So, you know, male brains are also fluctuating based on testosterone fluctuating.
So just set that aside to think that males are like these sort of stable, steady, you
know, like there's no such thing as like, you know, emotional men who are the ones that
like drive up the back of you really close and do all that stuff in a car and like who
start fights and wars, etc.
I don't think it's the women of the emotional ones here.
Yeah, sounds a little hysterical to me.
I think that men can be like big boys, you know, babies, not even boys, you know.
Hey, hey, and welcome to the 40s Formula, your go-to place for insightful discussions
on navigating the 40s and thriving in this transformative decade.
We're your hosts, Jasmine and Amanda, two women that are passionate about exploring
the challenges and adventures that come with turning 40 and what lies ahead.
Dr. Sarah McKay is a neuroscientist and renowned science communicator with a talent for making
brain science accessible to enhance health, wellbeing and performance.
A graduate of Oxford University, Dr. Sarah holds an MSc and a PhD in neuroscience.
After moving to Australia, she spent five years conducting postdoctoral research on
spinal cord injury before founding ThinkBrain, an online platform dedicated to professional
development in applied neuroscience and brain health.
In 2019, Sarah took to the screen presenting an ABC catalyst episode on brain health, biohacking
and longevity.
She is also the author of two acclaimed books, the Wellness Brain Book, the Neuroscience
of Health, Hormones and Happiness and Baby Brain, the surprising neuroscience of how
pregnancy and motherhood sculpt our brains and change our minds for the better.
Her upcoming third book, part of the iconic For Dummies series, will focus on brain health
and is set to release in early 2025.
Sarah's work has been featured in numerous outlets, including the Wall Street Journal,
The Guardian, Sydney Morning Herald, Australian Women's Weekly and more.
She has shared her insights on SBS Insights, ABC Radio National, Mamma Mia and various
other platforms, as well as on stages like Business Chicks and Canberra Writers Festival.
Sarah lives on Sydney's northern beaches with her husband and two teenage sons, where
they enjoy surfing, sailing and ocean swimming.
Today we're diving into what I think is the most fascinating aspect of our health, our
brains, and here to help us unravel the mysteries of our mind, we have Dr Sarah McKay.
Welcome Dr Sarah.
Hello, hi, thanks for having me.
Oh, it's our pleasure.
Thank you for joining us today.
Before we kick off, I know that your book, Demystifying the Female Brain, is not about
the differences between men and women's brain, but I am intrigued.
Can you tell by looking at a scan whether you are looking at a female brain, a male
brain and can you also see whether you would be able to determine whether someone is non-binary
or how they identify just from the scan?
So, if I was to just like, say I was a surgeon, before we get to the brain scan, say I was
a surgeon and I was to open up a skull and look inside and look at a bunch of brains
and the people were covered from the eyes down, couldn't see who they were by their
bodies, we wouldn't be able to look at a brain and go, that's male, that's female, it's not
like they're pink or blue.
You might see, if you were looking at them at 100 brains or so, you might start to get
a little bit of a feel that some of them are a bit bigger than others and you might go,
well the big ones are probably more likely to be male brains than female brains because
on average, if you looked at 100 brains, on average the male brains might be 10% or so
larger, but you might get really big female brains and really tiny male brains too.
So you know, think about normal distribution curves.
That like from the outside in is the kind of the largest clear sex difference that we
see but we certainly can't sort brains based on size just by looking at them from the outside.
Now brain scanning technology and data sharing and analysis has changed like extraordinarily
within the last five to ten years.
So for a long time there we would, you know, scan a brain and you would do all of the data
analysis looking at the size and the shape and the connections, etc.
And you might have an MRI researcher who could like scan say 20 brains over the course of
a month and they'd be analyzing all of the data based, you know, with their Excel spreadsheets.
And even then we might not really get any, be able to see any clear differences particularly
if we were looking at brain structure.
If we started to look at brain function, sometimes perhaps we might see differences in connectivity
but again it's not very clear and we can't kind of sort pink, blue, pink, blue, pink,
blue.
What we have been able to start to do recently is now scientists have started to kind of
collaboration share like what we tell kids in primary school to do and they're pooling
all of like their data together into large biobanks.
So instead of, you know, one scientist studying 17 brains here and another if they were really
lucky had 40 to study, people are pooling their data together and we can now look at
like 10,000 brain scans that can all get pulled into a data bank and then scientists can like
pull that data out and analyze it using, not just using an Excel spreadsheet, maybe using
machine learning and AI now to analyze that.
