Embracing Authenticity and New Life Stages

Welcome to Hello Hormones with me, Dr. Carerie Jones, a podcast where we explore how to make friends with your hormones so that you can thrive in your thirties, forties, and beyond. Whether you're premenopausal, perimenopausal, fully post menopausal, or honestly just a woman dealing with the chaos of hormone imbalances, you are in the right place. becausecause handling your hormones doesn't have to feel like hurting cats. So let's decode what's really going on, Ditch that confusion and help you feel like yourself again. You bring the symptoms, I'll bring the science with a bit of Sass and get you solutions together Welcome to Hello Hormones, where we make friends with our hormones so that we can survive and thrive through our thirties, forties, fifties, and beyond. I'm Dr. Carrie Jones, intntegrative and holistic medicine doctor, hormone nerd, a longtime women's health advocate Today, I am joined by Dr. Lou Anne Brisndeine Neurop psychiatrist, founder of the womomen's mood and Hormone Clinic at UCSF, and honestly One of the most fascinating brains, Pun abbsolutely intended in the female brain science today She has been studying and working with women for decades In this episode, we kick it off with the brain and sex. Oh yes, we totally just dove right in We went deep on testosterone as well because I wanted to know about testosterone in the brain and how she prescribes and doses testosterone. We walked through brain fog and brain farts since that was my one of my top two symptoms back when I was just starting to go through perimenopause and how that ties together with glucose and estrogen in the brain I asked her about dementia, and she breaks down the big risk factors for it, and then of course, the top things that we can do proactively to help reduce our risk. We even laughed about her favorite phrase, which is no is a complete sentence And if you're setting boundaries and finding yourself like being a little adamant and who you are and who you're becoming, Well you're not alone as you are upgrading through this next phase in life. In fact, that's one of her books called The Ugrade So if you ever felt low libido fogy, forgetful or just completely unlike yourself and wildly wondering if this is just who you are now or if something is wrong Please keep listening Dr. Brzen Dyne completed her neurobiology degree at UC Berkeley. graduated from Yale School of Medicine and did her residency at Harvard. She's a total badass Her New York Times best seller, the female Brain, has sold nearly a million copies and has been translated into over thirty languages Her new book, Your Brain on Menopause is coming in january twenty twenty seven She has spent decades studying the female brain and every stage of life. And what she has found about this stage like over forty is genuinely revolutionary. I completely fan gired, so let's dive in Doctor Brzenin. welcome to the Hello Hormones podcast. I am so glad to see you and so glad to have you on today too Pick your brain literally about the brain Nice to see you again. there It's been a while, but it's really great to be back on with you. Oh my gosh. Well, I'm having you on to talk about the brain because I've noticed on social media there's a lot about weight loss. and hot flashes or rage or itchy ears. And then you talk about the brain and people are like . I don't know. like there's not, you know, like that's No I don't really want to talk about that. It's not sexy. What's going on with that Yeah, I know. I think they think it's just in this little big case here and there's this big gray blob of who the heck knows whether the joy and blob. But however you Hello ladies. Where does sex come from the sex comes and starts in your brain? This all the sex drive Lbido, sex drive, sexual interest in the male and the female brain comes from the brain. So actually by definition, the brain is sex the sex organ, the biggest sex organ they used to say members between your ears for women For a lot of reasons, that's true for us. but Let's be clear, the hormones se the hormone of sexual energy and interest in male brain and female brain is testosterone or in the Androgen family. So Females have testostrone. Males have testostrone. males usually have like They have ten times more than we have. We get a lot of bang for our bug ladies out of our smaller amount of testosterone. That's a big complaint I get in the perimenopause often. It's like Dror Bris and, I'm just like, you know, if I never, you know at this if I never had sex again, I wouldn't catch like. I' just do it for him or I just want to, you know, Yeah for like I'm tired of giving mercy screws, you know, that kind of You know, because it's like you just you feel you're not really interested in yourself. onnce you get started though, you can usually you whenever do your thing. once you get once you get once you get your engine started and women can usually but they never want to initiate, you know, that always indicates that there's ue and being tired as women because we're overdoing it.' that's another issue. I mean, that's part of that Pie ch this issue, but Um, you know, your sex hormones have started to go down in the perimenopause, sometimes starting between the ages of thirty eight and forty eight. bas' the time that they the sex hormones, particularly your androgens, your testosterone starts to drop a little bit from your Ovarian production, which is sort of ramping up to the real all perariod menopause and the per menopause. you got about a ten to fifteen year arc of that. And it's sort of subtle. So it's subtle. So there's always other things in our life like you're tired. you did this, you know on this, you'd rather sleep in on Saturday morning than have sex, you know, all the kids of this or this you know, you got the baseball games You got your juggling, right? I