Professor Eef Hogervorst, Professor of Biological Psychology at Loughborough University, sits down to discuss the factors influencing the menopause, what the best treatment options are, the relationship between oestrogen and dementia, and the controversies surrounding the andropause (the ‘male menopause’).
Time Stamps:
00:00 – 06:22 – Introduction to guest, the topic and background
06:23 – 07:45 – Oestrogen and its effect on dementia
07:46 – 11:32 – Menopause discussion
11:33 – 16:52 – Treatment vs environment: Which is more helpful with menopause?
16:53 – 19:23 – Is menopause being talked about enough?
19:24 – 26:39 – Andropause
26:40 – 28:30 – The four-day work week and focus on mental health importance
28:31 – 31:08 – Wealth and mental health
31:09 – 35:38 – Current and future work
35:39 – 37:26 – Outro
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We know from animal and cell culture research that estrogen should really benefit brain should protect brain against alzhe herous disease but so far the treatment Studies have not really shown long-term benefits deina M did a um documentary a couple of years ago now um where she talked about this and what
A difference it had made and what we can see overall that about half of the women say it really benefited them but often for short periods of time and most women don’t take it for that long for whatever reason uh sometimes they feel it stops working or they get a bit spooked
Because there is slight increased risk for breast cancer um or they just want to give it a go and and you know see how they fare hello and welcome to the experts in health podcast brought to you by lra University this podcast aims to highlight the latest research and Trends
In health as we welcome a variety of guests from a host of different disciplines I’m Dr Chris McLoud an academic in the school of sport exercise and Health Sciences with an expertise in behavioral nutrition and public health and today I’m delighted that we are joined by Professor E hog e is a
Professor of biological psychology at luer University e it’s wonderful to have you here today thank you very much for coming on the show well thank you very much for having me not at all so before we get going into the meat of what we’re going to talking about can you just tell
Me about biological psychology professor of biological psychology what is biological psychology well um I was originally trained in Health Sciences and I majored in Mental Health Sciences but my main Interest really is in how the body affects the brain and how the brain can affect the body and so that includes
Things like physical activity which is why I’m here um but also Al diet and and hormones interesting okay thank you for outlining that much appreciated can you then just tell the lists a little bit a bit more about yourself what what do you do you know tell us a little bit about
How you’ve come to this point it’ be really interesting to hear a bit more about you well I um I came here over 20 years ago and uh I I came to lbro because of its expertise in in exercise and physical activity and before that I worked at Oxford and and Cambridge
University to look at risk and protective factors for dementia and one of the things that we found was most protective throughout the lifespan was was physical activity so I thought well join the experts here and try to come up with something that could protect people against developing
Dementia or once they have dementia what we could do to improve uh you know their memory functions and and Independence so over that period of time do you feel feel like you’ve got closer to fully understanding how we can help people in that area or is it is there still a lot
To to work out well I’ve been really fortunate because love BR has got really excellent uh students and we were able to work with some amazing PhD students and they’ve come up with um various programs uh exercise programs using resistance BS to help people um improve their memories improve their strength
And in particular something called self Y which is where you realize that actually you can do more than you think you can so um yeah I I would say they’ve they’ve had success with that measurable Improvement on on memory tests and and mod and strength of these exercises so
Yeah no definitely made some good progress there it’s always helpful to have a team working with you isn’t it um so we’re we’re going to be talking about something mainly today which is sort of a side related but and a side to that um so can you just give us a a brief
Opening statement to wet people’s appetite to say why what we’re going to talk about today is is so important to you and should be to our listeners well one of the um things we discovered very early doors was that risk for dementia goes up in in women in
Particular and um we weren’t quite sure why that was the case and one of the reasons could be um and and I’ve been looking at this since 1988 I’m afraid that still don’t have an answer is um is is women undergo the menopause so they they lose estrogens
And um we know from animal and cell culture research that estrogen should really benefit brain should protect brain against Alzheimer’s disease but so far the treatment Studies have not really shown long-term benefits um so they show short-term benefits but then if people keep on taking it or if people start taking it
When they’re over the age of 60 they actually seem to have negative effect so not entirely sure why that happens just to take us back to that first part then can you outline what is the menopause just for people who are listening how does it present on on the outside and
