The Dr Louise Newson Podcast - 248 - The menopause brain: why it might be feeling strange and what you can do about it

Episode Date: March 19, 2024

The Dr Louise Newson Podcast is celebrating two huge milestones this week: not only is the podcast five years old, we’ve hit six million downloads since Dr Louise started her podcast back in March 2019! Making a welcome return to the podcast this week is world-renowned neuroscientist Dr Lisa Mosconi, PhD. Her new book, The Menopause Brain is released on 21 March and in it Dr Lisa shares some of the fascinating changes that occur to the brain during menopause. In this episode, Dr Lisa explains how our understanding of the importance of hormones’ role in the brain is relatively new – man was walking on the moon almost 30 years before scientists realised that the hormones that play an important part in ovarian function also have a fundamental role in the brain. She explains that she wrote her book to empower women with the information they need to navigate the menopause – by understanding why your brain might feel foggy and the science behind it, she hopes to reassure and enlighten. You can follow Dr Lisa Mosconi on Instagram @dr_mosconi Click here to find out more about Newson Health  

Hello, I'm Dr Louise Newsom. I'm a GP and menopause specialist and I'm also the founder of the Newsom Health Menopause and Wellbeing Centre here in Stratford-Pon-Avon. I'm also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research,

bust myths on menopause symptoms and treatments, and often share moving and always inspirational, personal stories. This podcast is brought to you by the Newsome Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So some of you might have heard my podcast recently with Lisa Muscone, who's the most amazing neuroscientist,

who's done incredible work and continues to do work to champion for women's health and our hormones and our brains. So welcome back, Nisa. Thanks for coming back to the studio. Thank you. So I'm very excited again to talk to you. I'm always excited because actually I love it when people can talk my language. I speak to so many people and they look at me and go, what's she going on about?

Oh my goodness. How does she think hormones work in the brain? But I talk to you and it's just like, yeah, of course, it's so obvious. So I love it. I love your intelligence and energy. And your book that came out before the XX brain was phenomenal. It was really good. I read it.

I recommend it to a lot of people. people, it unpicks it off a very basic science. But you've got a new book that's just launched, and I was very fortunate. I don't know, am I allowed to say this, Lisa, that you actually shared with me the proof of the book. And I flew to Australia in a conference, and Rebecca Lewis, who's also a doctor and medical specialist, was with me, reading a novel, watching stupid films. She said, what are you doing, Louise? I said, I've got my red pen. I'm going through this book, because I want to read it, and I want to help Lisa. And I don't drink alcohol. whole. And so there were lots of, you know, offers of, would you like a wine? Would you like a drink?

No. All I want to do is read this. All I want to do. And you made my journey to Australia a lot more pleasurable and enjoyable. And actually, I was talking and lecturing in Australia about mental health and hormones. So actually, it gave me even more confidence to know what I was saying was right. So indirectly, you helped me with my conference or my lecturing in Melbourne. So thank you for that. I'm glad. I'm glad. The whole point in the book, I even have it on the cover. Empowered women with knowledge and confidence. That's the whole point.

Yeah. That is absolutely it. So your book, tell me more about it. Why is it different to your other book? And tell me or tell others, I know what I can get out of it because I've read it. But tell others what is the book about and why is it so important that we all read it? Thank you. Thank you so much for reading it, first of all.

And thank you so much for your notes. and you're catching typos. I was like, oh my God, that's a typo! I said, this is unacceptable. I'm so great for you. And it was very, very informational as well to see your comments and how you think about aspects that sometimes, you know,

different countries have a different take on things. People have different takes and things. And it's really to then get together and just talk and discuss and come to a common understanding and a common vocabulary and conversation, I think it's so wonderful and so important. So like you said, I am a neuroscientist by training. I specialize in women's brain health, and I have a PhD in neuroscience, but also nuclear medicine, which is a branch of radiology, where we use radioactive isotopes to measure a number of things that can happen in the brain

from energy levels, Alzheimer's pathology, tau-posthi, inflammation, serotonin, dopamine, all the different neurotransmitters. For a very long time, my focus was mainly on Alzheimer's prevention, but with a very special focus on preventing Alzheimer's specifically in women. Because out of every three Alzheimer's patients, two are women, and women also are really most of the caregivers for people with dementia and other forms of disabilities and women just receive zero support when it comes to our health and wellness, especially mental health and wellness. So I wrote The X-X-S brain, which was my second book,

