March 5, 2025
The Delicate Dance of Women’s Brain Health
Women’s neurology is an emerging subspecialty that explores how neurological conditions uniquely affect women, especially during reproductive phases like pregnancy.
TOPICS: People
Designs on Aging-Ready
By Strategic Communications
Brains are squishy, wrinkly and drab. Side by side, a man’s and a woman’s brain look nearly identical to the untrained eye due to minimal anatomical differences.
Yet, neurological conditions can affect women differently than they do men. In Alzheimer’s disease, for example, women are more likely to decline cognitively and face more instances of memory loss, language difficulties and trouble with social interactions.
But, why? And how can they be prevented?
To answer those questions, researchers have accelerated work in women’s neurology—an emerging subspecialty that focuses on neurological conditions in women and girls—within the past few years.
However, women’s neurology is still considered a niche specialty, according to Eliza Miller, division chief of women’s neurology and associate professor of neurology, University of Pittsburgh School of Medicine. But she doesn’t think it should be.
"The brain is a vital component of women’s health," said Miller, a globally recognized leader in women's cerebrovascular health. "Unfortunately, many young neurologists lack specialized training in reproductive physiology—leading to significant knowledge gaps and unnecessary fear in how to navigate neurological problems women are faced with."
Pitt’s Department of Neurology is one of only two neurology departments in the United States with dedicated divisions of women’s neurology. The other is at Brigham and Women’s Hospital (BWH) in Boston, Massachusetts, affiliated with Harvard Medical School. Page Pennell was an active contributor to the development of the women’s neurology program at BWH before she joined Pitt as neurology chair and Henry B. Higman Professor.
Pennell recognized the importance of considering sex as a biological variable and the expression of neurological diseases early in her research career. Researchers at the center of women’s neurology, including Pennell and Miller, are exploring whether certain neurological disorders in women may be influenced, signaled or exacerbated by the many physiological changes that occur during pregnancy, other reproductive phases and other sex-specific factors in women. They’re still not entirely sure how it’s all linked.
“I really think we are set up to lead this field,” Miller said. “A lot of this work is already happening in different divisions and places across the University, but centralizing and formalizing this work would benefit our patients in the long term.”
Eliza Miller, associate professor of neurology and division chief of women’s neurology
Pitt’s division was established by Autumn Klein, a former assistant professor of neurology in the School of Medicine, pioneer in women’s neurology and the founder of BWH’s division, before her early death in 2013. Klein envisioned the division as an interdisciplinary unit that integrates neurology with subspecialties like obstetrics and gynecology. It was then led by Janet Waters until her retirement in 2024.
Pennell recruited Miller, who had collaborated with Pitt researchers through multicenter cohort studies. Miller cites Klein, Waters and Pennell as the blueprints for her leadership. Her research focuses on cerebrovascular complications of preeclampsia and other adverse pregnancy outcomes. As of March 2025, Miller has published more than 45 research publications and founded the Mothers Center Neurovascular Clinic at Columbia University.
Miller plans to expand the division at Pitt into a multispecialty care unit, grow the fellowship program, improve education in women’s health, recruit top faculty and strengthen collaborations. Her end goal is to position Pitt at the forefront of this growing specialty.
“I really think we are set up to lead this field,” Miller said.
Miller’s career path was unconventional. She became a mom to twins first. Her career as a professional dancer took her to New York City, but when she learned she was pregnant, she left the “struggling artist” life behind.
“Being a dancer is a tough life,” Miller said. “I’d always been interested in the body, and I thought there was one thing that might be easier than being a dancer: going to medical school.”
She attended medical school at Columbia University—having another baby along the way. Throughout her residency, fellowship and career, her work became inspired by the patients with pregnancy complications she cared for.
"These women left a lasting impression on me," Miller said. "The complications of these conditions can profoundly impact a person’s life—economically, psychologically, and beyond. But we're discovering predictors, which means there’s potential for intervention."