Latest / The Dr Louise Newson Podcast / 46 - Why understanding your hormones changes everything

Transcript

46 - Why understanding your hormones changes everything · The Dr Louise Newson Podcast

• 0:00
  I have a professor of endocrinology, which is the
• 0:02
  study of hormones. On my podcast today, Mary Ryan
• 0:05
  has come over from Ireland. We talk a lot about hormones in
• 0:08
  general, what they are, how they all work together, how magical
• 0:11
  they are for our bodies to function well and how they so
• 0:15
  often have been misunderstood. So enjoy this episode.
• 0:20
  So Mary, I'm really excited to finally meet you in real life.
• 0:24
  Thank you because we've been coming to spending.
• 0:26
  For a while. And and in fact, when you first
• 0:28
  wanted to come on my podcast, I didn't.
• 0:30
  I wasn't doing it out of the studio.
• 0:32
  Yeah. And now you're here.
• 0:33
  You've flown over from Ireland with your lovely son.
• 0:35
  Thank you. And, you know, I had Fenella on
• 0:38
  my podcast talking about Ireland.
• 0:41
  And I wish you could say that it's better than over here for
• 0:45
  access to hormones, but I don't think it is really, is it?
• 0:47
  No. No, a lot of our patches like
• 0:50
  Easter dots are unavailable and with generic patches that don't
• 0:54
  absorb as well and they're falling off and patients are
• 0:56
  sticking them on with tape, which isn't ideal, but we're
• 1:00
  we're we're both empowered women, Louise, So we're going to
• 1:04
  just keep advocating. Yes.
• 1:05
  And, and we really believe that this, you know, women are need
• 1:09
  treatment. And it's just, you know, when we
• 1:12
  think what women and, and one of the reasons I and you got
• 1:15
  involved in all this area was that we heard the stories.
• 1:17
  And as, as doctors, we hear his stories and the real stories.
• 1:21
  And I think that's what we're privileged as doctors to hear
• 1:23
  the real stories. But unfortunately, we heard the
• 1:25
  stories of suffering of women in their 60s and 70s and 80s who
• 1:29
  told me how they were severely anxious, severely depressed.
• 1:32
  You know, one woman said how she had dreadful perianal itching,
• 1:36
  dryness, intimacy, was absolutely not able and it
• 1:40
  completely destroyed her marriage.
• 1:42
  So we heard all those stories of suffering and you know, those
• 1:46
  women lived what should have been the best years of their
• 1:49
  lives postmenopause. They lived them in a in a
• 1:52
  dreadful way. And I was really anxious and you
• 1:55
  were very anxious to change that.
• 1:57
  And I think that's what we're doing.
• 1:58
  We're empowering women, we're empowering society because not
• 2:01
  only women are we empowering, but if, if women are healthier,
• 2:04
  then their sons, daughters, partners are healthier.
• 2:08
  It's a healthier society for all.
• 2:10
  So that this is so important and and that's what we're about
• 2:13
  really. Absolutely.
• 2:14
  And you're, you're right there. You know, I feel everyday I've
• 2:17
  so privileged being a doctor and being a practising clinician as
• 2:21
  well, because the stories that we hear and we can't choose the
• 2:24
  people we, we speak to, it's so true, which again, is the real
• 2:28
  privilege. It's when I was a junior doctor,
• 2:30
  I used to find it very scary because the consultations would
• 2:33
  change so much or people would tell you things that you've
• 2:35
  never heard before. Yes, gosh, this is a huge
• 2:38
  responsibility. This is a confidential
• 2:41
  consultation. They're telling me things that
• 2:43
  perhaps they've not told other people before.
• 2:45
  Yeah. They're looking at you to help
• 2:48
  them. You might not have all the
• 2:50
  answers, but you really, really want to help them.
• 2:53
  And you learn. I mean, every day is a learning
• 2:56
  day when you're practicing clinician.
• 2:57
  Incredible, incredible. And we're so privileged to be
• 3:00
  able to help them. But I think that's why we're
• 3:02
  such a profound duty as well. And particularly as women, I
• 3:04
  think because women with a great understanding of women and I
• 3:07
  suppose you know, women weren't always in medicine.
• 3:10
  It's a hard being a woman of medicine.
• 3:12
  Thankfully there's a lot more of us now, but I think, you know,
• 3:15
  we're, we're very anxious that Women's Health comes forward.
• 3:18
  Yes. And just as much as I want men's
• 3:19
  health to come forward to, there's a lot of research in
• 3:21
  that area because I have two sons and I want that and, and,
• 3:24
  and you similar. But you know, Women's Health has
• 3:27
  been so left behind that I really, really want to make a
• 3:31
  difference. And I know you're doing that in
• 3:33
  space. Yeah.
• 3:34
  And we're all anxious to do the same.
• 3:35
  Tell me a bit about your background being a medic so.
• 3:38
  I'm a consultant anthropologist, which basically anthrologist
• 3:41
  means hormones and hormones as we know are chemical messengers
• 3:46
  and I, they basically operate everything.
