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  • Women are works of art.

  • On the outside as on the inside.

  • I am a neuroscientist, and I focus on the inside,

  • especially on women's brains.

  • There are many theories on how women's brains differ

  • from men's brains,

  • and I've been looking at brains for 20 years

  • and can guarantee that there is no such thing

  • as a gendered brain.

  • Pink and blue, Barbie and Lego,

  • those are all inventions that have nothing to do

  • with the way our brains are built.

  • That said, women's brains differ from men's brains

  • in some respects.

  • And I'm here to talk about these differences,

  • because they actually matter for our health.

  • For example,

  • women are more likely than men to be diagnosed with an anxiety disorder

  • or depression,

  • not to mention headaches and migraines.

  • But also, at the core of my research,

  • women are more likely than men to have Alzheimer's disease.

  • Alzheimer's disease is the most common cause

  • of dementia on the planet,

  • affecting close to six million people in the United States alone.

  • But almost two thirds of all those people

  • are actually women.

  • So for every man suffering from Alzheimer's

  • there are two women.

  • So why is that overall?

  • Is it age?

  • Is it lifespan?

  • What else could it be?

  • A few years ago,

  • I launched the Women's Brain Initiative

  • at Weill Cornell Medicine in New York City,

  • exactly to answer those questions.

  • And tonight, I'm here with some answers.

  • So it turns out our brains age differently,

  • and menopause plays a key role here for women.

  • Now most people think of the brain as a kind of black box,

  • isolated from the rest of the body.

  • But in reality, our brains are in constant interaction

  • with the rest of us.

  • And perhaps surprisingly,

  • the interactions with the reproductive system

  • are crucial for brain aging in women.

  • These interactions are mediated by our hormones.

  • And we know that hormones differ between the genders.

  • Men have more testosterone, women have more estrogens.

  • But what really matters here

  • is that these hormones differ in their longevity.

  • Men's testosterone doesn't run out until late in life,

  • which is a slow and pretty much symptom-free process, of course.

  • (Laughter)

  • Women's estrogens, on the other hand,

  • start fading in midlife, during menopause,

  • which is anything but symptom-free.

  • We associate menopause with the ovaries,

  • but when women say that they're having hot flashes,

  • night sweats, insomnia, memory lapses, depression, anxiety,

  • those symptoms don't start in the ovaries.

  • They start in the brain.

  • Those are neurological symptoms.

  • We're just not used to thinking about them as such.

  • So why is that?

  • Why are our brains impacted by menopause?

  • Well, first of all,

  • our brains and ovaries are part of the neuroendocrine system.

  • As part of the system, the brain talks to the ovaries

  • and the ovaries talk back to the brain,

  • every day of our lives as women.

  • So the health of the ovaries is linked to the health of the brain.

  • And the other way around.

  • At the same time,

  • hormones like estrogen are not only involved in reproduction,

  • but also in brain function.

  • And estrogen in particular, or estradiol,

  • is really key for energy production in the brain.

  • At the cellular level,

  • estrogen literally pushes neurons to burn glucose to make energy.

  • If your estrogen is high,

  • your brain energy is high.

  • When your estrogen declines though,

  • your neurons start slowing down and age faster.

  • And studies have shown that this process

  • can even lead to the formation of amyloid plaques,

  • or Alzheimer's plaques,

  • which are a hallmark of Alzheimer's disease.

  • These effects are stronger in specific brain regions,

  • starting with the hypothalamus,

  • which is in charge of regulating body temperature.

  • When estrogen doesn't activate the hypothalamus correctly,

  • the brain cannot regulate body temperature correctly.

  • So those hot flashes that women get,

  • that's the hypothalamus.

  • Then there's the brain stem, in charge of sleep and wake.

  • When estrogen doesn't activate the brain stem correctly,

  • we have trouble sleeping.

  • Or it's the amygdala,

  • the emotional center of the brain, close to the hippocampus,

  • the memory center of the brain.

  • When estrogen levels ebb in these regions,

  • we start getting mood swings perhaps

  • and forget things.

  • So this is the brain anatomy of menopause, if you will.

  • But let me show you

  • what an actual woman's brain can look like.

  • So this is a kind of brain scan

  • called positron emission tomography or PET.

  • It looks at brain energy levels.

  • And this is what you want your brain to look like

  • when you're in your 40s.

  • Really nice and bright.

  • Now this brain belongs to a woman who was 43 years old

  • when she was first scanned, before menopause.

  • And this is the same brain just eight years later,

  • after menopause.

  • If we put them side by side,

  • I think you can easily see how the bright yellow

  • turned orange, almost purple.

  • That's a 30 percent drop in brain energy levels.

  • Now in general,

  • this just doesn't seem to happen to a man of the same age.

  • In our studies with hundreds of people,

  • we show that middle-aged men usually have high brain energy levels.

  • For women, brain energy is usually fine before menopause,

  • but then it gradually declines during the transition.

