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Kousha Navidar: This is All Of It from WNYC. I'm Kousha Navidar in for Alison Stewart, who's on medical leave. It's Monday, which means we on team All Of It are happy to bring you Mental Health Monday. Today, we're talking about in book investigating new science about menopause. Now, menopause is a time when many women feel battered by the effects of hormonal changes like sleeplessness and brain fog. What's now becoming clear is that menopause changes the brain in the same way it changes reproductive organs.

The book is called The Menopause Brain: New Science Empowers Women to Navigate the Pivotal Transition with Knowledge and Confidence. This book is split into four parts. You'll see topics like the bias against women in menopause, the brain hormone connection, hormonal and non-hormonal therapies, and integrative health. The author is Dr. Lisa Mosconi. She's an associate professor of neuroscience and neurology and radiology at Weill Cornell Medicine, and she's the director of the Alzheimer's Prevention Program at Weill Cornell Medicine, New York Presbyterian Hospital. She's with us now. Dr. Mosconi, welcome to All Of It.

Dr. Lisa Mosconi: Good morning. Thank you for having me.

Kousha Navidar: Absolutely. Listeners, we want you to be a part of this conversation too. We'd love to hear from you. Are you experiencing menopause or perimenopause? How prepared did you feel for this stage of your life? Was it something you were prepared for? Was it something unexpected? What's something you maybe wish you knew beforehand? We'd love to hear your story. Give us a call. Shoot us a text. The number is 212-433-9692. That's 212-433-WNYC, or you can DM us on Instagram. We're @allofitwnyc, X as well, same handle.

Just a quick disclaimer just to note, Dr. Lisa Mosconi is joining us to share her research, but what you hear today isn't a substitute for medical or mental healthcare. You can reach out to your medical professionals for that as well. Let's get started. Dr. Mosconi, you have a dual PhD in neuroscience and nuclear medicine. So cool. It's a branch of radiology. Your work involves brain imaging. When did your research start to focus on menopause?

Mosconi: My research started to focus on menopause in 2016. The reason being, I have been studying women's brain health for the vast majority of my career over 20 years. I started really young because I have a family history of Alzheimer's disease. I was just listening to your previous conversation about this terrible disorder, which happens to affect more women than men. Something that many people don't realize is that almost two-thirds of all Alzheimer's patients are women.

I always wanted to know why and what is the individual risk for every woman and what kind of factors may be triggering this risk. My research led me to study and research menopause as a female-specific risk factor for Alzheimer's disease. That was 2015, 2016. Soon afterwards, we published the first study, believe it or not, that used brain imaging, brain scans, to look at the brain of women before and after menopause. That was 2017, which as a woman was really quite upsetting. There was nothing done prior.

Kousha Navidar: Sure.

Dr. Lisa Mosconi: Other studies had looked at menopause in terms of the effects or the outcomes of menopause, what happens after menopause in the brain. We really wanted to know what happens to the brain as women go through it. Why do so many women experience symptoms like hot flashes and night sweats, insomnia, depression, anxiety, brain fog, memory lapses? Because those are symptoms of menopause, which have nothing to do with the ovaries. Those are symptoms that come from the brain. They're neurological symptoms. We're just not used to talking about them as such.

Kousha Navidar: In your research in that 2017 study, you saw that there was this shift in the brain during that period. Can you break that down a little bit? One thing that you do in the book is differentiate between perimenopause and menopause. Is that attached to that study?

Dr. Lisa Mosconi: Yes, and it's a very important distinction because the way that we describe menopause in clinical terms is basically that at some point as a woman, you stop having a menstrual cycle and that's it. It almost sounds like just one day on the calendar, something similar to puberty when many, many years prior, one day you wake up and you have a menstrual cycle and that's the day.

In reality, menopause is a very long transitional state, is a process that goes through several phases, but they're usually simplified as perimenopause. When your menstrual cycle starts-- when you start skipping periods, your menstrual cycle becomes less predictable. Then menopause, which is defined on menstrual period, and then the postmenopausal stage is the entire rest of your life, which for many women is 30% or even more than 30% of your entire lifespan. This is a long process to go through.

