E55: The Intellectual Domain of Midlife

Kirtly: Well, two important things happened to my brain when I went through menopause. I stopped biting my fingernails after 45 years, and I stopped having migraine headaches. These are things that originate in the brain, and they changed.

I'm Dr. Kirtly Jones, and I'm joined with my co-host, Katie Ward, who's a Doctor of Nursing Practice and Associate Professor in the College of Nursing and a certified menopause clinician. We are continuing our "7 Domains of Midlife," and today we're talking about the intellectual domain.

Yeah, I know chewing your fingernails isn't really an intellectual problem, but we're going to talk about the brain. We're going to start with our producer, Chloé, who's going to give us a little view as someone who's not doing this but someone she loves is doing this midlife thing.

 

Kirtly: Chloé, do you want to tell us your story?

Chloé: I would love to tell you my story. I was telling you earlier, I think it's my mom's story and I'm her microphone. I'm her echoer. But a couple years ago, when she was going through menopause, she were having all the regular symptoms, right? She had some hot flashes, and she was tired all the time, and she had headaches and body aches and all that sort of stuff.

And she didn't really know what it was. She just thought it was getting older, which is obviously menopause, getting older. But she didn't think it was a symptom. She didn't think that this was a phase of life that all women all go through.

When she went through that, she didn't tell me about it. And it wasn't until a couple years ago, which was maybe a decade after her menopause had finished, and she was explaining to me kind of this time in her life where she was having all these weird symptoms, but nothing came out of it. It didn't end up getting her sick or illness or with cancer or anything like that. It was just a weird phase in her life.

I'm like, "Mom, that sounds like menopause." And she was like, "Well, what's that?" And I'm like, "Well, it's after your last period." And she's like, "That's a thing?" It was just astounding to me, this conversation that we had afterwards. She didn't know that this was a thing, a real legitimate health thing that women go through. She thought it was just her. She thought that it was just her suffering through these little random symptoms of a random, weird stage in her life.

It's just opened a can of worms of all the things that she didn't know about. And I have to wonder if it's maybe because of the culture that she grew up in. She grew up in Vietnam. She did most of her growing up there. She came over here when she was 30-something. And so my grandmother never told her about what happens to your body when you reach a certain age.

Thinking back even further for me personally, you know how when you watch movies and TV shows or whatnot, you hear people say, "Oh, my mom gave me the talk," or, "My dad gave me the talk what happens to your body when you mature"? I actually never had that talk. My mom didn't give me that talk. I had to learn on my own.

And luckily, at the time, it was something taught in health class, so I knew it was coming. But I don't remember ever there being a sit-down or a formal or informal conversation with my mom about, "Okay, this is the age where you get your period. That's what this means. Don't freak out. You're not going to die." I didn't get any of that from my mom.

It was just something that I learned in school. It happened, and then I told her that it happened, and then she was like, "Okay. Great. Cool," and that was just it.

And so I don't know if it's a culture thing or if it was just something nobody ever taught her. I'm not really sure, but that's the story.

Kirtly: Well, I'm sure it's partly a culture thing. In a way, it makes me sad because while she was experiencing those symptoms, she didn't have anyone to tell her, "You know what? This will not last forever. This is a stage, and you'll be back. You'll be a new person, and you feel better."

That's what we're trying to do here in our "Midlife" podcast, is give women a foundation so they can say, "Okay, I'm not alone. I'm not crazy. This is just a change I'm going through." I think I told a chicken joke once, about the chicken who was going through the change.

But I think that it makes me kind of sad that there are women all over the United States and all over the world who are not feeling well. They're not themselves. Katie, you've got that term for it. What is it? "I'm not myself" or . . .

Katie: Yes, that's the term exactly. "I don't feel like myself."

Kirtly: "I don't feel like myself," and they feel like they're going to be this new person forever, and it isn't forever. It's just for a while. And if you know about it, and if you've got friends or a physician or someone you can talk to about . . .

And I'll refer any of our listeners to our podcast on complementary medicine and the MENOGAP program here at The U, where you can go and do part of a group process, which includes medical counseling and maybe prescriptions, but also maybe acupuncture in a group with other women. It's really helpful to know that you're not alone and to share your stories.