got to get my hair done, you know, my hair done is more important than. R? My Oes I but you know The thing is just orgasm is good for your brain, orrgasm is good for your body. So let's ladies, thiss not evenven though it kind of feels like it's drizzled away, get your hormones checked just to see where they're at, just so that you know what you're dealing with. because otherwise, we can always make up stories, right? We can always make up stories about why something is or isn't the way it is. then You know, you feel bad, your partner feels bad. You don't talk about it, and then all of a sudden two, three, four years has passed. You know, you're down some rabbit hole and then going to the sex therapist or the divorce lawyer so Don't let it go that long. So the brain is really sexy. The brain is obviously very sexy or Actually, I wantan to go back to testosterone. Now that you've said that, I got an email right before we got on here. and someone a woman was like I got my hormones checked. my testosterone is Well, Zero was the lower end of range for the lab she was using Faosterone And she said, my testosterone was zero. And my doctor said, well That's in the reference range because the reference range went down to zero. So you don't need it. And she was like If anything gv youro, what the heck You know, um So I've been in this business. but the testosterone stopped for a good long time, like for almost thirty years And you know, the reference rings for women in the ultr sensitive testosterone range, you know, is down, you know, if you're below a five or you're below a four or three or you know and I rememberind you in my perim mopus would go down to a one or two. It's hardly measurable The labs will come back and say it's virtually zero You know, which is basically unmeasurable by that person by that lap So if you had the doctor order the ultr sensitive testosterone, it won't be zero, but it'll tell you where it is. Anyway, ladies, if you're getting zero back from the lab it's going to be low. And if it correlates with remember what hormones at four The purpose of a hormone is to create a behavior to do a behavior. hunger hormone makes you want to eat seex hormone makes you want to have sex. So it's not rocket science. It's kind of basic, one to one. So if your testosterone level has gone down, your interest in sex goes down. If your hunger hormones go down, you're taking a GLP one and, you know, your your hunger goes down and you lose weight. So, you know, it's it's not it's not fancy stuff. It's sort of the basics. So ladies, get it tested So you know what you're dealing with. And it's a real easy. You just put testosterone cream on every morning or you can take it in a pill, you can take it in a jel, you can take it on an injection. Don't suggest the pellets though You know, the pellets that get put in for ninety days are longer Aant. It may be too much for you and then you'll get some vocal cord stimulation and sometimes you'll start getting a permanent low voice. So I would rather have something that I can dial up or dial down as we go along to find, you know, your magic number of like Enough libido and plus enough stimulation to your muscles to not lose your muscle mass as you get older. I mean, usually women at perimenopaus are don't have to worry about that, but as you go along into the menopause and after you need to worry about not only bone loss because if you't have your estrogen replaced, you know. during menopause, you will lose twenty percent of your bone mass within the first five years. So you don't want to go down that path goingo back to testosterone replacement, like how often do you see women go on it get the right dose and feel amazing. And how often do you see women go on it and they are like, eh, I didn't really notice anything Every doctor said this story, but the women it just Well, I'm a fan. I'm a big fan of teststerone. but I have noticed in the comment section more women are like, I went off of it because I didn't notice anything. I'm like Right So it's all about It's all about dosage and it's all about having your blood level then redrawn. know P problem is like If you put your test people you post put your testone right above your pubic hair on that part of your fat stomach. that's where you usually get the cream is going there. it's going there on your stomach there. on your lower alin And that's an easy place to have it. But you know, it's a lot of women put on the hairless part of here You don't want to get your testosterone level measured within about six hours after putting on the cream meal because It bounces all over based on when you took your dose. Yeah So a lot of wom men will get it. Oh, I took, you know, I get at the next they'll get the next day after they took it twenty four hours before and then it's kind of low is shouldnt You want to get It's not really hard to dose, but I would say every woman should give themselves like three tries at the different doses. so If it's doing nothing for you, that's the person you're talking to Yeah It's doing too much for you. So let's talk about the two ends of this book. Okay. Right Do doing too little for years obviously getting any getting nothing out of. Your libido is still kind of flat., you know, that's that's That end upper endes You feel like a nineteen year old boy? I had this happen with one of my patients once when the pharmacist made a decimal point change in it So of one point zero they did ten point zero And so Buting h just , I'm embarrassed to tell you about this, but you know,' I'm a school teacher at I'm in between classes and running into the bathroom to kind of like you know rel might I'm having to, you know, I'm going master and I feel like I'm nineteen year old boy, like, you know She said, you think this is too much for me Anyway it took us a while to figure mjor to a level and it was like