And we will, and there's a lot of power in numbers and so that has started to show very
subtle differences that can be picked up by artificial intelligence when you've got thousands
and thousands and thousands of brain scans.
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Now back to the chat.
So that's a different kind of way of thinking, can we see male or female brain differences?
The thing is when we're looking at differences, we're looking at, you know, are we looking
at size?
Are we looking at a specific part of the brain?
How it's kind of organized?
Are we zooming in and looking at like different parts of the brain and how they function?
Obviously in a female brain, there's a part of the brain that's evolved with ovulation.
You know, I haven't got that part of the brain in a male, but could you look at it and see
difference?
Could you sort of zoom on in with your microscope and perhaps look at different kind of levels
of chemicals or where neurons are organized?
Maybe.
So the differences that we're starting to see are these very subtle differences, but
they can really only be picked up when you're looking at many thousands of people.
We've then got this other problem.
Typically what we do when we're looking at people's brains is we're looking at what we
call like kind of weird populations.
We're looking at like white, you know, white male college students from America, because
they're typically the people that might volunteer for these studies.
We're not kind of looking at the diversity that we would see across the global population
in terms of brains.
So when we start to think about differences, we tend to think it's biological sex only
that would be driving any difference we see.
And biological sex differences tend to get amplified at puberty.
So if we're looking at children's brains, we're not really seeing many differences.
Differences that we might start to see might start slightly to emerge at puberty a little
bit.
But there's a whole lot of other stuff going on.
So I was talking yesterday, I actually posted something on Instagram about this.
This interesting study was published in 2013 looking at how experiences of gender and gender
equality and sort of different socioeconomic climates in countries influence brain differences.
And this is interesting because they kind of ranked a whole lot of different countries
by gender equality within that country.
So countries like Sweden and Finland and Germany, you know, are scoring really, really high
on gender equality and countries that are worse on gender equality at places like India
and Turkey.
So you can kind of get us get a ranking of countries.
And what they found was that in countries with more gender inequality, male and female
brains were more different.
Wow.
In countries with more gender equality, where males and females are more equal, their brains
were more similar.
And what is interesting is it's not the male's brains in any of those countries that differ.
The differences, the women's brains in countries where there's less gender equality are more
different to the others.
And so here it's not just a biological sex difference that's driving that.
It's the gendered experiences that girls and women have as they're growing up in those
countries because, you know, you're kind of growing a brain your whole life.
So we're seeing more sex differences in countries where there's less gender equality.
So it's not just sex differences that are driving.
That's because someone's male, because someone's female.
The whole thing about like what is your gender identity is so, so, so new.
We have hardly got, we don't, we have got barely any research data in the neuroscience
space on that.
There have been no studies done this far.
There's been, there've been a few little case studies like let's look at this one person,
like you've got a kid who wants to transition, give them puberty blockers, whatever, cross
sex hormones.
Let's look, like we looked at like kind of one kid here or there.
We have no evidence of what is going on.
We have no evidence in terms of gender identity, what that looks like in a brain.
I don't know whether it looks like anything.
I don't think it's any different from identifying as a, you know, like I identify as a New Zealand
or an Australian or you might identify as British or Singaporean or American, right?
When we're not going to, we can't really kind of pick that sort of thing up in a brain
scan.
So the whole gender current discussion around gender is very different from what I've just
described, gendered experiences of girls growing up with this inequality and adversity and
perhaps lack of education.
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And now back to the show.
And when you say that the brains looked more similar or looked more different, are you
referring to specifically the physicality of that brain or are you referring to different
reactions?
Yeah, I'm looking, I'm specifically referring to the physical sort of structure and volume
of certain parts and certain brain regions in those women in countries where they face
more adversity and stress and inequality and lack of access to education.
So their brains are less similar to the males.
The male's brains anywhere in the world are all the same.
The brains that appear to have suffered from, you could call it the patriarchy, the girls
and women's brains in those countries with lower gender equality because they haven't
had access to the same opportunities, like literally the person and therefore their brain
hasn't had access to the same equal opportunities.
So we're not just seeing here biological sex determining how a brain develops.
It's the environment in which someone grows up.