Kousha Navidar: We just got a text actually from a listener that is on this topic. Exactly. It reads, "I'm a woman in my mid-30s and have experienced a lot of change physically and mentally in the last two years. When does menopause actually start affecting us as perimenopause? How can we know? How can we prepare?"

Dr. Lisa Mosconi: That's a wonderful question. This process is very variable from woman to woman. In the United States, the average age menopause is 51, 52, but globally, it's actually 49. It's a lot earlier than any woman has any notion of for sure. 49, you're effectively quite young to think about whether or not you may be going through menopause. The important thing to realize is that perimenopause, which is actually the transition to a menopause stage, can last up to a decade.

I have friends and we have patients who are starting to go through the process in their 30s, and they have absolutely what they had, absolutely no idea what hit them. For some women in your 30s, you may actually be experiencing some symptoms of perimenopause. That is a very important time to really focus on self-care and make sure that you do everything you can, if you wish to support yourself, of course, to ease your transition to menopause and really support your body and your brain for the years to come because it can take years.

Kousha Navidar: We got another text just now that goes to this. You're on the ball with the ways that listeners are thinking this through right now. The text says, "I was not prepared at all. I just thought it was just sweating. It's a physical, mental, and emotional turmoil. I was tearing up in meetings and in conversations that were emotional, which was bad because I am a therapist," the listener that's texting right now. "I'm suffering from exhaustion as I wake up seven times a night at least and still have to work. I found myself this week thinking to ask my doctor for time off."

You were saying, Dr. Mosconi, ways to take care of yourself. What does that look like when you hear texts like this? What does your research suggest could be helpful ways forward?

Dr. Lisa Mosconi: There are several things that all women can look into to support and ease their transition through menopause. Usually, there are things that are pharmacological in nature, like prescription medications. Then there are things that are not and revolve around lifestyle, behavioral adjustment, behavioral therapy. I think every woman is different and every woman has different risks and different concerns and also specific risk tolerance. Some women prefer a prescription, some women prefer to do things differently and everything-- There is no right or wrong. That's the important thing to know that whatever solution works for you is the solution for you.

I really encourage all women to look at all the options. Hormone replacement therapy is a viable option for many women. In 2022, professional societies really revamped their guidelines. They're now stating that for most healthy women, younger than 60, or at least within 10 years, the final menstrual period, then taking hormone therapy is a viable resource. More often than not, the benefits really outweigh the risks. The sweating, the hot flashes is really alleviated by hormone therapy for most women.

Other therapies involve sometimes testosterone therapy, sometimes it's birth control that can help as well. For non-hormonal therapy, there are a few options like gabapentin is an option, but so is this new medication. It's called Veozah or Fezolinetant, which is nonhormonal that can really help with the hot flashes. Then there's a range of things like cognitive behavioral therapy. Hypnosis is also recommended by professional societies. Then lifestyle exercise is very helpful. A healthy diet is very helpful. Sleep support is helpful when sleep is a concern. There's a whole range of options that they do describe in the book as well.

Kousha Navidar: This is a major section of your book as well. There's integrative and lifestyle sections about therapies and hormonal nonhormonal therapies, which you're starting to get into. I just want to thank everyone who's sending us messages right now and sharing their stories with us. We're going to take a quick break and then get into some more of those messages. We're talking to Dr. Lisa Mosconi, who's a neuroscientist and women's brain health expert. Listeners, we want to hear from you. If you're a woman experiencing menopause or perimenopause, tell us how it's affecting your life. Do you have questions for us? Give us a call. 212-433-9692. We'll be right back after this.

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Kousha Navidar: This is All Of It on WNYC. I'm Kousha Navidar. We're talking to Dr. Lisa Mosconi, who's a neuroscientist and women's brain health expert, about menopause and the effect that it has on the brain with new science from her studies. She put out a book, The Menopause Brain: New Science Empowers Women to Navigate the Pivotal Transition with Knowledge and Confidence. Listeners, we're taking your calls. We want to know about your experience with menopause. Give us a call, shoot us a text. The number is 212-433-9692, or you can hit us up on social. Our handle is @allofitwnyc. Dr. Mosconi, we do have a couple of calls ready to go. Let's talk to Erin in Brooklyn. Hi, Erin, welcome to the show.