What’s happening internally so the menopause you have a finite number of ovaries and at one point they’re just not functional so the eggs basically producing helping to produce the estrogens and estrogens normally help your body in a wide variety of ways but they can also affect the
Brain in the years before the menopause these estrogen start fluctuating and that’s when we see the majority of complaints like flushes people can’t sleep very well people have memory problems and so some people thought well maybe that makes people more vulnerable for an increased risk of dementia later
Later on so because estrogens can affect the brain can protect the brain and if that effect Falls away then then maybe that lack of estrogens um could could make women more vulnerable to dementia and keeping it lay for myself how does estrogen have that relationship with dementia what
Actually happens as I say keeping it as lay as you can be for me yeah no it’s it’s estrogens to put it in the simplest way there was a lady called Barrett Connor in 1998 and she said the biological plausibility for estrogens to protect the brain is its strongest suit now what
That means is that any mechanism implicated in alims because we loads and loads of research in looking at for instance a lack of blood flow through the brain causing a lack of oxygen uh which of course the brain needs to function um issues in how the brain works with sugar as it develops
Alzheimer’s also the chemicals that um allow us to have communication between the brain cells the neurotransmitters they’re affected in Alzheimer’s there is um Alzheimer is the most common form of dementia there is a buildup of plaques in the brain but all those mechanisms estrogens can protect against
So really by all intensive purposes they should protect women and so giving estrogens back to women after the menopause the hormone replacement therapy that should help and we’ll come on to whether it doesn’t in a second but um I can imagine from what you’ve sort of said there that the menopause and
What those experiences are like that’s always been the case for people who have the S similar biology within them since time began or or is it a more modern phenomenon the the menopause and how that presents I think it’s interesting because what menopause means we can see that in different cultures is very
Different um for instance um some research I’ve read from India and also some of the work we’ve done in Indonesia where women reach a higher status where they become more important as they go through menopause and they now can be part of the wise Council of the village
For those women it is actually very positive it’s a positive experience they talk about the menopause is change is something that’s you know positive again you need to be a little bit careful with this sort of anthropological approach because of course people hear what they want to hear um and of course people
Speak to people in the way that they think people want them to answer um but uh what we do know is that some of the Hallmarks of flushes of menopause like flushes the hot flushes people get because of these changes in hormones you a sudden get really hot and
You can start sweating and your heart starts racing that occurs in pretty much everybody about 80% of women have that to a larger or lesser extent with more or less B but other symptoms like for about half of the women complain about changes in mood in
Memory uh brain fog no longer being able to concentrate and that can be quite severe in fact a third of women going through that transition is thought to want to quit their jobs there’s been some surveys where women say I can’t I can’t do this anymore I’m going to quit my job
And an estimated 14% of women going through this quit their job because they can’t function anymore because the flushes can also occur at night so you can’t sleep uh you can’t concentrate when you’re you know at at your work some people have to wear uniforms and so
It can be quite severe but the extent to to how that is experienced and for how long for some women it’s a couple of months for some women it’s 12 years so it is’s a wide wide variety and how you interpret that change for instance there’s some studies
Finding out Catholic women for whom it’s very important to have many children in the past um had had great problems with with the menopause going through it so there’s this interaction between the biology but also what what your what your position is like within the particular society or family you know
How whether you’re working or not working and all of these interacting factors so so do would you say then if someone says you know the menopause is a biological phenomenon would you not say that’s the case well it’s obviously it’s triggered by something biological but the way that
People handle it and and handle the symptoms is very individual and and it’s determined by so many things your partly biological factors like your weight if if you drink a lot if you smoke lot a lot of stress those symptoms will be often quite severe uh but also your psychological
Makeup you know if you how you view this change and whether it’s a challenge whether it’s something you know that that you look forward to because it it comes with a different set of circumstances and a different you in many ways as well I guess so if we move
On to the idea of you know treatment do you think that’s the right is that helpful term is that is seen as something to to Aid the individual normally by from my you know understanding taking something to change the way that their biology is functioning should should it actually
