You're listening to Mistreated. I'm Nam Kiwanuka. Brain health is a woman's issue.

Those are the words of Lynn Pausland's the founder and president of the Women's Brain Health Initiative, which recently hosted Canada's inaugural Women's Brain Health Summit in Toronto.

So, why is brain health a women's issue? Women get migraines three times more than men.

And studies show that for women aged 18 to 49, migraines are the leading cause of disability around the world.

Some studies show that women are twice as likely to be diagnosed with anxiety and depression.

According to CAMH, women's symptoms for depression are more severe.

And would it surprise you that some 70% of Alzheimer's patients are women?

Why is that? Is it genetics? Is it age? Historically, women have lived longer than men.

But studies show that quote, "Of every three patients with Alzheimer's, two are women, even after accounting for their greater longevity relative to men."

And that quote, "Post menopausal women account for over 60% of all those affected."

In short, we are only now learning the importance of hormones in brain health.

In a TED talk that quickly went viral in 2019, Lisa Moscone, author of the menopause brain, broke down how in menopause we usually associate hot flashes, brain fog, depression, and anxiety with changes in our hormones.

But she states those changes are all neurological symptoms and they begin in the brain.

She explained, "Why are our brains impacted by menopause? Our brains and ovaries are part of the neuroendocrine system.

So, the health of the ovaries is linked to the health of the brain and the other way around.

Because estrogen is very important to our brains, Alzheimer's researchers are investigating whether estrogen therapy could help to ward off dementia in women.

And since the FDA removed the black box off hormone replacement therapy, scientists are hopeful that this will help to foster more research.

Canada recently approved a new drug to treat Alzheimer's and research shows that the shingles vaccine could slow the progression of dementia.

On today's episode, we speak to Professor Natasha Raja about how menopause and hysterctomies can impact her brain health and why menopause is not a monolithic experience.

We also talk about the work lab is doing to better understand this [music] and more.

Professor Raja joins me now. Thanks so much for being here. Uh could you please start by introducing yourself and what you do?

>> Sure. Uh my name is Professor Natasha Raja. I'm a full professor and Canada research chair tier 1 in sex, gender, and diversity at Toronto Metropolitan University.

And I do research the current main research project from my lab is called the brain health at midlife and menopause study.

and we're interested in looking at how menopause affects brain health and might be a window to understanding if certain females might be at risk for dementia later in life.

>> It seems like we don't know a lot. And um the thing that I learned this year was that women weren't included in clinical trials until 1993, which is just like I remember rap songs like uh remember Sir Mix a Lot [laughter] Baby Get Back. That song is from 1993

and uh we're learning so much about the differences between men and women.

>> When we are talking about brain health, how is brain health different from men compared to women?

>> So we're still learning but we do know that developmentally like the body and the brain are connected systems, right?

So I think one of the things that will come about is really people studying the brain without really considering how endocrine function, physiological function of the body will influence brain development as well.

>> What do you mean by that?

>> Um so how your gonatal and your sex development will influence like the hormones that are in your body and how hormones have effects throughout the body both in the body and in the brain.

And so it will lead to differentiation and different patterns of development um both in development and then also potentially as we age.

So the reason historically people haven't really looked at you know whether or not the neural coralates of brain aging differ by sex is because behaviorally often the patterns are similar.

So males and females will show memory related declines with aging and because the patterns of behavior are the same people assume that the underlying mechanisms must be the same.

And what we noticed was we were shocked because we were using a data-driven method and um we all the results pointed to sex differences

>> and it wasn't something I was anticipating. I'd been doing this research in aging for quite a while um and I never really explored sex myself thinking oh behaviorally they're similar. episode there probably isn't any sex differences.

But then when we looked at the neural mechanisms, it was just a wakeup call to me. It was just wow.

So in females, what we noticed was a lot of the results that were been out there as far as the cognitive aging literature might have been driven by females because females tend to volunteer for research more than males in the older adult population, but no one disagregated the data by sex.

So we didn't know.

>> So everything was in the same pool.

