Speaker 1: Life Uncut acknowledges the traditional custodians of country whose lands
Speaker 1: were never seated. We pay our respects to their elders
Speaker 1: past and present, Always was, always will be Aboriginal Land.
Speaker 1: This episode was recorded on Cameragle Land. Hi guys, and
Speaker 1: welcome back to another episode of Life un Cut.
Speaker 2: I'm Brittany and I'm Keisha, and today we are discussing
Speaker 2: a topic that so many of you have written into us.
Speaker 2: The guest has been one of the most requested guests
Speaker 2: that we have had in a very long time.
Speaker 1: We are speaking to doctor Louise Newson, now Dr Newson
Speaker 1: or we will refer to her as Louise, I have
Speaker 1: asked for that permission. Is a leading expert in the
Speaker 1: field of menopause and perimenopause. She's a GP menopause specialist, educator, podcaster,
Speaker 1: and author. She's the woman in the know of menopause
Speaker 1: and today we would like to break down the misunderstandings,
Speaker 1: the myths, the misconceptions and medical misogyny surrounding menopause. Louise,
Speaker 1: Welcome to the podcast.
Speaker 3: Ah, thanks for the great introduction and thanks for inviting me.
Speaker 2: We've done a couple of episodes on the podcast on
Speaker 2: all Things Women's Health, and the current theme seems to
Speaker 2: be that there's a lot of medical misogyny that we
Speaker 2: all go through, to the point that a lot of
Speaker 2: people didn't know what perimenopause was, and I was one
Speaker 2: of them. I knew about menopause. I knew that when
Speaker 2: my mum experienced hot flushes, she would say, oh, I'm
Speaker 2: going through menopause, and she had a lot of side
Speaker 2: effects to do with her mental health and changes to
Speaker 2: her body, and other than that, I didn't really know
Speaker 2: much about it. Louise, can you talk to us about
Speaker 2: the difference between perimenopause and menopause?
Speaker 3: Yeah, for sure. The whole thing about all of this
Speaker 3: is that there's just a hell hormonal imbalance. So in
Speaker 3: an ideal world, I don't think we should be talking
Speaker 3: about perimenopause menopause, because then we're forgetting women who have
Speaker 3: PMS pre mental syndrome, or PMDD pre mental dysphoric disorder,
Speaker 3: or even postnatal depression, which is related to changing hormones.
Speaker 3: What happen is usually as we age, but it can
Speaker 3: be at any age. Our hormones fluctuate and reduce. Our
Speaker 3: hormones are just chemical messages that they're all around our body,
Speaker 3: but they're really important, so they affect every cell in
Speaker 3: our body. So when the levels aren't optimal in our body,
Speaker 3: we can get a myriad of symptoms and also some
Speaker 3: biologically negative effects in our body as well. The whole
Speaker 3: definition of menopause is a year after our last period,
Speaker 3: which is I just think, really just I'm not bothered
Speaker 3: about my period. I'm not bothered when it is, I'm
Speaker 3: bothered about my function, bothered about my brain. So the
Speaker 3: perimenopause is defined as when periods fluctuate and change and
Speaker 3: people get menopause or symptoms. But lots of people don't
Speaker 3: have periods, or they have artificial periods because they're on contraception,
Speaker 3: And a lot of women are saying, well, I'm getting
Speaker 3: regular periods and my perimenopausal or not, and that's why
Speaker 3: I think, I don't know. I hope you agree as women,
Speaker 3: I'm more than just my periods, do you know. So
Speaker 3: it's looking at what are hormones, what do they do
Speaker 3: in our body? Why are they having this effect? And
Speaker 3: then we can open the conversation to my thirteen year
Speaker 3: old who's started periods and feels terrible a day before
Speaker 3: her periods to my I can't tell you how old
Speaker 3: she is, my mother who has been menopausal for thirty years.
Speaker 3: You know, it's sort of we've got to be changing
Speaker 3: the conversation because otherwise people are no. My doctors told
Speaker 3: me I can't be menopausal because it's only eleven months
Speaker 3: and you know, two days since my last period. Therefore,
Speaker 3: it's like, oh, come on, please, you're having symptoms affecting
Speaker 3: the quality of your life. You have health risks without hormones.
Speaker 3: Let's just be a bit more grown up about this conversation.
Speaker 3: And that's why I think a lot of work has
Speaker 3: to change.
Speaker 1: Well, I think that's really interesting because I've always been
Speaker 1: under the understanding exactly what you just said before that
Speaker 1: menopause happens when you have from a year to the
Speaker 1: day not had a period. So it's interesting that you say, like,
Speaker 1: that's rubbish. How would you define menopause then?
Speaker 3: So I don't think I need to define menopause. I
Speaker 3: think what we need to define is a hormone imbalance
Speaker 3: in women's bodies and a hormone deficiency or insufficiency. Because
Speaker 3: the thing about menopause, if you take a step back
Speaker 3: and think, actually, what happens to our body a year
Speaker 3: after our last period? And if it's elite year, do
Speaker 3: we do three hundred and sixty five days or three
Speaker 3: hundred and sixty six days? Like? It's just getting a
Speaker 3: bit silly, now, isn't it. Like I'm trying to read
Speaker 3: I've read a lot of history books from the eighteen
Speaker 3: hundreds recently for a tour I'm doing in September, and
Speaker 3: I can't work out who actually decided who sat around
Speaker 3: a table and were it was all men obviously because
Speaker 3: they were only male doctors then, so who actually decided
Speaker 3: that it's a year? Like it just doesn't seem right.
