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As Lisa Mosconi, Ph.D delivered her last remarks during her TED Talk in December 2019, she seemed surprised, almost caught off guard by the audience’s response. “Brain health is women’s health,” she says to the audience when the room erupted into applause and rose from their seats to give her a standing ovation.
During the previous thirteen minutes, Mosconi, the Director of the Weill Cornell Women’s Brain Initiative (WBI) and Associate Director of the Alzheimer’s Prevention Clinic, Mosconi had earned that praise by laying out a simple premise: that when it came to Alzheimer’s, women were nearly two-thirds higher risk of developing the disease compared to men. Why? “It turns out our brains age differently, and menopause plays a key role here for women,” she explains in the video.
Estrogen, we learn, is important for both reproduction and brain function. “The health of the ovaries is linked to the health of the brain.” So when a woman’s levels of estrogen decline in midlife, it disrupts a woman’s life with symptoms like hot flashes, sleep deprivation, night sweats, and more. On the other hand, she deadpans, “men’s testosterone doesn’t run out until late in life, which is a slow and pretty much symptom-free process, of course.”
Since its release, Mosconi’s presentation has garnered more than four million views, helping to raise awareness about menopause and the intersectional approach the medical establishment must use to protect women during the biological transition. Through her research and publications, Mosconi advises women to think about their brains as an organ to protect. In her 2018 book, Brain Food: The Surprising Science of Eating for Cognitive Power, the neuroscientist explains how to fight cognitive decline with nutritious ingredients that come mostly from the Mediterranean Diet.
She followed up in late 2022 with her influential book, The XX Brain: The Groundbreaking Science Empowering Women to Maximize Cognitive Health and Prevent Alzheimer’s Disease. In many ways, the book is a call to action in that it urges women to take control of their health by implementing behaviors around nutrition, exercise and sleep that will protect and restore brain health.
In early 2024, the neuroscientist will publish The Menopause Brain: New Science Empowers Women to Navigate the Pivotal Transition with Knowledge and Confidence. In this book, Mosconi makes a bold case for the benefits of hormonal therapies to help protect women’s brains and starting before menopause symptoms arrive or early on as well as throughout the menopausal journey. She also highlights the potential benefits of selective estrogen receptor modulators (SERMs), plant- or animal-sourced versions that mimic estrogen. “These preparations are specifically engineered to target one organ — the brain,” she told CNN in a recent interview. “It’s kind of genius because you really want an estrogen that goes straight to your brain and does not impact your reproductive organs and raise the risk of cancer.”
Before Mosconi can scale her solution, she’ll have to cut through the ongoing controversy surrounding hormonal therapy as a safe and viable option to treat menopause symptoms and to protect women’s health. However, a recent meta analysis co-authored by Mosconi and other researchers looked at 50-plus studies and saw promising results. Their review indicated that women who took hormone therapy in midlife to treat menopause symptoms were less likely to develop dementia.
Meanwhile, women who took hormone therapy after the age of 65 did not lower their chances of developing dementia. “We need more clinical trials evaluating the effects of midlife hormone therapy on biological indicators of Alzheimer’s disease, which we can now measure using brain imaging and fluids such as blood,” she said recently.
Mosconi is pressing on and is already at work on another study with her colleagues to look at PhytoSerm, a plant-derived version of estrogen, and how it impacts the earliest presence of Alzheimer’s in the midlife brain. “The more women demand this information, the sooner we’ll be able to break the taboos around menopause, and also come up with solutions that actually work, not just for Alzheimer’s disease, but for women’s brain health as a whole.”