Tag Archive for: brain health

Behind the Science: Decoding Menopausal Hormone Therapy

Interviewee: Dr. Laura Gravelsins, Postdoctoral researcher, University of Toronto, Centre for Addiction and Mental Health |Authors/Editors: Romina Garcia de leon, Janielle Richards (Blog Co-coordinators)

Published: October 11th, 2024

Can you tell us a little bit about your research?

There’s a large body of literature to suggest that menopausal hormone therapy (MHT) may benefit brain aging in females and reduce their dementia risk. However, not all females show memory benefits when taking MHT. The main goal of my research is to understand why there’s such a varied cognitive response to MHT. MHT comes in many forms, for example, it varies in dosage, formulation, route of administration, and timing of initiation. These many forms of MHT are usually not accounted for in research. By accounting for the various forms of MHT, as well as other biological and lifestyle factors, we aim to clarify why some, but not all, females show memory benefits when taking MHT. Our goal is to move toward personalized or precision medicine, and identify effective formulations of MHT that will support healthy brain aging in all females. 

What led you to do this work? 

I think where it really started is in my undergraduate studies. I was taking a physiology course which was very content heavy. We reached the unit on female reproductive physiology and I remember it was skimmed over quickly.  We were encouraged to refer to the textbook for more detail, rather than having the topic prioritized in lectures. This experience made me realize that women’s health isn’t given the attention it deserves. Fortunately, around the same time, I stumbled upon a research article by Dr. Emily Jacobs that explored the interactions between the menstrual cycle and dopamine levels, and how these interactions affect working memory. This was the first article I encountered that combined a female-specific factor with neuroscience. It opened my eyes to the endless possibilities within this area of research, and made me realize that female-specific health factors are actually something that can make your research more interesting, rather than be a complicating or nuisance variable.  I think I was very lucky to have had this realization at this stage in my research journey. This motivated me to focus on women’s health research during my undergraduate studies, then my graduate work, and that’s how I ended up here today.

Are there any findings that you can share with us? 

My PhD research focused on females with surgically induced menopause, specifically those with risk-reducing bilateral salpingo-oophorectomy (BSO) because they carry a genetic mutation that puts them at a higher risk for breast and ovarian cancers. Unfortunately, early ovarian cancer detection techniques are poor, so the best preventative option for these individuals is to get their ovaries removed when they’re quite young. BSO is recommended as early as 40 years old, several years before spontaneous/natural menopause. 

There is substantial research indicating the importance of ovarian hormones for brain health in later life. Previous studies, including work from Dr. Walter Rocca’s lab, have shown that females with bilateral oophorectomy may be at greater risk for dementia without MHT. In our research, we recruited midlife women, averaging in their mid-40s, to assess changes in memory, sleep patterns, and brain function, while also evaluating the effects of estradiol-based MHT. Overall, we found that estradiol-based MHT benefitted working memory, sleep, and hippocampal volume, but was not fully protective. When plotting individual data points, we observed that for some individuals estradiol-based MHT works really well. For others, it’s not as effective. 

What’s next for you and your research?

My background has been primarily in quantitative research, so looking at performance metrics from neuropsychological tests and memory assessments, and quantifying brain volumes and hormone levels to understand individuals. I’m hoping to incorporate more qualitative components into my research next. Adopting a mixed-methods approach, which combines both quantitative and qualitative data, would allow me to explore how individuals perceive their memory changes and can provide rich insights that numbers alone may not capture. Even if someone does not score low on a quantitative measure, their subjective experience is really valuable. I hope to incorporate this qualitative perspective into my future work. 

Women’s Health Interrupted Podcast: Season 2 Recap

Authors: Edidiong Daniel, BSc. Environmental Toxicology | WHRC Social Media Committee Member | Editor: Romina Garcia de leon Reviewer: Bonnie Lee

Published: July 19th, 2024

We’ve come to the end of Season 2 of the Women’s Health Interrupted Podcast! – a podcast that centers on women’s health across these four themes: general health and wellness, brain health, socio-cultural determinants of health as well as politics, policy, and advocacy. The second season of the Women’s Health Interrupted Podcast was hosted by UBC’s Masters of Journalism students, Chhavi Mehra and Sarah Williscraft, and featured guests across various institutions and fields. All episodes are available on any major podcast streaming platform. If you haven’t tuned in yet, here’s a quick recap!

Season 2 kicked off with Dr. Lori Brotto, a professor in the UBC Department of Gynecology, a registered psychologist in Vancouver, and Executive Director of the Women’s Health Research Institute of BC, discussing Cultivating Female Sexual Desire through Mindfulness. Dr. Brotto shared the role of mindfulness and environmental influence in cultivating female sexual desires and discussed the orgasm gap and contributing factors, while also debunking some myths surrounding female sexuality.

Next, we had Dr. Najah Adreak, a clinical researcher and an advocate for cardiovascular health and treatment, especially for underserved women patients, for episode two: Why are Women’s Cardiovascular Concerns Often Downplayed? Dr. Adreak discussed why women’s cardiovascular health is often downplayed and also shed light on the knowledge gaps in women’s cardiovascular health, the differences between male and female hearts, how hormonal changes and social determinants of health can affect women’s heart health long-term, and the role of physicians in filling the knowledge gaps in female cardiovascular health.

