they had and the population [47:03] they had but the problem is that they [47:06] were looking at women who were in their [47:08] 70s and [47:09] 80s right so if your brain has changed [47:13] at that point and The receptors are not [47:15] there you can't simply put the hormones [47:18] back in because the system is not there [47:20] to use them and what those investigators [47:23] have found is that actually that can do [47:26] more harm than good with the hormones [47:29] that they were using back then okay [47:31] right so today we have different [47:34] hormones um we use lower doses the [47:38] hormones are taken either by mouth or [47:41] transdermally like the patch through the [47:43] skin which is gentler on the liver and [47:46] reduces the risk of blood clots and [47:48] other vascular issues we have different [47:51] types of progesterone which is another [47:53] important hormone we today we tend to [47:57] use bioidentical hormones rather than [48:00] synthetic hormones which were used back [48:03] then and that overall seems a lot safer [48:06] and at the same time hormones should be [48:09] used for menopause when women are going [48:13] through menopause not after not after [48:16] and a lot of research including my work [48:18] has shown that hormones work best for [48:20] the brain if you take them within a [48:22] 10-year window of the final menstrual [48:25] period and Tech Al you want to start [48:28] taking them prior to your final [48:31] menstrual period because what these [48:33] hormones do is that they stabilize your [48:35] hormonal concentration so they're not [48:37] just [48:38] supplements but the real power the real [48:41] magic if you will of hormone therapy at [48:44] least the way it was intended is that [48:46] you take it before menopause to really [48:49] stabilize things so your hormones don't [48:51] start fluctuating back and forth and [48:53] hopefully you don't even get the [48:55] symptoms The Hot Flashes the nice wor [48:57] the insomnia give me an analogy for that [48:59] then so those studies that were done in [49:02] the [49:03] 1990s there was what 160,000 women took [49:05] part in that study yeah the Women's [49:07] Health Initiative that's was a disaster [49:10] for an analogy because they were because [49:12] they were giving the hormones to women [49:14] that were in their 70s 80s yeah it's [49:17] effectively like trying to put Petrol in [49:19] a car when the petrol valve is sealed or [49:25] the car is Prett much pretty much yes [49:28] just pumping it into there when the [49:29] systems are no longer on doesn't work [49:31] and the systems are no longer on because [49:34] they shut down because there was no [49:36] estrogen yes they didn't those systems [49:38] didn't shut down because the person was [49:39] just old those systems would have [49:41] carried on working if they were given [49:43] estrogen is that accurate that's the [49:45] idea yes okay so the whole idea you want [49:47] to just start you really want to be [49:49] thinking about taking estrogen when [49:50] you're when those systems are still on [49:52] and working so that it can work and [49:53] sustain the systems that's right and the [49:55] the idea is to hormones when you have [49:58] the symptoms it's kind of like a car cuz [50:00] if you don't use a car for a long time [50:01] it just doesn't you know the engine [50:02] stops working yeah pretty much if you [50:05] left a car for 10 years just on the side [50:08] and then tried to put Petrol in I'm [50:09] pretty sure it still wouldn't work um [50:11] there would be glitches at a minimum [50:13] right yeah at a minimum so what what age [50:16] then because you know I've got a partner [50:17] that's what she's 30 31 years old that's [50:20] young that's young to start I think once [50:22] you have once you start having the [50:25] symptoms of menopause the heart flashes [50:27] so right now hormone therapy is only [50:30] approved for vom Mo symptoms which are [50:33] heart flashes and ey sweats okay it's [50:37] also used off label for support of [50:42] sleep especially when sleep is disrupted [50:45] by having hot flashes at night and it's [50:48] it's also used for relief of mild [50:50] depressive symptoms that are caused by [50:53] menopause and not other reasons we're [50:56] doing research now to test whether [50:59] hormone therapy may be helpful for brain [51:02] fog because believe it or not it's not [51:04] an [51:05] indication and hormone therapy is not [51:09] currently recommended for support of [51:12] cognitive function and there are a lot [51:14] of scientists myself included who find [51:17] that a little bit [51:19] puzzling but we also agree that more [51:21] research is needed so we are trying to [51:24] do the research and show that [51:27] well we want to understand if taking [51:29] hormones can can actually support [51:31] cognitive function because look when I [51:33] go through menopause I want to have all [51:35] the solutions and options that I can [51:37] possibly have so I'm doing the research [51:39] as fast as I can to also help myself in [51:42] the lot of other women but right now if [51:44] you have brain fog as a menopausa woman [51:47] the overall recommendation is kind of [51:49] suck it up what would you do you said [51:51] when you go through menopause what would [51:53] you do so the the pillars of uh life [51:56] style adjustments for menopause are diet [52:00] exercise sleep hygiene stress reduction [52:04] avoiding toxins which is where I go a [52:07] little bit overboard sometimes regular [52:10] medical checkups to make sure that um [52:13] you are in good health overall and [52:16] there's nothing in your medical history [52:18] that might make your menopause worse and [52:22] then I am also looking into phac [52:24] pharmaceutical options which I do not [52:26] take at this time but I am I'm deciding [52:30] whether or not that's an option for me [52:32] when the time comes do you know a [52:34] prepper is it's a term for someone who's [52:36] preparing for the end of the world oh [52:38] goodness and they have like a bunker [52:39] they have a food supply they're like [52:41] buying guns that I wouldn't do but they [52:44] do other things like um there's no [52:46] plastic in my kitchen plastic okay so [52:49] let's have a look at some of these [52:50] things then preparations and why you're [52:52] choosing to do them before we do that I [52:53] just wanted to to for people that don't [52:56] know the full range of symptoms and when [52:58] those symptoms the phase in of menopause [53:01] in which those symptoms typically show [53:03] up okay are there different symptoms for [53:06] different [53:07] phases no they're not they're just a [53:10] variety of symp so since you seem to be [53:12] interested in the stages let's go a [53:14] little bit deeper okay all right let's [53:16] say so your girlfriend is in her 30s [53:19] yeah right so most women in in in their [53:21] 30s have a regular menstrual cycle as [53:24] soon as you hit 40 [53:27] ish ballpark you still have a regular [53:31] menstrual cycle but you may start seeing [53:34] changes some months it could be a little [53:36] bit shorter some months it could be a [53:38] little bit longer some months it could [53:40] be a little bit lighter some other [53:42] months it could be a little bit heavier [53:45] I strongly recommend keeping [53:47] track because that's very helpful to [53:51] realize when you are past the [53:54] premenopausal stage and when you're [53:57] about to enter the per menopausa stage [54:00] which is more complex than just one two [54:02] three stages so once you have a regular [54:05] menstrual cycle is the Prem menopausa [54:07] stage and there's actually two separate [54:10] phases there's the early phase where [54:14] your menst cycle is the way it's always [54:16] been for women with a very regular [54:19] menstrual cycle then it starts changing [54:21] a little bit maybe just a couple of days [54:24] maybe a little bit little bit earlier [54:26] little bit later lighter heavier but [54:28] still very regular that's the late [54:31] premenopausal stage at that point you [54:34] may start skipping periods but maybe you [54:36] just skip it one month and then it's [54:38] back and then at some point you skip it [54:40] for two months and then it's back and is [54:42] regular that's the early per menopausal [54:45] stage at that point the most common [54:48] complaint is difficulty sleeping it's [54:50] poor sleep okay when women start having [54:53] a hard time not just falling asleep but [54:57] staying asleep and that's usually [55:00] because progesterone is going down it's [55:03] unusual to have hot flashes at that [55:06] point but brain fog may happen [55:08] especially around your menstrual cycle [55:11] when you wake up in the morning you have [55:12] no energy and just the idea of checking [55:16] your email feels like an ordeal it can [55:19] really happen usually it may last just a [55:21] couple of hours perhaps it lasts a day [55:24] but it's something to pay attention to [55:26] because because that could be a preview [55:28] to the menopausal [55:31] transition so then you start skipping [55:33] periods and then you start skipping more [55:35] periods and at some point your periods [55:38] would be more than three months apart so [55:40] you have one today nothing for three [55:41] months you're not pregnant it will come [55:44] back but you know what I mean so the the [55:46] frequency is going to diminish it's get [55:48] you're going to get fewer and fewer and [55:50] periods spaced apart more and more [55:53] that's the late Pam menopausa stage [55:56] where the symptoms really creep in so [55:59] that's when most women have the half [56:00] flashes the nice sweats actual insomnia [56:05] sometimes mood changes sometimes there's [56:08] irritability sometimes there can be [56:10] tearfulness sometimes you cry for no [56:12] reason sometimes you just feel really [56:13] down in the dumps and you don't know why [56:16] there could be the brain fog there could [56:18] be forgetfulness it's important to know [56:20] that that as disruptive as that might be [56:24] it's actually not common I can't say [56:28] normal because it does not feel normal [56:30] for sure but it's expected included in [56:34] many women I saw in your book you said [56:36] things like vaginal dryness yes that's [56:39] not the brain symptom is a bodily [56:41] symptom that can happen earlier weight [56:44] gain yeah that can happen slow [56:46] metabolism and digestive issues [56:48] overactive bladder yeah that's a little [56:51] bit later usually more like after [56:54] menopause muscle tension and aches yeah [56:58] look there's a whole range of symptoms [57:01] yeah well you can have tinitus tinius [57:04] which is that bringing in the air yes or [57:06] electric shock [57:07] Sensations panic attack please do keep [57:10] going with your that was very helpful [57:11] you're going through the phases and [57:12] overlapping them with the symptoms yes [57:14] so the late per menopausa stage which is [57:19] defined as not having your perod for 3 [57:22] months or more at a time is when the [57:25] symptoms really kick [57:27] hard then at some point you just stop [57:30] having your period for good sorry what [57:32] age does the symptoms start kicking hard [57:33] typically on average 47 47 you 45 47 [57:38] okay it's harder on black women and [57:42] Hispanic women why we don't know but [57:46] there are some differences related to [57:48] race and [57:49] ethnicity and usually um yeah Black and [57:54] Hispanic women [57:57] may experience more severe symptoms of [58:00] menopause which is something that we [58:01] should really talk about because there's [58:04] hardly any research done on this and [58:07] it's it's completely unfair you know I [58:10] was reading a stat that really shocked [58:12] me about suicidality yes yes it tends to [58:15] increase for women in in midlife and it [58:18] tends to be at least a corate of going [58:21] through menopause also the rate of [58:23] divorce is significantly higher [58:26] as women transition to [58:28] manop see that's why it's important for [58:31] men to know these things too I read that [58:35] the time in a woman's life where she's [58:38] most likely to die by Suicide is when [58:41] she's in that sort of 55 years old [58:45] region yeah it's right after so let me [58:49] get through the the so there's the late [58:51] per per menopausal stage then you hit [58:54] menopause which is a DI agnosis right [58:57] and then you start the early [58:59] postmenopausal phase that's as hard as [59:03] the late per menopausal stage so the the [59:06] four years around the final menstral [59:10] period in either direction both [59:12] directions are the [59:14] hardest right so the few years the the [59:16] last three to four years before the [59:19] final manral period and the 3 four years [59:22] right after the final menstral period [59:24] those are the worst by all accounts this [59:26] is when most women really have a hard [59:28] time uh the women who do have the [59:31] symptoms as I mentioned there's a whole [59:33] range of symptoms not just the type of [59:36] symptoms the number of symptoms but also [59:38] the severity of symptoms that is not [59:41] recognized or formalized in medicine [59:43] which I think is is unacceptable and is [59:46] is really not okay if you think think [59:50] about pregnancy right so this is what I [59:52] wanted to tell you before and I'm going [59:53] to say now because I think it's [59:55] important [59:56] the modern definition of menopause is [59:59] that menopause is a neuroendocrine [60:02] transition specific to women that ends [60:06] with reproductive inessence the end of [60:08] fertility but also impacts a number of [60:12] different systems in the body including [60:14] the brain and the reason that this is [60:17] important to realize is that it's a very [60:20] specific and unique medical category [60:23] that cannot be equal to getting older [60:27] and cannot be compared to having a [60:30] disease it's it's a very unique thing [60:32] that happens in medicine that only has [60:36] three entries in this category of [60:38] neuroendocrine transition brain hormone [60:40] transition there's puberty there's [60:42] pregnancy and there's per menopause [60:46] right now what happens with puberty and [60:48] pregnancy let's talk about just [60:50] pregnancy what happens with pregnancy is [60:51] that we all know that many pregnant [60:54] women experience [60:56] changes in mood for example changes in [60:59] attention changes in focus and [61:01] concentration brain fog also 30% of [61:04] pregnant women have half flashes it's [61:07] just something we never talk about so [61:09] the symptoms are not that different from [61:12] menopause we've seen them before only [61:15] when you're pregnant everything is [61:17] gorgeous Everything Is Beautiful there's [61:20] baby showers there's parties people take [61:23] pictures and if you're having a hard [61:25] time [61:26] everybody's very compassionate and [61:28] supportive and tries to make you feel [61:30] better so you're saying we need to have [61:31] a manopause party yes little but also I [61:35] want vocabulary because we know that for [61:39] example with pregnancy post parm it is [61:43] understood that this transformation is [61:46] not just that you're having a baby your [61:47] body is changing and so is your brain [61:50] some women have no depressive symptoms [61:52] some women have baby blues some women [61:55] have post depression and some women have [61:57] postpartum [61:59] psychosis right yeah it can happen it's [62:01] rare but it can happen and it's a range [62:04] and now that we understand that number [62:06] one it's important and it's common and [62:09] there's a range we have a framework to [62:12] address it so once you have a baby and [62:15] you go to the pediatrician for the baby [62:17] you mother get a screening for [62:19] depression and the pediatrician you [62:21] don't have to go to a [62:22] psychiatrist they do it right there and [62:24] then you are effectively screened and [62:26] monitor it to make sure that you're fine [62:29] if you have postpartum depression we now [62:31] have therapies the very specifically [62:34] work for that type of depression that is [62:36] different from other types of depression [62:39] you know what I mean there's no such [62:40] thing for menopause there's no system in [62:44] place where you can even describe your [62:46] symptoms to a provider because the [62:48] language is in there you're going to [62:49] have to say I have brain fog and nobody [62:51] knows what brain fog is because it's not [62:53] a clinically meaningful category how [62:56] much education do doctors get on medical [62:59] very little so it's one in five OBGYN [63:03] residents what's an OBGYN for anybody [63:05] that's in Europe athetics and Gynecology [63:08] okay person is the person that you go to [63:11] for menstrual cycles and pregnancy and [63:14] then menopause okay and anything related [63:17] to fertility or the function of your [63:18] reproductive organs they don't know [63:20] about menopause one in five does but in [63:23] reality when you look at the curric ulum [63:26] is more like six maybe eight hours in [63:28] total of training throughout the entire [63:31] Residency program so it's it's not much [63:33] it's really not much so I would say that [63:35] the vast majority of Specialists are not [63:40] OBGYN Specialists are not actually [63:42] manopause [63:43] Specialists and even those who are don't [63:47] receive a lot of training so in school [63:50] at least so it's really important to go [63:52] see a specialist who number one is a [63:55] certified menopause specialist you can [63:57] find it on the internet and number two [64:00] somebody who has personal experience [64:02] because at this point you really have to [64:04] to gain your own experience and the [64:07] thing that is very upsetting to many [64:10] professionals is then even the best [64:14] OBGYN specialist is not a brain [64:17] specialist right so menopause has been [64:20] pigeon hold as an issue with the ovaries [64:23] go see an obig Wayan specialist [64:26] where the symptoms that most women [64:28] actually suffer from are neurological in [64:31] nature and the specialist you go to is [64:34] not trained to manage or diagnose [64:38] anything brain related they're not [64:39] supposed to right it's a complete [64:41] different organ instead of skills so [64:44] we're trying to change this framework so [64:47] the brain Specialists can be [64:50] involved in the medical evaluations and [64:53] treatment of menopausa women [64:56] have we finished off with the stages [64:58] there so we were yes we finished off no [65:00] just one more just one more stage so [65:02] there's the early post menopausa stage [65:04] that is still a little bit like a [65:05] tornado it can be a tornado with a lot [65:07] of symptoms but then six years after the [65:11] final menstrual [65:12] period That's the late post menopausa [65:16] stage which is the stage that a woman [65:19] would live into for the rest of her [65:21] life that stage varies and that I find [65:26] is really interesting for many women the [65:29] symptoms like hot flashes the night [65:31] sweats the mood changes