[Dr. Sarah McKay]
Everyone's being flogged with this menopause story, which is all about catastrophising this phase of life. It's menopause, it's brain fog. Do I need HRT or not?

Oh, is it dementia? My brain's eating itself. We're honing in and focussing on what we're missing.

[Angela Foster]
I think the biggest thing that concerns so many of the women I speak to is the brain fog.

[Dr. Sarah McKay]
Brain fog is a systems puzzle. It's a complex web. It's hormones, it's sleep, it's metabolism, it's mood.

If you wake up at 3am, I guarantee it'll take you less than a minute, probably five seconds to find something to worry about because your brain is a prediction machine. So your brain's going, I feel nervous in my body, there must be something that I need to be thinking about that explains this.

[Angela Foster]
What are the things that we can do from a nutritional perspective, a fitness perspective, a lifestyle perspective?

[Dr. Sarah McKay]
If we could focus more on doing cool stuff, like flying around the moon versus freaking who had the stupid facelift or the Botox.

[Angela Foster]
This is so much better for us, right? Dr. Sarah McKay, you are deep into the science of the female brain. You've written a number of bestselling books, the Women's Brain Book, Baby Brain, and Brain Health for Dummies.

I think the biggest thing that concerns so many of the women I speak to is the brain fog that can show up in midlife. What's driving that? And whether it is something to be concerned about long-term.

Can you describe what's happening during that peri- to post-menopause transition?

[Dr. Sarah McKay]
This is one of these questions where there's a number of different answers or kind of puzzle pieces. Brain fog, as we would describe it colloquially, doesn't really have a very good, clear, firm definition clinically or neuroscientifically, so to speak. Because lots of people might use different words to describe a similar feeling or sensation, like you're forgetting words, or you look into a room, you don't know why you walked in there, or you find it hard to pay attention or concentrate.

We would- lots of people might have those experiences and at different points of time in their lives or ages or stages use different language to describe that. So right now, women in midlife have been taught that the word we're using to describe the feelings that our brain isn't functioning like it used to is brain fog. I think it is worth pointing out that there was a study done here, or a survey done here recently of Australian women by Jean Hales for Women's Health, who found that the greatest proportion or the age group that was most worried about feeling foggy in their brain or their brain's not working were actually women in their early 20s.

So there was more of them concerned about what women in midlife might call brain fog than actual women in midlife. So we've got, you know, and that's probably just a hint that we're going to be using different words to describe these different experiences, depending on who we are and where we're at and what we're kind of ascribing it to. Similarly, we've got baby brain, you know, and, you know, pregnancy and motherhood.

So I think if we just focus on what we do know about what could potentially be causing women to feel like their brain isn't working properly at midlife, and I don't- do I need to get into the physiology of perimenopause and menopause and the ovarian brain conversation in much detail for your audience?

[Angela Foster]
No, not too much detail.

[Dr. Sarah McKay]
I think they're pretty well-versed in that. Yeah, they're pretty well-versed in that. Yeah, it kind of gets a bit tiring to hear that trotted out over and over and over again.

But it's safe to say that there are a whole host of changes that could possibly be taking place in our bodies and our brains and our minds that could be contributing to this experience of brain fog. So the first is probably the one that we have the clearest neurobiological story about, and that is the idea of temperature control in the brain. The hypothalamic neurones, the hypothalamus is this like kind of key hub in the centre of our brain, which maintains kind of our physiological, you know, biochemical homeostatic basis.

And it's receiving signals from our ovaries when that conversation starts to fluctuate, the ovarian levels start to fluctuate, the ovarian hormone levels start to fluctuate, the neurones in the hypothalamus become very, very hyperreactive. And that means they become very, very hyperreactive, particularly to temperature. The reason that these neurones and ovarian hormones and temperature, like, are even related at all, it's like, why do they even care?

Because reproduction and temperature is very, very intimately entwined and controlled. So we can see these very clear variations of temperature across the course of a natural menstrual cycle. And lots of women chart their body temperature to know when they ovulate and then to find out when they're pregnant.

So body temperature, thermoregulation, intimately entwined with reproduction. When you're not reproducing anymore, you don't need to have that same tight thermoregulatory control. So what happens?

We get the hot sweats, we get the night sweats, we get the hot flashes, la, la, la, la. Everyone's familiar more or less with that kind of scenario. Long story short, that disrupts sleep.

Now, it may disrupt you enough to wake you up at night, or, and you are aware that you're awake at night and then you kind of lay there awake, or it may be that you don't necessarily wake up, but it disrupts your sleep architecture. So that nice, those kind of like patterns that we want to ideally go through down into the deep stages of sleep, back up into REM and up and down nicely through the night. Temperature regulation and sleep architecture are also intimately entwined.

So you may not necessarily have to be waking up to have healthy sleep disrupted. For those women who are waking up at night, we kind of know, if you're familiar with that, you're familiar with that, I don't need to explain what that feels like. One interesting nervous system pathway is potentially involved here with brain fog is the idea that our hypothalamus and our sympathetic nervous system, which is the kind of the activation branch of our autonomic nervous system, it's that branch, which is involved with the sweating and the flushing and the heat dissipation.

And so every time you get a little bit of an increase in body temperature, your sympathetic nervous system has to kind of fire off to dissipate that heat. And when you get repeated sympathetic nervous system activation, particularly when you are asleep, you end up feeling kind of wired, you kind of become hyped up and hypervigilant, but you're also tired because you've had your sleep disrupted. So we've got this relationship there between your autonomic nervous system responses and the sleep disruption.

And we can kind of track that back to the hormones. What is a really interesting thing to think about here is when you feel tired and wired, so when you feel kind of hypervigilant, the sympathetic nervous system's kind of dialled up and you're not bringing it back down as easily as you used to be able to, what does that hypervigilance feel like? Well, that feels like kind of anxiety in your body.

And if you wake up at 3 a.m, I guarantee it'll take you like less than a minute, probably five seconds to find something to worry about because your brain is a prediction machine. So your brain's going, I feel nervous in my body. There must be something that I need to be thinking about that explains this.

And you just glom on to the most clearest and obvious thing in your life that is concerning you. That's kind of what anxiety is. It's like your brain filling in the gap when your body is hypervigilant.

So again, what happens when you're feeling anxious, you're sleep deprived, your mind finds something to worry about, we can start to see the emergence of mood disorders. And what we might call brain fog goes hand in hand with the sleep disruption, with the anxiety and perhaps even with the low mood if that's kind of a downstream kind of consequence of that. The kind of the fourth, I don't know whether up to three or four pieces of the puzzle here now is around the idea, and it's kind of less related to the thermoregulation and the sleep, et cetera.

