Dearest: Dr. CLAIRE L. WARGA is a research Neuropsychologist and New York State licensed clinical health Psychologist.

Her professional interests, in research and in private practice, have focused on the interface between brain, biology, and behavior.

She trains health and mental health professionals, and women, in midlife research. Dr. Warga has written for numerous publications including, Psychology Today, Science Digest, and American Health. She received her doctorate from New York University.

In the much discussed 1997 cover article for New York Magazine entitled "Estrogen and the Brain," she first reported some of these findings on both the new research and the estrogen-loss related symptoms, interviewing many leaders in the neurosciences. Dr. Warga is the author of the groundbreaking book, "Menopause And The Mind: The Complete Guide to Coping with the Cognitive Effects of Perimenopause and Menopause Including Memory Loss, Foggy Thinking And Verbal Slips."

In "Menopause And The Mind," Dr. Claire Warga draws upon cutting-edge brain research and many never-before-described cases. Dr. Warga provides the first scientific explanation for why the symptoms occur and reveals how they can be reversed or alleviated shares her research and provides techniques and tools for women experiencing perimenopause/menopause/midlife-related memory changes, learning and attention problems and various symptoms associated with estrogen changes.

Please remember that although Dr. Warga is a Neuropsychologist and has done tremendous research in this area, she is not a medical doctor.

Dr. Warga, a warm welcome to Power Surge :)

Dr. Warga, Power Surge is a community for women in menopause. Could you please share with us what your mind misconnect syndrome, WHMS, stands for and how it's related to women going through various stages of menopause?

Claire L. Warga, Ph.D.: Warga's Hormonal Misconnection Syndrome is a set of 40 cognitive symptoms that affect different aspect of the mind: thinking, speech, attention, memory, spatial skills, the 3 R's (reading, writing, 'rithmetic).

Also many different behavioral changes. Some people who don't know that these symptoms are as common as hot flashes think they are developing Alzheimer's Disease or a brain tumor. So it's important for women to spread the word that these symptoms though strange are as normal as hot flashes.

Dearest: Thank you, Dr. Warga. So many women complain of many of these symptoms in Power Surge - you've done so much research on this subject. Why has this condition so often been overlooked by the medical community?

Claire L. Warga, Ph.D.: It's been overlooked because most of the research that explains why the symptoms occur have only been discovered in the l990's the decade of the brain.

Neuroscientists - brain researchers - understand why the symptoms occur but the information unfortunately hasn't yet been absorbed by the doctors who women actually treat.

The pipeline from basic research to clinical treatment moves slowly in science. That's why its important for women to spread the word and to take books like mine to their doctors and to say "How come you haven't told me about this?" - to shame doctors into reading about it.

Most ob/gyns don't read things about brain research. They're centered on areas below the neck typically.

HeartofDelaware: I am a 58 year old college student. I use the Vivelle estrogen patch and Revival Soy Protein. In the last two years since I had a hysterectomy, leaving my ovaries, my mind has lost some of its clarity and my memory is much worse. My studies are much harder this year. My professors sometimes can't believe how bad my memory has gotten. I wonder if this is a normal part of aging?

Claire L. Warga, Ph.D.: There are many possible reasons why you may not be improving on the treatment you are on. While estrogen and progesterone may work on bones, vaginal tissues, etc. the brain seems to require higher amounts to function better. So you may need to go to higher doses for awhile - up to a year.

Also many women don't absorb properly the type of estrogen they are taking. So you need to have your levels measured after 3 months on a specific regimen. Switch brands, several times, if necessary.

Dearest: Would she be better off with bioidenticals - where they can be dosed specifically for her needs?

Claire L. Warga, Ph.D.: Bioidenticals are also a possibility and worth trying. Though some women respond to one kind of estrogen while others don't do as welL. The bottom line is that women are highly individual.

I, for example, had only one hot flash when I was 46 and wasn't even thinking hormones yet. I was the mother of a 3 year old. While some of my friends have had endless years of hot flashes.

As I say in my book a rose is not a rose is not a rose. Unfortunately there are few true experts who know all the answers about women's menopausal traits.

Some women have not cognitive symptoms and think everyone else is crazy who complains about them. Women have to have tolerance for the diversity of women's experiences.