>> Yeah. Everything was in the same pool. What we noticed was only in females did we see age related differences in frontal and parietal function.

Um in males there wasn't any age related differences and that implied to us that perhaps females are using different types of cognitive processes to maintain memory function and to try and do the memory tasks that we were challenging them with.

And so that really was like a wakeup call saying, "Oh, so all of these effects that we've been looking at in the frontal cortex, are they driven by females or you know what?"

So we decided to go in and you know deep dive into looking at sex differences, brain health equity in my lab at that point.

>> When I was younger, you know, I don't think I really thought about my brain health. Yeah.

>> It was more like, okay, how do I look on those jeans? [laughter]

>> Yeah. Yeah. Don't judge me. Um, but as I've gotten older, it's something that I'm thinking about a lot.

Um, is it true that approximately 70% of those suffering from Alzheimer's in Canada are women?

>> Yes. So, twothirds of Alzheimer's disease cases are in females in Canada.

>> That's shocking. It's shocking.

>> Why is that? So, historically, the assumption was that it's because females live longer than males on average. and Alzheimer's as all dementias are diseases of aging and that's why there's such a disproportionate effect.

But what a lot of researchers started noticing is that in um when you look at individuals with Alzheimer's disease, there's a gen a genotype called the Apollo protein eep epsilon 4 which puts you it's a genetic risk factor for late onset Alzheimer's disease.

And what people started noticing that there's a disproportionate portion of females with that genotype compared to males in these Alzheimer's clinics.

And so that pointed to, okay, it's not just age. Perhaps there's something about this genetic risk factor for Alzheimer's disease that has a greater effect in females.

And then the research started coming out in the '9s and in the 2000 and is still coming out right now that what does this gene do differently in females and males.

And in females, what we know is it it leads to earlier accumulation of some of the neuropathologies associated with Alzheimer's disease and a steeper decline in females.

So this is something that seems to be female specific. This gene is important for cholesterol transport. It's important for vascular health, is important for inflammation.

So it's, you know, this gene is a risk factor for Alzheimer's disease, but the mechanism by which it acts, you know, we're still studying and we're still trying to determine the details, but it seems to interact with all of these health factors that are modifiable as well at midlife.

So that's why it's a really interesting result. Um it I think it also shows the importance of studying uh with different sexes.

>> Yes. Exactly.

>> Because if it's impacting majority women and you're not studying it that way

>> Exactly.

>> then I'm sure there's gaps that fall.

>> Exactly.

And so like historically people just did not consider how biological sex might be and gender related you know factors such as social determinance of health which are also very gendered.

um how they might interact with our biology and contribute to different profiles of risk and outcomes.

And so with in the case of Alzheimer's disease, exactly the assumption was oh females are living longer and that's why.

And then these kind of other findings were popping up and then people decided yes it's time to look at sex differences like we can't really hide this.

There was a lot of strong advocates for it and people started listening but it takes advocacy and it takes you know the scientist that wants to ask the question.

>> What roles do hormones play in brain function?

>> Hormones play a huge role in body and brain function. And so we know that within the brain there's multiple different types of estrogens.

So estrogen is not a single chemical. There's many types and they have different

>> Yeah. So there's different factors and different ways in which they function in the brain.

And the primary one that most of us study are interested in is estradiol 17 beta or E2.

Um, and that type of estrogen has receptors in the brain in two key brain areas important for memory and cognition.

The hippocampus, which is a critical area of the brain from memory.

So damage to the hippocampus leads to amnesia. Some of you might have heard of a scientist named Brenda Milner.

So she did a lot of research on this patient HM who had damage to the hippocampus and he could not learn new information and he had really poor memory.

Um and so the hippoc campus is a key uh part of the brain for learning new things and remembering things.

And then the prefrontal cortex which is very important for organizing behavior, predicting the future, perspective, planning um our sense of self, things like that.

So it's very important for what neuroscientists will call cognitive control.

And so here are two brain regions that are really enriched for estrogen receptors. And so and they're really important for a lot of types of cognitive behaviors as well.