Speaker 3: It's another way of sort of gasiting women and putting
Speaker 3: us into a box and just making everything normalized when
Speaker 3: we're feeling terrible. So I think we should be talking
Speaker 3: about a hormone insufficiency. I think we should be realizing
Speaker 3: that the three hormones we're talking about are estrogen, progesterone,
Speaker 3: and testosterone, and we can lose or have changes in
Speaker 3: these levels of hormones at different times. So some people
Speaker 3: are more testosterone deficient the nestrogen deficient. There's a lot
Speaker 3: of women out there, especially with endometriosis who have progesterone
Speaker 3: deficiency more than estrogen or testosterone. But all these hormones
Speaker 3: are just derived from cholesterol. They're all natural hormones that
Speaker 3: are made in our ovaries, of course, but they're also
Speaker 3: made in our brains and other organs in our body.
Speaker 3: So we have to be thinking about what's going on
Speaker 3: in our brain, because without our brains, with nothing are
Speaker 3: we And for too long we've just been concentrating on
Speaker 3: how heavy are your periods? Do you get period pain?
Speaker 3: Are they regular? Are they not? Like it's irrelevant. Actually
Speaker 3: I can cope with any periods if I'm functioning as
Speaker 3: a person, if you see what I mean.
Speaker 2: Yeah, absolutely, Louis. Not many of us would be going
Speaker 2: for regular blood tests. Not many of us would have
Speaker 2: kind of any idea of what levels our hormones of
Speaker 2: any of the three that you mentioned were at. So
Speaker 2: what are some of the other symptoms that there could
Speaker 2: be a hormonal change happening?
Speaker 3: Yeah, and that's a really important question. And even if
Speaker 3: we did go for blood test, do you know what,
Speaker 3: I did some blood tests on a patient ten times
Speaker 3: in a day and they were completely different every single time. Wow,
Speaker 3: And so our hormones fluctuate all the time. But the
Speaker 3: other thing is when you do a blood test, what
Speaker 3: hormone is in the level of woman in my blood
Speaker 3: is not the same that's in my brain or my tissues.
Speaker 3: And so there's a lot of wasted money on blood
Speaker 3: tests where people are just going, oh, no, my blood
Speaker 3: test is normal, But I'm waking up eight times in
Speaker 3: the night, and I've got night sweats, and i can't concentrate,
Speaker 3: and my blood is shot to pieces, but you know,
Speaker 3: my heart. So we have to be really careful. But
Speaker 3: we also have to remember in medicine, not everything needs
Speaker 3: a test. Like I have migrain. I don't need a
Speaker 3: brain scan or a blood test to diagnose migrain. I
Speaker 3: need somebody who's an expert, and me as an expert
Speaker 3: patient to make that diagnosis. If I've got the right information,
Speaker 3: if there's certain classic symptoms of migrain which enabled me
Speaker 3: to make the diagnosis myself actually as a patient, but
Speaker 3: also as a doctor, if I'm seeing women with migraine,
Speaker 3: exactly the same with hormonal changes. And what we have
Speaker 3: to do is, which is what's forgotten for many years,
Speaker 3: actually is talk to women properly, ask them to help
Speaker 3: with the decision making about the diagnosis. And often when
Speaker 3: people have the right information, and that's one of the
Speaker 3: reasons I develop the Free Balance app. That people can
Speaker 3: have information, they can look at symptoms, and there are
Speaker 3: lots of symptoms we can talk about, and then it's
Speaker 3: that light bulb moment going, oh, yeah, actually I'm getting
Speaker 3: those symptoms and they're worse before my periods, when my
Speaker 3: hormone levels are at their lowest. That must be somehow
Speaker 3: related to my hormones. Might not be everything, but it
Speaker 3: might be ten percent or eighty percent related to my hormones.
Speaker 3: But actually, if it is related to my hormones, do
Speaker 3: I need an antidepressant or a painkiller or a sleeping
Speaker 3: tablet or do I just need some natural hormones? And
Speaker 3: then you're changing that whole conversation. But you've got to
Speaker 3: put you know, I went into medicine to help people
Speaker 3: feel better, but also to have my consultations where the
Speaker 3: payats are in the center. So if a patient's coming
Speaker 3: in to me and saying, do you know what, I
Speaker 3: think this is related to my hormones? Ninety nine point
Speaker 3: nine percent of the time that lady is right, and
Speaker 3: the problem is so many times every day in my
Speaker 3: clinic people have said, but I'm not listened to. Doctor.
Speaker 3: I've tried to explain and I've not listened to. And
Speaker 3: that's in all countries, not just in the UK.
Speaker 2: Doctor Louise, this is something that I've been diagnosed with
Speaker 2: peacos nearly two years ago. I had seen three different GPS.
Speaker 2: For anyone listening who doesn't know polycystic avariance inndrome, it's
Speaker 2: a hormone in balance. I have fluctuating hormones of all
Speaker 2: different kinds of levels. And like you said, I've had
Speaker 2: blood tests that showed things were normal. I've had blood
Speaker 2: tests that showed that things were excessively abnormal. I saw
Speaker 2: so many doctors I presented with so many of the symptoms.
