From the brain to the vagina: how female scientists are revolutionizing women's health research

BarcelonaHe arrives with his mother and grandmother, his eyes wide open and expressive, nibbling on a piece of bread. As we move through the building to go up to the second floor of the BBRC Alzheimer's Research Centre, of the Pasqual Maragall Foundation, he looks around him in a serious manner. He can hardly understand Nilo, a beautiful 15-month-old boy, who today will be the protagonist of an experiment that aims to change what science knows about women's mental health during a crucial and vulnerable stage of their lives, pregnancy and postpartum.

"Have you brought the samples?" the coordinator of the experiments asks Neus Ramos, 34 years old, Nilo's mother and one of the more than 300 volunteers between 25 and 45 years old who have been participating for at least 30 months when it happens in a study closed by the . To answer this question, they investigate the structural and functional changes that take place and how they influence the bond established between mother and child, as well as the emotional health of the woman after giving birth.

When he learned about the news a few years ago, BeMother collaborative research initiative

While we are talking, Nilo is complaining discreetly, seeking his mother's attention. The trick works and she gives him a few soft kisses on the cape and holds him close to her. The boy smiles, satisfied. "My body has really surprised me, all the physical and mental changes I have experienced," adds this woman, who is also dedicated to research. "I like to think that I have contributed to advancing scientific knowledge about this very important stage in a woman's life," she says.

Catalan researchers, pioneers

And she did. Thanks to her participation and that of the other female volunteers, the UAB-IMIM researchers, coordinated by neuroscientists Òscar Vilarroya and Susana Carmona, have been able to see how 94% of the grey matter in the brain of women changes during pregnancy. Specifically, they have seen that it is reduced by 5% in regions linked to social cognition, although later, in the postpartum period, it recovers. And this recovery is associated with a better bond with the baby and greater emotional well-being of the mothers.

"It is not that women lose abilities or become dumber, as I am sometimes asked, far from it," specifies the predoctoral researcher Camil Servin-Barthet, who led the study, "but that the brain becomes very specialized to be able to attend to the needs of the baby and guarantee its supervision."

The conclusions of this new work, recently published in Nature Communications, They are added to the corpus of knowledge provided by the pioneering study undertaken by this research group in 2008. At that time, Vilarroya's laboratory used magnetic resonance imaging to study what happened in the brains of children with hyperactivity and, unlike other research, they did so over time to see how it changed. In this context, one of the doctoral students at the time became pregnant and, together with two other doctoral students, including Susana Carmona, who continues to be involved in the research, they suggested to Vilarroya that they investigate the woman's brain throughout pregnancy.

"I remember that when they proposed it to me I thought that it must have already been investigated, but surprisingly there was nothing," says Vilarroya, director of the Cognitive Neuroscience Research Unit at the UAB and researcher at IMIM. So with the encouragement of the three researchers they went ahead, "without funding": "And Finally in 2017 we published some spectacular results: For the first time we demonstrate that produced structural changes in the brains of women before and after pregnancy," she says. Since then, they have continued their research, trying to answer many other questions that have arisen. In the latest work, for example, they have also looked at the brains of non-pregnant mothers, and in future experiments, they say, they will seek to identify biomarkers that can predict which women are at increased risk of suffering from a mental disorder.

A sisterhood of scientists

It is at least surprising to think that, despite the large number of tests that women undergo during pregnancy, it was not known what happens at a neurological level and that no one before these Catalan researchers had had the curiosity and the initiative to study it. Especially because the hormonal dance that intervenes in the brain changes that prepare mothers to care for children influences the mental health of women during pregnancy and in the postpartum period, a period of maximum vulnerability during which it is estimated that between one and two in 10 women develop some type of neurological problem that can become serious and can even be life-threatening.

Although women make up 50% of the population, studies focused on and directed at women's health are still scarce. And this lack of specific knowledge – examples are numerous, from the symptoms of heart attacks in women to many medications with deleterious side effects in women – has a negative impact on women's quality of life.