So when there's estrogen related fluctuations, you could imagine how the way that these regions function and communicate with other areas of the brain because the brain is a large scale neural network.

Um it has profound effects across many different behavioral domains.

I when I was going through my health issues, I kept hearing from friends, oh, it could be parameopause and something that comes up a lot.

Well, I think there's a lot of confusion about parameopause and menopause. They're two different things.

>> They're different stages.

>> Can you explain to us?

>> Sure. So, in midlife, most of us enter midlife and we're premenopausal.

I say most of us because some people do enter pmenopause in their 30s,

>> as early as 35, right?

>> Yeah. Some people menopause before the age of 40, right?

So, but on average, spontaneous menopause, if you have ovaries, occurs in Canada on the at the average age of 51.

And so, you're premenopausal, meaning you're having regular cycles. You're still, you know, reproductively fertile.

Um, and you still have like the menstrual cycle, like the lutil phase, the follicular phase. It's very stable and it happens.

And then things start to change in your body. Your ovaries, you know, your eggs are getting fewer. your estrogen starts to increase and kind of fluctuate.

And so it is fluctuating during pmenopause, but it is on the slow decline.

So it's jumping around, but it's slowly declining. Um, and so pmenopause is a time where females might experience night sweats, difficulties in sleeping,

um, start to have urinary tract infections, have, you know, dryness down there,

>> itchy ears.

>> Itchy ears, itchy frozen shoulder.

>> Yeah. Frozen shoulder. all sorts of interesting um side effects of this natural phase in human aging like female aging.

I do like to like highlight that it is a natural process but some females do experience um you know 60% of females report having brain fog and memory complaints and so it is a phase of a lot of change.

You know, your body is really rewiring its system like your body and brain is rewiring as there's this slow decline in a primary sex hormone in the female body

>> and then eventually it declines to the point that it's un not even measurable by like traditional techniques that we use in the lab called Eliza

>> and you and you stop having periods altogether. You no longer are releasing eggs. you're no longer reproductively, you know, healthy, I guess, or I don't like to use the word healthy, but reproductively fit, right?

So, and you enter menopause. So, menopause is technically defined medically as one year of no, you know, no cycling.

Um, so if you're spotting after menopause, it's often important you go visit your doctor because it's not a n that's not a natural part of menopause to spot after you menopaused.

>> But you do spot,

>> you know, here and there until you reach menopause and then it's one year of no cycling, no spotting, no periods

>> and that's menopause.

>> That's menopause. Up to that point, you're permenopausal.

Thank you for explaining that because I think uh we're using we're seeing a lot of um

>> things online where it's the same thing and it's two different things.

>> It's two different things.

>> It's two different things.

Parmenopause can last 10 years and uh this you know um circus of horrors [laughter] that goes on.

But one of the things that uh people always say uh when you're going through the change is uh the night sweats and uh the brain fog and it's got like cute words but it's actually quite scary when you are in the prime of your life and you your brain is not working uh the way

and I I should also mention that studies do show that even though we're going through parmenopause and have brain fog it doesn't mean that women are less capable in the workplace.

>> No, not at all. But I think that also leads to people not talking about it because you also don't want people to think like you're not as capable as you used to be.

>> Yeah, I think that's an important point.

I think historically there's been a hesitance to talk about women's health because of this concern about how we are perceived and how we will be treated because the history of womanhood on you know in society and so we've been hesitant to talk about it

>> but aging is related to a lot of things as well and I always like to frame menopause within the context of healthy aging because we're all aging males and females and you know there are differences in our cognition as we age and in our bodies as we age and we study that because we want to optimize our aging and make sure people age as well as possible.

So why not do the same with menopause? Like we just we need to optimize how females experience this very natural part of endocrinological aging, right?

Like we just we need to optimize how females experience this very natural part of endocrinological aging, right?

>> Well, explain to us how it works because um as we've been talking about [clears throat] estrogen tends to fluctuate throughout a woman's life, but never more so, I guess, during menopause.

What happens to a woman's brain at this time?

>> So, we're just starting to understand what's happening to the women's brain during menopause transition.

Um and that's the primary focus of what the the research in my lab is um doing.

