The Female Brain: Balancing Social Expectations with Your Own Health 10/30/12. Louann Brizendine, MD

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1 BIOGRAPHY: The Female Brain: Balancing Social Expectations with Your Own Health 10/30/12 Louann Brizendine, MD DR LOUANN BRIZENDINE is a neuropsychiatrist who completed her degree in Neurobiology at UC Berkeley, graduated from Yale School of Medicine and did her internship and residency at Harvard Medical School. She has also served on both the faculties of Harvard University and University of California at San Francisco. Now at UCSF, Dr. Brizendine pursues active clinical, teaching, writing and research activities, where she founded the Women s Mood and Hormone Clinic in 1994 and continues to serve as the clinic s director. Her first book, The Female Brain, is being translated into 30 languages and its follow up, The Male Brain, is in 17 languages. She is currently developing programs for prevention of postpartum depression and for maintaining optimal health and resilience in the perimenopausal and postmenopausal female body and brain. Louann Brizendine, M.D. is a practicing clinician, best selling author, public speaker, media consultant, endowed professor and international media commentator who specializes in the emotional, sexual, and social effects of hormones on the brain.

2 The Female Brain and Balancing Social Expectations with Your Own Health Professor Louann Brizendine, M.D. Founder/Director, Women s Mood and Hormone Clinic Lynne and Marc Benioff Endowed Professor University of California, San Francisco Sexual Differentiation Begins with Conception 1

3 eyes Female Male 2

4 Hormones from conception thru puberty The Female Brain 15-fold ESTROGEN increase in GIRLS Pg/100 ml estrogen Adapted from, Grumbach and Styne 2003, Williams 10th ed. 3

5 Increased girl social-aggression Increased girl-type aggression Rumor-mongering Formation of cliques Purposeful exclusion of girls Manipulation as form of girl-type bullying 25-fold Testosterone Male/Female Sleep Patterns 4

6 The Brain s Stress Response ON The nervous system attempts to maintain a stress-balance in the body via the autonomic nervous system The Brain Stress Response OFF It has a brake pedal called the parasympathetic nervous system It has a gas pedal called the sympathetic nervous system That can rev up the heart rate/breathing [hormones: cortisol and adrenaline] That can slow down the heart rate/breathing [vagal nerve, hormone oxytocin] The Female Brain Teen girls feel the pain of a loved one more..and cry 4 times more.. Estrogen Progesterone Testosterone (T. Singer, Science, 2004) Emotional Pain of Social Loss Menstrual Cycle and the Brain Verbal SEX sleep PMS Testosterone 5

7 Why? Female Brain-- It Changes and refreshes during the menstrual cycle Up to 25% more connections are formed in the working-memory part of the brain--the hippocampus The male brain does not change monthly this way Female Puberty Hormone surges start 8-10 years old Gradual awakening of the ovaries Ovaries secrete more and more estrogen Estrogen takes control of the hypothalamus and initiates the menstrual cycle, age 12 Surges of emotion and mood accompany this onset of fluctuating hormones When does this start for girls? Onset of breast development-average age White: c. 10th birthday (30% by age 8) Black: c. 9th birthday (40% by age 8) Menarche--onset of menstrual period (years)..age depression increases in girls White: 12.6 (30% by age 10) Black: 12.1 (40% by age 10) Onset of breast stage 5--fully developed (years) White: 15.5 Black: 13.9 Hispanic-middle/Asian-later* Best Worst week Morales, 1986 The Effects of Blocking the Hormones from the Ovaries on PMS Symptoms Best Patient 4 July 2001 August September Menstrual Cycle Week and All Psychiatric Admissions Worst Best Worst Best October January 2001 November 2002 February March December April Lupron 3.75mg IM Q1M Menses Sadness Irritability Anxiety Stability If random, admissions of women to psychiatric hospitals for all psychiatric diagnoses would be 25% on each week of the menstrual cycle Worst Week of Menstrual Cycle Placebo E2 (100 g/day) + P4 (200mg BID) 6

8 Risk for Depression by Age & Sex Risk for Depression by Age & Sex Start mense s perimenopause 1:1 Pregnancy/post partum female Start Mense s 2:1 13-fold increase male Perimenopause hot flashes Kessler R. J Affect Disord, 1993;29: Kessler R. J Affect Disord, 1993;29: Pregnancy Hormone Levels Testosterone Prolactin Postpartum Severe Postpartum Depression requiring Hospitalization Pregnancy 2 Years 1 Year Childbirth +1 Year +2 Years *Rate of psychiatric admissions in the 2 years before and after delivery in a population of 470,000 people with 54,087 births in a 12-year period Kendell RE, et al. Br J Psychiatry. 1987;150:662. 7

9 Phases of the Female Brain s Life Ovary Fertile Perimenopause Menopause Erratic estrogen THE MATURE FEMALE BRAIN Erratic FSH Brain Perimenopause? Longitudinal Study: Increased Risk of Depression Proximate to the Meno Last 2-9 years, starts age Over 50% of women will complain to a doctor about mood (even if they don t have hotflashes!) Number of Depressive Episodes Cumulative Years at Risk for Depression LMP 0 Years Before Last Menstrual Period 0 Risk for Depression by Age & Sex 1:1 Pregnancy/post partum female Start Mense s 2:1 13-fold increase male Perimenopause hot flashes Kessler R. J Affect Disord, 1993;29: Assessment for Perimenopausal Depression Two screening criteria: Shortening of cycle Menstrual cycle = 1 st day of menstrual bleeding until 1 st day of next menstrual period Depressed or irritable mood No labs tests for perimenopause: FSH and LH highly variable throughout the menstrual cycle, and more so with irregular cycling. When FSH may be helpful - woman age presents with depressed mood only. 8

10 The Female Brain The brain, HRT, STRESS, MOOD, MEMORY Sexual Complaints in Women Hippocampus Working memory Sexual Function in Males and Females Sexual Function in Males and Females Male/Female Testosterone levels 9

11 Sexual Desire in Men I think about sex more than twice per day: Age % Age % Age % Work-up of low libido new onset Lack of Desire: Low free testosterone--get labs = free Testosterone, SHBG Medications, oral estrogens, ssri Assess Anger at partner, masturbation, r/o sex abuse history, previous sexual function Bancroft J Int J Impotence Res 1998;10:S40-S43. Case Example from the UCSF Women s Mood and Hormone Clinic Judy is a 53 y.o. administrator s/p TAH/BSO 2 years ago--now no sexual arousal/pleasure and decreasing or absent libido/ses=0-1 Husband has demanded she get her hormones checked The Mature Male Brain No masturbation or interest in using her vibrator x 1 year. She can t remember the last time she had any sexual interest, which used to be substantial in her 30s--when her SES = 4 or 5. SES (Sexual Energy Scale, 0-5 max)=0 or at best 1/5. Her OB/GYN started her on the ORAL ESTROGEN 3 weeks ago; she has no history of breast cancer in self or family. Testosterone The Mature Male and Female Brain in Conversation 10

12 My Top Hormonal Advice The End Thank You! THE BEST HORMONE:OXYTOCIN A special thank you to the UCSF staff 11