Although women make up half the population, the natural transition to menopause has been a taboo topic for many generations. In the past, scurvy, epilepsy, schizophrenia, insanity, and hysteria were blamed for menopause.
Lisa Mosconi, a neuroscientist and women's health advocate, aims to change that.
Menopause is not something that happens to an individual. It is a physical change that half the population experiences, and it is also a societal issue. A recent Mayo Clinic study estimated that menopause-related symptoms cost $1.8 billion annually in lost work time and $26.6 billion each year, including medical expenses. By 2030, 47 million women worldwide will enter menopause each year.
There have been more open conversations about menopause recently. Public figures such as Michelle Obama and Maria Shriver and celebrities such as Oprah Winfrey, Gwyneth Paltrow, Drew Barrymore and Naomi Watts have raised the topic, while some companies have added menopause-specific benefits to their corporate offerings.
Even with increased awareness, the menopausal experience is often ignored or presented as lip service.
With her new book, “The Menopausal Brain,” Mosconi wants to open the dialogue about women's health, advocate for better and more equitable care for women, and explain the complexities of menopause on the body and brain. The new book builds on the work of her previous books “XX Brain” and “Brain Food.” Mosconi is an associate professor of neurology in neurology and radiology at Weill Cornell Medical College and director of the Alzheimer's Disease Prevention Program at WCM/NewYork-Presbyterian Hospital.
Market monitoring: Does menopause need a rebrand?
Mosconi: I would say so. I really feel as a woman and a scientist that menopause is treated very poorly in society, especially in Western medicine and the Western world, where all the attention has been on the potential risks. The dignity of this important life transition has been taken away, and there is this parade of symptoms and risks and treatments and despair and making women invisible. Essentially, society has made menopausal women invisible and largely ignored by medicine – and this is unacceptable. Just think about the sheer numbers: by 2030, there will be 1 billion women entering or about to enter menopause – menopausal women are the fastest growing demographic group and women spend 40% of their lives in menopause.
Menopause really needs to be rebranded, from something women fear and women fear, to being just another stage of life that women go through if they live long enough. It comes with some symptoms and some vulnerabilities, but it also brings another dimension to a woman's life that we are only beginning to understand. There is something good that comes from menopause that Western medicine has decided to completely ignore.
Market monitoring: Did you mention in the book that menopausal women are underserved and represent a huge blind spot in medicine? Do you see that changing or improving?
Mosconi: There has been change, but it is very marginal. Partly because of financing. If you look at the federal health care budget, the National Institutes of Health budget, there is a certain amount of money directed toward women's health. The vast majority of them are directed at breast cancer, cardiovascular disease, osteoporosis, and the subcategory of aging at the bottom of the list. Menopause is a subcategory of the subcategory. It's like three or four thousand (in funding). nothing. There is hope that priorities will change with the new women's health initiative announced by the White House a few months ago. we will see.
Credit: Courtesy of Penguin Random House
Market monitoring: Some companies add menopause support benefits for their employees. Is this the beginning of a change in mindset or just a trendy thing to do?
Mosconi: It may be a combination of both. In terms of pregnancy, the US doesn't have a lot of support for pregnancy and the postpartum period – if you're lucky, you get three months with a newborn. There is an understanding that a woman needs a period of rest after giving birth to a child, and this is limited – months.
The problem with menopause is that it is a longer process that can extend for years. Some women can transition within two years, but others can take up to 14 years – obviously that's the limit. But the average in the United States is seven years. These are seven years in which a woman may legitimately have a hard time. It is humane to provide some flexibility and additional benefits during that period. Partly I think it's a bit trendy, but more and more women are realizing that it's something to fight for.
Market monitoring: You mention in your book that menopause can manifest itself in several hundred unique symptom combinations. This seems to be an insurmountable problem to diagnose, treat and tolerate. Can you talk about that?