It's the idea of how our brain is using energy and metabolising glucose for energy. So we know oestrogen helps neurones in the brain to generate, to turn glucose into ATP, which is kind of like the energy currency of the cell. And you might remember back to like high school science and you're looking at mitochondria, et cetera.

When we're going through perimenopause, the shift in oestrogen can cause a bit of a shift in how efficiently neurones can metabolise and kind of produce energy. And perhaps while the brain is going through this shift and it comes out the other side because it's very adaptable, it could be that thinking feels harder or slower or feels effortful. And it doesn't feel great when something feels hard.

It's like you're learning calculus at high school and it was really difficult. It didn't feel great. The struggle doesn't feel good.

And so we might then kind of notice that struggle and the discomfort that comes from that and go, oh, well, that's brain fog. And that could be like kind of a brain energy metabolic shift. So that's kind of another piece in the puzzle.

We know structurally the brain is possibly reorganising slightly, but it's very much debatable. Any structural changes we see from say pre to peri to postmenopause are due to the hormonal changes or if they're due to ageing. Because you could start perimenopause at 45 and be comparing a brain who's 45 to the brain of someone who's 60.

You've got 15 years of ageing there. The brain's going to change over the course of 15 years no matter what happens. So it's quite hard to shift out chronological ageing from hormonal ageing.

But we do know that there are changes taking place in the structure. Whether that's underpinning the feelings of brain fog, not really sure on that. We also know that how different parts of the brain networks interact with each other and work together change across the course of our lifespan.

So when we go through puberty, they become very kind of specialised. So we've got specialised circuits for different roles. As we get older, perhaps underpinned by the shifts in brain energy, more kind of networks are recruited and become more integrated together to support the same cognitive task.

So the brain's still getting to the same end result, but it just might be going around in a bit of a different way. Perhaps that network reshuffling around perimenopause might slow down your processing speed. So we've got like a whole host of these different kinds of changes here.

And then we've also got just simply our attention. If the 18 to 25-year-olds are more concerned about their attention and their memory than anyone else, you've got to wonder how much this device, a mobile phone plays in this whole thing. Because I've started to think we carry our phones around like little newborn babies.

And what we remember and how we pay attention, what we remember depends on where our attention goes. And if we have lost the ability to thoughtfully monotask and focus on the job at hand, instead of constantly being distracted by a device, if it's in the room with us, this competing demand of a phone constantly pulls attention. We've got some really good data showing that even just having a phone in a room with you decreases your cognitive performance.

So I think I've named eight different things there. Brain fog is a systems puzzle. It's a complex web.

It's hormones, it's sleep, it's metabolism, it's mood, it's brain networks, it's structures, it's attention. And there's also a little bit of, dare I say, perhaps ageism in there as well. Because right now everyone's being flogged with this menopause story, which is all about we're all catastrophising this phase of life as if we're about to commence the slide to the end with dementia being inevitable.

And so the tiniest little blip, you forget where you put your keys or your glasses or you can't remember someone's name. We're going, oh my God, it's menopause, it's brain fog. Do I need HRT or not?

Oh, is it dementia? My brain's eating itself. We're like catastrophising.

And so we're honing in and focussing on what we're missing. And we've paid zero attention to the wealth of research out there, which is emerging around the idea that cognition isn't in this inevitable decline at midlife. Not all women experience brain fog.

Lots of women sail through the menopause. Lots of women's cognition improves. My teenage boys forget their shoes and whatever all the time.

They're not like, oh my God, am I getting dementia? Have I got menopause? No, they just forgot something, right?

So we're also paying attention to the deficits because I feel like right now we've been primed to look at them and worry about them a bit. End of TED Talk on brain fog.

[Angela Foster]
That has thrown up so many questions for me because there's so many things that you've said there that I think warrant a bit more investigation in a way, just because of the things they throw up. But firstly, when you were talking about social media there, one of the things that struck me is that we're not just getting lots of short form content. We also, and I think for many people in their jobs now, because of AI, we are being required to synthesise vast amounts of information that we wouldn't have done before.

So if I look back a few years ago and I wanted to prep, for example, for our interview together, I could research you myself and read your materials. And I would go into definitely what you were saying around depth, right? I would go into the depth of the content because everything would need to be read before it.

[Dr. Sarah McKay]
You'd hopefully read my book.

[Angela Foster]
That's what I'm saying. I read your book, exactly. But what I can also do on top of doing that now is I can very quickly pull information from things like Notebook LLM and upload them to different AIs and find out everything you've ever said that might be interesting to my particular audience.

And so I think there's some of this thing of like, everything is moving so fast and what we're required almost to know is so much greater. When I think back to when I was practising as a lawyer and also just my law degree, I think about the large amount of information that I had to synthesise then, reading case studies and things like that. And my understanding is that some of this is actually neuroprotective if you push the brain in a way and you create better capacity.

Is that true? So I'm just wondering where this boundary lies in terms of how much things might be damaging and how much things might be stretching and expanding capacity.

[Dr. Sarah McKay]
Yeah, yeah, yeah. So we've got great evidence from lots of different ways in which we can study ageing brains and looking at years of education or kind of the cognitive demands you've placed on your brain, particularly when you were growing up. And it's pretty easy to get a metric of did someone leave school when they were 15 or did they stay at uni until they were 30, right?

And look at those, how many additional years of education, how does that contribute to cognition at midlife or dementia risk later in life? How cognitively demanding is your job? Let's compare a lawyer's brain to a factory worker's brain, which I don't mean to be dismissive in any way, but we can look at the cognitive demands placed on the brain.

And typically, and there's lots of different outcome measures. We can do types of cognitive tests. We can look at dementia risk outcomes.

We can, there's a new measure that neuroscientists have come up to because we could do so many different measures on a brain. We could do a hundred different tests. We could pop you on a scan or we could look at structure function.

We've come up with this measure now called brain age gap, which essentially you kind of pull together all of the different measures, metrics you've got of a brain. And you go, hey, does this brain look older or younger than what we would expect for this person's age? So if you've just turned 50, does your brain look like it's more like a 60 year old's brain or more like a 40 year old's brain?

So we can look at brain age gap. And so now we can look to see what increases brain age gap and what decreases brain age gap. Ideally, of course, you want a younger brain than an older brain for your age, right?

You want to be kind of younger and fitter. And so we've got ideas around the cumulative years of education, how cognitively challenging your job is, that will reduce your brain age gap. And that will also reduce your risk of dementia.

