Latest / The Dr Louise Newson Podcast / 13 - HRT after 60: myths, facts and finding your own path with Ann Newson

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13 - HRT after 60: myths, facts and finding your own path with Ann Newson · The Dr Louise Newson Podcast

• 0:03
  On the podcast today, I'm with my mother and we're talking
• 0:06
  about taking HRT as an older person.
• 0:09
  Of course, I don't mention her age, but lots of times she's
• 0:12
  tried to have her HRT taken off her by various GPS.
• 0:17
  So we're just talking about choice.
• 0:19
  It's a good episode and I hope you enjoy it.
• 0:21
  So you're here in the studio. Last time we did a podcast was a
• 0:26
  while ago and we did it actually on my sofa at home, didn't we?
• 0:30
  That's right, yes. And I wasn't expecting to do it.
• 0:32
  And then suddenly I came downstairs and we're doing it
• 0:34
  like, oh, why? I'm not ready.
• 0:37
  And now we've asked because by popular demand, we have had a
• 0:40
  lot of questions from people that listen to the podcast
• 0:44
  asking about no disrespect, older people, what happens?
• 0:48
  Excuse me, I'm going to interrupt you right in the
• 0:50
  beginning. I like the word maturer, not
• 0:53
  older, because I think things like cheese and wine improve
• 0:56
  with age. So I'm hoping, hoping I am.
• 1:01
  Yeah, of course you are, Mother. Yes, thank you.
• 1:05
  So lots of people have actually asked, I'm over the age of 60,
• 1:09
  is it too old to take HRT? And I know I'm not allowed to
• 1:12
  mention your age and I'm not going to, but someone said to me
• 1:15
  yesterday, Louise, you are nearly 55, so your mother is
• 1:18
  going to have to be 60, so. I was a child bride.
• 1:23
  Yeah, but Even so pretty hard. So I'm just really keen to like
• 1:27
  unpick it because I see lots of women and I speak to lots of
• 1:30
  women who have missed out, if you like, on HRT because lots of
• 1:35
  the listeners know about this WHI, the Women's Health
• 1:37
  Initiative study that came out in 2002 and HRT prescribing was
• 1:42
  really high and it was increasing, but it fell off a
• 1:46
  Cliff because of the misreporting of this awful
• 1:49
  study. So lots of.
• 1:50
  Women breast cancer. Yeah.
• 1:52
  So lots of women then were stopped.
• 1:55
  So you've carried on, which is great and we'll talk about that
• 1:59
  in a bit. But actually you were really
• 2:01
  lucky to have been prescribed HRT, like almost from the
• 2:07
  beginning. Well, when I initially went to
• 2:10
  the doctor, my doctor, he's in, in my day, of course, as you
• 2:14
  know, it's called the change. The, the doctor said, oh, don't
• 2:18
  worry, you're just on the change.
• 2:19
  And I was teaching drama to students in London and I just
• 2:23
  felt so exhausted and on reflection, probably depressed
• 2:26
  as well and having to juggle all sorts of things in my life.
• 2:30
  So I went to another doctor and this doctor, she was a she, the
• 2:35
  first one was a he. I shouldn't say that, but it's
• 2:38
  true. She said well try HRT so I tried
• 2:43
  it and I just came back to life and I could cope.
• 2:47
  Well, you, you must remember that.
• 2:49
  I think I was about 15. Yeah, something like that, you
• 2:52
  know, sort of the exam term and everything.
• 2:54
  Yeah, because I mean some people listening.
• 2:57
  No, but you know, Daddy died when I was 9.
• 3:00
  You single mum, three children. John was my brother was only
• 3:04
  two. You were working as a teacher,
• 3:08
  there's lots of reasons why you could be low in your mood and
• 3:11
  struggling. Absolutely.
• 3:13
  So when he said the change, did you know what that meant?
