Live Like a Girl with Dr. Mindy Pelz - Women's Brain Health: Environment, Hormones, Menopause & Neuronal Pruning with Dr. Sarah McKay

Episode Date: October 27, 2025

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

On this episode of the Resetter podcast, I bring you Dr. Sarah Mackay. Ooh, you ready for some neuroscience? This is so good. And let me just kind of cue up what you're going to hear because I think your mind is going to be blown. First, I've not met another human that loves neuroscience more than I do. But I would say that Dr. Sarah Mackay may have 10 times to me. she committed her whole career to this.

But if you look at her Instagram, which I highly recommend you go and look at, she has combined neuroscience. She is an official neuroscientist with women's health. And her focus is really helping us all understand the female brain. I love that she has on her Instagram. She calls herself a science communicator. And she absolutely is that. and she is the author, a three-time author, but the most interesting one that she has brought forward

is called the Women's Brain Book. And she just redid the, she did a second edition with new information in it. So what I wanted to bring Sarah to you all for is to, again, help us understand these brain changes that are going on after 40 as our hormones shift. And you've heard me talk a lot about Lisa Moscone. I did an interview with her about a year and a half ago. You've heard me talk about my new book, Age Like a Girl, which is all about the rewiring of your brain for the positive. And now you're going to hear the nerdy scientist. And I promise you, it's going to be entertaining. So in this episode, we talk about this idea that Lisa brought forward, which is the pruning, the pruning of the neurons. What is exactly does that mean? How does that happen? We then dove in

to lifestyle tools for things like dementia. This one was really interesting about where does memory loss come from? And is dementia preventable? And you're going to be shocked at what she has to say. I'll give you a little clue. She says based off science, HRT is not proving to prevent dementia. But she does list out about four or five different things that I had never even thought about that can help to keep our neuroplasticity up and prevent things like Alzheimer's and dementia. Of course, we had to talk about metabolic health and how it related to neurons. We dove into neurotransmitters and the whole system of neurotransmitters and how that works in the female brain. It's super interesting. And don't be scared by the science. I think we both did a

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

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

I just have to start off by welcoming you to my podcast, Sarah. You don't know this, but I've been stalking you for several years now. And I only mean that with a loving. Yeah, I know, I only mean that with a loving stalk. A loving. I just love neuroscience and I love what you've been up to with the female brain and educating all of us on it. So this is a real treat for me. So welcome to my podcast. Oh, well, thank you for the invitation. And thank you for stalking me. Yeah, I know. It's funny because it's a term we use a lot

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

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

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

I just am here to help translate that work for them. When we think about the brain, it's a very big question because when we're thinking about how our brain changes, there are so much. ways in and then when we add hormones in as well, it gets a whole lot more complicated. So we could start by sort of zooming all of the way in and look at what we know about how hormones, as they ebb and flow, dial up during pregnancy, dial down, ebb and flow across a menstrual cycle and then kind of roller coaster through perimenopause and then fade away, how they change individual neurons and neurons structure.

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

So there's lots of, when it comes to the brain, there's lots of different levels. Yeah, I can see that. We can kind of study the brain and talk about that. So I don't know where you want to start. Yeah. You know, like zoom in or zoom out or somewhere in the middle. Well, I think I want to start with what Lisa taught me on a podcast interview, and it was this idea that when estrogen starts to decline, there's a pruning process. So that would be going at the level of the neurons, that there's a pruning process that is making way for a new brain to form. That concept is. Yeah. Talk to me about that. Cool. Yeah, that's a cool. That's a cool kind of concept in why I'm thinking of.

about it. And I think we see this concept of pruning, I would always say pruning and tuning, because that's kind of what neurons are doing. We see this at different points through the lifespan of all humans, but particularly in females, we see

this, a similar process taking place during puberty and adolescence during pregnancy and early postpartum. And then we think what we're seeing, although we don't yet know as much as what we do in these other life phases, this is what we might be seeing during perimenopause and then perhaps during post-menopause years.

And this word pruning is interesting because we're not here, we're not talking here about pruning away of whole parts of the brain or pruning or removal of neurons. We've not got what we would call neural apoptosis, which is the death of new neurons and neurons. If we were seeing neural death would be in puberty, pregnancy and perimenopause, we'd be in a lot of trouble. When we talk about neural pruning, we're talking about the connections between neurons and how they are being, you know, sometimes flourishing, sometimes being pruned away, and sometimes what I would call being tuned, existing connections being tweaked, maybe being weaker or stronger. And the way I would describe it is if you imagine you've got one neuron and it looks a little bit like a tree.

So we've got a cell body and then it has all of these branches, coming out of the cell body, which we call dendrites, and they look like branches on a tree. And then we've got the long axon, which will be connecting to other neurons or other parts of the brain. The dendrites are like input receivers. And at various stages through the lifespan

and even in response to hormones across the menstrual cycle, we would see dendrites flourishing, particularly when we've got high levels of estrogen, we typically see dendrites flourishing, and little spines on those dendrites, which look very much like buds on a tree branch in spring, we would see them flourish,

and then when we've got lower estrogen, they would kind of prune away. And so what may be happening, I'm not entirely sure about menopause, but certainly during pregnancy and certainly during puberty, when we've got these massive hormonal shifts, we see the pruning away of these little buds and twigs,

which means that we're altering the connections between neurons. A little bit like we see a tree flourish in spring and then perhaps you might prune away the branches and the connections in the autumn if you were a garden. You're not reefing the whole, you're not pulling that whole tree out and throwing it away and planting a new tree in. And that alteration, we would call this synapse plasticity,

these connections between neurons and how they are regulated and shift and change is kind of adds up to what we might see in terms of structural changes in the whole brain and or in terms of how networks react and respond and connect. So in pregnancy, which, and I'm just talking about this because we're pretty sure we know what is happening here, when you're going through the course of your first pregnancy and you've got all these sky high levels of hormones that are made by the placenta because the placenta is a gland, we're seeing this massive kind of,

flourishing and pruning and tuning of all of these, these connections. But what we end up seeing is that grey matter gets slightly thinner. This might happen during perimenopause as well. Grey matter is getting slightly thinner. Now, this isn't the brain degenerating. It always sounds terrible when you think about the part of the brain getting smaller. Yeah. It sounds like degeneration or disaster or a catastrophe.

It's not, it's the brain streamlining and refining. And putting itself in a state of heightened plasticity, so that the experiences that we then have can help continue to prune and tune that brain. So what I think might be happening during perimenopause, and we're not sure because we don't have very many studies yet, if we see reductions in grey matter volume, that's not because we've got less neurons. What we're probably seeing is reduction in the numbers of connections between neurons.

That doesn't mean they're giving up. That means they're probably doubling down. let's just put all of our energy energy and focus into strengthening the connections that we absolutely need and getting rid of the superfluous ones. I think, I believe what Lisa Mascone's menopole, you know, she's tracked, unfortunately we haven't got a good longitudinal study where we've got a big group of women and we've tracked them all the way through, kind of from pre-perry, peri, peri menopause, post-menopause because that might take like 15 years.

It's hard to do. It's hard to do good science with longitudinal studies because it takes a long time because it's longitudinal. But she's compared different cohorts of women. I believe there's a figure in one of her papers that shows during perimenopause in grey matter. So that's like the cortex of the brain. That's like this wrinkly kind of outer covering of the brain. There's a bit of a sort of a dip and then it kind of bounces back up postmenopause. It's just kind of crazy.

So I don't know. Maybe that's the downlighting of wisdom. Who knows? What's underlying that at the specific individual neural level is probably not apoptosis and neurogenesis, so the death of neurons and the birth of new neurons. We don't see that in cortex. What it is probably is the reorganization of the existing neurons and the networks so that they become kind of more streamlined.

