Latest / The Dr Louise Newson Podcast / 56 – Why confusion around contraception and hormones is failing women

Transcript

56 – Why confusion around contraception and hormones is failing women · The Dr Louise Newson Podcast

0:01
So Jordan, I'm very excited. I love having US doctors on the
0:06
podcast because I think you're just a bit more outspoken and
0:11
you just see it as it is and say it as it is.
0:13
And that's what we need. Like we need to cut through this
0:16
like mountain of confusion actually.
0:19
And I, I reached out to you on social media because I loved one
0:23
of your posts that you did. You were in your car with your
0:26
sunglasses on and you were talking, but you just prescribed
0:32
someone some estradiol, quite, you know, standard treatment.
0:35
And the pharmacist had sat down your patient to talk through new
0:39
medication. That's fine.
0:41
But sat down and told your patient inappropriate risks of a
0:44
safe hormone. And you had a little rant.
0:47
And I was like, I want you on my podcast.
0:49
So here you are. Well, I think that maybe in
0:53
continuing with Americans being outspoken, I, I, you know, heard
0:57
that message back from my patient and I was quite
1:00
literally in the car when it happened and I just had to post
1:03
something about it. So, yeah, well, thank you so
1:05
much for having me here. And I was just so honored to be
1:08
invited and I'm excited to be here.
1:11
Well, I, you know, I think you're the same as me.
1:14
You'll soon tell me if you won't.
1:15
But I went into medicine to help people and to help people feel
1:20
better. Actually, it sounds really
1:22
naive, but, you know, I was like, really young when I wanted
1:25
to do medicine. No one in my family's done
1:27
medicine. And I was about 5 or 6.
1:29
And I just said I want to help people get better and feel
1:32
better. And doing the work that I do is
1:35
transformational. Like the majority, not all of
1:38
them, but the vast majority of women do feel better when they
1:41
take hormones. And that's even that has
1:44
forgotten somehow with all this like confusion and noise that we
1:48
can talk about. But I don't think it's a bad
1:51
thing. Is it?
1:52
Or if I got it wrong, if we're just making people feel better.
1:54
I mean, I, I couldn't agree more.
1:56
And, and honestly, it's, it's quite a frustration for me, even
1:59
just from a medical training standpoint, because I'm, I'm
2:02
relatively recently out of residency.
2:04
You know, I would say I'm relatively new to this field.
2:06
And in my OBGYN training, there was almost no discussion about
2:12
hormone therapy. And when it did come up, it was
2:15
essentially told to me as this should only be used in
2:18
absolutely the most severe of situations because of the risks
2:22
are so high. And then so that was my
2:24
understanding coming out of training.
2:25
And then I become an attending physician.
2:28
I have my own practice, my own clinic, and every single one of
2:32
my patients is coming to me with symptoms of menopause or
2:36
perimenopause or sexual dysfunction.
2:38
And I had no tools to offer them.
2:40
And I think that there's a very similar story to a lot of people
2:43
who get into this field. And I couldn't agree more.
2:45
It was, I felt so helpless that I got into this field to help
2:49
women, to advocate, take it for women and, and to, to bring that
2:52
passion to my work every day. And people were coming to me and
2:55
I had no training and being able to offer that.
2:57
And so I really invested myself into learning that for myself.
3:01
And I couldn't agree more. It's, it's remarkable the
3:04
transformation that people have when they start hormones, even
3:08
within a relatively short amount of time.
3:10
And so I, I just think that we, we need to be spreading the word
3:15
on that and we need to be calling out the, the, the
3:17
misinformation that exists because, you know, my patient
3:20
with the pharmacist, it's unacceptable, you know, and, and
3:23
she was terrified when she came back to me.
3:25
Yeah, and it's, it's definitely harming women.
3:27
And I was looking at some adverts for Premarin.
3:29
So the older type of HRT that as you know was made for pregnant
3:33
horses urine. We don't prescribe that now.
3:35
We just prescribe the natural estradiol and we prescribe
3:37
estrogen. But even then there, there were
3:40
pictures of women in the in the 60s and they were happy.
