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XXplored - The Midlife Transition: Menopause and the Brain
Episode 32321st November 2025 • Dementia Researcher Vodcast • Dementia Researcher
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In this episode of the Dementia Researcher - Xxplored Women’s Brain Health podcast, host Dr Laura Stankeviciute speaks with Professor Claudia Barth from Charite University and Dr Gillian Coughlan from Harvard Medical School to examine the midlife transition, menopause and its significance for women’s brain health.

Together they outline what the menopause truly involves across the early, late, and post stages, and explain how hormonal change affects brain structure, energy use, mood, and cognition. They also explore why this period may coincide with greater vulnerability to later Alzheimer’s disease and discuss the role of early or surgical menopause, symptom severity, and gaps in existing research cohorts.

The episode highlights the need for richer reproductive data, real time biomarker studies, and closer collaboration with digital health tools to better capture women’s lived experiences. It reflects a growing wave of research and public interest aimed at improving understanding, support, and evidence based care during this important life stage.

Takeaways

  • Menopause is a long transition shaped by fluctuating hormones.
  • Cognitive and mood symptoms reflect changes in brain networks.
  • Earlier menopause is linked with increased later Alzheimer’s risk.
  • Major research cohorts lack detailed reproductive data.
  • New real time studies are beginning to track symptoms and biomarkers.
  • Digital tools will be key for future research.
  • Better global representation is needed across studies.
  • Momentum is building to close long standing gaps in women’s health.

A transcript of this show, links and show notes and profile on all our guests are available on our website at https://www.dementiaresearcher.nihr.ac.uk.

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The views and opinions expressed by guests in this podcast are their own and do not necessarily reflect those of the producers, funders, or sponsors.

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Transcripts

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- [Voice Over] Welcome to

XXplored, Women's Brain Health,

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a dementia researcher podcast

exploring the many factors

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that shape women's brain

health across the lifespan.

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(upbeat music)

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- Hello and welcome to another episode

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of XXplored, Women's Brain Health.

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Today we're diving into very important,

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yet often misunderstood

reproductive stage in women's life,

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which is the midlife transition,

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also known as the menopause.

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(upbeat music)

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I'm your host Dr. Laura Stankeviciute

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and today we are talking about menopause.

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In the world, over one billion women

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are going through this stage

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or are already post-menopausal,

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and this number is expected to rise

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up to 1.2 billion in five years time.

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There was a recent study

conducted in the UK

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which found that nearly one

in four women aged 40 to 60,

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covering this post-menopausal

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and per menopausal period

that are considering

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to quit the work due to

the menopausal symptoms

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and there 14% of those who

are actually considering

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to do so if not have done yet.

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So women make up nearly half

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of the global workforce population

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and many will spend a huge amount

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of time in the post reductive years.

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Yet our research, support systems

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and clinical care still remains patchy,

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but perhaps it's not all that grey.

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And in the past years indeed,

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we have seen a huge

proliferation and a boom

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towards the topic of

menopause, both in research

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but also in the in the societal campaigns

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such as Let's Talk About Menopause

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to global celebrities

sharing their navigation

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through this difficult and

sometimes daunting period.

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But menopause is still only

framed around the topics

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of vasomotor symptoms such as hot flashes

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or night sweats, hormonal therapy,

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or also sometimes mentioned

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as the reproductive

ageing, while the brain

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is still left out of the picture.

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That's why today's episode will explore

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how menopause might act not merely

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as an endocrine transition,

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but rather an neuroendocrine tipping point

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and will help us understand

through this conversation

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and move menopause from the sidelines

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into the scientific

and societal spotlight.

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And I'm joined today by

two great researchers

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in this field of women's brain health,

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but also specifically working

on the menopause transition.

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So they're gonna help and

unpack these questions.

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So it's my honour to

introduce Dr. Claudia Barth

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who holds a professorship

for the neurobiology

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of hormonal transitions at the Department

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of Psychiatry in neurosciences

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and the research unit gender in medicine,

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university of Berlin in Germany.

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She's a biologist

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and also neuroscientist by training

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with a strong background

in neuroendocrinology.

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And another speaker of today,

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our guest in the series

is Dr. Gillian Coughlan.

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She's a junior researcher faculty

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at Harvard Medical School MGH.

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And her research projects

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focus on elucidated

personalised risk factors

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associated with the changes

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in Alzheimer's disease biomarkers,

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but also she's extremely

interested in understanding

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how factors such as sex differences

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may shape different trajectories

in AD pathophysiology

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and cognitive decline, so welcome.

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- Thank you very much for the invitation.

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- Very happy to be here.

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- Thank you for that introduction Laura.

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That was great.

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(upbeat music)

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- So just before we diving

into our main themes of today,

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I would like to ask just

a very simple question.