But why would the body do that? Well, the body reacts and responds to, all of the experiences that it has. So I always think about, let's imagine kind of the brain, it's receiving a ton of information of what is happening in our body, not least ebbs and flows of sex hormones, but all the kinds of hormones in our body. Everything that is happening in our body is, you know,

that information is making its way up to the brain in various kind of ways, whether it's neural signalling or hormonal signaling or immune signaling. But we've also got what's happening around us, like the sort of the outside in social world, the experiences that we're having, and then we've also got, we're humans, we've got our psychology or our mind,

which is also shaping and sculpting the brain. So why would the brain react and respond? Because hormones are, you know, dip. Roller coastersing and then flatlining, although maybe if you're taking HRT, you're perhaps leveling that out. So the brain simply reacts and responds

to the hormonal kind of milieu, it's in. but it also reacts in response to everything that it's all of the data that's making its way into the brain. It's perhaps not, I wouldn't like to say it's the loudest voice in the crowd is always hormones, but there's perhaps different points in times in the lifespan when that hormonal signal is louder or quieter. And depending on who you are, we know this, some women like ride this rollercoaster of their

hormonal fluctuations emotionally, other women just don't even notice a thing. So the brain is always reacting and responding, and that's simply what it's doing during the menopause. And so in that moment, what I heard and what you're saying is when estrogen is high, we have these very active dendrites. We have a very receptive extension of the neuron that's trying to grab information and carry information. But when estrogen goes low, they're not as. receptive and in times of big hormonal swings like puberty pregnancy and perimenopause we are going to see the effects of that more than we typically do yes because those are much bigger shifts of hormones but there's a bit of a U-shaped curve sometimes so it's not linear it's not like more

and more and more and more estrogen more and more and more dendrites there's because you know if we think about it it's cyclical and it's responsive and it's adaptive So actually, if you look at increasing the – and studies have been done, looking at this, we can do this in rodents in the research lab. We can do this in humans, but less well because living human women don't want to give up bits of their hippocampus or bits of their brain for us to look at under the microscope. I don't understand. Why not? But there's actually a U-shaped relationship there. So the more, you know, you get across the kind of the course of the menstrual cycle, we'll,

get kind of flourishing and then pruning and then flourishing and pruning. But in pregnancy, it's something different because we've got like these sky high levels of all of the estrogens because the placenta is also making them. And the kind of the HPO axis is kind of the breaks are off so that, you know, the ovaries are also pumping a lot out. So we're getting a bigger dose of estrogen across the course of one pregnancy than we would get in the total of the rest of our lifespan. And the kind of the net result of that is actually pruning because there's a bit of a U-shaped relationship there. So the brain is never really straightforward. It's always got, there's always a feedback loop in there to kind of throw us into a bit of a loop when we're

trying to explain that. So then would it be fair to say that there's also this, this, I'm going to call it, expansion of the dendrites and contraction of the dendrites throughout the menstrual cycle because of estrogen levels changing? Yes, that's partly because of estrogen, but we've also got progesterone in there. So we understand this most well. And like, out to kind of one of the sort of, you know, the queens of neuroscience research, Catherine Woolley, who was the first person to show that the brain actually reacted and responded to these fluctuations of sex hormones. This is back in the 90s.

And she got a bit of pushback when she first presented this research at a neuroscience research conference. But now it's, I mean, if I was to take my textbook out from underneath my microphone here. Don't do that. I could show you the pictures in the neuroscience textbook now. So across the course of a menstrual cycle and particularly within the hippocampus of the brain, and we see this in the estrus cycle and little mammals that we study in the research labour, it's far easier, or at least they sacrifice themselves for us to be able to do the research and the way that humans aren't going to.

Animal, you know, the people have got different thoughts about animal research, but that's where we get most of our data from. So in a particular region of the hippocampus, she was able to see these little neurites' flunkers, when estrogen went up and then kind of retracting when estrogen went down. If we do very, very, very careful studies of human brains and brain imaging, you know, we put someone in an MRI scanner and then we do precision imaging. And we're really only getting to the point where the resolution is enough for us to be able to sort of see, let's look at the hippocampus of living human women across the course of the cycle.

we see some parts of the hippocampus kind of getting slightly bigger, probably due to flourishing of neurites, and then other parts kind of retracting, and there's a bit of a relationship there between levels of estrogen and levels of progesterone. But it's very kind of, it's very complicated, and we're really only getting to the point where we can map this very carefully, but still quite roughly, I would say, in the human women at the moment. with technology is going through great leaps and bounds. That's beautiful. But it's probably only been in the last five years that we've started to get any decent data through from living human women's brains.

And because we've got all of these amazing women in the neuroscience kind of a space now who are asking the questions and getting the funding in and there's some really cool research groups around the world that are driving this research forward and it's asking these questions. So would it be fair to say then we may have noticed that our brain was working differently when we had a menstrual cycle, but the swings were very subtle,

because the highs and lows of estrogen within 28 to 32 days, it's just not enough for us. I mean, we might be like, I'm not quite myself today, but then five days later, if estrogen's higher, we might feel more in sync, but since we're not culturally talking about that brain change, we may not have been aware of it. But once we get to menopause,

because estrogen is declining, you know, by a natural, it's natural state, are we noticing it more? It's always been there, but we're just noticing it more because of the decline being so consistent and so steep. Yeah, I think, well, firstly, I would say different women have very, very different experiences, as I said, across the, you know, if we just look at naturally cycling women across their lifespan, as I said, some women will react incredibly, they're riding the roller coaster. They've got PMS, they've got PMD, they're really noticing these shifts. Other women are just like, I don't, I'm just carrying on. I don't really notice everything. And then we've got lots of different people sort of in between.

Parymenopause is different because we've not necessarily just got declining levels of hormones. We've got rollercoastering levels of hormones, particularly in that perimenopause. Because as our ovaries run out of eggs, you know, one month there may not be a lot of estradiol released from our ovaries. so the brain, the hypothalamus and the pituitary are going, hey, next time, louder, more, we can't hear you when the ovaries go, oh my God, okay. And then there's more estrogen and then the next month the brain's going, no, not that much. So we get this real roller coastering. And we've got the ratios between your estrogen and your progesterone are shifting and shaping and changing.

We mostly understand from a neurobiological kind of mechanistic perspective, which is what I kind of like, the neuroscience. what is happening in terms of the vasor motor symptoms and how they are a neurological consequence of these changing levels of hormones whereby in our hypothalamus, which is a part of the brain, which does things like regulate body temperature and it receives information about hormones and heart rate and blood pressure, etc.

For some reason, and I'm not entirely sure why Mother Nature had this in mind when we evolved this way, the hypothalamic thermostat, which regulates our body temperature, is tweaked and set in women by levels of estrogen. And when you've got these rollercoastering levels of estrogen, the neurons involved in that thermostat get much more hyperreactive. So it's almost as if the level of the thermostat gets much narrower or the kind of happy, healthy range is much narrower. So your body temperature only needs to rise very slightly for it to kind of hit the top level and your hypothalamus to go, oh my God, it's hot in here, panic station. and it sets off this massive kind of heat dissipation response, which is both physiological and that we sweat, we vasodilate.

Part of that is controlled by a sympathetic nervous system. So we get this massive kind of sympathetic nervous system discharge, and lots of women can feel that, particularly if you are asleep, because your brain might have tried sweating a bit, but you've got your covers on, and then the brain's like, girl, we need to wake up to throw the covers,

off and you'll get this kind of you can almost feel like this kind of discharge go through your thing and you kind of wake up. So you've got this massive sympathetic nervous system sort of response which is an attempt to call you down because the brain's panicking thinking you were overheated. So we've kind of got the involvement of our autonomic nervous system in there as well. So why the estrogen is involved with this process. Yeah, it's great question. I would like to know. I'm not in. hardly sure whether anyone has got there yet, apart from the fact that everything is kind of interrelated. And why that heart of the brain is so, takes so long to kind of, because some

women can have these vasor motor symptoms for seven, eight, nine, ten years. Some women don't notice them. Some women don't have any other women do. And why it takes the brain so long to adapt and respond? Because sometimes the brain adapts and responds quite quickly. And, and you know, it will adapt and within a year you'll find others. It takes a much longer time. I'm not entirely sure what's going on here. There's probably loads of different components. So we understand that quite well.