Speaker 2: I was fatigued, I had brain fog. I had a
Speaker 2: feeling within my body that something wasn't right, and I
Speaker 2: constantly felt invalidated. And it took for me to actually
Speaker 2: go and get roacotane. I went and saw a dermatologist
Speaker 2: and she was the one who led me to an
Speaker 2: endocrinologist who ended up saying, we need to get to
Speaker 2: the bottom of what's going on with your hormones. So
Speaker 2: for me, that was a really frustrating experience. And I
Speaker 2: can only imagine that women going through the period of
Speaker 2: being maybe forty into their fifties, you know, this either
Speaker 2: perimenopausal or menopausal state. Because of how many of us
Speaker 2: are going to experience this, I would have hoped that
Speaker 2: doctors would be a lot more receptive to these concerns
Speaker 2: and these symptoms that so many of us are going
Speaker 2: to present with.
Speaker 3: Is that the case, Yeah, you'd hope, But I think
Speaker 3: one of the problems, many problems in traditional medicine. Actually
Speaker 3: one of it is that we've been trained and we
Speaker 3: still are, to treat disease rather than prevent. We also
Speaker 3: have become more and more siloed, so that if I
Speaker 3: was a cardiologist, I would only be looking at the heart,
Speaker 3: If I was a neurologist, I would only be looking
Speaker 3: at the brain. And you know, I'm a general physician,
Speaker 3: so I have been trained to look at every organ.
Speaker 3: Because they're called sex hormones, it's almost like they're an
Speaker 3: optional extra, but they're not about sex, they're not about gender.
Speaker 3: Men have estrogen and progesterone. Testosterone is the most biologically
Speaker 3: active hormone we have, so they're heterosexual hormones, they're health hormones,
Speaker 3: but they've almost been put to the bottom of the pile.
Speaker 3: And the other thing. In medicine, we're often so busy
Speaker 3: thinking about how to prescribe a medication that we are
Speaker 3: also not thinking holistically about treatment options because hormones often
Speaker 3: are really important, but so is everything else as well.
Speaker 3: So it's not just take the hormones and go away
Speaker 3: and enjoy your life. It's like, let's rebalance your hormones.
Speaker 3: When I see you again, let's then talk about your lifestyle,
Speaker 3: your exercise, your sleep, your stress, everything else. And that's
Speaker 3: often forgotten because in medicine it's quite a conveyor belt.
Speaker 3: You know, you're in and out. You deal with one problem,
Speaker 3: one consultation, but actually, if you spend time helping people
Speaker 3: as soon as they start to have symptoms, you know,
Speaker 3: so we're investing in future health and people that I
Speaker 3: see in the clinic, it's transformational medicine because with hormones,
Speaker 3: if their symptoms are due to hormonal changes, the symptoms improve,
Speaker 3: they feel better, which is wonderful, but more importantly, they
Speaker 3: are improving their future health. They're reducing risk of disease,
Speaker 3: keeping away from doctors and enjoying their lives, and that's
Speaker 3: what we all should be working towards as doctors.
Speaker 2: Doctor Louise, what was it that made you so passionate
Speaker 2: about hormones and this research that you're now conducting with
Speaker 2: perimenopause and menopause as a GP? What was it that
Speaker 2: made you go down this path?
Speaker 3: It's mainly I was working part time as a GP,
Speaker 3: but I was also a medical writer for many years,
Speaker 3: unstripping sort of evidence, looking at all diseases and conditions
Speaker 3: and writing about them so that doctors and patients could
Speaker 3: understand more. And I was asked to write a review
Speaker 3: on the guidelines for menopause that came out in twenty fifty.
Speaker 3: So I reread all the evidence and I was shocked
Speaker 3: by how it's been misinterpreted by so many people, and
Speaker 3: I thought, this is outrageous. And then I started to
Speaker 3: experience symptoms that didn't realize. I spent six months shouting
Speaker 3: at my husband, having unretracted infections, worsting my brain, putting
Speaker 3: on weight, it just feeling miserable that thought I couldn't
Speaker 3: cope with my third child, at my job and everything else.
Speaker 3: But the biggest thing that drives me is that I
Speaker 3: decided as an individual to take hormones, including testosterone, but
Speaker 3: I can't get them from my NHS doctor the dose
Speaker 3: and type I'm on, So if I can't get them like,
Speaker 3: that's really hard for others. And so every day I
Speaker 3: speak to women who don't come to the clinic. You know,
Speaker 3: women who are very disadvantaged, and they're being sidelined in society.
Speaker 3: They've been given these other drugs, is cocktail of antidepressants, antipsychotics,
Speaker 3: pain killers. They know it's their hormones, but they can't
Speaker 3: access it in the way that I can't access it.
Speaker 3: So I'm determined not to stop and tell every woman
Speaker 3: who wants to get the treatment that's right for her
Speaker 3: is able to because it's such an injustice to women.
Speaker 2: As a GP. Were you specifically, like when you went
Speaker 2: through med school and I guess even when you were practicing.
Speaker 2: Are there things in place to educate gps that this
Speaker 2: is something that half the population are likely to experience?