over the moon so. That was clear. We just dialed it back, but these funny stories happen. you know. So And you remember your highest Chest sas shown in your life. in the life of a woman's about age nineteen. And you kind of remember what you were like at nineteen In terms of libido and sex tribe and sexual interest Usually women ages like seventeen to twenty seven. you know, they if they have a normal sex driver or a normal sex life, they They often don't worry about liido. They don't worry about orgasm. They don't worry the things that you worry about in your late thirties and up to your fifties. You don't worry about them. But I consider that a woman's baseline for when you're at a level that's going to work for your sexual function. So think about ladies how you were between ages, let's say, seventeen, twenty seven in terms of your interest, your libido. Sometimes you just don't think about it because it's just all everything is running on all cylinderers at that point in your highest level of This Sason's woman is This is night to dis all. And I think that's important because, you know, we willll hear we'll give stories from women who are like, well, I was told I was in range. I'll put that in quotes. I'm in range But I love that you were like thinkink back to when you were younger because what's in range for me might be different from what's in range for you versus You know, somebody who's listening, like we may all have different to twenty seven year old experiences and libidos. So just because you're in a range doesn't mean it's the right range for you Right. I mean, you see, that's all the lab the lab can tell you the lab tells you something that's important The real important thing For most doctors who spend any time listening to you, just like If you listen to your patient, they will tell you whether this is working or not working for them, even though their labs may be in range. So if someone in wr Smackdab in the middle range. and I get more information from her and she's not feeling much from it. She may have been someone who was in the top of the range all of her life And so she needs to be dialed up a bit until So I really encourage women don't get discouraged. And it's like I say, when I start with womens like This may take us six months to sort this out. So at least it gives me a six month range of working with the person, you know, and they don't expect it to The truth of the matter is when Test Austen works, it's one of the fastest things that works within the first It often works within the first day, but you know, whatever. I have a lot of women and you know, take it They can take it on a Saturday morning and by the by by noon they're ready to go. Wow. L love that. Yeah, so how' the vaginal warm and flushing in some women, you can you can feel it in your generital sort of suonish, but not not everybody. But I just feel, you know, you got to give yourself a little elbow room and time with this. and the estrogen level 's also important. You you can't just give testosterone if you don't have estrogen really because you're not going to get lubrication, you're not going get care your vaginal tissues are without estrogen are really thin and they will tear. So you know, you don't want to start having sick Yeah We don't have the right amount of estrogen in your vagina because it will be pain and then you'll get infections. You know, you don't want to go down that route. So it's have it right, It's like the Gldilucks and have have just the right on mount of that too heart, I mean, just Do I just out of curiosity, do you have a preferred route that you prescribe testosterone I in this country, so I've been involved with this for a long time in the United States is no testosterone, cream or gil anything for what I've been working on this and the FDA has like, whatever, there's a whole lot of political stuff about why they bail on it. and they don't have a women's division anymore they used to have I don't know anyway. France, Europe your bureau has their little plun, their little plunger and you push it once and it gives you the right female dose Anyway, so here in this country, I tend to use the compounding pharmacy because the one and they they well, the one I really trust happens to be in the Bayy, but it's used all over the country' the Cauchland pharmacy. You know they do a very, very technical, very specific job on putting exactly the amount that I want them to in and the absorption is good. And it's a plunger.'s a plung you push it down once and then you put it right in that area right above your pubic hair So that's what I tend to use for women because it's safe, it's effective. I can change the dose on it month to month if we need to til we get it right So that's what's that's what's the best one to use as far as I'm concerned, the oral ones you know, you put you don't want to put stpping to liver that you don't need. I mean, so better to put it through either a patch or a gel or a cream. Or if you're lucky to live in Europe or go there often and probably even in Mexico, you can probably just get it over's not quite over the counter, but almost. What about people who are the other side of the spectrum where they've tried testosterone or maybe they like went all in on testosterone and they get all these side effects. They're like, oh, my acne and hair loss and Do you have a lot of patients report that So more you've heard of DHEA as well ronically THA in Europe is not allowed to be over the counter Here in America, any health food store has whatever dice you want of it. So I did some of my early work in the nineties on studying DHA GATA is an androgen It does once you take it in your body, it goes into testosterone and estrogen. So that sounds pretty good However, it's We don't ever find it this effective for libido and it causes more acne. So it stimulates those glands that