Katie: That's also the important part of maybe listening to podcasts, is you feel like you're sharing a story with somebody else who's talking about it. And I think that's maybe some of the appeal of podcasts at the moment.

I put together a talk that I do for people in the community, and I call it Maturation 2.0. We call our maturation programs . . . that's the talk that you were talking about, Chloé. I think that's what we need for women.

Somewhere in your 40s is Maturation 2.0, where somebody sits down and says, "Here are the things that that you may experience." We do that with puberty as well, right? Everybody goes through this at a slightly different age and a slightly different pace. You may get one period, and they come once a month.

And so menopause is a little bit like puberty in reverse, where each woman's experience is slightly different, but there's an arc. And I think if you understand the change that's happening to you, that makes it a lot easier to navigate.

And so, for your mom, I think not having any vocabulary for describing that, that's . . .

Chloé: Yeah. And I think what was really fascinating when she told me the story . . . Again, menopause happened, and then it was more than a decade later when she told me that she had experienced these symptoms at a weird time in her life, and she was just kind of remembering it. I was like, "When did this happen, Mom?" And she's like, "Oh, more than a decade ago." And I was like, "Wait a minute."

But I think what stood out even more for me was, obviously, I have a grandmother. My grandmother never told my mom about what she went through. And even more surprising, my mom has six sisters, and they never shared stories about what happens to their body.

I think maybe it was a cultural thing. You just don't really share that kind of detail with even your close sisters. But the fact that she grew up with all these women around her, and yet nobody shared stories about, "This is what happens when you get your period. This is what happens when your period stops," none of that was shared among close sisters living in a close environment.

And that, to me, is . . . again, I'm not sure if it's a cultural thing, or if it's just a family thing, or they just don't like sharing. But I think it's very helpful to know that, like you two have been mentioning, you're not alone and it's normal. You're not going to die, and it will pass, and there will be happier things at the end of it all.

 

Kirtly: Well, we did a podcast on "When does a girl become a woman?" and in many cultures, there's a celebration of this. I think of the quinceanera, which is a celebration for Hispanic girls. But there is no celebration at this other end, this 2.0, this midlife and menopause transition. In fact, there's often some shame. Women don't feel like their bodies are the same and their brain isn't the same, and they're not fertile anymore. And at least in Western cultures, there's this loss of youth that brings shame.

So maybe some shame, privacy. The kinds of things that are going on, unpredictable bleeding, a bladder that doesn't want to behave anymore, sweating through your clothes, those aren't things that you are proud of.

I mean, growing boobs, that's great. You can be proud of that. You like them to stick out, unless you like to have them flat. But when your boobs just sag, that's not a proud thing.

And so it could be cultural that we don't sit around and talk about what happened to our waistlines and what happened to our boobs, and why we're so sweaty at night.

Oh, dear Katie, share a little something other than the fact you teach about this.

Katie: Well, I'm going to take your line, Kirtly, of this is a time when you're becoming more brain than body. So you were just describing a bunch of body changes. It's certainly a time when women are sometimes not feeling like themselves and complaining a little bit about their brain. But I also think that the post-menopause brain is a really wonderful thing.

So as a woman who's beyond the menopause transition, I can tell you that this is a time of great brain growth and personal growth and a time when you can really still learn new things and you have sort of the wisdom to know what to spend your energy on.

And if you've taken good care of your body and you're healthy and you've taken good care of your finances, you're often at a place where you really are capable of doing a lot of things that you might not have been able to do in your youth.

Kirtly: Well, I completely agree with you. I completely agree that I'm much happier with my post-50-year-old brain because it's more artistic, it's more creative, it's more integrative. I pull in my willingness to think about spiritual things and my willingness to accept other people's views as part of this wonderful midlife transition.

But I think there are a lot of fears about women losing their brain. In fact, there are some data from studies where women might be given an anti-hormone for treatment of a condition called endometriosis, and this anti-hormone turns off the ovaries. So essentially, it acts like a medical menopause for a little while.

And they actually did cognitive studies for people before they took this drug and after they took this drug, when their estrogens were dropped down really low. And they did find a small change in word finding, but they found the brains worked pretty well, except for some word finding.

So menopause doesn't mean you're going to lose your brain. I bet your brain does rewire. We've learned from pregnancy that the brain is rewired during pregnancy and after for a whole new set of social and attention and child-attention skills. We may be rewiring our brain at menopause as well. We just haven't studied ourselves.