• 3:48
  So, you know, every organ in the body is operated by hormones.
• 3:52
  The bowel is operated by hormones with a little hormone
• 3:55
  Control Center on the top. As you know, I always talk about
• 3:58
  the master controlled plan called the pituitary and that
• 4:00
  controls everything. And the hormones work in a very
• 4:04
  circadian rhythm and we have such control and a lot because
• 4:07
  they, if there's a positive and negative feedback.
• 4:10
  And as women in particular with periods, you know, if we've
• 4:14
  heavy periods, perimenopause, where there's hormone imbalance,
• 4:17
  that all affects the hormone Control Center and that
• 4:20
  therefore effects everything else.
• 4:22
  So that's, you know, I always say to patients, you know,
• 4:24
  that's why your bowel is off, because hormones draw your bowel
• 4:27
  muscle. And it's important people know
• 4:29
  that because they're wondering why am I bloating?
• 4:30
  Why am I, you know, and it's all hormonal.
• 4:33
  It's not in your head, you're not making it up.
• 4:36
  And I think that's the appreciative thing that patients
• 4:39
  love is that education. So I'm a consultant
• 4:42
  entrecologist, which traditionally always dealt with
• 4:44
  diabetes, thyroid, polycystic ovaries.
• 4:48
  But I think we as a woman, I was very anxious as female
• 4:52
  endocrinologist to, you know, I heard the stories about the
• 4:55
  menopause. I heard about, I knew we were
• 4:56
  trying to prevent osteoporosis. And I said we need to do more
• 4:59
  because we're not treating as adequately if we're not giving
• 5:02
  these women estrogen when they should be getting it or if the
• 5:05
  women were coming in with desperate sweating and flushing
• 5:08
  and restless legs, it wasn't enough just to be giving them,
• 5:11
  you know, drugs for a peripheral nerve.
• 5:14
  Why? Why not try estrogen, which we
• 5:16
  know helps and reduces the histamine release on the itch.
• 5:19
  And then, you know, the vaginal estrogen pesterase to prevent
• 5:22
  the UTI's and the sepsis that we know women get as they get older
• 5:26
  and prevent hospitalization. So there was a whole learning
• 5:29
  carve and even the heart disease, we know that Eastern
• 5:32
  reduces bad cholesterol and improves the good cholesterol.
• 5:35
  So there was all of this that we weren't doing and wasn't being
• 5:39
  done. So I really felt that it was
• 5:40
  important as a woman to talk. And we we live in a very
• 5:44
  institutionalized medicine. So what I did was I went out and
• 5:48
  I spoke to the public and educated the public.
• 5:51
  And that was a very good way because you got all the stories.
• 5:55
  You really created a momentum. And then what happened to
• 5:58
  Ireland was Joe Duffy was a famous presenter and RT invited
• 6:02
  me on to his radio show and he asked me to tell me some of the
• 6:06
  stories and talk to a woman who was saying she's a creepy crawly
• 6:08
  sensation on her face. And I said, but that's that's a
• 6:11
  symptom, you know, because you have a little nerve going to the
• 6:13
  muscle hormones go down the peripheral nerve.
• 6:15
  If the hormones are off, that's why you get the creepy crawly
• 6:18
  sensation. And next thing the phone lines
• 6:20
  were flooded and all these women are ringing in about their
• 6:23
  stories. That was wonderful because it
• 6:24
  created change in Ireland. And suddenly we had the, you
• 6:28
  know, menopause really taken center and we got now, you know,
• 6:32
  have the HRT free in Ireland which.
• 6:34
  Which is absolutely. Fantastic.
• 6:35
  Yeah, yeah. So, so as I said, it actually
• 6:38
  has opened up and it was always about hormones anyway.
• 6:40
  And we should all be involved in in improving hormonal health.
• 6:44
  So that that's what. Endocrinology, I think it's
• 6:46
  really interesting because often when we talk about hormones in
• 6:51
  women, people always think just about estrogen.
• 6:53
  They don't even think about, they didn't even realise that
• 6:57
  other types of estrogen, but also all the other hormones as
• 7:00
  well. Totally.
• 7:01
  You know, it's endocrinology I used to love as a, as a junior
• 7:05
  doctor, I work for an endocrinologist and people would
• 7:08
  come in to have various tests like the shorts and acting tests
• 7:11
  and they'd have a day case unit where people would come and do
• 7:14
  these amazing tests looking for diseases like Cushing's disease
• 7:18
  and various things. So very rare.
• 7:20
  And occasionally, you know, you'd pick something up a lot
• 7:23
  like you say about thyroid. And I used to work in a diabetes
• 7:26
  clinic as well, but I was never taught about menopause then at
• 7:30
  all. No, no, it.