• 3:16
  Well, yes, because, you know, one didn't talk about health
• 3:19
  issues when I was young. I didn't, you know, talk about
• 3:22
  periods. It was the sort of secret word,
• 3:25
  the curse. She's got the curse.
• 3:27
  But then, and you know, some of my mother's friends, especially
• 3:32
  one in particular, I can remember her sitting in her
• 3:35
  living room pouring with sweat and really low and depressed.
• 3:40
  And the, my mother said, well, she's on the change, you know,
• 3:44
  so that that's what I knew about it.
• 3:46
  But I knew, you know, after daddy died, I had to pick up
• 3:49
  life and carry on and was teaching.
• 3:52
  So I knew I could do it. But suddenly it hit me this
• 3:57
  energy loss, this, as I say on reflection, depression.
• 4:02
  I didn't have the hot sweats or anything.
• 4:04
  I can't remember whether my periods had stopped or not, but
• 4:08
  that's to me is irrelevant. The fact I was having to cope
• 4:12
  with life and it was so incredibly hard.
• 4:16
  I can remember, you know, having to catch the train up to London
• 4:20
  and it was just one foot in front of the other.
• 4:23
  It was just so much. And then, you know, being given
• 4:28
  HRT as it was my choice, I could try it and I did.
• 4:33
  And as I say, it was a a great thing.
• 4:36
  And on reflection, they say, you know, you react to the menopause
• 4:42
  as your parent, your mother has sometimes.
• 4:45
  And on reflection again, my mother was probably very
• 4:49
  depressed, but she didn't get the hot sweats.
• 4:52
  And but we, as I say, we, we just didn't talk about.
• 4:56
  No. Things like that.
• 4:58
  It's. It's funny, I don't know if you
• 4:59
  know this, but I was reading one of my Diaries recently because I
• 5:03
  was showing my children how argumentative I was and how
• 5:07
  irritable I was as a. 15 year old I'll zip option.
• 5:11
  And I was writing and there were things I was saying like no one
• 5:15
  understands me, I'm just on my own.
• 5:18
  I try and explain to them about work I'm doing or the interested
• 5:22
  and mummy's not interested and she slammed the door or
• 5:26
  something. Honestly, I was reading it to
• 5:28
  good girls, it was a while ago because I was saying look, it's
• 5:31
  not just you that feels like this.
• 5:32
  It's part of, and I would have been having a hormonal changes
• 5:35
  of course, but I also then at the time didn't know anything
• 5:39
  about the change, menopause or anything.
• 5:41
  But I wonder how much of you and me not getting on so well was
• 5:46
  because your hormones were fluctuating as well?
• 5:48
  Because we wouldn't have thought about it, would we?
• 5:51
  No, I we weren't, I wouldn't be aware.
• 5:54
  And I'm sure that on thinking about it, you know, it probably
• 5:58
  was part of it. I mean, yeah, I think we have
• 6:01
  similar personalities of. Course no, we can't blame
• 6:04
  everything. On our hormones, cash, yeah.
• 6:07
  Yeah. So I'm not blaming everything on
• 6:08
  my hormones, but it does make me think because, yes, you know,
• 6:12
  and it is actually, like you say, when people still have
• 6:15
  periods. So perimenopause often is the
• 6:17
  more turbulent time. Yes.
• 6:19
  And, you know, households can really break down.
• 6:22
  It's not just relationships, but actually with children as well.
• 6:26
  And, and that really worries me because it can be very difficult
• 6:29
  bringing up children, as we both know, but even harder if you've
• 6:32
  got anything else that's going on and not being recognised.
• 6:36
  So I just think it was very forward thinking of that female
• 6:39
  doctor to actually prescribe you.
• 6:42
  But she prescribed you a tablet, didn't she?
• 6:43
  Of HRT? Yes, yes.
• 6:45
  And only watching your theatre tour.
• 6:48
  I realised that they were made from horse's urine or something.
