Steph:
So, you interviewed 22 brain experts around the world. Firstly, that sounds like a dream gig anyway. Where did the idea come from?
Dr Ginny Mansberg:
So, I’d written The M Word: How to Thrive in Menopause.
One of the biggest symptoms of perimenopause — which is the lead-up to menopause, because menopause is only one day, right? It’s one day, 12 months after your last period. And you don’t know it was your last period at the time, because who ever knows that?
You only work it out in retrospect.
But in peri, in some studies, up to 80% of women report brain fog.
Then there was all this discussion around COVID and brain fog.
I became super interested in the brain because I was trying to work out how it all fit together with hormones and menopause.
At the same time, we had the Aged Care Royal Commission. And then lockdown happened.
We were hearing just how awful aged care facilities were, and then these poor people were isolated from family, locked in their rooms 24/7.
Honestly, I could not think of anything worse.
It broke my heart.
And all I could think was: This is the leading cause of death in women. Statistically, I’m more likely to die of this than anything else.
What am I going to do about that?
I didn’t know.
So I thought: I’m going to go find out.
And I wasn’t writing as some neuroscientist or keeper of all truths. I had no knowledge.
So I had to do a lot of learning, very quickly.
But I loved it.
Steph:
Your book looks at the fact that almost 50% of dementia cases could have been prevented or delayed.
That’s insane.
Ginny:
It’s crazy.
A lot of people think dementia is just something that inevitably happens as you get older — that when your number’s up, your number’s up.
My husband always jokes he’ll take up skydiving and one day forget to pull the cord.
But I used to think there wasn’t much you could do.
Then you realise there’s actually so much you can do.
A lot of people think Alzheimer’s disease and dementia are interchangeable terms.
They’re not.
Alzheimer’s is a type of dementia, but it very rarely happens on its own.
Usually, something else is going on too.
The most common is vascular dementia.
That’s when the same processes that block arteries in your heart and cause a heart attack — or block arteries in your brain and cause a stroke — also block the tiny arteries feeding your brain.
That gradually causes brain decay.
If vascular dementia combines with Alzheimer’s, it brings it on earlier and makes it more severe.
And while there’s not a lot we can yet do about Alzheimer’s itself, there’s so much we can do about vascular dementia.
That’s what really interested me.
Steph:
And women are more likely to have dementia than men?
Ginny:
Yes.
It’s the leading cause of death in women.
Heart disease is the leading cause of death in men; dementia is second.
Partly, women live longer, so we have more time to develop it.
But even accounting for age, women still get it more often.
The thinking is that hormones play a role.
Not the hormones we have while we’re young and ovulating.
It’s actually the loss of those hormones that seems to turbocharge deterioration — not just of bones, which is why osteoporosis is considered a women’s disease, but also of the brain.
We know this because the younger you are when you go into menopause, the higher your risk of dementia later.
And taking hormone replacement therapy — not too late, but during peri or soon after menopause — seems to reduce that risk.
That tells us the loss of hormones is a major factor.
Steph:
I was reading about Chris Hemsworth saying he has two copies of the APOE4 gene.
What does that mean?
Ginny:
There are different APOE genes — 2, 3 and 4.
APOE2 reduces dementia risk.
But if you inherit APOE4 from both parents, your risk increases by between five and eight times.
That’s significant.
If we knew you had that gene, like Chris does, the advice would be: don’t do anything else that turbocharges the process.
You’d get the same lifestyle advice we give everyone — just with even more urgency.
But I can see a future where knowing that gene status becomes vital.
We’ve made huge progress with monoclonal antibodies.
These are lab-made antibodies that target harmful proteins.
We already use them for chronic migraine and osteoporosis.
And now we have one targeting beta amyloid — the protein strongly linked to Alzheimer’s.
The issue is we’re giving it to people who already have dementia.
Too much damage has already been done.
But imagine if we tested people in their 40s and gave them a preventative treatment before symptoms began.
That would be game-changing.
I don’t know if it’ll happen in my lifetime or yours.