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Can you tell in a few sentences

what are you actually doing?

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'Cause obviously your

biographies are so, so rich,

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but if you can distil

it very, very shortly

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for our listeners, Claudia,

maybe you can go first.

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You've been thinking for

some time, you want go first.

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- So my research kind of as the title

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of the professor where I was lucky

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just got two months ago, kind of covers it

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really how hormonal transition

periods impact the brain

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with relevance to health and disease.

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We broadly focus on depression

and Alzheimer's disease risk,

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but thereby we focus on

diverse hormonal transitions

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if it's just menstrual cycle

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but also pregnancy and menopause.

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In the last years,

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the focus has been very much

shifted towards menopause

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and perimenopause specifically.

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I recently got a grant from

the European Research Council

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to really tap into what's happening

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during perimenopause transition.

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So that's what I am doing

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as I just started in my new

position like two months ago.

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What I'm actually doing right

now is setting up a big study.

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- Congratulations,

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This is amazing and thank you so much

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for doing the work

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that you're doing

specifically in this area

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that we know have been historically

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really difficult to get funding.

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So kudos definitely for this huge grant.

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- Thank you very much.

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- Yeah, so hi, so I'm Gillian Coughlan,

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I'm junior research faculty

at Harvard Medical School

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and I'm part of a grant

that kind of sets me up

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to start off a lab the

start of:

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So pretty soon, I'm mostly interested

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in preclinical Alzheimer's disease

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and I look specifically at,

you know, sex differences

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in order to understand disease processes,

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you know, kind of to a greater degree.

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So coming at it for more of this

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kind of personalised medicine approach

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and then to understand why women

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are disproportionately affected

by Alzheimer's disease,

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I also look at things

like age at menopause,

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specifically premature and early menopause

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and the use of hormone therapy.

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And I kind of investigate

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how those two things are

associated with AD biomarkers,

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primarily amyloid and tau pet,

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but also plasma biomarkers

like 217, et cetera.

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So we have a number

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of different grants now both from the NIH

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and different kind of foundation entities

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as well as private funding

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to look at women's brain health

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and how it can potentially increase risk

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for Alzheimer's disease in

that post-menopausal stage.

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So I think at the moment,

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there's actually so much interest

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it seems on a global level in

terms of women's brain health

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and Alzheimer's disease risk

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and there's a lot of research being done

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but I'm sure as we'll

discuss today, there's a lot

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of research that we can also do I think

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over the next three to five years.

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- Well this is a very

rich portfolio of topics

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that you are covering.

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Jillian, I think there's so many research

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that's gonna come up in the upcoming years

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from both of your labs and

congratulations to both of you.

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- Thank you.

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(upbeat music)

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So to start, I would like to go actually

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into the very, very basics

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of the question of what

is actually menopause.

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'Cause sometimes I feel like

it's a very confusing topic

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in terms of its terminology

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because you know, sometimes we may think

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or we can hear menopause being described

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as this one point in

women's reproductive life

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when a woman hasn't had

her menstrual period

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for 12 consecutive months.

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But of course that's more

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of an oversimplification than the reality

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because rather it's not just one point

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but a culmination of biological changes

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that have been preceding over the years.

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So Claudia, could you clarify to us

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what menopause really is?

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And then obviously you

have mentioned already

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the terminology of perimenopause,

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so can you also touch

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upon that and let us

clarify these two concepts.

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- Of course.

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- You kind of already hinted towards this.

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So it's kind of actually a lengthy

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endocrine transition period which starts

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with the like progressive

failure of ovarian function.

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So I like to compare it like,

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or I always like to say to students,

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so adolescence is when the

hormonal systems go online

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after they went already went online once

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during foetal development and mini purity.

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But then menopause is

kind of the delayed stage

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where systems slowly go offline.

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But it's not that you turn a switch

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and everything is offline

and you stop having cycles.

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The system goes slightly offline

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because it's regulated via the HPG axis.

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I hope I don't mix up the German

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and the English observation,

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but basically the brain

regulates the ovaries

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and this kind of little

dance gets interrupted

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more and more and more, which leads

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to erratic hormonal fluctuations,

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which then eventually cease.

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And that's the end of the

menopausal transition.

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And as you nicely said,

menopause by definition

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is actually just one time point

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after you haven't had a

menstrual cycle for 12 months.

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But preceding that, that's

what we call perimenopause,

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which are years of increasing like levels

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of fluctuation.

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Normally in the early

perimenopausal stages,

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you get slightly more variations

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in menstrual cycle length,

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tentatively more towards shorter cycles.

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You don't really have symptoms yet

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but your menstrual cycle length varies

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and there's some hormonal markers

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which slightly start changing.