Speaker 3: No, not properly. I certainly I didn't get any education
Speaker 3: as an undergraduate or a postgraduate, and I did a
Speaker 3: lot of hospital medicine before general practice, So I did psychiatry,
Speaker 3: I did cardiology, I did rheumatology, I did gastro entrology,
Speaker 3: I did cancer medicine. Jobs no one to speak about
Speaker 3: hormones at all, then, no. I mean, we've created a
Speaker 3: Confidence in the Menopause Education Program, which is a remote
Speaker 3: program where we've videoed ourselves doing consultations with actresses. We've
Speaker 3: got links to the available evidence, and you know that's
Speaker 3: head over thirty three thousand downloads. So it's a really
Speaker 3: sort of different course that's available to people in Australia,
Speaker 3: to people in any country to learn from because you
Speaker 3: have to learn the evidence, but you also have to
Speaker 3: be able to put the evidence into clinical practice. And
Speaker 3: that's the art of medicine is individualizing care. So education
Speaker 3: has to be completely transformed for everybody, not just gps,
Speaker 3: not just nurses, not just pharmacists. Every single healthcare practitioner
Speaker 3: needs to know about hormones.
Speaker 1: Which is absolutely wild to think that something that affects
Speaker 1: fifty one percent actually of the population is something that's
Speaker 1: not even taught to you guys when you're practicing. I
Speaker 1: think people underestimate the impact of hormones. And I'm glad
Speaker 1: you said what you said. Before, because I didn't know
Speaker 1: that that you tested one patient ten times in a
Speaker 1: day and the hormones fluctuated the entire day. How much
Speaker 1: scientifically speaking, how does the pill work in suppressing hormones?
Speaker 1: And I guess i'd love to know your expert opinion
Speaker 1: on the contraceptive pill.
Speaker 3: Yeah, it's a really interesting question. And again, I feel
Speaker 3: doing a lot of reading about history of contraception for
Speaker 3: this tour that I'm doing, but I've also got a
Speaker 3: pathology degree, so I'm really interested in science how things
Speaker 3: work in our bodies and how things don't work when
Speaker 3: we have conditions and illnesses. But our hormones estrogen progesterone,
Speaker 3: testosterone are structurally we know the molecular structure, so the
Speaker 3: biochemical structure, and all the hormones that are prescribed as contraceptives,
Speaker 3: they're called estrogen progesterone, but they're synthetically made, so they're
Speaker 3: chemically altered. So if you think about a lock and
Speaker 3: a key, we have, like the lock, the receptor on
Speaker 3: every single cell, and if you think of the hormone
Speaker 3: as the key, it goes in, it fits nicely, and
Speaker 3: then you've got these lovely chemical reactions occurring in every
Speaker 3: cell that are really beneficial for our body. And that's
Speaker 3: what estrogen, progester in, testosterone we produce, as well as
Speaker 3: insulin and thyroxin and adrenaline and quarters are all these
Speaker 3: other hormones. They all have the lock where the key
Speaker 3: can go in and then you know, our bodies are
Speaker 3: amazing when they work properly. Now, these hormones have been
Speaker 3: chemically altered, so they might fit the lock, but they're
Speaker 3: not going to unlock. They're not going to have this
Speaker 3: lovely cascade of reactions. But also when they're in that lock,
Speaker 3: they're blocking another key coming in, so they're blocking the
Speaker 3: natural hormones coming in. So it's almost a double whamme,
Speaker 3: officer when people are on hormones as contraception, in that
Speaker 3: they're sort of blocking their natural processes occurring and they're
Speaker 3: blocking the natural hormones working. Now, some of them are
Speaker 3: different to others, so some of them will have like
Speaker 3: a partial turning of that lock, so they might have
Speaker 3: some chemical reaction that's beneficial, but a lot of people
Speaker 3: have side effects. We know to the contraceptis like you
Speaker 3: felt numb, you felt flash. You know, a lot of
Speaker 3: my teenage children friends are just put on the pill,
Speaker 3: and then they're put on antidepressants without anyone thinking, oh,
Speaker 3: what's happening, Why is this happening. And when contraceptions were
Speaker 3: first brought out in the sixties, they had done no
Speaker 3: studies on contraception. They just did studies on the womb
Speaker 3: and saw that periods became lighter and thought, great, women
Speaker 3: don't like heavy periods. Let's give it. Then after a
Speaker 3: year they said, let's market there's contraception. But no one
Speaker 3: did any studies on the metabolism in the body. They
Speaker 3: didn't do any studies on heart or inflammation or the
Speaker 3: brain function. There were some studies where they gave women
Speaker 3: like a hundred times the dose they do now and
Speaker 3: women were vomiting, have blood cuts, But they dis ignored
Speaker 3: some of those studies because they wanted to get it
Speaker 3: out to market because there was a massive market. Obviously,
Speaker 3: we all want contraception when we don't want to be pregnant,
Speaker 3: and this is part of the problem. Now there's a
Speaker 3: myriad of contraceptives, and obviously I'm not saying we can't
Speaker 3: have them, but there are ones that have different effects
Speaker 3: on different people, and we need to be really careful
Speaker 3: what we give and listen again to women.
Speaker 1: What is the general age guidelines of when women usually
Speaker 1: stop their period in going to minipause. And I know
Speaker 1: that's not a cut number.
Speaker 3: Yeah, so I mean it's a great question. But on
Speaker 3: average it's about the age of fifty in the UK,
Speaker 3: probably in Australia as well. India it's lower, it's about
Speaker 3: forty five. And this is a really important but about
Speaker 3: one in thirty women under the age of forty will
Speaker 3: have an earlier menopause. So I've seen in my clinic
Speaker 3: this week two women who have never had periods, so
Speaker 3: their ovaries didn't develop properly, so they were menopause at
Speaker 3: age fourteen. They were bugged on the contraceptive pill, never
Speaker 3: felt great, so they just need proper natural hormones. One
Speaker 3: of them has now got osteoporosis aged thirty eight. So
Speaker 3: lots of women will become menopausal at an earlier age.