3:43
And it just talks about well-being, improving
3:45
well-being. And there's some, some of the
3:47
adverts I don't quite like because they're, they've got men
3:49
next to me saying it helps his marriage, it helps him and it,
3:53
you know, your wife's happier to live with.
3:55
So, but you know what, fair play.
3:57
Like my husband will tell you it's a lot easier at home.
4:00
Now I take hormones because, you know, I didn't have symptoms for
4:03
very long, but I was really miserable and I was very
4:06
irritable and I was very cross and very angry.
4:08
But I also felt very socially isolated, withdrawn.
4:12
I was crying at work. Like, I've never cried at work
4:14
over something, you know, there was a partner, a doctor that
4:17
didn't agree with something I did.
4:20
And I knew I was right. And normally I would have just
4:21
gone back and given them some more evidence.
4:23
And I just withdrew and started crying at my desk.
4:25
And one of the receptionist said, Louise, what's going on?
4:27
Are you OK? She didn't realise it was my
4:30
hormones. I didn't realise it was my
4:32
hormones. And so it's difficult, It's
4:35
hard. And it's one of the things that
4:37
upsets me a bit is that because this happens at a time in our
4:42
lives, which often is, you know, in our 40s on average, but
4:45
obviously some women can be a lot younger.
4:48
It's blamed for, oh, it's that sandwich generation.
4:52
You've got children, you're working full time, you've got a
4:54
busy life. Like who says that to men?
4:58
Like, I don't understand. Like women are coppers and they
5:01
go on and do things and they don't usually whinge.
5:04
But when you've got a hormonal imbalance, whether it's
5:07
perimenopause, menopause or PMSPMDD, post Natal depression,
5:11
doesn't matter that it's all hormonal changes, it can cause
5:15
havoc in our brain and body. So why are we just suddenly like
5:18
if you just do a bit of self-care, if you sort out your
5:21
stress, everything will be fine? Like it doesn't make sense.
5:25
Well, I, I, I mean, I, I, I completely agree.
5:28
And, and I think that there's really kind of two forces that
5:32
go into that, which is one that there is the societal
5:35
expectation that women are just supposed to put away their pain,
5:39
are supposed to push forward, ignore their own needs, ignore,
5:42
you know, how they're feeling because there are these
5:44
responsibilities that are overwhelmingly put on women's
5:48
roles in society. And that in and of itself is a
5:51
problem. But I think there's also this
5:54
just ongoing paternalism to Women's Health that that really
5:59
needs to stop. You know, even just the idea of
6:01
what we were starting with about, you know, shouldn't it be
6:04
enough just to help women feel better?
6:06
And, you know, if that was the only thing that hormones
6:09
improved, shouldn't that be enough?
6:11
And I feel like it goes along with the same thing of saying,
6:14
well, a woman isn't responsible enough to make a decision for
6:16
herself about risks and benefits, right?
6:19
We, we've just decided that, oh, there was this study that was
6:22
misinterpreted and, and, and misrepresented, and therefore
6:26
women aren't responsible enough to understand that information
6:29
or make decisions for themselves.
6:30
And and that's something that I really try to counter, you know,
6:32
both in my public profile, but also on an individual basis with
6:36
all my patients. It's so important that I could
6:37
go and buy a car tomorrow and no one would give me a randomized
6:41
control study showing whether the car is safe or not.
6:43
I wouldn't be able to work out whether it was safe
6:47
mechanically. I could look at the color and if
6:49
it was comfortable and if I had enough money in my bank account,
6:52
I could buy it and I could drive it as recklessly as I liked.
6:55
And it's up to me as a person. And I think this is where, as a
6:59
doctor, I feel very strongly that our patients should be able
7:03
to advocate for themselves. And sometimes I don't agree with
7:06
what my patients do, like if they're smoking or doing drugs
7:09
or alcohol or having a chaotic lifestyle, but I'm not there to
7:13
preach them. I'm there to advise them and
7:16
tell them perhaps they should reduce their smoking or drink.
7:19
But I also, I want to learn from them, you know, why are they
7:22
smoking so much more? Why are they drinking so much
7:25
more? What else is going on?
7:27
And I think so often I've been to lectures at different
7:30
menopause society meetings, UK and globally, where they've just
7:35
been presenting the data. They haven't been talking about
7:39
a person, a patient, a woman, the impact on the life.
