Lisa Mosconi: How Does Menopause Affect The Brain? We associate menopause with the ovaries, but its symptoms start in the brain. Neuroscientist Lisa Mosconi explains how brain health during menopause affects the rest of the body.

Lisa Mosconi: How Does Menopause Affect The Brain?

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MANOUSH ZOMORODI, HOST:

On the show today, how our brains change throughout our lives. And now finally, onto the aging brain and, for women, a stage in life that most people associate with changes in the body rather than brain function - menopause.

(SOUNDBITE OF TED TALK)

LISA MOSCONI: 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.

ZOMORODI: This is neuroscientist Lisa Mosconi on the TED stage.

(SOUNDBITE OF TED TALK)

MOSCONI: Those are neurological symptoms. We're just not used to thinking about them as such. So just to clarify, if this is you, you are not crazy.

(LAUGHTER)

ZOMORODI: Not crazy because women's brains age differently than men. And Lisa's research is just beginning to shed light on how and why that is.

MOSCONI: And this is really important because the way the brain ages is really, in big part, dependent on the health of the reproductive system in women. And the reason for that is that their hormones play a big role in brain function. And this is a connection that's been really overlooked systematically for decades, probably centuries, really.

ZOMORODI: And we should just mention that when we're - we say women, we're referring to those born in bodies with ovaries. And as we've talked about on the show before, there are a lot of people that don't fit into that description.

MOSCONI: Yes.

ZOMORODI: And so in your TED talk, you say that the brain and the ovaries are connected. Like, it's like they're talking to each other all the time, right?

MOSCONI: (Laughter) Yes. Yes, they do from the moment we're born. So the brain is connected to the reproductive systems via a network that is called the HPG axis, which is hypothalamus pituitary-gonadal axis, which - yeah, which is a very important system that connects specific parts of the brain like the hypothalamus, which is - for example, is in charge of regulating body temperature but also is in charge of making hormones like estrogen and progesterone. And then there's the pituitary gland, which is in charge of making other hormones. And all these hormones together are responsible for the menstrual cycle in women, and they're connected to the ovaries, the gonadal system.

(SOUNDBITE OF TED TALK)

MOSCONI: Men have 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. Women's...

(LAUGHTER)

MOSCONI: Right? Women's estrogens, on the other hand, start fading in midlife during menopause, which is anything but symptom-free.

So when women say they're having hot flashes - right? - that's the most common symptom of menopause. They're having night sweats or depression, anxiety, brain fog - it's a very common symptom - memory lapses. Those symptoms don't start in the ovaries. They start in the brain. And what we have shown is that the symptoms are very likely caused by energy changes inside the brain.

(SOUNDBITE OF TED TALK)

MOSCONI: 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. 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.

ZOMORODI: So, Lisa, you were doing more research into this. But basically, are you finding that women's brains are more sensitive to hormone changes as we age?

MOSCONI: Well, from my perspective, it means that the role of your hormones is a little bit stronger in your brain.

ZOMORODI: If you're female.

MOSCONI: Yes, if you're a female because you're already wired to go through not just puberty, but also, there's an expectation that you're going to be pregnant and have kids and then eventually lose your fertility and survive it. So I think there's more - and this is speculative, but I think there's more that needs to happen in a woman's body.

(SOUNDBITE OF TED TALK)

MOSCONI: So this is the brain anatomy of menopause, if you will. 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 brainstem in charge of sleep and wake. When estrogen doesn't activate the brainstem 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's levels ebb in these regions, we start getting mood swings perhaps and forget things.

See; I think it's really important to appreciate that for women, there's a very different story going on. And we should be more focused on the health of our hormones and really protecting our hormones because they have really strong effects on our brains.

ZOMORODI: Is that similar to why - I have hypothyroidism, or Hashimoto's, a thyroid disorder.

MOSCONI: Yeah.

ZOMORODI: And when I was diagnosed with that, it was like, oh, this happens to a lot of women.

MOSCONI: Yes, this is one of the things that we're looking into right now. We know that menopause acts a little bit like a trigger for existing medical predispositions. If you have a hormonal problem to start with, like thyroid issues, those are really likely to become an actual problem during menopause. Anxiety - there's a good chance that you're going chance that you're going to get more...