In the third episode: All You Need to Know about Gynecological Cancer, co-hosts of the Gynecologic Oncology Sharing Hub (GOSH) podcast Nicole Keay and Stephanie Lam told us everything we should know about gynecological cancer, explaining how gynecological cancer differs from other forms of cancer and the importance of researching these cancers as separate entities. Nicole and Stephanie also shared new research tools for gynecological cancer such as the Opportunistic Salpingectomy for prevention strategy and the Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) for endometrial cancer diagnosis.

Dr. Lindsay Larios, assistant professor at the University of Manitoba’s Faculty of Social Work, joined us to discuss Abortion Rights with Precarious Immigration Status, highlighting the challenges in accessing abortion and general reproductive care as immigrants in Canada. Dr. Larios explained how access to reproductive care for pregnant immigrants differs based on class, race, ethnicity, and other socioeconomic factors, the difference between private and public health insurance for immigrants, the importance of including reproductive rights and justice framework in Canada’s immigration system, and reforms and repairs that need to happen.

For episode 5: Housing and Health Barriers Faced by 2SLGBTQ+ Youth, Dr. Alex Abramovich, an Independent Scientist with the Institute of Mental Health Policy Research at The Centre for Addiction and Mental Health, took us through the current state of housing access for 2SLGBTQ+ Youths in Canada. Dr. Abramovich laid out some factors that impact access to housing for 2SLGBTQ+ youths in Canada and shared some useful resources for 2SLGBTQ+ youths experiencing homelessness. 

PhD student, Amanda Namchuk, and recent B.Sc. in Biology graduate, Tallinn Splinter, came on the podcast to discuss the Exclusion of Women from health Research: Then and Now. Amanda and Tallinn helped differentiate between sex and gender and addressed the need for sex and gender-based research using the difference in the breakdown of Tylenol in men and women, among others, as a clear case study. They also explained how the exclusion of women in research impacts historically underserved communities and the role of big institutions like the Canadian Institutes of Health Research (CIHR) and journals in ensuring sex and gender are properly incorporated in scientific research.

Featuring Dr. Ann-Marie de Lange from the University of Oxford, and Dr. Claudia Barth, biologist and cofounder of the Women’s NeuroNetwork, we went deep into the brain for episodes 7 and 8. Dr. Ann-Marie de Lange discussed some common misconceptions about how pregnancy affects the brain, highlighted some changes that happen to the brain during pregnancy and after birth, and shared what women can do to improve their brain health for episode 7: Mommy Brain: It’s Not Just in Your Head. In episode 8: How Does Menopause Affect the Brain, Dr. Barth shed light on some hormonal changes that happen to the brain during menopause, menopausal symptoms, the impact of menopause on mental health and neurological disorders, and the need to educate women and men on menopause.

Dr. Debra Anderson, Dean of the Faculty of Health at the University of Technology Sydney, explained how lifestyle factors and health behaviors such as smoking, exercise, and nutrition can impact quality of life in the ninth episode: This is How You Can Improve Your Quality of Life. Dr. Anderson also stressed the importance of looking at women as a whole and also shared a shocking revelation on how big a role calcium plays in reducing premenstrual syndrome (PMS).

For episode ten: Domperidone for Low Milk Supply: Is it Safe? we were joined by Dr. Janet Currie, a social worker and the founder and director of Focus Consultants, and Dr. Suzanne Hetzel Campbell, a professor at UBC School of Nursing, to discuss the use of domperidone, a drug approved to treat stomach problems in Canada, in treating low milk supply in breastfeeding mothers. Dr. Currie and Dr. Campbell mentioned some factors that have contributed to the dramatic increase in domperidone use, safety concerns, and what Health Canada can do to better regulate the safe and effective use of off-label drugs like domperidone.

Finally, we had Kirann Mann, a first-year obstetrics and gynecology resident at McMaster University, for our eleventh episode on Breaking the Stigma Around Pelvic Floor Dysfunction. Kirann explained the pelvic floor, what it does, and the importance of maintaining pelvic floor health, and listed some symptoms of a weak pelvic floor and stressors in one’s life that impact pelvic floor health. Kirann also explained how socioeconomic factors like socioeconomic status, education level, and racial and ethnic background can create disparities in gaps and knowledge, and shed light on how the pelvic floor awareness campaign builds community surrounding pelvic floor health.

What an incredible journey Season 2 took us on. The Cluster is so grateful to all the wonderful experts that took the time to sit down with us and discuss these timely women’s health topics with us. We hope you were able to learn a new thing or two from all the different disciplines and perspectives featured throughout Season 2. All episodes and corresponding resources can be found on our website. We hope you join us for Season 3. Stay tuned!

 

 

The Brain’s Journey during Pregnancy and Menopause: A Spotlight on Estradiol and the Immune System

Authors: Hannah Oppenheimer, PhD student, Arielle Crestol, PhD student, Claudia Barth, Senior Researcher/PI FemHealth Project, Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Oslo, Norway  | Editors:  Romina Garcia de leon Reviewer: Magdalena Martínez-Garcia

Published: June 21st, 2024

There are clear sex and gender differences in several brain-related disorders. For example, relative to men, the lifetime risk for depression is twice as high in women*, and twice as many women develop late-onset Alzheimer’s disease. But what’s  causing these differences?

