Beyond ‘Bikini Medicine’: Bridging gaps in women’s brain health research
Historically, women’s health research and care has gone underprioritized; traditionally not going beyond ‘bikini medicine,’ a mistaken belief that women’s health only differs from men in the areas under a bikini – like reproductive health.
However, women have a higher risk for several health conditions, including brain disorders like stroke, Alzheimer’s disease and depression. Additionally, these conditions may often present differently in women than in men. Despite this, sex-specific differences have not been translated into clinical practice, sometimes resulting in delayed diagnosis, misdiagnosis or inadequate care.
Sunnybrook is determined to change this reality by bringing women’s health to the centre of care, integrating biological factors with lived experience and emotional well-being.
Dr. Jennifer Rabin, Scientist in the Hurvitz Brain Sciences Research Program and Neuropsychology Lead for the Harquail Centre for Neuromodulation, is just one Sunnybrooker leading research to better understand sex differences in brain health to inform more precise care. Her work focuses on the relationship between menopause and dementia risk.
Two-thirds of those diagnosed with Alzheimer’s disease are women. Dr. Rabin’s research aims to understand the biological, hormonal, and life-course factors that contribute to this sex disparity, particularly how changes in estradiol during menopause may influence women’s vulnerability to Alzheimer’s disease.
Menopause is a natural stage of aging, during which the ovaries gradually produce lower levels of key hormones, including estradiol, the most potent form of estrogen, and progesterone. While the ovaries and estradiol are best for their role in reproduction, they also play an important role in brain health. Estradiol is a neuroprotective hormone that helps protect the brain from damage. As estradiol levels decreases, women lose some of that protection, which can impact brain health and increase the risk of dementia.
“All people who menstruate experience menopause, but not all will develop Alzheimer’s disease,” adds Dr. Rabin. “I became interested in this research because estradiol’s role in the brain is so intriguing. Menopause marks a major change in this and other sex hormones, and I wanted to understand how that transition affects women’s brain health, and why some women go on to develop Alzheimer’s disease while others do not.”
To date, her research shown that earlier menopause may be more detrimental to brain health. Through a recent study, Dr. Rabin found that individuals who experienced earlier menopause and therefore earlier depletion of estradiol, had an increased risk for Alzheimer’s disease.
“Understanding this relationship can inform not just precise treatments for women, but Alzheimer’s disease research as a whole,” adds Dr. Rabin. “Understanding the different ways Alzheimer’s disease develops and presents has significant implications for diagnosis, as well as prevention and intervention strategies.”
Before focusing on the relationship between menopause and Alzheimer’s disease, Dr. Rabin’s work focused more broadly on risk factors for Alzheimer’s disease. After switching focuses, she observed first-hand the underfunding and under prioritization of research into women’s brain health and care.
“Women have questions about what’s happening to their bodies and brains, and they want guidance on what they can do to better support their health,” explains Dr. Rabin. “Unfortunately, many clinicians don’t have those answers because women’s biology and women-specific health have been largely overlooked throughout history, and further limited by ‘bikini medicine’.”
Dr. Rabin’s hope for the future is that all women have clear answers to their health concerns and receive the compassionate and comprehensive care, care that looks far ‘beyond the bikini’ and recognizes the full complexity of women’s health.