Erin: Hi. Thank you so much for taking my call. I want to thank you for studying this, Dr. Mosconi, because so little seems to be known about menopause even though it affects half the population. I have a symptom that even my female doctor, who's older, didn't know whether it was related to menopause, but a friend of mine who had a similar symptom thought it was. I'm in my early 50s, and I've been going through perimenopause for a number of years now. I don't have hot flashes, but I do have trouble sleeping and the brain fog.

Then I've had this other symptom where I feel like my head-- It's hard to explain without sounding crazy, but it feels like my head is floating. I feel spacey. I feel like my brain is rolling as I'm walking down the street, say, and I just feel untethered. It will last for a few minutes, up to 20 minutes, and then I feel normal again. I wasn't sure if something like this could be related to menopause or perimenopause or if you'd ever heard of it since you studied it more.

Kousha Navidar: Erin, thank you so much for that call and describing that. Dr. Mosconi, any insights there?

Dr. Lisa Mosconi: It might be. Menopause really impacts the brain ways that we are just starting to fully appreciate. We do know that menopause is a neurologically active state. What Erin was describing are some neurological symptoms. They would define sometimes as vertigo, dizziness. They go hand in hand with this kind of changes in perhaps blood pressure or other things that can occur leading to a feeling that there's something going on in your brain.

It's interesting how different women describe the symptoms using their own words because we actually lack a specific medical vocabulary to really do justice to what women experience during this transition. I would say it is possible. It is good to get a neurological examination in this case because it may be menopause, it may be something else. What we do that is very helpful is brain imaging, and maybe that's something that Erin's doctor may look into.

Kousha Navidar: Erin, I want to thank you for that sharing and for calling us. We also have Jane in Brooklyn. Hi, Jane. Welcome to the show.

Jane: Hi. Thank you for taking my call. I'm so appreciative of this conversation because before I became perimenopausal, my only access to menopause was the All in the Family episode where Edith went through it. I really didn't know anything about it. My mother never talked about it. I'm thankful for the conversation. I'm Black, and last year I just went through horrible times. I was 56. My sleep was affected. I was also a super hot flasher, for me, meaning that I would have intense hot flashes anywhere from four to five times a day literally in front of people, just breaking out into puddles of sweat.

Against my primary doctor's recommendation, I did seek out hormonal therapy replacement, and it's been a game-changer for me. What I am concerned about is, I've read that Black women tend to be super hot flashers more so than other ethnicities. Also, that tied to Alzheimer's that you were talking about. Is there connection ethnically in terms of the way you experience menopause? How concerned should I be about the Alzheimer's connection seeing as I was a super hot flasher?

Kousha Navidar: Thank you so much, Jane. One thing that I wanted to point out, Jane's call too, is that connection that she's asking about with menopause and Alzheimer's. I think a lot of listeners would find that valuable as well.

Dr. Lisa Mosconi: This is a really, really good question. It's a really good point. We know that there is a correlation between ethnicity and some of the symptoms of menopause. We do know that Black women and Hispanic women tend to experience more severe symptoms sometimes. That has been noted. The correlation or the association between menopause and Alzheimer's disease is under investigation for sure. We are doing quite a bit of research in that field, and we look at menopause as a trigger for Alzheimer's as a risk factor for Alzheimer's for some women.

It's also really important to know that all women go through menopause, but only some women, about 20% of women, develop Alzheimer's disease in old age. Clearly, there's something else that's also impacted and important, and we need to do more research for sure to really appreciate all the different components. I would not over-worry. I think it's important to keep in mind that there are many things that everyone can do to really support their brains for life and reduce the risk of Alzheimer's disease, especially by leading a healthy lifestyle. Things like diet, exercise, sleep hygiene, stress reduction, is really important. Those are all things that one can do if there is a concern around Alzheimer's risk.

Kousha Navidar: Another thing I noticed about Jane's call, which Jane, thank you again so much for calling, was this idea of having to ask her doctor about therapy versus being offered. There's this term that you use in your book, Dr. Mosconi, the phrase bikini medicine, and you call it one of the major healthcare challenges of our time. Seems like a good connection with this call we just had. Can you say what bikini medicine is? Talk us through that a little bit.

