On this week’s podcast, we have good news for women: you improve with age. Dr. Louann Brizendine’s new book The Upgrade details how the female brain improves in the time of life typically known as menopause. We delve into how hormonal changes can actually help our productivity and why you can look forward to your 30s, 40s, 50s, 60s, and beyond. That’s right, ladies: your best days are ahead.
Dr. Louann Brizendine is a neuropsychiatrist and author of the new book The Upgrade: How the Female Brain Gets Stronger and Better in Midlife and Beyond. She’s the Lynne and Marc Benioff Endowed Chair in Clinical Psychiatry at the University of California, San Francisco; founder of UCSF’s Women’s Mood and Hormone Clinic; and bestselling author of The Female Brain and The Male Brain.
TRANSCRIPT
Beverly Hallberg:
And welcome to She Thinks, a podcast where you’re allowed to think for yourself. I’m your host, Beverly Hallberg, and we have a treat for you. On today’s podcast, we are discussing a new book that shares some good news for women: you improve with age. Dr. Louann Brizendine’s new book, The Upgrade, details how the female brain actually gets better in the time of life typically known as menopause.
So we’re going to delve into the hormonal changes that can actually help our productivity and why you can look forward to your 30s, 40s, 50s, 60s, and beyond. That’s right, ladies, your best days are ahead. Dr. Louann Brizendine is a neuropsychiatrist and author of the new book, The Upgrade. She’s the Lynne and Marc Benioff Endowed Chair in Clinical Psychiatry at the University of California, San Francisco; founder of UCSF’s Women’s Mood & Hormone Clinic; and bestselling author of the two books, The Female Brain and The Male Brain. Dr. Brizendine, it’s a pleasure to have you on She Thinks today.
Dr. Louann Brizendine:
Thanks for having me, Beverly. I’m really excited to talk with your audience and with you.
Beverly Hallberg:
And I’m excited about this topic. I started reading your book; it’s already very informative. I was glad I could talk to you because I am 42. I’m entering into those years known as menopause. And I think a lot of women like myself, we wonder if we should be facing this with dread, if we should be fearful of it. So I think your book gives encouragement.
Before we get into what you have learned and what we can all learn about our brain and what it means for us as we get older, I would love to hear just a little bit about your background as a neuropsychiatrist. How did you get into this field, and have you been surprised by your findings over the years?
Dr. Louann Brizendine:
Well, I got into the field in a kind of… You know how you back into your career somehow, whatever, you just find something that’s really fascinating. I became really obsessed as an undergraduate with hormones and behavior because a lot of my professors at UC Berkeley were doing, at that time, the groundbreaking research into the behavioral effects of all kinds of hormones, especially testosterone and sex drive. Of course, when you’re 19 or 20, what else is better than knowing about sex drive, at any rate.
The purpose of a hormone is to cause a behavior. That always just fascinated me because there’s all kinds of aspects of hormones that have behavioral effects and mood effects and emotional effects and all kinds of things that are really important to know about. That’s what I’ve been researching for all of my career.
And then when I went back to do my medical school at Yale, I was in my third year, and I was doing my rotation in psychiatry and was reading all the literature and found out that the depression rate in women was two to one over men.
Beverly Hallberg:
Wow.
Dr. Louann Brizendine:
I was shocked by that, especially when I found out that it was a one-to-one ratio in childhood, and then it didn’t start to go to the two-to-one until 13, 14 years old. And I thought to myself… Remember, there weren’t very many women in the field when I was starting out, but my obvious thought was like, well, hello, what starts then? The menstrual period starts then, so the fluctuating hormones start then. I became obsessed with that, and I’ve been working with the hormone effects in the brain, the female brain in particular, for the rest of my career, and then starting the Women’s Mood & Hormone Clinic after I finished my residency and some faculty work at Harvard, I came out to UCSF in San Francisco. So I’ve been there ever since doing that work.
Beverly Hallberg:
And you had great success; New York Times bestselling author for The Female Brain and The Male Brain. Can you just give us a synopsis on how, in these books, you explain that women and men think very differently?