Not be about taking something but changing the environment around because ultimately there’s nothing wrong with the experiences that they’re having that’s a really good point I think again you know women need to think about this for themselves and what they want and what they need it’s very put them women
Drive that agenda themselves um and I think you should start slow where you look at changing Lifestyles for instance drinking alcohol smoking stress drinking lots of coffee not sleeping all these contribute to severity of flushes so that interacts with one another if I’m not sleeping because I’m having flushes
I’ll then be drinking lots of coffee during the day and then because I need to calm down I’ll be drinking lots of alcohol and smoking and so you get caught in this vicious cycle try to adjust that eating hot foods wearing sweaty clothes like you know nylons tight fitting things um that doesn’t
Help um making sure you create a good environment to sleep if none of that helps you can think about you know some over the-counter products there are phyto estrogens bl- based estrogen products on you can just get without a prescription but I think I think um a
Lot of people I know I’ve I you know we’ve discussed taking Easter dial you can get transdermal Easter dial and um Davina Mall did a um documentary a couple of years ago now um where she talked about this and what a difference it had made and what we can see overall
Is that about half of the women say it really benefited them but often for short periods of time and most women don’t take it for that long for whatever reason and uh sometimes they feel it stops working or they get a bit spooked because there is slight increased risk for breast
Cancer um or they just want to give it a go and and you know see how they fare and so most women don’t take it for that long maybe a year maybe a couple of years but um and and the question is you know does that benefit you if it does
Keep on doing it you know if you if you don’t want to go there there are alternative ways one one of the ways way is um working for instance with your thoughts how you think about the menopause what it means and uh Professor Myra hunter in London has developed a
Therapy for this um and also helping you to sleep so helping to change your thoughts to sleep and this has been shown to be really really successful so there are other ways of of doing it what is the evidence based like at the moment for all these different options you know which
Ones mostly going to going to work you know I’m I’m intrigued as to with so many different options yeah which one is the best well I think it depends a little bit on um the individual and works for you again you know so um I I I
Think the the talk therapy where you’re where you where you’re tackling your thoughts you can do that in a group you can also do it by yourself with booklets uh Professor Hunter has has got a lot of resources out there um it’s called CBT T So cognitive behavioral therapy for uh
These symptoms and that works really well it works to improve sleep and people feel less B uh by the flushes uh that’s been shown other types of therapies maybe not so much because for instance what I was interested in the memory improvement um to then protect against
Demena we found only really works for a couple of months and then it seems to level off and as women take it over time for longer than 10 years it actually starts becoming worse with discontinued therapy interesting why do we know why that’s the case there’s been some work by
Professor Robbie Brenton Diaz showing that estrogens if you give them to a healthy cell they help maintain that cell but if the cell has damage which we know is associated with Alzheimer’s disease like the mitochondria little energy factories don’t work so well or the calcium channels estrogens will make that
Worse so it’s a big problem so it’s it’s almost like and it’s the same for heart disease like aterosclerosis if you’re well estrogens will help you stay well and healthy if you’re not well estrogens will make you get worse so yeah so individual should probably see a physician to work out
Absolutely best pack and you can’t you know you you need to talk and and have a good because there’s also risks for breast cancer for deep Fain osis for stroke so you the tiny risks but anomal cancer but you need to sort of make a very good judgment on that whether
Whether you should you know go ahead with it or maybe not you mentioned about deina mccol and the uh documentary and that was quite big actually and I’ve seen a lot more in media talking about the menopause do you think that’s being a good thing um in terms of people who
Actually experienced the menopause I think it’s absolutely great because a lot of women feel very embarrassed going through menopause and sort of try to hide it and um I think like at the University they’ve been very good about flexible working you know if you haven’t slept and sometimes you feel quite
Overwhelmed going through the menopause you know you’re having these flushes mood swings concentration issues you can’t deal with it if women are allowed to have a little bit more flexible work you know they can deal with it you can you can deal with these sorts of uh
Symptoms and again you know the vast majority of women won’t have objective cognitive impairments that’s that’s a minority maybe it’s one and five when they followed women through time it’s predominantly in that in the transition period so when the hormones are all over the place your body and your brain needs time to
