Latest / The Dr Louise Newson Podcast / 32 - Tackling myths and misinformation in menopause

Transcript

32 - Tackling myths and misinformation in menopause · The Dr Louise Newson Podcast

0:00
Amy Alcon is the guest on my podcast today.
0:03
She's an author and a scientific writer specializing in applied
0:06
science. Her most recent book is Going
0:10
Menopostale, and she's really unpicked a lot of the evidence.
0:14
She's dispelling a lot of myths about the confusion between
0:17
natural and synthetic hormones, and she really talks with a very
0:21
personal experience as well. It's a really great book and
0:26
it's a brilliant conversation for you to listen to.
0:31
So Amy, I'm really excited to have you, even though you're
0:35
over in US. But I've been reading your book
0:37
the last few days and I just love it.
0:41
I love the way you think, I love the way you write.
0:44
I love your inquisitive nature. So just before we talk too much
0:49
about the book, tell me a bit about you and why you even wrote
0:52
this book. Well, I have had the luck.
0:55
I've been an applied behavioral science writer, so my writing, I
0:59
give advice, but it's informed by science.
1:02
And in 2007, I met Sandra Greenland, who's one of the top
1:05
epidemiologist and biostatisticians in the world,
1:09
and I was just desperate. I'm always desperate to be
1:11
better at assessing research. And this guy is so generous.
1:15
He coached me since 2007 and how to read and critically evaluate
1:19
research, and he goes after methodological error and fraud
1:24
and abuse in medicine. And so he sent me all these
1:27
articles and papers about the horrible, horrible effects of
1:33
care that is not based in good evidence.
1:35
And because of that, when I have an issue at the doctor, I don't
1:40
go to the doctor and say, like I with my hot flashes, I'm
1:43
uncomfortable. What should I do?
1:45
I go to the research base. I learn what, you know, what the
1:49
research says. And then I go to the doctor.
1:51
And that is very protective. And and This is why I wrote the
1:54
book for other women because most women can't do that.
1:58
They're not these huge nerds. I read science day and night.
2:02
And so we all deserve the evidence based care that you you
2:06
know that that that you are a source of you're my hero.
2:08
And, you know, you're one of the few people in in this area that
2:12
I actually just fully respect. Oh, thank you.
2:15
And it's interesting because I'm not you.
2:17
I'm very scientific. I love reading papers, you know,
2:22
quite meaty scientific papers. But I also really like evidence
2:25
based medicine. And medicine is an art and a
2:28
science. You know, I feel very strongly
2:30
that the art form is individualizing care, but it has
2:33
to be based on evidence. And many years ago, like 22
2:38
years ago, I wrote a book on evidence based medicine for GPS.
2:42
Actually it was called Hot Topics for the MRCGP.
2:45
And the MRCGP is the membership of the Royal College of
2:48
Physicians. So it's an exam that we take as
2:50
GPS over here, but I realized that a lot of people are not
2:54
quite so geeky as me. They have a better social life
2:56
and they read other things. And so as busy doctors, you
3:00
often read like the top line of other sort of highlights of
3:03
guidelines, and you never read the papers.
3:05
Whereas when I read the papers, I'm not just reading the
3:08
science, I'm learning about the authors, what conflicts they
3:11
might have, what other agenda they might have, who's, who's
3:14
paid them? Is farmer behind them.
3:17
Like what sort of paper is it? And, and what are the numbers in
3:21
the studies and all sorts of things, which is really builds
3:24
up this picture. So I read the first book and
3:27
then I did three more books after which were just like, you
3:30
know, 1st edition, second edition, so that when people
3:33
were like treating someone with diabetes, I would be unpicking
3:38
all the papers and just just summarizing what they were.
3:41
And, and I've always worked like that and I really enjoy it.
3:43
But I realized a lot of people don't.
3:45
And it's not just the doctors. It's like you say, patients
3:48
don't either. And then they go to a doctor,
3:51
they don't know how much science they've read.
3:53
They don't know how many papers they've read.
3:55
They know they've got a medical qualification, but it's very
3:58
difficult to know, isn't it? And so to have access to
4:02
information as a patient is really crucially important.
4:06
In our training here, medical education in the US, it sounds
4:10
like there's training in how to read and critically evaluate
4:12
studies there. And I write about the three big
4:15
myths in our medical care. And 1 is that doctors base your
4:18
treatment according to evidence. And that's not true because here
4:22
in medical schools, it's it's more a moral failing.