Those vasomotor symptoms can have knock on effects both physiologically, neurologically and also psychologically, particularly if they're responsible for waking you up multiple times. Right. Right. There's a neuroscience researcher Pauline Mackie. You should totally get her on your podcast. She has tracked how much. many times if we're getting vasemotor hot flashes overnight, how many times a woman waking up,

you know, how many are getting at night, how many are you getting during the day. And we know that, you know, if you go through the course of a night and you're healthy and well, you've got this beautiful sleep architecture where you go into deep sleep and up again and back down into deep sleep and you go through all of those cycles and stages of sleep, vasor motor symptoms are completely disrupting that. Whether you remember waking up or not, Oh, interesting. So we've kind of got that. So we've got this massively disrupted sleep architecture,

whether or not you remember waking up. On top of that, and this is, there are not very many research labs studying this around the place, perhaps one or two, one I know is in Santiago in Chile, they're interested in this autonomic nervous system response. Because we tend to focus in on the brain, but we've got a brain and nervous system. If you are repeatedly activating your sympathetic nervous system

over and over and over again to call you down, well, we start becoming, we get more, and there's less parasympathetic nervous system kind of bringing you kind of back to baseline. The parasympathetic and the sympathetic nervous system are always kind of working kind of in harmony together. You're repeatedly activating a sympathetic nervous system. Well, then you kind of become hypervigilant and wide.

Right, right. And you start noticing, oh, I'm kind of waking up with a fright, like what's going on? and I don't know about you, but if you get woken up at night and you can't get back to sleep, it doesn't take very long to find something to just worry about.

Oh, it's the worst. It's not like you sit there and go, I'm just going to lie here and think about awesome fun stuff. It's horrible. You immediately go directly to the catastrophe, whether that be, you know, thinking about, and I've got teenage sons, and I've got aging parents,

and, you know, whether it's immediately what's in front of you or whether it's that silly thing you said when you're in high school, there will be something. And because we're kind of hypervigilant, our brain's going, oh, well, we're feeling anxious for some reason that we must fill in the gaps. So we've kind of got that playing out as well.

That happens one night. Imagine if it's happening days or weeks or months. Oh, yeah. Finding any way to kind of modify or react or respond or adapt, it's almost inevitable that some people are going to start feeling anxious. And lots of women might say that these kind of growing levels of anxiety feelings of anxiety, not necessarily clinical anxiety, but feeling anxious might be one of the earliest signs of going through perimenopause. We've also got, you know, some women, you know,

it's a kind of a window of kind of vulnerability for women starting to experience depression. Particularly women who have had prior experiences of depression, it's a really, particularly if, you know, they were the women who had PMS or they were the women who struggled postnatally, you know, they kind of feel like they know they're hormonally sensitive. This might be another window of vulnerability to experience depression. Occasionally you'll get women where it's first time. They've experienced depression, but most commonly it's women with these prior experiences. So we've kind of got this perfect storm.

Unpacking what's underlying all of these negative neurological symptoms, you know, we're not quite there yet. Is it directly due to estrogen's acting on neurons in the brain? Or is it like we've got. these dominoes lined up, you know, with the vasemotor symptoms and the sleep and perhaps a bit of anxiety and perhaps depression. And then have we got some knock on effects in terms of overall metabolic health, overall immune health, overall cardiovascular health. Because if you're not sleeping and then you, it's much harder to exercise the next day and manage your

diet well. And perhaps you've got, you know, a lot of social, you know, concerns, you know, you've got chaos in your family or something. We've got all these dominoes. So what's like, the first domino to fall. Yeah, right. It's a bit of a perfect storm time, and it's so it's hardly surprising lots of women struggle when we go through this phase of life. And I am 50, so I can kind of put my hands up and say, I kind of, I do my damn just to do all of the things, but I'm familiar how it feels. Yeah, which is beautiful. You teach it from that, from that place, which is so helpful. The two in the morning wake up, I used to, to call it, I would do a worry scan. It was like, I would wake up and then my brain would be like,

okay, which topic do you want to try to fix right now? Yeah, it's a bit like that. And I think, you know, we haven't talked about how we can kind of manage this, but there's hormone therapies, etc. You know, pick or choose what you're going to use here. But cognitive behavioral therapy for insomnia is a really great kind of holistic kind of, I call it. bottom up outside and top down or biocyco social way to help address this because we need to get to the point where we're just not kind of giving in and going, well, I've woken up at night, therefore I will worry. It can become very habitual. What techniques and tools do you have that you can kind of intervene and convince yourself to not worry and be able to go back?

It sounds easier said than done, but there are resources and tools and support out there if this is the kind of situation you find yourself in because it can become, it's a very easy feedback loop to kind of lean into particularly, particularly because you've got this autonomic nervous system involvement as well as your mind. Right, right, yeah. And that's kind of how we end up with people with kind of anxiety and or depression.

We need to kind of roll that back and kind of intervene as early as possible. And protecting sleep is one of the most important ways to do that. Of course. Yeah. And that's what I always hear when they're like, here are the lifestyle tools you should do as you go through perimenopause. And one of them is like, get a good night sleep. And I think whoever created that list never went through perimenopause because it's not the easiest. Yeah. It's a great idea if you knew how to, if you knew how to do it. Yeah. But we do have tools and resources there for people. So I think cognitive behavioral therapy. I've heard that. with an eye at the end is that's, that's your goal.

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

anxiety go away, and I've watched all the hot flashes, the sleep, all of that change. And so I'm wondering if the brain is less sensitive to glucose, is that playing in to this brain function that you're talking about as far as raising temperature and trouble sleeping? Yeah, 100%. And this may be part of what is happening in the hypothalamus in terms of this kind of glucose insensitivity. And the brain reacts and responds and kind of tries its best to compensate for that. And also it's not just cells in the brain. It's just neurons in the brain. It's every cell in our body.

Some people, not everyone, can become more kind of insulin resistant and, you know, kind of metabolize and process glucose and make ATP and all of that in the same way. And I'm not, no expert on cellular metabolism. and just kind of makes me want to shut my eyes and have a nap. But that's my TED talk on that. But we see this in every cell in the body, right? You haven't been familiar with that. Yeah, you haven't been up late at night studying the Krebs cycle?

I don't understand. Oh, gosh. I'm sure there's a textbook around here somewhere with the diagrams. And I think I actually tagged a good diagram the other day that I saw somewhere on social media. I should save that to revise and then I never did. But we see the brain and the cells in the brain react and respond in the same way that cells and the brain do everywhere. We've got, and it's hard to kind of tease out, you know, all of these different body systems because they're all interconnected. And the brain and the nervous system aren't separate from the rest of the body.

And I often, we can talk about metabolic health. So we've got neurons in the brain perhaps finding it harder to do the job that they used to. But luckily the brain adapts, if it is healthy, adapts and reacts and reacts and reacts and response. and we sort of see this, and I believe some of Lisa Morsconi's work has shown that, I mean, we're in such early stages of imaging menopause and women's brains. But she has shown that adaptation and that response to,

and we've got, you know, different people have got different kind of health profiles and genetic profiles and susceptibility, et cetera, underlying that. But the brain does have to work harder as to other cells in our body when metabolism kind of shifts. I think what we know about the brain, as the brain gets older, regardless,

sort of menopause aside, if we just look at all humans as we get older, as the brain starts to perhaps struggle metabolically, what it starts to do is it kind of recruits more neurons on board to get the job done. So what may have been quite a specific, well-defined, well-functioning, efficient network that was required perhaps just on one side of the brain to solve a problem.

And we can image people doing different types of problem solving, say, in the fMRI scanner. The brain will start to recruit more neurons and more networks to get that job done. So the brain's pretty cool and that it goes from having these very well-defined, quite segregated networks. And as you age, we know that sometimes those networks get what we would call more integrated or they kind of tend to cooperate. and we might go from having one side of the brain doing the job to both or perhaps more brain activated to get the job done.

So, you know, the brain's adapting and reacting and responding in its own way. Yeah. To find kind of workarounds to get the same solution. That process of perimenopause perhaps speeds that process up. It speeds up that kind of, I suppose, I don't want to say it speeds up aging, but it does alter. the brain's metabolism does alter over this point in time. And it's possible that the shifts that we are seeing

and that their feelings of part of the feeling of brain fog. And me in particular, because my sleep is pretty well managed, asked my husband, he's just like, I did 10 hours the other night and didn't wait. Whoa. It's got like a 93 score on my Fitbit. Oh, my husband is just like always. He's like the one lying awake every night. I'm like just to sleep for 10 hours.