Ladyblue: Is it true that women who take anti-estrogen compounds such as progestins or Tamoxifen and are treated for fibroids or endometriosis or PCO (polycystic ovary syndrome) with those or have a hysterectomy, et al, that the loss of estrogen (Estradiol particularly?) may be part of the mind problems as well as Menopause? (Thank You for being here)

Claire L. Warga, Ph.D.: Absolutely. All the types of women you mentioned can have these same symptoms. Also women who are receiving standard chemotherapy which can suppress ovarian function. Also women who are on aromatase inhibitors such as Arimedex. Also women who are estrogen deprived who have premature ovarian failure - i.e. they don't have eggs and are under 39. Also women who are too skinny to have their periods. Also women who are breast feeding and who can't get pregnant for 6 or so months. I write about these women in my book and describe a case of a breast feeding mother. She calls the syndrome "mommie mind" which is a little stigmatizing of all mothers. Again many but not all have them.

Ladyblue: Thank you so much Dr. Warga, I can't wait to read your book. Ah yes for breast cancer another antiestrogenic. I am on Estradiol and have been for years and all I know is you'd have to rip my arm off to get mine away from me. :)

Claire L. Warga, Ph.D.: Good for you that you made the connection. Also women being treated for endometriosis with estrogen suppressing drugs.

Solaz: I had an hysterectomy at 40. I am now 59. Does it EVER stop, the hot flashes, sweats, mind fog, tongue slips, etc., or does it just keep getting worse? What things can I do to live more comfortably as this is a sad, unhappy, not to mention wildly uncomfortable way to live. I quit estradiol because of all the dangers I kept reading about.

Claire L. Warga, Ph.D.: In my book I have different chapters for those who do want to take estrogen, and those who don't. Based on the research evidence I present an "estrogen-mimic plan" that tries to copy the major functions of estrogen. This includes some of the following. Estrogen is a potent antioxidant. So fill your diet with Vitamin E and other vitamins I cite in the book.

Develop a grazing pattern of eating that will boost your supply of the major energy source in the brain - glucose. With menopause or estrogen loss the supply of glucose transporters from the liver declines by 30% so you need to try to "feed your brain" more regularly.

Consume phytoestrogens - they won't necessarily improve you memory or speech, because they are too weak. The research overall doesn't say they help in this way. But they have a unique chemical structure - called a phenolic A ring - that does offer protection against the toxicity associated with Alzheimer's Disease. Read my book for more details.

Estrogen is a potent antinflammatory agent. So take ibuprofen - it seems to work the best in this regard. I can't tell you how long your symptoms will last because again, there is great individuality. Sorry. We are living in the midst of a sea of lack of research or conflicting research and we are the innocent guinea pigs. We unfortunately have to wade between the dangers and the problems caused by changes in our quality of life.

What are your worst symptoms? Because there are now other options for treating hot flashes. You've probably heard of Vitamin E 100-800 mg twice a day. Neurontin seems to help some people. I don't have any research evidence on these. Also Zoloft seems to help hot flashes immediately - not in several week. Also Clonidine. Ask a psychopharmacologist to help.

Dearest: Solaz asked, "Are you saying estrogen is really okay and not dangerous?"

Claire L. Warga, Ph.D.: The research on estrogen is a mess at the moment in terms of what's been found. Yes, the Women's Health Initiative did find increased risks with estrogen and progesterone but not with estrogen alone. The risks are definitely there but overall are smalL. If my family had a history of breast cancer I would probably avoid it altogether. But you have to weigh the quality of your life against the risks. You need to find a good doctor to help you do this. It may be hard to find one but persist, through the pipeline of friends at Power Surge.

LL1816: Hello Dr. Warga. As a neuropsychologist with a research emphasis on the brain, biology and behaviors, do you believe it possible that neuro-hormonal imbalances could be one explanation for symptoms of anxiety, depression, and continuing cognitive decline in a young male entering adolescence (began at age 11, now 15 years)? I do realize that genetics can play a role as welL. I am interested in your thoughts on the possible role of hormones in relation to these symptoms appearing in male youth.

Claire L. Warga, Ph.D.: I don't know of any specific condition that might affect an adolescent. Adolescence is associated with many hormonal changes, and depression may well result from some of these.

In the last decade researchers have learned that ongoing depression can affect a major memory center and shrink it - the hippocampus. This is reversible. So you might try to see if going on antidepressants under a good doctors care reverses some of the cognitive decline.

Some depression is endogenous, i.e.. genetically based - don't let your son suffer too long without trying some things.

LL1816: Thank you, actually Zyprexa is working the best now.