4:26
They do not teach doctors doctors how to read and evaluate
4:30
papers. So doctors don't read papers
4:32
because they don't know how. And then to be fair, at an HMO
4:36
like mine, they see patients every 20 minutes and so I might
4:40
read a night. You're a nerd too, but but you
4:43
people want to go home at night. And I can accept and understand
4:46
that as much as I think it is a moral failing for doctors to not
4:49
educate themselves in the ways medical schools have have failed
4:53
them. Yeah, and it's interesting.
4:54
So I've, I've worked 25 years ago when I trained as AGPI was
4:59
in hospital medicine before and I worked full time and I didn't
5:02
have time to read many papers then.
5:04
But then I worked part time as AGP so I could be flexible
5:07
around my children. But when I wasn't working as
5:10
AGPI was doing medical writing. So I was writing articles that
5:15
was based on evidence for healthcare professionals, but
5:18
also for people as well to learn more.
5:20
So I've had a lot of blue sky thinking time.
5:23
I've been really privileged with that.
5:25
And then I, when my, I had my third child, it was only working
5:28
one day a week as AGP and it was really hard.
5:31
Like I'd come home after seeing maybe 60 patients and I would
5:35
literally my children would know not to go near me on a Monday
5:37
night, you know, I was broken. But then the rest of the days I
5:41
would be reading articles, guidelines and papers and then I
5:44
would be summarizing them. And if you're, if you're writing
5:46
about it, you have to know the evidence.
5:48
You have to know it inside out, back to front.
5:50
You can't write something unless you can support it by knowledge.
5:54
And then I'd go back to the practice the following Monday
5:56
and I'd say, oh, hi, guys, what have you been doing all week?
5:58
And they've been just seeing patients.
5:59
They would be having my Monday every single day.
6:02
So of course, they're not going to read.
6:04
But medicine does advance and change.
6:07
And things that I learned at medical school, very different.
6:10
The drugs that are available are very different now.
6:12
You know, I qualified 30 years ago.
6:14
So things have changed and some doctors just haven't advanced in
6:18
the same way with their knowledge.
6:20
I have to tell you, you'll know how horrible this is better than
6:22
anyone. The head of gynecology at the
6:25
big, massive West LA facility had an appointment with me about
6:29
two months ago because my my gynecologist, who's great, is
6:33
off. She told me the circa 2002
6:36
advice from the discredited Women's Health Initiative study
6:39
that I should taper off estrogen at 60 because it causes, and I'm
6:44
61, it causes breast cancer and Alzheimer's and all this.
6:48
And I was so shocked. You know, here's this woman.
6:51
She told me she read the science.
6:53
Yeah. No, you, you haven't.
6:54
You not only that, you haven't even read the practice bulletins
6:56
from the Menopause Society from 2017, 2022 that say we don't
7:02
have a stopping role. We have what you said,
7:04
individualized care. So important, you know, we look
7:07
at a woman's health and then monitor her.
7:10
And that's why you, you can, if you initiate estrogen right at
7:13
menopause or within six years, you know, for cardiology, for
7:17
cardiovascular health, you know, you can take it throughout your
7:20
lifetime if you remain healthy. And so you have it in your body
7:24
protecting your bones at 79 when you're likely to fracture.
7:28
And then you're not left for years, from 60 to 80, without
7:32
this, while your bones, you know, become more and more
7:35
fragile. I think, well, I'm going to ask
7:38
you, it's really important based on your book as well.
7:40
So I've got teenage children who are girls and I've got an
7:44
elderly mother and my younger children can get hormones very
7:49
easily. They can go and ask for
7:50
contraception whether they need it or not.
7:52
They might just want it for their skin or their mood or
7:55
whatever. They can go and ask it and I can
7:56
pretty much guarantee if they wanted it they'd come out the
8:00
same day with a prescription of hormones.
8:02
My elderly mother has been on HRT for about 30 odd years now,
8:07
maybe a bit longer. She has been phoned up by her GP
8:11
last week to tell her she needs to stop it now.
8:15
They're on different hormones, say the hormones of
8:18
contraception are not the same as the hormones my mother's on.
8:21
So just just tell me with your knowledge and research which
8:24
hormones are safer. Oh, OK.