Wow. but I still, so I feel pretty good. But my words like, man, I'm like, you replacing, I will just say stupid things like one of the kids walked in the other day with a cap on. And I went, you've got a nice lid. And I was like, no, I mean hat. Or I might, I will use words that are kind of similarly related semantically, but not quite correct.

Or I'll say, oh, well, that's a nice soft apple instead of a nice hard, crunchy apple. I'm like, what is it soft instead of crunchy? Just stupid things that a little word flips. And maybe we don't know, maybe this is this process of different networks becoming recruited in this sort of change from pre-menopause to post-menopause that shift may play out in terms of, you know, for me it's this kind of like verbal problems or this verbal recall or sometimes just pulling a complete blank on someone's name. Apparently, and the research shows that lots of.

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

respond to the brain's energy demands because that's how we do brain imaging. And if your capillaries aren't healthy, we know that capillaries are kind of the first things to go. That's why people with metabolic and cardiovascular problems, their kidneys go because of the fine vascular chore, their retinas go. Your brain is the same. And so that's why the brain is quite vulnerable as well. like if you've got super high blood pressure or heart failure or you know type 2 diabetes etc.

Is there a way to increase blood flow to the brain? Well, by being, by managing your cardiovascular health. Yeah, so just so like a workout, like a good workout would be. Yeah, yeah, a workout does, but the brain doesn't just get more blood going to it because the heart is pumping faster. Okay. Because those those capillaries react and respond to the neural demands. So brain imaging is like fMRI, a lot of those beautiful like kind of rainbow images you see where this part of the brain lights up or that part kind of dulls down, comes about via looking at

shifts in blood flow, not necessarily shifts in neural activity, we're kind of looking at a proxy. And so that process is very, very tightly regulated and managed by the neural activity. It's like saying, hey, we need more blood here. It's not just like make the pump faster and push more blood in. it's much more kind of carefully coordinated than that, which is why we need to take care of it. Right, exactly. Okay, let's talk about staying at the neuronal level here. Let's talk about neurotransmitters.

So one of the studies I saw, this is like seven years ago, was about estrogen's impact on dopamine, serotonin, glutamate, gabas, acetylone, oxytocin, BDNF, melatonin. And like, like, I call, yeah, I call them Estrogen's Girl Gang. I'm like, the first time I read this study, I was like, wait, she had like a gang of neurochemicals that helped her do this miraculous job. So if she goes away or she declines, what happens to these neurotransmitters? Do we need, do they, like, do what you're talking about where they create an upsurge so because they're having to compensate for a loss? or do we need to use our lifestyle to try to coerce these other neurotransmitters to keep pulsing through our brain?

Neurotransmitters and neurotransmitters systems are incredibly complicated. And again, it's very hard to look at this in living humans because most of the information that we would have comes from animals in the research lab. And I would say that estrogen, all hormones are going to, that can cross the blood brain barrier, of course, and get from the blood into the brain will react and respond with a, you know, there's receptors for estrogen throughout the brain, but it is localized in certain areas of the brain at higher density. the main receptors that we understand for estrogen are actually nuclear receptors, so they're not necessarily working at the level of the synapse where we've got. Estrogen can make a neuron automatically dial up or dial down the amount of neurotransmitter is being released. Typically what we would see would be, it's not so much about the neurotransmitter

that's being released, whether that's glutamate or gabber or serotonin or dopamine. it's about the receptor where we're probably going to see most of the action taking place. Right. Because you've got one neuron, almost always just makes one type of neurotransmitter, and it's the next neuron in the chain with the receptors for that neurotransmitter, which determine how the brain will react and respond. And the hormones themselves are probably because they go into the nucleus and they act on transcription factors on DNA to kind of promote,

or speed up or slow down protein synthesis, and that would be the synthesis of different types of receptors. So we're kind of seeing a knock-on effect here. I think the language I would use myself would be on the neurotransmitter systems versus simply thinking we're going to get more or less. If we haven't got estrogen, we've got, we're getting less serotonin release, for example.

What we're probably more likely seeing is shifts over time, and perhaps different shifts in different directions and different parts of the brain in terms of how the receptors are reacting and responding to perhaps initially that roller coastering level of estrogen and then the lowering levels. Bearing in mind, of course, that estrogen is just one of many thousands of signals

that our brain is making meaning of and processing. So, you know, it gets a lot of attention right now, which is cool and good, but there's a lot of other things kind of that the brain is, that the brain is making meaning of and is reacting and compensating to over time. I'm mostly familiar with some of the work that's been done looking at, one, at dopamine and two, it's serotonin, and I believe, actually in my woman's brain book, I can't remember every word I've written in it.

Oh, that happens. I was looking at the role of ovarian hormones. on serotonin, that serotonin neurotransmitter system, because we've heard the receptors as well. And you could increase the level of estrogen and in some parts of the brain, you would see that that might dial up certain serotonin receptors, but in another part of the brain at exactly the same point in time, that might dial it down. So again, it's never linear. And as I said, even when it comes to the flourishing and pruning of dendrites,

there's a U-shaped relationship when we look at levels of estrogen. So it's super complicated. Estrogen will be one of the signals that's involved with these neurotransmitters and these signalling. And we can see that play out when we zoom out a bit, of course, because we're seeing the networks react and flux and change. I'm not sure whether we've got enough of a clear story there yet. Yeah, that makes sense.

But calling it a girl gang's like, that's kind of, that's fun. That's what I like to keep it all fun. I actually, the first time about 20 years ago when I started learning hormones, a friend was walking me through a Dutch test. You know the Dutch test? It's like a ovarian, it's a urine test. It's a dried urine test to see what your hormones are. And it shows you all the hormonal pathways.

And I said to her, these pathways are so, these clinical names, nobody's ever going to remember. And she's like, yeah, they should be the names of nail polish, shouldn't they? And I was like... Gosh, I don't know about that. I was like, people would know it then if you gave it a nail polish name. I think if we educate people carefully and thoughtfully, we can use the appropriate words. That's what I try and do.

But maybe no, colors versus nail polish. There we go. There we go. There we go. So I want to go back to what you. you said though, you said that estrogen's not the only thing stimulating these neurons. Oh, gosh, no. So one of my thoughts when I saw this study on how estrogen impacted and I love the way you said, the neurotransmitter system is, okay, so here we sit. Like, I look at my 86-year-old mom and she'll tell you, she went through in menopause with no problems at all. And I would say what I'm witnessing is a very sharp brain. Of course, she had a few moments. So, like, what was going on

with her lifestyle? Then I look at somebody like my sister, my older sister, who was a couple years ahead of me, and I can tell you firsthand, she didn't make it through menopause as well as she thought she did with her brain just very quick to react to stress. And I start seeing that every woman is having a very different brain experience, and you've mentioned it a couple of times. I mean, we're all different. We all understand that. Right. Same as pregnancy, right?

Oh, good point. And we can all have wildly different experiences of pregnancy, even if the sort of the biological shifts are the same. And between pregnancies, you know, you can have two completely different pregnancies yourself. That's true. That's true. So then where do you think lifestyle fits into this? Like, the thing that has been really, like, weighing heavy on my heart is that the, the, the main message that's being brought to the public right now is just get on HRT and everything's

going to be okay. Yeah. The metapause conversation is wild right now. Yes. Thank you. I have lots I could say about this. Oh boy, I was even reading a paper this morning that was published from some researchers here in Australia talking about the, they've surveyed Australian women about their reactions to the massive commercialization. of menopause and how the conversations are being played out. And it was very interesting to me. And you can get pushback for this. And I've been, you know, there's all kinds of factions at the moment,

for want of a better word. There was some lines in this paper. Actually, I might even have it up on my computer. It's actually called All About the Money, if you can believe. Women were talking about the catastrophizing narratives about menopause whereby commercial actors seek to connect with women and capitalize on their concerns for financial gain.