It kind of almost builds resilience in. And what we tend to see is we might still see, we will still see a brain age, but it's like it's ageing from a much higher level. Like, you know, it's got much, much further to fall.

Like, it's like if you've got a really big, strong muscle, it'll, you know, it'll shrink if you don't, if you stop using it, but it's still going to look bigger than a little spindly muscle that was never used. If that's a decent analogy, I don't know. That's kind of something different from what you're talking there about like kind of cognitive overload, which is much more, much more kind of an in the moment idea of how much kind of working memory capacity have I got?

How much information can I take in and keep in my mind, you know, during the course of the day or an hour or, you know, across the course of a minute before I'm either overwhelmed and I can't perform the tasks I'm doing at hand or I'm just too distracted. So we've kind of got more of an in the moment thing versus a lifetime accumulation thing. And that might be one way you kind of look at the two.

And an example I would give would be thinking about, you know, because we often think, oh, my brain's not broken. It's not working. It doesn't, it's, I can't, I can't do all of the things it used to do.

And lots of people are talking about that now. As I said, we've got this really good data that if you have a mobile phone in the room with you, even if it's turned off or, you know, people place them face down on the desk next to them, that reduces your working memory capacity. And working memory is kind of the number of items you can hold in your mind at any one moment, like your ability to, say, do mental maths or, you know, a bit of linguistic gymnastics if you're a lawyer like yourself.

How adept are you at that? And working memory is then the driver of a lot of other executive functions, like decision making and planning and judgement and reasoning and kind of critical thinking and deep thought. And simply having a phone there is kind of reducing the kind of the driving engine of that.

So, you know, we've, that's got nothing to do with how many years of education you've had, right? That's just got to do with the fact that a mobile phone has become so emotionally and incredibly salient to us. If it required to like, oh, I'm not going to look at it.

No, I'm not going to look. No, I'm not going to look at my phone. I'm going to go back.

That just reduces our performance overall. So another way to think about it is not just blame the phones, just blame the cognitive overload of everything. It's like when you're learning to drive a car.

There's so many things to think about, not just like where you put your hands on the wheel and where's the indicator and the seatbelt and the mirrors and the lights and the accelerator and the brake, et cetera. You know, maybe you're driving a manual. You've got to learn how to change gears.

You've got the traffic. You know, you've got all of these distractions. And, you know, over time, you get better and better and better at automating a lot of those tasks.

But we can still get to the point, even if we're very, very skilled, whereby you've got, you know, you've got kids fighting in the back seat. You're trying to do a work call at the same time. And then, you know, there's some crazy people driving traffic in front of you.

That doesn't mean that you aren't able to drive a car well anymore. It just means there's so many things competing for your attention. It's impossible for you to be able to do them all perfectly well.

Your performance on them all is going to drop. And that feeling of fighting to maintain that level that you're used to feels horrible. Like, we don't like feeling like that.

And so, again, that, you know, over time, just, you know, that the cognitive fatigue of it all can burn us out. So we've got, I would like to think about it as sort of two slightly different things that you're getting at there.

[Angela Foster]
It's very interesting because what I'm hearing from you is that people in their 20s are seemingly more worried about brain fog than necessarily women in midlife. Australian women in their 20s? Australian women in their 20s.

That's just to be, just to be, like, precise. Just to be precise. You know what's funny, Sarah, is that, and I think this is down to TikTok, is that even my teenage daughter has a word for it.

You know, she talks about brain fog and obviously they talk about brain rot. But, yeah, it's just interesting.

[Dr. Sarah McKay]
Yeah, I actually just, I looked, I just looked at the data up quickly. So attention difficulties, getting distracted, finding it hard to concentrate, tuning out instead of focussing, difficulty organising tasks that have many steps. 60% of 18 to 24 year olds say they are concerned about that.

38% of 45 to 64 year olds. 65 plus 22%. So it's going the opposite way than what we might think it would be.

Young women are more likely than older women to report being concerned about their attention and short-term memory, right? Is it, is that menopause? Are we going to, like, go, oh, maybe menopause starts at 18?

I just feel like we need to start casting the net a little wider when we're talking about women's health and not just always assuming it's going to be what we think it is or what's, you know, what's driving the algorithm.

[Angela Foster]
Yeah, it's kind of, it's crazy, right? Very interesting, because as you say, right, this is what we're being almost conditioned to, that this is menopause. And I've also seen you write about the fact that your expectations around what will happen also influence the brain.

So if you're expecting bad outcomes, right, that can also influence it.

[Dr. Sarah McKay]
Yeah, and because you'll go, what will you go? One, you'll go looking for them. You'll notice them and you'll amplify them, because whatever we pay attention to, that tends to amplify that problem.

I mean, we know that with, say, something like chronic pain or, you know, dizziness or, you know, you've got a bad back, you have an MRI, there's a few little, like, kind of, you know, blops on the MRI that makes your back pain worse as soon as you get the MRI report, right? We've got very well-established data that if you kind of start looking for something, you'll find it and it will start to feel worse. And kind of, we've also, I mean, this amazing study came out just even in the last kind of couple of weeks, I think I've got that on my computer screen now, it came out, like, really recently, this idea that how we perceive ageing, we've had this idea out there for a while, we've got this embedded ageism and now I feel like it's turning into gendered ageism with the good work that's being done around menopause awareness might have a bit of a dark side, that when we assume that ageing is around decline and dysfunction and we're kind of, you know, it's only downhill from here, that exacerbates worse cognitive outcomes and exacerbates physical outcomes. But if you are taught about positive ageing and, you know, the upsides and, you know, some of the, you know, because we've got all this cognitive data coming in now showing how test scores and various metrics can improve, can peak at midlife, can peak in your 60s, can peak in your 70s, then when people learn about positive ageing and positive outcomes, their own cognitive scores improve.

So the expectation is an enormous part of that.

[Angela Foster]
This is massive, this is like those hotel workers, right, that were told they were going to lose weight through their housekeeping job and then they did.

[Dr. Sarah McKay]
Exactly, exactly. We see that these outcomes, so this was published, a researcher, Becca Levy and Martin Slade, they just published, they're at Yale, they just published this in the Geriatrics Journal within the last couple of weeks called Ageing Redefined, Cognitive and Physical Improvement with Positive Age Beliefs. And like, I'm a massive fan of talking about women's health and women's brain health and puberty, pregnancy, menopause, menstrual cycles, et cetera, but I feel like it's, there's been a bit of a gold rush and people have jumped on in because it's now being seen as a problem to solve, which might be making the problem worse.