And we know that from other studies that have been done, looking at 10,000, looking at the
brain scans of 10,000 kids kind of growing up through infancy childhood through to like
kind of early puberty.
We've got data on that.
Children who are experiencing more adversity in early childhood, so perhaps they're growing
up in a really chaotic family home, they're growing up with abuse, they're growing up
with extreme poverty, you know, perhaps they're experiencing war or natural disasters.
Those kids' brains will not develop at the same rate as children who don't experience
that.
What's really interesting is sometimes their brain age appears to be more advanced.
It's almost like their brains have aged faster than the kids who have not faced adversity.
If the children have been experiencing complete neglect, often we see their brains ageing
slower.
So there you're going to be unpacking not only sort of adversity and trauma and socioeconomic
class and status, but you've also got the experiences of gender in there.
And in many parts of the world, it's girls that are suffering more than the boys, you
know, for some of those trauma indicators.
So it's really complicated when we want to start to try and be really ask very simple
questions about are the brains different, we have to ask very sophisticated questions,
go how different are the differences?
What might be potentially driving them?
Which population of people are we looking at?
You know, like I said, AI could sort male brain, female brain, with a reasonable degree
of accuracy, maybe 80% accuracy on the data set it's been trained on.
So you train an AI on the UK Biobank data set, which is British people, but then can
that AI then sort male, female brain sex differences that's given the data from a Chinese data
set or a Brazilian data set?
It would need to be trained up on that data set because it might be picking up different
differences.
And that would be like the nature nurture sort of difference because depending on where
you grew up, your experiences are very different.
It's fascinating.
100%.
And that's clearly what this gender inequality brain difference study showed.
It's not just sex differences that are driving any differences that we see, it's gendered
experiences, access to, you know, all of the things that we know that all people need to
grow.
So when it comes to sort of male female differences, obviously, one of the big things is hormones
and menstruating.
And you know, you often get the, are you on your period?
Is there any truth to this statement when women are in a bad mood?
How does our hormones influence our mood, our emotions during this time?
When we look at how brains go through puberty and we're looking at female hormones and male
hormones, essentially male and female brains go through puberty and they both go from having
a child's brain to an adult's brain.
And that's kind of driven by the sex steroid hormones, primarily testosterone in the boys
and estrogen in the girls, but they kind of follow the same trajectory and get to the
same result.
It's not like they go like that, they just sort of track along together.
But the pubertal hormones are driving that, but it didn't really kind of matter whether
you were the male with the testosterone, your brain was sort of patterned in utero to be
primed to understand the signal of testosterone and then the female was primed to understand
the signal of estrogen and those two brains kind of end up in the same way.
What we then have is like we've got fluctuations of hormones through the lifespan and there's
always this sort of story that females are more fickle in their brains, it's going to
be harder to study brains because they've got cyclical hormones.
Well male brains also cycle based on, even if we look at sex steroid hormones, testosterone,
their testosterone cycles through the seasons, so you've got high levels in autumn, it cycles
based on parenting, so testosterone levels plummet in males when they are active, care
giving parents, if they are just there for fertilisation and then bugger off, their testosterone
doesn't drop off 9 months later, they have to actually be involved in parenting, it fluctuates
during the day.
So male brains are also fluctuating based on testosterone fluctuating, so just set that
aside to think that males are like these sort of stable steady, there's no such thing as
like emotional men who are the ones that drive up the back of you really close and take all
that stuff in a car and who start fights and wars etc.
I don't think it's the women that are the emotional ones here.
Sounds a little hysterical to me.
I think that men can be like big boys, babies, not even boys.
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Right, now let's get back to the chat.
Boys and men aside, I have teenage boys in my house and they're gorgeous and adorable.
They are pretty emotionally level, there's not a lot of, let's just say there are not
a lot of roller coasters.
Is that caused by hormones or not?
I think we have to be really really careful when we look at what creates any kind of emotional
state in anyone at any particular point in time.
And I always say like the brain is receiving a whole lot of data from our bottom up biology
including our hormones, including our menstrual sex hormones.
But we're also receiving data you know from like the food we've eaten and our posture
and our muscles and you know how much we've slept or not.
We're receiving streams of data from the outside and world primarily through our visual system
because we're very visual mammals but also through what we hear and also smell and taste
and touch.
And we're receiving so much chaotic information like 20 centimeters from our faces nowadays
because what we're doing is like looking at this thing and this is like streaming in a
world war from the, you know a war from the other side of the world that we never, that
was on the other side of the world.