7:43
And we do that often in medicines.
7:45
Mrs. Bloggs has her heart attack.
7:47
Let's look at the heart attack protocol, but let's not see what
7:51
else is going on. And I think this happens a lot
7:54
with menopause. And then people are scared about
7:56
hormones for the wrong reasons, like this pharmacist, but
8:00
they're worried what if she gets breast cancer?
8:03
What if she has bleeding? What if she, well, she might get
8:06
that anyway. But, but also, you know, we're
8:10
just prescribing natural hormones.
8:12
So the risks are actually incredibly low, if at all,
8:15
because it's just a natural hormone replacement, isn't it?
8:18
Yes, exactly. And in fact, even, you know,
8:20
with, with that specific patient, it was remarkable that
8:23
the exact concern that the pharmacist had brought up was
8:26
that she was going to get a heart attack from it.
8:29
And completely ignoring the data that the physiologic estradiol
8:33
replacement is actually cardio protective.
8:35
And so it's, yes, I, I mean, I, I, I completely agree with
8:39
everything you just said. And, and I think that, you know,
8:41
we, we are slowly making that change by, you know, people like
8:44
you and I being loud about this and bringing that forward.
8:47
And I was, I'm always encouraged to see just the numbers of
8:50
people that are showing up to meetings and, you know, becoming
8:53
interested in this topic. But at the end of the day, there
8:56
is, you know, billions of women who are going through menopause,
9:00
and we only have a handful of providers who are actually
9:03
really. Witness isn't it?
9:04
It's absolutely crazy how few women, I completely agree,
9:08
access care. And so this brings me on to
9:10
something else. Because one of the things really
9:14
that I love being a doctor is that I see all sorts of people
9:19
from all sorts of backgrounds. And I've worked in areas of real
9:22
deprivation, especially when I was working up in Manchester,
9:26
which is in the northwest of England.
9:28
And I've seen things that most of my friends will never have
9:32
seen. I visited homes that most people
9:34
would just couldn't believe. I've heard stories which makes
9:37
me feel very privilege that people trust me ever invited me
9:41
in to be able to be part of something.
9:43
But women often from lower socioeconomic classes, if they
9:48
don't have English as their first language, if they're
9:51
having a very difficult social or home life, it can be very
9:55
difficult to advocate for yourself.
9:57
You haven't got any or enough financial freedom to choose your
10:02
provider. You don't understand, maybe you
10:04
can't read, you can't listen, you don't know what's going on.
10:08
You don't have friends or your partner is probably someone that
10:13
you're finding very difficult to live with, let alone talk to if
10:16
you have a partner. So I worry about women from
10:19
deprived areas a lot actually. And one of the reasons I set up
10:22
Balance was so it's a free app to help people to have a bit of
10:26
me in their pocket if you like. But I know you work in quite
10:30
deprived areas as well, don't you, with your work.
10:32
So just tell me a bit about the women that you see.
10:35
Yeah, absolutely. So the the majority of my time
10:39
is spent at a community Health Center here in the Bay Area
10:43
where I live. And the vast majority of my
10:46
patients are Spanish speaking, only very recently immigrated,
10:51
many of whom are undocumented, which of course is an added
10:54
stressor and you know, the current state of American
10:56
government. And so, but we're really
11:01
operating from already a population of patients who can't
11:06
access care because English is a barrier, can't access good
11:10
nutrition because there aren't grocery stores with healthy
11:13
vegetables at an affordable rate in their neighborhood.
11:17
And also just at baseline have a significantly lower health
11:21
literacy. And so it's been remarkable, I
11:25
think, to practice menopause medicine in this population
11:28
because I think that we, you know, we, we, we almost take for
11:33
granted that a lot of people know, you know, what the
11:37
gynecologic organs are or how the menstrual cycle works or how
11:40
these hormones, you know, even just the basics of what is
11:43
estrogen, what is progesterone. And yet most of my consultations
11:48
related to menopause with my, my patients in, in the community
11:52
Health Center, we none of that is a given.
11:55
We are starting from the absolute basics.
11:57
We are starting from where is the uterus?