While the underlying reasons are not yet fully understood, sex hormones and inflammatory processes (i.e., the immune system’s response to irritants such as pathogens), are thought to play important roles. Women’s lifespans are marked by major hormonal and immune-related changes, particularly during pregnancy and menopause. Research suggests that these phases are important for brain health and mental health, both in the short-term and long-term.

What happens during pregnancy that affects brain health and mental health?

During pregnancy, the immune system fluctuates between three immunological stages with unique inflammatory profiles, each corresponding to a trimester. The first is a pro-inflammatory stage, where inflammation is enhanced to allow for the implantation of the embryo and the formation of the placenta. This is followed by an anti-inflammatory stage, namely a reduction in inflammation to support the growth of the fetus. The final stage is again pro-inflammatory and helps initiate birth. A successful pregnancy depends on the adaptation of the maternal immune system to each of these stages. The stages are also linked to hormonal changes such as rises in estradiol — the most abundant form of estrogen in women — which play a vital role in creating an anti-inflammatory immune environment.

Alongside the hormonal and immunological changes, pregnancy and the postpartum period also impact the mother’s neuroplasticity, that is, the brain’s ability to change. Changes in brain volume during pregnancy and postpartum have been associated with fluctuating estradiol levels. These changes can be beneficial! A recent study showed that cortical brain volume changes follow a U-shaped trajectory whereby volume decreases during pregnancy and increases again postpartum. Both the reduction and the increase in volume throughout this trajectory have been linked to a higher mother-to-infant attachment later on, thereby potentially helping women transitioning to motherhood. However, some of these brain changes may also lead to increased vulnerability to mental disorders such as depression, which affect almost one in five women during and after pregnancy.

Do all changes revert postpartum?

While some of the maternal brain changes revert shortly after giving birth, other changes may sustain for years or even decades. Possible long-term impacts of pregnancy on the brain have been shown in studies that found younger-looking brains in middle-aged women with biological children compared to those without (see image). This effect may be linked to the exposure to hormones and inflammatory markers during pregnancy. Furthermore,  regulatory T cells — cells that play a critical role in stopping immune responses when no longer needed and show an increase during pregnancy which persists postpartum  — may reduce risk for Alzheimer’s disease later in life. Another mechanism which may be involved in the relationship between pregnancy and long-term brain health through its effects on the maternal immune system is fetal microchimerism — the lasting presence of fetal cells in the mother’s body long after giving birth.

What happens during menopause?

Hormonal and immune-related changes during the menopause transition are thought to be the basis for menopausal symptoms which are largely neurological in nature, such as hot flashes and night sweats, mood and sleep disturbances, and trouble with memory and cognition. The transition to menopause has also been linked to changes in the brain and a heightened risk of depression. For some women, symptoms and brain changes may stabilize, or even revert after menopause. However, the presence and severity of these symptoms may increase the likelihood of developing Alzheimer’s disease in older age.

With the transition to menopause, estradiol levels decline and again influence the immune system. A balance between pro-inflammatory and anti-inflammatory responses during the reproductive years can shift to an imbalance leaning towards more pro-inflammatory responses during the transition to menopause. This process can get exacerbated in a subset of women, leading to negative health outcomes. Research suggests that the anti-inflammatory processes associated with pregnancy may shape the emerging inflammatory processes during menopause, and thereby influence later brain health.

Overall, pregnancy and menopause are transition phases encompassing hormonal and immune-related changes, which can have short-term and long-term effects on women’s brain health and mental health. Scientists are still working to better understand the implications of these relationships, including their role in disorders with large sex differences. Once that is better understood, this knowledge may help pave the way for better treatments, disease prevention, and individualized care.

Potential Effects of Pregnancy on Brain Health Through Hormonal and Immune-Related Changes

Research has found differences in brain health between women with biological children (parous) and women without (nulliparous).

*Although we acknowledge that individuals who are biologically female (i.e., XX) do not always identify as women, we used the gendered term “women” to align with common language usage.

 

Behind the Science: Stroke and Health Inequities in Women

Interviewee: Ismália De Sousa, PhD Candidate, Registered Nurse, University of British Columbia, School of Nursing. Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators).

Published: August 4th, 2023

Could you tell us more about your research?

My Ph.D. research is a two-phase project. The first part is a literature review of health inequities in stroke care. The second phase is a qualitative study exploring the experiences of young women with stroke history in British Columbia, with an equity-oriented lens. In particular, I am interested in how intersecting systems of structured inequity (e.g., racism, sexism, and other isms) influence their experiences accessing healthcare. 

What drove you to study the experience of stroke in young women?