• 7:31
  Was nothing. It was almost like that part of
• 7:35
  the brain and the body and those humans were ignored by
• 7:38
  endocrinologists. And also the fact that
• 7:40
  autoimmune disease was way more common in women, particularly
• 7:43
  around postpartum when estrogen levels dropped, particularly on
• 7:47
  perimenopause when estrogen levels dropped, that was never
• 7:49
  looked into. And of course we now know what
• 7:51
  research that estrogen is very important with the whole innate
• 7:54
  adaptive immune system and reducing, you know,
• 7:57
  inflammation. And so, so the questions weren't
• 8:00
  asked back then. And I think we're now asking the
• 8:02
  questions, which is? Absolutely right.
• 8:04
  And and even now you know, I see quite a few patients who've had
• 8:08
  a pituitary adenoma. So, so a growth in the pituitary
• 8:11
  gland and it's stopped. There are a hormone production,
• 8:14
  they give an ad back hormones, but not progesterone, estradiol,
• 8:18
  testosterone. It's almost like that signal.
• 8:20
  You don't need those. Absolutely.
• 8:22
  And I see women who then have osteoporosis or they've had
• 8:25
  extreme fatigue or they've had all sorts of other symptoms and
• 8:29
  it's only like, oh, only have those hormones if you if you
• 8:31
  need or if you're thinking about becoming pregnant.
• 8:34
  And they're not just the totally hormones.
• 8:36
  Totally. And when I was speaking to a
• 8:38
  female gynecologist recently and she said one of the practices
• 8:41
  that she doesn't like is that, you know, a lot of gynecologist,
• 8:45
  before he used to take out ovaries and when a woman was
• 8:47
  menopausal, But they forgot the fact that those ovaries, 10
• 8:50
  years postmenopausal, produce testosterone, which can be
• 8:53
  converted into estrogen. So they have a purpose.
• 8:55
  So unless they need to be taken out, don't take them out.
• 8:58
  Yeah. You know, and this is all
• 8:59
  education that we have to do because you said, Louise, it
• 9:01
  wasn't done in medical. School.
• 9:02
  No, it wasn't. And you know, I, I, I've said it
• 9:05
  before so people know I had a hysterectomy a few years ago,
• 9:08
  yes. And I was early 50s and I
• 9:10
  decided to keep my ovaries in, whereas if 10 years ago I was
• 9:13
  going to have a hystereo, I probably would have said, oh,
• 9:15
  take them out because then I'll never get ovarian cancer because
• 9:18
  that's obviously why a lot of people take them out, of course.
• 9:20
  And then my gynecologist said to me, well, when you're 55, you
• 9:23
  need to come back and we'll take them out for you.
• 9:25
  When I'm now 55, I'm not going to have my ovaries taken out.
• 9:28
  And that's because they still secrete, yes, hormones.
• 9:31
  And we're very simplistic when we talk about hormones because
• 9:35
  we talk about progesterone, we talk about estradiol, estradiol,
• 9:39
  estradiol, estrin, different types of estrogen.
• 9:42
  We talk about testosterone but there's loads of they've just
• 9:47
  not been looked at. No, no, no, not at all.
• 9:49
  And I suppose that, yeah, I always say to patients, you
• 9:51
  know, with such control in in eating healthily, in recharging,
• 9:56
  in resting and meditating. Because the the more that we all
• 10:00
  are at 10 out of 10 energy, the better our hormone Control
• 10:03
  Center is, the better it is at helping whole hormone, you know,
• 10:07
  controlling it with that lovely circadian rhythm and, and just
• 10:11
  helping all our organs because hormones control everything.
• 10:13
  Whether we laugh, whether we cry, whether we're happy, yeah,
• 10:16
  you know, whether we fall in love.
• 10:17
  Yeah, it's massive. And I think look at that and.
• 10:19
  It is really interesting because our hormones work in conjunction
• 10:22
  with each other as well, and for so long people have thought
• 10:26
  about them being ovarian hormones, yes, reproductive
• 10:29
  hormones, period hormones, just like down in the pelvis.
• 10:35
  Whereas when I see people, I've got some patients who are
• 10:37
  athletes and they say, gosh, when I'm doing a really long
• 10:40
  race, I, I think I need to increase my estadiol.
• 10:43
  And I said, well, you probably do because you've got more
• 10:45
  adrenaline, you've got more cortisol, you've got more other
• 10:47
  hormones and there's this balance.
• 10:49
  They all work together. Yes.
• 10:51
  And then we see it's a lot of people who are perimenopausal,
• 10:54
  their thyroid hormones become off kilter totally.
• 10:58
  And they often have seen maybe an endocrinologist had lots of
• 11:01
  different thyroid hormone treatments still haven't been
• 11:04
  quite right. And then you give them estadiol,
• 11:07
  maybe progesterone, testosterone and and their thyroid.
• 11:09
  Absolutely. It just works so much better.
• 11:11
  Totally, totally. And I think one of the things we
• 11:13
  really need is more research, you know, for all of us, because
• 11:17
  we, we all have great knowledge and we are all now in this
• 11:19
  better understanding and we're reading around it all the time.
• 11:22
  And the, the one thing we do need, though, as physicians is
• 11:25
  more research. And of course this wouldn't have
• 11:26
  happened, only that we're all having the conversation.