Claire L. Warga, Ph.D.: Also have his thyroid tested - this can cause cognitive decline - hypothyroidism.

LL1816: Thank you, will try that.

YoungOldMe: I did read your book a few years ago and have thought of it many times since! I do use bioidentical hormones, and estrogen helps my memory. My question is whether you know why chocolate seems to make my WHMS worse, though caffeine supposedly helps short-term memory. I seem to make more "absent-minded" mistakes and have trouble remembering words when I have had chocolate. Thanks

Claire L. Warga, Ph.D.: Interesting. The only thing that comes to mind is that chocolate is high sugar and may make your sugar swing up and then crash too soon.

Try eating it with something that slows down it's absorption - something high fiber. But I really don't know why. I will however keep it mind and try to get answers for others at a later date.

LinsJean: Thanks. I'm 50 years old, and my periods are all over the place, along with hot flashes. 2 doctors said nothing whatsoever can help alleviate that. However, my sister, one year older, uses progesterone cream and those 2 symptoms disappeared entirely. Maybe you can touch on progesterone use alone just a bit.

However, I am mostly here because of my concern about my memory. I used to be a very organized person, and would *like* to think I still am. However, I noticed lately that I am misplacing things constantly, I say things that don't come out right, and most importantly, I started a new job about 2 months ago, I am required to remember LOTS of info.

Do you think that I am just so overwhelmed with learning a new job or that I am experiencing those symptoms from menopause? I am completely embarrassed and my job is on the line for not remembering stuff!

Claire L. Warga, Ph.D.: While only a few years ago they said that the symptoms of estrogen loss only occurred after menopause - the experts said this when I began my research.

Now we know that perimenopause, which is what you are in can be just as symptomatic and sometimes worse. Believe it or not, despite Dr. Lee, there has been relatively little research on progesterone in the formal scientific literature. However, as I have been reading the most recent findings, some there are some indications that progesterone can improve some - many I don't know of the symptoms of meno and perimeno.

Dr. Candace Pert - a highly respected researcher in the neurosciences believes greatly in progesterone cream and writes about it in her book, Molecules Of Emotion: The Science Behind Mind-Body Medicine.

She researched it. It's trial and error but worth trying possibly. In general progesterone tends to rev down what estrogen revs up. It can also have anesthetic properties in high enough doses. You might want to take it at night therefore.

I have limited expertise in this area. So read what Dr. Lee and other physicians write about it. It can make you sleepy.

Wildkitty: I have the 1999 edition of your book. Since then, have there been any distinctions made between HRT and BHRT? Do you believe BHRT is neuro- and cardio-protective? Do you have a preference? Do you believe your chances of avoiding heart disease or stroke are better with BHRT if you are suffering many signs of estrogen loss?

Claire L. Warga, Ph.D.: I don't know if BHRT (Bioidentical hormone replacement therapy) is better or not. Dr. Barbara Sherwin one of the experts in this area believes that HRT may prove afterall to be protective for heart disease - but likely only if it is begun during the window of opportunity right after menopause begins. In a recent article in Hormones and Behavior in March of 2005 she cited research which suggests this.

As you may know the Women's Health Initiative found that HRT wasn't cardio protective. But they used women who were on average 72 years old with a range of 65-79. IN these women the speculation is is that their blood vessels have become too stiff and plaque has built up which then ruptures possibly when estrogen is given ten years of more down the road.

She cites other research in animals which shows that starting treatment years after having ovaries removed in animals doesn't work for the heart but does in younger animals.

MollyRoberts: Can the same cognitive and memory problems affect MEN who are low in testosterone (male menopause) I would think so as I have been reading about low testosterone should be tested in men to rule out a deficiency as part of Alzheimer's Screening.

Claire L. Warga, Ph.D.: I have been reviewing this for two years. Yes, testosterone has been linked with related cognitive changes. Chapter 14 in my book addresses these symptoms in men.

In recent years several researchers have found cognitive changes to exist in testosterone low men. Men's brains have also been found to be loaded with estrogen receptors and their testosterone in part breaks down into estrogen.

The problem is that testosterone measurement is mess at the clinical leveL. The Institute of Medicine has decided to hold off recommending it for men low in testosterone.

Because of concerns about benign prostatic hypertrophy testosterone may make this worse and other reasons.