the brain fog [65:35] tend to go away over time I've got a [65:38] graph that I'll put on the screen that [65:39] shows how brain flog changes over time [65:42] and as you can see it's kind of like a [65:44] u-shape so it's there's no brain fog and [65:47] then it goes you have severe brain fog [65:49] and then the brain fog seems to recover [65:52] not to the same height as it was um [65:54] before menopause but postmenopause which [65:57] is I'm getting when it guessing where it [65:58] recovers there this is yeah this is post [66:01] menopause so this cognitive function [66:03] right it's nice and high before it [66:05] menopause then it takes a dip yeah [66:07] during the transition then it goes [66:09] typically back up for a few women it [66:12] would be up here so it goes back to [66:14] premenopausal level levels cognitive [66:16] function for most women is a little bit [66:18] lower than it used to be but still [66:20] pretty good this is good news yes that [66:23] is good news absolutely and but for [66:25] other women is not it keeps going down [66:27] it keeps declining and that's why a lot [66:30] of women come to us at the Alzheimer's [66:32] prevention Clinic because they're really [66:35] scared that that may be a sign of early [66:37] dementia is there any reason why some [66:40] women's brain fog doesn't return back to [66:43] normal levels postmenopause we are [66:45] looking at that right now is this also [66:47] why you're prepping Yes actually it's [66:50] the study that we have under review that [66:53] I believe is the first to look at brain [66:58] Cates of menopausa brain fog so as far [67:01] as I know this is the first study that [67:03] shows that that there are very specific [67:06] changes in the brain that strongly [67:09] associate with having or not having [67:12] brain fog that is the first step to then [67:16] clarifying why certain women have it and [67:18] certain women don't have it and how how [67:21] can I make it better right is it [67:23] hormones is some other kind of therapy [67:25] how how can I reverse it how can I [67:27] prevent it so this brings us back to [67:29] this conversation around prepping you [67:31] you're you're in this phase of life [67:33] where you're prepping um why does [67:34] exercise matter for menopause so [67:36] exercise matters for everything from [67:39] hormonal Health to brain health to heart [67:41] health because everything is [67:42] interconnected right we are effectively [67:45] a system where every part of you needs [67:49] to be healthy for you to feel healthy as [67:51] a person um for both menopause and brain [67:54] health we know that physical activity [67:57] stimulates the production of certain [67:59] proteins that can travel all the way [68:01] inside your brain and they're also made [68:04] inside the brain that support neuronal [68:06] Health from growth hormones to very [68:08] specific peptides they have [68:11] um a boosting [68:14] functionality and for menopause in [68:17] particular all exercise is good but [68:21] cardiovascular [68:23] activity seems to be a especially [68:26] helpful for the Hat flashes in the brain [68:29] fog where strength training seems to be [68:33] more helpful to preserve metabolic [68:36] activity and bone mass but also mood it [68:40] supports [68:41] mood and um flexibility exercises and [68:46] Mind Body techniques like yoga Pilates [68:49] taichi those are helpful not just for [68:52] flexibility but also for stress [68:54] reduction and sleep [68:56] so it's good if possible to do a little [68:58] bit of everything and if if time is a [69:01] constraint then it's helpful to know the [69:04] different types of exercise may be [69:06] especially helpful for one thing or [69:09] another there's a study in your book I [69:11] think in Chapter 13 where you where you [69:12] case study uh I don't think it was a [69:15] study you did around the Latin women [69:16] 3,500 Latin women me but wonderful study [69:20] wasn't it and and it showed that those [69:21] who engage in regular to moderate [69:24] intensity exercise were almost 30% less [69:26] likely to have severe hot flashes than [69:29] those who exercised less yeah which is a [69:32] really compelling argument for exercise [69:34] in that phase of life and there's some [69:36] other sort of um related information [69:39] that I read that said that women in [69:41] their 40s are the highest demographic [69:43] group to exercise [69:44] inconsistently or not at all yeah yeah [69:48] so we know exercise is great for that [69:50] phase of life and we to know that women [69:52] have no time is that what it is is it a [69:55] timing issues typically for most women [69:57] is a combination of factors I think [69:59] midlife is a bit of a is a turbulent [70:03] time when you're sandwiched in between a [70:06] lot of different responsibilities if you [70:08] have maybe young children and older [70:10] parents and you're trying to to maybe [70:13] get a career advancement and you also [70:15] want to take care of your health and [70:16] then boom you get hormonal changes and [70:18] menopause so it is a bit of a it's it's [70:21] a different age to navigate in some way [70:25] is and what a lot of women report is [70:28] that one they have no time to take care [70:30] of themselves and number two sometimes [70:33] that the reasons are outside of your [70:35] control like this fatigue that so many [70:38] women report the lack of sleep or uh [70:41] that that is a bit of an issue when it [70:43] comes to feeling energized enough to [70:47] also go to the gym so there are some [70:49] barriers and um I think it's good to to [70:52] be creative if you can right and also [70:55] realized then you don't have to wear [70:57] fancy clothing you don't have to go to [70:59] the gym it's good enough to go for a [71:01] walk in the park just keep your body [71:03] moving is there a certain type of [71:05] exercise that is um too much can you can [71:09] you do too much exercise CU I don't want [71:11] people that are listening to this now [71:12] that are in that phase of life to just [71:14] suddenly start running marathons every [71:15] single day or something thinking that [71:17] they'll be able to save off menopause I [71:18] think that's that's actually what most [71:20] people hear when you say exercise is [71:23] really good for you and they see [71:24] themselves like oh my God I have to join [71:26] the gymm and just work out three hours a [71:29] day that's not what the research shows [71:31] because your cortisol levels would go up [71:32] as well yes it may happen and also your [71:35] recovery time may increase okay [71:38] especially after menopause but what [71:39] Studies have shown is that in this case [71:42] there's an inverted u-shape relationship [71:45] between intensity of exercise and health [71:47] gains and I'm not talking [71:49] about Fitness or muscle mass I'm [71:52] thinking about overall health how health [71:54] you how healthy you actually are as a [71:57] whole and with the research in women [72:00] especially women who are recently [72:03] postmenopausal of 50s 60s what the [72:06] research shows that if you don't [72:07] exercise at all obviously there's no [72:09] gains but as soon as you start even just [72:12] in mild intensity the gains start [72:14] increasing and the peak of the curve is [72:17] for a moderate intensity regimen at high [72:21] frequency which is which is you work out [72:24] in a way way that bring some pink to [72:27] your cheeks and you may have a hard time [72:30] singing but you won't have a hard time [72:32] talking okay so your heart rate goes up [72:35] but not so high up that you can't [72:37] breathe physically actually and there's [72:40] different intensity intervals of course [72:43] uh Rich Roll called the he said to me [72:45] this is what professional athletes [72:47] called zone two okay so Zone to everyone [72:51] okay but if you increase the intensity a [72:54] lot more more the gains actually start [72:56] diminishing after menopause which is not [72:59] Universal there's plenty of women who [73:02] can do beautiful things physically but [73:05] on average what that suggests is that [73:09] just do the best that you can try to [73:11] shoot for this zone two or moderate [73:13] intensity exercise just do it often [73:15] enough that the gains are consistent and [73:20] as it relates to alzheimer's you talked [73:21] about those Alzheimer's plaques in the [73:23] brain yeah if I exercise more do women [73:25] in that exercise more have less of those [73:26] Alzheimer's plaques yes yes you do have [73:29] few Alzheimer's plaques and also what [73:31] the research shows is that women who are [73:33] physically fit in midlife have 30% lower [73:39] risk of Dementia in old age as compared [73:42] to women who are sedentary in [73:44] midlife so that's also really important [73:47] to have because if I had a pill that can [73:49] reduce your risk of dementia Alzheimer's [73:52] Disease by 30% I would be rich and [73:55] everyone would buy it you should become [73:57] a personal trainer yes pretty much but [74:00] the prescription is try to exercise at [74:03] least the moderate [74:05] intensity um level but do it [74:08] consistently enough which means three to [74:10] five times a week so let's talk about [74:12] your um diet then your diet regime as [74:15] you prepare for that phase of [74:19] life let's start with caffeine oh yes I [74:23] switch to decaf You Don't See [74:25] to everybody's anguish in my house yes [74:28] are you already switched to De CF why [74:32] because caffeine is a little bit of a [74:35] trigger for Sleep disturbances for a lot [74:37] of women and what people don't realize [74:40] is the caffeine is not just like the cup [74:42] of coffee that you drink at the moment [74:44] although you do feel a little bit of the [74:46] energy rush but what happens is that [74:49] caffeine um stays in your system and in [74:52] your brain for a really long time so the [74:55] half life is six hours which means that [74:58] six hours after drinking that cup of [75:00] coffee half of the caffeine will still [75:03] be in your [75:04] system and the fall life is 12 hours so [75:08] it effectively takes 12 hours to get rid [75:11] of all the caffeine from your body and [75:13] your brain which also means if you drink [75:16] a cup of coffee at noon some of that [75:19] caffeine is still going to be in your [75:20] system at 10 p.m. right and if you drink [75:23] a cup of coffee at 2 p.m. [75:25] half of the caffeine will be in your [75:27] system by 800 p.m. and the quarter of [75:30] the caffeine will still be [75:32] circulating everywhere in your body and [75:34] brain at 10 [75:36] p.m. so you can't just have a cup of [75:38] coffee at 2 p.m. and then hope for a [75:40] good night sleep unless you go to sleep [75:42] late which I can't afford because I'm up [75:44] at six so could could one also argue [75:47] then that coffee is going to increase [75:50] because if coffee is still in our brain [75:53] you know if I have a coffee at 9:00 p.m. [75:55] you know people used to have coffees [75:56] after dinner isn't that mad yeah they [75:58] still do that in restaurants they they [75:59] you eat your food and then they come [76:00] around and ask if you want an espresso [76:02] absolute Psychopaths I have no idea it's [76:05] so crazy they don't ask as much anymore [76:07] but to digest this is again is the idea [76:10] of optimizing for one thing without [76:13] realizing that you're de optimizing for [76:15] another so you improve digestion in some [76:17] ways but you're disrupting your sleep [76:19] cuz it's waking your body back up and [76:20] going go on yeah just before you need to [76:22] sleep right so if I have a coffee say [76:25] 600 p.m. 7:00 p.m. 8:00 p.m. at night M [76:27] and midnight you still have to half at [76:29] the caffeine which means I'm not going [76:31] to sleep as well which means my brain [76:33] isn't going to um do its job of clearing [76:36] things out and restoration that's [76:38] exactly why which is going to increase [76:40] my chance of Dimension Alzheimer yes yes [76:43] because what happens is then um the [76:45] brain needs to go through certain stages [76:47] of sleep and there's one stage of sleep [76:49] that is called a slow wave or deep sleep [76:53] which is really the only chance that the [76:55] brain has to clean itself up it's like [76:58] your brain's me time where the rest of [77:01] the body is completely still which is [77:04] really important because even when we're [77:05] sleeping during the other stages of [77:07] sleep the body can still move and that [77:10] means that the brain needs to be [77:12] partially active to control that [77:14] movement and initiate that movement so [77:16] deep sleep is really the only chance [77:18] that your brain has to take care of [77:20] itself from the inside out and there's a [77:22] system inside the brain that's called [77:24] the glymphatic system that gets [77:27] activated only during slow wave sleep [77:31] and it's like a car wash in know way [77:33] it's like a dishwasher there's like Jets [77:35] of fluid that goes everywhere inside the [77:38] brain and clean it up and remove all the [77:41] waste material so all the toxins the [77:43] byproducts the waste products the [77:45] Alzheimer's [77:46] fragments they get cleared during that [77:49] stage of sleep so if you miss out on [77:51] that window which is most people tend to [77:53] do because a lot of eyes unfortunately [77:55] tend to wake up at like 2: 3 in the [77:57] morning when we should be in deep sleep [78:01] but we're not because we wake up and [78:02] then you miss out on that cycle because [78:04] the brain starts again from cycle one [78:06] from stage one so sleep is super [78:09] critical here it is really important [78:11] there must be a pretty strong link [78:12] between people who don't sleep much and [78:14] Alzheimer's as well then there is a link [78:16] yes it's been explored and it seems to [78:18] be consistently significant across [78:20] studies and is there a relationship with [78:23] alcohol and menopause [78:25] yes alcohol unfortunately is a trigger [78:28] for some of the symptoms a menopause it [78:30] can make it can really make them worse [78:32] my biggest concern is that alcohol is a [78:36] dehydrating [78:37] substance it's def functional is one of [78:40] the main functionality of alcohol as a [78:42] molecule is dehydrating and dehydration [78:45] is a problem for brain health so the [78:48] brain is 80% water which is more than [78:52] everywhere else in the brain and water [78:55] is crucial for every single chemical and [78:58] cellular reaction to take place inside [79:00] the [79:01] brain so the brain is the one organ that [79:05] is especially sensitive to the effects [79:07] of [79:08] dehydration where even a two to 4% water [79:12] reduction of water volume loss can [79:16] prompt neurological symptoms the [79:18] headaches and migraines and [79:20] dizziness and brain fog so actually [79:24] alcohol by dehydrating your brain and [79:27] those sticks around in your brain for a [79:29] long time can make some of the symptoms [79:31] of menopause worse but also at any age [79:34] it can really have a bad impact on [79:36] cognitive function there's some studies [79:39] that I find very interesting where [79:41] people studied the effect of hydration [79:44] on cognitive performance and they showed [79:47] that if you have two groups of people [79:49] who need to do certain mental tasks like [79:51] neury testing and reaction times Compu I [79:55] tests that measure your pressy speed and [79:58] if you give one group a glass of water [80:01] or a couple of glasses of water before [80:02] taking the test they actually perform [80:05] 15% better than the group of people who [80:08] didn't drink any water prior D I need to [80:10] start drinking water on this podcast yes [80:12] and look yes you should and I will also [80:15] say that water isn't just water right A [80:18] lot of people drink purified water [80:20] that's not water that's just fluid so [80:23] your brain doesn't just want some [80:25] wet it wants water with electrolytes and [80:29] minerals and salts because it's the [80:31] combination of these factors that really [80:33] supports hydration so tap water is fine [80:36] as long as it's clean right and one [80:38] thing that we did at home is that we [80:40] install this ginormous filter for the [80:43] entire house where the water is now [80:45] filtered in a way that removes removes [80:48] all the impurities but preserves all the [80:51] electrolytes what else have you done [80:53] sort of scientist slab of a house that [80:55] you're building this you mentioned [80:56] toxins I'm a little bit strict sounds [80:59] like and yes so there's no plastic in my [81:02] kitchen not at all everything is just [81:04] glass why because plastic is really an [81:08] issue it's a very very common [81:10] contaminant and pollutant and what [81:13] happens is that when you heat it the [81:16] particles can penetrate into your food [81:19] and drinks and beverages but also in the [81:21] M also when you put plastic in the [81:23] dishwasher right the hot water will make [81:26] it leak and then it leaks into your [81:28] plates and glasses and what not and then [81:30] you drink it right back or you eat it [81:32] right back when you put plate food on a [81:34] plate so pollutants in general [81:39] accumulates in an organism concentrate [81:42] in an organism by [81:44] bioaccumulation which means that you [81:46] start a lower doses by they stick around [81:48] for a really long time so they keep [81:50] piling up over time and that's [81:52] especially an issue for women and for [81:56] children but for women in particular [81:58] because we have more body fat than men [82:02] for instance and pollutants tend to [82:05] accumulate in body fat especially breast [82:07] tissue so they've been linked to an [82:10] increased risk of reproductive issues [82:13] like reproductive infertility [82:14] endometriosis thyroid disease and more [82:17] recently to dementia as well not plastic [82:19] in particular but pollutants in general [82:22] breast cancer breast cancer yeah [82:24] reproductive cancers as well and you [82:26] could never say it's 100% this or that [82:29] but the fact that there is a strong [82:30] Association is reason enough for me to [82:33] stay away from plastic and what else [82:36] what do you put in your mouth in terms [82:37] of [82:38] food uh so there's plenty of research [82:42] showing that the brain really wants and [82:46] needs very specific nutrients to [82:48] function at its best because the reality [82:51] is that when I was studying my favorite [82:54] class has always been [82:56] neurochemistry and I was learning about [82:58] this all these different molecules and [83:00] all these different chemical reactions [83:02] that are so important for brain function [83:04] and neuronal health and whatnot and then [83:07] I realized well we're really looking at [83:09] potassium and sodium and magnesium and [83:12] omega-3 fatty acids and protein and [83:14] glucose and those are nutrients so the [83:17] nutrients that we obtain from the foods [83:20] that we eat literally become part of the [83:23] fabric of our brains so every day we [83:27] have a number of opportunities breakfast [83:31] lunch and dinner to either make a smart [83:34] choice that supports her brain health or [83:37] the opposite and feed her brain garbage [83:39] that is going to be unfortunately [83:41] Incorporated in the fabric of your brain [83:43] and I don't want that brain I don't want [83:45] that for my brain [83:49] exactly so it's really important to [83:52] focus on clean Foods the nutrient dense [83:56] and they prioritize the nutrients that [83:57] your brain wants the brain is not a [84:00] sponge I keep saying that because I [84:02] think there's some confusion in the [84:05] world where people think that whatever [84:07] you eat can have a direct impact on [84:10] brain health for instance I learned that [84:15] individuals who really are interested in [84:17] brain health would say things like the [84:20] brain is mostly fat has a lot of [84:22] cholesterol which is true therefore you [84:25] need to eat a lot of cholesterol to [84:28] support the fat inside your brain which [84:30] is absolutely not [84:31] correct the cholesterol from the diet [84:34] can never get inside your brain there's [84:36] no way for that substance to actually [84:39] get inside your head I mean your head [84:41] yes but not inside your brain so eating [84:44] cholesterol rich foods will not help [84:46] your brain at all eating antioxidant [84:49] rich foods will so the nutrients that [84:52] your brain really relies on are anti an [84:54] oxidants like vitamin C vitamin E [84:57] selenium [84:59] betacarotene um things that you find in [85:01] fruits and veggies basically and some [85:03] nuts and seeds [85:05] preferentially uh lean protein so amino [85:08] acids the essential amino acids and [85:11] polysaturated fatty acids which can be [85:14] from plant-based sources or animal [85:18] sources but they really have to be the [85:20] poly ins saturated fatty acids that the [85:23] brain really wants and needs and need to [85:25] be replenished consistently so you're [85:27] saying if I'm on if I'm struggling with [85:29] menopause then I should be aiming at the [85:30] Mediterranean diet pretty much yes thank [85:32] you that's the bottom line so a [85:34] Mediterranean style pattern seems to be [85:37] correlated or at least associated with [85:39] better outcomes overall for Women's [85:41] Health what about [85:44] supplements supplements are typically [85:47] used to supplement a healthy diet not to [85:50] replace it and I think that's important [85:53] because the Le here there's a tendency [85:55] to recommend really high doses as [85:57] supplements to everyone across the board [86:00] but we do know that supplements only [86:02] work if you have a deficiency or at [86:05] least a subclinical deficiencies whereas [86:09] giving high dose is something that your [86:11] body or let's let's say the brain at [86:14] least I just stay in my Lane but high [86:16] dose is something that your brain [86:17] doesn't want or need they're not going [86:19] to be very helpful you're just going to [86:20] either pee them out or do they're just [86:23] going to accumulate in other parts of [86:24] the body so they're not as helpful [86:26] because everyone that talks to me about [86:27] the brain talks to me about omega-3 as a [86:30] supplement that I should take for every [86:31] time I take omega3 I think I'm doing my [86:33] little brain a favor you may or may not [86:36] so the research shows that the brain [86:39] seems to need a certain amount of [86:41] omega-3 fatty acids that are between [86:44] three and six grams per day now if [86:47] you're able to obtain that from a diet [86:50] then maybe supplements are not necessary [86:54] but if you're not then supplements may [86:56] be helpful Omega-3s yes those are the [86:59] poliner fatty acids that the brain [87:01] really needs antioxidants as well I I [87:03] take vitamin C oh okay so you are on the [87:06] supplements you were just trying to keep [87:07] them all to yourself no I'm joking [87:10] wasn't well I you know what I really [87:12] like is more extracts okay and [87:15] Botanicals okay I'm not a take my peill [87:19] kind of person I I actually get quite [87:21] annoyed when I need to take pills I just [87:23] don't like it mhm I think because I work [87:24] in a hospital right so I associate that [87:27] as being sick so I don't like that [87:29] feeling but what I really enjoy is to [87:32] get my nutrients from either extracts or [87:35] concentrates from plants and veggies and [87:38] fruit so in the morning the first thing [87:40] I do is that I drink water immediately [87:43] but also then I have non juice which is [87:47] a sometimes you give me the eyebrow [87:49] you're just yeah yeah yeah no no juice [87:52] no n o n i a wonderful juice from the [87:55] Pacific Islands that has a little bit of [87:58] a bitter taste which is always good [88:01] because beers are really good for [88:03] digestion and gut health and that's [88:05] important for brain health and and [88:07] elimination as well and clearance and is [88:10] very rich in vitamins and minerals and a [88:14] lot of phytonutrients so that's a good [88:16] concentrated source and this mixed with [88:18] blueberry juice so that's that's also [88:20] really good to have one of the things I [88:22] found quite um fascinating is I read [88:25] that there was a study done on legumes [88:27] that proved yeah yeah it was in your [88:29] book it was in chapter 14 where it says [88:31] there's a legumes apparently to be seem [88:34] to be a bit of a miracle food for [88:36] delaying menopause yeah so a diet that [88:39] is rich in legumes and also fish fatty [88:44] fish yeah has been linked with the later [88:47] onset a menopause by how much 3 [88:51] years whereas women who [88:54] follow the standard American diet like [88:57] the said diet with more lots of sugary [89:01] Beverages and processed foods and [89:04] package meats and whatnot that's been [89:06] linked with an earlier onset of [89:09] menopause by about three four years and [89:12] the last thing you want is to go through [89:14] menopause earlier in life if you don't [89:16] have to right I was reading as well in [89:19] your book that um women who do con [89:21] consume enough omega-3 may experience [89:25] different types of menstrual pains and [89:28] fertility issues and stuff is that true [89:30] yeah well the research shows an [89:32] association between consumption of [89:35] omega-3 fatty acids and um well also [89:40] lower risk of [89:41] depression in recurrent depressive [89:44] symptoms in menopause as well as better [89:47] fertility overall and the same for [89:50] antioxidants antioxidants have also been [89:53] linked with the [89:54] gentler menopause overall and fewer [89:59] menstrual crms and less [90:01] pain uh and the lower risk of [90:04] premenstrual syndrome as well I all of [90:07] this begs the question because it seems [90:09] that the human body is designed if you [90:11] believe the theory of evolution which I [90:13] do to be very smart and to do things for [90:17] clear and obvious survival benefit and [90:20] reason but when I think about menopause [90:23] it you know it's hard hard to see on the [90:24] surface what the evolutionary reason for [90:26] such a process is why does it happen why [90:29] don't women just you know why don't [90:30] women's estrogen levels just stay the [90:32] same throughout their life until they [90:33] die and you know because it seems to be [90:35] the case that it's not the same for men [90:37] so is there an evolutionary basis for [90:38] everything we've talked about [90:40] today the theory of evolution was [90:42] developed by Charles Darwin who did not [90:46] love women oh really yes let's move on [90:49] then and the theory makes sense if [90:52] you're a man but not if you're a woman [90:55] because the theory of evolution says [90:57] that pretty much the only reason to be [90:59] alive is to pass your genes On to the [91:02] Next Generation so the fact that women [91:04] will stop being [91:07] reproductive in [91:09] midlife and be able to live after that [91:12] is clearly against the classic theories [91:16] of evolution but I I was thinking about [91:19] this and I was thinking well is it is it [91:21] not just because in the what 1700s 1800s [91:25] the average life expectancy was like 35 [91:28] 40 yes but there was a notion already [91:31] back then that women who were able to [91:34] live past that age at some point in [91:36] their lives would stop being [91:38] reproductive and hopefully remain alive [91:41] so [91:42] for this is what I will tell you that if [91:47] you're born with [91:48] ovaries that menopause seems to be just [91:51] a fact of life there is an understanding [91:53] that at some point your ovaries will [91:55] stop ovulating and you'll go through [91:58] menopause but in reality menopause is a [92:01] biological puzzle is a big question mark [92:05] because most animal species in most [92:09] animal species females actually die [92:13] right after menopause so your life pin [92:17] as a female animal tends to match your [92:21] reproductive pin which is what Darwin [92:23] was talking [92:24] about now this Theory only makes sense [92:29] if you are not able to outli [92:34] menopause and there are two different [92:36] theories when it comes to menopause [92:37] there are people who like Darwin say [92:40] well women should just die or women [92:43] areos were supposed to die after [92:46] menopause like all other animals on the [92:48] planet except just a few like killer [92:50] whales for example killer whales are [92:52] able to leave live long past menopause [92:56] or do some elephants and some giraffes [92:58] and some insects