Latest / Dementia Researcher Vodcast / XXplored - The Midlife Transition: Menopause and the Brain

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XXplored - The Midlife Transition: Menopause and the Brain · Dementia Researcher Vodcast

0:00
- [Voice Over] Welcome to XXplored, Women's Brain Health,
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a dementia researcher podcast exploring the many factors
0:06
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
3:15
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.
3:30
- 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,
3:56
but if you can distil it very, very shortly
3:59
for our listeners, Claudia, maybe you can go first.
4:02
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
4:56
during perimenopause transition.
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So that's what I am doing
5:01
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.
5:27
- 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 2026 actually.
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So pretty soon, I'm mostly interested
5:46
in preclinical Alzheimer's disease
5:48
and I look specifically at, you know, sex differences
5:51
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.
7:19
(upbeat music)
7:25
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.
8:21
- Of course.
8:23
- 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
8:35
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
10:33
when it comes to the actual length of that,
10:35
that's where the cycle variations
10:38
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,
10:58
hot flashes, but also cognitive disturbances
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and depressive symptoms.
11:05
And then menopause again, this is one day
11:08
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
12:12
outside these cognitive symptoms
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that sometimes kind of are pushed under the rug.
12:17
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.
12:40
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.
13:21
We know that declining
13:24
and especially volatility like this volatile
13:28
decline in oestrogen,
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it's not just like linearly declining.
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It's like really fluctuating erratically
13:36
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.
13:58
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
14:20
due to structural changes, mainly from animal work
14:25
but also for some human studies.
14:27
And I think Gillian might say more about that later,
14:30
but there are hint stories like grey matter,
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white matter changes,
14:35
Print was the first ones postulating.
14:40
There might be this bioenergetic shift in the brain
14:43
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
14:54
that away from glucose metabolism,
14:58
it shifts to ketone body,
15:00
like metabolising ketone bodies
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which are part of the white matter.
15:05
And so it's like it's a very complex system
15:08
which is likely very tightly interlinked.
15:11
And then any of these changes might then contribute
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to mood disturbance
15:17
and cognitive changes,
15:18
especially if you already are potentially genetically
15:21
at risk if you have a certain lifestyle.
15:24
So which might not provide resilience
15:28
against these shifts
15:31
and especially also when you already
15:33
have a history of depressive disorders.
15:36
Depression has been postulated
15:39
as a very well established risk factor
15:41
of Alzheimer's disease later in life.
15:44
So it's very much tightly connected.
15:47
But my main statement in this regard
15:52
would be really structural changes,
15:54
functional changes
15:56
and particularly also changes
15:57
in neurotransmitter functioning.
16:00
- Wow, so all of these changes obviously
16:04
expose that women's brain to be more vulnerable
16:07
to later life conditions and neurodegenerative diseases
16:11
because of these fluctuations in hormones
16:13
that you mentioned and obviously
16:16
the critical glucose consumption hypothesis
16:18
that has been presented by Brenton.
16:21
So now I'd like to shift the microphone
16:24
and give the floor to Gillian
16:26
because I would like
16:28
to talk about probably the research area that we work in
16:32
and the research area that has been receiving
16:35
so much interest in the greatest scheme of menopause,
16:39
which is Alzheimer's disease.
16:41
So obviously we know that women make roughly 2/3
16:44
of all Alzheimer's disease cases,
16:46
but obviously it's not just the longevity
16:49
that explains all of these staggering numbers,
16:52
but it's actually the underlying biology
16:55
and the also cognitive trajectories that we see in women.
16:59
And in the past decades we have had this hypothesis
17:04
of menopause really breaching through
17:07
and suggesting that this is due to the menopausal
17:10
hormonal fluctuation, specifically due
17:13
to the decrease in in oestrogen levels.
17:15
So I would like
17:17
to ask Gillian if you could share some evidence
17:20
specifically advocated
17:22
for menopause being this critical inflexion point
17:26
in women's life that exposes her
17:28
to increased susceptibility for Alzheimer's disease.
17:31
- Yeah, so just as Claudia had beautifully taken us
17:35
to there, we have this whole like of events that happen
17:39
around menopause and then you know,
17:41
we as Alzheimer's disease researchers,
17:44
we're studying women usually in their kind of mid seventies
17:47
and looking at levels of these neurotoxic proteins
17:50
that cause Alzheimer's disease essentially.