actually, which sadly came out during COVID, but that book was really, it's a guideline for Alzheimer's prevention in women. And when I was promoting the book and I was talking about the book, the vast majority of people just wanted to talk about menopause. It was really interesting to me that I would start talking about Alzheimer's and prevention and lifestyle and diet and everybody would be like, but how about menopause? And I realized this is something that we don't talk about enough, the impact of menopause on the brain and on brain health. So as a neuroscientist, I am aware that the research,

is hardly there, just very little research done specifically on menopause and brain health. And there's even less research on menopause and brain health and risk of chronic conditions and neurodegenerative diseases like Alzheimer's disease and dementia. And we are one of the, I would say, the few centers that really specialize at this point in understanding how sex different. differences play out differently in terms of brain health, and also Alzheimer's risk and risk of other diseases that can impact the brain. But also we focus on menopause at this point and how menopause changes the brain's energy levels, its structure, functionality, its biochemistry, and even its

connectivity. And so I thought, I know all these things that are so helpful to me as a woman also, and to my team and to our patients, why don't I write a book that really explains the science of the menopause brain and then looks at solutions that are scientifically validated and proven to work. So that's the book. The goal of the book is to empower women with the knowledge and information that they need to navigate menopause, knowing what happens to you. why are you experiencing certain changes? Why is your brain feeling funny? Why is your brain not really on today?

So that the fear goes out of the picture because you have a clear understanding that there's biology at play, there's a rational explanation for changes and symptoms that are definitely unsettling. It can be very destabilizing. However, there's nothing alien happening to you. There's a rational reason for it.

And then what do we do to feel better? and protect their brains during this transition and beyond. So it's very interesting. We spoke in our last podcast together about the power and the importance of hormones in our brain. And it's very interesting. My 12-year-old came home recently from her science class and said, oh, mommy, they've told us that estrogen is produced by the ovaries for women and testosterone is produced by men.

They didn't talk about testosterone in women. But actually, they just said it's all about our periods. And that's what we've all been thought. And even as medical students, that's all we were taught. And even now, our hormones, estrogen, progesterone and testosterone are often referred to as our sex hormones. Does that mean it's all about sex? Does it mean about what defines you as a woman? Does it mean it's about, and even menopause is always about period stopping or not or fertility, being fertile or not?

But actually what you've allowed people to think about as well as others is actually these hormones are produced in our brain as well as our ovaries. and they have really important actions in our brain. So even if we're not thinking about the menopause or the perimenopause, we need to think about what works. So how would do neurotransmitters work in our brain? And neurotransmitters, as many people realize, are just chemicals that tell the brain what to do. And I think sometimes we forget, as scientists or medics,

how much we know and how much other people don't know. And I think a lot of people, I'm talking to my mother about this recently, don't even realise that our hormones go in our bloodstream and they go to our brain. They literally have this visualisation that our hormones are just about our womb and our ovaries. And then when you talk about neurotransmitters, we've forgotten about our brain for many, many years. Of course we have and it's taken lots of time for people even to talk about clinical depression in a way that we know we've got treatment. And when the SSRIs, the serotonin reuptake inhibitors and the commoner type of antidepressants that are prescribed, people started talking about serotonin.

Before that time, no one would have heard of serotonin at all. But now we know it's a happy hormone. And increasingly people are talking about our brain gut access and how important our gut microbes are and how that can feed our brain and what we eat can make a difference to our serotonin levels. And when we think about addictions, many people are now talking more about dopamine,

our reward neurotransmitter or hormone, which is what they are and how they interact with each other and more and more people talk about stress and our cortisol and adrenaline. But all our hormones and neurotransmitters do not work in isolation. They all work together.

Our brain is really clever and it can compensate sometimes if one level is low, another level might change. But actually when you read about eustodial in our brain, it can affect levels of all of these other hormones. So when eustradial is low, then we've got lower dopamine,

We've got lower serotonin, lower noradrenaline. And when we know that serotonin helps us happy, no wonder menopause or women feel sad because their easterodal levels in their brain are lowered. And the same with dopamine. People feel that they have less joy. They've got less sort of get up to do things. And if they do something, they don't get the same enjoyment.