12:00
What is the cervix? What are the ovaries?
12:03
You know, how do these things interact?
12:06
And I think that also, particularly, I would say among
12:09
the, the, the Latina population that I see, there's I think a
12:14
lot of miscommunication and there's a lot of of kind of a
12:19
bias against talking about menopause.
12:21
And so even among peers, there's very little sharing of what that
12:26
experience is like. And so it's, I think
12:28
particularly fascinating just having my social media profile
12:31
where, you know, thankfully a lot of the people who are
12:34
reaching out or asking very informed questions, you know,
12:37
clearly are operating on a very different level of health
12:39
literacy. And I'm able to have a very
12:41
sophisticated conversation surrounding those topics.
12:44
But I think we need to remember that at the end of the day, the
12:48
people who who really are actually most likely to face the
12:51
health consequences of untreated menopause are the patients in
12:57
the community Health Center that that, you know, like where I
13:00
work. And so we know that that
13:03
Hispanic populations and black populations go through menopause
13:08
earlier and have perimenopause symptoms that last for longer
13:12
than a white population. And also at baseline, the health
13:16
status is lower. And so we're already talking
13:19
about a population that has a higher risk for diabetes, a
13:21
higher risk for heart disease, a higher risk for high blood
13:24
pressure, cholesterol, all of these various factors that are
13:26
going to ultimately lead to a shorter life expectancy.
13:29
So I would argue that there's even more of a need to educate
13:35
and to be making menopause care and hormone management in
13:39
particular accessible for this population because they are the
13:43
ones who are ultimately going to face the most health
13:46
consequences if that's unaddressed.
13:48
Absolutely. And there's so many diseases
13:50
that are related to menopause. And when we say menopause, we
13:53
mean this hormone deficiency that lasts forever.
13:56
There's so much talk about it being a transition, but it's not
14:00
a transition because whether people have symptoms or not, the
14:03
layer hormones increases inflammation in the body.
14:05
That's just fact because that's the way our hormones work.
14:09
But all the inflammatory diseases are the diseases that
14:12
are increasing as we age, and they're killing women and a lot
14:16
of them prematurely, but they're also diseases associated with
14:19
poverty and deprivation. So cardiovascular disease,
14:24
dementia, osteoporosis, but also mental health.
14:27
And one of the things that keeps me going a lot is thinking about
14:33
the mental health association of hormones.
14:35
So there are two things really that I think is worth
14:38
discussing. 1 is we've, and I've spoken about it many times, the
14:41
role of hormones in our brain. When these levels fluctuate and
14:45
reduce, we can get lots of mental health symptoms.
14:48
But the other thing that I worry perhaps more about is a lot of
14:51
women from low socio economic classes have mental health
14:56
issues for various reasons and they're prescribed medication.
14:59
So they're prescribed antidepressants.
15:02
Some of them are prescribed antipsychotics.
15:04
Some of them have a lot of pain as well.
15:07
So they're given opioids. Now all of those drugs can
15:11
reduce hormones. So they can make the estradiol,
15:16
progesterone, testosterone lower.
15:18
So we it's well known that morphine can cause night sweats.
15:21
Well, of course, because it's blocking us to diet.
15:23
And this is in men and women, of course, but I worry more about
15:26
women than men. But so when someone of one of
15:30
your patients, if you prescribed an antidepressant, I can't
15:34
imagine, Jordan, that the pharmacist sits them down and
15:37
says, do you know there's a risk of osteoporosis?
15:40
Do you know there's a risk of not being able to have an
15:43
orgasm? Do you know there's a risk of
15:44
dementia? Do you know these hormones might
15:46
block your own? It's a devil standard, isn't it?
15:51
A. 100% and I would even say even just moving beyond
15:55
antidepressants, all contraceptive pills are
15:59
prescribed so much more confidently by so many
16:02
providers. And of course they play a very
16:03
important role. I prescribed them myself, but
16:07
but there isn't that same level of conversation about, you know,
16:09
some of those similar health risks, particularly in regards
16:14
to to sexual health and mood. And so, yeah, I think that
16:18
there's this unnecessary fear that exists surrounding these
16:23
body identical physiologic hormones that really in every
16:27
way are safer than the alternative medications that we
16:30
would use to manage those conditions.
