How menopause affects the brain | Lisa Mosconi

譯者: S Y C 審譯者: 潘 可儿

Women are works of art.

女人就像一件件藝術品。

On the outside as on the inside.

無論是內在還是外在。

I am a neuroscientist, and I focus on the inside,

作為一名神經科學家， 我把焦點放在內在，

especially on women's brains.

特別是女性的大腦。

There are many theories on how women's brains differ

有許多理論在說明女性 和男性的大腦有何不同，

from men's brains,

and I've been looking at brains for 20 years

我已經研究大腦二十年了 ，

and can guarantee that there is no such thing

我可以保證沒有所謂

as a gendered brain.

「有性別的大腦」這種事。

Pink and blue, Barbie and Lego,

粉紅色和藍色， 芭比娃娃和樂高積木，

those are all inventions that have nothing to do

那些都是與我們大腦的構造

with the way our brains are built.

沒有關聯的發明。

That said, women's brains differ from men's brains

話雖如此，在某些方面，

女性的大腦和男性的確不同。

in some respects.

And I'm here to talk about these differences,

我來這裡跟大家談這些差異，

because they actually matter for our health.

因為這些差異會影響我們的健康。

For example,

比如，

women are more likely than men to be diagnosed with an anxiety disorder

比起男性，女性比較有可能

會被診斷出焦慮症或憂鬱症，

or depression,

not to mention headaches and migraines.

更不用說頭痛和偏頭痛了。

But also, at the core of my research,

但此外，根據我的研究核心，

women are more likely than men to have Alzheimer's disease.

女性也比男性容易患阿茲海默症。

Alzheimer's disease is the most common cause

阿茲海默症是地球上

of dementia on the planet,

最常見的失智症成因，

affecting close to six million people in the United States alone.

單單在美國就有 六百萬人受到影響。

But almost two thirds of all those people

但，這些人當中

有近三分之二都是女性。

are actually women.

So for every man suffering from Alzheimer's

每一名男性患阿茲海默症，

there are two women.

就有兩名女性患病。

So why is that overall?

整體來說，原因究竟是什麼？

Is it age?

是年齡嗎？是壽命嗎？

Is it lifespan?

What else could it be?

還有可能是什麼？

A few years ago,

幾年前，

I launched the Women's Brain Initiative

我在紐約威爾·康奈爾醫學院 發起女性大腦計畫，

at Weill Cornell Medicine in New York City,

exactly to answer those questions.

目的是解答這些問題。

And tonight, I'm here with some answers.

而今晚，我帶來了些許答案。

So it turns out our brains age differently,

結果發現，我們的大腦 老化的方式不同，

and menopause plays a key role here for women.

對女性而言，更年期 在此扮演了關鍵的角色。

Now most people think of the brain as a kind of black box,

大部分人想像，大腦是個黑盒子，

isolated from the rest of the body.

從身體的其他部位分離了出來。

But in reality, our brains are in constant interaction

但事實上，我們的大腦 經常會和其他部位互動。

with the rest of us.

And perhaps surprisingly,

你可能會很驚訝，

the interactions with the reproductive system

對女性來說，大腦和生殖系統的互動

are crucial for brain aging in women.

對大腦老化的影響很大。

These interactions are mediated by our hormones.

這些互動由荷爾蒙來居中調節，

And we know that hormones differ between the genders.

而我們知道，荷爾蒙會因性別而異。

Men have more testosterone, women have more estrogens.

男性有比較多睾丸激素， 女性有比較多雌性激素。

But what really matters here

但是，這裡真正的重點是

is that these hormones differ in their longevity.

這些荷爾蒙的壽命長短不一。

Men's testosterone doesn't run out until late in life,

到了晚年，男性的 睪丸激性才會用光，

which is a slow and pretty much symptom-free process, of course.

當然，這是個緩慢 且幾乎無症狀的過程。

(Laughter)

（笑聲）

Women's estrogens, on the other hand,

另一方面，女性的雌性激素

start fading in midlife, during menopause,

在中年的更年期時就開始減少，

which is anything but symptom-free.