Anyway, that's my thought. There are some short-term changes with people who have acute estrogen withdrawal. And then the literature says there are some long-term changes.

There, you have women who took hormones or didn't, and look at them at 60 or 70 and do a bunch of cognitive studies. And in fact, there's very little difference. There are some predictions, and Katie, you brought this up, in terms of people who've had an early menopause or a tough menopause that did predict some things for later life.

Katie: Yes. I mean, I think we do have some studies along those lines that women who go through menopause early, and by that, I mean people who are going through menopause more around age 40 or prior to age 45, in that case, we do see when we look at those people over time, that they do have a number of things. So maybe more dementia and more chronic health problems.

So there are a lot of things that for people who are going through menopause earlier than most women do, there may be an association with other problems down the road.

But whether you can take that information and then say, "This applies to people going through menopause in their early 50s," where most women do, is the thing that . . . I think you kind of can't draw that link, because people who are going through menopause prematurely, it might be because they had their ovaries removed because they had some kind of cancer, or they carried a gene that put them at higher risk for cancer and they chose to have a surgical menopause.

Or they had an autoimmune condition that caused the ovaries to quit functioning sooner than they might have been originally designed to, or it could be because of a few other environmental factors that we know maybe are associated with an earlier menopause, like smoking.

These may be people who have some other things that put them at risk for these more chronic health problems down the road, so that's a little bit harder to untangle.

What I do see a lot in the menopause space where I work, though, is a lot of people getting information online that's kind of promoting menopausal hormone therapy as though it's going to prevent dementia.

So I see people in this space saying, "We know that people that go through menopause early might have more dementia, and so therefore put everybody on hormones, and that's going to prevent it." I do have patients that ask for hormones just because they're worried about dementia, and I have to tell them we don't actually have that data that going on and staying on menopausal hormone therapies is going to be preventive for dementia.

Kirtly: There are some data that suggest that women who have a lot of really bad hot flushes have more cardiovascular disease and may have more dementia, but the people who have really bad hot flushes may have a number of other things, as you mentioned, that put them at risk.

And I think what we've learned from the UK studies are that when you look at people who develop dementia and those who don't, what doesn't fall out is hormone replacement therapy. What does fall out is people who exercised, had strong social bonds, who didn't drink a lot, who did not smoke, who ate well, their fruits and vegetables, and exercised and slept well. Those people had less . . . Those were the main things that helped divide those people who got Alzheimer's from those who didn't.

Those are modifiable things. You can't modify your genetics. But when people come to me and say, "I want to take hormones to prevent dementia," I say, "Well, can we talk about the other things that we know might be helpful? And those are things that don't really cost anything. Could you work on these, and then we could . . . If you want to take estrogen, you can, but these are the things that are really associated with long-term cognitive decline."

Katie: Right, and you sort of can't have your cake and eat it, too, in that you're doing a lot of things that are bad for you and hope that one small treatment is going to overcome all of that.

So I think it's an important conversation if people are wanting to prevent dementia to say, "What are all the things that you can do to improve your health overall?" And those are probably the place to put your energy.

Now, we can talk about menopausal hormone therapy, because the one thing that it does help women who are having hot flashes is sleep better. And I think people who sleep . . . We talk about that a lot. It's sort of dominoes. If you're getting a better night's sleep, then your brain is going to work a lot better. You might feel a bit more like yourself. It might have some really beneficial effects on your mood and your irritability and all of those things.

So I think treating those hot flashes in the transition is really important for all the things that we want to think about.

Kirtly: Well, I think you and I both want to talk about brain fog. Women would come to me and maybe they forgot where their keys were or they forgot an important appointment, and they're worried. They're 55 and they're not feeling quite themselves, and they are pretty sure they're on their way to being demented. I said, "Wait a minute. No. This is not exactly what it looks like."

The question is what do we recommend for women who are concerned about their brain? And I think that's a very tough question. There is the Montreal Cognitive Assessment test, the MoCA, and it is a very low bar. Every single one of my 50-year-old women or 55-year-old women who forgot their keys could sail through a MoCA.

It's a very short 10-minute test, and it's easy to do in the clinic, but it doesn't really address what people are saying when they say, "I just don't feel like myself," or, "Brain fog."