make oil in your skin and you can end up with cystic acne at the age of fifty. Ye old, you don't sw Get me out of here Testosterone will do the same thing for some women with the acne. So We either dial the dose down a little bit or we give them, you know some acne forbvent things. you give them retinA or you give them, you know, so it can, you, you can choose to treat the acne or you can dial the testosterone back just a little bit or make sure there's a right balance with estrogen. So acne And the reason Id suggest I don't like to use the pallets for testosterone is They're in for three months, they can sort of cause the clitorosyrobia. mostly is the voice is one of the big problems because You can kind of get a raspy horsebat voice sometimes. And then you can get The vocal chords, remember you know what happens to boys between the ages of like say eleven and fifteen that cracking boys I spe testosterone, which their testosterone is going from One level up times two hundred and fifty voice between agge nine and fifteen, it goes like and that's making p the scro longer the testicle sc and the vocal cords grow and thicken. And Adamsapple in the deepening voice. I ran into a girlfriend of mine at this conference I told you about in San Francisco, the womomen's Lveelong conference foren's the women's Health Summit This weekend and I've known her for a very long time, but I haven't seen her person for about ten years and She came up and started speaking to me and her voice is like Really eas And I didn't say anything. but she said, you know, I was on the pallets for a long time and it changed my voice and I'm She uses her voice a lot in her profession. so I just want women to just take that and know that taking the pellets or taking too much distalstone can you know, cause your voice to change. But the acne I read it O one of the nurses at the hospital today was saying she they put her on acccutane because she ended up with with acne at the age of what thirty five and she's trying to get her test a stronger place. So you know You're right. So so those those are the downs downsize The upside is you might become a horned dog, I know U you know, it may distract you from getting your worked. This my friend whose voice dropped or whatever. I know her well enough she says he s I was going in I was masturbating three times a day. I used to say it was like really I was going nuts. It actually it was kind of fun for it I was just like too much . Plus she had teenagage daught' like, Hey ye yeah, it' like, you know at any rate. So It's important to know that it's a very very robust hormone that gives you You know, it gives you a lot of bang for your buck. I bet literally, it can be if you have the right dose I want to go back to the brain part because ike you mentioned we've been talking about test testosterone, you mentioned estrogen, but Just as a one hundred one, I don't think've had anyone on here talk about the actual literal brain changes that are happening as women go through perimenopause into the doorway of menopause A lot of women are experiencing Brain symptoms they don't even realize it. They don't even realize a lot of things start up there. A brain fog is a big Ren, I would say the brain fog is a real complt Yeah during the paranelics So let's talk about what's going on in the brain then because Astrogen receptors are in every tissue in your body. and they're in all kinds of places in your brain, You know, you've heard about the blood brain barrier, it's like all these and all the vessels in the brain. There's estrogen are just all over the place and all the areas and pockets of the brain So s it's everywhere. It's in the synapsse. it's just in the, you know it's in the s of the nucleus of the cells. it's like really everywhere And it does different things, different places, But as it goes down Just a couple things. let's talk about. One of the things it does is it Estrogen makes the brain use the fuel glucose a lot So it turns on like glucose fuel, you absorb, you get f that through your blood brain barus into your brain and estrogen helps your, you know, you heard that little those little guys little powerhouses inside the cell called mitochondria. littleittle mitochondria, it like toialsle them up and they're just they're humming like keeping you active on all parts, all the cells When the estrogen gets low, they sort of get kind of like you're dialing down all of these little coutps, mitochondria. And they stopped using glucose as much during the peraram menopause menopause intermently and have to use ketones. You've heard the keto diet, right? Yeah It's kind of it changes your brain into a keto machine, which That's neither bad nor re in some ways except it's just not as efficient. And the brain fog come from that lack of power and energy in your brain from not using glucose, you know, carbs as much anymore. So there's some glitches that happen in the perimenopause years. perimenopause can lastasts from two to fourteen years. so yeah Yeah, yeah, it's a long time see get so That's the brain fog piece and And brain fog is super common. I mean I feel like a lot of women, I know my one of my very first symptoms of perimenopause besides not sleeping was Brain fart Like I tell this story a lot. I was going to do I had a brilliant idea I was sitting right here on this very chair with this very computer And I went, Oh my gosh, what a great idea And I moved my finger to open a new tab So I could search it and I can't remember what it was And that like less than a second to be like,, brilliant It was gone. It was completely gone. And I just started laughing because I knew what it was. I mean, I knew I knew I was forty four at the time. so I was like Damnit. This is hormonal. H's h I know with that is, you know it does kind of go away. it changes, it gets into it morphs and also you get relaxed with