interestingly enough [93:01] but then there's another theory that [93:03] says no no no it's not just medical [93:06] improvements are supportive women and [93:10] enabling women to live past menopause [93:13] the reality is that menopause makes [93:15] sense for a number of reasons and this [93:16] is called the grandmother hypothesis and [93:19] what this hypothesis says in a nutshell [93:22] is that evolution is much more [93:25] complicated than what Darwin was [93:27] thinking [93:29] perhaps and what makes more sense if you [93:31] are a woman and you have to bear this [93:35] children you have to grow a child and [93:38] there's a strong risk of dying from [93:40] child birth the older you are and [93:43] there's also a risk to The Offspring to [93:45] the children the older the mother is [93:48] then it makes a lot more sense to stop [93:51] being reproductive as simple point in [93:54] your life and remain alive to help your [93:57] daughters and your sons and your [93:59] grandchildren by providing all the [94:02] resources that they need for them to [94:05] outlive you know to keep on going and [94:07] keep having children so the theory is [94:10] that there at some point in the course [94:11] of [94:12] evolution where our ancestors were still [94:15] cavemen that the strongest women who [94:19] were able to live past multiple pregnanc [94:23] is the most fit of women at that [94:27] point somehow underwent these mutations [94:30] that enabled or perhaps that were able [94:32] to activate it to activate their [94:34] longevity genes where their bodies [94:37] evolved to be able to outlive menopause [94:41] by many many years if put in the right [94:43] environment of course and that means [94:46] that yes you're not passing on your own [94:48] personal genes to the Next Generation [94:51] but you are effectively stepping into [94:54] the role of [94:55] grandmother and caregiver and that helps [94:59] your own children have more children and [95:02] then you're going to make sure that your [95:03] grandchildren don't die because you're [95:05] going to be there to provide for them [95:08] this is very important when your babies [95:12] can't really take care of themselves for [95:13] a really long time like human babies [95:15] can't they're basically helpless for [95:18] many many years the parents had to keep [95:20] providing for them the grandparents had [95:22] to keep providing so that makes sense [95:24] for humans that women will stop being [95:28] reproductive but will keep being [95:31] productive and stay alive and anyone [95:33] who's ever had a grandmother would know [95:36] that that's very very important to have [95:38] so this idea that menopause is actually [95:41] an issue because we're living longer yes [95:45] I really don't that that well some [95:48] people think it's true some people think [95:49] it's not from what I can see clinically [95:54] our bodies have this unique capability [95:57] to really remodel themselves and change [96:01] themselves to adapt to menopause our [96:04] brains rewire our bodies [96:07] rewire and the idea that there is such a [96:10] mechanism in place suggests [96:12] adaptation I'm going to let you in on a [96:14] little secret what is in the DI of a COO [96:18] Cup this cup that sits in front of me [96:20] when I interview these people sometimes [96:21] for 3 hours and sometimes three people [96:23] day and the answer is this perfect de I [96:26] invested in the company on Dragon's Den [96:28] and since then they've gone from an idea [96:30] to the fastest growing energy drink in [96:33] the UK it is a mat energy drink and it [96:36] is absolutely delicious but that's not [96:39] why I choose to drink it on this podcast [96:40] the reason I choose to drink it is [96:42] because it gives me what I call all day [96:44] energy I don't get the same crashes that [96:46] I used to get with other energy drinks [96:47] if you're in the middle of a [96:48] conversation or you're in the middle of [96:50] a talk on stage or in the boardroom the [96:51] last thing you want to do is a crash you [96:54] don't want Jitters and you need focus [96:57] and that is why they now sponsor this [96:59] podcast not only is it delicious but it [97:01] gives me a significant competitive [97:03] Advantage if you haven't tried it go [97:04] down to a Tesco go to a waitrose or go [97:07] online and use the code diary 10 a [97:10] checkout and you'll get 10% off and when [97:12] you do try it let me know how you get on [97:14] I think I read in your work that a woman [97:17] is never happier than in that [97:19] postmenopausal phase than in any period [97:21] in her life an average Maybe because [97:23] she's dumped him or she's had the [97:25] divorce maybe that's why that's true [97:28] though isn't it that a lot of women do [97:29] do go through divorce in that phase of [97:31] Life they it seems like the number of [97:33] divorces increase exponentially that [97:35] point in life know what they want a [97:37] little bit more yes I think that you [97:38] know that comes up a lot also in our [97:42] research but mostly in psychological [97:43] research there's something that seems to [97:46] happen in part it might be Aging in part [97:49] you're older you know better but there's [97:51] also something that happens [97:52] neurologically [97:54] where this not my work but other people [97:57] have shown that there's one part to the [97:59] brain called the amydala that's in [98:01] charge of emotional control it's like [98:04] the center the emotional Center in the [98:06] brain and after menopause it gets quite [98:10] selectively turned off in a very special [98:13] way where emotions like sadness or anger [98:18] don't hold quite the same charge so your [98:22] amigdala doesn't quite fire as strongly [98:24] when something negative happens to you [98:27] but it keeps firing just as strongly [98:29] when something good happens to you so [98:32] the ability to sustain joy and [98:35] potentially contentment and just wonder [98:38] is if not Amplified is certainly stable [98:42] and that's been linked with better [98:45] emotional control after menopause and [98:48] those emotional Transcendence that in [98:51] the words of many of my friends is [98:53] really more like giving fewer F words [98:57] I've actually got a graph graph that I [98:59] found in your work that shows that by [99:00] the time women are in their 60s they're [99:02] sta statistically they've never been [99:04] happier yes well so it depends on the [99:07] studies right and that's always an [99:08] average so these Studies have measured [99:10] life contentment as a function of [99:12] menopause look we have the graph here if [99:14] you want Oh at the graph yeah yeah yeah [99:16] perfect so this is what these Studies [99:18] have shown and of course it's not [99:20] Universal it's never Universal there are [99:22] women who are miserable before and after [99:24] menopause and women are happy all the [99:26] time but there seems to be again a [99:28] little bit of this U curve and then [99:31] suddenly where life contentment is [99:34] whatever it is is Baseline over here and [99:36] then it takes a dip during the [99:38] transition to menopause when a lot of [99:40] women just have a hard time you know I [99:43] think it's it's import important to [99:44] acknowledge that but then life [99:46] contentment goes back up see that's the [99:48] window before like the three to six [99:51] years after menopause when things are [99:54] still not quite perfect you're still [99:56] adjusting but then it looks like it's [99:58] going back up and this is the late [100:00] postmenopausal phase where usually the [100:02] symptoms go away and you feel more like [100:05] yourself again or you feel better [100:08] overall and life contentment tends to [100:10] increase you have some other graphs on [100:12] there you have another one uh that shows [100:14] the impact of you call surgical [100:17] menopause yeah do you want to see that [100:19] yes please yeah what many [100:21] people let's just be honest nobody talks [100:24] about surgical menopause right um what [100:27] happens sometimes very often actually is [100:30] that women need to have their uterus [100:33] removed with or without the [100:36] ovaries often enough before menopause [100:39] these are very common surgical [100:41] procedures in fact a hysterctomy the [100:44] surgical removal of the uterus is the [100:47] second most common surgery for women in [100:49] the United States after the [100:51] C-section that's one in women either one [100:55] in eight or one in nine depending on the [100:57] statistics and what happened [100:59] historically is that until 2008 so very [101:04] recently professional guidelines of [101:07] medical [101:08] societies recommended removing the [101:11] ovaries all the time as part of a [101:14] hysterctomy so let's say that you go to [101:17] your surgeon because you need to have [101:19] the uterus taken out sometimes it's [101:21] because of cancer more often than not is [101:25] not because of a malignancy but it's [101:28] more for things like [101:30] endometriosis or benign reasons up until [101:34] 2008 the surgeon will say no matter the [101:38] woman's age as long as you're done [101:40] having children the ovaries are [101:43] redundant don't really matter let's just [101:46] take them [101:48] out so in [101:51] 2004 of the over 3 million women who had [101:56] their uteruses removed in America over a [101:59] half also had their ovaries removed [102:03] without a medical reason to do so it was [102:06] just common practice to say well I'm in [102:09] there let's get rid of the ovaries as [102:11] well why because it's a smoother it's