Dr. Louann Brizendine:
Well, I think… Let’s get a little nerded out here —
Beverly Hallberg:
Yes, please.
Dr. Louann Brizendine:
Just a little bit. Let’s rewind the tape here. The minute the sperm is going towards that egg, if the sperm is carrying an X chromosome, then, of course, the fetus will be XX; that’ll be female. If it’s carrying a Y, it will go scurrying and make a XY: male. And at eight weeks of fetal life, the tiny testicles in the male start to pump out huge amounts of testosterone that marinates the body and brain. It changes the body and the brain into male circuitry, male genitals, et cetera.
A female, XX, develops unperturbed by testosterone for those nine months. We each pop out with kind of our wiring and our genitals made for whatever sex our sex hormones are going to have us be. That’s the basics. As we pop out, remember, for the first year and a half, the male continues to pump out a lot of testosterone from the testicles in the boy.
Any of you mothers out there who’ve had a baby boy, you know that they’re born with these very big, puffy red testicles, because they’ve been very active and they’re continuing to be active for about the first year and a half of the baby’s life. It’s a time called infantile puberty. The girls, for the first time, the switch gets thrown on our ovaries to start making almost adult woman levels of estrogen for the first two years of our lives.
Beverly Hallberg:
Wow.
Dr. Louann Brizendine:
So if you’re looking at a little one- or two-year-old girl, you’re not realizing that she has a lot of estrogen. They don’t know really what infantile puberty’s purpose is. The hypothesis is it’s something to do with finishing the finishing touches to all of the fertility communication between the body and the brain, so something’s happening. And then remember, we have childhood, and childhood is a time that… Humans particularly have childhood.
Lots of animals don’t have something called childhood, but childhood we have about the same… Our hormones are really, really low, low, low for both males and females; and males and females both have a small amount of estrogen, a small amount of testosterone during the childhood years, until ping, ping, ping from the pituitary down to the ovary, starts to wake up the ovaries, or ping, ping, ping down to the testicles, starts to wake up the testicles and make either testosterone or estrogen. So that, of course, we know ends up with the rock and roll of puberty. You probably all remember puberty or actually most of us would like to forget puberty.
Beverly Hallberg:
To forget it. It’s always that awkward stage of life, for sure. And so it’s very interesting. You show these distinct differences between men and women. I often hear friends say this: men always get better with age. I know a lot of times we’re thinking about the outside and how we look. And that women are on the decline especially once they hit 40, when that’s when men are hitting their peak.
I think it’s fascinating that you’ve studied this from just the mental capacity and what has it meant for women once they’re approaching menopause, once they’re in menopause. What have you found really happens to the women’s brain at that point in time when obviously estrogen is changing, so much is changing in their bodies?
Dr. Louann Brizendine:
Exactly. What you have to look forward to, and I know you’re just barely entering… Age 38 to 42 is what I call kind of, it’s the pre-transition. I’ve renamed them into pre-transition, into transition and upgrade, because the technical medical terminology is perimenopause, which is really about an illness. It’s not really about the whole woman’s experience going through the transition. And it’s not about, then, once the menopause hits with no more periods from that time on, it’s not just about post-menopause, which is really a medical diagnosis. It’s basic, the whole woman effect, it’s really an upgrade. The reason that I call it the upgrade is because we are not being pushed and pulled by our hormones every single week of the month like we are during the fertility cycle.
That fertility cycle that ends up actually the first two weeks of our period, we’re building all kinds of circuitry in parts of our brain; it’s sprouting and sprouting and connecting. And then the last two weeks of our cycle, the progesterone comes around and tears all that down. So it’s almost like our pathway during the fertility years, we’re walking along a path that’s right next to the tide line. The tide comes in and it washes everything away that just got built up and then it starts over again. So we’re constantly being pushed and pulled, pushed and pulled in terms of our brain circuitry, which at the upgrade, at the menopause stage, when there’s no more periods, we’re walking on a path that’s higher up the hill. We’re more steady, stable, we can see things much, much more clearly. We’re on terra firma at that stage. We’re not getting everything washed away and built up and washed away.