而且一定會有症狀。

We associate menopause with the ovaries,

我們會把更年期和卵巢拉上關係，

but when women say that they're having hot flashes,

但有些女性會說她們有潮熱、

night sweats, insomnia, memory lapses, depression, anxiety,

盜汗、失眠、健忘、憂鬱、焦慮，

those symptoms don't start in the ovaries.

這些症狀並非源自於卵巢。

They start in the brain.

它們源自於大腦。

Those are neurological symptoms.

它們都是神經症狀。

We're just not used to thinking about them as such.

我們只是不習慣將它們 視為神經症狀而已。

So why is that?

所以，為什麼會這樣？

Why are our brains impacted by menopause?

為什麼我們的大腦 會受到更年期影響？

Well, first of all,

首先，我們的大腦和卵巢

our brains and ovaries are part of the neuroendocrine system.

都是神經內分泌系統的一部分。

As part of the system, the brain talks to the ovaries

身為該系統的一部分， 大腦會和卵巢交談，

and the ovaries talk back to the brain,

卵巢也會跟大腦交談，

every day of our lives as women.

在女性的生命中， 每一天都會有這些交談。

So the health of the ovaries is linked to the health of the brain.

因此，卵巢的健康會 和大腦的健康連結在一起。

And the other way around.

反之亦然。

At the same time,

同時，

hormones like estrogen are not only involved in reproduction,

像雌性激素這種荷爾蒙 不只和生殖有關，

but also in brain function.

也和大腦功能有關。

And estrogen in particular, or estradiol,

特別是雌性激素，或雌二醇，

is really key for energy production in the brain.

更是大腦中能量產生的關鍵。

At the cellular level,

在細胞的層面，

estrogen literally pushes neurons to burn glucose to make energy.

雌性激素會促使神經元 去燃燒葡萄糖來產生能量。

If your estrogen is high,

如果你的雌性激素含量很高， 你的大腦能量就很高。

your brain energy is high.

When your estrogen declines though,

不過，當你的雌性激素含量下降，

your neurons start slowing down and age faster.

你的神經元的活動就會開始減緩， 也會老化得比較快。

And studies have shown that this process

已有研究指出，這個過程

can even lead to the formation of amyloid plaques,

甚至有可能導致 澱粉樣蛋白斑的形成，

or Alzheimer's plaques,

或阿茲海默症的斑塊，

which are a hallmark of Alzheimer's disease.

而它是阿茲海默症的特徵。

These effects are stronger in specific brain regions,

在特定的大腦區域中， 這類影響會比較大，

starting with the hypothalamus,

首先就是丘腦下部，

which is in charge of regulating body temperature.

它負責調節體溫。

When estrogen doesn't activate the hypothalamus correctly,

當雌性激素沒有正確地啟動丘腦下部，

the brain cannot regulate body temperature correctly.

大腦就無法正確地調節體溫。

So those hot flashes that women get,

女性的潮熱症狀

that's the hypothalamus.

就是丘腦下部造成的。

Then there's the brain stem, in charge of sleep and wake.

接著，還有腦幹， 它負責入睡與蘇醒。

When estrogen doesn't activate the brain stem correctly,

當雌性激素沒有正確地啟動腦幹時，

we have trouble sleeping.

我們就很難入眠。

Or it's the amygdala,

還有杏仁核，大腦的情緒中心，

the emotional center of the brain, close to the hippocampus,

它很接近海馬迴， 也就是大腦的記憶中心。

the memory center of the brain.

When estrogen levels ebb in these regions,

當這些區域的雌性激素減少時，

we start getting mood swings perhaps

我們可能就會有 情緒波動並忘東忘西。

and forget things.

So this is the brain anatomy of menopause, if you will.

這可以說是更年期的大腦解剖學。

But let me show you

但讓我給大家看看， 女性大腦實際上會是什麼樣子。

what an actual woman's brain can look like.

So this is a kind of brain scan

這是一種腦部掃瞄，

called positron emission tomography or PET.

它名為正子斷層造影，或 PET。

It looks at brain energy levels.

它顯示的是大腦的能量高低。

And this is what you want your brain to look like

四十歲的時候，你理想的大腦

看起來是這個樣子。

when you're in your 40s.