I’ve been a registered nurse for 14 years. In my career as a registered nurse, I specialized in stroke care. For this reason, I have developed a clear understanding of the complexities of the care of stroke survivors. There have been significant advances in stroke care but in the last 20 years, the focus has been on the acute stroke phase (those immediate hours to days after the stroke) and not so much on the rehabilitation and recovery phase. This poses a gap in stroke research. Another component is that people often think strokes occur only in older people, but this is not true. Stroke rates are increasing among younger people. Moreover, there are sex and gender differences in the incidence of stroke and stroke outcomes. For example, pregnancy and menopause confer a higher risk of stroke and women have greater disability and poorer health-related quality of life. And all of this can be exacerbated by health inequities, the unjust, unfair, and avoidable health differences. So we really need to know better the experiences of young women who have had a stroke, how these health inequities manifest in their experiences during stroke rehabilitation and recovery, access to healthcare, and so forth.

What impact do you hope to see with this work? 

I really hope that my findings can influence health policy or can inform health policy and clinical practices and the development of equitable practices in stroke care in British Columbia. I also think that this work can inform national strategies and resource allocation for neurorehabilitation. The Heart and Stroke Foundation of Canada has a big emphasis on women’s health and the invisible and inequitable effects on women (and I would recommend reading their recent report). And the World Health Organization (WHO) recently released a position paper asking countries to prioritize brain health and reduce the stigma, impact, and burden of neurological disorders, since strokes are a neurological condition with significant burden for stroke survivors, their families, and caregivers.

Are there other projects you are currently working on? 

Another project I worked on looks at the History of Black nurses in British Columbia, between 1845 and 1910. This is important because we need to reflect on the invisibility of Blackness and Black nurses in British Columbia but also to understand how some of our current-day issues, such as the lack of representation of Black nurses in senior leadership positions, can be linked to historical events such as colonialism and chattel slavery and the ideas and thinking that shaped that period in our history. This work is about what has happened in the past, and how it has a trickle-down effect on where we are today. The specific time that I looked at, an important historical juncture for nursing, was the beginning of the professionalization of nursing, with the development of nursing schools. This meant that to be a nurse you needed to be trained within a nursing school, but not everyone could be a nurse. Because of the ideas that were prevalent during chattel slavery and colonialism, Black people were continuously stereotyped as less intelligent and lazy, and I think this then has a trickle effect in preventing Black nurses from being accepted into nursing schools.

I’ve also recently conducted research looking at student nurses’ perceptions of educational strategies that promote critical awareness and engagement with social justice. Promoting health equity is a professional mandate in nursing, but how do we enact a social justice pedagogy in the classrooms? Together with faculty in the UBC School of Nursing, I interviewed nursing students to understand how they see social justice and what educational strategies should be used or have been used that promote critical awareness and engagement with social justice and positively influence their professional practice as registered nurses. We are yet to publish the findings of this work.

Where can people learn more about your work? 

Find more about what I do on my website where you can see my publications and other projects I’m working on. Find Ismália on Twitter at @Ismalia_S.

Behind the Science: Clearing the Fog of Midlife Ovarian Removal and Cognition

Interviewee: Alana Brown, Ph.D. Candidate, University of Toronto, Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators).

Published: July 14th, 2023

Could you tell us about your research?

In Dr. Gillian Einstein’s Lab of Cognitive Neuroscience, Gender, and Health, my PhD work explores the relationships between ovarian hormones (e.g., 17β-estradiol) and cognition, specifically in women with breast cancer gene mutations who opt to have bilateral salpingo-oophorectomy, which is the removal of both ovaries and fallopian tubes. This surgery usually occurs for cancer prevention purposes around 10 years prior to the typical age of spontaneous/natural menopause (~51 years). Bilateral salpingo-oophorectomy results in an abrupt and early loss of ovarian hormones. Our group in Dr. Einstein’s lab is trying to understand the cognitive impact of this hormone loss, especially given that oophorectomy is associated with an increased risk of developing Alzheimer’s disease (AD) in later life.

What drove you to study women’s health research? 

There is a dearth of research examining factors contributing to cognition among middle-aged women. The spontaneous menopause transition is a time period often defined by self-reported brain fog. So, women are specifying that their memory is changing during this period. Not only is there a gap in research to try to understand this change, but this is also a unique opportunity to answer more nuanced questions about memory in a healthy population. This research gap is even wider for women with bilateral salpingo-oophorectomy.

It is really interesting that we can ask richer questions about memory by looking at an ovarian hormone shift that affects a large number of people in the world. For example, how can the memory changes associated with ovarian hormone loss be differentiated from the memory changes associated with aging? How can we use ovarian hormone-related structural and functional brain changes to answer questions about how the brain supports memory more broadly? In the realm of neuroimaging, menopause and sex-specific factors are conflated with aging and largely overlooked and disregarded. It is very common to see neuroimaging research focusing on aging by studying groups of young adults who are 35 or younger and comparing them to groups of older adults who are 65 or older. The large gap between those age groups, representing midlife, during which menopause is typically occurring, is often ignored. There is a really small percentage of research looking at female-specific outcomes during that time.

What impact do you hope to see with this work?

I hope that this work can contribute to a larger picture of precision medicine. Given that we are studying a group of women who are at increased risk for AD, there may be implications for AD biomarkers. Female-specific AD risk factors must be studied and clarified. I hope this work can contribute to a larger body of research focused on studying people and the complexities of their lives while integrating that complexity into neuroimaging. Further, I hope we know more about the functional effects of reproductive aging and/or ovarian hormone loss in the future, above and beyond the effects of aging. This is new territory for neuroimaging. Those considering bilateral salpingo-oophorectomy deserve to be fully informed and aware of what they may experience after the surgery.