Mosconi: Diagnosing menopause is relatively simple. You go to your gynecologist and hope they have training in menopause care, which is 1 in 5. All that happens is you get asked, “Do you have your period?” The diagnosis is made retrospectively. You must have gone a full year without any menstrual cycle. The process is clear and straightforward. But we're trying to bring in the brain component. This diagnosis is based on the ovaries. The symptoms women experience – at least half of them – have nothing to do with your ovaries, and everything to do with your brain. We need to bring more fields together and improve the diagnosis of symptom clusters, but we are not there yet.
Market monitoring: What are some positive aspects of menopause?
Mosconi: In Japan, they don't have a word for menopause like we do here. Here, it's the end of your menstrual cycle. In Japan, they have a beautiful word “Konenki”, which means renewal, renewal, the next stage of life. Doesn't place a strong weight on negativity. It is a new stage in a woman's life. This removes a lot of stress and stigma.
Happiness is one of the most amazing things I've learned about menopause. Postmenopausal women are usually happier than younger premenopausal women. They are generally happier than they were before menopause. There are many cross-cultural studies looking at better mental health and greater life satisfaction after menopause.
Then there's emotional mastery, which many women say: I don't care as much as I used to about things that no longer serve me. I'm no longer bothered by certain things. I no longer let people tell me what to do. There is more self-confidence, determination, and a greater sense of one's sense of worth that comes with the ability to maintain joy. Studies show that there is a neurological reason for this. The part of the brain that is involved in emotional control is rewired in such a way that it does not overreact to negative situations but maintains a good response to positive situations. You don't sweat the small stuff. Postmenopausal women tend to be very good at empathy. There are definitely positives that we are just beginning to consider.
Market monitoring: Do you see a need for federally funded or more comprehensive research on the impact of menopause on the body and brain? Or women's health in general?
Mosconi: I think gender differences in brain health are a major priority. Women's brain health, in particular, is one of the most under-researched, diagnosed, treated and under-funded areas of medicine, which includes menopause. Neuroscience was really based on this concept that reproduction had no effect on brain health, which turned out to be completely untrue. This will be my first priority: how brain health impacts differently. We are missing a lot of important information. Take pharmacology for example, we have long known that women do not metabolize drugs in the same way as men do. We don't even metabolize food in the same way. The vast majority of the medications we have that have been developed in the last 20 years have been tested exclusively in men, which is why many medications don't work well in women. Women's brains have really been overlooked.
Market monitoring: Aside from medicine, what lifestyle issues do women have to face during and after menopause?
Mosconi: There are things that are associated with menopause that are easier, primarily exercise of any kind. But it depends a little on the symptoms. If you suffer from hot flashes and brain fog, cardiovascular exercise seems to be the most beneficial. If you suffer from mood changes and depression, a combination of cardio and strength training seems to be very effective. If someone has problems with stress and sleep, exercises such as Pilates, yoga, and mind-body techniques can help. There isn't a lot of research on this yet. But there are some clues as to what might be more helpful.
The Mediterranean-style diet appears to be very beneficial for women's health. Women who follow this type of diet have approximately 20% fewer hot flashes and a lower risk of chronic diseases such as cardiovascular disease, stroke, diabetes, high blood pressure, and dementia. Reducing stress is important. Sleep hygiene is really important and avoiding toxins – it is becoming increasingly recognized that there are toxins in the environment that can negatively impact hormonal health and this leads to early puberty in girls, an increase in endometriosis, as well as early menopause, a risk factor. For dementia too, because toxins can really affect your brain.
Market monitoring: As a neuroscientist and women's health specialist, how do you prepare for menopause?
Mosconi: I'm working on my lifestyle. I want a really strong baseline when I get there. I'm working on my sleep hygiene. Fixed routine. no sound. there is no light. No screens in my bedroom. I'm meditating more frequently than ever before. It only takes 10-12 minutes and I feel better than ever. I'm exercising more – five times a week. I do more cardio and Pilates and my diet is very clean – I don't eat any processed foods at all. There is no sugar in the house. I have greened my diet. I follow a Mediterranean diet, but I try to increase green vegetables in my diet, meaning more fruits and vegetables. There is no alcohol and I just switched to decaf. I think this is the essence of avoiding all the things that can make menopause worse and trying to focus on all the known things that make it better and praying and hoping for the best.