Really nice and bright.

很好、很亮。

Now this brain belongs to a woman who was 43 years old

這個大腦的主人 是一位四十三歲女子，

when she was first scanned, before menopause.

這是她在更年期之前的初次掃瞄。

And this is the same brain just eight years later,

八年後，更年期後，

after menopause.

同一個大腦變成這個樣子。

If we put them side by side,

如果把兩張圖並排，

I think you can easily see how the bright yellow

各位很容易看出亮黃色

turned orange, almost purple.

轉變成橘色，幾乎算是紫色。

That's a 30 percent drop in brain energy levels.

那就代表著， 大腦能量下降了百分之三十。

Now in general,

一般來說，

this just doesn't seem to happen to a man of the same age.

同年齡的男性不會有這種狀況。

In our studies with hundreds of people,

我們研究了數百個人，

we show that middle-aged men usually have high brain energy levels.

發現中年男性的大腦 通常會有比較高的能量。

For women, brain energy is usually fine before menopause,

對女性而言，在更年期前， 大腦能量通常都很好，

but then it gradually declines during the transition.

但接著，能量就會 在這個轉變時期漸漸下降。

And this was found independent of age.

且這和年齡無關。

It didn't matter if the women were 40, 50 or 60.

不論是四十歲、五十歲、 六十歲的女性都一樣。

What mattered most was that they were in menopause.

最重要的是她們是否處於更年期。

So of course we need more research to confirm this,

當然，我們需要做更多研究 才能確認這一點，

but it looks like women's brains in midlife

但看起來，中年女性的大腦

are more sensitive to hormonal aging

對於荷爾蒙老化的敏感度

than just straight up chronological aging.

高於對年齡老化的敏感度。

And this is important information to have,

這是一個非常重要的訊息，

because so many women can feel these changes.

因為有很多、很多女性 能感受到這些改變。

So many of our patients have said to me

有好多病人告訴我，

that they feel like their minds are playing tricks on them,

她們覺得大腦在玩弄自己，

to put it mildly.

這還算輕描淡寫的。

So I really want to validate this, because it's real.

所以，我真的想要驗證 這件事，因為這是真的。

And so just to clarify, if this is you,

澄清一下，如果你也這樣認為，

you are not crazy.

你並沒有發瘋！

(Laughter)

（笑聲）

(Applause)

（掌聲）

Thank you.

謝謝！

It's important.

這很重要——

So many women have worried that they might be losing their minds.

許多女性會擔心她們是否發瘋了。

But the truth is that your brain might be going through a transition,

真相是，你的大腦 可能正在經歷轉變，

or is going through a transition

或確實是在經歷轉變，

and needs time and support to adjust.

而這需要時間和支持來調適。

Also, if anyone is concerned

還有，如果有人想知道

that middle-aged women might be underperformers,

中年女性的能力是否會因此下降，

I'll just quickly add that we looked at cognitive performance,

我要快速補充一下， 我們也研究了認知能力，

God forbid, right?

但願不會，是吧？（笑聲）（掌聲）

(Laughter)

Let's not do that.

好了好了。

But we looked at cognitive performance,

但是，我們研究了認知能力，

and we found absolutely no differences between men and women

我們發現，在更年期前後，

before and after menopause.

男性和女性的表現完全沒有差別。

And other studies confirm this.

其他研究也確認了這個發現。

So basically, we may be tired,

所以，基本來說， 我們可能感覺很累，

but we are just as sharp.

但我們還是同樣的精明。

(Laughter)

（笑聲）（掌聲）

Get that out of the way.

不用擔心這部分了。

That all said,

也就是說，

there is something else more serious that deserves our attention.

還有更重要且需要 我們更加注意的部分。

If you remember,

還記得，我剛提過 雌性激素下降可能會

I mentioned that estrogen declines could potentially promote

the formation of amyloid plaques, or Alzheimer's plaques.

促成澱粉樣蛋白斑 或阿茲海默斑塊的形成，

But there's another kind of brain scan that looks exactly at those plaques.