If they do exercise that they might have done before, it's like, I just go through the motions, I don't enjoy it. And so it's all these neurotransmitters, how they work together on neural pathways. And I think once people start to realize that, you can then be a bit more reasonable and thinking more about how our hormones are biologically active in our brains, which is so important, isn't it? Well, it's really important, and I think that nobody talks about it. No. But we need to because it is the only way to really understand how menopause and other reproductive events impact your mental health and your cognitive effect.

So like you said, I've been struggling with this definition of estrogen and testosterone and progesterone as sex hormones because the truth is that these hormones were discovered in the 1930s by scientists that were studying reproduction. And so they found these hormones and realized that they were regulating ovulation and pregnancy and fertility or not. And so they were labeled sex hormones and we've been stuck with that definition of this, which is really painful because as a scientist, I have to reclaim these hormones for ourselves as neurohormons, right?

Because of this definition. So it was in 1996, if you can believe it, that scientists at Rockefeller University realized for the first time that the same hormones that were so important for ovarian function also played a fundamental role for the brain. And they found this role in relation. to stress and to memory. This was Dr. Bruce McHughan, wonderful human being from Rockfeller University and my mentor, Dr. Roberta Diaz-Brington, who I absolutely adore. One of them is she's incredible,

smart and just so committed to women's health and women's brain health and supporting hormone therapy development. And so I was fairly young back then and I had no clue that that was such a big fine and never even heard about it at this point. But I think it's ridiculous that for context, men have walked on the moon for 30 years, you know, and people were taking hormones and we were doing clinical trials of hormone therapy. The Women's Health Initiative started and was really put together in the 90s and then started in 1993.

So before anyone even had a clue of how these hormones actually worked, in the brain. So the scientist really missed a huge amount of information that would have probably led to better planning, especially for the dementia component of the study. Right. Of course, absolutely. What we've learned since is that estrogen is very important as a hormone, but it's important, even more important that we consider how it actually works. So estrogen is like a key that needs to open a lock. And the lock is an estrogen. receptor. And these estrogen receptors are especially abundant in the brain. So ovaries and reproductive

tissues and brain tissue, they are ubiquitously distributed in brain, which means that are a little bit everywhere in neurons and ostracides, so all brain cells, even in the white matter of our brain cells. And they're more abundant in certain parts of the brain, which means that when estradiol enters the bloodstream, it gets inside the brain, it can bind to the receptors, turn on the receptors. And then there's estradiol that is made by the brain itself, right? They will have so little information at this point. It's so frustrating. But we're starting to. And all these astrodial binds to the same receptors. We have three different types, alpha, bed, and g-per. And these receptors then activate the whole cascade of molecular events

and prescriptions on pathways that lead to all the wonderful effects that you mentioned. So there is increased neurotransection, right? The immune system has been activated by this binding of estrogen with the receptor. The synthesis of serotonin is improved. The synthesis of dopamine and glutamate, even, right? All the major neurotransmitters are influenced by this binding. And so it's energy levels. We've done so much work with brain scans showing that when estradiol is high in the

brain, then your neurons burn glucose faster to make energy. And there's more blood flow to the brain that is very important for brain health. So overall, estrogen is the master regulator of women's brain health, which is an expression that Dr. Brinton came up with. And what she means is that estrogen is like the orchestra conductor of women's brains. It's really on point and is able to orchestrate this harmony and symphony of all different neuronal functionalities almost seamlessly. So what happens with menopause when Estradaeol retires, if you will, to some extent, is that the brain keeps playing, the orchestra keeps playing, but the tune is not quite the same, right? So for some women, it's the hat flashes, but for many women, there's more than just

hap flashes. There's insomnia. There's mood changes. There's this depressive symptoms, there's anxiety, there's brain fog, which is whatever we have that comes to us for, there's the memory lapses. And then there's even more severe manifestations of estrogen withdrawal that we really never talk about. I mean, some women are suicidal. Some women have panic attacks. Some women have extremely severe depression. And this range of symptoms is just not formalized in medicine. And the fact that we don't formalize it and we don't have words for it, Like we have postpartum depression, right? We understand that women who are pregnant after having the baby can go through very severe depression.