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Then in the late per menopausal stage,

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which tends to on average we

between one to three years,

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but they're varying accounts

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when it comes to the

actual length of that,

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that's where the cycle variations

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become a much more

pronounced, late perimenopause

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after the straw criteria

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are defined by like not having

a cycle for 60 plus days.

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And then that's when also symptoms

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start to emerge in the majority of women.

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And that can be sleep

disturbances, night sweats,

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hot flashes, but also

cognitive disturbances

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and depressive symptoms.

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And then menopause again, this is one day

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and then post menopause is kind of starts

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after one year of not having had

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a menstrual cycle for 12 months.

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So actually there's one point

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of menopause which is often used

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to name the whole transition

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is really assessed retrospectively

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when you can say, okay, no,

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after now I haven't had

a cycle for 12 months.

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But also again for a lot of women,

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this might not be textbook,

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like they might not have a cycle

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for one year but then it comes back.

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So this system kind of

trying to compensate,

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just having another cycle

and eventually it stops

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and then hormonal fluctuation

stabilise and are stably low.

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- Well I hope our listeners can appreciate

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just how complex this whole continuum

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of pre, peri and post menopause is.

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And obviously each stage is accompanied

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by different symptoms

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and you mentioned obviously

the vasomotor symptoms,

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which are those that are

related to hot flashes,

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night sweats, but also you didn't leave

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outside these cognitive symptoms

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that sometimes kind of

are pushed under the rug.

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And I would actually like to go

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a little bit into those ones.

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So what is the actual

neurobiological explanation

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behind those symptoms?

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'Cause obviously it varies.

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We have different centres in the brain

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that orchestrate different functions.

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So we have the hypothalamus

perhaps more related

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to this thermo regulation.

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So vasomotor symptoms.

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But what about these cognitive symptoms.

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And also we hear that a lot of women

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are experiencing really huge differences

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in their mood from what they used to be

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to how their mood or like even

their personality changes.

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So what do we know about that Claudia,

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in terms of the brain specifics?

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- Well we know the most, you

already kind of hinted at,

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is like the changes in firm of regulation

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due to kind of changes

in the hypothalamus.

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So that's also the most studied symptoms,

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when it comes to the cognitive symptoms

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and the repressive symptoms,

we don't know that much yet.

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We know that declining

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and especially volatility

like this volatile

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decline in oestrogen,

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it's not just like linearly declining.

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It's like really fluctuating erratically

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and oestrogen has multiple

functions in the brain

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but it's also a very potent modulator

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of neurotransmitter systems

which are very important

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for your mood but also

your cognitive function.

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So that would be one potential mechanism

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which could like explain disturbances.

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Then also this oestrogen

is neuroprotective

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and with its declining level

this like neuroprotection

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might be lifted and in some women,

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which then also can contribute

to more accelerated ageing

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but also kind of neurological decline

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due to structural changes,

mainly from animal work

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but also for some human studies.

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And I think Gillian might

say more about that later,

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but there are hint

stories like grey matter,

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white matter changes,

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Print was the first ones postulating.

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There might be this

bioenergetic shift in the brain

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that kind of what the brain uses

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as an energy source might shift.

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And because glucose metabolism changes,

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then there's this theory

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that away from glucose metabolism,

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it shifts to ketone body,

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like metabolising ketone bodies

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which are part of the white matter.

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And so it's like it's

a very complex system

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which is likely very tightly interlinked.

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And then any of these

changes might then contribute

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to mood disturbance

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and cognitive changes,

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especially if you already

are potentially genetically

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at risk if you have a certain lifestyle.

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So which might not provide resilience

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against these shifts

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and especially also when you already

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have a history of depressive disorders.

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Depression has been postulated

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as a very well established risk factor

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of Alzheimer's disease later in life.

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So it's very much tightly connected.

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But my main statement in this regard

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would be really structural changes,

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functional changes

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and particularly also changes

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in neurotransmitter functioning.

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- Wow, so all of these changes obviously

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expose that women's brain

to be more vulnerable

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to later life conditions and

neurodegenerative diseases

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because of these fluctuations in hormones

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that you mentioned and obviously

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the critical glucose

consumption hypothesis

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that has been presented by Brenton.

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So now I'd like to shift the microphone

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and give the floor to Gillian

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because I would like

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to talk about probably the

research area that we work in

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and the research area

that has been receiving

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so much interest in the

greatest scheme of menopause,

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which is Alzheimer's disease.

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So obviously we know that

women make roughly 2/3

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of all Alzheimer's disease cases,

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but obviously it's not just the longevity

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that explains all of

these staggering numbers,

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but it's actually the underlying biology

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and the also cognitive

trajectories that we see in women.