但還有另一種腦部掃瞄 專門檢視那些斑塊。

And we used it to show that middle-aged men hardly have any,

這種掃描的結果說明， 中年男性幾乎沒有斑塊。

which is great.

這樣很好，

But for women,

但對女性而言，

there's quite a bit of an increase during the transition to menopause.

在轉變到更年期的過程中， 這些斑塊有相當明顯的增加。

And I want to be really, really clear here

我要在這裏先說得非常清楚，

that not all women develop the plaques,

並非所有女性都會長斑塊，

and not all women with the plaques develop dementia.

且並非全部有斑塊的女性 都會患上失智症。

Having the plaques is a risk factor,

有斑塊是一個風險因子，

it is not in any way a diagnosis, especially at this stage.

但無論如何，都不能把它 當作診斷，特別是在這個階段。

But still, it's quite an insight

不過，若要研究阿茲海默症 和更年期的關係，

to associate Alzheimer's with menopause.

它仍是一個令人深思的發現。

We think of menopause as belonging to middle age

我們認為更年期是中年人專屬，

而阿茲海默症則是老年人專屬。

and Alzheimer's as belonging to old age.

But in reality,

但現實生活中，

many studies, including my own work,

許多研究，包括我自己的研究，

had shown that Alzheimer's disease starts with negative changes in the brain

都指出阿茲海默症 始於大腦中的負面改變，

years, if not decades, prior to clinical symptoms.

在臨床症狀出現前的數年， 甚至數十年。

So for women,

所以，對女性而言，

it looks like this process starts in midlife,

看起來，這個過程 是從女性的中年開始的，

during menopause.

從她們的更年期開始。

Which is important information to have,

這項資訊很重要，

because it gives us a time line to start looking for those changes.

因為它給了我們一張時間表，

說明了何時要開始注意那些改變。

So in terms of a time line,

在時間表的方面，

most women go through menopause in their early 50s.

大部分女性的更年期 發生在五十歲初。

But it can be earlier,

但有可能更早，

often because of medical interventions.

通常是因為醫療介入的關係。

And the common example is a hysterectomy and/or an oophorectomy,

常見的例子是子宮切除術 及／或卵巢切除術，

which is the surgical removal of the uterus

也就是用手術移除子宮

and/or the ovaries.

及／或卵巢。

And unfortunately, there is evidence

不幸的是，有證據顯示，

that having the uterus and, more so, the ovaries removed

在更年期之前就把子宮移除，

尤其是把卵巢移除，

prior to menopause

correlates with the higher risk of dementia in women.

和女性失智症風險增加有關聯。

And I know that this is upsetting news,

我知道這是讓人心煩的消息，

and it's definitely depressing news,

肯定也是讓人沮喪的消息，

but we need to talk about it

但我們必須把它拿出來談，

because most women are not aware of this correlation,

因為大部分女性並不知道 有這種關聯性存在，

and it seems like very important information to have.

而這似乎是她們 應該了解的重要消息。

Also, no one is suggesting that women decline these procedures

此外，如果女性需要做這類手術，

沒有人會建議她們不做。

if they need them.

The point here is that we really need to better understand

重點是，我們真的需要更加了解

what happens to our brains as we go through menopause,

我們的大腦在更年期時 會發生的各種事，

natural or medical,

不論是自然的或醫學上的，

and how to protect our brains in the process.

以及在這個過程中 要如何保護我們的大腦。

So how do we do that?

所以，我們究竟要怎麼 保護我們的大腦？

How do we protect our brains?

我們應該補充荷爾蒙嗎？

Should we take hormones?

That's a fair question, it's a good question.

這是個合理的問題，是個好問題。

And the shortest possible answer right now

目前能提供最簡短的答案

is that hormonal therapy can be helpful

就是：荷爾蒙療法可以幫助我們

to alleviate a number of symptoms, like hot flashes,

減輕許多症狀，比如潮熱，

but it's not currently recommended for dementia prevention.

但目前並不建議 用它來預防失智症。

And many of us are working on testing different formulations

我們有許多人在努力 測試不同的配方、

and different dosages and different time lines,

不同的劑量、不同的時間表，

and hopefully, all this work will lead to a change in recommendations

我們希望這些努力能 開花結果，帶來改變，

讓未來有更多的可能。

in the future.

