Michelle Obama, Gwyneth Paltrow, Naomi Watts, Tracee Ellis Ross, Salma Hayek and Oprah Winfrey are among the celebrities who’ve talked openly about menopause in recent years and have shed light on a topic long considered taboo.
Even New York City Mayor Eric Adams joined the conversation last January, when he said that if men experienced menopause, “they would get a paid vacation.”
Menopause is “one of the most under-researched, undertreated and underdiagnosed fields of medicine, especially as far as the impact on the brain is concerned,” said Dr. Lisa Mosconi, an associate professor of neuroscience at Weill Cornell Medicine. “For a very long time, the vast majority of research was done on men. Men don't go through menopause.”
Mosconi’s new book, “The Menopause Brain,” offers guidance about menopause, particularly on how it affects the brain. The book covers bias against women in menopause, the brain-hormone connection, hormonal and non-hormonal therapies, and the health care approach known as “integrative health.”
Although menopause is perhaps best known for changing reproductive organs, it also changes the brain, according to Mosconi, who also directs the Alzheimer's Prevention Program at Weill Cornell Medicine and New York-Presbyterian.
She recently spoke with WNYC’s Kousha Navidar on “All Of It” about menopause, self-care and other health topics. Their conversation has been edited below.
Kousha Navidar: When did your research start to focus on menopause?
Dr. Lisa Mosconi: My research started to focus on menopause in 2016. I have been studying women's brain health for the vast majority of my 20-year career. I started really young because I have a family history of Alzheimer's disease. 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 afterward, we published the first study, believe it or not, that used 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.
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.
We just got a text from a listener. 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?"
That's a wonderful question. This process is very variable from woman to woman. In the United States, the average age of menopause is 51, 52, but globally, it's actually 49. It's a lot earlier than any woman has any notion of for sure. At 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 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 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.
What does that self-care look like?
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. 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 encourage 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 of the final menstrual period, taking hormone therapy is a viable resource. More often than not, the benefits really outweigh the risks. The sweating, the hot flashes [are] really alleviated by hormone therapy for most women. Other therapies sometimes involve testosterone therapy. Sometimes it's birth control that can help as well.
For non-hormonal therapy, there are a few options. Gabapentin is an option, but so is this new medication. It's called Veozah or Fezolinetant, which is nonhormonal [and] 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. 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.
Can you talk about the connection with menopause and Alzheimer's?
It's 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 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 are really important. Those are all things that one can do if there is a concern around Alzheimer's risk.
There's this term that you use in your book, “bikini medicine,” and you call it one of the major health care challenges of our time. Can you say what bikini medicine is? Talk us through that a little bit.
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 health care and research for centuries 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 under-researched, undertreated and underdiagnosed fields of medicine, especially as far as the impact on the brain is concerned.
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?
I think that more and more women today are 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 [is] 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.
We've got just a little bit of time, but there's one more audience question I wanted to bring up. Essentially, what's the upside of menopause?
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.