"Women's bodies and knowledge about their health have been neglected, controlled and persecuted for centuries, resulting in a health disparity that persists today," says bioengineer Sarah Leeber of the University of Antwerp, who has the light, an organ that, despite being present in half the population, is quite forgotten when compared to its male equivalent.

As is the case with the intestine, populated by billions of microorganisms, the vagina also has a population of microscopic beings, which form the so-called vaginal microbiota. And if there are thousands of scientific articles about the intestinal microbiota that link it to practically all known diseases and its role in health is known, there are only suspicions and indications about the vaginal microbiota. For example, it is known that it is key to preventing infections, both vaginal and urinary - more frequent in women - and to having a healthy pregnancy, and also that it is involved in cervical cancer. However, it is not known what a healthy vaginal microbiome looks like, nor which bacteria are beneficial and which are harmful.

To close this gap of ignorance, more than 6,000 scientists from four continents and nine states – including Spain, where the Valencian Country is leading the Manuela project–, in addition to thousands of female volunteers, have launched This initiative on a planetary scale, Isala. In a recent article they published in Trends in Microbiology They note the huge gap between scientific knowledge about the vagina and what exists about the penis (which also has its own microbiome). They raise the alarm about the differences in research in this field and stress that it is urgently necessary to understand what a healthy vaginal microbiota looks like. Because, they argue in the article, without a clear understanding of the function and composition of this vaginal microbiota, the ability to diagnose, treat and prevent a wide variety of diseases is more than limited, which means that women cannot receive adequate medical care.

How does space affect menstruation?

Not only has there been little scientific interest in the vaginal microbiome, but also in another fundamental issue of female health, namely menstruation. And this is both on Earth and in space. It is true that female astronauts are still a minority compared to men – 10% – but at this time more than a hundred women have already participated in space missions on the International Space Station and there are plans to send them to the Moon and Mars. And this without any study being made. How spatial conditions affect your body. Because until now what space agencies have done is to induce amenorrhea through the use of contraceptives. "In this way they put them on an equal footing with their colleagues, avoiding what they considered a "formality," says Carla Conejo, biologist and scientific communicator, president ofHypatia Mars.

But this doesn't make much sense. And going without a period for years, as happens to astronauts, who are prevented from menstruating by medication from the beginning of their preparation for the space race, can have an impact on their health. After all, the hormonal cycle regulates countless factors in the female body. That is why the researchers who are currently participating in the second mission of the Hypatia Mars project, and who are at the project's station located in the Utah desert in the USA, which recreates some of the conditions that a station on Mars would have, are carrying out a small study to shed light on the menstrual cycle in space.

"One of Hypatia's goals is to generate useful knowledge for future lunar or Martian missions, which can be used by whatever space agency leads these first explorations," says Conejo, who recalls an anecdote that exemplifies the lack of knowledge – and disinterest – of space agencies in women's physiology. NASA asked American astronaut Sally Ride if 100 tampons would be enough for a six-day stay on the International Space Station. She replied that less than half would be enough. The anecdote inspired a song by a well-known comedian, Marcia Belsky: 100 tampons.

At the station, the Hypatia scientists will keep a diary of how the menstrual cycle affects their decision-making and mood, in a study in collaboration with the Hospital de Sant Pau. Conejo explains that they want to provide data so that "if we go to Mars, the only option for women is not to take hormones for not having their period." "We also want to learn about other aspects of women's health that have not yet been answered, such as the quality of sleep, nutrition and stress in the extreme conditions in space to which they will be subjected," she says.

They will also test a menstrual cup specially designed for astronauts, AstroCup, and carry out a small experiment with menstrual blood, a waste product in space like feces and urine, in which they will try to evaluate its potential as a fertilizer for the plants in the small vegetable garden in the small vegetable garden.

Conejo highlights the importance of the experiments from the two Hypatia missions to provide data to combat the bias in existing knowledge about the effects of a space mission on women's physiology. "We will send men and women to the Moon and Mars, and any health effects that have been seen before will be exacerbated precisely by the duration of the missions," says Conejo, who warns that "for women there is very little data and they will surely suffer the consequences much more."