Period 24: the turning point at which these newsletters slowly turn into very long weird period facts
We’re finally home after a perhaps too-long vacation. It was good to see family, and if I could have stayed with my sister and her kids another month I would, but it was hard to live out of a suitcase for so long and the kids struggled a bit towards the end. Now we’re all scrambling to play catch up and prepare for the start of the semester, and… yiiikes. But the Titcomb's Bookshop event was a lot of fun, and in addition to being interviewed by my sister the first female coach I ever had attended! (She's also the mom to a friend and former teammate - Meghan if you're reading, hi!)
Covid is on the rise again – my local wastewater is showing an upward trend and this seems to be happening all over. Makes me nervous considering there will be another inevitable rise when tens of thousands of students show up to Shampoo-Banana (Champaign-Urbana Illinois for the uninitiated) for the start of the semester. Fingers crossed it dips down again soon after and that boosters become available soon to help reduce severity of this latest variant.
Ugh. Let’s move on to some links.
Links
It’s the women’s world cup which means we’re only capable of talking about three things in gender and sport: pay equity, ACL tears, and menstrual cycles. I’m glad for this coverage, but it often trots out the same old beliefs that sports science researchers who study menstruating people go to great pains to debunk (I won’t do it here but head on back to newsletter 13 to see a paper I discuss on the topic). Also: Carli Lloyd was not wrong.
I want a biopic about Ursula Nordstrom. TODAY.
Harvard Business School professor who does research on honesty is investigated for research misconduct and has papers retracted… and is now suing the researchers, and the university, for defamation. What a mess.
If any of you have been following the even bigger mess happening at Texas A&M this summer: after massively fucking up the hiring of Prof. Kathleen McElroy they are now having to pay her a cool million. She deserves ten times that but at least it’s a start.
Weird period fact: this is your brain on estrogen (these are increasingly getting longer and nerdier, hope you don’t mind!)
I got several responses to last week’s fact on perimenopause, estrogen, and sleep. On top of that I got a question at the Titcomb’s Bookshop event this week on it, asking why perimenopause was such a black box of a topic.
I’ve noticed an uptick in articles that note some variant of “Gen X women have decided not to take menopause lying down.” And yes, sure, but also: instead of just noticing that midlife people in 2023 are clamoring for more information, how about we… provide more information? There is some stuff out there! Not enough, but some!
Something that has come up with friends and colleagues lately is a major concern about changes to cognitive functioning. People describe losing their train of thought mid-sentence, or starting to have word recall issues, or to experience brain fog. This is something I’ve often worried about as a former soccer, rugby, and roller derby player who’s had her share of concussions… and as someone who turned forty-four just a few weeks ago.
In addition to level of education and concussion history and age (and covid), there is evidence that ovarian hormones affect our brains – not just in terms of traumatic brain injury itself, as I mentioned in newsletter 18, but in terms of how we have grown to understand dementia and Alzheimer’s. We also know that hysterectomies, especially those that include removal of the ovaries, can contribute to general cognitive decline and specifically to an increased risk of those aforementioned conditions. These gonads are important for so much more than making eggs!
Health providers who do not have specific expertise in menopause and perimenopause might not know about or believe the brain fog thing is real, or attribute it more to general aging. Thankfully, that perspective seems to be on the decline, but there is still confusion about why these changes happen around perimenopause. For instance, when looking to see what might pop up for a layperson curious about cognitive decline in perimenopause, I found this piece in the Harvard Health Blog that attributes cognitive issues during perimenopause solely to sleep issues and “stress.” This Mayo Clinic Minute also largely attributes cognitive issues to sleep issues (though in this case the piece mentions that hormone therapy may help). There is definitely a link, but cognitive issues during this time cannot be wholly explained by night sweats and insomnia.
Instead, there is growing evidence that estrogen plays a role in all of this. Again. Dammit. One recent study assessed cognitive health through perimenopause in eighty nine participants in over 400 appointments. At these visits research participants provided blood samples that researchers measured for estrogen and follicle stimulating hormone (FSH, one of the gonadotropins secreted by the pituitary that is involved in follicle development in the ovary). They timed the visits so they were always in the early to mid follicular phase.
The researchers statistically sorted the 400+ observations into four groups, “cognitively normal,” “some cognitive weaknesses” and two groups that had particular cognitive strengths. What was interesting was the difference between the group with some cognitive weaknesses compared to the other groups: their estrogen and FSH levels were not lower. Instead, they were less variable.
Rather than pooling all the samples and looking at variability generally, I wish they had looked over time. But this is still an interesting finding, and consistent with what we know about depression and estrogen in the perimenopause: similarly, less variability in estrogen is associated with a higher risk of depressive symptoms. What does this mean practically? Hard to say without the study authors sharing a more longitudinal assessment of the numbers. It means it may not be the amount of estrogen you secrete per se that plays a role in cognitive functioning differences, which is why something like hormone therapy may not be a fix in all cases.
I’ll leave you with a quote from the discussion of the paper because it matches how I think about normality and looking towards the “average person” to understand health:
“[W]hen a group mean approach is used, the true extent of decline in those who are at risk is missed.”
That is, when we do not separate out people by symptomology, or lived experience, or what have you, the majority masks important findings for the minority. The observations of cognitive “weaknesses” were less than a quarter of the total observations in the study. But looking to them specifically was how this difference was uncovered.
Source: Weber, M. T., Rubin, L. H., Schroeder, R., Steffenella, T. & Maki, P. M. Cognitive profiles in perimenopause: hormonal and menopausal symptom correlates. Climacteric 24, 401–407 (2021).