And there's two things that we're trying to address. So first there's a big debate of whether or not some of these changes that females experience subjectively can we objectively you know valid like yes this is true you are experiencing memory decline.

Like it's not because a lot of times females will go to the doctor and they'll be told it's just you know it's that's fine. Like it's just subjective. you're not really showing any decline.

And many tests are insensitive to showing an objective measure.

And so one of the things that my um lab designed was a memory task that really does objectively show that at menopause there is an age related decline.

So we use this task called a spatial context memory task. It's very like scient, you know, something you do in a lab.

Um but it's something we actually do in real life as well. So we ask people to memorize faces and the place they are on a screen.

And it's something you do dayto-day. you park your car, where is it in the parking lot?

>> I forget every day.

>> Exactly. I took a photo now, right? Just to [laughter] know exactly where it is.

But, you know, so we test this uh ability, the me the ability to memorize a face and its facial location.

What we notice is this type of task which is a very challenging task is sensitive enough to validate that yes, objectively females at menopause show an age-related decline on average.

And I always like to like stress the on average because not all females show this decline and the level of decline varies across females.

And so what we're trying to understand is what accounts for that variation. Is it their vascular health? Is it inflammatory biomarkers in their blood? Is it having genetic risk factors for Alzheimer's disease?

And then what we need to follow up with is is it transient or is it something that is chronic?

And [clears throat] we hope that for the mo vast majority of females it is something transient right as the system is neuro you know pla the plasticity of the system during this transition it's rewiring itself and as it adjusts things will kind of get better and we might even adopt new ways of being that are healthier in the long term as we age.

Um, but for some females it might not be transient. It might be chronic.

And they might be the females that really need intervention and attention to kind of promote healthy aging and prevent or delay the onset of dementia.

That's what the research is focused on.

>> Something I've been seeing a lot online is that um when women get to a certain age, they stop doing, you know, the people pleasing, which I am very much looking forward to. [laughter]

But um you know a surgery that seems to be the go-to for a lot of females who are experiencing gynecology illnesses like fibroids is hysterctomy.

Hyerectomy is the second most common surgery for women behind a C-section.

Um but I recently found out that getting a hyctomy depending on your age if you're too young can actually increase the likelihood for women developing Alzheimer's later in life.

Why is that? And why aren't we talking more about that?

>> Sure.

>> Because what the

>> Yeah. And you know I I too was offered hysterctomy because of fibroids and opted not to get it um for these reasons.

Um and so and it always depends on how extreme your fibroids are and how much it's affecting your quality of life uh your decision.

But it's because the blood supply to the ovaries are altered.

So you're, you know, if you do get a hyctomy, you need to have a conversation with your doctor about keeping your ovaries if possible, just because they are the primary source of your, you know, um, peripheral estrogens.

And if it's not possible, then you do need to have a conversation with your doctor about the options of doing menopause hormone therapy to pre to kind of mitigate the loss of estrogen suddenly after a newertomy.

But if you even if you do keep your ovaries, the blood supply to the ovaries

>> can be altered. It really depends on the surgeon, right? Like it's it's there are surgeons that are better at surgery and others that aren't.

And sometimes they do nip some blood supply and sometimes there is a lack of blood supply to the ovaries which will lead to it not functioning optimally.

And so that's why um some females that you know even if they maintain their ovaries and u have their hysterctomy um their uterus removed may still show some cognitive decline with aging especially if they're not treated appropriately with hormone replacement therapy.

>> And so that's how it's related to the brain health. Yes. Because of the estrogen.

>> Yes. Exactly.

Um my health went downhill uh after I got COVID for the first time. And again it was kind of like what's going on? Do I have pmenopause? Is it long COVID? Um,

and a lot of my girlfriends were having similar conversations and talking about the brain fog, uh, which can be a side effect of long COVID or pmenopause.

And now we're seeing more studies that show that women are actually more likely to be impacted by long COVID. Do we know why that is?

>> No, we do not know why that is. And that needs to be studied.