Adapt can and I guess raising awareness of it helps people understand that there may be some differences that someone might might be experiencing and understanding can help then uh allow the person to find support and that doesn’t have to be you know official doctor support it can just be an understanding
Support can’t it I think knowing that you’re not alone is is a big thing and that you’re not making this up but this is real for some women it’s a big big issue but it is probably thankfully the minority of women so I don’t think you
Know it it’s quite difficult as as a manager to strike a good balance there where you want you want to enable women but you don’t want to patronize them by saying oh are you going to the menopause then love or are you having your period again darling you
Know it’s not it I don’t think the anology should be used against women you should work with women it’s like you know are you going through the menopause is there something I can support you with you know I’ve noticed that you know you might be a little bit distracted or
Or unstable or you know well you might not want to go that far we’re in England after all but you know a little bit more subtle um would be good yeah yeah so I’m now interested and something that I’ve heard I’ve seen that you’ve been looking
Into so I really want to ask because it’s can be a mildly controversial topic and that’s this idea of the androp pause um something where men might go through something question mark similar to the menopause now tell me what is the andropause what do you understand by
This well so this came up again recently because uh e East Midland’s uh Ambulance Service supposedly according to the papers I was giving them a year off for andropause everybody was outraged it’s like how dare they now there is in men we see um small decrease in testosterone
Levels over time but it’s not quite as erratic and abrt unless these men um have their testicles removed for whatever reason cancer or accidents and then of course that drop is huge and they get massive symptoms they get very similar symptoms also if men you know have chemical castration if
They have prostate cancer and testosterone is a risk for that so you want to bring that down you give them chemicals they experience very similar um symptoms they got flushes night sweat mood instability brain Fork memory issues uh they tend to gain weight often develop breasts and of course this is a
Huge stigma for men it’s it’s very difficult um to deal with um so there is that but that that’s a small group of men again it’s maybe you know between anywhere between two and 10% of of men uh in in midlife who would experience something like that
But if men um grow obese in midlife uh between the ages of say 40 and 60 um they have a lower level of free testosterone often and especially if they drink alcohol a lot of alcohol and smoke and a lot of stress that can affect testosterone levels as well and
Have little activity and of course it can affect your mood and your memory um so you you want to make sure again for men that um you you you you keep on exercising a lot of men and women in in the in the middle AG in midlife they are um very
Busy very stressed you’ve got the kids who all hate you your teenagers slamming doors you’ve got parents suddenly getting ill you’ve got friends perhaps passing away it’s quite a stressful time in life and uh there’s lots of Demands Plus workwise you’re usually at the top
Of your career now if you then you most people stop exercising then and they start then eating junk food and start expanding and that affects your your hormone levels it affects all your hormones and it will affect your mood and your brain function we know it does
So these types of behaviors do affect um your brain and affect your risk for heart disease of course but also dementia later on I’m interested what the pros and cons are of calling it a name which is very similar to the menopause and kite could
Be seen as the opposite side of the same coin when actually for the majority of men I think from what you were saying this isn’t a necessarily a big biological change over time but for for women it for the majority it is about a significant biological change interacting with Society do you think
It’s helpful to keep have the term quite similar when they’ve got a different almost causal reason why they come about yeah I think it takes away a little bit from the menopause as a topic but on the other hand I’m quite happy that it came
Up we wrote a piece about this for the conversation because in midlife um this is when most of the suicides in men occur it’s an incredibly serious issue and and I don’t think enough attention has been given to it and in fact when I probed into what uh the East Midlands
Ambulance Service um had had said was that if men have mental health issues or physical issues we will look at that on a Case by case basis and give them up to a year off if they need to because that’s a statutory right you know if
You’re ill if you can’t work anymore you need that break then you should be given that not because of the menopause but because of of um the strains on on people midlife and I think um where women are quite good in talking to other women other men
Seeking support men don’t and and a lot of men end up drinking uh or or in the very worst case scenario uh committing suicide and this is perhaps even worse but very poorly investigated in minority groups and in LGBT where we know from from some studies that this is significantly worse
It’s a very very difficult period in life for some people and um people need support with that so whatever we call it it is it is a vulnerable period I think in life yeah and I can I can see that instead of terming the concept of midlife crisis automatically negative association