So we're in this particular moment in time right now where the conversations around menopause are an active ingredient and the experiences that we have. And when it comes to the brain, the brain isn't prioritising. The brain is making sense of information from our biological body and how the food we eat and how we sleep and how we exercise and our hormones

and a million signals coming in from our body that we're not even aware of, that your brain is making meaning of, but also from the outside world, from what we see and hear from the rising and setting of the sun to the messages that we are getting from our social media feeds as well. That is also an active ingredient. And I'm really fascinated by these.

There's also a really interesting paper as well. I was reading a couple of days ago looking at the relationship between, I have all these papers I was just going to say you're the true scientist over there pulling out. This is like, this is my life. I wish I was your neighbor.

This was talking about, although you might not like this one as much, this was talking about nocebo effects and side effect experiences based on the conversations that women have about oral contraceptive use. And that's not to say H.R.T. Pro, we should be on the pill. We shouldn't. We should be on H.R.T. We shouldn't. Rather that

the conversations that we are having and where our attention goes will also influence the experience that we have. And we need to also understand that our brain is making meaning of these these signals and where we're getting our information from can sometimes, it's just so great that we have all of these, you know, opportunities and options and tools available, but to just keep in mind that a conversation can shift an experience that you have of your own physiology. I've written a whole book called Baby Brain because I was so interested in this kind of social cultural narrative we have. I mean, and honestly, Mindy, I don't know whether you think this, I feel like as soon as a girl hits puberty, the conversation is about her,

broken female brain as soon as you add some hormones in it's broken right puberty puberty blues you know baby brain brain fog it's all negative there's never any there's never any upside yeah and there's a and there's this incredibly strong cultural narrative that is also driven the research whereby women are going the end stages of pregnancy perhaps or early motherhood oh my brain I have baby brain mummy brain my brain isn't working identity I can't do what I want it to do but what's happened in pregnancy is that it has been reorganised to focus on the baby.

Your social cognition networks have been focused are there to adapt and respond and react to your baby because that's kind of the mother nature's intention is that you're focusing on your baby and your memory and your cognitive function

depends on your attention so what information you take in and what you filter out. We've now got mobile phones which are almost like a baby as well sucking our attention and so you can't

possibly you can't do everything. Your brain is trying to multitask and task switch and everything doesn't work as well. It's not, as I always say, it's not women's brains that are letting them down when it comes to baby brain. But the way that women have been primed is like, well, if my brain's not working something whilst you're wrong with me neurologically, and so then that's driven the research when it's probably more of a social support issue there for motherhood. So now we've got, we've gone from this pendulum swing from in the 90s women were taking hormone therapy to the women's health initiative study, and this has been talked about endlessly.

I was working in a breast cancer research centre when that study came out in 2002, and it was like it was kind of like a war room panic station type situation. They were trying to like dampen down the fear around hormone therapy causing cancer. We're seeing a shift back now. And in the last few years, this massive shift back. Massive. Metapause is starting at like, I've got friends in their 30s, like, oh, it's perimenopause, and I'm like, you're still breastfeeding.

Yes. Maybe it's, maybe every... It's like a trend everybody wants on. And I understand that when we have gaps, we have swings and conversations shift to fill that narrative. But I think that it's a bit of a... I don't want to use... I'm going to say bull in a China shop. Sometimes the information is not necessarily being impartial.

thoughtfully in the way that we know from public health communications, from health literacy communications, the kind of space I come from. If we've got research, how do we talk about that in a really thoughtful, careful way, whereby we communicate absolute risk. We're very cautious and careful understanding that how we describe something can influence someone's experience. Yeah. And right now, menopause isn't quite...

Yeah. isn't quite in that space. And there are researchers out there that are saying, if we're going to be talking about men and pause in the workplace, is that going to have knock on effects for gendered ageism, perhaps? Or is that enabling women to be able to talk to their manager in a way without stigma? Yep. We need to be using exactly the same approaches about health communications

and risk communication and treatment options and tools that we've always done within public health communications, but right now it's glitzy and it's having its moment and all the celebrities are getting on board and there's a massive, you know, what does that paper say, all about the money? So it's just this kind of crazy perfect storm at the moment, which I actually find quite interesting

because the brain is going to be, the brain is making meaning of all of this. Oh, that's interesting. So, yeah, so go back to that because, so let's start off with, like, social media because it's interesting. It's like the Wild Wild West when it comes to menopause and social media. And what I'm hearing you say is, so let's use, do you know about the Do Not Care,

we do not care club that has been started on social. Yeah, yeah, yeah. And that woman is hysterical. Yeah, so funny. But what you're saying, if I take that and I put it in the context that you're talking about, if I'm watching this woman and I'm laughing and then I'm like, wait a second, I don't, care. That's right. I don't care either. So is it now all of a sudden we get on the bandwagon of what, because the brain is constantly trying to make sense of its environment. And if it's

environment, it's, your brain has been told, oh, you're not supposed to care. Then are we really starting a whole generational of women that do not care? Right. Yeah. Maybe, maybe. I'm not, I don't think we've, I mean, it's been having its moment just really in the last few years. so I'm not sure whether we can see knock-on effects yet. Certainly, like if we looked at data from the UK, which has looked at prescribing of, say, hormone therapy, that's kind of gone up and that's tracked alongside, you know, the media and the conversations around this,

which is really great for lots of women who need that help. But are there more women perhaps over-identifying or attributing other health issues or other issues in their life to their hormone shifts when it might just be, you know, they've got a, you know, a very stressful life. And so the narrow focus on the hormones being part of the conversation, we're not looking at, you know, this kind of holistic approach to what's happening in our whole life. And so that's where the lifestyle has to come in.

And I think genuinely most people are also, are not just saying the only thing you do is take hormone therapy, that you should also address all of these other parts of your. parts of your life. But to be fair, well, I mean, hormone therapy is kind of the main tool that we've got right now. And it's, and if everything, yeah, you've only got to hammer, everything looks like a nail, right? That's the, I keep saying that exactly. And all we've, and all we've got, and with, you know, if we look back across like your lifespan, say, and you were naturally cycling, you went on the pill, you didn't have an IUD, you didn't have many pregnancies,

you know, your brain learned to react and respond to your ovarian cycles. When you reach perimenopals, all we can do is kind of add an exogenous estrogen. And all we can do is just add in a bit more and then add in a bit more. We can never really kind of mimic that. True. Which is not necessarily a bad thing or a good thing. It's just this is the tool that's currently having its moment in the sun, which is excellent, but perhaps we should also be looking at what else is.

available on what else we can do. But then I also say that with the caveat that I, you know, have, you know, I've had a great education. I live in a very healthy, wealthy part of Australia. It's very easy for me to implement lifestyle change. I know how to go about that. There's lots of women in the world that just don't have any access to any of these tools or resources. And it's very easy for us to go, oh, well, you should just exercise more and manage your sleep. when, you know, they can't manage to feed their kids a healthy meal. Well said. Pay the power bill, you know, so the shiny celebrity messages are great for, you know,

healthy, wealthy white women who are living in, you know, not in poverty and don't have a lot of, you know, might just have a shitty husband. But it's not addressing it from a public health perspective. And I feel like we need to zoom out a little bit more and kind of look at how can this message land across populations and that's what public health does right now there's just it feels like there's a little bit of a clash

between the careful cautious thoughtful approach of how can we help everyone and ensure access and you know justice for all versus don't go HRT because it'll prevent to measure which it won't

you know social media is having its having its moment a 92nd reel is very different from a broad-scale public health campaign that's looking across socioeconomic kind of strata. Yeah, that's really well said. And it's funny because I've been teaching metabolic health and hormonal health on social media for about 15 years now. And I always feel like my job is to bring information and help people make the best decision for them.