• 11:28
  And now we want that research done on testosterone.
• 11:31
  We want the research done, eh, where, where you know, I believe
• 11:35
  that we will be rewriting the books at the moment they're now
• 11:37
  saying we, we give it a six 60, right?
• 11:39
  I believe. And and we now know that as
• 11:42
  individualized, we're looking after patients where you try to
• 11:44
  wean it off and they're not, they don't do well and you put
• 11:46
  them back on it. But I believe that's all going
• 11:48
  to change because when we see the research, which hasn't been
• 11:52
  done to date of, you know, how this will help heart, because we
• 11:56
  know it lowers, it helps the, you know, before 60.
• 11:59
  It does lower the bad cholesterol, increase the the
• 12:01
  good and helps with our chair wall.
• 12:04
  But therefore, you know, that must help later on and we need
• 12:07
  to see that. And the same with with it'll
• 12:10
  just give patients more confidence and those physicians
• 12:12
  more confidence. So that research has been done,
• 12:14
  but it won't be done unless we advocate for it.
• 12:16
  So that's what we're doing. Absolutely.
• 12:17
  And in the meantime, when we haven't got the research, we can
• 12:20
  still look at common sense and basically we've always.
• 12:23
  Treated patients as individuals, They can't be done as a big
• 12:27
  group. You know, we're all very
• 12:28
  individual and we always listen to their histories and everyone
• 12:32
  has a different history. So, yeah, as good physicians,
• 12:34
  we've always done there. Absolutely.
• 12:35
  And I think also we can unpick the science totally.
• 12:39
  And the problem is with the WHI, the Women's Health Initiative
• 12:42
  study that came out in 2002, it wasn't using the hormones that
• 12:45
  we prescribed now. So they were synthetic
• 12:48
  chemicals. Totally.
• 12:49
  You know the estrogen was made from pregnant.
• 12:51
  And they were older when the Garthatra teeth, you know, when
• 12:53
  rather than getting younger, which is what we.
• 12:56
  They started it older, but the big the big problem was really
• 12:59
  the progesterone totally with the majority.
• 13:01
  Progesterone acetate is a synthetic progesterone, yes, and
• 13:05
  we don't prescribe that. So the risks we've always known
• 13:07
  are there for cardiovascular disease, for clot, totally.
• 13:10
  Even for cancers as well. It's only small risk.
• 13:13
  Yes, yes. But actually now if I see a
• 13:15
  woman in her 60s, seventies, 80s, I've had one lady who was
• 13:18
  90 who wanted to start HRT, yes, we can say, well, we don't have
• 13:22
  the studies, but we do know that the hormones work.
• 13:25
  Absolutely. And we're making new cells all
• 13:27
  the time. Absolutely.
• 13:28
  And each cell has got an Estradi receptor on it, progesterone
• 13:31
  receptor, testosterone receptor. They work, as you say, to reduce
• 13:35
  inflammation. Absolutely.
• 13:37
  So I can't see in the body how like our bodies know, oh, you're
• 13:41
  61 now you're going to respond differently to the hormones.
• 13:44
  It it doesn't make sense. Absolutely, and bone health is
• 13:46
  huge. 'Cause you know and it's.
• 13:48
  Huge as we get older, yeah, particularly as women.
• 13:51
  We all know women that's going on with Dodger Hump and we're
• 13:54
  thinking, you know, that's so preventable and yes, diet is
• 13:57
  important. We all advocate that and we all
• 13:58
  have educate our resistant exercises and our vitamin D, but
• 14:02
  we know estrogen works so well and testosterone as well.
• 14:05
  Yeah. So, so all of this, you know, is
• 14:07
  so important for women and, and that's why I'm so thrilled that
• 14:10
  we're talking this. But also we know the research is
• 14:13
  is ongoing and it's going to help.
• 14:15
  More and more women. So we think about Bonehouse.
• 14:17
  It's interesting because there was an article in the British
• 14:20
  Medical Journal about osteopenia, yes, and they
• 14:22
  presented a woman I can remember Exact's age.
• 14:24
  I think she was 52 or she was early 50s 'cause they often do a
• 14:28
  case and then what would you do? And then they do the evidence.
• 14:30
  So it's great article, but it's talking about somebody who had
• 14:33
  osteopenia. So this is reduced bone density.
• 14:36
  And then they went through whether she needed a, a, a scan
• 14:39
  and the, the frac score and all this, these things.
• 14:43
  And then there was one sentence about HRT, but it was basically
• 14:46
  saying if her frac score was great, if she had a really high
• 14:50
  risk of fracture, then considered treatment.
• 14:53
  And obviously there were all the treatments with bisphosphonates
• 14:55
  and various other things. But what they never said was
• 14:58
  the, you know, about menopause, about HRT being licensed as a
• 15:03
  treatment to prevent osteoporosis.
• 15:05
  And in my mind, if anyone is menopause or perimenopause are
• 15:09
  regardless of their age and they have reduced bone density, they
• 15:12
  should be considered. Without question, absolutely.