Have you seen any interesting findings yet in your research? 

We are finding that oophorectomy without 17β-estradiol  replacement therapy is associated with decreased hippocampal activation, specifically while learning/encoding during a face-name pair memory paradigm that is thought to be sensitive to AD progression. The hippocampus is a brain area critical for learning/memory and is also among the first regions affected by AD. We do not see the same pattern in individuals with oophorectomy who are taking 17β-estradiol replacement therapy. It is possible that 17β-estradiol has a role in maintaining function in the hippocampus and potential markers of AD risk could be detected in midlife. 

Where can people find more about your work?

Twitter: @4alanabrown and @EinsteinLabUofT, 

Online: https://einsteinlab.ca

LinkedIn: https://www.linkedin.com/in/alana-brown-23544a111/

Check out this recent publication by Alana and the Einstein Lab on how midlife ovarian removal affects cognition!

Oral Contraceptives & the Autonomic Nervous System: the Effects of the Pill on Your Body’s Autopilot System


Authors: Tania J. Pereira, PhD candidate, Women’s Cardiovascular Health lab at York University| Editors: Romina Garcia de leon, Shayda Swann  (Blog Coordinators).

Published: November 4th, 2022 

It has almost been 100 years since it was discovered that you could make an animal infertile by implanting an ovary from a pregnant animal. This discovery would be the basis for the birth control pill, although it wouldn’t be commercially available until the 1960’s. Since then, multiple variations (known as generations) have been created to reduce the side effects of birth control use – ranging from blood clotting to unwanted weight gain or acne and changes in mood. Thankfully, newer generations of birth control have been made with lower hormone levels – although some of the more minor health-related side effects persist. 

While most side effects are physically visible, what about the unseen consequences? 

Research suggests that within three months of use, birth control changes certain tissue volumes in specific regions of the brain. These regions control our emotions and how we manage emotional information. This means that birth control users could experience more negative and intense emotions. Birth control also changes the connections between different regions associated with higher cognitive function and emotional processing, meaning that birth control may alter mood by affecting how an individual regulates their emotions. 

From these changes, it is understandable how birth control might affect a user’s mood – but could other functions also be altered?

My research focuses on how birth control alters the function of your autonomic nervous system, which controls all unconscious processes, such as heart rate, blood pressure or breathing. The autonomic nervous system is a network of the brain, neurons and the body’s organs. This system is also responsible for your “fight or flight” response. 

More specifically, I am interested in how the body controls these processes in response to exercise. During exercise, key feedback about the physical movement and the metabolic environment of the exercising muscle are sent to the brain. This feedback is used to adjust your heart rate, blood pressure or breathing to support the exercise intensity.

Interestingly, birth control users have lower blood pressure responses to passive movement and handgrip exercise than non-users. Additionally, birth control users breathe more rapidly during handgrip exercise than non-users. Women generally do not increase their blood pressure during handgrip and other studies have observed that birth control rescues the blood pressure response. Both studies used similar exercises and performed the trials at similar times of their pill cycles (i.e., the birth control pill has an active dose phase ~21 days and a sugar pill or no-hormone phase ~7 days). Although, the types of birth controls used in each study were different; the first had increasing hormonal doses over the pill cycle, while the second had the same hormone dose with every pill.

While it is not clear what the effects of birth control are, both studies confirm that birth control use is altering the control of the body’s exercise response. 

There is not a lot of research on birth control, and it is made more complicated by the fact that different types of oral contraceptives can have different effects. Additionally, birth control is not the only form of hormonal contraceptive. There are implants, injections, intrauterine devices, vaginal rings, and patches. Each unique method of administration could present unique altered effects. 

My future research will aim to clarify some of these inconsistencies by more strictly controlling for phases, formulations and generations, as well as expanding the current body of knowledge on alternative hormonal contraceptives. 

Hormones are a complex and fascinating aspect of women’s health that I hope to further explore. 

Mind Over Menstruation: How the Menstrual Cycle Influences Brain & Behaviours

 

Author(s): Kiranjot Jhajj (B.Sc., University of Northern British Columbia) and Annie Duchesne (Ph.D., University of Northern British Columbia) Editors: Negin Nia & Romina Garcia de leon (Blog Co-coordinators)

Published: July 29th, 2022

Research investigating relations between the menstrual cycle and women’s behaviours has a controversial history. It is rooted in attempts to demonstrate that women are biologically programmed to be less intelligent, more caring, and more emotional than their male counterparts. While this research and rationale has long been debunked, today’s growing interest in studying the brain and behavioral correlates of the menstrual cycle exists to understand how this phenomenon brings a distinct source of variability to people who menstruate, which remains understudied in fields such as neuroscience.  

One dimension of the menstrual cycle that has been increasingly studied in relation to brain and behavior is its hormonal dimension, which encompasses the variations in the ovarian hormones, estrogens and progesterone (see Figure 1), and how these influence reproduction, brain, and behavior. The menstrual cycle can also be investigated as a social phenomenon, which encompasses the attitudes, beliefs, and stigma around menstruation. However, the social and hormonal dimensions of the menstrual cycle are rarely investigated together. Little is known about how the social framing of the menstrual cycle can influence the hormonal dimension and vice versa. We introduce an integrative view of the menstrual cycle as both a hormonal and social phenomenon.