I think brain fog, to me, is a new term. And I had to actually go up and see what the Cleveland Clinic and what I call Harvard Medicine kinds of clinics think is brain fog. But Katie, you've been thinking about this for a while, about brain fog.

Katie: I have. One, I agree with you. I think brain fog is a little bit of a new term. I've certainly heard women say to me for many years, "I just walk into a room, and I can't remember why I went there." Is that menopause, or is it just that your brain's full and you're busy? Is it a sign of dementia and do you need cognitive testing? We can talk about all of those things.

But brain fog, to me, feels like a term that was just recently invented to sell hormones. And there isn't a standard definition of what brain fog is exactly, but I always do want to think about it with people or just talk about it with you in this context. For the last 10 years, as long as I've had a smartphone, I have had about 100 times the amount of information coming at me than I used to have.

And so now I'm having to pay attention to just every little ping that comes through, so much more email. The number of times I have to switch my attention from one task to another is so much more frequent than it was early in my career.

And so I think for all of us that are . . . If you're experiencing this hard time paying attention and this rapid shifting in task focus, and you also happen to be going through menopause, it's easy to sort of say, "Oh, I'm having a hard time remembering all these things, and it must be menopause," but I think it's happening to people both male and female at all different kinds of ages just because we have so much information coming in.

There are lots of studies actually looking at how we're paying attention, and there's an interesting sort of cause-and-effect. I was listening to a discussion about how people make films, and the amount of time you might spend on a shot is even getting shorter because directors understand that people aren't paying attention for quite as long as we used to. And so they're adapting the material that they provide for us to switch up faster because our brains are running at a pace that they didn't used to.

Kirtly: Well, there is this fantasy that people can multitask and, "I'm a great multitasker. I can do two things at once." It's actually been kind of studied, and it turns out that people who think they can text and drive really can't do both well. And people who think that they can . . .

When I watch myself trying to make spaghetti . . . And spaghetti and rice are my two main culprits. I'm starting with spaghetti or rice, and sure enough, I think, "Well, I'm going to go turn on the water for the hose, and then I'm going to quickly run to the bathroom because I have to pee. And then I'll check the rice." And sure enough, my rice or my spaghetti is going to boil over. And I think, "Oh, I must be getting demented." No. I was trying to not watch the pot. I was trying to do three other things.

When I think about women who don't remember where they put their keys, I see women stop their car and the first thing they grab is their phone. They actually do it at every stoplight, and they're looking at their phone. They stop the car, they look at their phone. They're texting as they're going into their house, and no wonder they don't remember where they put their keys.

So I think the business about multitasking has been oversold based on both data and my personal experience watching people. It really helps if you can slow down and do one thing at a time.

Maybe that's not the way our culture can work now. Maybe you can't just do one thing at a time, in which case I recommend you not make spaghetti or rice, or get a rice cooker so it will do it for you. You have to watch your rice.

Katie: I think also, one, we need to spend a little bit of time thinking about the impact of the devices and the structure behind them. The people that make those devices and make those platforms are selling our attention to advertisers and influencers online.

And so I think that's the other intellectual piece of this for me, is learning about how that works and then deciding how to be a better user of that technology, and kind of thinking about what are the best ways that I can make my brain work.

So I use a lot of these little techniques. If I'm trying to get some work done, for example, I'll use a technique where I set a timer, and for 20 minutes or 45 minutes until the timer goes off, I am not going to look at my phone. I put it out of reach.

Kirtly: Do you turn it off, Katie?

Katie: It's on because it's the timer that's going to tell me when my 20 minutes is up, and I can go back and check what texts have come in. But I do put it out of reach and . . .

Kirtly: Out of sound?

Katie: When I feel that little itchy feeling of, "Oh, I should just check and see if anybody texted me," it's like, "No, the timer hasn't gone off yet."

And so I've learned to sort of employ some techniques to help me stay focused long enough that I can grade a paper, or write a paper, or do whatever it is I need to do.

Kirtly: Well, the other thing about having our social networks mined and our emails, in fact, mined so that advertisers can give us content that they believe we want is that if it's content that's interesting to us and we click it, we get a dopamine hit. And dopamine is a great drug, but we're constantly getting little dopamine hits, which will rewire your brain for only that thing.