Speaker 3: And sometimes it might be because their ovaries are removed
Speaker 3: in an operation, or they've had a hysterectomy, or they've
Speaker 3: had some chemotherapy or drug treatment for cancer that's affected
Speaker 3: their ovaries working. But a lot more women will have
Speaker 3: hormonal changes, so about ninety percent of us have PMS,
Speaker 3: but like you just, oh, it's only two or three
Speaker 3: days a month, but actually that's about a month a
Speaker 3: year that you're not functioning properly and not performing properly.
Speaker 3: But about one in twenty I think probably more have PMDD,
Speaker 3: which is a more severe form of PMS. It's really
Speaker 3: flawing people and they are just given antidepressants, but that's
Speaker 3: not treating the underlying cause.
Speaker 2: Yeah, we've actually done an episode quite recently on PMDD
Speaker 2: that if anyone is thinking that that could be something
Speaker 2: that they're experiencing, will link it. In the show notes
Speaker 2: that was with an endochronologist, Luis. You spoke briefly about
Speaker 2: these changes in function, saying that at these time when
Speaker 2: our hormones are acting differently, we can be not functioning.
Speaker 2: What does that look like in day to day life, Like,
Speaker 2: how would someone identify that's a symptom? Maybe there's something
Speaker 2: going on inside.
Speaker 3: Yeah, so there's a myriad of symptoms and you'll be
Speaker 3: pleased to hit not everybody gets every symptom, but symptoms
Speaker 3: can come and go, they can change between people, but
Speaker 3: also between time as well. The commonest symptoms and we've
Speaker 3: done a survey of six thousand women. But we hear
Speaker 3: it all the time in the clinic too. But the
Speaker 3: commonest symptoms are symptoms affecting our brain, so brain fog ma,
Speaker 3: memory problems, fatigue, low mood, anxiety, inability to concentrate, irritability,
Speaker 3: this iridescent rage that just comes from nowhere. But also
Speaker 3: just feeling more withdrawn, not feeling quite so engaged with people,
Speaker 3: feeling just quite flat, quite joyless, having very little motivation.
Speaker 3: A lot of people just feel like they're just existing
Speaker 3: rather than living. And then people can get headaches, and
Speaker 3: then you know, if you work down the body, people
Speaker 3: can get dry eyes, they can get changes in smell,
Speaker 3: they can get sore mouth, they can get changes in taste,
Speaker 3: they can get tinatus in their ears, hearing problems, breathing problems.
Speaker 3: People can get palpitations, irritable bounds type symptoms. People can
Speaker 3: get dry skin, itchy skin. They can get worsening xma.
Speaker 3: They can get this formication, this sort of feeling of
Speaker 3: spiders crawling over their skin. They can get pins and needles,
Speaker 3: they can get nerve pain, they can get muscle and
Speaker 3: joint pain. And as I'm working down the body, Hopefully
Speaker 3: you'll realize it's no surprise because I said at the
Speaker 3: beginning of this show that our hormones affect every single cell,
Speaker 3: therefore every single organ in our body. So if if
Speaker 3: that beautiful key and lock lovely chemical reaction isn't occurring,
Speaker 3: then our bodies don't work properly, and especially a lot
Speaker 3: more symptoms occur before periods actually stop. When our hormones
Speaker 3: are in flux, they're going up and down, and that
Speaker 3: really causes a lot of chaos to our organs, especially
Speaker 3: our brain.
Speaker 1: Is there a male version of this, and I don't
Speaker 1: mean a male version of menopause, but like a huge
Speaker 1: point in life that their hormones change.
Speaker 3: Yeah. So testosterone deficiency obviously is a thing, but it's
Speaker 3: about thirty to forty percent of men, and it's usually
Speaker 3: just as they age, their testosterone levels reduced and they
Speaker 3: can have very similar symptoms. The other thing, it's not
Speaker 3: just symptoms because without these hormones, our organs don't work
Speaker 3: as well, so we have an increased incidence of heart disease, diabetes,
Speaker 3: clinical depression, an osteoporosis, dementia. These are all conditions that
Speaker 3: are inflammatory, so they cause more inflammation in our bodies,
Speaker 3: and that's the same for men as well.
Speaker 2: So Luise, let's say that someone is let's say hypothetically,
Speaker 2: they're forty eight years old, they're feeling a little bit
Speaker 2: checked out of life, They're feeling as though they've just
Speaker 2: lost a little bit of passion and a bit of oomph.
Speaker 2: They go to their GP and they say, I think
Speaker 2: I could possibly be entering the early phases of menopause.
Speaker 2: What happens next, Well.
Speaker 3: Many of the question because it depends what that doctor says.
Speaker 3: But in an ideal world, that doctor will listen, talk
Speaker 3: through symptoms, to talk through what else is going on.
Speaker 3: And often we do do a blood test to make
Speaker 3: sure there's nothing else going on, because I don't want
Speaker 3: to say, oh, it's related to your hormones, but then
Speaker 3: find that that woman has an undirective thyroid gland, or
Speaker 3: she's got lo iron or you know, something else going on.
Speaker 3: So often the tests are done to exclude other causes.