• 6:51
  That made me feel quite. She didn't know.
• 6:52
  Did you? Well, no, no, but, and I didn't
• 6:55
  talk about, I didn't know the word menopause, I don't think
• 6:58
  till you started specialising in menopause and certainly I had
• 7:02
  never heard of perimenopause. What on earth that I know all
• 7:07
  about it now. But you know, I just feel sorry
• 7:11
  that we're talking about how many years ago.
• 7:15
  Long time, 40 years ago. 40 years ago but things haven't
• 7:21
  moved on. I've got friends who've actually
• 7:24
  gone to their doctors now and, you know, because I've persuaded
• 7:29
  them or they, you know, they might be a little bit older and
• 7:33
  I've got some young friends as well.
• 7:35
  And they're not getting the help from the doctors that they
• 7:38
  deserve. And I think it's not just the
• 7:41
  help they deserve, it's also given the choice.
• 7:46
  And you mentioned earlier on about this scare of breast
• 7:49
  cancer and I can remember then I think you would just sort of you
• 7:55
  qualified. But anyway, we were talking
• 7:58
  about it and I said, oh, should I come off?
• 8:00
  And you said, mum, you know, if you think about you've been on
• 8:05
  HRT for several, if you get breast cancer tomorrow, you've
• 8:08
  had a good quality of life for those last few years you've
• 8:11
  been. And I agreed with you totally.
• 8:14
  And I just think it's just fate if you get it or not because I
• 8:20
  have 4 friends that I can name who've had breast cancer.
• 8:24
  They've all survived, thank God, but none of them have been on
• 8:29
  HRT. So I think things like that are
• 8:32
  the luck of the draw and life is for today.
• 8:34
  Yes. And I remember at the time
• 8:37
  writing articles because, you know, I was writing that weekly
• 8:39
  column for GPS and I, I actually found them recently because
• 8:43
  you've very kindly have kept everything that I've written,
• 8:46
  unlike me. So in 2000, I'd written about
• 8:49
  HRT saying that it's good for mood, it's good for mental
• 8:53
  health, it's good for bone protection, it's good for heart
• 8:55
  disease, probably good for dementia, type 2 diabetes with
• 9:00
  the evidence associated with it. Then in 2002, the Women's Health
• 9:04
  Initiative study. So again, I found another
• 9:06
  article that I'd written saying there's a study that's come out,
• 9:10
  but actually it doesn't tell us anything we didn't know already.
• 9:14
  There might be the small increased risk, but it's
• 9:16
  associated with synthetic hormones and there are still the
• 9:20
  benefits to the heart, the brain, the bones, so forth.
• 9:24
  So in my own little world as a GP and also helping advise you a
• 9:28
  little bit, I I just thought business as usual.
• 9:31
  I didn't realise the rest of the world were going into a mega
• 9:34
  panic because the data had been misinterpreted.
• 9:38
  And that's been the hardest thing because going forward you
• 9:42
  say those 3 letters HRT and everyone says people.
• 9:45
  Still remember, because they still remember it.
• 9:47
  They're still scared of it. But you know, life is a risk.
• 9:52
  You know, crossing the road is a risk.
• 9:56
  We have a choice, don't we? We have a choice whether we want
• 9:59
  to cross that road or not and wait for the little Green Man.
• 10:03
  So we should all as women have a choice whether we want to take
• 10:08
  HRT or not. But we're not women generally
• 10:13
  and not given that choice. No, but the also the irony is,
• 10:16
  is that all those studies and all that missing interpretation
• 10:22
  was based on older types of hormone.
• 10:24
  The one that you weren't taking, the one that you're now taking,
• 10:28
  the one that I'm taking is what we call body identical.
• 10:31
  So it's exactly the same hormones.
• 10:33
  No horses urine has been used to make this type of HRT.
• 10:38
  So it's it's sort of like comparing apples and bananas,
• 10:42
  saying all fruit is yellow, like we just can't do it.