you go like, Oh, okay, if it's important enough, it will come back to me, right? Yeah. you do that. Yeah. You do that more and more as you can. Yeah. So yeah So the brain fog, but I guess the thing women should know is that brain f isn't necessarily permanent and once you get on some estrogen replacement. you know, this issue of the critical window of I think women wait too long to get on asker show. So let's talk about that. because I got another question, another email of a woman who waited eight years And she was really concerned. likeike she's like, I'm eight years post onopausal just starting hormones for the first time. I think I missed it And so let's talk about the critical window The idea is know have we just talked about estrogen and all these little parts in your brain and they do things on the synapses and your neurons speaking to each other, they do things inside the cell, they do things in the blood brain barrier will allow in to the brain and out It's part of all the machinery and the little mitochondria, everything So when it goes down and you're trying to replace it, you know, it it's this pro. And you got it's like the other thing. you had to kind of keep up on it as an individual where you're going to go with this. And yeah, except R Amy Can reorient me to the question that you're wanting me to answer it right next? There's so many places can I know. I think the biggest question that I get is how do I know when to start too get the most bang for my buck. L the woman who had waited eight years was like, oh, I waited too long. Some things were better For the for the ye, the way I was going to do the window, that's right So the window, so All of the cells that use the estrogen, You want to catch it before That's really gone way down because You know, missing it means that those cells have kind of been without it for so long that the receptors have changed and s of gotten used to not having enough and it's so much harder to start the engine back up from being, you know, if you think about if you can start an engine you crank an engine back up if it's gone down to fifty percent. It's easier to get it back up to ninety five or one hundred, then if it's down it' zero or five So you don't want your astrogen engine to be like idle for too long that it's down that low. which really has to do with the synapses have kind of started to fade away in certain areas of your brain. You don't want that to happen. So you want they think of the window of opportunities like about a five year period minus a couple on the five year period. and each woman, the thing is there's no magic there's no magic blood test you can do to tell you that. So I like women to get Usually women in their early forties mid forties are on some kind of hormone replacement with usually a birth control pill because it helps with, you know, it helps with your not building up your uterus too much with you know extra extra extra blood and extra endometria And you're not quite you know, the estrogen level in the pill is much higher than in the HRT, not times two to five, you times And then by the Paredacus when you're starting to not bleed that off kind and stuff, you know, you're going shift over probably to HR te. And For the women, let's say somebody's listening who's like, o, I don't tolerate the pill well at all or I don't want to go on the breir uil pill Is there ever a time where you would say, okay Let's do like a low dose patch or a low dose estrogen gel. Yeah Okaykay. J oral or a patch, a low dose estrogen or even even not low dose, maybe medbe even because you're you're young. You guys are young That's true. you know, you start on with the you know, barely you, you can start up with one milligram of estrog oial orally or the patch at, you know at one point zero or even z sevenenty five. you know, some of these like It's just the medium to high range in the perimenopause in just giving you the estrogen as long as you're still beding every month So you mentioned the oral estrogen, and I know oral like swallowing your estrogen gets a bad rap of course, because of blood clots. But when you look at the data, the original data, like a lot of the data on cholesterol and stuff, it's always on oral estrogen. Eone's doing oral estrodol. Is it the same for the brain? Brain research and brain data are they looking at what's been swallowed as opposed to a patch No, yeah, the brain doesn't care how it goes in. If it goes in through a patch or an oral As long as it' once it's in the bloodstream brain is it doesn't distinguish, okay, Do doesn't doesn'tatter You can do the either the patch or a pill, eith either one. Okay. ladies. Don't miss your window My generation, you know We I mean, I didn't because I started mine when I was fifty three, which is still a little bit late. I mean, I wouldn't recommended Well, I was on the pill to you know I take someessestrogen. so for You know, I would think that women by the time you're forty eight, you should really just have have a look see around what's going on with your hanisca. Have that been the year of you're doing your forty forty eight years old and you should if you're not on it already, some are at forty five, forty four, forty two, depending on where you are then you should just have a liix see whatce you're estrogen statuses,roosterone statuses, just go in for your Pretend you're going your fifty thousand mile checkup, but you're gonna do it at forty eight instead And then You know, talk to me about like what's the what's the data on like dementia Risk and Alzheimer's in and women So you know, this is an area that's hot. Yeah. And how do you prevent Alzheimer's and dementia in women? especially a lot of women are particularly concerned if you had a family member that had it, you know? So the idea is if you get estrogen in the critical window of opportunity, that you're giving your