You know, maybe, you know, what we are calling brain fog is us noticing something because we feel like we should be seeing it. Not to say that some women don't experience this, just if we're seeing younger women reporting more problems than older women, we can't default to the hormone with menopause story anymore, right?

[Angela Foster]
Yeah, absolutely.

[Dr. Sarah McKay]
That's kind of turned it on its head.

[Angela Foster]
When we look at Dr. Lisa Moscone's work, she's definitely sort of shown on, I think on brain scans or she's continuing to research that there is some kind of reorganisation that happens at key events in terms of puberty, pregnancy, the work around sort of theory of mind and how you can understand your baby's emotions and things without them telling you because they can't speak was super interesting to me. And then this separate one that happens in that menopause transition, are those things happening in reality aside from these sort of brain fog symptoms?

[Dr. Sarah McKay]
Yeah. Yes, Lisa Moscone's work is very much focused on menopause and she has done some studies, although not longitudinal studies, you know, looking at groups of women and comparing them at different ages. What we need is a nice longitudinal study where we've got a big group of women, we followed them through.

We're still waiting for that data to mature. Lisa Moscone has done some studies, particularly around the idea of the metabolism shift that I described earlier, whereby the neurones aren't using glucose and producing ATP as efficiently as they did through the perimenopause, but that we see that shift during perimenopause and then it kind of levels out as the brain adapts. And there's lots of ways in which the brain adapts in response to this hormonal shift.

And she's also seen some structural reorganisation. She saw, she has described in one of her studies that actually grey matter gets slightly thicker as you go through the perimenopause transition, which is kind of interesting. That's kind of the opposite of what you might anticipate.

Other studies have shown, actually we see it getting in some areas of the brain getting slightly narrower and other studies are going, well, it's just age related. So that's a bit of a fuzzy space. It's harder to study menopause than it is to study pregnancy because pregnancy is like nine months.

Menopause could be 10 years. So you've got to wait 10 years plus for you to gather your data. So you can study one menstrual cycle over one month.

You know, you can gather lots of months up. What we see during pregnancy has been driven, and there's like quite a few researchers working in this space now, but shout out, must go to the original woman who were in charge of that study, Aselina Hoxheimer, who's in the Netherlands now, Susanna Carmona, Erica Barbara Muller, Susanna, and then a lot of the people that have come out of her lab have done a lot of great work and they've kind of partnered up with Emily Jacobs in California just to kind of put the right people's names next to the right studies. That first study looking at how women's brains change during pregnancy was fascinating. And what they saw was they saw grey matter volume reduction, which sounds like the brain is shrinking.

We see grey matter volume reduction in adolescence as well. And both instances associated with the enhancement of various types of cognitive skills. So during pregnancy, and it's driven by the hormones of pregnancy, not by parenting, but by pregnancy per se, we see that that enhances those skills of empathy and theory of mind.

So what does someone else think? What does someone else feel? Can I react and respond to, well, it's primarily your baby, but we also see enhanced.

If we were to test empathy and emotion recognition in a new mom versus a non-mother, not just her baby's emotions, but other people's emotions as well, we would see a bit of enhancement there. So the maternal brain and that neurobiological reorganisation of matricence enhances those social cognitive skills, which are pretty important for keeping a baby alive and for, I suppose, gathering the mother helpers in the tribe and around you to care for your baby. But again, typically for many years, all we ever talked about was this idea of baby brain.

And you lose your mind, you become forgetful, you can't remember anything. There's been so many studies done trying to tease this out because women keep saying, I don't feel like my brain is working the way it used to. So the scientists keep going and looking for a deficit.

It's only been in more recent years, some scientists have started going, maybe there's not a brain dysfunction. Maybe, again, this is a cognitive overload. Maybe the brain is so consumed by the baby and all your attention is focused in on your new baby, as it kind of should be because you're a mammal, right?

That you're not paying attention to all of the other things. And so they're not, so you're not remembering them, but you're still expecting yourself to be able to do everything and all of the new things that are involved with mothering. Add on top of that, of course, massively disrupted sleep, recovery from birth, maybe even a bit of postpartum depression, high levels of anxiety and hypervigilance, which are kind of part of your nervous system response to focussing in on your baby.

So there's a whole lot of things going on in there. So the brain is probably completely fine, if not functioning more efficiently and flexibly than it used to be, but it's just in this brand new, super challenging, demanding environment. And so the studies aren't necessarily always picking up cognitive decline and deficit and memory loss.

Might feel like that subjectively, but actually that subjective experience is much more closely associated to how much sleep you're having, of course, but also how socially supported you are, your overall sense of health and wellbeing, you know, your experiences of motherhood and the fact that your brain isn't like worrying about your husband's ironing or whatever the other, the email from your boss, it's biologically primed to focus on the baby.

[Angela Foster]
It's interesting. I do remember having to write things down for the first time to remember them when I was pregnant. Yeah.

And that, but it all kind of came back. One of the questions that just comes up in the comments on my account when we post stuff around the brain is, you know, can I expect things to return to normal for whatever reason, whether it is social media, whether it is the attention deficit, all the problems we've got going on. Women in midlife, many of them are saying, I'm really struggling.

Is it going to come back online? Is there any reassurance you can give? A hundred percent.

[Dr. Sarah McKay]
When we are able to pick up these kind of cognitive, like we do a cognitive test and in some women, they might score like a point or two less than what they would have the rest of their lives. And typically we see that in verbal skills. Are we going to pick it up?

The type of cognitive test we would pick it up on is one of like verbal recall, like here's 20 words. Can you remember them? You know, 10 minutes later, whatever.

That kind of verbal recall. And women are actually much outperform men. On average, the average female will outperform the average male on that test.

And so women going through perimenopause, when they do see that reduction, you might only remember one word or two words less. You just get down to the level of the average male anyway. So it's not like you're doomed and on your way to dementia.

You're just functioning in the same way the average dude does. For those women that do show that blip, it's much more tightly related with thermoregulation, vasomotor sleep disruption, anxiety and depression. If they get out to the other side of menopause and all of these things start to resolve, then typically we do see that those verbal things resolve.

But there's lots of stuff that we can do in the meantime to support that process. And so I think it's probably, it's like such a great, like, not canary in the goldmine, because that sounds melodramatic, but, oh, well, I've, you know, what is happening with my sleep? Do I have vasomotor symptoms that are waking me up at night?

Are my levels of anxiety dialling up? Am I struggling more with mood? Like, am I as well able to, you know, manage the stressful events and regulate my emotions in the same way that I could in the past?

You know, what's my diet? What's my exercise? Like my sleep, you know, those basic biological functions.