But our kids? There’s a real chance they might never get dementia.
That’s mind-blowing.
Steph:
There are so many practical ways to help our brains now though.
Diet, exercise, sleep…
You talk a lot about sleep and circadian rhythm.
This is huge, isn’t it?
Ginny:
Massive.
I hadn’t fully appreciated the impact of circadian rhythms on brain health either.
People think it’s just about avoiding blue light before bed.
But it’s also about when you eat breakfast, lunch and dinner.
When you exercise.
When you shower.
Doing things consistently.
That routine improves not just sleep, but brain health.
And there’s fascinating early research into the gut microbiome and how it affects circadian rhythms — and vice versa.
That’s why when you fly overseas your digestion goes haywire.
It’s not just plane food.
Your gut bacteria change because your rhythms are disrupted.
The exciting part is: once you know this, you’re empowered.
It’s one reason every expert I interviewed wanted to stay in the workforce as long as possible.
Not because they’re all professors.
It doesn’t matter what job you do.
Work keeps your brain engaged.
It keeps you social.
And it keeps your routine stable.
That’s incredibly protective.
Steph:
I love that your book is like a buffet of options.
There’s no judgment.
Ginny:
Exactly.
Doctors can sound like professional scolds.
Eat less. Drink less. Move more. Sleep more.
And honestly? I don’t perfectly follow all my own advice either.
Fantasy me does yoga at 5am.
Reality me stumbles toward coffee.
So I wanted this book to offer choices.
You don’t have to do intermittent fasting or go vegan or do keto if that’s not your thing.
Just find what works for you.
Steph:
Stress and burnout are massive too.
Ginny:
Huge.
We’ve gone from bushfires to floods to a pandemic to financial stress.
Australians have been living in chronic stress for years.
Stress is hard to measure scientifically.
What’s easier to measure is depression.
And what we know for sure is: depression damages the brain.
Especially depression in midlife.
For women in their 40s and 50s, this is the highest-risk period for anxiety, depression — and suicide.
It’s deeply hormonal, under-recognised, underfunded and under-researched.
And it increases dementia risk later.
That should concern everyone.
Please: if this is you, don’t hate yourself for it.
Depression isn’t weakness.
It’s a biological brain disease.
And treatment can literally help regrow parts of the brain involved in memory and processing.
Steph:
What’s the best first step?
Ginny:
See your GP.
Especially one with an interest in mental health.
For mild to moderate depression, lifestyle interventions can be incredibly effective:
For severe depression, medication can be life-saving and brain-saving.
Please let us help.
You wouldn’t feel ashamed about taking an asthma puffer.
This is no different.
Steph:
You and Shelley Horton have done so much to break the taboo around perimenopause and menopause.
You were involved in Australia’s first parliamentary menopause roundtable too.
Ginny:
Yes.
We started Don’t Sweat It — focused on menopause in the workplace.
Because women are leaving work in huge numbers due to unmanaged symptoms.
Australian women lose billions in lost earnings and super because of this.
We went to Parliament with groups including:
We asked for one thing:
A national menopause strategy.
That means:
Because right now, the best hormone therapies are expensive and often not PBS-listed.
Menopause shouldn’t be something only wealthy women can manage properly.
Fixing this would improve mental health, physical health, workforce participation — and likely reduce dementia risk too.
Steph:
Dr Ginny, you are a national treasure.
We adore you.
Thank you for so much practical wisdom across so many important topics.
Save Your Brain is out now — everyone, go grab it.
Amazing.
Ginny:
Love you, Steph. Thank you.
Steph (Outro):
And just a reminder — if you ever need it, Lifeline’s crisis support service is available 24/7 on 13 11 14.
And We’re Rolling is produced by Habari Productions and Stephanie Hunt Media and recorded on Darug Country.
Head to Stephanie Hunt Media for extra bits and pieces.
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And as always, if you liked this episode, please share it with someone who might need it too.
Until next time, be true and kind to yourself.
Thanks for listening.