• 15:15
  Yeah. Particularly now with the safe
• 15:16
  methods of giving it and even with the patients with the
• 15:19
  family history, we can do the bracket gene testing.
• 15:21
  It's wonderful. We've all this available now for
• 15:24
  us. So there's so much because I
• 15:26
  think for too long there's been the scare tactics out of or what
• 15:28
  if. But the reality is, is breast
• 15:31
  cancer is, is much lower than the, you know, obesity And you,
• 15:35
  I saw your studies that come out on the, the, the patients you
• 15:37
  follow, obesity and smoking are of much higher risk of breast
• 15:41
  cancer than HR. And as we now know, as you said,
• 15:45
  with the transdermal and the sprays where we, you know, that
• 15:48
  that's a much safer method of giving it.
• 15:50
  You know, the other thing that I don't think they advocate not
• 15:53
  for is the mood. We all know we've women coming
• 15:55
  in. They're saying, Oh my God, I
• 15:56
  feel a different person and progesterone, you know, it's a
• 15:59
  natural way of helping our GABA, which is our calming
• 16:02
  neurotransmitter. I mean, that's wonderful.
• 16:04
  And now they're suggesting that also helps in inflammation and
• 16:07
  reducing it. Absolutely.
• 16:08
  So, you know, as well as helping women's mood and feeling better
• 16:11
  and the whole family feeling better, you're also helping
• 16:14
  their immune system, you know, and that's got to help too with
• 16:17
  heart and just soft developing plaque as well, because we know
• 16:19
  that that's inflammation. So as you said, everything is
• 16:22
  related. So I'm super excited to announce
• 16:27
  to you that my next book is now available for pre-order.
• 16:30
  It's coming out on May the 21st. It's called the Power of
• 16:35
  Hormones. Break free from fear and
• 16:38
  misinformation about hormones and harness them for a
• 16:41
  healthier, happier life. It's very historical, it's very
• 16:45
  factual. It talks about how hormones work
• 16:48
  in our body and the mess that we're in actually when we don't
• 16:51
  have them. There's a lot of information,
• 16:54
  it's taken a lot of work and I really hope you enjoy it when it
• 16:58
  comes. So you can find out more about
• 17:01
  it on my website, on my social media, and pre-order it.
• 17:07
  Because I've got a pathology degree and I really spent a lot
• 17:11
  of my time in my science degree looking at the role of the
• 17:13
  macrophage. I love that favorite cell you
• 17:15
  did A. Great job of that in Australia,
• 17:17
  I enjoy that. Thank you.
• 17:18
  Well, it's the most amazing cell because it protects us from
• 17:22
  inflammation if it's working well in the right micro
• 17:25
  environment, but it can turn against us very quickly.
• 17:28
  So it not only doesn't work as well, it works against us.
• 17:32
  And this is what a lot of people don't realise.
• 17:34
  It can become pro inflammatory. So that's really can be
• 17:38
  detrimental to our health. And it's very interesting when
• 17:41
  you think about autoimmune diseases.
• 17:44
  Which is hiring those women? Yeah.
• 17:45
  Which is. They're more common in women.
• 17:47
  They're more common in the late 40s.
• 17:50
  Like, what else is going on then?
• 17:52
  And you know, when I did a rheumatology job many years ago,
• 17:54
  we would we would just be dishing out Prednisolone and
• 17:59
  methotrexate. And I know things have moved on.
• 18:01
  The biologic agents are now available to people.
• 18:04
  And of course, these drugs have a role.
• 18:06
  He could prevent it to be. Fabulous.
• 18:08
  Wouldn't it be great, Yes, to actually target the problem.
• 18:12
  So if we can change our immune system so that it's working
• 18:15
  better for us, it's not working against us totally.
• 18:19
  And thyroid. Disease is the same way and
• 18:21
  women have a much high instance of thyroid disease.
• 18:23
  I mean, the bone covers is, is women.
• 18:25
  Yeah. And it's autoimmune.
• 18:27
  So in the same way. And then we we do believe it has
• 18:29
  it's, you know, we know what happens at key times in the
• 18:31
  cycle. It's either a right eye after
• 18:34
  having a baby, Yeah. Or it's around perimenopause,
• 18:37
  menopause. So it's all at times of hormone
• 18:39
  imbalance. Yeah, absolutely.
• 18:41
  And so I think we need to really think about hormones in very
• 18:44
  different ways and also just take it away from the ovary a
• 18:48
  bit. Yes, because even our heart
• 18:51
  muscle produces estudiol. Our muscles in general are very
• 18:55
  metabolically active and I'm sure a lot of women who exercise
• 18:59
  regularly don't need as much hormones because they're
• 19:02
  producing them from their muscles.