Am I putting myself in situations or not managing my environment, whatever that context is, whether it's the workplace or not, whereby I'm just constantly distracted and I'm trying to multitask and my performance is going down and everything. There's so many different ways that we can kind of approach that and look at how we can, you know, turn a few little dials. Men are all like over the place about being peak performers and tweaking this and that, and, you know, taking all of the things and doing all of the things.

Women, I feel like women at midlife are kind of not quite as dialled into wanting to see where they can make the changes. Also, there's loads of women out there that don't have that ability or the resources or, you know, the capacity to do that. I understand that as well.

So there's perhaps lots of places where you can like kind of try and tweak the dial slightly and also see if you can address a little bit of that, you know, gendered ageism that might be like floating around too and look for examples of women in midlife doing great things. We just had one. She flew around the moon.

You know, we've got these examples of these amazing people in midlife conquering the universe. You know, they're not flopping about at home worrying about their brain fog. They're out there, you know, doing great things.

We need to sort of start looking for those examples too to give us a bit of hope.

[Angela Foster]
If you're getting value from this show, the single best thing you can do to help us keep bringing you the highest calibre guests is to subscribe or follow wherever you listen or watch. It takes 10 seconds, but it genuinely makes a difference to the quality of the guests we bring you week after week. I love that.

I love that. It just makes it so much more positive. One of the things that the volume, as you've already mentioned, has been massively turned up on social media is that taking menopause hormone therapy can alleviate definitely the symptoms that you've talked about in terms of that contribute to brain fog, right?

The hot flashes, the night sweats and things like that. But when we look at menopause hormone therapy and its effects on the brain, what effects does oestrogen, progesterone and testosterone increasingly being taken by women, what impact do those three hormones have if you're using them exogenously on brain health?

[Dr. Sarah McKay]
The evidence is very, very clear around oestrogen in that it all comes back to those like, because peptone neurones in the hypothalamus put the oestrogen back in, their thermoregulation capacity kind of goes back to what it was. They're not like becoming overly hyperactive in response to just a little tiny shift in your core body temperature. So some of them actually get colder than usual.

My mom, I remember like for years is always complaining that she was always too cold, she was too hot, her thermoregulation kind of band was so narrow, it didn't take much. And so some women get colder, but typically it's the overheating and that's just your brain thinking, it's so hot, it needs to quickly cool down and it's an emergency. So that resets that kind of thermostat in your brain.

And then if the disrupted sleep was a result of that, that might help with the disrupted sleep. And then that in turn, because you're not got that repeated sympathetic activation to cool you down particularly if that's waking you up at night, then that might help dial down the anxiety. If it's gone on for a long time, often the insomnia and the anxiety become kind of a bit more embedded and they're not as easy to just kind of dial back with just some HRT.

And so we've got the kind of the data showing that, that it will help with disrupted sleep if that's directly due to the vasomotor symptoms. Will it always help with disrupted sleep or insomnia? No, because that's a much more complex kind of biopsychosocial issue that needs to be addressed.

Will it always help with anxiety and or depression? No, because they're much more complex. It can help some women some of the time, but it's not always going to help all of them.

So the indications are very clear in all of the clinical practise guidelines and they're continually being kind of reviewed very much around the vasomotor symptoms, that that's what the oestrogen is doing. The progesterone in terms of what it's doing to the brain, we don't have as clear a data. Right now it's taken to reduce kind of endometrial growth that can come to kind of counteract the oestrogen in your uterus.

So women who don't have a uterus don't need to take progesterone, but some women do report that they find, particularly women who are sensitive to oestrogen, do report feeling it like reducing anxiety. I'm not as convinced about the proposed biological mechanisms there. I don't think you can pop oestrogen and 10 minutes later feel sleepy.

I think there's probably a good dash of placebo in there because we do know that, yeah, progesterone. I think that the actions of that are, like most hormones act in the brain like kind of a day or two after you've taken them. So they've got kind of a bit of a lag time.

So you're not going to like put oestrogen on and feel better 10 minutes later, right? If you do, that's a placebo effect because it acts on like receptors that activate the transcription of genes. So, you know, there's a bit of a lag time there.

Testosterone, no idea what it does on the brain. I think it's massively, if you would look at the good careful randomised control studies that have been done primarily by Sue Davis here in Australia, who's like kind of the main researcher in this space who's done the good, careful, thoughtful, you know, gold standard of the studies. There's a massive placebo response with it.

She says the biggest placebo response that she's typically seen in clinical trials come from testosterone. And the data's more so around, you know, sex drive. And I think it's mostly only been tested in post-menopausal women.

Whether it like makes you think or feel or behave in a different way, data's, jury's kind of out on that. Data's a bit fuzzy. Perhaps the doses that you'd have to take might end up having side effects that lots of women don't want.

So less clear on that. But in the long-term, we've got like this, and the data's best described as mixed. If we're looking long-term, take HRT at menopause, perimenopause to treat your vasomotor symptoms, what are the long-term outcomes on brain health?

Your brain won't eat itself just because you're not taking HRT despite what the algorithms have pushed the crazy stories out to, fuel people's business aspirations. The data is clearly mixed. Some studies show, even for women who are taking transdermal oestrogen just to treat thermoregulation symptoms at perimenopause, some studies are showing an increased dementia risk.

Some is showing a decreased dementia risk. It may depend on your genetic profile. It may depend on your actual status of your health at that point in time.

Like how healthy are your cells? An unhealthy cell may react badly to oestrogen supplementation. A healthy cell may react good, including a neurone.

How long you've been taking it for, whether you were taking that old school equine oestrogen and synthetic progesterone that they used to take back in the Women's Health Initiative study days versus the kind of types that you take now, how long you take it for, et cetera, et cetera. It's a very fuzzy kind of space. My personal feeling is it's probably going to be a bit net neutral.

I don't think that HRT is going to be the tipping point towards dementia risk reduction or not. I don't think it's going to be the weight that tips the scales more strongly than lots of other factors, but I might be proven wrong.

[Angela Foster]
Very interesting. I guess we've got to wait to see on that. Just to come, I'm going to circle back on the things because you mentioned how men tend to focus much more on that sort of productivity and optimisation of their brains.

I want to come back to that. Already, you mentioned something very interesting there because this is something that many of us have been sort of led to believe across social media is the idea that when you use bioidentical progesterone, that interacts with GABA and calms the brain. Rounds from what you're saying that isn't necessarily the mechanism.

[Dr. Sarah McKay]
I'm not convinced because part of my PhD research was looking at the development of GABA neurones in the visual cortex. And I'm like, I don't think a hormone is that. Maybe we don't have progesterone receptors for GABA and progesterone receptors and GABAergic neurones in visual cortex.