So I think that women who get a whole new purpose at that stage of life have a lot more like both feet on the ground and stability without this wash. So that’s why, ladies, it is really going to be an upgrade. You have a few years to get through the transition.
Beverly Hallberg:
Sure.
Dr. Louann Brizendine:
Which can kind of push and pull you quite a lot because remember that stage that a lot of us like to forget about called the PMS stage, that day or two before we start our periods — about 80 or 90% of women or more have had that feeling. And in my clinic, we call it the days of the crying over dog food commercials.
Beverly Hallberg:
For sure. I can relate.
Dr. Louann Brizendine:
At the drop, right, at the drop of a hat, Beverly, I mean, we can just like boo-hoo or things that someone does that irritate us, they might annoy us at other days of the month, but on those days, they can feel like fingernails on the chalkboard. You just feel like you’d like to strangle someone. All kinds of intense emotions come out during that period. And that is because the rapid hormone changes right before the blood flow starts with a huge drop off in progesterone, which is actually the Valium of the brain is what we call progesterone. And then all of a sudden, it’s gone — boom, it’s gone — and you get really irritable and you can be very tearful. The reason I focus on that right now is that that can happen erratically during all kinds of days of the month during what we call the perimenopausal, the transition.
You can kind of get jerked around during different days. I think as long as you know that it’s going to happen and you have your own skill set, you have your own toolbox, your own toolbox on how to deal with those. A lot of women find that it’s a nice time of life in your… About age 45 to 55 is when like the majority of women go through the whole transition and go into the upgrade to the menopause at that time. That’s the basic of like about, if you look at the bell-shaped curve, that’s the majority of women will be doing it then. Although 7% of women do it before age 45.
Beverly Hallberg:
Wow.
Dr. Louann Brizendine:
And then about 5 or 6% after 55. So there’s some… If you’re [inaudible 00:10:48] don’t think it’s not normal, it’s just that you’re not happening in that group. So at any rate, the good news is also no more periods. You don’t have to have cramps or walk down that aisle in the grocery store, et cetera, et cetera, all kinds of cool things. You don’t have to worry about all the stuff we have to worry about with periods and all that.
Beverly Hallberg:
So let’s talk about getting to that menopause stage. So we’ve kind of gone from conception to birth, to puberty. Then you get to, for a woman, you go through the fertility years, then you go through menopause. And so you’re now at the stage of you’re at the level place of the brain. You’re not crying more a certain time of month, or as I like to call it the time when my husband doesn’t like to be around me as much because I can cry about anything at that point. But once you get to this leveling out, how should one utilize the fact that there is a more steady brain function there; your hormones aren’t pulling you at the same way. Is this a time of opportunity? And is it something where women just automatically are going to have better brain activity and be able to be more productive and have more clarity? Or is it something that has to be worked on?
Dr. Louann Brizendine:
I think that it comes as a really pleasant surprise. So let’s go back. And as I talk about in the book, you can figure out which stage you’re in by different… So I take you through in the book of what I call the pre-transition, 38 to 42, in that range; or age 42 to 45 or 6 is what I call the early transition period. And that’s when you may be waking up a little hot some nights of the week or that feeling of after you’ve done your usual workout or some exercise that you do, you’re really surprised that you’re not cooling down as fast as you used to. And so that can be a big surprise to some people, but that’s basically because the thermostat in your brain is set by estrogen and changes in the estrogen changes that thermostat.
I’ll give you an example. If you’re in a group of people in a room and someone changes the temperature by 10 degrees, they put it up 10 degrees. Well maybe, yeah, most people in that room might feel hot and start to take off a layer or something like that. However, when the hormones start to change, the estrogen starts to change during the transition perimenopause time, what happens is, if they change the temperature one degree, nobody else is going to feel hot, but you’re going to be sweating.