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And in the past decades we

have had this hypothesis

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of menopause really breaching through

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and suggesting that this

is due to the menopausal

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hormonal fluctuation, specifically due

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to the decrease in in oestrogen levels.

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So I would like

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to ask Gillian if you

could share some evidence

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specifically advocated

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for menopause being this

critical inflexion point

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in women's life that exposes her

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to increased susceptibility

for Alzheimer's disease.

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- Yeah, so just as Claudia

had beautifully taken us

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to there, we have this whole

like of events that happen

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around menopause and then you know,

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we as Alzheimer's disease researchers,

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we're studying women usually

in their kind of mid seventies

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and looking at levels of

these neurotoxic proteins

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that cause Alzheimer's

disease essentially.

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And so what we do is

we look at these women,

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we image them for these

neurotoxic proteins

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and then we look back to see

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how they experience menopause basically.

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Now typically we don't have data sets

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that can look at the fluctuations

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in the hormones around menopause

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and link them to later AD biomarkers

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like these neurotoxic proteins.

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But what we can do is we can look

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at how women experience menopause

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in terms of their menopausal

symptoms which will be proxy

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for those hormonal fluctuations.

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We can also ask them, you

know, when did they have

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their last period,

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which would be their age at menopause

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and then we can also

ask them whether or not

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they were treated for

menopausal symptoms with HRT.

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And so I guess one of the

things we've learned so far

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is that if women move into

this kind of menopausal

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or perimenopausal state

earlier than expected,

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so particularly before the age of 40

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or maybe between 40 and 45,

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those women seem to be at a higher risk

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for depositing these neurotoxic proteins,

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amyloid and tau later in life.

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So that association has been

shown in neural imaging studies

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but also shown in these, you

know, epidemiological studies

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that show that the age of menopause

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is associated with Alzheimer's

disease prevalence.

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Right, so then we look at the biology

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of what that link could be.

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In terms of hormonal fluctuations,

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we are writing grants at the moment

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and I do know a couple of

other scientists in the US

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who are writing grants to look

at how all of those events

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during perimenopause change

the women's brain structure

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and function in real time.

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So not necessarily

looking at women's brains

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down the line like we currently are doing,

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but in real time

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as the fluctuations in the

hormones are occurring.

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So some of the leading scientists

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in that area right now

would be Roberta Briton,

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but also, you know, Emily

Jacobs, they have a grant

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kind of basically looking

at exactly these questions.

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Also Caitlyn Castello,

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she's another scientist

who's very prominent

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in this area and then ourselves.

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So me and Rachel Buckley,

we're also proposing

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a grant to look at perimenopausal effects

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and how that implicates the brain.

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In terms of what we look at in the brain

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in menopausal women, we don't look

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for the proteins of Alzheimer's disease

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because it's very unlikely that they exist

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at that stage, right?

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So typically, if menopause

is going to increase

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women's risk of Alzheimer's

disease, we won't know

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that will have officially

happened until they are at the age

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where they can actually start

depositing these proteins.

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So what we instead look at

is these other risk factors

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that might suggest that

women are on the road

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to preclinical Alzheimer's disease.

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And so some of those things

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would be like more the plasma biomarkers.

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Also things like inflammatory

pathways, vascular pathways,

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looking at brain structure

and function of course

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and brain structure,

particularly in subfields

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of the hippocampus like the CA3,

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that would be a kind of region

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we'd be particularly interested in

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in these menopausal women.

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And then looking at, you

know, the structural integrity

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of white matter tracts,

those kind of things.

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So those biomarkers are

more likely to change

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due to menopausal changes.

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And then if they do change,

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that kind of puts the brain

in a more vulnerable state

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to deposit these neurotoxic

proteins later down the line.

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And it's really the proteins

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that underlie the actual onset of symptoms

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related to Alzheimer's disease, at least,

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of course there are other dementias

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but we focus mostly on Alzheimer's,

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so there's a lot to unpack.

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Basically the way we're

doing at the moment

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is, as I said, we're looking at,

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we have this big space of time

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between when women report menopause,

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menopausal symptoms and

their menopausal age

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and then we get pet scans

on them 15 years later.

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Whereas the way the field is moving

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is to actually do those imaging studies

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as the women are actually

going through menopause

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and that will be able to,

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that will tell us a lot more

basically about how menopause

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leads women at risk, potentially

could leave women at risk

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of cognitive decline later in life.

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- So we are seeing that definitely

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a lot of retrospective studies

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have laid this foundation

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where we are now knowing or

learning about how menopausal

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or menopausal related

factors are associated

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with later accumulation

of these toxic proteins

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but also of structural changes

that then also as you said,

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kind of lead the brain to

become more vulnerable later on.