17:52
And so what we do is we look at these women,
17:56
we image them for these neurotoxic proteins
17:59
and then we look back to see
18:01
how they experience menopause basically.
18:04
Now typically we don't have data sets
18:06
that can look at the fluctuations
18:09
in the hormones around menopause
18:11
and link them to later AD biomarkers
18:15
like these neurotoxic proteins.
18:16
But what we can do is we can look
18:18
at how women experience menopause
18:21
in terms of their menopausal symptoms which will be proxy
18:25
for those hormonal fluctuations.
18:27
We can also ask them, you know, when did they have
18:31
their last period,
18:32
which would be their age at menopause
18:35
and then we can also ask them whether or not
18:38
they were treated for menopausal symptoms with HRT.
18:43
And so I guess one of the things we've learned so far
18:47
is that if women move into this kind of menopausal
18:51
or perimenopausal state earlier than expected,
18:55
so particularly before the age of 40
18:58
or maybe between 40 and 45,
19:01
those women seem to be at a higher risk
19:04
for depositing these neurotoxic proteins,
19:07
amyloid and tau later in life.
19:09
So that association has been shown in neural imaging studies
19:13
but also shown in these, you know, epidemiological studies
19:16
that show that the age of menopause
19:18
is associated with Alzheimer's disease prevalence.
19:22
Right, so then we look at the biology
19:24
of what that link could be.
19:27
In terms of hormonal fluctuations,
19:31
we are writing grants at the moment
19:33
and I do know a couple of other scientists in the US
19:36
who are writing grants to look at how all of those events
19:39
during perimenopause change the women's brain structure
19:44
and function in real time.
19:46
So not necessarily looking at women's brains
19:48
down the line like we currently are doing,
19:50
but in real time
19:51
as the fluctuations in the hormones are occurring.
19:55
So some of the leading scientists
19:57
in that area right now would be Roberta Briton,
20:00
but also, you know, Emily Jacobs, they have a grant
20:04
kind of basically looking at exactly these questions.
20:06
Also Caitlyn Castello,
20:10
she's another scientist who's very prominent
20:13
in this area and then ourselves.
20:14
So me and Rachel Buckley, we're also proposing
20:18
a grant to look at perimenopausal effects
20:20
and how that implicates the brain.
20:22
In terms of what we look at in the brain
20:25
in menopausal women, we don't look
20:28
for the proteins of Alzheimer's disease
20:30
because it's very unlikely that they exist
20:33
at that stage, right?
20:34
So typically, if menopause is going to increase
20:39
women's risk of Alzheimer's disease, we won't know
20:43
that will have officially happened until they are at the age
20:46
where they can actually start depositing these proteins.
20:49
So what we instead look at is these other risk factors
20:53
that might suggest that women are on the road
20:56
to preclinical Alzheimer's disease.
20:59
And so some of those things
21:00
would be like more the plasma biomarkers.
21:03
Also things like inflammatory pathways, vascular pathways,
21:09
looking at brain structure and function of course
21:12
and brain structure, particularly in subfields
21:15
of the hippocampus like the CA3,
21:17
that would be a kind of region
21:19
we'd be particularly interested in
21:22
in these menopausal women.
21:23
And then looking at, you know, the structural integrity
21:26
of white matter tracts, those kind of things.
21:29
So those biomarkers are more likely to change
21:31
due to menopausal changes.
21:36
And then if they do change,
21:38
that kind of puts the brain in a more vulnerable state
21:41
to deposit these neurotoxic proteins later down the line.
21:46
And it's really the proteins
21:47
that underlie the actual onset of symptoms
21:50
related to Alzheimer's disease, at least,
21:53
of course there are other dementias
21:55
but we focus mostly on Alzheimer's,
21:58
so there's a lot to unpack.
22:02
Basically the way we're doing at the moment
22:05
is, as I said, we're looking at,
22:06
we have this big space of time
22:09
between when women report menopause,
22:11
menopausal symptoms and their menopausal age
22:15
and then we get pet scans on them 15 years later.