Maybe it's only in neurones and those parts of the brain which are processing emotions or wakefulness and sleep. So typically hormones, typically oestrogen and progesterone act via receptors which are on the nucleus, which are involved with gene transcription, making new proteins and putting proteins in. It's a kind of a process which takes a few days to roll out, right?

It's not instantaneous. It's not like taking progesterone is like taking a sleeping pill. Even taking melatonin isn't like taking a sleeping pill.

That is also a hormone. It doesn't act to like make you fall asleep. It tells your body it's night and then your body does all of the things that it typically does at night to help you fall asleep.

So people that are taking melatonin and falling asleep 10 minutes later, that's a placebo effect. It's taking about three or four hours for the effect of melatonin to kind of roll out appropriately. So we must keep that in mind.

I can't square in my own mind if progesterone acts on GABA receptors so instantaneously that people pop the pill and they fall asleep, why it's not interacting on the entire GABAergic system. Why is it not impacting my vision? Why is it not impacting my, like every other brain system which requires GABA?

Because GABA is just like kind of in, like your brain is just like this, like this partly we can think about the brain is just like this kind of electrical circuit with on off switches and some things turn it on and the circuit and some things turn it off and GABA just kind of makes neurones quieter. But you could make a neurone, a GABAergic neurone fire more which makes the next neurone quieter, which makes the next neurone and the path louder, right? And then that, you know, if you turned GABA off in the visual cortex, you would be able to see lines and edges and colours and shapes.

So I can't square in my own mind that somehow progesterone acts to make people fall asleep because it acts via the GABAergic pathway. Again, I might be proven wrong. I just, I feel like the default right now because we don't know, like people keep talking about oestrogen and progesterone.

They work on serotonin and dopaminergic pathways and GABAergic pathways and when their levels reduce that's why you get depression. There's no plausible biological mechanism whereby that is what always happens. Sometimes when we reduce oestrogen we see serotonin levels in some parts of the brain go up and in other parts of the brain they go down.

And it's not just because that neurone's making more or less. It could be to do with more or less of the receptors being embedded and we've got like, we can have opposing effects and different pathways in the brain. So people are throwing this neuroscience sounding explanation out there that I'm not buying.

I think they're just saying these neuroscience words without, and even if you see it in a paper and you look back for the original paper it'll go back to a review which just might go back to someone saying, oh, hormones impact neurotransmitter systems. I'm not massively convinced that it's happening that way they say it is. I think it's a bit more complex than that.

I mean, even say SSRIs like antidepressants don't act on the serotonergic system in the way people think they do. Sure, they mean that there's more serotonin available in the synapse because it blocks its reuptake. But that doesn't mean that more serotonin makes you happy and therefore depression is a deficiency of serotonin.

That's just like the straw man that people are talking about. What happens is when you take an SSRI and you've got more serotonin in a synapse almost immediately in anyone who takes it means you like then have a different perception of like things in the world around you. And so you might be shown like a series of faces.

You will perceive the emotions in those people as much more positive versus negative. And someone who's depressed is always going to perceive the context they're in through a negative lens. And this extra serotonin kind of gives you a bit more of a rose tinted lens on the world.

And once you have more repeated positive experiences over days and weeks and months instead of repeated negative experiences your mood starts to lift because your brain starts to learn that actually the world can be not always terrible. It can actually sometimes be positive. And so your mood lifts as you have more good positive emotional experiences which is kind of much downstream of the serotonin.

So this is why I just think the hormone neurotransmitter space right now isn't... We don't have a clear story but it sounds scientific to say so.

[Angela Foster]
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Head over to mitoq.com and use my code ANGELA for 10% off your first order. That's MITOQ.COM code ANGELA for 10% off. Yeah I mean it's really interesting what you're saying there because obviously I'm not a scientist but when I look at it from a kind of I guess with my lawyer hat on we would just look for evidence of things.

Yeah of course. I would question that if I look at women you know who like they're on after about a year of taking menopause hormone therapy they're taking continuous oestrogen and progesterone so if that's making them sleep it would immediately call to question for me then why is it for the whole of my life up until this point when I only had lots of progesterone in the last two weeks of the month why did I not have insomnia for the first two weeks of the month if it was having such a powerful effect?

[Dr. Sarah McKay]
I think there's a massive placebo effect like I said I don't think it's happening I don't think it's happening in that way but there are some women who are very sensitive to the ups and downs of progesterone but like I said it doesn't I don't believe it acts within a few minutes or hours it's more it's a time lag response if we image the brain and we look at like say functional connectivity in the brain across the course of the menstrual cycle so we're looking at when's your peak oestrogen when's your peak progesterone and we've got measure from the blood and we're looking every single day the shifts in functional connectivity we see in the brain are kind of lagged by a couple of days because that's how long it takes for the hormones to act because they're hormones they're not neurotransmitters a hormone is by virtue broad and diffuse and slow we're not using hormones to process echo you know we're not like locating sound using hormones because we need millisecond precision we need to be able to detect the sound hitting our right ear versus our left ear and that allows us to locate where that sound is because it's reaching one ear at a different speed than the other ear and so we need very precise fast neural communication there to detect that size difference a hormone can't do that a hormone might kind of go in and modulate the overall state of a system but it's not doing that fine tuning because it's just making its way in from the blood it's just coming out of your ovaries and or the patch or whatever and then just making its way through your system but I mean again I might be proven wrong but the story isn't clear yet yeah the jury's still out on that one yeah and it's and we have to learn to accept that I know it's frustrating but we need to learn to accept that and to not make rubbish up when there's a little bit of a gap in our knowledge don't make rubbish up or tell people stuff that isn't true

[Angela Foster]
yeah I'm glad you've highlighted that super important what can we do then to really optimise our brains if we want to be productive at work and we want to be able to switch off at night and get into those deep work phases you know and really just feel more relaxed than we are now what are the things that we can do from a nutritional perspective a fitness perspective a lifestyle perspective yeah I always talk about