There are many mechanisms that are potential like vascular health and inflammation especially if you're going through pmenopause and menopause during that time because the decrease in estrogen does relate to an increase in vascular risk and an incre and an increase in inflammatory response or immune reactivity.

Um so there are if you're going through pmenopause and there's you know a disease that affects the inflammatory system like CO does um you might have this double kind of hit but we need to like this is ongoing research and I am not a specialist in COVID.

So I would not want to say something that you know may not translate or may not hold up in the long run. Yeah.

Um I want to uh talk again about parmenopause and menopause. According to reporting from the New York Times, women of of color experience pmenopause differently. Black women experience it earlier and more severely.

Asian-American women women uh a group that includes women who are of Chinese, Korean, South Asian, and Filipino backgrounds. Uh studies have found that they were more likely to experience chronic pain and anxiety as opposed to hot flashes.

Um why is it important to recognize that pmenopause menopause impacts different populations differently? because the treatments that you offer are different and also the health the lifestyle approaches might differ for these different communities.

All females around the world who have ovaries experience menopause. And we need to understand the experiences within the context of these cultures because we don't know how much is related to physiology and actual, you know, cultural differences in physiology, uh, cultural differences in communication style, cultural differences in the language that is used.

You know, certain cultures might not even have the words for hot flashes.

>> Right.

>> Right. And so they may not use that term, but it's because and so we might not think they have hot flashes, but they might. They just might use a different term.

So we really need to understand um how menopause is experienced across the world and also what the average age of menopause is across the world.

because another thing that um you hear a lot of is how you know the age of menopause matters and a younger age of menopause might be a risk factor for poorer health outcomes as we age.

But we don't know if that's true for all females in all communities. That that is based on western standards and results that have happened in studies that have not represented um more diverse populations.

The average age of menopause in India is 47 right 46 47. So and that means the average that means females are entering menopause on average younger as well.

Um, does that mean that Indian women are more likely to have poorer health outcomes as we age? I don't know. We have to study that.

Same the average age in African-Americans is a bit younger like 48 I believe.

Um, so what is that? you know, how does that translate these concepts of average age and early onset of menopause being poor health outcomes and how do we disentangle menopause right which is um a biological phenomena from the context in which these fe females were born and raised.

So the social determinance of health because the social determinance of health are the biggest modifiable factors for preventing dementia, delaying dementia and for aging well and for health in general, optimizing health in general.

Um and so we know that but you know to implement changes in social determinance of health it really is a policy you know these are policies that need to be adopted at a governmental level and you know to help people age better and

Um and so we know that but you know to implement changes in social determinance of health it really is a policy you know these are policies that need to be adopted at a governmental level and you know to help people age better and

>> by age I mean not just older age I mean age like this you're developing and then you're aging and we need to start thinking of aging as a life course um as well.

We're aging from the time we're young adults.

>> My daughter my daughter says we're born to die.

>> Yes. I'm like, you're too wise for to be 12 years old. And I guess also too, the dangers if you have this idea of the age of when uh females are supposed to go through menopause is if you're younger and if you are from a culture, a background that might go through it younger, if you go to get help, they might dismiss your symptoms as being nothing to worry about.

You mentioned the social determinants of health.

>> What role do they play when it comes to our brain health? because I don't think um a lot of people realize how we live or where we live can impact how we age.

>> Yeah. So this concept in cognitive aation called cognitive reserve.

It comes from the literature in dementia where we observed that there are some individuals as they age they seem to maintain their cognitive health later in life but then once they are diagnosed with dementia they show a steeper decline.

And so individuals started looking at their brains using PET imaging and then autopsy.

And what we noticed was these individuals actually had more neuropathology in their brain when they hit di when they got diagnosed but were able to maintain their cognitive function despite the presence of these neuropathologies.

And so this implied to us that you know there is this ability in h in the human brain to kind of compensate and make up for these this damage that's accumulating in the brain. And this concept is cognitive reserve.

And so cognitive reserve is related to social determinance of health. So we know that higher education you know leads to more cognitive reserve.

People that have a more more educated tend to age well and maintain cognitive function longer.