You’re potentially doing something wrong whereas I me know couching it in something else Andre pause or maybe I don’t know if there’s another term that we come up with at any point but somewhat more positive or frame differently at least which is good yeah I think midlife crisis you know that’s
Actually relatively rare where you see that massive drop overall it that occurs in some people but definitely not in all and and I don’t think you know it’s it’s got this s the image of people suddenly buying a Porsche so I think um it’s it
It it is it is a big issue it the the problem with it is is if it only were a crisis but in the vast majority there’s just very many people desperately unhappy and drinking too much and getting more and more unhealthy and not sleeping and being stressed and if we
Look at some countries like Sweden for instance where they said well people who are middleaged should really only work uh part-time because they’ve got the experience and they can work faster they don’t need to work full-time and it’s much better they’re much more productive so that would I think that would help
Both men and women yeah we we do I think you know there’s still so much of a a stigma I guess about these two subjects and I know sometimes the word stigma can be thrown thrown about for various different things but do you still think there is in the workplace in the UK
Because we see in other places you just mentioned Sweden different work life balance I I from what I read anyway um I think we have a very different one in the UK is there something we need to do to to change this to help people in their middle age dealing with these all
Of these issues coming up I think we need to look at that from childhood like Mo most things really you know if if we look at the students now especially people who’ve gone through covid being isolated at home they’ve they’ve had a knock you know it’s it hasn’t done them
A lot of them any favors being isolated and just and only focused on academic achievement and I think you know the English could could learn a lot from from Scandinavian countries where it is about family it’s about you know having fun with each other coming home and
Relaxing and not this we need to keep on working Mommy needs to work late daddy isn’t coming home tonight because he’s working overtime you know you need to get the highest grades possible there is very much that achievement and I think by teaching people that um they need to
Invest in Social Capital we could we could solve a lot of problems like social isolation is huge in young people and all people and is associated with a lot of mental health um stresses so yeah we need to have a bit of a revamp I
Think of our values but yeah we we could get there at some point you never know it could be valued the work life balance you know there’s the idea of the 4- day week that we see you trialing in places I I’ve got I’ve got hope hope um but do
You think for women in particular you know we try to ask some tough questions on on this podcast and a lot of the time we see there a lot of biases against women in in the workplace still in 2023 whether that’s based on a payb pay Gap
Or treatment or promotions do you think the menopause you know adds another thing so actually the menopause and women at work is going to be harder than the anoor and Men at Work I think we need to look at it if we take a little
Bit of a step back we see that you know the most severe mental health issues and physical health issues are associated with low social economic status of poor people and we’re seeing an increasing gap between the rich and the poor and um this is a major issue this is an issue
That needs to be tackled because if people you know it’s all right for the likes of us where we’re sitting here quite comfortably and discussing this those people who come to my public lectures about you know prevention of demension heart disease they’re already doing everything they need to do but
They also have you know the exercising diet Etc and not stressing but they also have the money to do this if you can’t eat your home or you can’t get a good diet because you can’t afford it all of this is null and void you know and you’re stressed because you can’t can’t
You know maintain a normal quality of life so and this is a growing issue in in the UK it’s a very scary issue it’s it’s almost back to Victorian times in that way and I think that and we know that that’s associated with an earlier age of onset of menopause with surgery
To um induce early menopause in women um so yeah that’s a bit yeah that’s scary that and it is I think with uh we know we’re sitting here and talking at the back end of 2023 about this and the UK has difficulties with its economic growth as well and
Productivity and there can be quite a lot of pressure to get more out of the same number of people that we have and so those pressures are just continuing all the way through your working life and then if you have other things biological that are that are happening
As well as your life situation all of that leads to a difficult melting po I can imagine yeah it is and it’s very difficult to see where an intervention would need to lie I think you know whether a political or biological or psychosocial you know change I think
It’s it’s probably all of those combined you know where we need to facilitate Healthy Lifestyles you know to to reduce mental health issues so tell me a little bit about the work that you’re doing in this area now you know what are you and your team looking at at the moment well