a [102:14] more straightforward surgery and also [102:16] that reduces the risk of developing [102:18] ovarian cancer in the future while that [102:21] is true the r risk of ovarian cancer is [102:24] relatively low for women who do not have [102:28] genetic risks or a strong family history [102:31] but what people were not realizing is [102:33] that surgical [102:35] menopause this procedure of removing the [102:37] ovaries in women who had a menstrual [102:39] cycle would effectively plunge a woman [102:43] into menopause almost overnight and the [102:46] consequences are far more severe than [102:49] going through menopause as part of the [102:50] aging process and the tall on the brain [102:53] is actually significant because surgical [102:56] menopause has been linked with an [102:58] increased risk of cognitive decline and [103:00] dementia parkinsonism stroke and major [103:04] anxiety and depression so this is [103:07] something that we need to talk about in [103:10] 2008 the American College of um Oban [103:16] surgery changed their [103:19] recommendations saying that they now [103:22] recommend and preserving the ovaries [103:26] whenever [103:27] possible now this is not a strict [103:30] medical guideline it's a [103:33] recommendation which means that you've [103:35] reached different people at different [103:37] places at different times and still [103:41] today a lot of Surgeons advise their [103:45] patients to have the ovaries taken out [103:48] even when the ovaries are healthy [103:50] because of surgical considerations [103:52] without [103:53] necessarily thoroughly explaining the [103:56] possible side effects of that procedure [103:59] and look this is not to say that women [104:01] should decline medical advice but it [104:04] really calls for an informed [104:06] conversation where you go to your doctor [104:08] and say well why should I be taking out [104:10] my ovaries now and what are the [104:13] consequences of doing so and if I do it [104:16] what do I do to feel better because the [104:19] symptoms of menopause may be more severe [104:21] and we know that that's no picnic and [104:23] then we need to consider the increased [104:26] risk of these other medical [104:27] complications like an increased risk of [104:29] osteoporosis and heart disease and brain [104:32] and neurological disorders so this is [104:34] something that we need to talk about and [104:37] this is what I wanted to to show you [104:39] which we've just done this study I I'll [104:42] say to everybody that's watching um the [104:44] podcast it's on the screen but for those [104:45] that aren't watching the podcast because [104:46] you're listening and you walk in the dog [104:48] or whatever all of the graphs and images [104:51] that we're talking about will be listed [104:52] in the description below so you can [104:54] click on them and take a look for [104:55] yourself so this is something else that [104:58] we're doing for the first time as far as [104:59] I know at least to my knowledge which is [105:02] to do brain scans in women before and [105:07] after an [105:09] ectomy the evidence that we have so far [105:12] is more clinical so we know that [105:14] ectomies are associated with all these [105:17] risks or neurological disorders but to [105:19] my knowledge there are no studies that [105:22] are really looking at women's Brains [105:24] before and after the [105:26] surgery if there are any I haven't seen [105:29] them send them to me I would love it [105:31] this is what we are seeing in our own [105:34] cohort and population so this is one [105:36] woman uh who's been working with us for [105:38] over a year and we had done three sets [105:41] of brain scans the first brain scan [105:43] before the surgery like a couple of [105:46] weeks prior the second brain scan six [105:49] months later and the third brain scan [105:52] one year after the surgery this woman is [105:54] not taking [105:56] hormones and we are looking at the [105:59] brain's gray matter right now and when [106:02] you see I we're also showing parts of [106:05] the brain that is losing gray matter and [106:09] those are shown as [106:12] blue blobs I would say there are blue [106:15] spots okay over the brain scans which [106:18] show the parts of the brain that are [106:20] losing volume so this is the Brain [106:22] before for the surgery this is the brain [106:25] 6 months later and this is the [106:28] brain one year later where all these [106:31] parts in light blue are parts of the [106:33] brain that have lost gray [106:36] matter her ovaries were removed and the [106:38] gray matter of her brain [106:41] shrunk has diminished has it seems to [106:43] have disappeared in some parts of the [106:46] brain is thinning quite a bit and these [106:48] are statistical maps that I'm showing so [106:51] these are regions where the change is [106:53] statistically significant okay but that [106:56] you know there's an overall thinning and [106:58] it just goes to show that that [106:59] relationship between the ovies in the [107:01] brain and this is very direct because [107:04] one of the things that been happening to [107:07] us for a few years now that we studying [107:09] menopause is that there's push back that [107:12] what we're seeing is not menopause it's [107:14] just [107:15] aging and look I show you one more thing [107:18] that we've done to say no it's not [107:20] actually just aging it's much more like [107:23] to be menopaused and aging so now we [107:25] have women who are exactly the same age [107:28] these are all women who are 50 years old [107:31] one has a regular menstrual cycle one [107:33] has irregular menstrual cycle she's in [107:36] per menopause and this woman is also 50 [107:39] years old and does not have a menstrual [107:41] cycle do you see the differences I mean [107:44] yeah their brains look completely [107:45] different thank you and they're all [107:47] exactly the same age drastically [107:49] different so the the lady there in [107:51] premenopause her brain is really really [107:54] illuminated um and then the same a [107:57] different lady but the same age in post [108:00] menopause I mean yeah if it looks like [108:04] it kind of looks like the lights have [108:05] gone down you can see this just by [108:07] eyeballing a brain scan it's crazy and [108:09] again these are three cases and we now [108:12] have more and more women so we're going [108:14] to do a statistical examination a group [108:16] differences but still it you can't tell [108:19] me how you feel this how do you cuz you [108:22] you know you've got the scans you've [108:23] done the work and then you must look out [108:25] into the world and see a narrative which [108:28] you know is wrong how does it make you [108:30] feel I mean you know as a scientist [108:32] that's the whole process you do things [108:35] and then you wait for other people to [108:36] replicate what you have done but you [108:39] know there's women right now that are [108:40] suffering I know that is because they're [108:43] misunderstood but it's also really [108:45] important for the research to be [108:46] substantial enough to really be sure [108:50] that this is menopause that [108:53] you know we have hundreds of women in [108:55] the study I would love to have thousands [108:58] right and the more people look at this [109:01] question from different angles in [109:03] different countries with different [109:04] populations and they higher our [109:07] confidence that what we're seeing is [109:09] actually menopause and if she had taken [109:11] in the last graph you showed me in the [109:13] last image you showed me with the three [109:14] women same age different phases of [109:16] menopause if she on the right who was in [109:20] postmenopause had been on hormon on [109:22] hormones I don't know she's not on [109:24] hormones that's why I'm showing their [109:26] skins but we're also looking at that [109:29] we're also doing clinical trials to test [109:31] whether hormone therapy uh can change [109:35] this brain scans so this is another [109:37] thing that's quite upsetting as a woman [109:39] and the [109:40] scientist um the only clinical trials [109:45] have have looked at the effect of [109:46] hormone therapy on [109:50] cognition or using brain scans [109:53] have been focused on women who are past [109:57] menopause there isn't a single clinical [110:00] trial that uses brain scans to test the [110:04] efficacy of hormone therapy in women who [110:06] are per menopausa for example which is [110:09] bizarre to say the least so we started [110:12] we're doing one right now so we have an [110:14] active clinical trial where so the other [110:18] concern is that hormone therapy has this [110:20] terrible reputation for being linked [110:22] with the higher risk of breast cancer [110:25] right and that's been addressed and [110:26] professional societies are saying [110:28] actually whatever risk increases very [110:31] small and it's actually a rare [110:34] occurrence but there's there's history [110:37] there's history and a lot of women are [110:39] just scared of taking hormones and so [110:42] what we're doing we're working with an [110:45] alternative which is an estrogen [110:47] designer estrogen is a designer estrogen [110:50] I'm very excited about that so this is [110:51] the new generation [110:53] of hormone options hormonal options and [110:57] they're called selective estrogen [110:58] receptor modulators or serms or designer [111:02] estrogens and the one we're testing is [111:04] called the neuro serm is a serm is an [111:07] estrogen for the brain that's been very [111:10] specifically developed by my colleague [111:13] Dr Roberta D Brinton