It always is on the other side of the world.
Well it depends where you live whether it's on the other side but 20 years ago it was
beyond the horizon and now it's like in front of your face and you're expected to have an
opinion on it and whatever, respond and react as if it's there.
So there's a lot of information streaming in from the outside world from the rising
and setting of the sun to the crap on your phone to the other people you're interacting
with and then we've also got you know our thoughts and our feelings, our psychology,
our mind, our expectations, our previous experiences.
And all of those inputs at any one moment in time are responding to you know the status
in our body and the context of the world we're in and the meaning that we're making of that
to create an emotional state.
Yet we tend to focus solely in on one of those little data points as if it is the primary
driver of everything that we feel and therefore think and therefore behave and that's often
estrogen or maybe progesterone if you're slightly more sophisticated and you're thinking about
the female sex steroid hormones.
So I always think it's really dangerous if we're going to kind of always listen to just
one voice in the crowd or hone in only on that and we are telling girls and we are telling
ourselves from puberty that our menstrual cycles are synonymous.
If you mix up a menstrual cycle in a brain or a reproductive incident like pregnancy
or you know another reproductive transition like menopause that automatically equals dysfunction
and decline and emotional instability and quite frankly that's not the case.
I do not believe.
I do not think the neuroscience believes that.
Social media might have you believe that.
So studies of I was really interested in digging into this for my when I wrote my first book
and I'm doing a 2025 edition update at the moment so I'm like well down in the weeds
of looking at all of that data right now and it's interesting and so I've explained how
brain creates an emotion.
There's this story about PMS and depends whether it's the week leading up to your period or
your period depending on kind of which sort of story you tell that women are just useless.
We're angry, we're emotional, we're kind of incapable, we're weepy, we're all of the
negative emotions because there's only negative emotions there's no positive ones and I was
interested in this and I thought well I'm going to find out what are the rates of the
PMS globally in the world because I better put a number on it and I found this fascinating
meta analysis which pulls together data from lots of different parts of the world looking
at rates of PMS reported in different parts of the world and you can see a theme here
in terms of the research I'm interested in.
Let's like take a global perspective of what's what's happening and this was fascinating
because it depended on which country you looked at what were the rate with the kind of the
percentages of women saying oh I have PMS put in the hands up saying yes that's me and
France it was like 10% which I think is hilarious because French women they don't take no shit
from anyone they're like not like not angry and not sticking up for themselves but 10%
of them put their hands up say yes I have PMS and then you go all the way to Iran where
it's 90% and then all of the other countries in the world kind of fell somewhere between
like 10 and 90 percent and I was like what is going on like 10% to 90% like we can't
really narrow it down any further average data at about 50 so I was like if this is
if premenstrual anger and emotional instability is solely driven by hormones why does it vary
so much depending on which culture and society and part of the world you you grow up in and
you live in so that was interesting so as a woman psychiatrist in New Zealand Sarah
Romans has interrogated this and there is a whole lot more kind of data kind of looking
into this as well where if you get women to record their mood in daily life but you don't
tell them what the study's about because you don't like prime people to say this is a study
on PMS so tell us that you move in daily life and record it on your phone app and every
day will give you emotions to choose from will give you like 10 negative 10 positive
and 10 neutral bear in mind if you ask women to self-report emotions they only ever report
the negative ones almost as if they haven't got the literacy to expand beyond the 10 negative
maybe neutral and then happy which is immediately skews data right so if you like try not skew
the data and not skew the expectations we find out that most women in these type of
studies are French or at least French like and that it's about 10% of women are showing
clear variation of negative mood based on day of menstrual cycle so they put down mood they put
down menstrual cycle day they but they were also asked about things like stress and social support
and overall health and well-being and what negative emotions tracked most closely to was
feeling stressed poor overall well-being not menstrual day but also most strongly social support
so French women are pissed off with the man that's you know like a sort of a tri-silly
stereotypical way of saying it but but most women when they're blinded to what the study is on and
not reporting negative mood that always closely correlates with the menstrual cycle about 10% of
women are and what we think in this very this kind of emerges throughout the lifespan that
we do have these different groups of women and instead of going oh all women this or all women
that or or one in 10 women let's not look at the other nine we've got different kinds of groups of
women who have more or less perhaps sensitivity or susceptibility to fluctuations in hormone shifts
and that is very very clear that plays out in terms of what we might call pre-menstrual
