Can Brain Retraining Help Perimenopause Symptoms? Inside a New Research Study

Welcome back to Menopause Mastery. Today I am joined by Kate, who is the research manager at the Chronic Conditions Research Firm. And today we're going to talk about a really important study of which I'm the principal investigator, and I can explain a little bit about what that is for perimenopause and early menopausal symptoms and how to address them. So let's talk a little bit about this. So I'm going to go through some just understanding here of where women are at in perimenopause and menopause. So, the core understanding that we have is obviously that when a woman goes through perimenopause and menopause, that loss of estrogen and testosterone and progesterone causes core metabolic challenges and changes. It drives mitochondrial dysfunction, which are your powerhouses. It changes insulin resistance. It also changes body fat composition, amino acid disruption, which can change neurotransmitters, and your experience in the world. And, the vast majority of women, their early symptoms of perimenopause are things like mood swings, anxiety, depression, brain fog. And, conventional approaches of do nothing or SSRIs often aren't helpful. And, approaches with hormone replacement therapy also may not address all of the neurobiological underpinnings of the symptoms that women experience. And so, obviously, when women report things like brain fatigue and brain fog and mood changes and metabolic shifts that persist, especially even with normal treatments, we're forgetting that there's a mind-body connection. And, that mind-body connection goes down to things like our amygdala and the insula, which play a major role in how our nervous system interprets and responds to those hormonal transitions. And stressors. So, all of that nerd speak says our body responds differently to stressors and it is at a brain entrainment sort of scenario. And so, this study that we're going to talk about today really bridges the neuroscience, the endocrinology, and how we can retrain potentially the nervous system to support healing during menopause. That's what we're looking for. And so, Kate, for those who may be unfamiliar with the amygdala and the insula, and particularly AIR, the amygdala and insula retraining, why is this intervention potentially supportive for a perimenopausal to early menopausal woman?

Sure. So we have done studies on different chronic conditions, and we've seen some of those conditions like brain fog, fatigue, anxiety, depression come up in these multi-system chronic conditions like long COVID, fibromyalgia. And we were interested in trying to figure out whether this is something that we could use on something that women experience. All of us will go through the menopause transition, many of which are included, you know, go through these symptoms. So we wanted to see if this would be a way to use something outside of hormone therapy or any other kind of medication approach to give women the option to have a safer maybe, or a treatment that they can use in addition to what they're doing already?

Yes, absolutely. So for everybody listening, you're probably like, what do you mean? So this AIR, right? So amygdala insula retraining is a mind-body intervention. That basically retrains how the brain perceives threat, like the threat detection system, which is basically what the amygdala and the insula do and how we respond to it. And what we do know is that when we lose estrogen in particular, but progesterone and testosterone, the brain during perimenopause can potentially become hypervigilant because of those changes in hormones. And so you might get hyperarousal or sleep disruption or fatigue or pain. And, the idea is that AIR teaches your body how to recognize and interrupt those loops so you can have some agency over the experience. And, what's really interesting about this, so I'm going to point this out because this is one of the reasons why I got involved with this study. And so, the AIR training has published research in fibromyalgia and there's multiple randomized clinical trials showing a 54% reduction in pain and a 63% reduction in sleep disturbances.

Wow.

And, even long COVID, 97% showed improvements in fatigue. So, what this tells us is that our experience even physiologically could be things under our own conscious control. We just don't have the tools to do it. And so, what we understand is all of these studies show consistent reduced functional impairment and things like anxiety and depression. But here's the gap that Kate reached out to is we haven't looked at it in women specifically and particularly perimenopause and menopause despite this being a really huge neurobiological window. And so, this study is really an exploratory study to look at what happens when women have these symptoms whether they're on hormones or not and how does AIR potentially play a role. So Kate, walk us through what a study participant might actually experience and what they could possibly, uh, if they wanted to participate, which I'm asking you to consider doing because that's how we help move science forward is we participate in studies. What would they possibly experience?