That is hormonal. And now we have a word for it that not only validates women's experience, but also allows us to have a conversation with our physicians and allows us develop, enables development to new treatment that are specifically targeted for that medical condition. There's no such vocabulary in menopause, and there's no recognition that this is a reality for so many women and that there needs to be a support system in place that considers not just the ovaries, but your brain health at the same time. I like to say that menopause is a renovation project on the brain, right? It's a neurologically active phase where your brain changes. in sync with your ovaries, and many of the symptoms that ensure are neurological in nature. So we need to have physicians and clinicians and specialists who are able to address all the different aspects of menopause, and we don't have that right now. No, and it's so frustrating. You're absolutely right. And someone's also described

as nature's psychoprotectants. So it's protecting the brain. And we do know there's an increased risk of like you say depression, anxiety, bipolar. 98% of women we see in our clinic have psychological symptoms related to their hormones. It is huge. And we see and speak to a lot of women who have very dark, very intrusive thoughts. And I'm not saying all these women, everybody who's menopausal does, but there are some women who are very sensitive to changing hormone levels. And our brains like homeostasis, some more than others, you know, my husband can operate all day.

He'll come home at 10 and a clever clock at night. and he'll say, oh, is there any food I haven't eaten all day? I get migraine. If I don't eat regularly three times a day, I will get a migraine triggered. My brain doesn't like things out of kilter. So we're all different. But actually, that's the same with hormones. Some people will say, oh, never had a symptom ever.

And maybe their brains adapt, that's fine. But other people, especially in the perimenopause, actually, when the hormones are fluctuating a lot, that's where this often over-prescribing of antidepressants, because the symptoms are very similar. But what we find and what we're doing with some of our researchers we're funding a PhD in suicide prevention is actually women present quite differently when you speak to them.

So a lot of women I've spoken to who have had very deep, dark thoughts, they actually have a lot of eye contact, they have a huge amount of insight. They are aware that they shouldn't be feeling like this and they don't want to and they can't see a way out often. But also when you talk to these women, have what's called reproductive depression. So you say to them, well, have you been pregnant? Oh, yes. When I was pregnant, that was the best I ever found. What about when the baby was born? No, no, no. I had postnatal depression. I actually wanted to kill my baby. I was so awful. It's

terrible. And then you say, well, did you ever have any PMS or PMD? Oh, yes. Yeah, absolutely. Just the days before my periods, I felt dreadful. But increasingly, we see people who've, or their periods have stopped, their menopausal. I spoke to someone the other day who, who, who's 58. So she's menopause or she's never had hormones because for one reason now that she's refused them. She's got osteoporosis now. She's got every single symptom under the sun.

But what's very interesting is she said to me is I mark on the calendar the first to the third of every month because for many years, for decades when I had my periods, my period was always on the fourth of the month. And she said, and as soon as it came, it was a relief because those few days before I was bile and I was awful, terrible. She said, but I'm still getting those symptoms. now. And so for days like the one, two, and three of every month, I say, behave yourself, and I put it on my calendar to remind me, calm your mood, don't be cross, don't be short-tempered.

And she said, and I've spoken to doctors about it, and they said, don't be ridiculous, that's all in your head, because you're not having periods. I hate that work. But actually, like, firstly, I don't believe anybody has anything in their heads. I feel that there must be a reason. But secondly, when I said to have actually, our brains produce hormones, and I'm sure they produce them in a psychical nature, it's not. just our ovaries. She was honestly, I didn't give her hormone. She wasn't my patient. She was someone I met at a meeting. But she was literally skipping around as she was leaving the room, knowing that she wasn't mad, knowing that there is a reason why she was having these

psychical symptoms. And so it's very interesting. Yeah. And to your point, the brain keeps making hormones way longer than the ovaries do. So the ovaries stop producing estradiol during midlife, in menopause, but there's evidence that the brain keeps producing gastrodial. It's just the amount is much lower. Yes. And some women, it might be enough, you see, and that's what we don't know. There are some women who can function. They can, I'm absolutely fine.