dysmorphia disorder I think that's the serious serious mental health form of of PMS we're seeing
sometimes 14% depends which kind of data you're looking at we're seeing that in terms of like
women who are susceptible to strong shifts of hormones at other points in a lifespan like
postnatal depression also depression around menopause we see we see we see this kind of
subsets of women some women are much much more susceptible to these shifts and other women are
very very resilient and I think that that's really important to acknowledge that the experiences
women are having are real but if we're saying all women everywhere are kind of riding this roller
coaster of hormones that we can't get off we're removing a lot of agency for a start what's the
point and we're constantly conflating hormones and reproductive status with dysfunction and
instability and decline and I don't think that that's what the data shows and that's not how
brains function yeah you mentioned that the rate you know from this self-report study was about
10% right with no other prompting is that similar to the rates of reported PMDD and the rates of
reported postnatal depression or like are we always looking at around 10% no I wouldn't say
these are the exact same groups of women but there are groups of women who are more vulnerable so if
we look at like kind of the end of the lifespan like look at say menopause because that's like
all anyone talks about nowadays it's just got discovered it's having its movement so women who
experience depression through menopause the highest risk of experiencing depression during
menopause are women who have also experienced postnatal depression and perhaps also were
experiencing PMDD who have had prior episodes of depression that are related to hormonal shifts
that's not to say they are the only woman that might experience depression then or that if you
experience that then you are guaranteed to then experience depression at menopause it's just that
we understand these are the risk factors and so there are clearly in some women there are these
these kind of biological emotional vulnerabilities when there's big hormone shifts and I think that
that's really important because I think especially if we're the mothers of girls and girls are
starting to go through puberty and we automatically default to blaming their hormones or blaming their
periods on emotional instability or just being grumpy or weepy or whatever we're not teaching
them to have any agency over their emotional responses and to look at what else is going on
I mean what happens when you're going through puberty like you're usually going from primary
school to high school depending where you are in the world how the school system is structured
here in Australia kids are going from primary school to high school at 12
12 is 13ish I mean like there's a lot going on when you're when you're 12 and you're going from
primary school to high school and your friendship group changes and you're changing your perception
of yourself your perception of your body how other people perceive you your friendship group
we know that the emergence of emotional instability through adolescence the
the strongest predictor of that is not just when periods start or in boys when puberty begins
but how that kid perceives themselves tracking alongside their friendship group
so early developing girls are far more vulnerable than late developing girls or girls that develop
at the same rate as their peers and the boys who develop early are more vulnerable than late
boys who develop earlier are often slightly protected because what happens to them their
social status rises because they're the ones that become the alpha in the group and they're more
protected they may kind of go off the rails and like be more vulnerable to risk taking
but they're not typically as emotionally vulnerable as the boy who goes through puberty much later
than all of his friends he needs like the the support what about lifestyle choices um in your
book i read that you know as mild uh feelings of depression can attribute to poor lifestyle choices
is there anything we can do to sort of help these feelings and what sort of what would you consider
as a poor lifestyle choice that could possibly trigger gosh did i use the language poor lifestyle
choice i might have to eat that one is that what i said um so i think that that's probably a
statement i would rephrase and that i think i believe i said depression comes in many shades
of blue and mental health you know there are there are as many potential causes or risk factors for
say developing something like mild depression as there would be shades of blue um and we know
that you know often what we see when people develop mild depression it's it's kind of situational or
it's reactive or it's because you know there was an incredibly stressful event there is a very
strong correlation between stressful events whether that's starting high school or you know a parent
dying or covered like who didn't find covered stressful and hideous and all the lockdowns who
would ever want to go through that again school closures all of the things um that when we've got
really stressful events then those who are perhaps more vulnerable are more likely to go on to develop
depression it doesn't mean because you weren't doing all of the right things that that's how come
you got depressed but we do know when it comes to something like mild mild depression moderate to
severe depression typically requires like proper medical help and care and it depends where you
are in the world what the kind of access to mental health services are like and kind of you know how
you're going to be supported and funneled through that clinical practice guidelines here in Australia
say you patch up to your gp and you know say um i wouldn't say something my age because i'm 49 i