Speaker 3: So if in conjunction with the patient, as a doctor,
Speaker 3: I feel that it's related to their hormone or I
Speaker 3: think some of their symptoms might be then I will
Speaker 3: just say, well, let's try hormones you know, they're very safe.
Speaker 3: We're very fortunate we have the natural hormones available to prescribe,
Speaker 3: which are safer than the contraception. They are just the
Speaker 3: same chemical structure as our own hormones, and we have
Speaker 3: them in different doses. We give them individually, so some
Speaker 3: women I think, well, you might be more progesterone deficient
Speaker 3: than estrogen deficient, or vice versa. So we start with
Speaker 3: some hormones and then review people after about three months,
Speaker 3: and they might say this symptom has improved, that this
Speaker 3: one hasn't. And then we can try and work out
Speaker 3: do they then need a different dose or a different type,
Speaker 3: or a different formulation. And then often do do testosterone
Speaker 3: levels because it's a guide, and if their testosterone level
Speaker 3: is low and they have symptoms suggestive of testosterone deficiency,
Speaker 3: then we often try testosterone as well. And the hormones
Speaker 3: are very safe. You know, they don't last in the body.
Speaker 3: They only last a day that you use them. Actually,
Speaker 3: a lot of people say, well, I'll try them and see,
Speaker 3: because they're safer than giving an antidepressant or a painkiller
Speaker 3: or something else that is a chemical in the body.
Speaker 3: And if they don't work, you just don't continue taking them.
Speaker 3: It's it's not difficult, but the hardest thing is for
Speaker 3: women to be believed and to see someone who understands hormones.
Speaker 1: And so natural hormones is a script that you would
Speaker 1: need to get from your doctor, and it is not
Speaker 1: something that somebody can just go and purchase at a
Speaker 1: health shop or a pharmacy.
Speaker 3: No, no, no, you can bite worse things at a
Speaker 3: health shop, but they are prescribable. But we usually give
Speaker 3: the estrogen through the skin as a patch or gel
Speaker 3: because then it gets absorbed straight into the bloodstream keeps
Speaker 3: us A natural estrade progesterone can be to given orally
Speaker 3: or sometimes we give it as a psari and the
Speaker 3: testosterone is either a cream or a gel. So it's
Speaker 3: very easy medicine, it really is.
Speaker 2: So after you know a patient has come in they've
Speaker 2: started on hormone replacement therapy, and let's say you get
Speaker 2: the concoction right straight away, what changes do they feel
Speaker 2: within themselves?
Speaker 3: So if their symptoms are due to hormonal changes or
Speaker 3: lowering of their hormones, then they feel better, and that
Speaker 3: can take a little while. Sometimes people start to feel
Speaker 3: better within days. Sometimes it can take weeks or months.
Speaker 3: And that's partly because the cells the body has got
Speaker 3: to use these hormones in an efficient way. And not
Speaker 3: only do they have chemical reactions going on in the cells,
Speaker 3: they can also affect our genes, our genetic material, and
Speaker 3: that can just take a bit longer to occur. So
Speaker 3: usually people say, gosh, I started to feel better, and
Speaker 3: now I feel so much better, but it's taken three
Speaker 3: months or so. But if they've still got some other symptoms,
Speaker 3: we can change the dose. Or they might say, well,
Speaker 3: I rub the gel on and it just slides off
Speaker 3: my arm, so therefore they're not absorbing it, so they
Speaker 3: might need to use a different dose or change to
Speaker 3: a patch. That's where individualization of dose is really important.
Speaker 1: Why do you think hormone replacement therapy gets such.
Speaker 3: A bad rap ah? There's so many reasons. Partly it's
Speaker 3: because because of this study that came out in two
Speaker 3: thousand and two, this WHI Women's Health Initiative study, and
Speaker 3: it showed this breast cancer or supposed breast cancer risk
Speaker 3: with women who were taking HRT. But the thing about
Speaker 3: that study is it wasn't giving natural hormones. It was
Speaker 3: giving hormones that estrogen was derived from pregnant horses urine
Speaker 3: and the progesterone was a synthetic progesterone, which is actually
Speaker 3: in the contraception, and actually it was only the combination.
Speaker 3: So with the synthetic progesterone, there was this small increased
Speaker 3: risk of breast cancer, but it wasn't statistically significant. But
Speaker 3: you know, we don't prescribe that, So what's the point
Speaker 3: of even thinking about that study? Actually we know we've
Speaker 3: known for a hundred years how important our natural hormones
Speaker 3: are to help our bodies work. But you know what,
Speaker 3: they're really cheap. They're not very exciting because they just
Speaker 3: had natural hormones, so big farmer don't make loads of
Speaker 3: money from it. But there's also this whole thing about
Speaker 3: the way women are treated in general and not listened to,
Speaker 3: which I don't know how to change that narrative.
Speaker 2: Are there any risks associated with hormone replacement therapy?
Speaker 3: So not with then that sure, because why would we
Speaker 3: have hormones in our body that are at risk to us?
Speaker 3: Like it doesn't make sense. Everyone worries about risk of
Speaker 3: class or risk of cancer, but that's with synthetic hormones
Speaker 3: that have been chemically altered because they don't have the
Speaker 3: same biological effect of the body, Like, why would we
Speaker 3: be designed to have a hormone that's dangerous in our
Speaker 3: body if it's given in the right way, in the
Speaker 3: right formulation, and the right dose as well, So you know,
Speaker 3: of course, I mean I use testosterone a lot in
Speaker 3: my patients. I personally use it. If I was using
Speaker 3: ten times the dose, I'm sure I'd get side effects
Speaker 3: or problems, But why would I do that. All we're
Speaker 3: doing is replacing what's missing, so it's very safe. Yeah.