So at any rate, that thermostat in the brain, for some reason, reasons we don’t quite scientifically understand yet, all of a sudden feels like it’s all of a sudden hot. When objectively, it’s not really hot. But it’s feeling hot and you’re going to sweat. You’re going to have hot flashes, hot sweats. That can go on at night when the covers are on you, you might not usually feel hot and then you got to throw them off and et cetera, et cetera.
So that usually happens a few times a week during that first stage of the early transition, like age 42 to 46 and then 46 to 50 in that mid-transition stage, or 46 to 49. That is when you’re maybe having sometimes heavier bleeding. And the reason we get heavier bleeding is because the ovulation doesn’t happen every month. We don’t make a new egg every single month; we have what’s called eggless cycles a lot during that phase. And all of a sudden, this beautiful choreography between the pituitary and the ovary is breaking down because the pituitary is like a conductor of a symphony. It likes to scream at different instruments of the organs in the body that make hormones that aren’t playing loudly enough. And so it’s starting to scream pituitary, I mean, estrogen, please come out of the ovary and screams very loudly.
But the ovary is saying, I’m retiring, I’m ready to retire, I’m done with this egg stuff; and it’s not giving you enough estrogen. So then, all of a sudden, though one day it will squirt out a huge dose of estrogen for a couple of days during this transition — so some days you’ll have even more breast tenderness or you’re making more blood and you can start to have heavy flow that you end up getting during this day. So there’s all kinds of reasons for that. So I think women that are listening should know that probably what you’re going through is completely normal. I mean, have a good doctor that you have a good relationship with during this phase or take your girlfriend or your sister or somebody with you because it’s a confusing time because there’s all of these things kind of going every which way. And you just need someone to say, okay, this is what’s happening, and this is what you can do about it. Here’s your tool, I’m going to give you a new toolbox of tools.
Beverly Hallberg:
And you’re not crazy.
Dr. Louann Brizendine:
Right, to fix this. Right. And you’re not crazy.
Beverly Hallberg:
You’re not crazy, which is an important thing. And so as we, though, get into this stage where things do level out, what tips do you give? I know you talk in the book about just practical tips on how to manage this time well and why we should look forward to it. What are some of those things once we get to that stage of leveling out that really are beneficial?
Dr. Louann Brizendine:
Well, there’s a lot of things about this. I mean, first of all, biology is destiny, unless you know what it’s doing to you. So that leveling out that’s going to happen for you, that you need to know about and the kinds of things are that basically be delighted and surprised at the increased energy you have, the better sleep that you have, and also know that just the energy that you have for focusing on new projects or finding a new purpose or a new direction can be something that feels sort of surprising to you at this stage. You’re kind of thinking like, well, I thought I was done already, but now I’ve got all of these really cool things that I still want to do. So you feel like you have a real tailwind.
And I just say that women need to know how to seize it and to be feeling in themselves that kind of increased power and a newfound clarity and really to embrace it. So I give you lots of tips in the book, like in chapters five and six, where I talk about the neuroscience of self-care and all kinds of tips about how to also keep your brain in tip-top shape through this whole second half of life.
Beverly Hallberg:
Well, I wanted to take a quick break to ask our audience a question. So here it is. Are you a conservative woman? Do you feel problematic just for existing in today’s political landscape? If so, I have something for you. Every Thursday morning on Problematic Women, Lauren Evans and Virginia Allen sort through the news to bring you stories and interviews that are of particular interest to you, a problematic woman; that is, a woman whose opinions are often excluded or even mocked by those on the so-called pro-women left. Lauren and Virginia break down the news you care about in an upbeat and sharp-witted way. So search for Problematic Women wherever you get your podcasts.
Now, Dr. Brizendine, I want to talk just briefly about some of those things as tips to really help you in this stage where we really have to take care of our health. You talk in the book about the need to exercise, eat well, the importance of sleep, all of those things are what we hear about in general life. Is there anything else? And then those are all important, but is there anything else in addition to that you think it’s really important for women to follow during the years post-menopause?