[Dr. Sarah McKay]
bottom up your body the outside and the sort of context you're in which can be social environmental could even be like urban you know workplace and then like kind of the mind you know your thoughts feelings and mindset so the biological basics have never changed like the sleep and I think the sleep's the foundation if the sleep is disrupted then everything else falls apart from that and if the sleep is due to the hormone or disruption and you can want to take HRT or you can take HRT and that helps with that that's a really good place to start if you don't want to but you've got vasomotor symptoms that are disrupting sleep there are other treatments available so we must seek them out and then nutrition and we all kind of I mean I just find kind of find nutrition a little bit boring but you know just we know what to do we just don't always do it just eat like not don't eat crap and just don't eat too much and eat your fruit and veg and you know make it enjoyable and then exercise and exercise of course and everyone's just like lift heavy and I'm like what I don't even know what lift heavy means I've been going to pump for like 25 years have I not lifted heavy enough I don't know but we just there's these things that like trend it's like six seven or whatever lift heavy like we're no better than the teenagers but exercise is very good both like for your cardiovascular health and having good vascular health is very good because your blood vessels feed your brain good you know and it's good for your overall metabolic health so we want to reduce you know all of our blood pressures and our blood glucose and you know all of the metabolic kind of risk factors and also muscle strength we've got tonnes of really great evidence about the link between kind of having good strong muscles and that being having good knock-on effects for our brain because there's kind of signals that go from muscles to our brain which promote brain health and if we kind of think about what we've always used our brains for to navigate bodies kind of through the world hunting and gathering and seeking and exploring and if we've got a good strong body that's able to do that then that's kind of what the brain evolved to do was to move that body around the world and then that kind of I suppose that's all your sort of your bottom up then from the outside in I suppose there's lots you know we think about how does the outside world get into our brain through our senses through what we see and through what we hear so protecting our vision and protecting our hearing is massively important and is an enormous risk factor for poor brain health as we age but then you know not just protecting those sensory pathways but then also you know what's our kind of like our work environment like so we can kind of maintain you know maintain the intellectual enrichment that comes from that without that cognitive overload at the same time how can we sustain good strong social connections and relationships one because it's cognitively engaging and good for us cognitively to be engaging with other people but also because other people are there for us and they reduce our stress and being in it together is you know better for our stress response systems and being alone having people to you know when we're sick take us to the doctor you know there's so much to be said for a good strong social health and then you know I think perhaps under recognised and depends where you live in the world I live in the northern beaches of Sydney so I can look out my office window and see the beach right I live in this amazing practically a blue zone environment but not everyone lives in a walkable neighbourhood or has access to you know beaches or forests or you know the water's polluted the air is polluted there's lots of noise there's you know artificial light all of that so we kind of need to think about how we can manage the environment that we live in to kind of prioritise health because I think we tend to forget that we're just like these mammals that evolved on this planet right you know that they we talk about the neuro expo zone the kind of environmental environment we live in and everything we're exposed to is pretty important and then there's that you know then there's the kind of the thoughts and the feelings like you know our emotional regulation and how we are able to use our minds and our thoughts to regulate our stress responses and manage kind of emotional responses to situations you know the stories that we consume like we've kind of touched on in a number of times how social media has become a really active ingredient in health you know that's something that I think we're starting to realise the stories that we consume influence health outcomes so what are the expectations you have what are your you know your kind of habits your motivations kind of explore a little bit of that and then explore those expectations you have around what does ageing look like what does it look like to be a woman in your 40s or 50s or 60s or 70s or 80s what messages have you absorbed through your life up until this point I'm trying so hard and I feel like I'm kind of starting to get there that to like unwind myself you know I'm 51 like what my face looks like and my body looks like matter far less than who I am as a person and what I do and if we could focus more on women doing cool stuff like flying around the moon versus freaking who had the stupid facelift or the Botox or whatever um like we just have we'll have so many more we just it's just it's just so much better for us right I think we think that the teenagers fall prey to that but I think we do too so yeah so bottom up outside and top down that's it

[Angela Foster]
one of the things just to kind of before we close that I have had we've had so many kind of thousands of women take our quiz and the thing that comes back consistently again and again in midlife is I feel like I've got goals but I don't seem to be able to focus or bring the clarity of picture to what I want my future to look like that I could do in my 20s is that something that's happening to the brain why would that be and how can we help women

[Dr. Sarah McKay]
that's a really interesting question I have not thought about that a lot but I feel like I remember what it was like to be 20 and to like the world was my oyster but you're constantly being told at 20 the world's your oyster no one's telling me the world's my oyster but there is this school of thought within cognitive science and ageing science that when we are young and we are building and growing whether that be building a career or building a family and we're young we're fertile and we're quick and we're fast and we can do all of the things well we could before we started worrying about our attention which is probably because of the phones everything's like kind of fast and reactive and building and growing and then when we kind of reach midlife and we're kind of especially for women when we're beyond our reproductive years there's a kind of a stillness that comes and perhaps some of the slowing down the matriarch being wise is not so much about growing and building anymore because you've kind of been there and done that it's more about imparting that on to the next generation we see so many women in their like second and third careers that are moving into coaching or whatever it's about imparting the wisdom versus growing the knowledge and we see these different types of cognitive studies that are done that show these different types of cognitive skills peaking at different points in time in the life and I wonder if there's something in that whereby we feel when we're 20 we can look 20 years ahead and that feels exciting and hopeful we get to 50 we've been told looking 20 years ahead is looking into what's your perception of a lady who's 70 or a woman who's 70 is she awesome and dynamic and fun and engaged and you know still doing kicking career goals and doing things or do we have we just started to think about that as you know something small and shrivelled I don't know I feel like we need to start telling better stories I found it so like life-changingly inspiring watching those astronauts go around the moon like oh my god like I think it was one of the most amazing things I have ever seen I like live streamed the NASA feed I didn't have it on 24 hours a day when I went to bed I turned it off I thought that was the coolest thing in the entire world that I've almost ever seen and they were 47 49 50 and 50 I did it I did an Instagram post on it they were like they're all 50 like we need more perhaps it's just we don't think that we can because we've never seen it

[Angela Foster]
I think I mean what you're saying is so positive and I think we definitely need more of those stories I mean it's just like one thing I think about all the time right is that you get two stories that women will tell themselves in midlife particularly women who have children this might be different for women who don't one is the kids are leaving home they're flying the nest I'm thinking about downsizing the second story and the one that I think would be I find more empowering is I'm thinking about upsizing I need a bigger house because my kids are going to go and they're going to find partners and then they're going to have children and there's this opening up of abundance right life is growing and getting bigger I guess there's two paths we can walk down and I think the message I'm taking from you Dr McKay is one of positivity and one to be ruthless about what you listen to and not assume that it's correct because it's a narrative we're hearing on social media to think very carefully about what you really actively listen to and think about because the brain as you said is a predictive machine and so that is actually creating our future in lifetime would that be right?