22:18
Whereas the way the field is moving
22:22
is to actually do those imaging studies
22:25
as the women are actually going through menopause
22:29
and that will be able to,
22:30
that will tell us a lot more basically about how menopause
22:36
leads women at risk, potentially could leave women at risk
22:40
of cognitive decline later in life.
22:42
- So we are seeing that definitely
22:44
a lot of retrospective studies
22:46
have laid this foundation
22:49
where we are now knowing or learning about how menopausal
22:52
or menopausal related factors are associated
22:55
with later accumulation of these toxic proteins
22:58
but also of structural changes that then also as you said,
23:03
kind of lead the brain to become more vulnerable later on.
23:07
And you mentioned one of the risk practises
23:10
that you have done in your research is actually
23:13
the earlier age of menopause
23:15
and most of the people probably think of menopause
23:19
as a natural process as it comes to ageing,
23:21
but obviously we have different types of menopause
23:24
such as surgical menopause.
23:26
So could you maybe comment a bit on that?
23:29
- Yeah, so I think the original hypothesis
23:32
was that it was probably surgical menopause
23:35
that would be women at risk and we're seeing in our data
23:40
or at least the data sets we work with,
23:42
if not so much the fact
23:43
that it was a surgically induced menopause,
23:45
it's more just that the menopause was early, right?
23:48
So you get this earlier than expected
23:51
deprivation in circulating estrogens, et cetera.
23:56
And then the fact
23:58
that this happens earlier than it should
24:00
is kind of having the detrimental effect,
24:03
as opposed to it being surgically induced as such.
24:07
At least that's what we're seeing
24:08
in the data we look at
24:10
from the Alzheimer's disease perspective.
24:12
But just by nature of having a surgically induced menopause,
24:16
then that is likely happening earlier than the average age
24:19
of menopause, which is 50, right?
24:22
It it's probably happening before the age of 45
24:25
if not before the age of 40.
24:28
So I think, you know, when we do
24:30
kind of interviews we also say
24:32
it is important for women
24:33
to always kind of know what's happening
24:38
with their reproductive health
24:38
and know if they're getting, you know,
24:42
surgically induced menopause that that is happening
24:45
for the right reasons
24:46
or at least it's really necessary in their case
24:49
'cause it can have implications for women brain health
24:53
and then you know, the brain health later down the line.
24:56
- Okay, so obviously that becomes less clear then,
25:00
it's not just again
25:01
the type but maybe the age
25:05
but then again maybe there is something behind that
25:07
that we don't know yet
25:08
and probably we don't know how to quantify
25:10
because historically the data sets that we are working on,
25:15
they don't collect that data
25:16
or if they collect, it's not to the extent
25:20
that we would like to.
25:21
So I would like to now move a little bit from what we know
25:26
to what we will know based on both of the work
25:28
that you are doing and specifically maybe talking
25:31
a little bit about the historical blind spots
25:35
in terms of the methodologies, these ageing cohorts
25:39
or Alzheimer's disease cohorts have been using.
25:41
So obviously like we know like ADNI
25:45
which is Alzheimer's Disease Neuroimaging Initiative,
25:48
but we also have more huge data sets
25:50
that are looking specifically
25:52
into how individuals
25:54
develop Alzheimer's disease from preclinical.
25:57
So this asymptomatic stage where the proteins start
26:00
to accumulate but yet in the absence
26:02
of any cognitive symptoms,
26:03
but none of these data sets have considered
26:06
sex specific variables
26:09
or perhaps to a very, very brief extent.
26:11
And why do you think that was the case potentially,
26:17
and then the follow up question, what would be
26:21
your kind of perfect list of reproductive variables
26:26
that you would like to include in your studies?
26:30
Because I know both of you are spinning big brands now.
26:32
So let's start with Claudia
26:35
and then go to you Gillian with your wishlists.
26:39
- So yeah, that's a good question
26:42
because like I've in the past mainly used like UK Biobank
26:47
which is a big UK based population sample
26:51
covering 500,000 individuals
26:55
and the nice thing of the UK Biobank it started collecting,
26:59
so inclusion ranges between like 40 and 70,
27:03
which again is already like actually a bit younger
27:09
than the most ageing cohorts,
27:11
which normally starts at the age of 65
27:14
historically rooted into based on the retirement age
27:19
in most countries.