And maybe they don't need as much estradiol, or maybe there's other hormones or neurotransmitters that take over. But there are definitely others. And we know that because when we give them their hormones back, they go, wow, I feel motivated, I'm enjoying life, I feel very different. So everyone's different. And certainly in your book, what you've also done is given us lots of information and choices because hormones are really important.

But there's no point having hormones and eating processed food and never exercise it. And not thinking of anything else. So you've got a lot of scientific information also about, you know, various diets and how to be anti-inflammatory with our nutrition and exercise and everything else, which was really important. and I love the way that it's based on science because it's, you know, it's so important because there are so many fad books that come out and you think, oh, great, but then you realize

there's no substance in them, whereas your book, the XX brain book, the new one especially, has got a lot of longevity, something that is not just going to tire. I mean, you will add more and more research as time goes, but what you've written is the building blocks, really, isn't it, for our brains and how important they are,

especially for women. Yes, and I was really trying to embrace the idea that different women want different solutions. Yeah. Right. There are women who really want the prescription. Yeah. And want to attack the problem and bad at the angles. And there are women who prefer more natural. I mean, natural is not the right word, but prefer lifestyle adjustment, prefer to manage whatever comes, weight, weight, diet and exercise and feeling more empowered. So I wanted to make sure that I think it's so important that every woman has access to the information that she needs to make the best informed choice for herself in collaboration with the specialists, in my opinion. Yeah, I totally agree. And, you know, as a prescribing clinician, I feel that I'm a patient's advocate.

And you do yoga. I've seen you do the hand-in. Oh, yeah. Oh, yeah. And Pilates. I started doing Pilates as well. We just bought a pelagic performer. I'm very excited about that.

Yes. And I think it's important to counsel women using a well-rounded approach, right? Because like you said, you can eat all the broccoli you want. But if you never move and if you spend all your time in front of a screen and your homes polluted, there's only so hard. It's not going to work. So it's a multi-layered approach. Of course it is. And sometimes we don't know what works. You know, yesterday I was spent four hours in the car because I was going to visit somebody with work and talk at a conference. And so in the morning, I thought, I'm going to do 20 minutes of yoga. I'm going to. I was a bit nervous about going. So I wanted to do a headstand because a headstand's very empowering. But the night before I went to bed, I was really tired. And I thought, oh, I could just do that extra 20 minutes. But actually, I woke up just before my alarm and I thought, this is a sign. So I got out of bed. I did my yoga.

practice. And actually, you never regret doing exercise. And I've done yoga today because it's Wednesday and my yoga instructor comes over to the clinic. And I've often said to James, I wonder what I'd be like if I wasn't ever doing yoga. I know I'd be stiff. I know I'd be a different body shape. I know my core strength would not be good. But mentally, actually, I would be so scatty and so all over the place. But yoga, for me personally, keeps me very focused and it reduces my stress levels. It resets me. Other people, it might be going for a run in the park. It doesn't really matter, but I think it's really important that we look at what we're doing and do we finding benefit from it. So if I did yoga and I never noticed any different, then there's probably a little point me doing it.

If I ate broccoli and I think we've got to find something that works and you can see benefit. You know, I know if I eat healthily, I feel better and I don't get migraines. So there's no point me opening a packet of crisps because I'll be punished by having a migraine later on. But that's fine. I know that. But I think the healthier that we are and the healthier our lifestyle is there's nobody I know who has a healthy lifestyle who regrets it or feels bad from it. But I think your book has allowed people to not feel overwhelmed that they have to have the perfect lifestyle from the get-go. You can just do it gradually and know why you're doing it as well. Because otherwise if you don't know why you're doing it or the benefits,

it's very easy to lapse and not bother, isn't it? Yes. And I think also prioritising. I feel like sometimes you pick up these books and you feel like, oh God, I need to change my diet, my exercise, my sleep pattern, my stress reduction techniques. I think it's best to just identify your priorities and then pick maybe two or three things that are proven to really help in that respect and then just be consistent. There's a concept that I'm very fond of, which is that quick fixes just do not work for brain. health. The reason being that from the neck down, our bodies are engineered, they're really bi-designed build for change, to be adaptable and be able to change relatively quickly in response to the environment, to the diet, to your exercise, and to external stimulations. That's because your cells have a certain turnover rate, right? So blood cells have renewed every few weeks,