8:26
So transdermal estradiol, that's basically an estrogen sticker
8:32
that is the that is the safest form of estrogen to take.
8:36
And it again, if you you need to initiate it as close to
8:40
menopause as possible. So menopause being 12 months
8:43
without a period and, and this is healthier than the oral
8:48
estradiol and you need less of it.
8:50
So oral estradiol can do all sorts of bad things like raising
8:54
clotting factors because it goes straight to your liver.
8:57
It's called first pass hepatic effect.
8:59
That's fancy, fancy talk for, you know, you, you take it
9:03
orally goes to your liver. Your liver is very good at
9:06
getting rid of stuff from your body.
9:08
So you need a huge amount and then transdermal estradiol
9:11
because it goes to your bloodstream, there's a
9:13
negligible amount amount, trace amount that gets to your liver
9:16
and so it can't elevate those clotting factors.
9:19
This is very important and doctors don't know this.
9:21
I know because in one of the other substitute gynecologist
9:24
just told me transdermal could cause me to have a heart attack
9:28
or a stroke. And it OK, that's
9:30
physiologically implausible to impossible, you know, and you
9:34
know, and the stroke thing, my blood pressure is 99 / 62.
9:37
You know, I'm not going to have a stroke.
9:39
OK, let's look at our whole health.
9:40
And this is something I appreciate that you do where
9:42
doctors don't Looking the patient is a system and being
9:46
the creativity, the art of medicine you're talking about,
9:49
you need to have the deep trans transdisciplinary knowledge to
9:53
be able to look at what is the actual underlying effect.
9:56
And of course, one of the other myths of medicine I bring out is
10:00
that the doctors are not trained in diagnostic reasoning.
10:03
So this is a big problem because what they do is that you come in
10:07
with a symptom. Now, we're empathetic as humans.
10:09
We evolve that way. And so the doctor wants to ease
10:12
your suffering. Doctors are not terrible people.
10:14
There's a sociopath in every profession, but they want to
10:17
help you. They just don't know how you
10:20
know. And so if you treat a patient
10:23
the way doctors do with their fear, their unwarranted fear of
10:26
hormones, give a patient antidepressants, you know, and
10:29
there are patients who need that, you know, who, who can't
10:32
take hormones. If you give the patient
10:34
antidepressants, what you're doing is leaving their breasts
10:37
and uterus unprotected, their endometrium, their uterine
10:40
lining they're being on. They're, they're not being
10:43
protected against cancer, breast cancer, uterine cancer, They're
10:47
not having their, their, you know, their bones helped.
10:50
So you're treating the symptom of hot flashes and these do the
10:54
antidepressants do, but you're not, you're leaving so much of
10:58
them not protected did not help. And it's just terrible.
11:02
And it comes out of the lack of science, you know, in our
11:05
medical care and the fact that our practice standards, they,
11:09
they're not science based and doctors don't know.
11:12
And, and I want to bring out one thing because since you, you're
11:14
the antithesis of this in America, almost none of the
11:19
gynecologists have any training whatsoever in menopause and
11:24
perimenopause. They treat patients anyway,
11:26
which is a violation of medical ethics.
11:29
And then there are some experts and they've been trained by the
11:31
Menopause Society and the training is a joke. 45 hours
11:37
required of continuing medical Ed in Women's Health in general,
11:41
15 of which must be in menopause and perimenopause.
11:44
And then they take an online test and then they're experts.
11:47
They're absolutely not. And I know this because I'm like
11:49
a medical lie detector for science.
11:51
They say things to me in these appointments.
11:53
All I had 1010 gynecologists deny me that the increased dose
11:58
of estrogen I needed. And they they just say all these
12:02
things that are not scientific and I have to not come off like
12:04
the irritating know it all because that doesn't help you
12:06
get the drug you need. But it's very difficult, but
12:09
also like what I was trying to also tease out with my children
12:12
if they if they did, they don't. But if they did contraceptive,
12:16
then that's synthetic hormones. It's not even the same as my
12:19
mother who takes body identical estradiol, progesterone,
12:23
testosterone are the same structure as the hormones we
12:26
produce. Whereas in in the book you're
12:29
very clear, especially talking about the synthetic progestins,
12:32
but also ethanol, estradiol, the conjugated equine estrogens.
12:36
So the estrogens have been used in older types of hormones, but
12:39
they're still used in contraception.