Speaker 2: Interesting. Have you heard of many I mean, I guess
Speaker 2: this would be anecdotal more than an actual study. Have
Speaker 2: you heard of many people reporting changes in their relationship
Speaker 2: either going through menopause or going through menopause and then
Speaker 2: going on hormone replacement therapy?
Speaker 3: Yeah, for sure, every time. I mean I wrote about
Speaker 3: it in my book The Definitive Guide. I've got a
Speaker 3: section about relationships, and I talk personally about how much
Speaker 3: I hated my husband and I was paring menopausal. It's
Speaker 3: just the noise of his breathing just triggered me. But yeah,
Speaker 3: a lot, because if you think of those symptoms I mentioned,
Speaker 3: especially the irritability. You know, it's like you've got this
Speaker 3: demon in your head telling you you can just shout
Speaker 3: at anyone, especially people that you love. And so there's
Speaker 3: the mood changes, but there's also the physical changes. You know,
Speaker 3: if you look down at your body and you're putting
Speaker 3: on weight, you've lost your muscle tone, you're feeling horrible,
Speaker 3: like you're not going to jump into bed with your partner,
Speaker 3: and then if you do, you often have vaginal dryness
Speaker 3: or soreness, or you know you're going to get your
Speaker 3: only tracked infection after having sex, and you're like, oh,
Speaker 3: I can't do it, I can't do it. I'm just
Speaker 3: going to sleep, and I hope he watches a film
Speaker 3: and has a glass of wine downstairs and doesn't can't stairs,
Speaker 3: you know, while I'm still awake. And it just has
Speaker 3: this massive divide. And so most women I speak to
Speaker 3: in the clinic when they have hormonal changes, they're not
Speaker 3: having an intimate relationship. They do love their partner, but
Speaker 3: they really are having a lot of problems, but they're
Speaker 3: not able to talk about it. And the partners don't
Speaker 3: know how to bring it up because there's so much
Speaker 3: anger in the person and you know, divorce rates increase,
Speaker 3: but it's not just the partner, it's a family. So
Speaker 3: children are affected. They listen to arguments they'd not watching.
Speaker 3: You know, even my children so many where we thought
Speaker 3: you were going to divorce. You were so cross and
Speaker 3: we were so scared, and we were a really open family.
Speaker 3: And I've been with my husband since I was eighteen.
Speaker 3: But I often think, gosh, if I didn't have a
Speaker 3: stable relationship, if I had raw children and I didn't
Speaker 3: have a job and I was a single mum, like
Speaker 3: I would be shouting at my children, like what's going
Speaker 3: on behind four walls of so many homes? When there's
Speaker 3: such a simple answer. Because I've been telling so many times,
Speaker 3: you know, DODR. Newston, you have saved our relationship. You
Speaker 3: have saved our marriage. And it's not me. I haven't
Speaker 3: done it, but the hormones have because they've become rebalanced
Speaker 3: with their hormones and they can carry on as they
Speaker 3: should be. So it's awful. I've done a lot of
Speaker 3: work with divorce lawyers and you know, they hear the
Speaker 3: same women but coming to their forties, but then they're
Speaker 3: blamed on it's their job. It's because they've got young children,
Speaker 3: and it's because they're trying to work full time. But
Speaker 3: people don't say that to men, do they. You know,
Speaker 3: you're not coping with your high powered job.
Speaker 1: Therefore, well, that's the thing, isn't it. It's because menopause
Speaker 1: and perimenopause and what actually happens and what it means
Speaker 1: isn't spoken about. It's definitely not what it didn't used
Speaker 1: to be communicated with husbands and partners. So of course
Speaker 1: they didn't understand. They just think she's changed. You know,
Speaker 1: you don't love me anymore. You don't do this for
Speaker 1: me anymore. There's no understanding purely because there's no education
Speaker 1: in communication.
Speaker 3: Waits.
Speaker 2: How much does our lifestyle have an impact on our hormones?
Speaker 3: Yeah, it has a really important effect, and so much
Speaker 3: so that often we don't know because no research is
Speaker 3: done in it, but certainly are what we eat can
Speaker 3: really make a difference to our hormones. We also have
Speaker 3: to remember that our hormones like three hormones istum, gesture,
Speaker 3: and testostere and have an impact on quartisole because they're
Speaker 3: all made from the say, the very quartisole is very
Speaker 3: similar structure to these other hormones, and so if we're stressed,
Speaker 3: it can affect our hormone levels. Certainly what we eat
Speaker 3: or what we don't eat, or if we don't sleep well.
Speaker 3: All our hormones are very closely linked. They work very
Speaker 3: closely together. So it's like a big seas already we've
Speaker 3: got to look at everything together. But the problem is
Speaker 3: a lot of women have said told, well, if you
Speaker 3: improve your diet, if you exercise, you know, I'm sure
Speaker 3: you've been told with pecos oh, just you know, change
Speaker 3: your diet and everything will be fine. Well, actually rebalance
Speaker 3: your hormones, and then it's so much easier to look
Speaker 3: at your nutrition, look at your exercise, look at everything
Speaker 3: else together.