would fall into a different you know sort of they'll be looking at different causes say you know
your your your 18 year old girl and you'd pitch up to your your gp and you're like i've been a bit
blue and they're like you know have you just graduated from high school and you headed off
to university for the first time you've gone away to halls and you don't really kind of know anyone
we're not going to like slap an antidepressant on that problem we need to be supporting the someone
they're like this sort of psychosocial kind of finding who they are and finding their feet and
finding a good sort of social network and getting this you know sleep sorted you head away from home
for the first time you're probably not eating properly all of your routines are out of whack
you know you haven't got your same family networks around you everything has changed it's not because
you made poor lifestyle choices but if we can kind of almost ensure that supporting you through
that transition are some good healthy lifestyle habits you're going to be more resilient and you
might even be able to pull yourself out of that mild depressed state before it kind of heads off
into something something far deeper and so there's all of the basics and all the things that mums
would be telling their kids and they go off to uni for the first time saying they're not doing
so you know it's like making sure you're getting enough sleep um which is really hard and i was a
college student i was out partying all the time um but i had you know great strong social friendship
group you know eating good healthy food getting exercise um all of those things so i think that
those kind of we call them lifestyle interventions but i think we have to be really careful about that
language because it does kind of imply a little bit of kind of moral kind of judgment there like
well you didn't make the right choices and look where that got you that's not what the message is
the message is let's like put these solid foundations in place and then we're going to
be more likely to recover i love that yeah so it sounds like it's more you know as opposed to the
absence of these choices you will fail it's more like these choices could be protective why not
give them a shot yeah they're going to help and and it entirely depends you know the example i
always go depends on the context right i gave during covid like remember like march 2020 i
was like we didn't know what was going on we all thought we might die um zombie apocalypse
yeah and then you know you might say well you're you're feeling really stressed if you'll make
sure you have your daily walk make sure you go and do your exercise and when your world is filled with
uncertainty like and no one had certainty so you couldn't seek certainty from anyone else either
so if you went out for your daily walk what you didn't need to do then was go and explore some new
bush path you'd never run down before or go wandering around a suburb you'd never been or
kind of go and do something new and curious and exciting because there was enough uncertainty
without not not knowing what was down the road and around the corner so in those instances if you
were to go and exercise i would say follow the same path every day like get the exercise in
but if you're following a part a certain path like literally a certain foot path or a path through
the bush or whatever i live near the bush so i walk in the bush a lot you know exactly what's
coming next you know what's around the corner you're remote you're putting some certainty back in
so simply exercise to help make you feel better works but sometimes we can like kind of tweak
how we are how we are you know the choice of exercise i've got a dance class i go to weekly
with all my my friends i'm in a musical theater group i can't single dance i'm basically like
as coordinated and graceful as a camel but i'm there for the i've got the vibes and the enthusiasm
we just have like so much fun it's exhausting but it is so fun and funny i think that's uh that's a
bumper sticker we need there for the vibes um and that's as much for the collective as social laughs
that we have and we're not doing a performance for us to get together and dance and and you know at
the end of the day if you've got the enthusiasm for it the motivation to do it that's all you need
so many ways you could exercise for mental health although that that's Amanda's game speaking to a
competitive crossfitter but but i hear but i feel you yeah it's it's familiar for me absolutely
yeah it's like do crossfit don't do crossfit walk don't walk ride your bike do it you know ocean
swim you know i like love ocean swimming everyone who i know who ocean swims at the moment is loving
it because there's loads of port jacksons which are a type of shark yeah i definitely would
you know i've got a fear of open water and everyone's oh my god there's so many we call
them pj's there's so many pj's everyone's excited sharing photos of all of the sharks that we're
seeing lots of people wouldn't find that very exciting and a very fun thrilling way to exercise
so it depends right you do what works and so obviously during this sort of time of
perimenopause when your hormones are fluctuating can uh hormone replacement therapy and actually
having estrogen or even micronized progesterone help with balancing out those mood fluctuations
that some women feel do you think there's a place for replacement therapy 100 i'm not at the point
of saying put it in the water but i think that there are enormous benefits in terms of treating
symptoms we don't know whether there are despite every social media menopause influencer out there
saying you'll live longer and you won't die and you won't get dementia and you won't get heart
disease we simply don't have the data where we can clearly say and we certainly do not in the
