How Menopause Shapes Brain Health Over Time
In this short monologue, Dr. David Perlmutter explains why women face a two‑to‑one higher risk of Alzheimer’s disease compared with men. He describes a biological cascade that begins with the menopause‑related drop in estradiol, which allows the complement protein C3 to bind to neuronal synapses. This binding flags the synapses for removal by microglial cells, leading to loss of neural connections. Dr. Perlmutter argues that this mechanism supports the use of hormone replacement therapy (HRT) that combines estradiol with progesterone to restore hormonal balance and protect synapses. He asserts that the benefit‑to‑risk ratio of such therapy is overwhelmingly favorable, downplaying the modest increased risks of stroke and the contested data on breast‑cancer risk. The talk references his new book, Brain Defenders, which expands on these ideas.