12:41
So I find it's like double standards.
12:44
It's fine to have a contraceptive that's synthetic
12:47
with risks, but people don't talk about those risks.
12:50
They're younger people. Whereas any type of natural
12:54
hormone everyone always presumes has got risks associated with
12:58
even though they haven't. As many of you know, I'm
13:02
passionate about helping women make positive changes for their
13:06
long term health and well-being. One of the things we often
13:09
overlook is how important our feet are.
13:13
They're our foundation. That's why I've been really
13:16
impressed by Vivo Barefoot Shoes.
13:18
They're designed to let your feet move as nature intended,
13:22
improving strength, balance and connection to the ground
13:26
beneath. You Vivo Barefoot are so
13:28
confident you'll feel the difference that they offer 100
13:32
day trial with a full money back guarantee so you can try them
13:36
completely risk free. And as a listener of this
13:40
podcast, you get 20% off your first order with the code NEWSON
13:46
20. Just head to vivobarefoot.com
13:50
and give them a try. Your body will thank you.
13:55
The irony of this, and this is where the art of medicine comes
13:58
in. So you have the deep
14:00
transdisciplinary knowledge and you see that this is ludicrous.
14:04
You know, I always tell women, you know, that, you know, I had
14:06
the copper IUD, which is just copper blocking the little sperm
14:11
from reaching the egg, you know, and, and so, and this is so
14:14
important because, you know, OK, there can be risk perforation,
14:18
everything. But those risks, to me, if you
14:21
look at the actual trade-offs, those risks are preferable to
14:25
the risks of taking these synthetics.
14:28
You know, we talked about the Mirena mustache or women who
14:30
have the Mirena IUD. There are all these viralizing,
14:33
you know, male side effects that can happen to you.
14:36
And you know, why would you take something that has health risks
14:39
when you can use the copper IUD that has no chemicals in it,
14:43
that just has a reaction that kills the sperm?
14:45
Yeah, I think because people don't know and often it's the
14:48
patients don't know, but also the doctors haven't been
14:51
educated the difference. And and I didn't know for many
14:54
years because no one sat down and spoke to me.
14:56
And if you don't really know, you're not really understanding
14:59
the difference in the chemistry. So I think this is where your
15:02
book is so good and interesting because it talks about the
15:05
science, but we've through it. You've got your own personal
15:08
journey as well. And we all change when we
15:11
experience something that's definitely for sure, whether
15:14
we're doctors or patients, we become more knowledgeable and we
15:18
also know how hard it is sometimes to access the medical
15:21
system. So your your book does a lot,
15:24
but it must have taken you a long time to write the book and
15:27
research, didn't it? Your deep dive.
15:29
I I did this thing we're not supposed to do.
15:31
As an author, I live, I'm still living off my savings.
15:34
I'm running out because this was such a mission.
15:36
What had happened was I went to my my healthcare provider, to my
15:40
gynecologist, you know, and I wanted to get oral micronized
15:44
progesterone for the wonderful work of Geraldine Pryor, MD, the
15:48
endocrinologist and clinician. And they on the formulary only
15:53
had Metroxy progesterone acetate, the synthetic knockoff
15:57
that raises your risk of breast cancer.
15:59
It is harmful to the brain. It's harmful to the
16:01
cardiovascular system. And so I fought 3 battles with a
16:05
woman who's now the associate director of the hospital, former
16:08
head of gynecology. They treated me with respect
16:10
instead of blowing bring me off, they listen and they allow the
16:13
the the progesterone, the dose I want to which they don't give in
16:17
the US for no scientific reason because we don't know how we
16:20
metabolize steroid hormones. And so you need to make sure you
16:23
have enough to protect your uterus and breasts against
16:27
cancer. And it's also very helpful
16:29
healthy drug that promotes GABA and sleep and mental Wellness.
16:33
And so this is not a drug where you're in danger.
16:35
It goes up 10 times the amount in a menstrual cycle in
16:38
pregnancy. Women are not dropping dead from
16:39
progesterone. Quite the.
16:42
And so when I did this because I'm naive, I'm from the Midwest,
16:45
and we're kind of like Pollyanna's.
16:47
And I said, OK, so now I've showed you the science, and now
16:50
will you put this on the formulary and give this to all
16:53
women? I think there's almost a laugh.
16:55
No, they wouldn't. And to me, this was like the
16:58
equivalent of, you know, I got the care.