27:21
And the UK Biobank
27:22
actually does cover the menopause transition,
27:26
but it has surprisingly little variables
27:29
on this particular aspect
27:31
and has no variables about symptoms.
27:35
And also it's really hard, we tried multiple times
27:39
to varying degrees of success,
27:43
to really establish if women in this court
27:47
perimenopausal.
27:49
So yeah, simply knowing if women have symptoms,
27:52
if they had symptoms as Gillian said
27:55
and that they ask retrospectively, how did you experience
27:59
the menopause transition is super important
28:02
'cause that varies a lot and, and there is more
28:06
and more indication that the severity of symptoms,
28:09
the number of co-occurring symptoms,
28:11
what kind of co-occurring symptoms,
28:13
how long they last might really be critical
28:17
for how women might age later in life.
28:22
So like questions around that are really, really important.
28:25
Then past reproductive history we have found associations
28:29
between a number of life births
28:32
and the ageing brain later in life.
28:35
So these kind of variables are really important
28:40
if women have used hormonal contraception,
28:45
can be very insightful to know for later brain ageing.
28:49
And so there's like, yeah,
28:52
like now that I'm starting acquiring data
28:58
across perimenopause,
29:00
like I'm setting up this like massive baseline questionnaire
29:04
about reproductive factors
29:05
and past histories and aged menarchy
29:08
and like trying to really kind of map out
29:10
all the reproductive years
29:12
as kind of comprehensively as possible to really kind of see
29:18
what we found in the UK Biobank, if that replicates
29:20
but also how that informs how women actively life
29:26
as Gillian said earlier, experience perimenopause.
29:30
So my grant really also kind of has a strong focus
29:35
on like symptom mapping.
29:37
So we are using an industry partnership
29:42
to have an app really for the participants to be able
29:46
to on a daily basis record their their symptoms
29:49
and their experiences
29:51
because I think that's a really big, big missing part
29:54
in all of these cohorts.
29:57
It's first of all that symptoms are not really acknowledged
30:01
but also it's mainly you have one,
30:05
two, three maybe time points.
30:08
So having also more densely sample data
30:09
across these critical inflexion points
30:12
is really, really needed.
30:14
And I'm really happy to see the trend
30:16
towards like focusing on perimenopause
30:18
and then focusing on longitudinal studies
30:21
during perimenopause
30:23
because I got money to do my part
30:26
but we need like comparable samples globally
30:29
so we can really look for robustness of effects
30:34
and generalizability of effects
30:36
and also to be able to tap into biopsychosocial aspects.
30:40
How does it differ between countries?
30:44
Does it differ between healthcare systems?
30:46
How kind of the experience of perimenopause,
30:51
transition impacts ageing later on life.
30:54
And there are already kind of some indication
30:57
not from imaging studies
30:58
but more also from when it comes
31:02
to attitudes towards menopause and mental health
31:06
because of attitudes towards might differ
31:07
between societies and between societal structures
31:09
and between potentially the western
31:13
and kind of the global north and the global south
31:19
and all these kind of differentiation.
31:21
So it's nice we are going in this direction
31:24
of having more varied approaches
31:28
although it is still kind of clustered
31:31
to the global north I have to admit.
31:34
But yeah, that's more symptoms,
31:38
more dense sampling
31:39
and ideally in the long run, also much more diverse samples
31:43
which is not just white women.
31:47
- Thank you so much for sharing your study as well
31:49
and what you're gonna be doing
31:51
with this highly phenotyped cohort.
31:53
And you were obviously saying
31:56
that this is the global north
31:58
but since we were talking about Germany
32:01
and European perspectives because of your study
32:03
and my curiosity is what is the situation on the other side
32:08
of that Atlantic ocean and how are you gonna measure
32:12
and quantify your participants Jillian?
32:16
- Yeah, so where to start really?
32:19
So I think, well when it comes to you know,
32:22
what we would ask women,
32:24
Emily Jacobs is actually putting together
32:27
this standardised questionnaire, you guys know about it.
32:30
It's where all researchers in, you know women's health
32:35
can basically use the standardised questionnaire
32:36
which really covers the scope
32:38
of things related menopause, timing, symptoms, et cetera,
32:41
but also hormone therapy type of hormone therapy dosage,
32:45
you know, et cetera.