 

Figure 1. Hormone fluctuations across the menstrual cycle. “File:Estradiol.Cycle.jpg” by The original uploader was Ekem at English Wikipedia. is licensed under CC BY-SA 3.0.

The menstrual cycle as a hormonal phenomenon 

While it is established that the menstrual cycle and the related hormonal fluctuations are at play, a significant role in reproduction, a growing body of literature also reveals a role of these hormones in brain and behavior in humans and animals. However, these effects of ovarian hormones on the brain and psychological changes across the menstrual cycle vary. Several studies reveal a dissociation between cycle phase effects and hormonal effects on brain and behavior. One such study found that women with greater baseline inhibitory control were slower to react during the preovulatory phase compared to menses, while those with lower baseline inhibitory control showed the opposite pattern. Such evidence suggests that ovarian hormones may not be the only factors contributing to the effects of the menstrual cycle phases on brain and behavior. Additional factors may also be involved, specifically the related social constructs.   

The menstrual cycle as a socially constructed phenomenon 

The menstrual cycle is constantly surrounded by stigma. The stigmatized understanding of menstruation is evident across different societies, promoting ideas of menstruating women being unclean and unable to function normally. Further, menstruation stigma leads to negative impacts on those who menstruate, such as hypervigilance, self-consciousness around the need to hide menstruation, and the experience of shame related to menstruation. These stigmatized views can translate to various sources of stress for those who experience menstruation.

The stigmas around menstruation have consequences on how women perceive their periods. For instance, a study investigating women’s beliefs about menstruation in Mexico revealed that participants holding stereotypical views on women believed that menstruating people should follow specific guidelines about daily activities because they can be more fragile during this period. Participants who reported holding misogynistic opinions about women believed that menstruation is “annoying” and that people should hide menstruation to avoid embarrassment. Beliefs about menstruation tend to be negative, putting menstruating people in an unfavorable and restrictive state.  

 The influence of attitudes and beliefs about the menstrual cycle is not limited to menstruation alone, as they can also affect women throughout their cycle (see Figure 2). For instance, one study found that the mere request for menstruation-related information acted as a stereotype threat that influenced cognitive performance. While stigma can be related to the experience of menstruation, this study shows another similar source of stress, rooted in the awareness of one’s menstrual cycle. Taken together, this evidence outlines the importance of the social dimensions of the menstrual cycle when investigating its effects on the brain and behavior.

 

Figure 2. Hormone fluctuations across the menstrual cycle, with the addition of where stigma regarding menstruation may be prominent. Menstruation stigma can occur during menstruation itself, whereas menstrual cycle stereotype threat could arise whenever menstruation is mentioned, which is not tied to any specific cycle phase. “File:Estradiol.Cycle.jpg” by The original uploader was Ekem at English Wikipedia. is licensed under CC BY-SA 3.0.

The hormonal meets the social dimension

A majority of the research on the menstrual cycle tends to focus on either its hormonal or social dimensions. We believe that there is benefit in approaching the menstrual cycle as an integrated biopsychosocial phenomenon. Within an integrated approach, it is possible that the stigma activates stress systems and translates to a physiological phenomenon to influence brain and behavior. For example, one study shows that the expectation of stigma based on one’s identity can physiologically alter how one reacts to social stressors. Thus, effects of the menstrual cycle on brain and behaviour may partially be attributed to the stress-related effects of menstruation stigma and menstrual cycle stereotype threat. 

Another layer of integration between the social and hormonal dimensions of the menstrual cycle involves the interaction between their respective endocrine systems. Research shows that the stress and ovarian systems can interact, either through mutual inhibition or activation. Through the activation of stress systems, stigma and stereotype threat related to menstruation can influence the hormonal dimension of the menstrual cycle. Inversely, it is also possible that variation in ovarian hormones regulates how individuals react to menstruation stigma and menstrual cycle stereotype threat. Then, instead of considering the social and hormonal aspects as two independent dimensions by which the menstrual cycle influences brain and behavior, it is more productive to study the interplay between  the social dimensions and the biological aspects of the menstrual cycle. 

Conclusion

As research on the influence of the menstrual cycle on brain and behavior increases, there is an opportunity to consider the multiple dimensions of this phenomenon and how they interact to influence brain and behaviours. The menstrual cycle is a biological occurrence situated within various layers of social context. While ovarian hormones can influence cognition throughout the menstrual cycle, it is also vital to consider that these changes may be affected by the stigma associated with specific phases of the menstrual cycle, which in turn can influence the physiology of people who menstruate. 

The Gut-Brain Connection: Why Biological Sex May Matter

Author: Avril Metcalfe-Roach, PhD student, University of British Columbia | Editors: Negin Nia and Arrthy Thayaparan (Blog Coordinators) 

Published: November 12th, 2021

If you had to build your own house from scratch, what supplies would you bring to the job? High-quality building materials would certainly make the house much more durable, and having a diverse array of tools on hand will make construction much easier. 