  • And this was found independent of age.

  • It didn't matter if the women were 40, 50 or 60.

  • What mattered most was that they were in menopause.

  • So of course we need more research to confirm this,

  • but it looks like women's brains in midlife

  • are more sensitive to hormonal aging

  • than just straight up chronological aging.

  • And this is important information to have,

  • because so many women can feel these changes.

  • So many of our patients have said to me

  • that they feel like their minds are playing tricks on them,

  • to put it mildly.

  • So I really want to validate this, because it's real.

  • And so just to clarify, if this is you,

  • you are not crazy.

  • (Laughter)

  • (Applause)

  • Thank you.

  • It's important.

  • So many women have worried that they might be losing their minds.

  • But the truth is that your brain might be going through a transition,

  • or is going through a transition

  • and needs time and support to adjust.

  • Also, if anyone is concerned

  • that middle-aged women might be underperformers,

  • I'll just quickly add that we looked at cognitive performance,

  • God forbid, right?

  • (Laughter)

  • Let's not do that.

  • But we looked at cognitive performance,

  • and we found absolutely no differences between men and women

  • before and after menopause.

  • And other studies confirm this.

  • So basically, we may be tired,

  • but we are just as sharp.

  • (Laughter)

  • Get that out of the way.

  • That all said,

  • there is something else more serious that deserves our attention.

  • If you remember,

  • I mentioned that estrogen declines could potentially promote

  • the formation of amyloid plaques, or Alzheimer's plaques.

  • But there's another kind of brain scan that looks exactly at those plaques.

  • And we used it to show that middle-aged men hardly have any,

  • which is great.

  • But for women,

  • there's quite a bit of an increase during the transition to menopause.

  • And I want to be really, really clear here

  • that not all women develop the plaques,

  • and not all women with the plaques develop dementia.

  • Having the plaques is a risk factor,

  • it is not in any way a diagnosis, especially at this stage.

  • But still, it's quite an insight

  • to associate Alzheimer's with menopause.

  • We think of menopause as belonging to middle age

  • and Alzheimer's as belonging to old age.

  • But in reality,

  • many studies, including my own work,

  • had shown that Alzheimer's disease starts with negative changes in the brain

  • years, if not decades, prior to clinical symptoms.

  • So for women,

  • it looks like this process starts in midlife,

  • during menopause.

  • Which is important information to have,

  • because it gives us a time line to start looking for those changes.

  • So in terms of a time line,

  • most women go through menopause in their early 50s.

  • But it can be earlier,

  • often because of medical interventions.

  • And the common example is a hysterectomy and/or an oophorectomy,

  • which is the surgical removal of the uterus

  • and/or the ovaries.

  • And unfortunately, there is evidence

  • that having the uterus and, more so, the ovaries removed

  • prior to menopause

  • correlates with the higher risk of dementia in women.

  • And I know that this is upsetting news,

  • and it's definitely depressing news,

  • but we need to talk about it

  • because most women are not aware of this correlation,

  • and it seems like very important information to have.

  • Also, no one is suggesting that women decline these procedures

  • if they need them.

  • The point here is that we really need to better understand

  • what happens to our brains as we go through menopause,

  • natural or medical,

  • and how to protect our brains in the process.

  • So how do we do that?

  • How do we protect our brains?

  • Should we take hormones?

  • That's a fair question, it's a good question.

  • And the shortest possible answer right now

  • is that hormonal therapy can be helpful

  • to alleviate a number of symptoms, like hot flashes,

  • but it's not currently recommended for dementia prevention.

  • And many of us are working on testing different formulations

  • and different dosages and different time lines,

  • and hopefully, all this work will lead to a change in recommendations

  • in the future.

  • Meanwhile, there are other things that we can do today

  • to support our hormones and their effects on the brain

  • that do not require medications

  • but do require taking a good look at our lifestyle.

  • That's because the foods we eat,

  • how much exercise we get,

  • how much sleep we get or don't get,

  • how much stress we have in our lives,

  • those are all things that can actually impact our hormones --

  • for better and for worse.

  • Food, for example.

  • There are many diets out there,

  • but studies have shown that the Mediterranean diet in particular

  • is supportive of women's health.

  • Women on this diet have a much lower risk

  • of cognitive decline, of depression,

  • of heart disease, of stroke and of cancer,

  • and they also have fewer hot flashes.

  • What's interesting about this diet

  • is that it's quite rich in foods that contain estrogens

  • in the form of phytoestrogens or estrogens from plants

  • that act like mild estrogens in our bodies.

  • Some phytoestrogens have been linked to a possible risk of cancer,

  • but not the ones in this diet, which are safe.

  • Especially from flax seeds,

  • sesame seeds, dried apricots,

  • legumes and a number of fruits.

  • And for some good news,

  • dark chocolate contains phytoestrogens, too.

  • So diet is one way to gain estrogens,