17:00
And it would be like watching a stream of women, an endless
17:03
stream, walk into an open manhole and saying nothing.
17:06
And so I did this book. I call it the stupidest, most
17:10
horrible, and most important thing I've ever done, because my
17:13
joke is that I forgot to take endocrinology when I forgot to
17:16
go to Med school. I'd learn all this.
17:18
But I did this book as a mission because I thought, how dare you
17:22
leave women unprotected when you know this.
17:25
You've been trained by Sandra Greenland, You have the capacity
17:27
to write this book in a way others don't, you know?
17:30
And I include all this stuff on dietary science and everything.
17:33
The most efficient and powerful ways to eat and exercise doable
17:36
by mere mortals. And, and so I put this all
17:39
together, but it was really, really horrible because you have
17:43
to do what you're saying. You verify the science.
17:45
What I love about you is that, you know, you look at you, you
17:49
look at the, the, our people are, are The Who are the
17:52
scientists. And I look at that and what I
17:54
see basically is that every scientist, the ones I respect,
17:58
there, there's some way in which they are selling their point of
18:01
view a little too unscientifically.
18:03
And it is, it depresses me, but I understand that we're human
18:06
and people do this. But I look for it always and
18:09
everybody. And I look for also big famous
18:12
researchers. This woman, J Julie Kim, not to
18:14
call her out particularly, but she's famous.
18:16
She has a paper on how progesterone causes breast
18:20
cancer. What that OK, wait a second.
18:23
This, this doesn't make physiological sense.
18:25
So I go and I read her paper and I look, I always look at the
18:28
citations in the back. So the citations for this, they
18:31
all say medroxyprogesterone acetate.
18:34
And that's what those papers are about.
18:36
And so this gets spread. It's like a game of toxic
18:38
telephone. So in, in our, when you get a
18:40
prescription here for progesterone, you'll get this,
18:43
this scary sheet with it. This going to kill you Here is
18:46
how, because it's for medroxyprogesterone acetate, not
18:49
progesterone. That's how big the confusion is
18:51
and how terrible it is. Yeah.
18:53
And it is confusing because if you were use the word estrogen,
18:57
it can include ethanol, estadiol, it can include equine
19:01
estrogens and estadiol and estriol and estrogen.
19:04
So there's lots of different types of estrogen under the word
19:07
estrogen. But the word progesterone is
19:10
only progesterone. But that's where we're really
19:12
careful using the word. In the US, it's more progestins.
19:16
We say progesterdins but it's not progesterone and there is
19:19
this big confusion and like you say, priors work is amazing
19:24
because she has worked so hard for so many years and I was
19:28
reading the other day that she applied for so many
19:32
universities. I think there was 9 times to try
19:34
and get into medical school as a woman and like her determination
19:38
was huge, but she's still people like raise their eyebrows and
19:43
don't want to think about progesterone.
19:45
So The Who have got a list of essential medicines and
19:49
obviously there's antibiotics on there.
19:51
There's really important drugs, there's insulin.
19:53
But when you look at hormones, they only list the
19:58
contraceptives and medioxy progesterone.
20:00
They don't have progesterone, they don't have estudiol, They
20:03
certainly don't have testosterone.
20:05
And, you know, I think this is a real emission because it shows
20:08
this sort of ignorance between these different hormones.
20:11
And we've got to understand the difference because some are
20:15
associated with risks. The synthetic ones, the natural
20:19
hormones are associated with lots of benefits.
20:21
And as you say in your book, the benefits to symptom control, but
20:25
more importantly, the benefits to future health as well.
20:28
Exactly. And then another thing in my
20:30
book, I wrote the book and the the longitudinal research was
20:33
not out on testosterone. I now I'm taking it.
20:36
I had to write my own prescription in the
20:38
pharmacokinetics for somebody very high up in gynecology
20:43
because they don't know this. They have the male, the Androgel
20:47
on their formulary. And this men have 20 to 25%
20:51
thicker skin, more sebum. And because I know how to take
20:55
this, I have, I have to take it twice a day, you know, every 12
20:58
hours. I have to divide this, get it in
21:00
a little, get in a little container within 30 seconds
21:03
because it evaporates and I put it on with the back of it like
21:06
an eye drop of the individual eye drop thing that I use, you
21:10
know, and I mean, I'm not, I'm not getting an exact dose.