ZOMORODI: Great.

MOSCONI: ...After menopause.

ZOMORODI: Awesome.

MOSCONI: Sorry (laughter). But it's true. You know, the thing is that we don't talk about it.

ZOMORODI: No.

MOSCONI: I specialize in Alzheimer's prevention, the reason being that I have a family history of Alzheimer's that runs in my family and really affects the women in my family pretty heavily. And Alzheimer's disease actually affects more women than men. So currently, in the United States, of every three Alzheimer's patients, two are women...

ZOMORODI: Wow.

MOSCONI: ...Which really means that for every man suffering from Alzheimer's, there are two women. Alzheimer's disease starts with negative changes in the brain years, if not decades, prior to clinical symptoms. And my work in particular has shown that Alzheimer's disease starts earlier in women's brains than men's brains, specifically in midlife and even more specifically during the transition to menopause.

ZOMORODI: I've never heard that, actually.

MOSCONI: I find it so bizarre that this is not common knowledge and it's not something your doctors warn you about. And society's just absolutely unprepared. And doctors mostly are unprepared to really help women during this inevitable part of life. Like, all these symptoms that women have, in my opinion, could be avoided.

ZOMORODI: How?

MOSCONI: Oh, by living a certain lifestyle or taking certain medications or taking certain precautions.

(SOUNDBITE OF TED TALK)

MOSCONI: Food, for example - 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, 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, but it's just as important to avoid things to suppress our estrogens instead, especially stress. Stress can literally steal your estrogens. And that's because cortisol, which is the main stress hormone, works in balance with our estrogens. So if cortisol goes up, your estrogens go down; your cortisol goes down, your estrogens go back up. So reducing stress is really important. It doesn't just help your day. It also helps your brain.

So these are just a few things that we can do to support our brains, and there are more. But the important thing here is that changing the way we understand the female brain really changes the way that we care for it.

ZOMORODI: Lisa, we have gone from talking about babies' brains to adolescent brains to adult brains. And now we are talking about what happens in women's brains as they go through menopause and transition into this sort of last stage in their lives as seniors. And I guess, you know, we have spanned all that time. But I'm wondering, in the next five, 10 years, what are you hoping to discover with your research? Like, what is the question that you want to answer or understand about our aging brains?

MOSCONI: Well, I think there's so much that really needs to be done. And I work in the medical field. And still today, women's brain health is one of the most underresearched, underdiagnosed and undertreated fields of medicine. Even though women have twice the risk of anxiety and depression as men, we're three times more likely to have an autoimmune disorder, including those that attack the brain, like multiple sclerosis. We're four times more likely to have headaches and migraines. We're much more likely to develop a brain tumor, like a meningioma. We're far more likely to die of a stroke when we get a stroke, and we're also more likely to get Alzheimer's disease, which is the most common form of dementia on the planet and really a major public health issue. And if we don't understand how women's brains work, we will not be able to really help them.

ZOMORODI: That's neuroscientist Lisa Mosconi. Her latest book is "The XX Brain." You can see her full talk at ted.com. And you can also hear her talking about hormones and biological sex on our episode The Biology of Sex.

Thank you so much for listening to our show this week on brain stages. To learn more about the people who were on it, go to ted.npr.org. To see hundreds more TED talks, check out ted.com or the TED app. And if you've been enjoying the show, we would be so grateful if you left a review on Apple podcasts. It's the best way for us to reach new listeners. So thank you.

Our TED radio production staff at NPR includes Jeff Rogers, Sanaz Meshkinpour, Rachel Faulkner, Diba Mohtasham, James Delahoussaye, J.C. Howard, Katie Monteleone, Maria Paz Gutierrez, Christina Cala, Matthew Cloutier and Farrah Safari, with help from Daniel Shukin. Our intern is Janet Woojeong Lee. Our theme music was written by Ramtin Arablouei. Our partners at TED are Chris Anderson, Colin Helms, Anna Phelan and Michelle Quint. I'm Manoush Zomorodi, and you've been listening to the TED Radio Hour from NPR.

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