So other things, like, "Is the rice going to boil over?" or where you put your keys, or did you put your peanut butter in the pantry with the flour, those kinds of things require your attention. And having your cell phone constantly give you little dopamine hits that you didn't ask for is definitely going to screw up your brain for anything else that isn't that dopamine-enriched.

Katie: Yeah. So I think anybody going through menopause at this particular moment in time, there's a lot of, again, just the age-old thing, "Is this menopause or is this circumstances?" And so I do like to think about that.

I also think about we need focus, and we also need episodes in our day that are not loneliness, but you almost need boredom or solitude. You need a little bit of time when you're not asking your brain to do anything. And so whether that's singing, dancing, chanting, praying, meditating.

Kirtly: Does reading junk novels count?

Katie: Yes.

Kirtly: Because I'm definitely the queen of checking out junk . . .

Katie: Or maybe that's where you play Candy Crush. I mean, I think it's okay to have those times where you aren't trying to think about anything. So just being aware that we need that, that we need that time to be creative.

Kirtly: And it doesn't help if it's fueled by alcohol. So please remember, if you're trying to calm your brain down, alcohol will be a temporary friend, and then it will disrupt your sleep and it gives you calories that you may or may not feel like you need.

Beware of the snake oil salesman. I think there are a number of online services for midlife and menopausal women that will tell you that they can create the body and the brain of a 25-year-old if you take these hormones, and this drug that will make you stop thinking about eating, and these supplements that will give you a brain that works forever.

Beware, I think, because the anxiety that we aren't who we were at 25 leads us to be especially vulnerable to people who say that they have something that could create that awareness, that sense of being now, when you're 55.

Katie: Oh, my goodness. Honestly, the amount of myths and disinformation in the meno-fluencer space . . . I don't know what we call this. Somebody has a term for it. Meno profiteering, I think.

Kirtly: Meno profiteering. Oh, God, yes. By the way, we take no money, we have no advertisers, and we don't get paid for this podcast.

Katie: No, absolutely not. I don't get paid whether people take hormones or not. Just trying to provide information. But because I'm interested in menopause, and I do tend to click on a lot of menopause products and information that comes across my feed . . . I don't know what Google thinks I'm interested in, but I have a diverse interest.

Kirtly: I was going to say, Katie, they're confused because you're interested in everything.

Katie: But I do see a lot of the menopause influencers out there, and it sort of breaks my heart because I see patients who are trying so hard. They really feel like they have to sort this out on their own.

If you were to kind of take one piece of all these different podcasters and different advertisers and try to follow all this advice, women come in and they feel like they need all kinds of testing to get to the bottom of some problem. And I want to say, "At the root cause of your problem is your genes, and I can't change those."

Kirtly: But it makes them feel like, "Well, what can they do?"

Katie: They're wanting supplements and labs. Optimization is a word I'm hearing a lot, and I can link that back to one particular podcaster. It's hard. Our healthcare system is not ideal, and people are shopping around for providers, and you just don't have a good old GP anymore.

And certainly, if you have other health issues or you've had a bad experience with healthcare, you start believing that somewhere there's a cure if you can just get to the bottom of it. And if you just go on the right diet, or you take the right supplements, or you take the right hormones, you're going to go back to probably an ideal that you never experienced.

But people are searching for this and going broke doing it, and being sold any number of things that aren't even diagnoses. That's probably a whole other podcast of spurious diagnoses.

Kirtly: Well, it's hard. I mean, media has images of midlife actresses who are gorgeous and slender, and they are shown in their bikinis at 50 and 60, and who knows. Of course, Jane Fonda looks great. She and her plastic surgeon have done a phenomenal job.

Katie: She does look great.

Kirtly: But I think it's difficult for an ordinary . . . not that any woman is ordinary, because all women are extraordinary, and so are guys. But what you see before you is an example that doesn't really commonly exist. And I'm sorry for that, because women just don't love themselves enough.

Katie: Well, there are some particular pitches, and once you've identified these sales pitches, I think that they're easy to spot. So if you'll indulge me for a minute, I'm going to give you my list of things that I see in various forms.

And whenever I hear anything that sounds like this, I always just want to look a little deeper at the source information. So this is the intellectual side of me, of saying, "If I recognize these sales pitches, then I'm going to be a little bit more skeptical about what I'm hearing."