Genies-genes: I stopped bio-identical hormones (estradiol, progesterone, T-3, all sublingual) July after about 3-1/2 years. I heard that it was best to stop after about 3 years. Hot flashes are occurring more frequently. I am using black cohosh and evening primrose, occasionally Maca.

I have taken large quantities of various vitamins for decades, including Vitamin E, C, and all the major B's. There is serious history of heart disease in family, early deaths. I am over 56 and have beat the familial odds thus far. The symptoms of fogginess, malapropisms, major overall forgetfulness definitely in play here (understatement!).

I started Strattera (for A.D.D.) in hopes of alleviating some of the symptoms. I take antidepressants as well (Wellbutrin and Prozac). While on hormones, I had a period of varying degrees regularly (every 3 - 5 weeks); off hormones, "slight rusting" occurred last month, otherwise nothing.

Obviously, I need to read your book. In the meantime, what do you think? (I realize that's a tough if not impossible question, and I just appreciate your presence here, with or without an "answer". Thank you for bringing up the fact that we are all different with unique symptoms, despite the sameness of the process itself (i.e., MEN-O-PAUSE!) Incidentally, I took a 6-month course of Lupron Depot back in 1993. I have never been the same since! Hormones continue to rule and baffle!

Sorry for the "essay". I got busy while waiting in queue. I apologize, more lapses in the synapses. Is it better to stop bio-identical hormones after 3 years or is it safe to continue use?

Claire L. Warga, Ph.D.: Lupron, of course, suppresses estrogen, but I assume you are off it.

Genies-genes: oh my yes!

Claire L. Warga, Ph.D.: I don't really know the relative differences in outcome with BHRT. Roberta Brinton finds that all the formulations of HRT do active things in the brain. They differ in what parts they hit, however.

TeddyReady: I had an hysterectomy this past July. They left nothing. I went straight into menopause and was put on the Vivelle patch for aching bones and hot flashes. I stopped taking it because I was getting overweight and had fluid retention. Since I have been off of it I haven't yet gotten my hot flashes back. Should I be concerned about taking hormones?

Claire L. Warga, Ph.D.: There is accelerated aging in several organ systems in younger women who are off of estrogen prematurely. You can try exercise for your bones and hearty, but estrogen does many things. It stimulates nerve growth factors that keep tissues active and responsive. I have no interest in pushing estrogen.

But Barbara Sherwin cites a number of studies and thinks that while these organs undergo premature changes without estrogen in those with hysterectomies. She thinks there may be related aging changes in the brain. I haven't worked with patients for decades and can't vouch with my own personal knowledge in what I've personally seen.

Sorry for this grim assessment. Lets hope it's wrong.

LinsJean: My main reason for being in this chatroom tonight is this. I used to be a very organized person, and lately, I have been misplacing things or they are right there in front of me and not seeing them, or saying things that come out wrong, especially on the job. I started this new job 2 months ago, and I need to remember LOTS of info, and quality assurance is monitoring our calls in this call center. I have at least 20 post-it notes on my computer. Still, I don't remember stuff and my job is on the line if I don't do the "musts" during a calL. Think this is just normal overwhelming from starting a new job or having more perimeno symptoms? This memory thing is so embarrassing! I know it's happening as it's happening, but I can't control it which makes me very tearfuL. I feel like an outcast.

Claire L. Warga, Ph.D.: You have my full sympathy. You are having quite normal symptoms that can drive people to tears. Some lose jobs. You might try a 3 month trial of beta estradiol at more than minimal levels to see how many of your symptoms get better with this.

IF they get better at least you will know what your symptoms are due to. Some women switch to jobs where they have more control over their circumstances. A woman in advertising started a newsletter at home that succeeded. Reading about other women with the same symptoms and how I suggest they cope may help.

You might try to cover up for your glitches by indicating that there is some serious illness or condition or your family.

Wish I could be more helpfuL. But this is a reality just as hot flashes are strange but normal symptoms. IN time society will give us time out's for dealing with this. In some it gets better and is only temporary.

Dearest: I strongly recommend reading Dr. Warga's book - you'll get all the answers you need. It's a very comprehensive book. Menopause And The Mind.

Wildkitty: A couple of times I have had trouble spitting out a sentence - in a really big way. It freaked me out - I had all the words, but I couldn't get them in the right order. I feel like my tongue is this big fat blob. Does this fit squarely into your syndrome and should my BHRT that I'm just starting improve this?