• 10:46
  So the conversation, the studies, the research has moved
• 10:49
  on, but the people being scared still hasn't.
• 10:52
  But we also, well, from this study, there was a big
• 10:55
  misunderstanding because it's it what they did, as you probably
• 10:59
  know, is that they were giving the wrong type of HRT to women.
• 11:02
  And they, the average age of women in this study was 64, so a
• 11:07
  lot older than we usually start women on HRT.
• 11:10
  And they found that some of those women had an increased
• 11:13
  risk of heart disease when they started HRT over the old of 60.
• 11:17
  So now lots of doctors think we can't start HRT in women over
• 11:22
  the age of 60 because there's this increased risk of heart
• 11:26
  disease. Actually, that's with the older
• 11:28
  types of hormones. So the natural type of hormones
• 11:31
  we know reduce inflammation on the lining of the blood vessels,
• 11:34
  they help reduce blood pressure, they help the whole
• 11:38
  cardiovascular system to work well.
• 11:40
  So, So in the clinic, we often do start women over the age of
• 11:43
  60 with a lower dose of the natural body, identical
• 11:46
  hormones. But also a lot of doctors now
• 11:50
  think anybody over the age of 60, red flag, you must stop your
• 11:53
  HRT now. Do you know roughly how many
• 11:57
  doctors have tried to stop your HRT?
• 12:02
  I could count them on more than one hand.
• 12:05
  And I can remember I wanted to repeat prescription.
• 12:09
  This is several years ago, my doctor.
• 12:12
  Oh, menopause. Well, it's not really part of
• 12:16
  our remit. And me being a bit arrogant, I
• 12:19
  suppose when as I left, I said, well, I want them so please can
• 12:23
  I have them and also promised me to make it part of your remit in
• 12:28
  future. And she said, Oh yes, we will
• 12:30
  have a meeting about it. And she was a woman, you know.
• 12:35
  But I think you know, people who've perhaps because you have
• 12:40
  brought it all to the fore, you have made people aware that they
• 12:44
  can get help out there. We as women can get help out
• 12:48
  there. I think people from the age of
• 12:50
  say 50 year old where they probably have become menopausal
• 12:55
  and then they've suffered all that time and something you've
• 12:58
  made aware that there's help for us out there.
• 13:01
  But why aren't the doctors so stubborn or so old fashioned or
• 13:06
  set in their ways that they won't give it?
• 13:10
  You know? And I went to one recently again
• 13:13
  and she gave me oh, why, Why are you on HRG?
• 13:18
  That's so mere because I want to be, but it shouldn't be like
• 13:22
  that. And because it should be my
• 13:26
  choice. And if you said to me, yes, OK,
• 13:30
  it might cause this, it might cause that, but then it will
• 13:33
  help you that way. It has to be my choice, surely,
• 13:36
  whether I want to take that risk or not or take that benefit or.
• 13:42
  But we're not given that choice, are we?
• 13:44
  No. And I, I, yes, I mean, there are
• 13:46
  so many doctors I know because you've told me have tried to
• 13:49
  stop your HRT or questioned you or said you should reduce the
• 13:52
  dose. What are you doing?
• 13:55
  And you know, that's even before talking about testosterone.
• 13:57
  You know, it's, it's just quite incredible.
• 14:00
  And I don't know, there's a lack of professional curiosity.
• 14:04
  I think if someone comes to me as a patient and they're asking
• 14:09
  me for treatment that maybe I've not heard of or maybe I don't
• 14:12
  understand, I might not prescribe it in the first
• 14:14
  consultation. But I would always say, let me
• 14:16
  find out about it, let me go to the guidelines, let me read the
• 14:20
  evidence, and then we'll have a discussion.
• 14:22
  And if I don't feel confident prescribing it, I can, you know,
• 14:26
  arrange for you to see somebody else.