• 19:03
  Exactly. We've not done good studies to
• 19:06
  really see true, you know, and I see in the clinic, you know, I
• 19:09
  start off on a dose of hormones for, for somebody and then they
• 19:13
  feel better. So they're exercising more,
• 19:14
  they're eating more, maybe their body shape changes, they have
• 19:18
  less fat, they have more muscle. And then they, they need a
• 19:21
  different amount of hormones and they're like, what's going on,
• 19:24
  doctor? And it's like, well, your body,
• 19:26
  your metabolism has changed, your requirement for for
• 19:29
  hormones has changed and, and maybe parts of your body are
• 19:32
  producing more of those hormones, but it's always been
• 19:36
  the ovaries. Totally, totally.
• 19:38
  And but that's actually one thing I love it about it.
• 19:41
  You do the holistic approach, you see the person as a whole
• 19:44
  cool related. And that's really what we're
• 19:47
  saying here, hormones, it's, you know, everything is
• 19:50
  interconnected. And if you don't see that, you
• 19:54
  can't. And that's why I always say to
• 19:55
  patients, you know, keep it the diet as on process, as organic
• 19:59
  as you can, because we know that interferes with hormones.
• 20:01
  You know, make sure you get your rest, your pace, make sure you
• 20:04
  exercise, but don't overdo it because otherwise you're getting
• 20:07
  a prolactin hormone up that's going to interfere with
• 20:09
  ovulation and getting carts all too high and so forth.
• 20:12
  So it's about moderation and it's about listening to your
• 20:15
  body, and the body will dictate, but that's all about hormones
• 20:18
  really. Isn't it?
• 20:19
  You know so. It's absolutely is.
• 20:21
  And you know, it's, it's interesting.
• 20:23
  I had a patient many years ago who was in her 70s and she had
• 20:27
  had her ovaries removed in her 40s and she always experienced
• 20:32
  really bad PMDD, so premenstrual dysphoric disorder.
• 20:35
  Her mood dropped at the beginning of the month just
• 20:37
  before her periods and she had her ovaries removed to try and
• 20:40
  cure this and it hadn't helped at all and she saw me and she
• 20:44
  said doctor still at the beginning of every month I get
• 20:46
  this drop in my mood and I wonder if there's anything that
• 20:48
  could be done now. She had never had hormones and I
• 20:51
  gave her hormones for her bone health and heart health and so
• 20:54
  forth. But it niggled me like why was
• 20:57
  she talking about this change? Because this was several years
• 20:59
  ago. And I thought, well, her ovaries
• 21:02
  produce the cycle, so she doesn't have ovaries.
• 21:04
  And now of course, labour hormones are made in our brain
• 21:07
  as well and they're determined by pulses that come from
• 21:11
  hypothalamus and so forth. And I thought, gosh, it's really
• 21:13
  interesting. It's still very simplistic
• 21:16
  medicine that often gynecologists choose to remove
• 21:18
  the ovaries because they say that will remove the hormonal
• 21:21
  problem. And we see it's a lot in people
• 21:24
  with PMDD, they the ovaries go in the bin or they're given
• 21:28
  something like Zoladex which blocks their hormones.
• 21:31
  But actually it's not really helping the underlying cause or
• 21:34
  problems. No, no.
• 21:34
  And progesterone deficiency is a huge problem and a lot of women
• 21:37
  in those situations, you know, and that's not an even with
• 21:41
  heavy periods, you know, rather than let women suffer for years,
• 21:45
  why don't you know, we need to be educating at medical school
• 21:48
  level to say to GPS, you know, and, and teach them how to go in
• 21:52
  early. Don't be just firing them on the
• 21:54
  pill for us, you know, because I do believe progesterone in in
• 21:58
  the luteal phase would help hugely.
• 21:59
  And we've sure. Absolutely agree.
• 22:01
  And, and I do think a lot, you know, women with PCOS, yes, a
• 22:05
  lot of these women before we've always been talking about
• 22:08
  they've got testosterone, but actually agree, I think a lot of
• 22:11
  them have got very low progesterone totally.
• 22:13
  And we can't really measure progesterone very easily.
• 22:15
  So it's more of giving a therapeutic trial but giving the
• 22:19
  proper progesterone, not the synthetic progesterone.
• 22:22
  Totally and many times if you come across patients where
• 22:24
  they've had the bar and they put on weight and solid every so so
• 22:28
  I believe because I've heard it so much yeah.
• 22:30
  We've never looked at the root cause of PCs.
• 22:32
  I believe that, you know, once once you interfere with that FSH
• 22:36
  yeah rhythm that if if you get then get it into OverDrive you
• 22:39
  yeah, of course they it's still recessors.
• 22:41
  Yeah. Next thing going to get your sis
• 22:43
  and exit with the whole thing so you know I think we need to look
• 22:46
  at how do we prevent these things yeah rather than we're
• 22:49
  going in too late and I think with endometriosis it's the same
• 22:52
  yeah we need to be going in much earlier than having these women
• 22:55
  suffering and they're only presenting when they want to
• 22:57
  have a baby yeah it's. Terrible.
• 22:59
  I totally agree. Endometriosis and PCOS I think
• 23:02
  have been misinterpreted by the medical establishment really.