Claire L. Warga, Ph.D.: The symptoms are exactly normaL. And yes the BHRT may help if you take them in sufficient doses. Many women need higher than minimal doses initially and then can go down. See my book for the experts who describe this such as Dr. W. Andrews.

Ladyblue: In speaking about Testosterone... From what I have read it's just as important as estrogen. That adding estrogen alone to hormone replacement diminishes testosterone even further. Is that so? Do you feel testosterone is just as important?

Claire L. Warga, Ph.D.: Well, the picture about testosterone in women is also a mixed bag. Some women respond to testosterone plus with with extra energy and sexual interest. But not all do to their dismay. I don't know why you think that estrogen reduces testosterone. I haven't heard that. In men too much testosterone as in body builders leads to excess estrogen and they develop breasts and shrunken testicles. But I don't know anything about this effect in women - the reverse.

YoungOldMe: Do you have any experience with or have you heard anything at meetings about the "smart drugs" or supplements, e.g., vinpocetine, Acetyl L-Carnitine, pregnenolone, or others? thanks!

Claire L. Warga, Ph.D.: My formal knowledge about these is limited - the only things I have really checked out are the phytoestrogens and ginkgo biloba which works for some. But things are on the way. They are called nootropic agents. They boost memory. They are also working on SERMs (Selective Estrogen Receptor Modulators) - things like Tamoxifen - that do good things for the brain, but don't harm the breasts or uterus.

Dearest: Dr. Warga, can you remind us, please, what WHMS stands for?

Claire L. Warga, Ph.D.: The syndrome stands for Warga's Hormonal Misconnection Syndrome. I originally called the Women's Hormonal Misconnection Syndrome but then I discovered that men get it too. It partially stands for a minds with "whims" of its own.

The reason it's called the Misconnection Syndrome is because it's been found that estrogen actually increases the branching and connectivity of brain neurons. There's a photo of this effect in my book. And even in old animals given estrogen extra docking sites for incoming information sprout in response to estrogen.

So there really may be a lack of connectivity in why it takes longer or how the memories get wired and retrieved without estrogen and with estrogen.

Dearest: So, bottom line, the symptoms associated with WHMS are reversible?

Claire L. Warga, Ph.D.: All the animal research and research with women with hysterectomies suggests this is the case. But again much remains to be known in even how to take estrogen. With a week's break without it, via the liver, or bypassing the liver.

I wish I could offer you more certainties. What I am certain of is that these symptoms are normal - since so many women have them. And I even think I know why they exist with estrogen loss. The last chapter of my book tells why. It is too long to go into in a brief answer.

I think nature designed us to be extra vigilant and in touch with everything cognitively during our years of ensuring reproduction of the species, and when the stakes of survival are off or fading (i.e. perimenopause) nature says we can be less vigilant and exhale. Ages ago women didn't survive to menopause, so this is modern situation, relatively speaking. But there will be solutions in the years to come.

Meanwhile women have to spread the word to each other about the symptoms and their normality.

MollyRoberts: Is it your opinion that in some cases men can safely take bioidentical testosterone (rather than synthetic) to avoid the issue of the benign prostatic hypertrophy?

Claire L. Warga, Ph.D.: I don't really know much about the bioidentical kind. There are many unresolved issues regarding who should get replacement testosterone or not. Men vary widely too. Some have low levels but work just fine. Some have high levels. If you replace a normal man with normal low levels are you going to overdose him. There's not a lot of standardization in labs about measuring it. So labs will now give different results. Not a lot of reliability yet. Its a recognized problem in the field.

Dearest: Dr. Warga asked me to send you this information. it'll be in the transcript as well.

"Dr. Warga welcomes individual stories of how women aged 30-60 have experienced the different speech, thinking,, behavioral, and reactions to these symptoms, the reactions of physician’s, partners, children, etc. Since men going through andropause or male menopause can have many of the same symptoms, she welcomes examples of observing these symptoms in males.

These personal stories can be sent to: claire_warga_phd@yahoo.com. Please indicate if these are solely for her individual knowledge, or if they may be used to share with others in future articles or books, either anonymously, without a name cited, or with a name cited for attribution. She regrets that she can provide replies to only a limited number of e-mails."

Dr. Warga, thank you for spending this time with us fielding our questions about menopause and mind/cognitive-related issues. I highly recommend Dr. Warga's book, "Menopause And The Mind: The Complete Guide to Coping with the Cognitive Effects of Perimenopause and Menopause Including Memory Loss, Foggy Thinking And Verbal Slips."