16:31
Yeah. Which a lot of people don't
16:33
realize. And you know, I didn't realize
16:36
actually, because I didn't think about it for many years as AGP
16:39
and I would prescribe these medications and I would
16:42
prescribe contraception, but also long acting contraception.
16:47
So implant or depo Provera, which I look back with, with
16:52
horror actually, because a lot of these women were, I was sort
16:57
of taught actually that women won't remember to take
17:00
contraception because they've got eight children, they've got
17:02
an abusive partner, they're alcoholic or whatever.
17:04
So just give them a depot, give them a long acting
17:06
contraception. So they always had it without a
17:09
choice. This was sort of 20 years ago.
17:11
So things I know have changed, but I didn't really think and
17:15
sit down and think, what am I doing to these women?
17:17
I'm stopping their own natural hormones working, I'm increasing
17:20
inflammation in our body. I'm going to probably make their
17:23
mental health feel worse. Firstly, I'm not telling them
17:26
about it because I didn't know know to tell them.
17:29
But secondly, they're never going to ask.
17:30
And then if they feel lower in their mood, they'll never or
17:34
they'll often not think about the association with humans.
17:37
They'll think, well, it's because of my life, what's going
17:39
on at home or what have you. So it's this spiral of doom that
17:43
often happens, doesn't it? No, absolutely.
17:46
It is interesting. I do find that in my patient
17:48
population, I think there is to some extent A baseline suspicion
17:53
of synthetic hormones. And so I think that a lot of
17:57
people, whether based on their own experiences in the past or
18:01
from talking with friends, you know, they have this, this
18:04
understanding that contraception might affect their mood or their
18:08
weight or, you know, various other factors in their body.
18:12
And that these, I, I think for this reason, I, I almost
18:16
sometimes struggle to, to, to talk to somebody about
18:19
contraception because I think that, you know, sometimes
18:22
there's a little bit of a resistance to even thinking
18:24
about it. But I completely agree.
18:26
And, and I would say again, you know, thinking about how
18:28
training differs across time, you know, in, in my, in my OBGYN
18:34
residency, I would say that there wasn't a very strong
18:37
discussion about a lot of these long term health consequences
18:40
that can happen with contraception.
18:41
And, you know, I, I don't like to hate on contraception because
18:44
I think it's so valuable. And, you know, we, we need to
18:47
use that appropriately. But I think that in terms of
18:49
actually thorough counseling, there is a huge deficiency in in
18:53
in that education element as well.
18:55
Yeah, and I think often with contraception choices taken away
18:58
because people think hormonal contraception is the only
19:01
contraception. And, you know, that is a real
19:05
shame, I think for for women. And I, I mean, I've got three
19:08
daughters. I, I've, they all have different
19:11
contraceptive needs and choices, but I've thought very
19:15
differently about them than I would have done if they were 10
19:19
years older, actually. And, you know, I think and
19:22
they've been very involved in the conversations as well.
19:24
And they do natural hormones as well, as well as their
19:28
contraception. So they're a bit atypical, but
19:31
they're not because a lot of people are learning from social
19:34
media, a lot of people are joining the dots.
19:36
And so I don't want anyone to think that we're saying anything
19:39
that's like controversial or we're trying to promote some
19:42
sort of conspiracy theory. We're just saying these hormones
19:45
are different. Like it's, you know, they, they
19:48
are not hormones. They are chemicals that are
19:51
similar to hormones for different and they have benefits
19:54
for some people but they have risks as.
19:55
Well, and I think it goes back to what we were saying before,
19:58
which is just at the end of the day, I think that we have to
20:01
really trust women to make informed decisions for
20:04
themselves. And but what that requires is
20:06
adequate counseling and adequate experience.
20:09
And so you're exactly right. It's not necessarily our job to
20:13
make a choice for somebody, but it is our job to make sure that
20:16
we are informed enough to be able to tell them these are
20:19
going to be the pros and cons and choosing various pathways
20:21
here and and I think ultimately. You know, people make fantastic
20:26
decisions for themselves when they're given the right
20:28
information. And in our, you know, in the
20:31
patient population that I see the, the burden is even more
20:35
intense because we have to start from a baseline level of, of
20:38
health literacy that is so much lower.