• 23:06
  And and because people are given the contraceptive to try and
• 23:10
  regulate their hormones. Supposedly yes.
• 23:12
  And it can obviously will stop fluctuations, but it often just
• 23:16
  switches off the hormones. That's.
• 23:18
  It and it's not what you want, no, no having like you say
• 23:24
  progesterone in the second-half of the cycle can often make
• 23:29
  periods lighter, regular, they have less discomfort, you know,
• 23:33
  and heavy periods cause a lot of school loss, a lot of really a
• 23:39
  lot of problems and it's just, they're just losing.
• 23:41
  Loads of oxygen, Yeah, which the whole body needs, you know, and
• 23:45
  the. And these women at the prime of
• 23:47
  their lives are going around, young girls going around, you
• 23:49
  know, really exhausted, tired, can't participate in sport.
• 23:52
  You know, what a huge effect. So.
• 23:54
  And I really think it's been an area that was been ignored for
• 23:58
  two months. It has been.
• 23:59
  Ignored, although it has been written about, you know, we've
• 24:02
  got Katrina Dalton who wrote about it.
• 24:05
  She sadly died now and that was ignored because when she was
• 24:09
  talking about natural progesterone, then the synthetic
• 24:12
  progesterone were all coming in in the 60s and the contraceptive
• 24:15
  pill. So people were trying to silence
• 24:17
  her and she had a very difficult time with the medical
• 24:19
  establishment. But when, when?
• 24:21
  If you read her books and her papers it's very clear giving
• 24:24
  the natural progesterone for post Natal depression PMSPMDD.
• 24:29
  When you take a step back it makes a lot of sense.
• 24:32
  Totally, totally, totally. And as you said, it's it's
• 24:35
  trying to understand the science and then extrapolate that to
• 24:38
  help people. That's what.
• 24:39
  We need to be started, and I think sometimes in medicine it's
• 24:42
  quite disjointed because I understand the science, You
• 24:45
  understand the science because you go back to the basics.
• 24:48
  But then if you look at guidelines, they're often not
• 24:52
  focusing on the science, they're focusing on a treatment and
• 24:55
  medical treatment. And you know, there's sometimes
• 24:58
  pharma influence as well. So always when it's about women
• 25:03
  with PCOS, endometriosis, PMDD, they don't really mention
• 25:07
  natural hormones. Absolutely, absolutely.
• 25:10
  And it would just be so wonderful to help those women,
• 25:14
  you know, even, you know, individuals that suffers what
• 25:17
  they suffer the pain that you know, it's just horrendous.
• 25:20
  So be lovely to be able to and infertility causes so much agony
• 25:24
  for so many great couples. Yes, so be lovely to you know,
• 25:28
  with and this is what we're advocating is, you know, do the
• 25:32
  research and you know, let's ask the questions, yes and let's get
• 25:36
  the answers. Yeah, and in the meantime,
• 25:38
  involve women so they can make choices because, you know, we
• 25:42
  see lots of women from fertility clinics and people have quite
• 25:46
  rightly focused on whether they're pregnant or not, but
• 25:49
  they've not thought about giving some natural hormones.
• 25:53
  Totally. I wrote a book Louise called
• 25:54
  It's probably Hormones. And in it I talked about there
• 25:57
  was a couple that came to me and it's a true story.
• 25:59
  They came to me and they had been through IVF six or seven
• 26:02
  times, right? Because unfortunately it's
• 26:04
  given, you know, when people have tried at home and they're
• 26:07
  not, they're not looked at. Well, what else?
• 26:08
  And it's a wonderful thing to have, but I'm not first line.
• 26:11
  And anyway, the thyroid was off. So I corrected her thyroid and
• 26:15
  they came in and with the third pregnancy, so literally 1 after
• 26:19
  the other and the, the, the, they were lovely couple and the,
• 26:23
  the husband said, we, we feel so bad, but what we do now because
• 26:27
  we're just getting pregnant so easily.
• 26:29
  And I said, well, I'm afraid it's your time now to have your
• 26:32
  vasectomy. She's done it all, you know, and
• 26:35
  it's about empowering men. But it was just it's just a a
• 26:37
  true story of unfortunately Torturas was off and we know,
• 26:43
  no, it has been missed. So thyroid is crater coasters.
• 26:46
  Yeah, yeah. So it's just so important.
• 26:48
  Testosterone, you know, I was reading a paper the other day
• 26:51
  and testosterone can improve fertility by 24% because it
• 26:55
  helps the ovulation, ovulation. And I was watching someone on
• 26:59
  social media the other day because someone had sort of
• 27:02
  alerted to me and it's a couple lovely young couple, but she's
• 27:05
  trying to get pregnant and, and can't.
• 27:07
  So she's now having letrozole, which is aromatase inhibitor for
• 27:12
  several days a month. And I can understand why it's
• 27:16
  given, but it does seem really barbaric as well because they're
• 27:19
  basically switching off the hormones and then hoping to have
• 27:23
  a rebound effect when they stop. Exactly.