So we’re doing a lot of work with the menopause um we’re looking at new therapies working with women because women told us they want to learn more about this talk therapy about exercise and diet um and also uh working with body image for instance body image changes over the
Lifespan I think what needs to happen in particular is um uh we need to look at at how this uh is for LGBT especially for Trans people there has been very little research in that one of the problems being that there are not enough numbers so we’re trying to really look
Into this asking people um you know T targeting people for this type of research because we don’t really know enough about it how that is experienced um if somebody has transitioned from male to female um and then needs to stop for instance taking hormones uh perhaps because of
Development of cyst which is risk cancer uh risk for breast cancer um how does that feel because all of a sudden you know your your body starts changing again and you’re going through a menopause so it’s it’s it’s quite devastating are GPS really clued into this I don’t know so that’s where it
Needs to is that where you need think it also needs to go next is there anything more broad rather than just that you know the particular important we we’re really interested in minorities uh and working with uh uh also with black women we are working together with black GPS
For instance because symptoms seem to be much worse in black women and the less likely to take HRT or to be prescribed HRT um but on a wider level um I think our work in in promoting our exercise programs uh we’re doing programs looking at uh keeping people with demena uh you
Know enabling them to drive uh we are doing work in Indonesia looking at early uh life interventions making exercise fun for kids you know trying to uh go from a Grassroots a preventative sort of approach approach yeah sounds very exciting where can people go to actually see you know what
You’re doing the output of it and anything in the future where can they find you um there are lots of resources on on on on the web we’ve got uh demena website and there’s some linked resources for instance to the exercises people can do some of the diets we found
That are protective like Mediterranean diet um some of the uh very plant Rich soy based diets in the Southeast Asian region um and we have evidence that that works um and again improves your memory they’re very easy recipes uh to do so you don’t don’t need to get any fancy
Things most of it you can just get in in most of the shops um so we’ve got that uh there is a menopause um website as well to illustrate all the work that we’re doing because there’s a lot of very important work done by Dr emo Donal who looks at cardiovascular
Disease heart disease and menopause uh Professor Rebecca Hardy looking at social inequality uh Professor Amanda Daly looking at sort of what exercise works for the menopause so there’s various people Professor F moner looking at cancer and menopause breast cancer menopause so there’s lots of people here looking at
That who have interesting resources um Professor Monier developed the resource for women to go back to work after breast cancer um I do a lot of public lectures um and uh there is one from altimus research UK where we’re we’re part of the Midlands Steering group uh where we
Outline most of this work uh for the public and it’s it’s online available via alzheim and then there’s always the luer University website for you to you know if you want to get in contact with you as well which is you know um I’m sure you’ll be open to hearing from there oh
Absolutely until you get millions of people messaging and we’ll we’ll cross that bridge for the time being um a standard one of the standard questions we we ask our guests is if you were to sell your area of academic expertise your area of interest to the next generation of
Curious minds what would you say to them how would you sell what you’ve done and what you do I’m always just really surprised anybody pays me for the work I like so it’s you know doing what I do I really love and uh that depends a little
Bit on the individual I guess years ago I had a student who wanted to do a PhD so to become a doctor which you need to do before you can become a lecturer senior lecturer Professor what have you and he said Eve I hate reading I absolutely statistical analysis
And I definitely find writing awful and I said well that’s a PhD so if you don’t like that then you can’t do what I do but um there is so many perks of the jobs is working with young people and often amazing minds and come up with
Fantastic ideas that is a lot of fun um but also traveling you get to do a lot of traveling uh either for research or to give lectures at conferences I’ve been really fortunate to have been invited all over the world from bonares to Japan to Australia to you know the US
So I’ve seen all corners of the world um with with to present my work uh both to the public but also to a big scientific Community sounds a good sale it’s and you get to come on a podcast like this yeah but thank you so much for coming on
Really really appreciate it it’s been really good and thank you very much for tuning in if you liked the episode uh then feel free to subscribe to the podcast and you can do that on the platform of your choice you can also check out our other podcast experts in
Sport as well and you can find a link to that in the show notes so that just leaves me to say thank you once again for tuning in and I look forward to welcoming you back to another health related podcast in a future episode bye-bye for now