Sure. So the study process is fairly simple. We're going to ask you a bunch of questions to make sure that we can just establish your eligibility. There is a consent form. We are looking for women between the ages of 38 and 60 who have not done brain retraining before and who are willing to take part in weekly webinars as well as additional 20 to 30 minute daily practices that are going to be part of this study. We are looking to start at the end of October, and this would be 3 months for the active and then 3 months for the waitlist group. So 6 months total, but really only 3 months really active where we're asking you to participate in those webinars and the daily activities. We would be reaching out, of course, to let you know about eligibility and ask any questions along the way. If you have anything that you need throughout the study, we have our research team who is available to connect with you as well.

Yeah. So, for everybody, so essentially, there's 2 groups. So, A, number one, if you're eligible, once you're eligible, there's 2 groups. There's a group that would go into the active training where they would be involved in those webinars and have daily activities that they're doing for 3 months. The other group is in the wait group. So, they act as the control. So, we're comparing results between those 2 groups. Then, the wait group actually gets to go through the study. So, it's not like you're getting shortchanged. It's just the whole study takes 6 months to do. And so, you know, yes, you might have to participate and be on the webinars weekly, but what you do get is not just education. You're actually interacting on those webinars. So it's by far more interactive than maybe what people might be thinking.

Yes. And to make sure, in case somebody is worried about the time commitment, we do record all the webinars. All of those are accessible after the webinars take place. So if you can't make a particular webinar, we ask that you just commit to watching that and ensure that you keep up with the program. So it's— and those who are in the waitlist group do not participate in the live webinars. They will have access to the recorded webinars. They get access to the program starts at month 3. Fantastic.

Fantastic. Now, you mentioned that women who are between the age of 38 and 60 are the inclusion criteria we're looking at. So let's go through. So they have to be experiencing symptoms of perimenopause and menopause. Doesn't matter if they're doing hormone replacement therapy. We're just looking for symptoms that we can actually assess outcome.

Exactly.

And then from a technology standpoint, they probably need high-speed internet, right?

Yeah.

Or a mobile device that has connectivity.

The great thing about this study is that it is entirely remote. You're not going to be coming to meet with anybody. You are doing this from the comfort of your home on your computer or your tablet. We do ask that once you are in the webinars, you just kind of have the space to focus on what we're doing in the webinars. But otherwise, you're, you can access any of the information at any time when you're comfortable doing that, which is a really great way to give access to people from all over the world who may otherwise not be able to participate if this was located and you had to be in an office somewhere.

Yes. And everything is English speaking, correct? So—

Absolutely.

Ability to handle and, and speak the, and read the English language would be important also. Now, exclusion. There's a few exclusions, so obviously like pregnancy. What other exclusions would we want to, uh, just point out?

So we are looking for participants who are not undergoing any active cancer treatment, uh, don't have any diagnosed psychiatric conditions. Don't have a prolactinoma or uncontrolled thyroid disease. That's on the medical side. We will ask for some medical history if you feel comfortable sharing it as part of the eligibility criteria. The other non-medical is, of course, the brain retraining. We want to ensure that we're looking at this scientifically. So we're looking for people who have not had experience with a previous brain retraining program. If you've looked at something, maybe checked out some videos, that's fine, but not something where you have committed and actually participated in a brain retraining program of over any type or any period of time.

Absolutely. Now, is there any risks or downside that somebody might consider if they were like, oh, I think I want to do this study? You know, obviously I would say the time commitment is thinking about making sure that you can either attend the webinar or that you will watch the webinar and do the daily practice. Like, Just like everything else, it's habits, people. We have to be willing to put the habits into place. Is there anything else they need to think about?

Luckily, this is a very low-risk type of intervention. We're not doing anything medication-wise. We don't have any adverse events from previous experiences with the studies. We do have— this is an approved study by the Luther College IRB who have consider this exempt. So we don't, you know, we're not expecting any kind of adverse events. What it could potentially do is help with your perimenopausal or menopausal symptoms, which would be a potential benefit. Again, that's a, that's what we're trying to figure out. That's what we're testing. So that's a big one. Another benefit is that once you do take part in the program, you get access to a full year of the program. So that's from the date that you get access, not from the date of starting the studies. So if you're in the waitlist group, You'll, you know, start those 3 months later, but it gives you the option to continue on with the prop— with the program, with the processes, the practices, and the treatment options, which hopefully will give you an even better idea or a better implementation of the practices to hopefully get results even further on. Yeah.