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And you mentioned one

of the risk practises

Speaker:

that you have done in

your research is actually

Speaker:

the earlier age of menopause

Speaker:

and most of the people

probably think of menopause

Speaker:

as a natural process

as it comes to ageing,

Speaker:

but obviously we have

different types of menopause

Speaker:

such as surgical menopause.

Speaker:

So could you maybe comment a bit on that?

Speaker:

- Yeah, so I think the original hypothesis

Speaker:

was that it was probably

surgical menopause

Speaker:

that would be women at risk

and we're seeing in our data

Speaker:

or at least the data sets we work with,

Speaker:

if not so much the fact

Speaker:

that it was a surgically

induced menopause,

Speaker:

it's more just that the

menopause was early, right?

Speaker:

So you get this earlier than expected

Speaker:

deprivation in circulating

estrogens, et cetera.

Speaker:

And then the fact

Speaker:

that this happens earlier than it should

Speaker:

is kind of having the detrimental effect,

Speaker:

as opposed to it being

surgically induced as such.

Speaker:

At least that's what we're seeing

Speaker:

in the data we look at

Speaker:

from the Alzheimer's disease perspective.

Speaker:

But just by nature of having a

surgically induced menopause,

Speaker:

then that is likely happening

earlier than the average age

Speaker:

of menopause, which is 50, right?

Speaker:

It it's probably happening

before the age of 45

Speaker:

if not before the age of 40.

Speaker:

So I think, you know, when we do

Speaker:

kind of interviews we also say

Speaker:

it is important for women

Speaker:

to always kind of know what's happening

Speaker:

with their reproductive health

Speaker:

and know if they're getting, you know,

Speaker:

surgically induced menopause

that that is happening

Speaker:

for the right reasons

Speaker:

or at least it's really

necessary in their case

Speaker:

'cause it can have implications

for women brain health

Speaker:

and then you know, the brain

health later down the line.

Speaker:

- Okay, so obviously that

becomes less clear then,

Speaker:

it's not just again

Speaker:

the type but maybe the age

Speaker:

but then again maybe there

is something behind that

Speaker:

that we don't know yet

Speaker:

and probably we don't know how to quantify

Speaker:

because historically the data

sets that we are working on,

Speaker:

they don't collect that data

Speaker:

or if they collect, it's not to the extent

Speaker:

that we would like to.

Speaker:

So I would like to now move a

little bit from what we know

Speaker:

to what we will know

based on both of the work

Speaker:

that you are doing and

specifically maybe talking

Speaker:

a little bit about the

historical blind spots

Speaker:

in terms of the methodologies,

these ageing cohorts

Speaker:

or Alzheimer's disease

cohorts have been using.

Speaker:

So obviously like we know like ADNI

Speaker:

which is Alzheimer's Disease

Neuroimaging Initiative,

Speaker:

but we also have more huge data sets

Speaker:

that are looking specifically

Speaker:

into how individuals

Speaker:

develop Alzheimer's

disease from preclinical.

Speaker:

So this asymptomatic stage

where the proteins start

Speaker:

to accumulate but yet in the absence

Speaker:

of any cognitive symptoms,

Speaker:

but none of these data

sets have considered

Speaker:

sex specific variables

Speaker:

or perhaps to a very, very brief extent.

Speaker:

And why do you think that

was the case potentially,

Speaker:

and then the follow up

question, what would be

Speaker:

your kind of perfect list

of reproductive variables

Speaker:

that you would like to

include in your studies?

Speaker:

Because I know both of you

are spinning big brands now.

Speaker:

So let's start with Claudia

Speaker:

and then go to you Gillian

with your wishlists.

Speaker:

- So yeah, that's a good question

Speaker:

because like I've in the past

mainly used like UK Biobank

Speaker:

which is a big UK based population sample

Speaker:

covering 500,000 individuals

Speaker:

and the nice thing of the UK

Biobank it started collecting,

Speaker:

so inclusion ranges

between like 40 and 70,

Speaker:

which again is already

like actually a bit younger

Speaker:

than the most ageing cohorts,

Speaker:

which normally starts at the age of 65

Speaker:

historically rooted into

based on the retirement age

Speaker:

in most countries.

Speaker:

And the UK Biobank

Speaker:

actually does cover the

menopause transition,

Speaker:

but it has surprisingly little variables

Speaker:

on this particular aspect

Speaker:

and has no variables about symptoms.

Speaker:

And also it's really hard,

we tried multiple times

Speaker:

to varying degrees of success,

Speaker:

to really establish if women in this court

Speaker:

perimenopausal.