brain the best health and activity as you can get it downown the line, twenty five, thirty years down the line, you're going to have kept your brain healthy. process of getting Alzheimer's stuff will have been cleaned out and be at least lessened by that chance, even if you have one of the, you know, one of you're carrying a family, you know, the jeans, you The three biggest things about Alzheimer's. The top one. numberber one is the biggest thing, which is age. You're eighty five year old woman your chances of having some type of degree of Alzheimer's is pretty high. So there's there's that age, age is number. You can't do anything about your age. So So list we'll say, yes, it's very important, but nothing to do about. Scond second one is genetics If you have a family history and whatever and you know your genes, if you have the family gene, the AOE four gene, which is about thirty or forty percent of women have it anyway, att least one of them There's nothing can do about your James, right? Not gonna j that. Third thing is estrogen down the line. the third thing. and that's the one you can do something about So do something about if if you're someone who can take estrogen, if you have, you know, the brack and one the breast cancer genes, et cetera, et ccetera You shouldn't take it and you should work with your doctor on that issue for other options. ' say all of the other women that can take estrogen, you should really consider doing it at a window of opportunity before your Synapsis get sort of crustust Kusty Kusty. Well, even with the brackogene now in the last what? like month or two, like they've even changed their stance, depending having a brackogene doesn't necessarily automatically exclude you from estrogen. I mean, I remember when I was in school, It was like, if you have any family history, you know, if you have the brachog genene, like there are all these very hard and fast rules around, you can't be on estrogen. Now thanfully, my mentor didn't feel that way. My mentor was like, we're still prescribing hormones. But Obviously, a lot of the guidelines and you know, ACOG and the Menopause Society and everybody was like, oh, we don't do it. And now in the last couple of months his research is turning a lot more towards women We're finding Family history is a gray area. Brcca is Like all these things that we used to think were like, no, no, no, no, no, no, we got that wrong Absolutely So, um, I think that You know, each woman has to take whatever her own biology and genetics are and work The problem is finding a good doctor who can do that because I know I can just like it's like it's a heavy liift because that's why all these online doctor groups and compies have sprung up 'ause they're train to specifically do there's nothing wrong with that' cou You I mean You may need to go in a gynecologist's office to have your vagina looked at and have the spectrum exam and look at your You know, give you the bimanual exam, feel your and there's times to do that, but you don't need that for everything. So. you can do it, you can do it online particularly A lot of the testosterone prescriptions are being done online now because of Honestly, the OBGYNs in the last twenty years because they couldn't prescribe HRT with great ease like you can now. I mean, Rackbox warning is off as last November You know, anyway, everybody is trying to jump into Learning stuff that for twenty years, they didn't even teach them more than one. One lecture in the OBGYN residency retty bad. So I'm feeling sorry for patients out there're having trouble finding a doctor to help them with their HRT and their testoster replacement but It's worth keep working at it. And there's a lot, I mean, I have nothing against the online companies. I worked for one four or five years ago when they first started coming in, I did about a three year stint kind working with L. So I really u By and large trusts that they have. you may need to have your local primary or any local OBGYN that does a public exam once in a while to get your pap iner and all that stuff, you know. What about lifestyle? I've heard you talk about alcohol before in caffeine, sleep. And of course at this time, a lot of women are like, my sleep sucks. I would say If you looked at the number four thing on the list of causing of dimensions It's the sleep factor is really more important than we under that we usually think about. Yeah. rememember sleep is the time when the garbage gets taken out of your brain. So every night when you sleep, there's these little, it's called the glyimmphatic systems, almost like little rivers in between all your brain cells The brain the brain cells shrink at night and they make bigger gaps in between them. and it's almost like they get hosed out. all of all of the synnaapted junk. It's been working hard all day long and it's made all kinds of extra, you know garbage there. So it gets hosed out every night. And if you don't sleep It doesn't get host out So it's accumulating garbage and garbage makes more inflammation in your brain. Big bad, bad, bad inflammation and then you get more You know, you get your synapses all gunked up and they don't work as well. And so that's going down the dementia train Sleep hygiene. Those was that nice I hate that word hyge. I don't know why It's angry. I don't think get it It a horrible word anyway it's good to think about like If you're not sleeping well, it's like having dirty fingernails That's awesome Oh go on and I wass like talking about. No, no, no. So B part. Number one thing for sleep hygene is for females especially is caffeine. Oh. caffine our dark chocolate after twelve noon for people We're talking about people who are sensitive. and all you l have great sleep. This is not for you because you' already whatever you're doing already works. You got to get the caffeine last in the female body and