21:13
And this is so terrible. And this is the, how deep the
21:18
lack of evidence in, in our medical care goes where, you
21:22
know, they don't even know that you need to have cream.
21:25
You know, they should have cream and they're called oral
21:28
syringes, which is they're not oral and you don't inject them,
21:31
but it's a precise dose for women.
21:33
Cream is better with women's skin.
21:34
And I know because I've read your research on I've read your
21:37
papers on testosterone. I was looking at one the other
21:40
day when I was writing the pharmacokinetics up and, and I
21:43
mean, this is, this is egregious.
21:45
We don't even have form approved in, in here in America and you
21:49
have to have hypoactive sexual desire disorder.
21:51
And by the way, before I did the medical stuff, I read the papers
21:54
on this because I'm an evolutionary psychology expert
21:58
and it doesn't really seem to work for that.
22:00
But you have to make up this story about your sad sex life in
22:03
order to get it, you know, because you have to get, you
22:06
have to look at what is it allowed to be prescribed for by
22:08
the menopause society. And I, you know, I'm not a
22:11
dishonest person, but I'm going to lie for my, for the benefit
22:14
of my health if I have to, to get the prescriptions I need.
22:18
I have a real issue with HSDD, which is hyperactive sexual
22:21
desire disorder, because it says that women have to be severely
22:25
psychologically distressed for at least six months before being
22:30
able to make that, you know, have that diagnosis.
22:33
Now, as a doctor, I didn't let my patients become severely
22:37
psychologically distressed with anything.
22:39
So and, and our guidelines and a lot of other guidelines say that
22:43
if women have reduced sexual desire, we can consider
22:45
testosterone, which is a lot nicer and it's a lot better.
22:49
But it's not all just about having sex with a partner.
22:52
So many of my patients are told by doctors, well, you haven't
22:54
got a partner, therefore you don't need a libido, therefore
22:56
you don't need testosterone. And I also think as a doctor, I
22:59
shouldn't be judgmental. If people want to improve their
23:03
libido, I'm not going to ask them like what what they're
23:06
doing with their improved sexual desire.
23:08
It's up to them. It feels really like going back
23:11
in time to have this very rigid criteria to say whether someone
23:16
can or cannot have a hormone that affects every cell in our
23:19
body. It just seems weird.
23:21
It's. Paternalistic, to use that word.
23:23
And The thing is the real reason I wanted it.
23:25
I have attention deficit disorder, which I I hate it.
23:29
I don't have a deficit of attention.
23:30
I have too much, you know, all over the place and I need to
23:33
focus. Adderall helps me with that.
23:35
But you know, in in menopause, you have a decrease in
23:38
norepinephrine and dopamine. And these are some of the things
23:41
that are already, you know, not not in sufficient quantity.
23:45
And those of us who have this. And so in menopause, I had, you
23:49
know, really terrible memory problems, other problems and
23:52
estradiol help, but the testosterone I've just been
23:55
taking it for maybe it's been 3 weeks.
23:58
Oh my God, I'm back to being myself again.
24:01
I saw that and I had to make up the story about how like my sad
24:05
sex life. And along the lines of what you
24:08
said, I want to point something out to women.
24:10
You know, I I have a whole section on vibrators in my book.
24:14
You know that that women, you know, to to tell them, you know,
24:17
it is wonderful. Give yourself pleasure.
24:20
You know that if you have sort of stigma against that in your
24:23
head here, here's why you might rethink that, you know, and and
24:26
to to get the pleasure throughout your life that you
24:29
can have, you know, from the marvelous little couture, we
24:33
call it, you guys say clitoris, clitoris here.
24:37
And and, you know, this is stopping women from having the
24:40
full rich lives they can all this this sort of prejudice
24:43
against, you know, the, the drugs that comes from a lack of
24:46
scientific evidence and fear defensive medicine, the practice
24:51
of medicine to defend a doctor's license, avoid getting
24:54
complaints, you know, and prioritizing that over the
24:57
patients. And the reason you have to do
24:59
that is if you're ignorant, if you know the medicine that you
25:01
can confidently prescribe for your patient and let them know
25:05
what the risks are and you know, the risks, if there are risks,
25:08
that's, that's, that's real, that that's doctoring how it
25:11
should be. And it's not what we get for the
25:13
most part. Yeah, for sure.