Dr. Louann Brizendine:
So I’ll share with you one of the really cool science stories of a big study that was looking at 80-year-old women, and those women who had the best cognition in that group also had the best leg strength. So surprise, surprise, something about having strong muscles also correlates to having a strong brain. So I think that gives you an example of things like if you keep the muscle strength and we know the muscles communicate with the brain through the nerves and the nerves system, but also the muscles squeeze out some specific compounds when they’re working out or when they’re exercising that actually goes to the bloodstream that communicates with the brain and keeps the brain functioning better and keeps it quote unquote kind of younger and firing on all cylinders.
So I recently… I say to women, one of the things you can do is just to make sure that you keep your leg strength good, but that one of the biggest muscles in your body, and I put a little thing on TikTok recently about this, about a little brain tip for women. And if you keep squeezing your glutes, like the thousand butt squeezes a day, sounds really silly way to kind of keep your brain in shape. But it really does because it’s something that’s communicating with your brain and a thousand butt squeezes a day is one silly little thing but there are lots of those things there are tips that I go through and the scientific reasons behind them to try to keep all of you, including your brain, most importantly, your brain, your female brain in great shape.
Beverly Hallberg:
And something you also talk about, and that is the importance of eating well. So eliminating sugar, you talk about inflammation and also something that I think Americans definitely have a problem with, we see the studies and the data behind it: drinking too much alcohol. What do you have to say about alcohol? Women have heard for so long that, oh, well, a glass of red wine a day helps you tremendously. Is that the case?
Dr. Louann Brizendine:
Well, first of all, you have to always look at who’s paying for these studies. The coffee, the coffee industry pays for the coffee studies and the alcohol industry pays for the alcohol and the chocolate industry pays for the chocolate studies. We all know this, right, we’re not stupid. So be that as it may. So if you think of a really stable stool, a stable stool has to have at least three legs. So the three-legged principles to keeping all of yourself together and strong are: number one, is the diet having a really healthy, Mediterranean diet that keeps your inflammation in your whole body down and keeps it low because inflammation is very bad for your brain. And alcohol can also cause lots of inflammation. The other pillar of that is of course your exercising, keeping your muscles strong.
Because remember, we all, males and females, start to lose their muscle strength at about age 35. And it goes down a little bit every year after that. So to keep it from going down too far, you need to keep using those muscles. And the third little stool leg is really important: it is sleep. And it is because, during the daytime hours, all these little neurons in your brain are talk, talk, talk, talking to each other. They’re problem solving all day. They’re doing all the stuff we do all day. And they’re throwing all kinds of little protein garbage everywhere. So it’s like the garbage in the brain accumulates during the day. And then at night, all these little nerve cells in the brain, kind of shrink back and leave these spaces in between where all the fluid can come hose out, just hoses out the garbage.
But if you don’t sleep, those little spaces don’t appear, and you don’t get the garbage hosed out at night when you sleep. So really, to constantly refresh your brain every night, you really, really have to focus on getting deep sleep. Two of the things that interrupt sleep the most are alcohol and caffeine. So especially for the female brain, if we have a strong cup of coffee at noon, it’s still in our blood, it’s still in our bloodstream at midnight. So see if you can cut it down and don’t drink any after 12 noon. The alcohol story’s a little kind of the opposite, in a way: you should probably have your alcohol at 12 noon. So maybe swap those out because what happens with the alcohol is that two or three hours after you drink alcohol, it kind of does make you go sleep, makes you sleepier. But as soon as it metabolizes out of your body, it wakes your brain up. So you might sleep for two hours and then you’re waking up in the middle of the night and that’s really interrupting your sleep. Plus it causes more inflammation and those women, they’ve correlated it with… It’s a correlation with breast cancer in women, to alcohol. Even one drink a day, they don’t want to say that. I mean, it’s surprising, but that is the data that even one drink a day can cause you an increased possibility of having breast cancer. So we don’t want that.
Beverly Hallberg:
And have you found the sleep you’re talking about, the importance of sleep and how that helps the brain because women have different brain functions than men, or maybe a better way to say that is I find women multitask more. There’s a lot they’re thinking about all the time. Men can typically, and this is a generalization, be a little bit more focused and focus on one thing at a time. Does that mean that women need sleep more than men in order to flush out their brain?