And the trends in social media have strongly gone towards do this, or you will get Alzheimer's, do this, or you will get Alzheimer's, do this, or you will get, dementia and that kind of fear-mongering is not one that I would like to participate in. So I think what you're saying is the most accurate statement I've heard anybody say because I think we both agree like it's a really cool tool, but we've made it the center of the conversation now. Yeah. And it's time to broaden that out. I think it will shift back. Yeah. But what I just wish was happening is that the, perhaps this is because of the world I come from and what I've spent years talking about and going to conferences too

is how we talk about these things really matters in terms of the decisions that people go on and make the healthcare decisions. And when we talk about, well, this is going to increase your risk or decrease your risk, we don't, what does that even mean? We say, well, it's got a 30% increased risk. What does that even, no one knows what that means. We've got to talk about absolute risk and absolute numbers And in a woman like you, if you were to take this therapy or treatment or not, this is how many more women or how many less women would go on to develop breast cancer or not to develop dementia or would see their hot flashes fade away.

We need more careful, thoughtful. And we've got evidence on how to do that conversations around risk. And I mean, I don't know whether we're going to, have we got time to talk about hormone therapy and dementia? Alzheimer's disease. Yeah, no, I was going to say, I want to talk about that and then I want to talk about because you said that and I was like, we need to talk about that. And then I want to talk about societal stuff here in a moment before. So, so, okay, so explain why HRT won't prevent dementia. Right now the data is very mixed. So there are lots and lots of different types of studies that have been looking at this over many decades. And some studies are saying, well, it

looks like it might slightly increase risk or women who are taking hormone therapies. Brains look slightly older than women who don't or have never taken it. Other studies are saying if we look across a population, we see slight increases in risk. And then we've got a whole lot of other studies that are going, look, we're not really seeing anything. Doesn't matter whether you've taken it or not. That's not what's really changing dementia risk profiles in people. It's a whole lot of other risk factors which we can get into.

And then we've got other studies saying, oh, well, actually, if you take it at the right age and you take it in this sort of formulation, it might decrease your risk. So right now, if we look at the consensus, we look at all of the studies that have been done. And I often say another way to think about risk is, you know, those old-fashioned, like, weighing scales. And so you want to tip the scales in your favour towards not getting dementia. Of course. So what can you do as a preventative and what can you, you know, what's the kind of the harms and what are the kind of actions that we can do to alleviate risk.

You tip it in your favour, but sometimes tipping something in your favour doesn't make any difference. I mean, people can get lung cancer if they've never smoked a cigarette, right. Yeah, well said. Right now, we've got all of these little, you know, weights that we can put on the side of prevention and weights that we can put on the side of risk. And hormone therapy, we're like, oh, we don't know whether we're putting it on this side or this side or this side, and how big that weight is. Right now, it's quite tiny.

and some studies put it on one side of the scales and some studies put it on the other. So until we've got a clearer story and scenario where we can say, if you are this particular age and this is your particular risk, this is your kind of current health status, this is perhaps, you know,

have you got the types of genes that would increase or decrease your risk for Alzheimer's disease and there's lots of different genes that may be involved? If you start taking hormone therapy be at this time for this long and this kind of formulation and combination and method of delivery, then we might see your risk tweak slightly in your favour. We're not really at that point even yet.

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

and it would be unethical to say that. And that's fine, that's okay, I'm fine with that because there's a whole host of other things that we know absolutely will make more of a difference. But right now this is the tool that's kind of got the shiny sort of attention. Yeah. What are some of those things? a host of other things.

Gosh, and we can look across like the lifespan in terms of where, where does kind of what was going to increase or decrease your risk. So we, some studies have come out looking and it's somewhere kind of around between 40, 50-ish percent of cases. There are modifiable risk factors. And this is across the global population. If we were to manage all of these, we would see these declining numbers, this declining prevalence and people who are old.

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

Right, they're not thinking like that. It doesn't seem like a very fun tool to talk about. You can't do much about it. You can't say, just put a education patch on and increase your years of education. But would it be your learning? You're learning. You're learning.

So new information's coming in. Yeah, so perhaps staying engaged and learning, but the risk does, the risk profile in old age does appear. some of that is around early life education. And this is particularly in parts of the world where, you know, many girls don't stay in school beyond ages 12, you know. You could stay in education up until your mid-20s if you were doing a PhD. So we've got these kind of big gaps there depending on where you live in the world.

Then we can look at midlife, and this is where all of the factors that you kind of work at, you know, the space you work in around metabolic health and cardiovascular health and your cholesterol and your blood pressure and, you know, the type of lifestyle that reduces your risk of Type 2 diabetes, all of those types of things like you diet and your exercise and your sleep and your stress. And they all coer less. But then we've also got factors which are incredibly unsexy, for example, untreated hearing loss. I've heard this. Yeah.

Yeah, lots of people have perhaps industrial related hearing loss. You know, you worked in a factory or you were a farmer or you were, you know, you were a rowdy for, I don't know, Taylor Swift, maybe. You know, your hearing loss started to be impacted by midlife. And particularly back in the days when we used to have those massive big hearing aids, there was a lot of stigma around that. They're much more discreet now. People weren't getting hearing loss treated. And that's an incredible burden in terms of brain aging and risk for dementia

because when you can't hear, you can't communicate, you can't interact, you just kind of withdraw from the world. and then your brain isn't in as an enriched, stimulating, engaged environment. You're losing your social connections. You're perhaps losing that ability to stay educated and engaged in an employment, etc. So your world shrinks down. And as soon as things happen where your world shrinks, your brain isn't being stimulated. And we see the same later in life with visual loss as well.

So I believe around 7% of cases globally of Alzheimer's disease could be kind of a limit. eliminated if everyone in midlife had hearing loss treated, of course, as different countries in the world that have got access to this or not. Vision loss in late life is the same because, again, your world shrinks. Right. And even if you've got your hearing and your vision and all of this, there's a real tendency, I think, like when you go to sort of this, and I've seen this in some people I know who are a bit older,

whereas the world just gets really small. You know, it's almost like they kind of live within the walls of their own house or their own garden. And the most exciting thing that happened was, you know, the neighbor didn't pick up their males. You know, there's some kind of like, they've got a very small world, and they're not out in the world and engaging and reacting and responding and using our brain to explore and navigate and engage. And all of these things, it's so important.

And there's other factors in there like depression, mental health issues, head injuries. And we think a lot about, you know, brain injuries or head injuries, and we think about, you know, kids playing sport or, you know, rugby players or hockey, you know, players and head injuries. But there's kind of an uptick in head injuries, particularly around men above the age of 60 who've climbed ladders. Oh, that's interesting. Because, of course, you know, your balance is a little bit off,

but particularly men are still, I'm still going to empty the gutters. I'm still capable of doing all of this and they fall off the ladder and hit their head. So we've got, you know, different types of risk factors in here, which go far and above and beyond simply menopause hormone therapy. Yeah. Oh my God. Yes. If you just listen to that little clip, that exactly is you went.

That was so beautiful. And it reminded me of my parents. They were in their early 80s when we went into COVID. And I was really clear that they were my top priority. lived in the same area as me. And we used to, like, I would have them come into my office. We had everybody masked up and doing all the protocols because I was like, you have to get out of the house. You have to come in and get some kind of interaction. We got the nasal swab tests really early on at. We were able to get them. And so I would nasal swab everybody and then we would have

them come over because, but you could see that they were incredibly social humans before the pandemic and there was a significant brain decline afterwards. 100%. Yeah. We see, and we can all remember what that was like. It was like, because if you leave your house and you see other people, you might kill them. Right, exactly.