32:48
So I think that will probably be incredibly valuable
32:51
to the field at large
32:52
and probably also using a global scale,
32:55
not just necessarily in North America I wouldn't think.
32:59
And so the interesting thing about women's health
33:02
is that, you know, in maybe 10 minutes,
33:06
we can acquire a huge amount
33:07
of data on women's reproductive health,
33:09
at least by participant self-report,
33:12
which has some limitations
33:14
but it still would be an awful lot better
33:16
than kind of the relatively sparse amount
33:18
of data we have on Women's Healths from these big data sets
33:21
that we work on at the moment.
33:23
So there's been a big push for, you know,
33:26
studies like a acne, the Wisconsin Registry
33:29
of Alzheimer's Prevention, the Harvard Ageing Brain Study,
33:32
all of these kind of open access data sets
33:34
to start including these questionnaires
33:37
as part of their screening processes.
33:40
And so I think there is a shift towards that now.
33:43
So in the next five years in particular,
33:46
I think we'll have a whole host of kind of new data
33:48
that we can work with from those data sets.
33:51
In terms of new studies that we're doing, a lot of it
33:56
is collecting blood samples from the women
33:58
as they go through perimenopause.
34:00
So these are more focused studies
34:02
on you know, menopause AD link
34:05
and then also using those blood samples
34:07
to run new, which can basically allow us
34:13
to capture all of these kind of inflammatory
34:14
and vascular pathways
34:16
and potentially cope apologies too like TBD 43,
34:20
and things beyond just Alzheimer's disease.
34:24
So I think the studies that we're designing now
34:28
specifically to look at menopause,
34:30
we'll be relying heavily on blood samples
34:32
and looking at hormone levels
34:34
and all of these other biomarkers.
34:36
But you know, when we think about these current
34:39
big scale data sets that are out there,
34:43
just bringing in these women's questionnaires
34:47
will also open us up to a whole kind of new field
34:50
of data analysis.
34:52
- Thank you so much and obviously your wishlist
34:56
allows, you know, all of our listeners
34:58
who are also potentially thinking
35:00
about conducting such studies, pay attention to variables
35:03
that you have mentioned today.
35:06
I also thought about something that Claudia,
35:09
you mentioned about the industry collaboration.
35:12
This is not still a common practise
35:14
in research environments.
35:16
Could you tell us how is your journey
35:18
with establishing that collaboration
35:20
and how that collaboration will help you
35:24
and how you using those industry supports?
35:27
- I kind of used to say when people ask me about that
35:31
that I'm just lazy
35:33
because I don't need to reinvent the wheel
35:35
or if they're much people out there
35:38
already kind of doing the work,
35:40
'cause for my study, like we have repeated imaging,
35:47
we have repeated blood samples
35:49
and we have like all the standards we've done
35:52
in previous studies but then I was like, okay,
35:55
how do we actually like really tap into symptom
35:59
and experiences and there is already
36:03
apps out there doing that.
36:07
And so I reached out to Clue,
36:10
which is a Berlin based menstrual cycle
36:14
tracking app startup.
36:16
And finally when I wrote my grant in 2023,
36:23
like they just released a perimenopause mode in September
36:27
and my deadline was in November
36:30
and then I just texted them
36:32
and said like I'm preparing this grant,
36:34
I just saw you release this board,
36:37
I would love to use that in my participants.
36:39
Would that be like,
36:41
are you interested in collaborating and so on so forth.
36:43
And they were super open so it was like very easy
36:46
and gave me a letter of support.
36:50
I budgeted for that.
36:51
And so it was like a nice story
36:54
and now we are kind of going back
36:56
and forth also how we could use already acquired data
37:01
and other kind of angles to really using
37:05
the data these EmTech startup, digital EmTech startups
37:09
already collecting based on their user base.
37:12
And Clue has a very nice kind of setup
37:17
where like in app you also already use
37:20
if you like already ask if you want
37:23
to participate in scientific research studies.
37:27
So that was really reassuring
37:30
so that they already have
37:31
very strict pipelines for research
37:35
and also very pragmatically for my context being in Europe
37:39
because it's a Europe based startup,
37:43
it also follows all the kind of GDPR,
37:46
which is like privacy law regulations in EU.
37:51
So that was also very attractive for me personally,
37:54
knowing that they would follow
37:56
the data protection standards we would need for research.