25:15
And actually there's a lot of risks in a lot of other
25:18
medicines that I prescribe as a doctor compared to hormones, you
25:21
know, and there's not nearly as much discussion out in the
25:24
public about risks of antidepressants or risk because
25:26
of antibiotics or risk of blood pressure treatment.
25:29
It's just mad thing how it's been shown into the space of.
25:33
Hormones. Yeah, absolutely.
25:34
So show me your book. I know you've got the blood
25:36
there. Just hold it up.
25:37
I forgot. To sell my book, This is going
25:41
menopausal what you and your doctor need to know about the
25:44
the real science of menopause and perimenopause.
25:47
And it's written in this everyday language because I
25:50
needed to tell women the science without it being in this medical
25:53
ease that where it's impenetrable.
25:56
So what what's been happening this this is so I I have joy
26:00
every time I get these messages. Women are going to their doctors
26:04
and sometimes screenshotting science in the book and using it
26:07
to get the evidence based medicine where they're getting
26:10
the hormones in sufficient amount, the right kind.
26:13
And that that's just so beautiful.
26:15
It's so beautiful. I think it's giving people more
26:17
confidence, actually, because your book is based on evidence
26:21
as well as opinion. That's really important so
26:24
people can learn from it and you write in such an easy way for
26:27
people to understand. So and I always ask for three
26:31
take home tips, but what 3 reasons are there why people
26:35
should buy your book? What are the three things you
26:37
hope that people will learn and be able to act on from your
26:40
book? Well, I tell.
26:41
Them you know the the actual science in contrast to what they
26:45
prescribe here. I also tell you beyond hormones,
26:49
because I'm transdisciplinary, I know the evidence across many
26:53
areas from decades since 1995 of reading and dietary science and
26:58
exercise, the most powerful and efficient ways to exercise.
27:02
And they are not based on nutrition research, which is the
27:04
crap fest of research where they ask you, did you have a
27:07
doughnut? What did you eat last month?
27:09
I can't tell you what I had yesterday.
27:11
And so these are doable by mere mortals.
27:14
I exercise, you can see my muscles.
27:16
I'm a lazy hedonistic pig. And so I, you know, I exercise
27:20
16 minutes a week with weights to get like this, you know, and,
27:24
and so you can do that. I've weights on my floor.
27:26
I'm not going to go to a gym, you know, regular people, you
27:29
get a gym membership, you don't go, then you feel bad because
27:32
you didn't go. Then you eat cookies because you
27:33
feel bad. So we're not going to have that
27:36
cycle. And then the other thing that I
27:38
do in the book is to talk about aging at the very end and how
27:43
women are stigmatized as we age and how ludicrous this is.
27:48
We're powerhouses. I'm so much better as a human
27:51
being at 61 than I ever was. And note that I talk about my
27:54
age all the time. I will tell you my ages
27:57
insistently as somebody who went to Harvard will let you know
27:59
that before you've licked your martini olive at a cocktail
28:02
party because I don't accept the stigma.
28:05
And if you're healthy, if you take the right hormones, use the
28:08
right hormones, eat and exercise this way, protect your bones
28:12
through eating and exercising this way, you can live, be old
28:16
and be fabulous and have a new career and a new you.
28:20
And menopause can be a beginning rather than the sad.
28:22
Oh, the change. And we're not going to talk
28:24
about it. And that that's why, by the way,
28:26
my cover, I designed my cover and the title and everything.
28:30
This is bold. It's like, we're not going to be
28:32
all like, ladies bathroom colors here, you know, the pink and the
28:35
flower or no, no, no, no broken fan.
28:38
This is about the inexplicable rages women feel in
28:40
perimenopause when they're not getting progesterone through
28:43
cycles where they don't ovulate. And it's also about my outrage,
28:46
the going menopausal at women being denied the care.
28:49
And so this is all about bold. See, my earrings, these are,
28:52
they're like $2.00. They're the size of coffee
28:54
tables. I wear red lipstick.
28:56
Here. I am.
28:57
I'm 61. I'm fabulous.
28:59
You're not going to ignore me. And that's how I'd like to see
29:01
women go out into the world, you know, because we're all, we're
29:05
old and powerful and fabulous. And if you have your health,
29:08
you're more able to do that than anybody.
29:10
Brilliant. What a great way to end.
29:12
So thank you so much. It's been really enjoyable.
29:15
Thank you.