Joe, on the other hand, brought just four zip ties and a wrench and is probably in for a tough time. If you live in a hot climate, you might consider installing air conditioning; in cold climates, good insulation and a heater will help you avoid freezing during the winter. In any case, putting love and effort into the home helps ensure that it keeps you comfortable for many years.

Similarly, the food we eat directly impacts every facet of our health. The links between diet, obesity, and cardiovascular disease are well known. However, more research indicates that dietary habits also directly impact issues like cancer, mental health, and even neurodegenerative diseases, including Alzheimer’s and Parkinson’s disease. Healthy eating can also indirectly reduce disease burden by ensuring that your body has the tools it needs to heal and combat infection.

So, how do different foods actually exert these effects? 

Each food, of course, has a different nutritional profile and will provide your body with different tools. We can anticipate what tools we will need and provide them before problems arise. For example, people who menstruate require more iron in their diets, and oral contraceptive use can lower the absorption of multiple vitamins and minerals. 

Humans also have a little problem: we’re more complex than our genetics allow. While our bodies directly absorb and create many nutrients, a lot of essential nutrients are created solely by the 100 trillion bacteria living in our intestines. In exchange for some energy and a warm place to call home, these beneficial bacteria help to prevent other harmful bacteria from infecting the gut. This keeps our gut tissue working properly, and produces vitamins and other compounds that can leave the gut and promote health throughout the body. For example, certain types of fiber are broken down by bacteria into molecules that enter the bloodstream and help to reduce inflammation.

Even the ‘happy’ chemical, serotonin, is mostly produced in the gut. Like us, each type of bacteria has its own nutritional requirements that mostly revolve around fiber-rich foods such as fruits and whole grains. By eating a variety of nutrient-dense foods, we foster a gut environment full of healthy, anti-inflammatory bacteria that in turn keep us healthy. 

What type of diets are sustainable and have health benefits?

Dietary research is progressing at a staggering rate, and it can be overwhelming to stay up to date. When the research is clarified, however, certain dietary patterns emerge that are consistently linked with specific health outcomes. 

The Mediterranean diet, which promotes plant-based foods, fish, and healthy oils, while limiting red meat and other animal products, is perhaps the best-studied healthy diet in the world. It has been associated with lower rates of cardiovascular disease, obesity, glucose sensitivity and diabetes, and overall mortality.

More recently, a few studies have suggested that the Mediterranean diet may improve brain health. Neurodegenerative diseases are not yet well understood, and there are very few known factors that help to prevent them. Recognizing this, Dr. Martha Clare Morris unveiled the MIND diet in 2015, which optimizes the Mediterranean diet against cognitive decline.

What is the MIND diet and how does it benefit us?

Most food groups are conserved between the two diets; crucially, however, the MIND diet also promotes brain-healthy berries and leafy greens, while restricting pro-inflammatory sugary, fried, and processed food. These latter foods are becoming increasingly common, especially in North America; some research suggests that their overconsumption can even negate some of the health benefits normally associated with the Mediterranean diet. 

As a result, the MIND diet has since been associated with significantly reduced rates of many neurodegenerative diseases, including Alzheimer’s, cognitive decline, and general motor decline; what’s more, the strength of these associations seems to exceed those of the Mediterranean diet.

We recently investigated the MIND diet in a group of individuals with Parkinson’s disease, where we assessed their normal dietary intake and assigned a score based on how closely their intake resembled the MIND diet. Female participants had higher scores on average, indicating closer MIND diet resemblance. Participants with high scores developed Parkinson’s disease significantly later than those with low scores; unexpectedly, this association was especially strong in the female participants, where dietary habits accounted for up to 17 years’ difference in disease onset. Interestingly, the MIND diet accounted for only 10 years in men, and the Mediterranean diet accounted for 10 years with no apparent sex differences.

How do these diets work exactly?

While the complexity of these diets means that it is difficult to know exactly how they work, a sizable amount of research has zeroed in on our microscopic friends as a key factor. Brain-healthy diets help anti-inflammatory bacteria to thrive, which may help to limit inflammation in the brain. Regulation of the immune system is known to be partially sex-specific – for example, women are more prone to autoimmune disease, where the immune system attacks healthy body tissue – and these differences might impact how effective the diets are against neurodegeneration. Indeed, women make up only 1/3 of all Parkinson’s disease cases. 

While our findings here are only correlational, they highlight the importance of including sex as a factor in further research. With a strong enough framework, everyone can design a house that will keep them happy and healthy for a lifetime.

 

Women’s Brain Health Series: Symposium 2 Summary

 

Author: Alex Lukey (@AlexandraLukey) – Registered Nurse, Master of Science in Nursing (UBC) and Women’s Health Blog Co-Coordinator | Editor: Arrthy Thayaparan, Women’s Health Blog Co-Coordinator

Published: December 14th, 2020

This past year has been a time of unprecedented change and constant adjustments. For the Women’s Health Research Cluster (WHRC) a lot of our work has shifted online to better serve our cluster members. In particular, the WHRC’s annual women’s health conference went from a single-day event to a series of 10 monthly sessions.