Um we know that eating healthy having a good lifestyle and maintaining you know um lower body mass like lower hip to waist ratio is good for aging as well.

So we know these kind of cognitive reserve variables are good living in an area that's not polluted. It has a lot of green spaces.

We there's a lot of research coming out that these social determs of health help bolster cognitive reserve and help maintain healthy aging for individuals.

And so we're starting to kind of tease apart how does this relate to different communities around the world? Is it just in North America things like you know and in Europe?

So we're starting to understand that but in general there is this concept of social determinance of health and its relationship to cognitive reserve and brain resilience.

And so this is something that needs to be studied um to identify what social determs of health are the most impactful.

So you know education policies is that where we should be putting money as a government as a country to you know to make education more accessible and less costly for people because it really does help people as they age as well.

So things like that, that's what social determines why they're important.

>> I've also heard like even racism can play a role in your brain health.

>> Yeah. And so that's like there's social determinance of health and then structural determinance of health where systems are built to kind of uh support certain communities and hinder other communities and then the structural effects of that.

So the racism that you see in society, the stress. So stress is an interesting thing because it's a biological phenomena like it's how you experience the world and then how it translates into your body.

And stress itself is not a social determinant of health but it probably is one of the major mechanisms by which you know having poor social determs of health.

So living in poverty, not having good access to high quality foods, not um you know being able to sleep well at night because it's noisy out or you're scared um for your safety, things like that.

All of these things accumulate stress in your body and that will have negative outcomes on brain health and aging starting from young adulthood and mental health.

Um because even we know that groceries are very expensive. Uh we have a lot of food deserts.

Um some people just don't have if you're living in uh an environment where you don't have access to that. It's pretty much, it seems as if you're, when you think about how you're getting older, how you're aging, it's already determined how your brain health is going to be when you get old. It just seems so unfair.

>> It's unfair. And, you know, this is why in some ways people are like, well, you need to exercise. You need to eat well.

And it's a very, it's coming from a place of privilege to say that because not any everyone can afford to take the time to exercise. Not everyone has the money in their bank to eat healthy.

Um so really um we we as researchers can come up with this is the ideal lifestyle like the Mediterranean diet getting cardiovascular training doing strength training um but the ultimate question is how do we make society more equitable so everyone can access these things

um because if we we might know the solutions but then to enact them into policy that goes beyond the researcher right that's the research what we do as researchers is we find these results then we communicate ate to the public and then some of us will, you know, become advocates or go that advocacy route to really push for policy change um to integrate what we know from research.

But that needs to happen for that translation. If that if that doesn't happen, it doesn't translate and we we might sit on a you know mountain of knowledge that cannot actually implemented because that's beyond our power.

But that needs to happen for that translation. If that if that doesn't happen, it doesn't translate and we we might sit on a you know mountain of knowledge that cannot actually implemented because that's beyond our power.

>> I wanted to uh talk about solutions and a way forward. You've mentioned policy. What should our governments be doing to support women's brain health?

>> Invest in it. Like they're really Canada is not investing in women's brain health at this moment.

Like there are there are researchers like myself who are funded and well funded by triil uh grants that are um so there's ner sh and c. They're the three major funding bodies in Canada.

um they have not had a a significant increase in funding from the federal government for many many years.

Um and the cost of doing research has increased. So in some ways by not increasing funding to these funding agencies, you're actually hurting researchers, you're actually reducing the amount of funding available because the cost of research has gone up.

We're all encouraged to pay our students a living wage. Right.

>> Right.

We're encouraged to pay our staff a living wage. That living wage is increasing as we all know.

And so and as researchers, you know, a lot of these um we want to take care of our staff and our students,

>> but that money then is going away from the research.

>> Exactly. And then the cost of actually like purchasing the equipment, um purchasing, you know, doing the tests that we need to do to do our research. Those costs are going up, too.

Everything's going up, but our funding line has not.

And so this really hurts research in general in Canada. And as a result, you know, people see women's health research as a niche thing and that needs to change.

It's not a niche thing. Women's health is health for all because by studying women, we actually learn a lot about men as well and what works for women and what works for men.