And I just want to explain what an IRB is for those of us who are nerds on the academic side. We totally know what that is. But an IRB is an institutional review board. And what they do is they review what's being studied, the inclusion, exclusion, all of the criteria, and then decide because there's humans involved that everything's safe, protected, all of that. And this is like Kate was saying, it is a low risk. There's the likelihood of adverse events other than maybe you're working on meditation practices and you might get sleepy and fall asleep. Who knows? But for the most part, you're working on retraining the nervous system. And so There's no risk there and there's nothing that you're taking internally, which is great. Now, so a lot of our listeners, I hope, are going, wow, that sounds like me. I'd like to participate. And, I'm going to say this, ladies, we are all— if you go on social media, you listen to me, we are demanding women's research. We get less than 1% of research dollars once we're in perimenopause and menopause, women-only perimenopause and menopause research. When we have the opportunity to participate, the only way these things happen is when we get women to participate. So I am imploring you. I got involved because I was like, we need more studies. We need more availability of tools that women can use to feel better in this time period. So, you know, if this sounds like you, if you're like, okay, hey, I think I'm still symptomatic, I need help. What, you know, what should I do? Should I do it now? You know, is there anything you can say, Kate, that's like, okay, what meaningful things could women imagine if we were participating in this research on a regular basis? Something like this.

Hopefully access to, you know, access to care that is easy, affordable. You don't have to schedule anything with someone because that's the beauty of a program like this is we are testing the program in a study environment. But if it does show that it works, this is going to be available to you beyond just the study environment. So you can continue to use it throughout and hopefully relieve any of those symptoms that you might be having. So that is, that is the key thing here. I think we want to— the Chronic Conditions Research Fund aims to expand access to care that does provide people, you know, the opportunity to go beyond just the pharmaceutical medication kind of approach to different chronic conditions, especially because chronic conditions are known to have various symptoms, multi-symptom, you know, they're complex conditions. And we are, it's strange to call perimenopause or menopause a chronic condition. So it's not that it is a condition, it's not that it's an illness or anything or a disorder, it's just that the symptoms are so similar. It came across as, hmm, I wonder if this is something that would also, if we're showing results in different symptoms, uh, in different conditions, I wonder if this could cross over into the perimenopause transition because, you know, half of the world is going to go through that and it would be great if we had access to additional options to what is already available.

Yeah. You know, Kate, I always think of it this way. Yes, menopause is natural. Everybody goes through it. We don't get a pass, but surviving significantly after it is actually unique. You know, if we look at our lifespan as women, in 1900, the average lifespan was 48 years. Now, if you take out maternal mortality, right, because death during childbirth was one of the major killers, still is, particularly in parts of the United States. But if we were to remove that, most women didn't live significantly past the menopausal experience. Usually within about less than 10 years, they would've passed away. Sanitation, dental, medical advancements, there's a million reasons why we now have a— 20 to 40 year potentially lifespan past menopause. So, so the reality is it's the largest like aging event that a woman will go through because we see an acceleration that occurs right with the loss of estrogen. Men don't experience that same loss. They have maybe a decline, but not a flat out loss. And so I look at it and we look at like the musculoskeletal syndrome of menopause, which sounds like looks like feels like a lot of the other things that we call chronic fatigue. Fibromyalgia, all these other kind of chronic conditions. And so, I think looking at perimenopause and menopause, I've always argued that we need to look at it differently, that it's not a life event, but it is an aging event that now changes our biochemistry and accelerates the aging process. And with it comes some of these symptoms that are associated with all these other kind of complex chronic conditions.

Exactly. And especially with, you know, heightened stress, the heightened stress response, the brain retraining is teaching us to retrain that part of our brain. So we, we kind of lower that window of where we would normally stress out about something. We call this the window of tolerance. So you're, if you're stressing out about the basic things, then that's going to have an impact on the rest of your nervous system, the rest of the potential symptoms that come as a result of that. By training that to start to feel safer in your environment through these brain retraining practices, we're able to potentially give you the chance to stop having such high reactions to basic life events that just because of the biology and the changing situation in your body might become more prevalent during the Yeah, absolutely.