Speaker:

So yeah, simply knowing

if women have symptoms,

Speaker:

if they had symptoms as Gillian said

Speaker:

and that they ask retrospectively,

how did you experience

Speaker:

the menopause transition

is super important

Speaker:

'cause that varies a lot

and, and there is more

Speaker:

and more indication that

the severity of symptoms,

Speaker:

the number of co-occurring symptoms,

Speaker:

what kind of co-occurring symptoms,

Speaker:

how long they last

might really be critical

Speaker:

for how women might age later in life.

Speaker:

So like questions around that

are really, really important.

Speaker:

Then past reproductive history

we have found associations

Speaker:

between a number of life births

Speaker:

and the ageing brain later in life.

Speaker:

So these kind of variables

are really important

Speaker:

if women have used hormonal contraception,

Speaker:

can be very insightful to

know for later brain ageing.

Speaker:

And so there's like, yeah,

Speaker:

like now that I'm starting acquiring data

Speaker:

across perimenopause,

Speaker:

like I'm setting up this like

massive baseline questionnaire

Speaker:

about reproductive factors

Speaker:

and past histories and aged menarchy

Speaker:

and like trying to really kind of map out

Speaker:

all the reproductive years

Speaker:

as kind of comprehensively as

possible to really kind of see

Speaker:

what we found in the UK

Biobank, if that replicates

Speaker:

but also how that informs

how women actively life

Speaker:

as Gillian said earlier,

experience perimenopause.

Speaker:

So my grant really also

kind of has a strong focus

Speaker:

on like symptom mapping.

Speaker:

So we are using an industry partnership

Speaker:

to have an app really for

the participants to be able

Speaker:

to on a daily basis record

their their symptoms

Speaker:

and their experiences

Speaker:

because I think that's a

really big, big missing part

Speaker:

in all of these cohorts.

Speaker:

It's first of all that symptoms

are not really acknowledged

Speaker:

but also it's mainly you have one,

Speaker:

two, three maybe time points.

Speaker:

So having also more densely sample data

Speaker:

across these critical inflexion points

Speaker:

is really, really needed.

Speaker:

And I'm really happy to see the trend

Speaker:

towards like focusing on perimenopause

Speaker:

and then focusing on longitudinal studies

Speaker:

during perimenopause

Speaker:

because I got money to do my part

Speaker:

but we need like

comparable samples globally

Speaker:

so we can really look

for robustness of effects

Speaker:

and generalizability of effects

Speaker:

and also to be able to tap

into biopsychosocial aspects.

Speaker:

How does it differ between countries?

Speaker:

Does it differ between healthcare systems?

Speaker:

How kind of the experience

of perimenopause,

Speaker:

transition impacts ageing later on life.

Speaker:

And there are already

kind of some indication

Speaker:

not from imaging studies

Speaker:

but more also from when it comes

Speaker:

to attitudes towards

menopause and mental health

Speaker:

because of attitudes towards might differ

Speaker:

between societies and

between societal structures

Speaker:

and between potentially the western

Speaker:

and kind of the global

north and the global south

Speaker:

and all these kind of differentiation.

Speaker:

So it's nice we are

going in this direction

Speaker:

of having more varied approaches

Speaker:

although it is still kind of clustered

Speaker:

to the global north I have to admit.

Speaker:

But yeah, that's more symptoms,

Speaker:

more dense sampling

Speaker:

and ideally in the long run,

also much more diverse samples

Speaker:

which is not just white women.

Speaker:

- Thank you so much for

sharing your study as well

Speaker:

and what you're gonna be doing

Speaker:

with this highly phenotyped cohort.

Speaker:

And you were obviously saying

Speaker:

that this is the global north

Speaker:

but since we were talking about Germany

Speaker:

and European perspectives

because of your study

Speaker:

and my curiosity is what is

the situation on the other side

Speaker:

of that Atlantic ocean and

how are you gonna measure

Speaker:

and quantify your participants Jillian?

Speaker:

- Yeah, so where to start really?

Speaker:

So I think, well when

it comes to you know,

Speaker:

what we would ask women,

Speaker:

Emily Jacobs is actually putting together

Speaker:

this standardised questionnaire,

you guys know about it.

Speaker:

It's where all researchers

in, you know women's health

Speaker:

can basically use the

standardised questionnaire

Speaker:

which really covers the scope

Speaker:

of things related menopause,

timing, symptoms, et cetera,

Speaker:

but also hormone therapy type

of hormone therapy dosage,

Speaker:

you know, et cetera.

Speaker:

So I think that will probably

be incredibly valuable

Speaker:

to the field at large

Speaker:

and probably also using a global scale,

Speaker:

not just necessarily in North

America I wouldn't think.