brain for about twelve plus hours. So you've had caffeine at noon, it's still in your stream it Midnight. So I know I've been working in this field first. I was trained in sleep medicine back in the eighties until I actually at some point had to stop taking caafeine entirely because of f GI some GI probps I realized now They were really right. I was so surprised at how much easier it was to ball aia. So if you're having trouble called initial Falling asleep type of insomnia The culprit can be Usually caffeine day Either you're drinking too many child laes. lookook, I, caffeine' rita I mean, really do a clean scrub of like everything you take or do. look to see if there's any light caaina and doesn't always it doesn't always end up the Darn label. so yeah So That's really a number one thing. twowo, of course is alcohol and alcohol youer can't chance have breast cancer like there's no question about it now. So as' bad alcohol causes I mean, alcohol is also a poison to the brain. So from a brain protection and a brain dimension, alcohol iss a poison to your brain, notot only your liver, but your brain. And I think this is important actually just to like pause on for a second because Obviously like wine culture, you know, a lot of women are they get their get togethers, they're marketed to a lot. E C shirts and hats and merch always has little wine glasses on them. Oregon everywhere. I mean everything is like about the wine cult in so I had to stop all at the same time. I had some GI problems where I had to stop drinking caffeee and alcohol completely. And so I've actually experienced what that's like in terms of my sleep improvement was enormous. Alcohol, if you drink I mean It's really hard to get people out their caaffing and alcohol because it's hard get their liifesty have. but I'm just saying Your goal is to clean all that up For the rest of your life, you got to clean that stuff up. Yeah, clean it up So I would suggest that if you are gonna to have a glass of wine you go at six PM six PM or six fifty get your cutoff for your last glass because It's that two to three to four hours after your last glass that's going mayaybe make you a little sleepy. go you can go down a little easier. T hours later to bring weeks up. Yeah it's kind of deficit. So it's like it's it's a roller coaster. So if you're The t this getting awake in the middle of the night And you do drink Try to go for ten days without it and see how your sleep changes. If you're having trouble falling asleep, it's probably the caffeine Okay, those two things said Everybody knows other ways to kind of help themselves out with sleep is that you get enough Bright sunlight in the morning and the first lightight three or four hours of the day You should get thirty minutes, ten to thirty minutes of bright sunlight And in the winter when you can't, I just get those little I get those little tiny ull spectrum light I put it on right on my sink and I'm, you know, or when I'm doing my My physical therapy exercise on the floor, I just lay it on the floor with me and turn it on.ep Zap your brain. If there's real sunlight, the best thing is real sunlight because sunlight has a hundred thousand lcks on it. so takes less time. Those little ones have about ten thousand lcks on them. So it's a big difference. get it anywhere you can l to get you the bright light and then of course exercise. I mean, Get yourself, I mean, I don't know My goal is between five and ten thousand steps a day I often don't make the ten. I try to like have five find a minimum and a max, find a place where you're going do it the pool for an hour a day. So I have I have a couple of things that I do actively I know will make my body sleep. yeah without without overdoing I think people Wen of your generation mine too, but just they get into the exercise and they kindt overdo it and you end up injured and then you have to take Advill and you know you end up on Paying meds all the time. Yeah. They're in boot camp classes and they're doing pilates in the morning sping in the afternoon and they're you know, lifting, but they're getting their ten, twenty, thirty thousand steps in. I mean, it's very much pushed on social media, right? If you're not getting your steps in You're not lifting heavy and you're not doing, you know, stretching and weight training, you know, pilate what are you even doing? I'm like, well, somebody who's never done it before, you're stressing them out. That's what you're doing We can't and it's bad because you' always enjoying yourself. the injuries are the worst you. So it's better to do something on a milder level and do it. reggular R than to wreck yourself. So yeah, you're right. Definitely. can't oververding it is bad bad bad. I know that's the culture right now to overdo it. but so weight, you know, now with the weight control, which is why we're do that Yeah Now with the GLP one inhibitors, you know, the embic, et cetera, ccera People are all taking those and that's going to be a anotherother story for late for next time for next. Well, the other thing I want to touch on too in your book, you write about Like the upside, the good things, like finding your purpose and like cutting away all the stuff that doesn't serve you and setting boundaries. and like like your brain, you know, because a lot of women are of course going through this right now and then they're like, their partner or their family, somebody's like, what's wrong with you? Like why are you setting all these boundaries? or why are you getting mouthier? Why are you They're like, I don't know. there must be something wrong with. There must be something in my brain. there's chang it's happening in my brain. I'm like, it is, It really is. Yes. I' like I'm like that phrase that no is a complete. Yes Yes, I say it all the time So it's a really important, uh, you know, it's important really important