I mean, it was this, it was a very frightening message. It's so scary. Yeah. Perhaps it was very well intention then and now we are seeing some of the consequences. And as you said, for older people whose worlds shrunk and they haven't been able to kind of grow that world again. And then we saw this with, you know, kids and. young people as well, particularly those kids who were a little bit like socially awkward or

going through adolescence. And adolescence is a time when the social cognition networks require social experiences to guide and wire up appropriately. And again, they were told, well, if you leave the house or you go to school, you know, terrible things will happen. So the messaging there was incredibly confusing. And when people's world shrink, there, of course, there's going to be knock on consequences. And perhaps in older people, we might see this in terms of brain.

aging and in younger people we saw this play out in terms of mental health sequences and I even know myself being very aware of this and and thinking about it it felt like your social fitness you'd lost social fitness and then it was easy if and I noticed people it was easy for people to opt out like you'd organize an event I remember organizing like a book event before COVID and everyone go oh I'm coming and then everyone that said they were going to come along would come along and then after COVID, people would say they were going to come along and then they just wouldn't because people would say, oh well, they've been, they've been told that they can opt out and they don't

need to show up. And so then it would be like this really tiny little event and I'd feel a little bit sad because people have lost their social fitness and just go, oh, I'm not going to bother anymore. Yeah. You still would have been a fair. Hopefully we're seeing that. Yeah. It would be interesting to see what the long term consequences of brain health are going to be like. it'll be, and we'll be able to perhaps look, I mean, maybe or not, we'll be able to look back and go, well, this state or this city or this part of the world, you know, was more restrictive and this wasn't, and we may be able to see, see that play out. Who knows? That would be interesting. I'm sure there's people studying those kinds of things, yeah. So would it be, would it be fair to say

then, one of the key things you want to do with your brain as you age is to put itself in different environments? Yes, 100%. Because each new environment is going to create new neuronal pathways. So this idea of shrinking your world is a classic age problem. You know, oh, I can't go to the gym. I can't do the things. I'm not going to work and your world gets smaller, smaller, smaller. But what I'm hearing is we need to put the brain in as many different environments, whether you're 85 or you're 25 to keep its neuroplasticity at its best. 100% trying to expand your world and some people may need support to do that. Yeah.

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

bit and you sometimes see a bit of an uptick and their health for a little while. So our brains evolved because we move and because we navigate through the world. There's some really cool research looking at different types of occupations people have. and how that provides resilience to aging and resilience to dementia and other types of Alzheimer's disease. And the occupations which provide the most protection are taxi drivers, not Uber drivers with their mobile phone navigation, but like the old style taxi drivers and ambulance drivers. Because they're constantly navigating and decision making and having to make complex cognitive decisions will they move through the world. And then they were like, oh, is it just driving vehicles?

compared them with like pilots who don't have to make the same. Pilots aren't turning corners up in the sky, right? They're just lying in a straight line. That will have to make some adjustments, right? And that will like say a ship's captain. But it's definitely that constant, challenging decision making. Say, imagine an ambulance driver. Like you watch those TV shows, right?

There's a lot of information coming in that they're like making meaning of very quickly. They're having to kind of think ahead. They're having to, you know, talk to the hospital. hospital, they're having to navigate, they're not going where they've been before like a bus driver driving back and forward. And our brains evolved to navigate and find our way through the world and that's reasonably cognitively demanding. If you, you know, cast back, you want to take an evolutionary perspective. We had to hunt and we had to gather and we had to remember where the berries were and how to, you know, socially coordinate to hunt down the animals and, you know,

find our way through the world. And when we stop moving, not only is, you know, the biological consequences of not moving our bodies, but we haven't got that same visual and auditory and sensory input kind of streaming in and challenging our brain. So fast. This is why I've seen some studies on travel. You know, you go and put yourself in a different country, maybe even with a different language. Like the amount of brain energy that is needed has to be tremendous. So, And then if you go to a country where the cars drive on the opposite side of the road and staring goes on the opposite side of the car, I think, I do not think that there's anything more cognitively demanding.

Yes. Navigating from the airport, picking up the car higher at the airport to like, you know, your first night stay and like everything's on the opposite side. That's crazy. It's very good for you. It's quite stressful though. I bet. You have to have a lot of emotional regulation within a family.

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

like, ah, she'll hesitate a little bit. By the time you ask that question at 13 at 4.14, the boy will tell you what he wants to eat, but the girl will say to you, I don't know, what are you going to eat? And so what Carol Gilligan came out of that research and said that there was a conditioning of the female brain that occurred because of social messaging. And the social messaging that a lot of girls got was you are worthy if you are selfless. You are worthy if you don't rock the boat. And one of the theories I have, right? One of the theories I have is that menopause is actually the unwinding of that. I like that.

Yeah. Yeah. So, I like that. Give me your neuroscience perspective. Oh, I'm not sure. I'm not sure. Oh, gosh, I'm not sure whether I could neuroscience my way through that, but I think it's a cool idea.

And I've looked a little bit at what happens to girls and boys when they go through puberty, because I think that's really fascinating because really that's when, you know, we've got the in utero, the brain kind of patterned up, ready to react and respond to the hormones of puberty and in boys that's testosterone and girls that's estrogen but also progesterone and we know that pubertal and adolescent brain development tracks more closely to pubertal stage than chronological age um so you know there's a bit of a narrative that old girls brains are more developed than boys at the same chronological age but that's just on average the girls have gone through puberty a little bit earlier than the boys yep um but you could get an early

puberty boy, say, and a late puberty girl who's, you know, so the boy's brain would be slightly more further along that developmental track than the girls. So typically we're talking about averages and I think it's always useful to think about individual trajectories. I'm familiar with some research that's come out of work here at Australia looking at how girls start to react and respond socially and emotionally, both to other people, but also their perceptions of themselves going through puberty based on the social context in which they experience puberty. So we've got girls perhaps who they might get their period at 9 or 10, which is early,

but it's still on the normal curve. They're not 5. Early, so it would say early but normal because someone's going to be at one side of the distribution curve and someone's going to be later. And what happens when a girl goes through puberty early? She's going to feel very different from her, you know, her. her cohort, her friends around her, she's going to be one noticing about how her body has changed

in comparison to her friends. Other people are going to start reacting and responding to her very, very differently. And then you've got a girl who goes through puberty, you know, she gets a period at 12 and a half like most of her friends or on average and then girl goes through later. So those girls who go through puberty earlier than their friends

are much, much more vulnerable, particularly to go on to develop perhaps anxiety and depression through that pubertal, transition but also later in life now kind of compounding that in some girls but not all is what drove that perhaps earlier but normal pubertal transition could perhaps be earlier life stress or trauma or abuse not always some girls are just like on the early early side of normal someone has to be first but those girls are more vulnerable but it's interesting because if you look at boys going through puberty depending on you know early average or later

a boy who goes through puberty earlier than his friendship group, or what happens to him? It's all big and tall and hearing his voice drops. And everybody wants to be him. The alpha in the group. And he's almost, and then everyone, all of the little dudes cluster around him, and he's like the alpha.

And he's kind of protected in a way. Now, he might go on and the parts of his brain, and particularly we see this more so in boys, and it's hard to know whether it's testosterone or whether it's society as a mother nature or the patriarchy. He will seek out more sensations and do kind of risky business, which teenage boys, and I know all about teenage boys slightly earlier. So he might get up to more mischief with older friends.

But typically he's going to be less vulnerable to the mental health issues that feeling like not part of the group versus the little dude who still hadn't grown at 16. and we all remember them from school. There would always be someone that was kind of on the far end of the distribution curve. So we've got here kids going through puberty at different ages and stages, but the vulnerabilities come about by the social context in which that is happening. So it's not simply just the hormones and the brain interacting, it's the hormones of the brain interacting with the social context.

And then, you know, how well supported. Like you've got an early puberal girl, maybe she's got an incredibly supportive, aware, you know, her mum and her dad kind of can see this happening and they provide all of the right supports and nurturing around her. And she goes to a great school and she's got good friends and she's just going to be okay. But perhaps there's a girl who's just neglected and just really struggles.

And, you know, she had puberty early and doesn't really kind of know how to cope. So that social, cultural context around the biology of puberty is incredibly important. And I did speak to one recent. in my book Jane Mendel, who's a, who researches puberty. And she said, particularly in girls, puberty kind of provides an emotional blueprint for how you all react and respond, particularly in those reproductive transitions later in life. Because one, you've had that psychological experience of perhaps it was just traumatic and horrible and maybe your first period was a, it was a scary, frightening experience. So maybe it was like cool and awesome. It could be anywhere in between,

right. But girls who go through puberty early, often then maybe their brain becomes sensitized and then they're more likely to have PMS symptoms and then maybe then that kind of compounds they're more likely to develop depression. Then they're going to struggle, you know, perhaps through pregnancy and early motherhood. So we kind of see a snowballing. Right now I think it's very hard and it would be perhaps unwise of me to say, well, there's a hormonal basis, there's a biological basis. It's always going to be this collision. of the biological and the psychological and the social. So well said.

