Emily Jacobs
Neuroscientists now have unprecedented access to the living brain, thanks to magnetic resonance imaging (MRI). More than 50,000 articles have been published on human brain imaging since MRI appeared on the scene in the 1990s. But of those, less than 0.5% consider women-specific health factors.
Women’s health is understudied and underfunded . This oversight is especially worrying given that 70% of people with Alzheimer’s and 65% of those with depression are women. Some neurological conditions are experienced only by people who have menstrual periods: postpartum depression, “ perimenopause brain fog ,” endometriosis, and menstrual migraines, to name just a few. Worldwide, about 400 million women take hormonal contraceptives. Some of those People experience depression as a side effect, but no comprehensive neuroimaging study has been done to understand how long-term hormonal suppression influences the brain.
Representation is not the problem: about 50% of people enrolled in neuroimaging studies listed on OpenNeuro.org are women. Researchers simply do not choose to study (nor funders invest in the study of) women-specific health factors, which is perhaps not surprising when 80% of tenured neuroscientists are men.
Only now is the scientific community beginning to realize how stark the imbalance is. Assigning equal value to the health of men and women will require “a global shift in scientific culture” ( RM Shansky & AZ Murphy Nature Neurosci. 24, 457–464; 2021 ).
That’s why, on November 16, the University of California (UC) launched the Ann S. Bowers Women’s Brain Health Initiative , of which I am director. It is a brain imaging consortium whose mission is to close the gender data gap and make neuroscience inclusive, both in terms of who asks the questions and who receives the answers.
Our initiative was also born from a second observation: the current isolated model of neuroscience is a dead end. Small-scale neuroimaging studies lead to underpowered data sets and serious questions about reproducibility.
The UC system is uniquely positioned to offer an alternative path forward. Its campuses span a geographically and demographically diverse state.
The initiative includes seven members of the UC system, with more to come. Together, these campuses generate data from thousands of MRI participants each year. MRI data and health metrics are pooled across sites, while our data coordination center at Stanford University oversees data storage automation, quality control, standardization, and data sharing open access on the OpenNeuro platform .
How menopause reshapes the brain
This consortium approach and the adoption of big data has led to important discoveries in fields such as genomics and particle physics, and we can do the same for women’s brain health.
We have built the infrastructure to collect MRI data from tens of thousands of women across the UC system. Analyzing this information using machine learning tools will help us establish trends at a population level, linking health factors such as hormonal contraceptive use, perinatal complications of childbirth, menstrual migraines, and menopausal symptoms with MRI data.
Additionally, the project will collect a large amount of MRI data from individuals. Precision imaging studies that intensely track people over time are already transforming what we know about the dynamic properties of the brain ( C. Gratton & RM Braga Curr. Opin. Behav. Sci. 40, iii–vi; 2021 ). In women’s brain health, these techniques are beginning to shed light on the brain’s ability to change in both structure and function throughout the menstrual cycle ( EG Jacobs Nature Mental Health 1, 700–701; 2023 ). The application of precision imaging lenses to other major hormonal transitions, especially pregnancy and menopause, shows great promise. In addition to shedding light on basic neurobiology, it could be the key to discovering early indicators of, for example, the risk of depression during pregnancy, postpartum and menopause.
Women’s health: ending the funding disparity
With this unprecedented data set, we aim to advance the understanding of depression and its links to hormones, and make material improvements in clinical care. Before puberty, rates of depression are approximately equal in boys and girls, suggesting that depression is often linked to hormonal transitions. We hope to use the tools of neuroscience to develop predictive models so that doctors can prepare early therapeutic interventions and provide people with appropriate support. We also hope to understand why some people who take hormonal contraceptives experience depression, while others experience benign or positive mental health outcomes. Answers to these and other questions have long been needed.
The Ann S. Bowers Women’s Brain Health Initiative includes trans and non-binary people, because the quality data on this population is even poorer than the data on women. By understanding how, for example, hormone replacement therapy and other forms of gender-affirming care affect brain function and subjective experience, we hope to improve clinical care and people’s lives.
In all of this, we are driven by a radically simple idea: that progress in neuroscience will flourish when the health of people of all genders is valued equally.
Reference : Nature 623, 667 (2023). doi: https://doi.org/10.1038/d41586-023-03614-1