• 14:28
  And I've always done that as a doctor.
• 14:29
  No patient expects you to know everything.
• 14:31
  And I think it's not just I don't want to run the medical
• 14:36
  profession down because I think you'll do a fantastic job
• 14:38
  knowing what you've been through.
• 14:40
  To just get your qualifications is is amazing.
• 14:44
  But I think in any profession, a lot of people are set in their
• 14:48
  ways and they've got their routine job and they do it and
• 14:53
  they go home and that and it's a way of life and they don't want
• 14:56
  to explore other avenues. And, and, but you always have
• 15:01
  had that inquisitive curiosity and you've wanted to help people
• 15:06
  so they haven't. And also for a lot of people
• 15:09
  still, it used to be my day that you had to put on your Sunday
• 15:12
  best to go and see the doctor. And it's yes Sir, no Sir, 3 bags
• 15:16
  full, Sir. You know, the doctor was on a,
• 15:19
  a, a pedestal, but it, it shouldn't be like that.
• 15:22
  The doctor should be the friend and you can reach out and help.
• 15:27
  And but with this HRTI remember when I had my first hip
• 15:31
  replacement, then for operations, you had to come off
• 15:34
  HRT. And you know, I was off for a
• 15:37
  while, but I was so glad to get back on it again, because again
• 15:42
  it was. Yeah.
• 15:44
  And that just just to let people know you were not on the type of
• 15:48
  HRT you're on now. Now the type of HRT you're on
• 15:52
  body identical. There's no increased risk, no.
• 15:54
  No, because when I had my second hip done, it was.
• 15:56
  That's fine. You can carry on, Mrs. Newson,
• 15:58
  you know. And just actually, I do remember
• 16:00
  you were feeling quite warm and and sweaty then after your first
• 16:03
  replacement. And yeah, and it probably made
• 16:06
  the recovery harder because you were not feeling so well with
• 16:09
  not being. Hormone, the difference?
• 16:11
  Yeah, yeah. And some people like I, I was at
• 16:13
  a conference recently and they were talking about how to stop
• 16:17
  HRT in our patients and how to reduce the dose.
• 16:19
  And, but why? Well, precisely, I've got no
• 16:22
  idea. But if some people do want to
• 16:24
  stop, there's lots of the doctors are saying, well,
• 16:27
  symptoms will only last however many years.
• 16:30
  But as people know, it's not just about symptoms, it's about
• 16:34
  improving our future health. And so even if you had no
• 16:38
  symptoms stopping as soon as you stopped, you have increased bone
• 16:41
  turnover, increased risk of osteo, increased risk of heart
• 16:45
  disease. And I hope you don't know what
• 16:47
  me saying, but when you had a problem and went to hospital
• 16:49
  last year, the nurse was really shocked that you're not on other
• 16:53
  medication. It wasn't she.
• 16:54
  Do you remember? Yeah, she sort of was quite
• 16:58
  surprised with your date of birth, which I won't say because
• 17:00
  you do look. Glad you keep saying that, you
• 17:02
  know. But she when you said, oh, I'm
• 17:04
  on HRT and I'm on just a heart tablet and she said, what else?
• 17:10
  And you know, people usually are on about a dozen medications
• 17:15
  when they're your age. They're on a blood pressure
• 17:17
  treatment, a statin, A painkiller, a you know lots of
• 17:21
  and and you're not. And I know I feel very, very
• 17:24
  fortunate and I'm sure it's well thanks to my family.
• 17:27
  But a big thank you to HRT because as you know, I only
• 17:32
  retired last year from work and it's not, it's not funny, no, I
• 17:37
  think. It's incredible.
• 17:38
  No but so but I know if I hadn't been on HRTI wouldn't have been
• 17:43
  able to keep going because I see friends who are my same age.
• 17:47
  I've got 2 particular close friends who were students with
• 17:52
  me, one I first met when I started teaching and they both
• 17:58
  sadly got dementia. And it, it, it's really sad.