Dr. Lisa Mosconi: Yes. Bikini medicine is saying that from a medical perspective, what makes a woman a woman is those parts of the body that fit under a bikini, so reproductive organs and nothing more. This has been an issue in healthcare and research for centuries really because historically, medical professionals, clinicians, and scientists really believed that women were essentially smaller men with different reproductive organs. That led to not studying women's brains, for example, as being different from men's brains.

For a very long time, the vast majority of research was done on men. Men don't go through menopause, which is one reason that menopause remains, still today, one of the most underresearched, undertreated, and underdiagnosed fields of medicine, especially as far as the impact on the brain is concerned.

Kousha Navidar: What do you think needs to change to get that bias out of the system? It would take a long time, but what's in the way?

Dr. Lisa Mosconi: Well, I think that more and more women today are really standing up for themselves and for each other. There's definitely a movement to reclaim and revamp menopause. There's so much stigma around menopause. There's a combination of ageism and sexism that has really done a disservice to so many women because again, women are more than half of the population, and all women go through menopause. You have to beg for solutions and remedies, if you will, and just very little support in place.

I think on one hand, culture really needs to change what menopause is embraced as one aspect of women's health and women's lives that, yes, it's natural, all women go through it, but the symptoms are very real. It's not all in our hands. A lot of women really deserve attention and care, which should not be denied, for sure. Also, women have really been taught to fear their hormones and doubt their brains, which is a very direct consequence of bikini medicine. As scientists and clinicians, we really need to work to dispel these myths and have a better understanding of what happens during menopause and how to help women.

Kousha Navidar: Speaking of debunking myths, and I'm looking at the clock, there's so many messages. I want to get through a couple more.

Dr. Lisa Mosconi: Oh, go ahead.

Kousha Navidar: One reads, "There is so much conflicting information out there about the safety, cancer risk of therapy, bioidentical hormone therapy, but sadly, little information about the safety or non-safety of bioidentical hormone therapy. What people tell me is, I will get cancer if I don't stop the therapy in a couple of years. Any insight on the connection between that, whether that's true or a myth to be debunked?"

Dr. Lisa Mosconi: I will tell you what professional guidelines are saying, which they're definitely the most conservative guidelines that we have, the most accurate, in many ways. Until 2022, the recommendation was to take the lowest possible dose of hormones and stop as soon as possible. It was a very conservative recommendation. As of 2022, that guideline changed to, "You do take hormones for as long as you need them." There is no set date that you have to stop taking hormones provided that there is no clear risk that the hormones may bring on to you.

In that respect, it's important to really work together with your PCP or with OB-GYN, with your menopause specialist, perhaps, to make sure that you still need the hormones, that there's no reason to discontinue. If there is a reason to discontinue, then it's important to know that as well. Mammograms are really important, and other tests can be done as well to assess risk together with a thorough family history evaluation.

Kousha Navidar: One more message here, and I should just point out, there is not conflicting information about the safety of hormone therapy. Like you said, Dr. Mosconi, very important to talk to your PCP, your OB-GYN about this.

Dr. Lisa Mosconi: Yes.

Kousha Navidar: We've got just a little bit of time, but there's one more message I wanted to bring up. "In addition to the medical and neurological aspects of menopause, what makes the period in women's lives so difficult, I find, is that it feels like a loss of things that are society values. I would like to know how women's brains become stronger as a result of menopause." Essentially, what's the upside, Dr. Mosconi? Got about 30 seconds. Let us know.

Dr. Lisa Mosconi: In 30 seconds, research shows that the brain rewires itself during menopause, and a few things are changing in ways that are actually supportive of a woman's intellectual activity and mental health after menopause. Some upsides are emotional mastery, which means that many women report that emotions like sadness or anger don't hold quite the same charge, but the capacity to sustain joy and gratitude are deepened after menopause.

Kousha Navidar: We've been joined by Dr. Lisa Mosconi, The Menopause Brain. Thank you so much. We'll be back after this.

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