[Dr. Sarah McKay]
A hundred percent a hundred percent and what we go looking for we will find and we're only just learning how that actually does impact our biology so you know we've just had this trend for years that old age is just about decline and I think like those astronauts man like I know I keep going back to them but I was obsessed and I was like they are the same age as me that is the coolest thing I've ever seen so why should this midlife have to be all about the freaking HRT not getting dementia as if like that's all that we've got we've just got to like put HRT on for the next 20 years so we don't get dementia is that all there is? plus you know trying to say I'm launching birds instead of having an empty nest yeah there's so many cool people out there doing cool things we just need to but it's yeah I'm very concerned that the current narrative is contributing to gendered ageism and much the same way all of the best of intentions of talking about mental health haven't necessarily made it better they may have made it worse they may have contributed to you know over diagnosis etc so but you know there's enough of us out there trying to change things it's just you know doesn't feel like it's very cool yet but we'll get there

[Angela Foster]
we'll get there you've definitely opened my mind today thank you so much for coming on and sharing all of this I would encourage everyone to go and check out your book the women's brain book

[Dr. Sarah McKay]
thank you

[Angela Foster]
it's just recently been updated to have all the latest science in there

[Dr. Sarah McKay]
very importantly I was getting embarrassed I would go to like give a talk and people say oh can we buy some of the book and I'd be like oh I know it was written like five six years ago it's like so out of date and so then I said to the publisher can we do a second edition they were like yeah I could just about write a third edition next year already there's so much

[Angela Foster]
it's like what was the biggest change on this?

[Dr. Sarah McKay]
oh almost every almost every chapter I rewrote I think the biggest like the concept of like a female brain versus a male brain is a very important shift and that has come because we've got more data so we've got like these longitudinal studies which are maturing we've got data sharing we've got consortiums we've got biobanks it's all come down to like more accessible data for more scientists to use and more thoughtful ways about thinking about sex as a biological variable when you've got more data we've also at the same time had the advent of machine learning and AI which has enabled us to kind of analyse these data sets and the signal can emerge from the noise that we couldn't necessarily pick up before so we can tell different kind of we can tell a clearer story so that's been fascinating to see both in terms of sex as a biological variable male versus female male and female biology what we've seen in terms of childhood brain development adolescent brain development all of the studies about pregnancy have basically been done since I wrote that book so I mean menopause is gone I wrote an article on menopause and brain fog in 2015 here in Australia for the ABC we put it on Facebook had hundreds of comments but if you read them it feels like you're reading something from like the 1930s like it's so weird to look back only 10 years in time to see what the work what the language use just how no one knew anything versus now so there's just been it's almost like I think it was like you know the four minute mile once someone ran it then everyone ran it and it's like once someone started it's like someone said oh why don't we look at what happens to women's brains across the course of her first pregnancy and do a brain scan and everyone's like oh we never thought about that before now loads of people are doing it so there's just it's just like the door cracked open to this portal of research that's being done so it's so it's super exciting to kind of be jogging alongside them all I mean I used to be the neuroscientist now I'm the science communicator and like cheering them on and you know amplifying the messages for them and yeah a lot that's just going to keep on I think that that data is going to keep on emerging and we'll get some more statistical analysis of it all

[Angela Foster]
and you'll be sharing yeah and it'll be very exciting what's the best way to keep up with everything that you're doing I mean if you're changing that quickly you could change the book already in one year what's the best way to stay

[Dr. Sarah McKay]
I have a newsletter that I publish every week that is probably the best way actually so I focus very specifically on women's brain health across the lifespan and each week we will gather and I've got a PhD another PhD neuroscientist who works for me and we kind of trawl through like LinkedIn and all of the journals and we look at you know what's being done in policy and neuroscience is coming out which cool new podcast has got an interesting episode and we put that together and we're very proudly my Lily who works for me is a AI conscientious objector I am not but she is and she writes my summaries so they are human written which we are very proud to promote so that's one really good way to keep and I mean honestly some weeks we've got too much we'll have too many items for one week because so many things have happened in the space so you can go into my website and sign up there we'll put a link in there scout around for the newsletter link in there and it probably pops up

[Angela Foster]
or something as a box we'll find that and we'll put it in the notes for everyone the brain age gap you mentioned as well is that as people can take?

[Dr. Sarah McKay]
No that's just that's kind of an analysis that scientists do whereby to try and get a one number out of like you could do you could put someone in a brain scanner say and you could get 100 different measures of their grey matter and their white matter and the structure of their brain but they want to sort of distil it down to one number because if you've got a thousand people and there's a thousand measures that's a lot of numbers right? So brain age gap is the current method of analysis that scientists are using it's not something you go to your GP and say can you do brain age gap study on me but typically I feel like people know if you know you're feeling forgetful and fuzzy and foggy and tired and burned out and your mood is low and you're anxious and you feel dysregulated like we've kind of already got these biological you know these feelings of discomfort within us which are often a sign that something's not right you don't have to wear your wearable to get your metric about that I mean go for it if it works for you and you like tweaking it all but I think that you know our biology does give us those clues it's then spending a bit of time to be aware of them and to kind of try and figure out where you can like kind of shift a few gears

[Angela Foster]
What I'm hearing from you is that we need to focus on fixing our sleep first if it is bad we need to consume positive information I think that's just like really come through the whole thread of this interview is just be really careful what we're consuming and not overloading our brains eat healthy lift some weights do some cardio to get our blood flowing and really just actually hang out with friends and enjoy life these seem like some of the best ways to protect our body

[Dr. Sarah McKay]
Yeah, yeah, yeah, yeah, 100%

[Angela Foster]
Sounds fun to me

[Dr. Sarah McKay]
Thank you so much No, you're so welcome I enjoyed our chat very much

[Angela Foster]
Me too Thank you so much Dr McKay

Brain fog in perimenopause isn't inevitable decline.Brain fog in perimenopause isn't inevitable decline. It's a systems puzzle, and once you understand what's actually driving it, you can do something about it.

In this episode I'm joined by Dr. Sarah McKay, neuroscientist and author of The Women's Brain Book, and we break down the real neuroscience behind why your brain feels different in midlife, what the research actually says about HRT and brain health, and the evidence-based strategies to protect and optimise your cognitive performance.

WHAT YOU’LL LEARN
• What actually causes perimenopause brain fog (it's not just your hormones)
• How night sweats disrupt sleep architecture even when you don't fully wake up
• Why anxiety and waking at 3am are early signs of the perimenopause transition
• What the research really says about estrogen, progesterone, and testosterone on brain health
• Why the progesterone and GABA sleep claim is not what it seems
• How your career and daily habits are already shaping your long-term dementia risk
• Why your mindset about aging may be affecting your cognitive performance
• The daily framework for protecting your brain: sleep, nutrition, strength training, and stress