Speaker 1: When you say diet and food is a huge thing
Speaker 1: that can impact it, is there something specific or you
Speaker 1: just mean not overall healthy eating? Do you like, is
Speaker 1: there a study that says that sugar is a trigger?
Speaker 3: Yeah? So often with nutrition and exercise, it's just very simplistic.
Speaker 3: You know, I'm not a nutrition expert or sports you know,
Speaker 3: coach or anything, but a lot of it is trying
Speaker 3: to avoid processed foods. It's looking at not just what
Speaker 3: we eat, but what we drink because alcohol obviously has
Speaker 3: an effect on our metabolism, but also any fizzy drinks,
Speaker 3: any drinks that aren't water or herbal teas are going
Speaker 3: to have an effect. Even caffeinated drinks can have an effect.
Speaker 3: We know that people's nutrition generally is nowhere near the
Speaker 3: same as it was thirty years ago, and of course
Speaker 3: that's going to have an effect on our hormones as well.
Speaker 3: Even just the quality of our sleep is really important.
Speaker 3: You know, we're all different. Some people need eight hours.
Speaker 3: I can survive quite well on six six and a
Speaker 3: half hour sleep. But it's not just how long you
Speaker 3: are asleep for it's how you're relaxing. How are you
Speaker 3: switching off, are you waking up several times in the night,
Speaker 3: or are you sleeping all the way through? You know,
Speaker 3: and all these things work together. You know, if I
Speaker 3: ate well, I don't eat caffeine, but if I had
Speaker 3: a chop before I went to bed, I know I'll
Speaker 3: be awake all night because you know, it affects me
Speaker 3: and then that will have a detrimental effect of my hormones.
Speaker 3: But other people can eat chocolate and go straight to sleep.
Speaker 3: So that's why we have to be looking what's right
Speaker 3: for us not judging ourselves with other people.
Speaker 2: Always in terms of other hormonal conditions, things like diabetes,
Speaker 2: things like peacos I mean, hyperthyroidism, whatever it might be.
Speaker 2: Does that change the onset or the severity of the
Speaker 2: symptoms in terms of menopause.
Speaker 3: Yeah, it can be. I've just recorded a podcast actually
Speaker 3: with a lady with type one diabetes in her glucose
Speaker 3: control really changed when she had asurgical menopause, when her
Speaker 3: hormones plummeted, which just shows actually in real time, how
Speaker 3: our hormones are very closely linked. But it's not just
Speaker 3: about symptoms. It's about the metabolic effects in our body.
Speaker 3: It's obviously important to talk about symptoms, but we have
Speaker 3: to be beyond that. Like when we talk about diabetes,
Speaker 3: we have really good control of sugar to improve that
Speaker 3: patient's future health. We don't ask them at nauseum about
Speaker 3: every symptom that they have. It's more about let's get
Speaker 3: your metabolic processes improving to reduce your risk of heart
Speaker 3: disease and kidney disease and stroke and everything else. And
Speaker 3: that's what we need to be doing with hormonal imbalances.
Speaker 3: We need to be balancing their hormones to improve their
Speaker 3: future health, reduce inflammation, improve metabolic changes going on in
Speaker 3: the body. And the problem is, for decades centuries, it's
Speaker 3: been gynocologists controlling our ovaries, and gynocologists are very good
Speaker 3: at controlling ovaries and womb, but they're not thinking about
Speaker 3: the body as a whole and the metabolic processes that
Speaker 3: are going on. And that's why I feel very strongly
Speaker 3: us as women who are experiencing these hormonal changes, need
Speaker 3: to have the information and education so we could make
Speaker 3: the right choices for ourselves about our hormones, about our
Speaker 3: lifestyle and everything else together.
Speaker 1: Do we come out the other side?
Speaker 3: Louise, Well, the day we die is the day menopa ends.
Speaker 3: You know, when we're menopausal, we have low hormones and
Speaker 3: they last forever. Not everyone has symptoms. A lot of
Speaker 3: people have less symptoms because they're not having this fluctuation,
Speaker 3: but without their hormones, they're still having this metabolic process.
Speaker 3: And that's why one in two women, for example, who
Speaker 3: are menopausal who don't take hormones have osteoporosis. You know,
Speaker 3: insidance of heart attacks increase. We know that women have
Speaker 3: a reduced health span as they age, they have more
Speaker 3: chronic inflammatory diseases, but it's a choice. Some people say, well,
Speaker 3: I've got such an amazing lifestyle, I feel I won't
Speaker 3: get anything out of my hormones. But far too many
Speaker 3: women are scared of hormones. But their bone loss is increasing,
Speaker 3: their inflammation in their body is increasing. They've got a
Speaker 3: cognitive decline and dementia, but they're not having hormones which
Speaker 3: would improve a lot of this.
Speaker 1: Thank you so much for your time today and helping
Speaker 1: educate people on menopause and perimenopause and hormone replacement therapy
Speaker 1: and everything we discussed. There is so much more to
Speaker 1: the conversation, so if anyone does want to know, we
Speaker 1: are going to link all your podcast, show notes, your website,
Speaker 1: everything that people need in our show notes, So please
Speaker 1: go and find out more if this is affecting you,
Speaker 1: or maybe it's your mum or a friend or a sister,
Speaker 1: and everything will be in one place.
Speaker 3: Thanks for inviting me. I really enjoyed it. Thank you.