• 18:02
  And if there's any chance of stopping that or helping us.
• 18:06
  And you know, if as I said to my doctor when she said recently,
• 18:10
  you know, you come off and I go why, why do I have to?
• 18:14
  And again, it's probably because it's expensive for them to
• 18:17
  prescribe it to me. Is it?
• 18:18
  I don't know. No it's not.
• 18:20
  That's the irony of it. It is actually really cheap, and
• 18:23
  even if you look at the risks of the worst type of HRT, it's
• 18:26
  still less than most other medications.
• 18:29
  But it's also about keeping people well for as long as
• 18:33
  possible. Well, and and then long term
• 18:35
  that's cheaper for thee it. Is absolutely is.
• 18:39
  But I also feel it does. It's a, you mentioned bones and
• 18:42
  everything, but I think it's also your skin, your hair and
• 18:46
  all those because again, I have several friends who, you know,
• 18:49
  really look wizened and you might, I might look in the
• 18:53
  mirror sometimes like, Oh my God, yes, but you know,
• 18:56
  hopefully. Well, we've talked about this
• 18:58
  too with Sad Rajpath, the dermatologist that you know as
• 19:01
  well, because you know, I've, I've been told off in meetings
• 19:05
  before saying Louise, people just take HRT because they want
• 19:08
  to have nice skin and that is terrible.
• 19:10
  Well, firstly, actually people want nice skin.
• 19:12
  That's not such a bad thing, but also the skin is an organ, It's
• 19:17
  living. We have blood vessels going
• 19:18
  through it and everything else, and the skin is a window to what
• 19:22
  else is going on in our body. Really important actually.
• 19:25
  And if people lose collagen from their skin, from their faces,
• 19:29
  they're going to lose collagen in their bones and their
• 19:31
  muscles. So they're going to be more at
• 19:34
  risk of having osteoporosis as well.
• 19:37
  So we have to be really clear about our skin is important.
• 19:41
  But the other thing is that a lot of people who are older,
• 19:45
  especially women, have ulcers in their on their legs and that is
• 19:49
  a real problem. And I know when I was AGPI had
• 19:52
  so many patients where the nurses would go in and out do
• 19:55
  all these things. Going yourself?
• 19:57
  Yeah, And we know there's a study that Saj and I found from
• 20:00
  decades ago showing that women who take hormones have, guess
• 20:04
  what, a lower incident of ulcers.
• 20:07
  Now the if you can imagine the cost of nurses going back and
• 20:11
  forth to somebody's home for the dressings and all that, but.
• 20:14
  Getting back to this sort of you said people their skin.
• 20:17
  If I want to take it because because it helps my skin, why
• 20:21
  shouldn't I? Why shouldn't I be allowed to?
• 20:24
  But can I ask you one question which I found really confusing
• 20:29
  the lot lot of almost several of my friends have been to the
• 20:31
  doctors. They're not getting HRT help,
• 20:34
  but they're advised to take antidepressant.
• 20:38
  So as I took antidepressant after your father died, but it's
• 20:43
  really hard to come off them. But as far as I in my naivety,
• 20:48
  antidepressants sort of dull the brain, don't they?
• 20:52
  And it's supposed to calm you down.
• 20:55
  But if you take HRT, it stimulates the brain so it
• 21:00
  brings you back to life. But if you come off, you don't.
• 21:04
  It doesn't. You don't have withdrawal
• 21:06
  symptoms or anything like that. So why is our antidepressants
• 21:12
  more important than HRT as far as some medics are concerned?
• 21:17
  Got a great question and I wish I could answer because it's
• 21:19
  easier actually for most women to get antidepressants than it
• 21:23
  is HRT. You're.