to know And Ging rates So anyway, yeah, there's so many there's so much more that we can do. but maybe going ask me One last really burning question you have. Yes. well, I actually have just quick just like rapid fire Rapid fire isn't a myth or like a mindset shift. So it's just a couple of quick sentences and I want you to tell me What you think So when women say My brain will never be the same after menopause Is that a myth Or is this something we need to shift I think we need to shift that because it's not either or there's a transition that's happening to a whole new developmental stage You have you have a lot of different options both in your real life and in your hormonal and in your brain life. And you know, I think women are wanting to come to the most part of their authenticity and who they really are after having years of you know, faking it or just, you know, they're having having to override their authentic feelings and wants. for all kinds of other things that, you know, we do put those aside for kids and families and But at that point that those little those little beings are grown up and they're taken off to college. I mean, it's like it's a life stage too. It's like your hormones are changing, but there's a time to take on your own authenticity and stand in your own truth I love that Okay, myth or mindset shift we need to make. Brain fog means I should start estrogen. Brain froog means that you should consider what the brain froog is about A you're not getting enough sleep? Are you all of a sudden trying to just go cold turkey off of caffeine or something? are you is there some other substance? Remember antihistamines like even benadryl The blue pill, the blue Tylenol or the blue an mill Theeneral an, There's all kinds of other drugs that can make you have brain functs. So let's not blame it all on just the hormones Yes, consider the hormone. So it's definitely it's a double barrel thing. J just be real cognizant of it. Don't let it get away with it. Don't don't don't let it like takeake him and run with it All right, last one orr we need a mindset shift. Cognitive decline is inevitable. My grandmother had dementia, there's not much I can do. I think that that's like Complex as well. It's sort of a myth, but you're needing to take into consideration all of your family history and your genetics just like with other illnesses. And remember nobody gets out alive We have a whole another like that called that's called Medical schoolool gallows. noobbody gets out of alive And nobody getivs off of like having like the perfect brain function that you maybe had at age, I don't know, if we ever had that, you know, Wh would want to go back to their teenage years?ourour teen brain is usually working pretty fast you know, really honestly it's it's a bit of it's a bit of a myth that because Diet, exercise, sleep hormones, they could all really help you out Amazing. withentiment Do not do not give up ladies Hold on for de life. We need because we need you. We need your love, we need your consideration. We need your your perspective and gradually, you know, we need your wisdom. We need women's wdom the world to speak out. more and more and not to put it dont hide your talets under a bushel. Remember that old saying, Don't get rid of that old bushel. Oh my gosh, you I just love talking with you. You are first of all, so you're so funny, real, you're down to earth and then you've been doing it so long reesearch You know, you have a clinic. And so I just really appreciate you making the time to come on today. Let everyone know where can they learn more about you what you do where you are, other thing L I met L waybrisndine dot com, doctr on L thewb Bronine. com this is my website. but that's the female brain book is the one I'm the best known for and it's still like everything is still pretty current And the male brain, don't forget that, even though it was just a pamphlet, not was going. it wasn And then the upgrade was the book I wrote and published in twenty two that has a lot about Health after the age of forty and perimenopause, menopause, testosterone has a lot of that in it. And the new book in January will be your Brain on menopause and it talks specifically more about the brain issues in menopause. So there's three of them out that you can get right now any moment you want to get it.. I think they're both an audio a lot of people. I do a lot of audio books myself these days, don't you? Yeah I likeud So the book that I've read myself that you hear my voice on is the female brain. I did that one I learned my lesson it's harder than you think to do. And then the m people the person who wrote the mail brain really has a really nice voice too. They got a really good person with that.ice and also for the upgrade. So those are You're welcome to just dig into any of those you want. Actually, funny enough, I will have to email this to you if you can find it. I was on TikTok today and there is a It's like a comedy skit and the woman was reading the female brain. Like she's holding it up is the like the other person, the protagonist comes in. And I was like I know that book and I'm going to see to talk to her today. I should have I'll go back and try to find it so I can email it to you. I think they did a pretty they did a really gorgeous color. They did a gorgeous color for the upgraded books this one here. They did. Yes. both of them. Both covers are very pretty. And you know, I did not use the wordenopuse and turn menopuse in this one You know, we was writing about it. So I wanted Bock Limited to kind of think about the upgrade through paramatopause and then pause. So it's a whole it's a whole notother take on How you end up being your best self. Oh, I love that. Dr. Brisndein, thank you again for coming on. I so appreciate your time My pleasure. Take care. Nice to see you. Nice to see you too