your hair is shed and regrows almost every day. Even the skeletons is renewed at the rate of 10% a year. But in the brain, that does not happen. The brain is built for stability. The vast majority of our brain cells are born with us and stay for us for life, which also makes them protected against quick changes. You can't change your brain quickly

because otherwise we will lose our minds just as quickly. If every time we changed our diet, our brain changed, we would be a mess as a population. So the only way, one of the best ways to really have an impact on the brain is by being consistent and doing things at a certain frequency. So lifestyle adjustments are gentle. They have gentle effects on brain health, whereas medications are developed to act pretty quickly and being quite strong. All this different, you know, your diet, your ethics, your exercise.

exercise, your stress reduction techniques, you have to do them for a certain amount of time, and they have to be the right one. So the book is really about explaining how certain things really work, and they're proven to work, and other things are just not. You know, cucumber cleanses? No, no. Or maybe fast into the point of eating less than 700 calories a day for menopause, who can sustain that? So why do it? Yeah. better, I think, to focus on nutrients and foods that are known to really improve brain health and also delay the onset of menopause. And we know that fruits and vegetables can do that and complex carbohydrates and healthy fish, right? Omega-3 fatty acids and antioxidants and

antioxidants and fibers and anti-inflammatory compounds have been linked with the lower risk of dementia, depression, or cognitive decline, of all sorts of brain-related symptoms. better sleep, fewer heart flashes and the gentler menopause overall. So always say, if you can make an adjustment for your diet, eat more veggies, eat more plants. Not saying go vegan. Everybody has their own diets, but do try to prioritize the amount of greens and fresh produce in your diet. It really, really helps, especially over time. Absolutely. So really great advice. It's called the menopause brain, but actually I don't think we have to wait till a menopausal to read it, because there's some really good common sense, and we should all be preparing ourselves

for the perimenopause and menopause. So then that time in our lives is the time we're the best version of ourselves. But as you say, we can't do it overnight. So don't wait till your menopausal to buy the book, that is for definite. So before we finish, Lisa, and I'm very grateful for your time, do you mind giving me three reasons why people, not just in the UK, but globally, you should not just buy your book, but read your book? I think the major reason would be to really understand the science behind the menopause brain. This is a neuroscientist's take on menopause.

And we also address the history of menopause and the culture of menopause and how science really hasn't been very gentle and very kind to women and how this new generation of scientists, many whom are women, are trying to change things. and really revamp menopause as something not to be feared, something to be addressed, something to be managed, but also something to embrace and own. Because every woman, good willing, if we live long enough, we will go through menopause.

So we need to know what it is and how to prepare for it and how to also have a wonderful life after menopause, right? Because at least a third of our lives, hopefully, will be spent in a post-menopausal stage. The second reason is that there are many things that one can do to really protect their brains. We can all protect their brains during menopause and beyond and really at any age and walk of life. And many of these things are described in the book. So we go through everything from hormone replacement therapy and other therapies for menopause, but also lifestyle and mindset, which I think is important, especially in this society.

And then the third reason is just to really understand how women's brains work from the reproductive perspective because there's a system that connects the brain to the ovaries that is activated during puberty, is once again overactivated during pregnancy, every time a woman get pregnant, and then it's turned off after menopause. And that each of these turning points in a woman's life, the brain is impacted just as much as the rest of the body. Only we're never taught this information. We never talk about it. We have some insight and understanding from our own experience

and maybe talking to friends or parents. But the reality is that there's a whole science that explains these reproductive transition states or neuroendocrine transition states that I think of really empowering to be familiar with and be comfortable discussing. Brilliant. So knowledge is power.

Absolutely. It's so true. Totally is and backed by science as much as possible. So we're very looking forward to welcoming you over in the UK when you can come, Lisa, because we're all desperate to meet you in real life. As nice as our Zoom relationship, it would be very nice to entertain you in the UK. So thank you so much for your time. And I really look forward to you coming back for the third time to the podcast to talk when you've produced even more wonderful papers and some more science to share with us all. So thank you again today. Thank you so much for having me. It's really a pleasure. Thank you. You can find out more about Newsome Health Group by visiting www.new.combe. And you can download the free balance app on the App Store or Google Play.