at the University [111:15] of Arizona she's a genius she's an [111:17] absolute Rockstar in this field and [111:20] she's been studying estrogen in the [111:21] brain since the 199 is and she's amazing [111:25] and she was like okay I am tired of [111:27] hearing that people won't take hormones [111:30] because of this this problem with the [111:32] breast cancer link and the association [111:34] we're going to start fresh and she went [111:37] back to the bench and she worked for 15 [111:40] years and she came up with this [111:42] formulation of this new type of estrogen [111:46] supplement actually it's more like a [111:47] supplement than a medication that goes [111:50] straight up to your brain it's like a [111:51] little GPS for your brain and leaves [111:54] your breast Ries alone so this [111:57] selectively improves brain [112:00] function while having no [112:04] impact on your breast and reproductive [112:07] tissues which means that can either have [112:09] no effect on cancer risk or actually [112:11] reduce the risk of cancer while [112:14] selectively supporting brain health and [112:15] now we're testing it with brain scans we [112:17] do cognitive testing we do all sort of [112:20] evaluations and we're actively enrolling [112:23] participants so if anyone is interested [112:26] we're looking for p menopausal and [112:28] postmenopausal women with hot flashes [112:32] specifically women who have at least [112:34] seven or more hatot flashes a day who [112:36] might really benefit from this treatment [112:39] in a short amount of time who are [112:41] willing to work with us in New York City [112:44] and everything is sponsored by the ni [112:46] the National Institute on health is a [112:49] phase to randomize Placebo control [112:52] clinical trial which means it's one of [112:54] the most thorough clinical trials you'll [112:56] ever get a headache for us how do they [112:59] get in touch with you if they want to [113:00] take part they can email my team can we [113:03] share their email yeah yeah we'll put it [113:05] on the screen afterwards so everyone can [113:06] see it while you're finding that I [113:08] wanted to share something from your book [113:09] that I found to be quite fascinating [113:11] there's a section where you talk about [113:12] um how to predict when a woman will go [113:14] through menopause and I pulled out a few [113:16] things I found fascinating here which [113:18] I'll probably be speaking to my my [113:19] partner about said the best predictor of [113:21] when a woman will go through menopause [113:23] is when her mother went through [113:24] menopause that's right and the [113:25] experience of the symptoms of menopause [113:27] is similar to for mother and for [113:29] daughter another indicat is a woman's [113:31] experience during puberty or pregnancy [113:33] for instance if they have mood [113:34] disturbances during puberty or pregnancy [113:36] they are likely to have it for menopause [113:39] that's right so maybe we should be [113:41] having conversations with our mothers if [113:42] we're women um to understand their [113:44] experience with menopause because it [113:46] might be the clearest indicator um of [113:48] our own potential future experience [113:51] that's right it gives you a sense of [113:52] when you might be going through [113:54] menopause what kind of symptoms you may [113:56] be having and then you consider your own [113:58] medical history so if you ever smoked [114:00] cigarettes for instance you may go [114:03] through menopause a little bit earlier [114:05] in life than your mom has or if your [114:08] diet is not very healthy same [114:10] considerations or if you don't exercise [114:12] at all those are all factors that um [114:15] reduce the age of onset of menopause so [114:18] you may go through menopause earlier on [114:20] but it's always good to talk to your mom [114:22] so that's really my my best advice here [114:25] is ask your mom because mothers just you [114:28] know it's really bizarre how very few at [114:32] least for my mom's generation nobody [114:35] would talk about menopause my mom talked [114:37] to me about puberty and periods of [114:39] course because you have to be prepared [114:41] need to know what to do she never once [114:44] mentioned menopause until I asked so how [114:47] how was it for you what age you know [114:49] should I should what am I expecting [114:52] what's going to be in store what what's [114:53] in store for me and I think it's a good [114:56] conversation to have ahead of time so [114:58] then you have time for you know to [115:02] prepare you should talk to your [115:04] girlfriend I'm going to I mean I had no [115:06] idea about all of this stuff so it's um [115:07] thank you so much for for sharing it in [115:09] the way that you do and doing the work [115:10] that you do because you're really [115:11] shining a light on an uh a very [115:14] unilluminated part of life that I think [115:17] by 2025 they say that a billion women [115:19] are going to be experiencing or have [115:20] gone through manipa which is crazy a [115:23] billion people that walk amongst us [115:25] that's what one one in8 one in N people [115:27] are currently going through or have been [115:28] through menopause at that stage and that [115:30] that means that someone in your life is [115:31] going to go through this your mother [115:32] your partner your your daughter whoever [115:34] it is so being um armed with this [115:37] information helps us to be I think [115:38] better [115:39] supporting um acts to those people but [115:42] it helps us to understand ourselves [115:43] better and helps us to be more [115:45] empathetic and to know how to to show up [115:48] for those people even if we're not one [115:49] of the the people that will be going [115:50] through menopause ourselves and that's [115:53] allowed me in my own life to understand [115:54] people in my life that I maybe didn't [115:56] understand before I thought well they're [115:57] acting strange or their Behavior's weird [115:59] or they're being a bit weird and you can [116:01] sometimes isolate those people and the [116:02] stats show that you know the suicidality [116:05] amongst that age group of people that [116:06] are at sort of 55 plus is probably so [116:09] high in part because they're confused [116:11] they don't have the answers and those [116:12] around them don't have the answers so [116:14] they can be shunn they can be rejected [116:16] they can be misunderstood and that's [116:17] exactly what your work confronts and it [116:18] shines a really important unique light [116:20] on the brain which I had absolutely [116:22] never thought about before never [116:23] considered never seen the scans and now [116:25] I have a better understanding of the [116:26] full um physiological process that's [116:29] going on when people go through the [116:31] different stages of [116:34] menopause Dr Lisa thank you so much we [116:36] have a closing tradition on this podcast [116:38] where the last guest leaves a question [116:39] for the next guest not knowing who [116:40] they're going to be leaving it [116:43] for and the question that has been left [116:45] for you if you could have one last [116:47] conversation with your parents what [116:50] would you say goodness my parents are [116:53] here right [116:55] now oh one last I would just say thank [116:57] you thank you for everything thank you [117:00] for being there for me my entire life [117:02] and thank you for being my my 100% [117:05] backup plan you know I I feel so [117:07] fortunate that my parents are such good [117:10] people and they've always been there for [117:13] me I never had I never worried about not [117:17] knowing where to go and when I was [117:19] little I didn't fully appreciate that [117:22] but now I really do I appreciate it so [117:25] much that I I never felt on my own I [117:27] always felt like I had a safety net both [117:30] financially legally physically and [117:33] mentally and it's just it's such a [117:36] blessing and I would just say thank you [117:38] I love you so much and I I'm sorry that [117:40] that was difficult when I was a teenager [117:42] but I think I redeemed myself you [117:45] certainly have thank you so much for all [117:48] the work you're doing and behalf of all [117:49] the people that I have to say this I [117:51] amum last had a conversation about [117:53] menopause [117:54] I for people that don't realize how sort [117:56] of impactful this is the top comment on [117:58] the video was had I not found these [118:00] videos I would have been convinced that [118:02] I was dying heart palpitations migraines [118:05] itchy skin insomnia pure rage crying [118:07] spells the list goes on I'm 43 and I [118:10] literally do not recognize myself and [118:12] the other top comment was sweating I can [118:15] deal with hot flashes I can deal with [118:17] what I can't deal with is the paralyzing [118:19] fear anxiety depression and fatigue [118:21] there the two top comments on the video [118:23] about menopause and I think that's why [118:25] it's so important for us to keep having [118:26] these conversations to stigmatize it to [118:28] inform ourselves and then to by doing so [118:32] push the research forward push attention [118:35] push investment forward in this subject [118:37] it's so wonderful that you're working on [118:38] the designer estrogen um because again [118:41] that if that if that is successful it [118:42] will help to change even more people's [118:43] lives so thank you so much Dr Lisa thank [118:45] you thank you so much for having me and [118:47] for doing this really appreciate it [118:52] a [118:53] [Music] [119:09] [Music]