dementia space um say hrt will prevent all of these we don't know what the long term protective
consequences are we've got we're pretty sure it's not causing heart it's not going to like give you
dementia but we do we know it's going to prevent dementia at the moment it's kind of sort of
neutral what we can say is that we know what hormone replacement therapy at perimenopause
when your hormones are kind of going up and down in each month it could be something different
um we do know what it does do we know that the the most obvious sort of objective measure would
be hot flashes and night sweats that are waking women up and we know if you put estrogen back in
women who are experiencing them it typically helps it doesn't like completely obliterate them
doesn't quite touch the sides and everyone but it pretty it helps quite a lot what we do not know is
are perhaps some of the secondary consequences perhaps improve mood or perhaps
and the data for black brain fog is really unclear as well is that because we've got putting
estrogen in or is it because women are sleeping better because they're not waking up from the
night sweats we actually don't know what would be really useful to know is if we stop the night
sweats in the hot flashes with a different type of drug that wasn't was an estrogen would we see
any consequences because there's been a couple of really really small studies there's a research
called rebecca thurston and another research called pauline mackey and they're like really
interested in that kind of like this not the long-term health consequences but almost like
the kind of the knock-on symptoms are they due to the disruption of sleep or are they due to the
drop of estrogen and if we treat the hot flashes do we see improvements if we can treat the hot
flashes using drugs that are not hormones and i think that's we're right we're just kind of at
the point in time where we've got a few new medications coming in on the market depends
where you are in the world whether they've been approved or not where that they specifically
target the neurons and the hypothalamus of the brain which are responsible for the dysregulated
thermoregulation so your your your your body's thinking you're much much hotter than you are so
it's doing this extreme response to cool you down which is where all the hot flashes come from
at night it's giving you a hot flashing you tip it down to covers and so then like you're starting
to sweat heaps but then your body's going well this isn't working your brain's going this isn't
working i'm going to have to wake her up so then this sort of shot of adrenaline goes through your
body to kind of wake you up and so then you wake up enough to be able to take the covers off and
then cool down now is it like that massive sympathetic nervous system activation and that
that adrenaline that's going through your body is that what's causing perhaps anxiety is that what's
perhaps then leading on to depression we don't we don't know we don't have that data there are a lot
of people out there making these grandiose claims that replacing these hormones will fix everything
but we have also we know the data's not clear on that we've got data showing hot flashes night
sweats reduce sleep often improves we don't necessarily always end seeing improvement in
brain fog and those women that are suffering from brain fog it's going to take like three or four or
five or six or seven months to improve we're not necessarily always seeing you know this kind of
cure of depression because depression isn't just caused by estrogen or not estrogen it's caused by
masses of contributing factors you're going to have to like kind of poll and tweak on lots of
different levers levers in there so the the menopause hormone therapy space is is super
interesting and all of the you know the the global guidelines doesn't matter whether you look at
australia menopause society us you know uk etc they're very very careful about making claims
that are based on the best available pooled evidence that we have not cherry picking this
paper here on that paper there because i'm charging you three thousand dollars for my
clinic consultation and so my you know i need you to think that this is the best thing ever and come
and see me they're making recommendations based on the best available data that we have and the
best available data supports the symptom relief in the moment a bit of data around osteoporosis
long term is still unclear might change in time when data if more data comes in and we can say
yeah hey it's going to help slow the rates of dementia great dementia is really interesting
because people are or you know more women than men have dementia two out of three cases of dementia
and women not men and they're reporting on prevalence which is different from incidents
and i'm not going to get into the the stats but if we had a look at like a thousand men in their
70s and a thousand women then in their 70s say in europe the the numbers of males and females out
of that 1000 that are getting diagnosed with dementia are pretty similar once you get into
your 80s then there are more slightly you might get like 16 out of a thousand versus 12 out of a
thousand are being diagnosed per year with dementia it's not like this massive like difference but
because there's more old ladies alive there's more cases but the incidence really only starts to
diverge slightly um in your 80s and then it depends which part of the world you're looking
at in some parts of the world even people in their 80s there's not an incidence difference between
males and females but you go into low middle income countries particularly low countries or
lower socioeconomic status people then you do see a bigger sex difference emerge so we're so caught