• 21:25
  Absolutely right. A lot of women who take
• 21:27
  antidepressants when they're not clinically depressed will say I
• 21:31
  just feel like I'm numb. I feel like I don't have
• 21:34
  emotions. I don't have sad emotions, but I
• 21:36
  don't have happy emotions. I feel like I'm going through
• 21:40
  processes in life without thinking about I'm just a robot
• 21:44
  and that shouldn't be right. Yes, we don't want people to be
• 21:47
  sad, but we really want people to be happy as well.
• 21:50
  So having the right balance of the happy hormones, if you like
• 21:56
  the good neurotransmitted is really, really important.
• 21:59
  And often when women are on the right dose and type of hormones,
• 22:03
  they'll say my life is in colour again.
• 22:05
  It's not black and white. That zest for life is come back,
• 22:10
  that joy, and that's really important.
• 22:13
  But one of the problems is it's very hard to measure that in
• 22:16
  studies. And in studies a lot of it has
• 22:19
  been looking at flushes and sweats.
• 22:20
  Because if I was analysing you, if you're better on HRT and I
• 22:24
  had my little clipboard with my tick box, I could see you having
• 22:28
  a flash. I could actually monitor that.
• 22:30
  If you tell me one day, oh, doctor news and I feel a bit
• 22:33
  happier. Well, I might not believe that
• 22:36
  that's due to your HRT. And then it's very hard to
• 22:38
  quantify in a study. So it's easier to exclude that
• 22:42
  sort of data and just think objectively about the symptoms
• 22:45
  that I can see as a scientist. Yeah, but we're all different.
• 22:49
  Of course we are. And I'm, I'm not a flat, you
• 22:52
  know, clipboard. I'm a person, a human being,
• 22:55
  absolutely. You know, I might be different
• 22:57
  to someone else. But, and it's we're all
• 22:59
  individuals, so we should have that choice.
• 23:02
  But what's what's I find, as you know, I spend most of my time
• 23:05
  very frustrated. But I find it frustrating
• 23:07
  because we have known for many years that well-being can
• 23:11
  improve with hormones and even some of those quite awful
• 23:14
  adverts in the 60s, yeah, did have women behind of a steering
• 23:19
  wheel of a car saying, you know, her well-being, she's happy,
• 23:22
  she's joyful. And actually that's not a bad
• 23:24
  thing if that's all it did. Yeah, it's not bad because
• 23:27
  certainly in the 60s there were a lot of other drugs been given.
• 23:31
  There were barbiturates been given, there were
• 23:34
  benzodiazepines been given, there were lots of amphetamine
• 23:39
  type drugs to try and boost people.
• 23:41
  And there was very much, we want women to be happier because then
• 23:45
  they'll be better at home, there'll be better housewives
• 23:48
  and all that. But we've known that hormones
• 23:52
  can help because we're replacing what's missing.
• 23:55
  But I wonder sometimes whether it's just because people don't
• 23:59
  want women to be the best version of themselves.
• 24:01
  They don't want them to be strong, independent women.
• 24:05
  Because we are still suppressed human beings, aren't we really?
• 24:11
  And of course, you know, in my day, it's not so many women had
• 24:15
  careers, you know, you didn't sort of have female lawyers or
• 24:21
  not many doctors. It'd be you, you know, come up
• 24:24
  against discrimination as far as being a female doctor.
• 24:27
  And that's still going on. And, and, and still, you know,
• 24:31
  my, my father was very much my mother's place was at home, but
• 24:36
  with a keen penny and, you know, cooking his meals and
• 24:39
  everything. And she wasn't allowed to have a
• 24:41
  career or anything. And, you know, when I was first
• 24:44
  married, I was doing the drama and everything.
• 24:47
  And I can remember my father saying your place is at home
• 24:50
  looking after your husband. And of course, your father, he
• 24:53
  was so supportive and you know that that that's what it should
• 24:56
  be all about. But I, I just feel that you,
• 24:59
  you, I know you're my daughter and I'm very proud of you,
• 25:02
  obviously. But I think you're doing a
• 25:04
  fantastic job to fly the flag for women.