And if we we always hear about precision medicine and using AI tools.

So in order to really get to a precision health in our in our society, which is what everyone wants, we need to study women and then we need to study the intersectional identities of people as well.

>> And hello, we make up 50% of the population.

>> Exactly. And you know, we need and the what most researchers can do is recruit women into your studies if you're doing human subject studying.

And if you're doing animal studies, test female animals as well and disagregate your data.

Like we we a lot of people have the data. They just haven't looked at it through a sex and gender based analysis lens.

>> Well, what can individuals do for to protect their own health because systems uh you know, I think we're all exhausted. We're all just trying to do the best that we can.

what can individuals do to um make sure that when they do get to a certain age because a lot of our brain health the diseases don't just happen

>> no

>> they take decades to develop right

>> exactly and so there are many things that you could do starting at a like young adulthood like you know I don't you know trying to your best to adopt a healthy lifestyle

one thing you can do is quit smoking like that's a modifiable risk factor that will save you money right so smoking is we know that that's one of the biggest risk factors for late life dementia and it's modifiable and so you could quit smoking.

Uh you could reduce your alcohol intake again saving some money. Um but we do know that you know high levels of alcohol intake is detrimental to aging.

So there are things you could do that will actually save you money. Um so you know quit smoking, quit drinking, um not quit but like reduce the amount.

Uh, and you could also like prioritize sleep. So, sleep is doesn't cost you anything.

Uh, and you could also like prioritize sleep. So, sleep is doesn't cost you anything.

>> But if you have night flashes, you can't sleep. [laughter]

>> I know, I know, I know. But prioritizing sleep.

There are new medications on the market that are purely for hot flashes. I'm not an advocate. I am not paid by the drug companies or anything.

I'm curious about how this will, you know, work um and whether that's a good alternative, especially for females that are concerned because they do have um you know, counter contraindications for taking menopause hormone therapy.

So, that's another thing women can approach their doctor and advocate for themselves um to consider menopause hormone therapy, but you really need to, you know, talk with your doctor, find a doctor that's open to these conversations and consider your your personal history.

um you know whether or not you have a history of heart attack and stroke because these um hormone replacement therapy it does increase risk of these things and so cardiovascular health is important to consider your family history of cancer

but when it comes to family history of cancer I will say that the original scare from the women's health initiative study um it was you know the percentage of risk was not as high as people were led to believe

>> and there are I know a person that has, you know, had personally had a breast cancer scare and, you know, was treated for breast cancer and was on menopause hormone therapy afterwards.

So, it is possible. You just need a doctor that's willing to walk that walk, you know, path with you and treat you and see you regularly to make sure that you can maintain menopause hormone therapy while still maintaining the rest of your body's health.

taking HRT right now. It's, you know, thought that it's best to take it when you enter pmenopause and into menopause, but then to stop taking it, like not to stay on menopause hormone therapy long term, because we still don't know about the long-term effects, and there's mixed results as far as um the cost and benefits.

There are some studies from the UK bio bank um led by Claudia Bar and others that show that women that have a history of staying on menopause hormone therapy long term they showed more hypocample volume loss and you know more gray matter loss.

So there are we don't know why because

>> because we don't study women's health.

No, we don't study women's health and this is like just like a cross-sectional data.

Like what we need is a large scale longitudinal study that really considers historically the different sex specific experiences of females.

Like we want to understand women's body health and brain health. We need to study from menration to through parody pregnancies through menopause like longitudinally at least cross- section like put a bunch of studies together that are longitudinal in nature to really get a full map of how do women age right

it just makes me really upset to think of all the millions of women who've had to suffer as we just play catch-up to

>> you know the lack of funding the lack of research um for you what makes you hopeful

Um what makes me hopeful is that there's a lot of female scientists and male scientists that are advocating for this in Canada, in Europe, in the US.

Um I think we realize how much biological sex and sex specific experiences um shape our brain health and our body health.