up particularly right now in this online menopause influencer space that hormone loss at menopause is
leading to dementia they don't understand any of the incidence stats that are out there looking at
what's going on in different countries so people have to be very very careful because
data is complicated and complex diseases have complex origins i mean this has been absolutely
fascinating and i feel like we can talk to you for hours yeah there's just so much so much i want to
ask you but we are coming to the end of the interview but before we finish up can i just
ask what is your 40s formula if you were to put together a formula which will help women who are
in their 40s thrive you know look after their brains what would you say would be the way to
move forward or sleep if you're not getting a good night's sleep everything else will just
utterly fall apart and i'm obsessed with getting a good night's sleep and i nap and everyone who i
know who strategically naps is usually a good sleeper at night because you lean into sleep
and you love sleep and i'll do anything in the world to protect my sleep it's number one
um the next is just is like just stop taking everything so this is not just enough self
deprecation and like lack of seriousness like the the the women i hang out with like say in my dance
group and who swim and they're just so funny and self-deprecating and we just have so many
so many laughs about ourselves and of each other's expense and we just don't take it all too
seriously so having like some kind of social group where you can just like enjoy that i think
like laughing at each other is quite funny not in a mean way but like we have just so much fun so
like just having the right kind of sort of social networks um around you and not like just taking it
all so seriously um and then i am very fortunate because my art was an s another s sleep and social
and it's like the sea like that is the place i'm looking out at it right now i'm very fortunate i
could set up the window um just having somewhere where everything kind of washes away like you know
that place you can go and you know salt water get in under the sea and um everything is cured
so sleep social networks and the three s's for success thank you so much sarah it was
wonderful speaking with you today you're very welcome bye have a great day
after talking to our amazing guests all day in studio we need a good drink to refocus and
let's be honest we could use a dash more energy too oh i totally feel that there's so many energy
drinks out there are packed with sugar and so much caffeine that you end up crashing hard that's
actually why i switched over to flojo asia's first productivity drink it hits the sweet spot for me
between eating a little bit of a boost but not wanting to chug a bunch of caffeine and flojo
actually has 80 less caffeine than your average coffee with no added sugar i also love that
flojo is a functional health drink it has seven organic nutrients and adaptions things like
racial mushroom for a stronger immune system and rhodiola for mental resilience but the fruit and
tea flavors are still light and fresh not weird flojo actually helps me stay calm and in control
so when i get home after work i can just be immediately present with my family not all
jacked up in jittery like i might feel after a later day coffee even better they offer a 14 day
money back guarantee so you can try it without any worry and you can get free shipping when you
order directly from their website at www.drinkflojo.com. This is Paul, our editor. He's a 25 year old
unmarried Singaporean guy listening to the ramblings of 12 older women on everything from
menopause to weightlifting to sex. So Paul, what's your thoughts on today's conversation?
Hey guys what's up, Paul here. So for this episode i'm not a neurologist or neuroscientist but
you know the brain is just fascinating and i have to admit i was kind of lost in the whole
brain related drug and you know while editing through this episode but i guess you know for
us there's always a lot left uncovered about how our brains function and well Dr Sarah thanks for
contributing in research. See ya! Guys you know how much we love coffee and if you want to share
some love you know you can get us one. Just visit buymeacoffee.com slash the 40s formula. Cheers!
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I think I would love that you know that whole sort of Ozzy vibe you know being a being close
to the beach we've got Sentosa but it's not quite the same. Oh it is not the same because I said when
you say the beach you're also referring to like surfing and actually doing things in the water.
Yeah yeah yeah and Singapore's water is not made for that I'll tell you what. Yeah their high school
is right by the beach so they just can go down. In fact they have surfing at school they have beach
sports at school and stuff so they just just head down for a swim after school. Wow and have you
ever been to Singapore before or have you come have you come here? I have once a very long time
ago before you could fly to Ireland via the boat and now we don't have to go via Singapore and
London you just go straight so I haven't been to Singapore since Emirates basically started. Oh
yeah now I think Singapore's changed. It was a long time ago unfortunately I got food poisoning.
Oh no and that you know we hold ourselves up for our food culture and our sanitation that's
that's heartbreaking. Yeah yeah I know it sucked so yeah I didn't have the best trip and then
then went to Borneo straight after me my husband we've met in Singapore and went to Borneo and
that's where we got engaged. Oh lovely okay so a good memory from Borneo to kind of cover up the
food poisoning. I would love to have spent more time in Singapore seeing Singapore
but it was yeah I spent a lot of time in my friend's bath. Oh the worst.