• 27:25
  But in my mind I was thinking, wouldn't it be kinder and more
• 27:29
  logical to give progesterone first for a few cycles?
• 27:32
  Yes, to try and help, Absolutely.
• 27:34
  Maybe think about testosterone as well.
• 27:37
  But I think people think if someone's taking testosterone
• 27:41
  and gets pregnant, they're going to just have some awful
• 27:44
  pregnant, but they're getting confused between natural
• 27:47
  testosterone and synthesis. I think so, yes, I agree with
• 27:50
  you. Yeah, I think and I think the
• 27:51
  questions, the questions weren't.
• 27:53
  It was never discussed. No, you know, you're asking the
• 27:55
  questions and you're making people think, which is
• 27:57
  wonderful. Yes, you know, Yeah, that's what
• 27:59
  needs to be done. And with your science background
• 28:01
  is fabulous as well. Yeah, because it's it just all
• 28:03
  falls into place. But we need to think differently
• 28:05
  because, you know, we've had some pregnancies in the clinic
• 28:08
  and not, you know, just just because the women then have
• 28:11
  their hormones and the ovaries can then work a bit better.
• 28:14
  And, and I've seen this before. I've got one patient recently
• 28:18
  who's now reducing her hormones and it's been really hard to
• 28:21
  get, you know, her under control.
• 28:24
  And I've been increasing and changing her hormones, her dose
• 28:27
  and her type. And then she was fine.
• 28:30
  And then suddenly things were worsting a bit.
• 28:32
  Did have blood levels and they were fairly high of of Easter
• 28:35
  Ireland testosterone. So we've reduced the but she's
• 28:38
  only in her 30s so I think her own ovaries are just coming back
• 28:42
  into function again. And probably not just her
• 28:44
  ovaries, the best of her body. Brilliant, but I'm sure that's
• 28:47
  something in England as well. In Ireland we're trying to you
• 28:49
  know, people aren't testing when women are HRT.
• 28:51
  What is her Easter dial is adequate.
• 28:53
  Is there a testosterone adequate?
• 28:55
  That's something we're trying to educate people to do, you know,
• 28:58
  because they don't do it as as part of the the norm which which
• 29:01
  it should be done, of course. Yeah, I know where we range it.
• 29:04
  Is useful, but but the range is really vary yes yeah, had
• 29:08
  somebody in fact today contacted me this one.
• 29:10
  So I've just seen my testosterone level it's .1 above
• 29:13
  the normal, but I feel really well should I reduce and it's
• 29:16
  like no, because if I do another test tomorrow it will be a
• 29:20
  slightly different result. They're just a guide, yes, but
• 29:22
  they are useful. They're getting contracting.
• 29:24
  So yeah, definitely, definitely, yeah.
• 29:26
  So I mean, there's so much we need to do, there's so much more
• 29:29
  research, but I do think going back and looking at the basics
• 29:34
  is really useful because that's been forgotten in the noise of
• 29:37
  hormones and menopause. And, and I do think, you know,
• 29:41
  as endocrinologist, people should be joining the dots more
• 29:45
  and thinking about all the hormones.
• 29:47
  So it's great. Like the work you're doing, we
• 29:49
  need to keep keep going. Louise and you.
• 29:51
  Equally Oh, thank you. So before we finish, just three
• 29:55
  take home tips. So three things that you think
• 29:59
  all doctors should know about hormones?
• 30:03
  That they control absolutely everything that without hormones
• 30:06
  we wouldn't be here yeah, that we ha can influence them, but
• 30:10
  our diet with our exercise, with how we we look after ourselves.
• 30:14
  We have a huge personal responsibility to help our
• 30:16
  hormones. But in addition to that, we need
• 30:19
  to understand our hormones more. We need to understand that how
• 30:23
  life interferes with with hormones and also how different
• 30:27
  times like if you know, hormones control the immune system
• 30:30
  particularly knows women around times of stress, around times of
• 30:35
  perimenopause, even heavy periods.
• 30:37
  So we need to understand the whole interlink between hormones
• 30:41
  and inflammation, because we could prevent serious amount of
• 30:44
  disease if we just do that, you know, and listening to women
• 30:47
  more, listening to their stories, listening to the what
• 30:50
  you said, the amount of autoimmune disease that you're
• 30:53
  seeing and actually studying that, how much rheumatoid and
• 30:56
  lupus, if you to diagnose you on perimenopause and menopause and,
• 30:59
  and for people to look and ask questions, why, what are we
• 31:01
  doing here? Why, how can we prevent this
• 31:04
  instead of just throwing them on drugs that are just going to
• 31:08
  suppress the immune system and cause more problems?
• 31:10
  Great to have them, but could we prevent it?
• 31:13
  And I think that with our knowledge and expertise and
• 31:15
  putting all our heads together, we can do that.
• 31:18
  And we we all to society to do that.
• 31:20
  I love it. So keep curious is a big
• 31:23
  message. So thank you so much for coming
• 31:25
  today. It's been very.
• 31:26
  Easy life ISIS to LICIS to LICIS.