Originally meant to be held in May 2020, this year’s conference focused on women’s brain health. The purpose of the conference was to highlight how women have unique health needs and are more susceptible to specific brain diseases. The fourth session of the Women’s Brain Health Virtual Conference Series was held on December 4th and welcomed experts to discuss the intersection between women’s health and mental health. A variety of ideas were considered during the session, which our blog coordinator, Alex Lukey, has summarized for our esteemed readers:

Dr. Shau-Ming Wei, NIH/NIMH

Mood disorders during Reproductive Transitions: Circuit and Cellular Substrates of Risk 

Many women experience Pre-Menstrual Syndrom (PMS) but for some women, the mood shifts can be so severe that they damage work and family relationships. When this happens what they may be experiencing is known as Premenstrual Dysphoria Disorder (PMDD); a far more severe form of PMS.

Dr. Wei presented research that shows that there may be differences at both the brain and cellular response to hormones in women with PMDD. This early research is exciting because it is evidence that the extreme psychological symptoms that some women experience have a biological basis. This also means that PMDD may be treatable.

The research showed that there were differences in blood flow to an area of the brain (subgenual cingulate) indicated in major depression disorder when exposed to high levels of estrogen and progesterone compared to women without PMDD. This means that the brains of women with PMDD respond differently to the normal fluctuations of hormones than women without PMDD. Early evidence from Dr. Wei also showed that when estrogen was suppressed in women with PMDD that there was as much as a 70% reduction in symptoms.

To treat a disorder we must first understand the biological reasons for the illness. That’s why this research is critical for us to better understand how to treat women with PMDD.

Dr. Cindy Lee Dennis, University of Toronto

Mental Health across the Perinatal Period starting Preconception

Perinatal mental health pertains to the period of time immediately before and after mother’s give birth. Research in this area is still in it’s early stages of conception – having only been addressed in the last 30 years. Dr. Dennis presented research that is critical to the effective treatment of perinatal anxiety and depression.

Due to public health efforts, there is an increased awareness of post-natal depression, commonly known as “baby blues.” What is less known is that depression and anxiety often start during pregnancy and can last several years after if not treated. According to Dr Dennis, at least a ⅓ of women had symptoms DURING and another ⅓ before pregnancy. Further one of the strongest risk factors for perinatal depression is a previous major depressive episode. Yet, screening and interventions are usually not completed until after the baby is born. Dr. Dennis advocated that screening and interventions must be aimed much earlier for better outcomes.

Anxiety is also not commonly addressed in women both during and after pregnancy. About 1/4 of women reported a major anxiety episode into their pregnancy. There were factors that reduced anxiety and depression according to Dr Davis. Two factors which reduced anxiety and depression in women were partner support and self-efficacy in breastfeeding. Both of these factors can be targeted for intervention.

Partner support is an important component to focus on as well because men also experience increased anxiety and depression. Dr. Dennis highlighted the importance of studying the effects and experiences of men with anxiety and depression during the perinatal period. Risk factors for paternal perinatal mental health issues varied from emotional abuse, financial instability, paternal ADHD, and obesity. Yet there is much less research and support for partners of women.

The main take-away message from this conversation? Perinatal mental health is not exclusive to mothers, but is a family affair. Thus, the imporatance to initiate interventions before pregnancy becomes even more vital. It really is never too early to address perinatal mental health. Especially considering that the first contact with antenatal care is usually too late to target major risk factors.

Dr. Benicio Frey, McMaster University

Mood Disorders and Reproductive Live Events: Translating Research into Clinical Practice

Dr. Frey started his talk with three clear objectives for the audience to understand:

  1. There are major links between mood disorders getting worse and premenstrual, postpartum and menopausal disorders
  2. The link between mood and premenstrual disorders is associated with worse clinical outcomes. In extreme cases even increased suicide rates
  3. Hormonal treatments may be one option to help improve symptoms and clinical outcomes

What do these conclusions mean? For women with serious mood disorders such as bipolar disorder, major hormonal changes such as pregnancy are risky. This could mean a relapse or worsening of their condition. Research also shows that with treatment this risk is significantly reduced. Unfortunately, according to Dr. Frey, hormonal changes as a risk factor for psychiatric emergencies is not widely taught to mental health professionals.

Dr Frey also discussed the connection between PMDD (Prementrual Dysphoric Disorder) and bipolar disorder.  A staggaring meta-analysis of 32 papers showed a 26% increase in suicide deaths at menstruation. This is further evidence that the effects of hormones are serious for women with mood disorders.

Dr Liisa Galea asked a follow up question for the women in the audience: What should a woman do if she thinks that she might have PMDD? Dr Frey suggested that women track their symptoms for two cycles using either an app or paper tracker. It is much harder for healthcare providers to dismiss symptoms when presented with a numerical measurement.

Alex’s main takeaways:

The talks although different in focus and topic had a clear message: We have a lot of work to do to understand the causes of mental health challenges in women. The hopeful message is that there are biological mechanisms specific to women that treatments can be aimed at. The talks by Dr Wei, Dr Dennis and Dr Frey are evidence of the immense progress being made in this field. Hopefully in the years to come, these essential conversations will bring to fruition results that will drive change in our understanding and treatment of women’s mental health.