20:40
But I don't think that that means that we should be ignoring
20:42
that population, which is unfortunately what happens.
20:45
I think it just puts even more emphasis on the fact that we
20:48
need to be getting basic information out there, whether
20:50
that's through our individual efforts or through broader
20:54
societal efforts, like for example, through the balance app
20:56
or really, you know, through even sex education when you're
20:59
in, when you're 10 years old. And so I think that, you know,
21:02
these, these, I think we need to have a complete shift in how we
21:06
think about Women's Health and woman's role in society to
21:11
really be able to have these informed conversations.
21:13
And again, just trust women, you know, to, to, to be smart about
21:17
themselves because it's, it's, it's really a, a travesty that
21:23
we don't do that. Absolutely.
21:24
And I often talk about health of women rather than Women's
21:27
Health. And even just that play on words
21:29
makes people think differently about overall health, just guiny
21:33
health because it's so important.
21:35
So when I worked as AGPI, worked in the same practice for many
21:39
years, I worked there for about 18 years and it was in quite a
21:44
deprived area and a lot of women, especially towards the
21:47
end when I knew more about hormones and the benefits, I was
21:50
prescribing hormones to the natural body, identical
21:53
hormones, often all three, often vaginal hormones as well.
21:57
And I loved it. You know, I was on a roll, my
21:58
patients really enjoyed. And then I left general practice
22:02
to dedicate all the other do all the other work that I did.
22:05
And 1 by 1, the doctors that I work with have taken every
22:08
single patient off their hormones.
22:10
And it's, I know it's like the saddest thing that's happened
22:14
because some of them have reached out to me like through
22:17
social media or they've just some of them have come to the
22:20
clinic, but not many because it's expensive and they haven't
22:23
got money. And I saw one of my old patients
22:26
last week in my clinic who's has an alcohol problem as the smokes
22:30
a lot of cigarettes. She's had a really difficult
22:34
time since I last saw her. And I worked really hard with
22:37
her 20 years ago to help her to come off her alcohol and she did
22:41
it because she's got fire in her belly.
22:42
She's had a very difficult life, but her hormones have impacted
22:46
her now. And like I know the doctors at
22:50
work just think it's a bit of a middle class problem having
22:54
hormones. They don't see the role.
22:56
Whereas I look at her and think, gosh, her liver is not going to
22:59
be very healthy because she's, she drinks a lot.
23:01
Her lungs are not gonna be healthy 'cause she smokes a lot.
23:04
She hardly eats. She's a, you know, a lot of
23:06
people who drink a lot, get their calories, and she drinks a
23:08
lot of cider. So she's trying to convince me
23:11
that the apples in the cider are the fruit that she eats, and
23:13
that's enough. We've all seen patients like
23:16
this and it's amazing that they keep going.
23:19
But I'm there thinking, if she doesn't have her hormones, her
23:23
life expectancy will be worse. Her risk of diseases will be far
23:27
higher. Of course, I could spend all my
23:29
time and energy talking to her about smoking and drinking, but
23:33
at the back of my mind I know that she'll be more able to
23:35
reduce her smoking and alcohol if she has hormones on board.
23:42
It's, you know, I, I know with time she will feel a lot better
23:45
and, and it's great to see her again, but I feel really sad for
23:49
all those women that are just missing out.
23:51
Like I don't know where they go or what happens.
23:55
Um, but it's a worry, isn't it? Absolutely.
23:57
And and I, I, I struggle with the same problem, you know, in,
24:01
in my clinic as well. And you know, we have wonderful
24:04
GPS who, who work at our clinic and I think, you know, people
24:08
who are very intelligent. But I think that there's still
24:10
just this baseline fear. And I can't tell you the number
24:13
of patients that I will start on some kind of hormone therapy
24:18
again using natural body identical hormones.
24:21
And then they end up with their GP upstairs and they're, there
24:25
is a whole conversation about how that's a very controversial
24:28
choice and that they're, you know, are going to be dangerous
24:31
to that. And that, you know, we didn't
24:33
have an informed enough conversation.
