What really happens inside a woman's body during the menopause transition—and what can your hormones actually tell you?
In this episode of the Optimal Protein Podcast, Vanessa sits down with Madeline Wood Alexander, a researcher at the University of Toronto and Sunnybrook Research Institute whose work examines menopause, ovarian aging, brain health, and Alzheimer's disease risk.
Madeline is the first author of the 2026 Nature Medicine study "Blood proteomics of menopause map to brain aging and dementia risk," which used large-scale proteomic analyses to investigate how menopause is reflected in circulating proteins—and how some of these changes may relate to brain aging and future dementia risk.
Vanessa and Madeline break down what women need to know about hormone testing, perimenopause, menopause, HRT, brain health, body composition, exercise, and healthy aging—including why a single hormone test may not tell you nearly as much as you think.
Madeline Wood Alexander is a researcher at the University of Toronto and Sunnybrook Research Institute studying menopause, ovarian aging and women's brain health.
Her work uses large-scale biological datasets and proteomics to investigate how reproductive aging relates to systemic physiology, cognitive aging and dementia risk.
Her recent Nature Medicine research identified menopause-associated differences in circulating proteins and investigated how these biological signatures relate to subsequent brain-aging outcomes.
Menopause is far more than the end of reproductive function. The transition occurs alongside changes throughout the body that researchers are only beginning to understand.
But this research should not be interpreted to mean that menopause inevitably causes cognitive decline or Alzheimer's disease. Many of the relationships researchers are uncovering are associations, and determining which mechanisms are causal—and which factors we can actually modify—is an important next step.
And when it comes to identifying perimenopause, more testing isn't necessarily better. Hormones can fluctuate considerably during the transition, which is one reason symptoms, menstrual-cycle changes and clinical history can sometimes provide more useful information than a single snapshot from a blood test.
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Featured study:
Blood proteomics of menopause map to brain aging and dementia risk — Nature Medicine (2026)
Find Madeline Wood Alexander and her research through the University of Toronto and Sunnybrook research community.
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Disclaimer: This podcast is for informational and educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. The information shared in this episode should not be used as a substitute for advice from your physician or other qualified healthcare professional. Always consult your healthcare provider regarding any questions or concerns about your health, medications, supplements, hormones, diet, exercise, or medical conditions. The views expressed by guests are their own and do not necessarily reflect the views of Vanessa Spina or the Optimal Protein Podcast.