I mean, that's a great way of kind of just summing up what is the research question. It's, is the AIR training process that has already been shown in chronic fatigue, fibromyalgia, and chronic conditions to be very, very impactful, does it also help with that same sort of stress response that we see in perimenopause and early menopause?

Exactly.

You know, and that's really the heart of the question. And I can tell you, this is Kate, this is why I got involved. I'm like, who's the token woman that we need employee of the month plaque for that didn't have decades of stress already?

Right?

I'm like, the cortisol response, the stress response, the amplification of all of that. I have yet to really meet a woman after 22 years in practice that hasn't had that, right? Or isn't in the middle of that as a sandwich generation.

So exactly.

And that's the thing. No-brainer. Yes.

At this stage in life, you are at that point where a lot of stressors are coming in from various, you know, high positions and a work environment in your professional career, potentially family obligations, not just from the kids, but also from aging parents. So there's all of these things that are happening where in addition to all of that time-wise, you also get thrown the curveball of here's some hormonal changes, good luck.

Yeah.

And so we are looking for the opportunities to, you know, help those I hope participants hopefully have positive changes with that. And then, yeah, further down the line, make this accessible so that it's something that, that people can use once we get the research back and show that hopefully it is effective. Again, it is research, so we are still deciding this. Yes.

Yes. But okay, so here's my last ditch effort, ladies. Okay. So here's, here's my call to action. If you're experiencing perimenopause or menopausal symptoms, and you're interested in trying a science-based program that can contribute to research for women, because again, we can't complain about it if we don't participate. It's kind of like voting. You don't get to complain about the vote if you didn't vote, right? In the show notes, we're going to have a link to the eligibility form where you can go fill it out and you can get listed in that. And then, the research group will reach out to you and make sure you're a fit or candidate. And, and I really, really want you, if you're thinking about this would be helpful for me to participate in the study, because again, we can only move women's health research forward by participating. And unfortunately, I can't directly participate as the principal investigator, but, but I can participate in getting the papers done after we get the study completed. Yes.

And participate in getting people interested and getting people, you know, aware of the study, which we're very grateful for your help in that, Betty. We really appreciate it. And just a quick note, we do have— we want to make sure that we have the informed consent form and the eligibility form. Both of those, they're 2 separate documents. Just make sure that both of those are signed so that— or completed so that we ensure we have your consent to participate in the study as well.

Yes, yes, yes. So we will have both of those linked in the show notes. We'll also have a blog on my website and the Minerva website. So drbettymurray.com. And the Get Minerva website that will have that information as well, just if people are having a hard time finding it. And then ladies, participate. Participate.

We would love to see you. We would love to have you join us. So we're looking to— we are looking for a cohort of about 160, but it could always go over. We have room for more. So if it's of interest and you think you can participate, again, webinars, About an hour a week, 20 minutes for some of those practices. We do have some questionnaires that we're going to be completing at 3 time points over those 6 months. That's really all we're asking. And then just of course, letting us know how you do afterwards.

Yes, absolutely. Absolutely. Well, Kate, thank you so much for being on Menopause Mastery.

Thank you so much, Betty. Great to be here.

Okay, ladies, remember the study starts At the beginning of November, right? End of October. So if you're listening to this, act on it immediately because there's— we only have 160 spots, right? So that's super important. We can add a few more, but like, get in there so you could be on— make sure you're in the cohort, right?

Yes, definitely. Um, get the forms submitted as soon as possible. We do review each of them individually, so it does take a little bit of manpower to get this sorted out, which is why we are looking to that, um, end of October start. So yeah, just get that to us as soon as you can.

Awesome. Awesome. Well, thank you everybody for listening or watching Menopause Mastery. If you happen to be doing that on YouTube, we will also have those links on our YouTube and I'll be back with you next week and have a wonderful rest of your week.

Yes. Have a good one. Thank you.