38:00
So for me that was a win-win.
38:03
- That's really inspiring to hear
38:04
that you have had a really positive experience
38:07
and obviously since we are talking
38:09
about really highly dense sampling methodologies
38:13
for our symptoms and potentially biomarkers,
38:15
I think also the future
38:17
of research and especially women's health research
38:20
should move from just laboratory based studies
38:23
to more remote settings.
38:24
And these platforms, these collaborations would allow us
38:28
to collect the data, whether it's symptoms,
38:31
whether it's some type
38:33
of sleep measures from the wearable device
38:36
or even like blood-based biomarkers
38:38
that obviously could be done through the health providers
38:42
and then they could put the information
38:45
related to the sampling time on their application.
38:49
So I think there's definitely way more bridges
38:52
that need to be billed between industry
38:54
and research in order to propel what we are doing.
38:57
And maybe fast track a little bit more in the future.
39:01
So our time is running away today,
39:04
but it's been a really rich
39:07
and great conversation about the menopause
39:12
and why this midlife transition has been really important.
39:15
(upbeat music)
39:21
Before we close, I would really like
39:23
to just bring one personal question to each of our speakers.
39:28
What does women's brain health mean to you
39:33
briefly in one sentence?
39:35
Personal Claudia.
39:38
- It means ageing gracefully and as best as possible
39:44
and by more research we can do that.
39:47
- Beautiful, Gillian.
39:49
- I think women's brain health for me
39:52
means sort of the forefront of research
39:56
and really coming out of the rug
39:58
and understanding everything there is
40:01
to understand about women's brains.
40:04
- Thank you, so that's it for the second episode
40:08
of XXplored, a huge thank you to both Dr. Claudia
40:12
and Dr. Gillian for your insights
40:14
and really taking us through this difficult period
40:18
in women's life.
40:20
But hopefully it's just brought a bit more light
40:23
and a little bit more understanding.
40:26
And as I reflect on the things that we have discussed today,
40:28
there are a few points
40:30
that kind of really struck a chord in me.
40:32
And one of them is both your research
40:37
and what you're doing on opposite sides of the world,
40:40
trying to bring the woman's brain health
40:42
and specifically during that critical vulnerable period
40:46
where it coincides with Alzheimer's, preclinical stages
40:50
of the disease and the multitude of methodologies
40:53
that you are using and trying to navigate the questions
40:58
that you are posing from multiple angles.
41:01
And I think that just kind of highlights
41:04
how still under researched this area is,
41:07
but with having such work coming up in the future,
41:11
I'm definitely feeling a bit more assured
41:14
about my own brain health
41:16
and also the health of our parents hopefully.
41:20
And then another also aspect that probably also
41:24
our listeners are gonna leave with
41:27
is that it's not just that one time
41:32
during the women's reproductive phase
41:34
and it's not just the menopause,
41:35
it's not just the stop in the menstrual cycle,
41:38
it's not just the drop in oestrogen,
41:40
but it's actually the lifetime exposure of oestrogen
41:45
through variables such as number of children
41:48
also the age at Menarchy, different pregnancy complications,
41:53
and as well as other risk factors that happen
41:58
during the whole life that all kind of shape
42:02
a woman's brain and may increase ones' risk.
42:07
So thank you once again for this great conversation.
42:11
I really hope that both of you can reconnect in conferences
42:16
and also we can bring more research
42:19
from these great ideas.
42:23
- Thank you very much for this nice conversation.
42:24
- Thank you Laura.
42:25
- So I'm Dr Laura Stankeviciute
42:26
and you have been listening
42:28
to XXplored, Women's Brain Health
42:31
on the Dementia Researcher Podcast.
42:34
(upbeat music)
42:38
- [Voice Over] Thank you for listening to Xxplored,
42:41
Women's Brain Health podcast from Dementia Researcher,
42:44
with generous support from the National Institute for Health
42:48
and Care Research, Alzheimer's Association,
42:50
Alzheimer's Research UK, Alzheimer's Society,
42:53
and Race Against Dementia.
42:57
From hormones to cognition, from risk to prevention,
43:00
we feature conversations with researchers, clinicians
43:01
and change makers working to challenge assumptions
43:04
and close the gaps in how we understand
43:06
and support the female brain.