• 25:08
  And I don't know anybody who's worked as hard as you and
• 25:12
  researched as much as you have on HRT and, you know, putting it
• 25:18
  out and, and giving us the opportunity to make a decision
• 25:23
  for ourselves. You're not telling us we have to
• 25:26
  take HRT. You're giving the pros and cons
• 25:29
  and giving us a choice. And it should be freedom of
• 25:33
  choice. Yeah, I think thank you.
• 25:34
  And I, I think that's so important because other things
• 25:39
  in life we can choose. Obviously some things we can't
• 25:42
  choose as we know, but we can choose what we eat.
• 25:45
  We can choose whether we exercise, we can choose whether
• 25:48
  we drink Sherry at 6:00, but that's fine.
• 25:54
  They they won't judge you. How many dogs has have said to
• 25:56
  you, how much Sherry do you drink?
• 25:57
  And is it they it's. Probably worse than than.
• 26:01
  Well, it is, isn't it? It couldn't be addictive.
• 26:04
  Yeah, yeah. And so it it does seem like just
• 26:08
  wrong that women, I can't think of any other medicine that's so
• 26:12
  hard for people to obtain as well when we've got the
• 26:15
  guidelines showing the benefits of.
• 26:17
  In our way, the guidelines are a bit strange, aren't they?
• 26:22
  Well, it depends which guidelines.
• 26:23
  There's many, Yeah. I mean, there's many different
• 26:26
  guidelines, and it can be very confusing for people.
• 26:28
  But we know that the benefits outweigh the risk.
• 26:31
  I find it, you know, we've got lots of good evidence about how
• 26:35
  safe hormones are, how different the body identical hormones are
• 26:38
  compared to the synthetic hormones.
• 26:41
  And we don't have evidence showing us that there are risks
• 26:44
  when we start HRT and older women or continue it.
• 26:48
  And we have to remember the health benefits too.
• 26:51
  So again, it goes back to choice.
• 26:53
  It goes back to allowing people to choose and also knowing that
• 26:57
  there is some uncertainty. There's uncertainty and lots of
• 27:00
  things we do. And women can usually, yeah,
• 27:03
  women can usually make that decision.
• 27:05
  But in my mind, like you say, the most important thing is
• 27:08
  having that patient in the centre of their decision making
• 27:11
  processes and reviewing that decision.
• 27:13
  We review people every year. So if you change your mind, of
• 27:16
  course, you can change your decision about whether to
• 27:19
  continue or if you we need the dose changing as well.
• 27:24
  So very grateful for you being quite so open.
• 27:26
  Thank you. And just to end on three tips.
• 27:30
  And this is really, I think that people would find it useful to
• 27:33
  know three things that have worked actually for you.
• 27:37
  When you've seen your doctor and you've wanted to continue your
• 27:41
  HRT, what are the three things that you feel have worked that
• 27:46
  you have been able to continue having HRT on your repeat
• 27:49
  prescription? I think, sadly, we still have to
• 27:54
  thump the desk. We still have to thump the
• 27:56
  table. And if we're not given the
• 27:59
  choice, we have to, you know, stick to our guns.
• 28:02
  And if our doctors won't give us, then we have to move on and
• 28:05
  find another doctor. We mustn't take no for an answer
• 28:09
  because life is for today and it's not a rehearsal.
• 28:13
  And we as women must be given the choice.
• 28:19
  That's probably three things all in one, isn't it?
• 28:21
  But you know, I'd like, I know we're going to end now, but I
• 28:24
  would like to say please continue your work.
• 28:28
  I know you've had lots of people anti, but please go for it.
• 28:32
  I will be there flying the flag for you.
• 28:35
  And I know there are a lot of women who will be and want to
• 28:39
  be. Thank you.
• 28:41
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• 28:47
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