Speaker:

And so the interesting

thing about women's health

Speaker:

is that, you know, in maybe 10 minutes,

Speaker:

we can acquire a huge amount

Speaker:

of data on women's reproductive health,

Speaker:

at least by participant self-report,

Speaker:

which has some limitations

Speaker:

but it still would be an awful lot better

Speaker:

than kind of the relatively sparse amount

Speaker:

of data we have on Women's

Healths from these big data sets

Speaker:

that we work on at the moment.

Speaker:

So there's been a big push for, you know,

Speaker:

studies like a acne,

the Wisconsin Registry

Speaker:

of Alzheimer's Prevention, the

Harvard Ageing Brain Study,

Speaker:

all of these kind of open access data sets

Speaker:

to start including these questionnaires

Speaker:

as part of their screening processes.

Speaker:

And so I think there is

a shift towards that now.

Speaker:

So in the next five years in particular,

Speaker:

I think we'll have a whole

host of kind of new data

Speaker:

that we can work with

from those data sets.

Speaker:

In terms of new studies that

we're doing, a lot of it

Speaker:

is collecting blood samples from the women

Speaker:

as they go through perimenopause.

Speaker:

So these are more focused studies

Speaker:

on you know, menopause AD link

Speaker:

and then also using those blood samples

Speaker:

to run new, which can basically allow us

Speaker:

to capture all of these

kind of inflammatory

Speaker:

and vascular pathways

Speaker:

and potentially cope

apologies too like TBD 43,

Speaker:

and things beyond just

Alzheimer's disease.

Speaker:

So I think the studies

that we're designing now

Speaker:

specifically to look at menopause,

Speaker:

we'll be relying heavily on blood samples

Speaker:

and looking at hormone levels

Speaker:

and all of these other biomarkers.

Speaker:

But you know, when we

think about these current

Speaker:

big scale data sets that are out there,

Speaker:

just bringing in these

women's questionnaires

Speaker:

will also open us up to

a whole kind of new field

Speaker:

of data analysis.

Speaker:

- Thank you so much and

obviously your wishlist

Speaker:

allows, you know, all of our listeners

Speaker:

who are also potentially thinking

Speaker:

about conducting such studies,

pay attention to variables

Speaker:

that you have mentioned today.

Speaker:

I also thought about

something that Claudia,

Speaker:

you mentioned about the

industry collaboration.

Speaker:

This is not still a common practise

Speaker:

in research environments.

Speaker:

Could you tell us how is your journey

Speaker:

with establishing that collaboration

Speaker:

and how that collaboration will help you

Speaker:

and how you using those industry supports?

Speaker:

- I kind of used to say when

people ask me about that

Speaker:

that I'm just lazy

Speaker:

because I don't need to reinvent the wheel

Speaker:

or if they're much people out there

Speaker:

already kind of doing the work,

Speaker:

'cause for my study, like

we have repeated imaging,

Speaker:

we have repeated blood samples

Speaker:

and we have like all

the standards we've done

Speaker:

in previous studies but

then I was like, okay,

Speaker:

how do we actually like

really tap into symptom

Speaker:

and experiences and there is already

Speaker:

apps out there doing that.

Speaker:

And so I reached out to Clue,

Speaker:

which is a Berlin based menstrual cycle

Speaker:

tracking app startup.

Speaker:

And finally when I wrote my grant in 2023,

Speaker:

like they just released a

perimenopause mode in September

Speaker:

and my deadline was in November

Speaker:

and then I just texted them

Speaker:

and said like I'm preparing this grant,

Speaker:

I just saw you release this board,

Speaker:

I would love to use

that in my participants.

Speaker:

Would that be like,

Speaker:

are you interested in

collaborating and so on so forth.

Speaker:

And they were super open

so it was like very easy

Speaker:

and gave me a letter of support.

Speaker:

I budgeted for that.

Speaker:

And so it was like a nice story

Speaker:

and now we are kind of going back

Speaker:

and forth also how we could

use already acquired data

Speaker:

and other kind of angles to really using

Speaker:

the data these EmTech startup,

digital EmTech startups

Speaker:

already collecting based

on their user base.

Speaker:

And Clue has a very nice kind of setup

Speaker:

where like in app you also already use

Speaker:

if you like already ask if you want

Speaker:

to participate in

scientific research studies.

Speaker:

So that was really reassuring

Speaker:

so that they already have

Speaker:

very strict pipelines for research

Speaker:

and also very pragmatically

for my context being in Europe

Speaker:

because it's a Europe based startup,

Speaker:

it also follows all the kind of GDPR,

Speaker:

which is like privacy

law regulations in EU.

Speaker:

So that was also very

attractive for me personally,

Speaker:

knowing that they would follow

Speaker:

the data protection standards

we would need for research.

Speaker:

So for me that was a win-win.