24:35
I, I, I just had this conversation way too many times.
24:38
So I completely agree. It's, it's a huge frustration.
24:41
And, and I think that it, again, it goes back to the education,
24:43
which is that at the end of the day, this, this isn't just a
24:47
gynecologic concern. This is a body wide concern.
24:50
And every single medical provider, whether you're in
24:55
OBGYN or whether you're an orthopedic surgeon or whatever
24:58
it might be, you need to be having these conversations in
25:02
this education about how hormones are going to impact
25:05
your patient because it does. And I can guarantee that if you
25:08
were a provider, hormones are going to impact your patient in
25:11
some way. Absolutely, and no disrespect to
25:13
you as an OBGYN, but I don't feel that gynecologists should
25:16
be in charge of women's hormones.
25:18
I think they are a provider that can help.
25:21
And I see like I was trying to persuade a cardiologist to
25:25
prescribe hormones the other day and they were like, Louise, we,
25:27
we just don't do that. So what?
25:29
So you give all these other drugs and, you know,
25:32
psychiatrists keep telling me they don't prescribe hormones,
25:34
but we recommend them. Now we talk about it more in the
25:37
letters, but I don't, again, I really don't understand.
25:40
And we need to shift this narrative and we need to do it
25:42
quickly because there's so much suffering of women.
25:45
And I think what we're doing with a lot of our work is just
25:50
empowering people, letting them have other conversations and
25:53
letting them, hopefully not just the women who are suffering, but
25:56
other people who know people who are suffering to actually be
26:01
part of this with them. But not just sit and hold their
26:04
hand and watch them suffering. Actually grab them by the hand
26:07
and take them to a doctor, a nurse, a pharmacist who
26:10
understands. And they it's fine to have a
26:13
second, third false opinion as well.
26:15
Whichever country you're in, it's fine to see someone else
26:18
isn't that. Yes, 100%.
26:21
And I think that people do get really locked into that mindset
26:24
of I guess this is just what the doctor says and I got to stick
26:27
with it. But it's it's 100% something
26:29
that is so important. And, you know, just like so many
26:32
things in the health of women, I think that there is a lot of
26:37
there's there's a lot of women, you know, for a variety of
26:39
conditions for endometriosis, PCOS who end up seeing multiple
26:44
providers before they get an accurate diagnosis and
26:46
treatment. And menopause is no different.
26:49
And and so, yeah, I think we need to just change that
26:52
conversation completely because at the end of the day, these
26:57
just like you said, hormones are just a part of a women's overall
27:01
health, not specifically a Women's Health concern.
27:03
Absolutely, very well put. So before I end I always ask the
27:07
three tick him tips. I'm conscious it's your wedding
27:11
anniversary so I don't want to keep you too late, but three, I
27:15
would like to ask you 3 risks to women if they are not prescribed
27:21
hormones. Yeah, absolutely.
27:24
It's, it's hard to limit it to just three, but, but when, but
27:29
when we, when we think about really what are the most likely
27:33
factors to impact not just women's lives, but you know,
27:36
anybody's life, Those would be heart disease, osteoporosis and,
27:43
and falls associated with that and fractures and then risks to
27:48
mental health and dementia. And all of those are so
27:52
infinitely affected by the, the lack of hormones that happens
27:57
after menopause. And so we know that heart
28:00
disease risks can decrease by 30 to 50% when hormone management
28:04
is initiated. And similar numbers for
28:06
osteoporosis prevention, similar numbers for improving mental
28:11
health. And these things, they, they,
28:14
they really don't just impact somebody's quantity of life, but
28:18
but more importantly, they impact somebody's quality of
28:20
life. And to go back to where we
28:21
started this whole conversation, even if all that happened is
28:24
that women felt better and were able to live the life they want
28:27
to live with hormones, that should be enough.
28:30
But in addition, we now have all of these other benefits for
28:33
their health overall. Oh.
28:34
That's so good, and thank you so much for your passion and
28:37
energy. And I hope I'll be able to meet
28:39
you in real life maybe next year when I come to US.
28:42
Thanks so much. I would love, I would love that.
28:44
Thank you. Thank you so much.