Dr. Louann Brizendine:
Well, I think everybody needs to flush out their brain for sure. And I don’t know whether the… During the teenage years, during puberty, males tend to like go to sleep an hour later and wake up an hour later; they have a slightly different what’s called chronobiology, which basically is a fancy word for your circadian rhythm. And females tend to go to sleep maybe a little bit earlier and wake up a little bit earlier. And that usually disappears, that sex difference usually disappears by the late 20s, but it can definitely persist in some ways. So there are some sleep differences, but all people need to… The flushing out of the brain from the garbage, it definitely happens with males and females. And remember, males don’t have the experience of having their hormones fall off a cliff at 50, whereas they start to lose their testosterone levels, between 30 and 35, males start to go down a few percent every year.
And theirs doesn’t dramatically drop, but then it starts to drop quite a lot in their 50s, 60s, and 70s, but it’s a slower tilt to the curve to go down. And males still have… Remember the eggs, we’re only given about a million eggs, females, and we ovulate them. And some of them, we’re done with our eggs by about between 37 and 42 or 3, we’re sort of done with our eggs and males continue to make sperm until the moment they’re in the grave.
Beverly Hallberg:
Not fair, sometimes, the biological clock, so different, but there’s a purpose for it.
Dr. Louann Brizendine:
It’s a difference. Yes, it’s different. Because we women, I mean, think about the poor female body, we have to make… That all of the female body has to do. The pregnancy takes a huge amount out of the female body and breastfeeding and the care tending of helpless infants, human mothers just put a lot of calories and energy and everything into the offspring. Males do too, but it’s not the same toll on their body.
Beverly Hallberg:
Right. Right. Well, final question for you. Something that you had said earlier that I wanted to come back to, you talked about the depression that you saw in young girls in comparison to young boys around the age of puberty, that girls were typically more depressed once they hit that age of puberty than men. What do you find post-menopause? Where is the depression level? Do you see it shift? Does it change?
Dr. Louann Brizendine:
So interestingly enough, if you look at the curve with that two-to-one ratio, the time that it starts to change a bit is at age 50, and it gets to be closer to the one-to-one ratio. And they don’t really know why, but they know that depression in men starts to increase around 50. So it’s almost like the males have kind of come up to join us, whatever. So yes. I still, because I treat a lot of women with depression and anxiety, and it’s a time when women are getting all kinds of tools in their toolbox to try to help themselves, whether they have mood issues or whatever kind of issues they have.
But the males, I think, sort of catch up with us. So something about the hormonal fluctuations in the female brain seems to be what gave that two-to-one ratio that starts in puberty. And of course, teenage girls are in a… There’s a mental health crisis in this country with teenage girls and with teenage boys as well, as we really know. So it’s something that I’m very passionate and obsessed with trying to improve the mental health system in our country. I think it really, really… All of us would benefit if the mental health system were in better shape in our country, as it is in some other countries that are equally rich to us.
Beverly Hallberg:
Yeah. I think you’re so right. And there’s so much that we can learn about the brain and what it means. And this is why this is such a great resource. For those interested in getting it, again, it is called The Upgrade. Dr. Louann Brizendine, thank you so much for writing this book and also joining us on She Thinks today.
Dr. Louann Brizendine:
Thank you so much for having me and thank you to your audience for listening.
Beverly Hallberg:
Yes. Thank you all for listening. I want to let you know before you go, Independent Women’s Forum does want you to know that we rely on the generosity of supporters like you. An investment in IWF fuels our efforts to enhance freedom, opportunity, and wellbeing for all Americans. So please consider making a small donation to IWF by visiting IWF.org/donate. That’s IWF.org/donate. Last, if you enjoyed this episode of She Thinks, do leave us a rating or review, it does help. And we’d love it if you shared this episode so that your friends can know where they can find more She Thinks. From all of us here at Independent Women’s Forum, thanks for watching.