And people are understanding more and more that the brain is not living in isolation. that things that happen in our body and in our environment affect our brain health and so there is this growing awareness of brain body interactions and you know social context and its effects on brain health and there is a movement I think within the neuroscience community to really invest in research uh that looks at this and that puts women's brain health at the forefront like that is the first thing we should be doing in order to get a bigger picture of how the brain um how brain health evolves over the lifespan

women that are considering taking more menopause hormone therapy. And I've said this um on some on social media and sometimes get backlash for it, but it is important to find a doctor that listens to you um and not to just follow the advice of individuals on social media that may not have the training.

And I understand that there's frustration in the space because a lot of females are talking to their doctors and are being like shut down or told, you know, you're being you're being silly, right?

And I understand that there's frustration in the space because a lot of females are talking to their doctors and are being like shut down or told, you know, you're being you're being silly, right?

>> Just lose 5 pounds.

>> Yeah. [laughter] Exactly. And that's that's not cool either. Like you have to find you have to keep sadly we have to be our own advocate and listen to our own bodies.

And so that's the other thing I'd like I'd like to say. If you do go on menopause hormone therapy, listen to your body.

you know, if your body doesn't feel right, you should talk to your doctor about that. Not just, oh well, you know, I I wanted to do this, so I'm just going to stick to menopause hormone therapy because from my personal experience, right, I went on menopause hormone therapy because I was having hot flashes.

And then I started to feel tightness in my chest.

>> And so I had to listen to that. And I went and I went through visited a cardiologist, got my heart checked, okay?

And they gave me the green light to keep staying on it. And so I went back on it. But there was a moment like where you have to listen and say, "Okay, is my heart healthy enough to be on menopause hormone therapy, especially if you have a family history of heart attacks or stroke like my family does."

And so you need to listen to your body. So you're you're you're the best advocate for yourself.

>> Professor Raja, it's been such a pleasure. I've learned so much. You make a complicated subject quite uh you know how to communicate really well. Thank you so much.

>> Thank you so much.

>> I appreciate you being on the podcast.

>> Thanks for having me.

>> That was Mistreated. Thanks for listening. You can follow our show wherever you get your podcasts so that you can get notified each time a new episode is available.

We would love to hear your feedback. You can write me an email at mistreatedodcast at tvo.org or reach out on my social channels.

We've got some reaction to our last episode on cranial cervical instability and Ella's Danlo syndrome.

Thank you so much for interviewing Sydney and bringing attention to cranial cervical instability CCI.

What patients are facing across every province in Canada is devastating and can have lifelong impacts. [music] We lack trained experts, accessible care, and clear diagnostic criteria.

Uh, one of the shocking things I've learned about these conditions is how few people are in the country who can help to diagnose and to treat cranial cervical disability and [music] Ella's Danlo syndrome.

So, a lot of people end up fighting for care and if they have the financial means, they travel outside of Canada to get that care and it shouldn't be that way.

We have another comment from last week's episode. There are so many underdiagnosed and mistreated citizens in Canada.

Canadian healthcare and governments need to take care of its people and it is clearly doing a failing job despite being a wealthy country.

Thank you TVO for your professional journalism and kudos to Sydney for articulating a very complex topic.

CCI and EDS are incredibly complex issues and as we mentioned last week, mistreater will be investigating what is going on with treatment, diagnosis, and how patients are being impacted. Look for that in early 26.

We've got one more comment. Healthc care is a human right. Governments need to step up more to unbburden citizens from this healthcare tragedy.

We really appreciate all of those comments and my deepest appreciation to Sydney for using her voice to bring attention to this.

This is our last episode of the year, but we will be back in January 2026. Thank you so much for all the support on this podcast.

And as mentioned, email us your uh suggestions, your comments, and uh we will try to incorporate them into the podcast.

This week's episode was produced by Matthew Mara and me. Edited by Colin Kish. Camera work by Max Dussy. Digital shorts by Ariana Longley, prompting by Christy Mloud.

Production support from Jonathan Hollowell and TBO's digital media services team. Lori F is the executive producer of digital. John Ferry is vice president programming and content.

Thanks so much for listening and we'll see you in 2026.