Speaker:

- That's really inspiring to hear

Speaker:

that you have had a

really positive experience

Speaker:

and obviously since we are talking

Speaker:

about really highly dense

sampling methodologies

Speaker:

for our symptoms and

potentially biomarkers,

Speaker:

I think also the future

Speaker:

of research and especially

women's health research

Speaker:

should move from just

laboratory based studies

Speaker:

to more remote settings.

Speaker:

And these platforms, these

collaborations would allow us

Speaker:

to collect the data,

whether it's symptoms,

Speaker:

whether it's some type

Speaker:

of sleep measures from the wearable device

Speaker:

or even like blood-based biomarkers

Speaker:

that obviously could be done

through the health providers

Speaker:

and then they could put the information

Speaker:

related to the sampling

time on their application.

Speaker:

So I think there's

definitely way more bridges

Speaker:

that need to be billed between industry

Speaker:

and research in order to

propel what we are doing.

Speaker:

And maybe fast track a little

bit more in the future.

Speaker:

So our time is running away today,

Speaker:

but it's been a really rich

Speaker:

and great conversation about the menopause

Speaker:

and why this midlife transition

has been really important.

Speaker:

(upbeat music)

Speaker:

Before we close, I would really like

Speaker:

to just bring one personal

question to each of our speakers.

Speaker:

What does women's brain health mean to you

Speaker:

briefly in one sentence?

Speaker:

Personal Claudia.

Speaker:

- It means ageing gracefully

and as best as possible

Speaker:

and by more research we can do that.

Speaker:

- Beautiful, Gillian.

Speaker:

- I think women's brain health for me

Speaker:

means sort of the forefront of research

Speaker:

and really coming out of the rug

Speaker:

and understanding everything there is

Speaker:

to understand about women's brains.

Speaker:

- Thank you, so that's

it for the second episode

Speaker:

of XXplored, a huge thank

you to both Dr. Claudia

Speaker:

and Dr. Gillian for your insights

Speaker:

and really taking us through

this difficult period

Speaker:

in women's life.

Speaker:

But hopefully it's just

brought a bit more light

Speaker:

and a little bit more understanding.

Speaker:

And as I reflect on the things

that we have discussed today,

Speaker:

there are a few points

Speaker:

that kind of really struck a chord in me.

Speaker:

And one of them is both your research

Speaker:

and what you're doing on

opposite sides of the world,

Speaker:

trying to bring the woman's brain health

Speaker:

and specifically during that

critical vulnerable period

Speaker:

where it coincides with

Alzheimer's, preclinical stages

Speaker:

of the disease and the

multitude of methodologies

Speaker:

that you are using and trying

to navigate the questions

Speaker:

that you are posing from multiple angles.

Speaker:

And I think that just kind of highlights

Speaker:

how still under researched this area is,

Speaker:

but with having such work

coming up in the future,

Speaker:

I'm definitely feeling a bit more assured

Speaker:

about my own brain health

Speaker:

and also the health of

our parents hopefully.

Speaker:

And then another also

aspect that probably also

Speaker:

our listeners are gonna leave with

Speaker:

is that it's not just that one time

Speaker:

during the women's reproductive phase

Speaker:

and it's not just the menopause,

Speaker:

it's not just the stop

in the menstrual cycle,

Speaker:

it's not just the drop in oestrogen,

Speaker:

but it's actually the

lifetime exposure of oestrogen

Speaker:

through variables such

as number of children

Speaker:

also the age at Menarchy,

different pregnancy complications,

Speaker:

and as well as other

risk factors that happen

Speaker:

during the whole life

that all kind of shape

Speaker:

a woman's brain and may

increase ones' risk.

Speaker:

So thank you once again for

this great conversation.

Speaker:

I really hope that both of you

can reconnect in conferences

Speaker:

and also we can bring more research

Speaker:

from these great ideas.

Speaker:

- Thank you very much for

this nice conversation.

Speaker:

- Thank you Laura.

Speaker:

- So I'm Dr Laura Stankeviciute

Speaker:

and you have been listening

Speaker:

to XXplored, Women's Brain Health

Speaker:

on the Dementia Researcher Podcast.

Speaker:

(upbeat music)

Speaker:

- [Voice Over] Thank you

for listening to Xxplored,

Speaker:

Women's Brain Health podcast

from Dementia Researcher,

Speaker:

with generous support from the

National Institute for Health

Speaker:

and Care Research,

Alzheimer's Association,

Speaker:

Alzheimer's Research

UK, Alzheimer's Society,

Speaker:

and Race Against Dementia.

Speaker:

From hormones to cognition,

from risk to prevention,

Speaker:

we feature conversations

with researchers, clinicians

Speaker:

and change makers working

to challenge assumptions

Speaker:

and close the gaps in how we understand

Speaker:

and support the female brain.

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