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

I mean, I guess you'd get more cranky and irritable when your hormones are kind of on the decline. Or some women, you know, don't notice. Other women just, you know, feel that very, very deeply. I think it's really hard to say, well, it's just the hormones that are driving, perhaps that I don't care anymore, the I don't care club. Perhaps in Australia we might use different language. What would you call it? I'm curious.

Perhaps you just give less, the give less farks. Yeah. But how much, it's kind of hard to tease that up because perhaps, you know, and I think about myself, I turn 50 at the beginning of the year. My oldest son is doing his final high school exams starting in 10 days, and he's going off to university, you know, going the way to college. He's going traveling in Asia over the summer holidays. Then he's going away to university.

You know, I've written all of these. books and I'm kind of having a year to just kind of suit myself and go to loads of parties and with friends around the world and and you know and I and I turned 50 and I'm there's there's so many things going on. So many variables. Is it just the hormones that have changed or is it just as you get older and you're in a different place and space and stage of life? And some people, I know, but I think I feel like I see more people struggling.

or at least people that are struggling are talking about it more. Maybe. And so then maybe then everyone goes, oh, perhaps I should have a terrible time too, so we'll let's get together and moan. Versus the, as if you talk about, there was a, this is this whole like the conversations

that we see around us, how they influence and shape us, there was a menopause kind of inquiry or kind of conversation and parliament here in Australia last year and one of the parliamentarians who was, talking about this, said this isn't about women who've had a great time and they've gone through menopause and it's been fine and we've pat them on the back and say, well done you. This is about the woman who struggle. And I was like, I don't think that we should only ever listen to and describe the stories

about the terrible times. Yes, we should also look at, well, hey, what about those women who did have, like, instead of patting them on the back and being a bit snarky and going, well, done you, how about we go, well, what have you done? Like, is this your mindset? Like, what have you done to have this great time? Yeah. Can we learn from you?

Because surely that's what you want. Yeah. How can we like learn from the wisdom of those who have gone before us? I think, like I said, I feel like at every reproductive life stage, we have this very strong tendency just to focus on all of the things that go wrong. Yeah, it's so well said. I don't think that as our daughters are entering puberty where they're catastrophizing. it and you're going to hemorrhage every month and you're going to have terrible period pains

and it's going to be awful and it's going to be humiliating and people are going to start looking it would hypersexualize you and la la la la la we're kind of trying to provide i don't have daughters but i imagine that's not the messages that people are their daughters no not at all it's going to be much more positive and empowering yes of course and we're going to be using wisdom to educate and i would like to think that that was what we were doing at this stage in life but i just don't feel like all of the conversations are there yet. But I'm very optimistic that they will get there. And I'm very optimistic also that on neuroscience research that comes through,

that sort of shows the upsides and the benefits and what kind of peaks at midlife and cognitive functions that we see continue to improve into old age, because I feel like all we do is grieve and talk about what we've lost. So well said. and not what we're potentially gaining. Oh, that is so beautifully said. And that was actually the whole, a big premise of my book, Age Like a Girl, was to talk about what's right with menopause,

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

professional development courses and applied neuroscience and brain health. So some of them are kind of like the basics of neuroscience and brain health, kind of a 101 type course. And I've also got one around women's brain health across the lifespan. I could say womb to tomb, which is, so it's accredited if people want to get their, you know, professional development hours for their different associations and organizations. And I look through the female lifespan. So in utero, childhood, puberty, menstrual cycle, adolescence, pregnancy. see, oh, and then I wrote, it kind of tracks along the chapters of my book, the woman's brain

book, which I first wrote in 2017, and I just did a second edition update, which came out this year because so much has changed even in the last five or six years. It was quite funny, though, because when I first put the, when I was writing the book, and the course maps along the chapters of the book through the lifespan, but it was funny because I think I went from adolescence, menstrual cycle. I think I had a chapter on anxiety, depression and mental health, and then pregnancy. And then I was like, oh, I forgot the bit about how you get pregnant. So there's also a chapter in there on sex, sex, love and relationships.

Amazing. I was like, oh, you've got to talk about how. That's the problem with writing a book. It's so stagnant. It's like you put it there and you can't go change it. And then when you get to change it, you got it. And then watch it. And I was like, oh, need a chapter on how.

how you get pregnant. And I still find that a little bit embarrassing to talk about. And aging. So the course is designed. There's online lectures where I kind of teach the basics. There's various kinds of tasks which enable people to take a closer look at various kind of academic articles or go and listen to webinars or explore the neuroscience underlying each of these life stages in a little bit more depth.

And then we have lots of time for live Q&A. And then it culminates, and this always scares people, but then people end up loving it, giving a little five-minute presentation on a topic of their choice that's perhaps relevant to the work that they do. So I have teachers and I have psychologists and coaches and therapists and I've had people from so many different professions come in. And then I kind of pick one of the topics and then like what have I learned about the neuroscience of? Maybe you know, you work in a girls' private school and you want to talk about the neuroscience of puberty. and then they'll give like a little five-minute talk, which is fascinating and it's so good for me because that's how you iterate and learn professionally yourself

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

I know. I just, I find, you think of a little presentation. I'm happy to. I find neuroscience just fascinating. I've actually thought about going back and getting my PhD in it. You should just do one of my courses. Exactly.

That would be a lot more time efficient for me. Yeah, yeah, yeah. Yeah, so some of them I've got two, I've got a 17 lesson curriculum, which is applied neuroscience and brain health. So we kind of go through all we've been talking about, about neuroplasticity and neurons and synapses and transmitter systems, but we talk about cognition, emotion, motivation, goal setting, brain aging, diet, exercise,

you know, sleep, stress, social connection, etc. And I teach that across. There's a 10-day intensive. It's like really full-on or there's a 12-week slow version. And so I just have all of these incredible people from all around the world come and do these courses. It's beautiful. And for me, that's how I've learned how to teach as well.

is by just inter, you know, you learn to teach well and explain the brain by getting feedback from other people about what's landed and what hasn't. Yeah, it's so beautiful. And, I mean, my favorite thing in the world is talking about neuroscience to people. It's just, yeah, it's like this all Venn diagram of all my favorite things. How do people sign up for the course? We'll leave a link, but do they just go to your website? Yeah, so go to Dr. Sarah Mackay.com.

and if you sign up to like my newsletter, I have like a little kind of mini email course that'll just get you in the system and then the enrollments for, it's called in her head. Actually, I wanted to call this book, the women's brain book, I wanted to call it in her head.

And the publishers were like, and this is in 2016, 17, they were like, oh, might all in her head might sound like the girl on the train or the woman in the window. They might think it's domestic noir, like a novel, not brain health. And so in Australia, they like what you see it.

What it says on the can is what's in the can. So it got called the women's brain. Yeah, it says it. That is what it says. Yeah. And then I still really liked all in her head. So I called the course. Good, good.

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

Amazing. Because there is just so much work being done. And shout out to all of the scientists who are the ones at the Coalface doing all of the hard work. There's some really amazing research groups around the world that are driving, this woman's brain health build forwards. So I can only do what I do because they're all doing the hard work. Amazing.

Well, Dr. Sarah Mackay, this was an incredible conversation. I can see when you're like, I could go three hours. I'm like, I could go three hours. We've only done menopause like I've got. Yeah, I've got more. We'll bring you back to do more. I'm very interested in your course. And I just think there's never been a greater time to understand yourself than this moment.

And, you know, that's what I love about neuroscience is you really start to understand human behavior in a new way. So thank you. It's endlessly fascinating. So thank you for giving me the opportunity to talk about it. Of course, of course. And we'll leave all the links and send everybody your way and I'll see you in your course. And I'll bring you back. So thank you for your time. I really appreciate it. Thank you. Thank you so much for joining me in today's episode. I love bringing thoughtful discussions about all things health to you. If you enjoyed it, We'd love to know about it, so please leave us a review, share it with your friends, and let me know what your biggest takeaway is.