Meanwhile, there are other things that we can do today

在那之前，我們現在 仍然可以用其他方法

to support our hormones and their effects on the brain

來支援我們的荷爾蒙 以及它們對大腦的影響，

that do not require medications

且這些方法不需要用到藥物，

but do require taking a good look at our lifestyle.

不過，確實需要我們 好好檢視自己的生活方式。

That's because the foods we eat,

因為，我們吃的食物、

how much exercise we get,

我們的運動量、

how much sleep we get or don't get,

我們得到或缺乏多少睡眠、

how much stress we have in our lives,

我們的生活中有多少壓力，

those are all things that can actually impact our hormones --

這些其實都會影響 我們的荷爾蒙——

for better and for worse.

正面及負面的影響都有。

Food, for example.

以食物為例。

There are many diets out there,

飲食模式有很多種，

but studies have shown that the Mediterranean diet in particular

但研究顯示，地中海飲食

對女性的健康特別有助益。

is supportive of women's health.

Women on this diet have a much lower risk

女性若按這種模式飲食， 相關的風險會低很多，

of cognitive decline, of depression,

比較不易有認知衰退、憂鬱、

of heart disease, of stroke and of cancer,

心臟病、中風，及癌症，

and they also have fewer hot flashes.

也比較少出現潮熱的症狀。

What's interesting about this diet

關於這種飲食，很有趣的一點是，

is that it's quite rich in foods that contain estrogens

它包含很多富含雌性激素的食物，

in the form of phytoestrogens or estrogens from plants

具體是植物雌性激素，

that act like mild estrogens in our bodies.

這種激素的功用就像 我們體內的溫和雌性激素。

Some phytoestrogens have been linked to a possible risk of cancer,

有些植物雌性激素 和可能發生癌症的風險有關，

but not the ones in this diet, which are safe.

但在這種飲食中的 並不會，它們很安全。

Especially from flax seeds,

尤其是這些：亞麻籽、

sesame seeds, dried apricots,

芝麻、杏乾、

legumes and a number of fruits.

豆莢，以及多種水果。

And for some good news,

好消息來了——

dark chocolate contains phytoestrogens, too.

黑巧克力也含有植物雌性激素！

So diet is one way to gain estrogens,

所以，飲食是攝入 雌性激素的一種方法，

but it's just as important to avoid things that suppress our estrogens instead,

但我們也要避開 會抑制雌性激素的事物，

especially stress.

特別是壓力。

Stress can literally steal your estrogens,

壓力真的可以偷走你的雌性激素，

and that's because cortisol, which is the main stress hormone,

而那是因為皮質醇， 即主要的壓力荷爾蒙，

works in balance with our estrogens.

和我們的雌性激素保持平衡。

So if cortisol goes up, your estrogens go down.

如果皮質醇上升， 雌性激素就會下降。

If cortisol goes down, your estrogens go back up.

如果皮質醇下降， 雌性激素就會上升。

So reducing stress is really important.

所以，減輕壓力真的很重要。

It doesn't just help your day,

不僅能幫助你的生活，

it also helps your brain.

也能幫助你的大腦。

So these are just a few things

上述只是我們 支援大腦的幾種方法，

that we can do to support our brains

and there are more.

還有很多別的。

But the important thing here

但重要的是，

is that changing the way we understand the female brain

改變我們對女性大腦的認識，

really changes the way that we care for it,

是真的能夠改變我們照顧大腦的方式，

and the way that we frame women's health.

以及我們表述女性健康的方式。

And the more women demand this information,

越多女性索求這些資訊，

the sooner we'll be able to break the taboos around menopause,

我們就能越早打破 關於更年期的禁忌，

and also come up with solutions that actually work,

也能提出真正行得通的解決方案，

not just for Alzheimer's disease,

不只是針對阿茲海默症，

but for women's brain health as a whole.

而是女性大腦的整體健康。

Brain health is women's health.

大腦的健康就是女性的健康。

Thank you.

謝謝。

(Applause)

（掌聲）

Thank you.

謝謝！

Oh, thank you.

噢！謝謝！