So there are some sales pitches that just come up over and over again. One of them is "the long ago and far away." So this supplement, this thing came from ancient glacial water melts, or it comes from some other place on the planet and . . .

Kirtly: Or some exotic fruit.

Katie: Yeah, some fruit you've never heard of because it doesn't grow on this continent. Or, "This is protein that comes from sheep in New Zealand only, and they're much better than the protein from the sheep grown locally," or things like that. So that's one sales pitch that always . . . when I hear somebody describing their product as coming from the past or coming from some faraway place, I'm like, "Oh, I'm not sure this is where I'm going to put my money."

The other one is that "doctors don't want you to know this," that we're all getting rich because people are staying sick, and we're in cahoots with big pharma trying to keep people sick. Somebody else has found the secret for something that's going to keep you young and keep you healthy, and the reason the secret information is being suppressed is the whole medical system doesn't want you to know.

And then there are testimonials and things that ask you to eliminate all kinds of stuff from your diet. Or you have the one charismatic podcaster who's selling it.

But they're a bunch of words that are vague and don't really say anything. So "balancing" is probably . . . Again, in the menopause work that I do, "This is going to balance something," which is not really exactly a medical term. At least it's always a red flag when I hear it next to something that you can purchase.

Or "cleanse," or "tonic." "Root cause" is another one of those now that starts to push my buttons. But they're things that sound like they should be true, but in reality, they just aren't exactly how we practice medicine.

Kirtly: But when you actually go to try to find any evidence that these things actually might be helpful, you can start looking . . . People are actually trying to make a foundation of what really works and what doesn't, and most of them don't work better than placebo.

It's good to believe. Just taking something you believe in, as long as it's not too expensive, has an advantage of at least your inner physician is trying to heal yourself, but you're helping other people make money at your expense, and that doesn't make me happy.

Katie: We'll come back to that on the financial domain, like how much it costs to be on some of these supplements.

Interestingly, when we look at just even the clinical trials around hormone replacement therapy, where you give somebody an actual hormonal product, the placebo arm in those trials work pretty well. So you're right. The belief that something is going to work works, so there's that influence as well.

Kirtly: Yeah, but I think this is how we evolve to have our brain try to treat our ills. Inside all of us is our own best physician most of the time. Not all the time, of course. And if you just give that inner physician what makes your body really feel good . . . I will tell you that a peanut butter and jelly sandwich is what my mouth wants, but it will put me in a coma. It's the most instant brain-stupefying food that I know. So I don't have peanut butter in my house. I just don't.

So, Katie, what else should we say?

Katie: Oh, I kept trying to think about, "What happens when you put two intellectual women talking about menopause together?" We start spending a lot of time thinking about how do we think and how do we do research.

Kirtly: Yeah, we do. Right.

Katie: I mean, I think the wrap-up is that if you're in the age where you're going through the menopause transition, there really are some wonderful treatments. And I'd say, for the most part, for healthy women, the benefits of using menopausal hormone therapy outweigh the risk. It's certainly worth talking to your healthcare provider about whether or not these are right for you and seeing what symptoms they can help with.

And I think it's probably great reassurance to see your healthcare provider and talk about whether or not you need a cognitive test about, "Is this brain fog something you need to worry about? And are there risks that you have that we need to be thinking about mitigating?"

All of those things become important. It becomes very important to keep your blood pressure under control and your cholesterol levels normal, and think about are you developing type 2 diabetes, and are you at a healthy body weight, and are you getting enough exercise, and are you getting the cancer screening that you need at this age.

And so, it is really important to work with your healthcare provider for all of those things that are going to help you stay healthy and prevent disease. And have the conversation about whether menopausal hormone therapy is right for you, but don't buy it online.

Kirtly: Well, for everyone who's listening, who's in midlife and maybe going through menopause at the same time, you have your very own story and the very own experience of your brain, and there's no one pathway. We hope that this has been helpful if you're thinking about different pathways and which one might be best for you.

If you're just signing on to our "7 Domains of Midlife," we've already posted the physical, emotional, and social domains, and we'll be adding the financial, environmental, and spiritual domains soon. So, use these podcasts to spark a conversation with your sisters, or your mother, or your friends, or guys, or your doctor, anyone.

Thank you for joining us on the "7 Domains of Women's Health" Midlife Series.