Latest / The Dr Louise Newson Podcast / 286 - Looking back on menopause and hormone health in 2024 – and what does the future hold?

Transcript

286 - Looking back on menopause and hormone health in 2024 – and what does the future hold? · The Dr Louise Newson Podcast

1:03
So on this episode of the podcast, I'm going to do
1:05
something a bit different. I'm not actually going to have a
1:08
guest. I am going to be the guest of my
1:11
podcast. It's towards the end of the
1:14
year, the end nearly of 2024, so I thought I would just talk a
1:19
bit about some reflections of the year and where everything is
1:22
going, where my work's going, where menopause is going and
1:26
where hormones are going as well.
1:28
It's been an interesting year and really every day is a
1:33
different day. I always say to my children,
1:35
every day is a learning day. There's always new things to
1:38
learn, and often we learn from experiences.
1:41
Anything that we experience helps us to grow, to develop, to
1:46
change, to improve and move forwards.
1:50
Actually, somebody said to me many years ago that you should
1:54
glance backwards and look forwards.
1:57
And it's so easy to not think too much about the future and
2:03
concentrate on things that have happened in the past.
2:06
And many of us have had things that have happened that we
2:09
wouldn't want to have repeated to us.
2:11
But actually every negative and positive experience can shape us
2:15
in different ways. When I started the work that I
2:19
do about eight years ago, when I really wanted to dedicate my
2:23
future career to thinking about hormones and menopause, I didn't
2:26
really expect it to be quite as turbulent as it has been.
2:30
But I also didn't expect it to be so hard for so many women.
2:36
One of the things that really drives me to work so hard is the
2:40
injustice that's happening, the stories that I hear from women
2:44
who are really struggling to be believed, to be listened to, to
2:47
be understood and also to be able to access evidence based
2:51
treatment. Now many of you might know that
2:54
I have a keen interest in evidence based medicine.
2:57
I've actually written four books about evidence based medicine. 4
3:01
GPS Many years ago I wrote a sequence of books and I've
3:06
always read a lot of academic papers.
3:08
I also have a pathology degree. So I have a first class degree
3:12
in pathology, which is the study of disease and it's made me have
3:16
a very inquisitive mind. I quite enjoy reading quite
3:20
difficult scientific text, hard literature, where it's really
3:25
explaining the nuances of how our bodies work in a
3:29
physiological but also a pathological way.
3:31
And I'm very interested in the role of our hormones with
3:34
respect to inflammation, but also not just at a cellular
3:39
level within the cells, looking at how they affect our
3:41
mitochondria, which is the powerhouse of our cells.
3:44
They've produced the energy that our cells and bodies need for
3:48
every chemical reaction. So I'm interested in the way our
3:51
hormones work and I'm obviously interested in the way that when
3:54
we don't have those hormones, it can affect us in many ways.
3:58
But what I am always hearing are stories from women who are
4:03
really struggling. And that is, I think, because
4:08
menopause has been mislabelled. It's been misunderstood for a
4:12
very long time. So the first part of this year,
4:17
I really spend a lot of my spare time reading, increasing my
4:21
knowledge because I knew I was doing this theater tour, which
4:24
started in autumn of this year. I wanted to make sure that it
4:28
gave people information and knowledge that they didn't have
4:31
in other ways. I've spent a lot of time
4:34
imparting my knowledge through my podcasts, through the free
4:38
Balance app, through the Balance Hyphen menopause.com website,
4:42
through my Instagram lives that I've started to do every Sunday
4:46
that are uploaded to my YouTube. Imparting knowledge is a really
4:50
important part of my work. I like to use the available
4:53
evidence and try and translate it into easy ways so people can
4:57
understand. And actually what I really
5:01
wanted to spend time on preparing for the tour was
5:04
finding out information that I hadn't shared before.
5:07
So I had read a lot of books, but I read even more about the
5:12
history of hormones, about how it was when hormones were first
5:17
discovered, what led to people discovering these hormones and
5:21
how they applied them to clinical practice.
5:24
I also read a lot about how women had been portrayed in
5:28
medicine for many years, and also female leaders, how thought
5:33
leaders have been treated or mistreated over the years as
5:37
well. And also, I've reread the papers
5:41
that I've spent many hours reading about the biological
5:45
effect of hormones, how they work in our body.
5:48
And so reading and understanding makes you want to learn more,
5:52
doesn't it? And so I spend a lot of time
5:55
reading texts, but then actually having to reread and read more
5:58
detailed information because I couldn't quite believe what I
6:02
was reading. Because on one hand, I'm reading
6:05
about how important these hormones, estradiol,
6:07
progesterone, testosterone are throughout our body, affecting
6:11
every cell in our body, improving biological processes.
6:14
And on the other side, I'm reading on various social media
6:18
platforms and websites how our hormones are dangerous, how we
6:22
have to restrict their use. And there seems to be a bit
6:25
confusion between what natural hormones are and what synthetic
6:29
hormones are. So I just want to spend a little
6:32
bit of time on picking the difference.
6:34
So when we hire younger as women, we produce hormones
6:38
mainly from our ovaries, but also from other tissues and
6:41
organs in our body. So we have estrozil,
6:43
progesterone, testosterone. They're produced from
6:45
cholesterol. Actually, they're synthesized
6:47
from cholesterol. These hormones are made and then
6:50
they go in our bloodstream and affect every cell in our body.
6:54
But they're also made in our brains, and they're also made in
6:57
other tissues and organs as well.
6:59
They have really important biological processes.
7:02
They help our cells to function and work.
7:05
They reduce inflammation in our body, and like I say, they help
7:09
the mitochondria to function. They have effects on our brain.
7:14
The way our brain works and functions, the way our
7:16
personality, our memory, our mood, even our sleep.
7:20
Other metabolic processes like our heart rate, our respiratory
7:24
rate, our metabolism are all determined by these hormones.
7:28
So they're very important ways that they work throughout the
7:32
body. So when we don't have them,
7:34
obviously our body doesn't work as well.
7:36
We have more inflammation, our mitochondria don't work as well.
7:40
We have an increased risk of diseases.
7:42
But when we give people hormones back, certainly in our clinic
7:46
and many other clinics, what we do is we give the natural
7:49
hormones back. So these are made, they're
7:52
synthesized, but they are actually the same biological
7:56
structure as our own hormones. So basically if you look at them
8:00
literally down a microscope, they look identical to the
8:03
hormones we produce when we're younger.
8:05
So we're replacing like for like, But over the years since
8:10
hormones were discovered, they were discovered in the 1930s,
8:13
people have made synthetic hormones because they wanted to
8:17
make a chemical that was similar but different to hormones so
8:20
they could market it out to people and make money from it.
8:24
And there were two different ways in which hormone
8:26
replacement therapy has been synthetic.
8:29
One of them is chemically altering them to different
8:32
estrogens and progesterogens. So we have a type of estrogen
8:35
called ethanol estradiol, which is a chemically altered type of
8:40
estradiol. It's not the same.
8:42
It doesn't have the same biological effects and it has
8:44
risks associated with it. But we also have synthetic
8:48
progesterone. So these are like progesterone
8:51
but they're chemically altered. So we have something called
8:54
medoxy progesterone acetate or norothistarone.
8:58
These two are synthetic progesterone that have been used
9:01
in different types of hormone replacement therapies.
9:04
We now prescribe the natural hormone which is usually
9:07
referred to as micronised progesterone or eutigestan is
9:11
the other name in the UK. So that is exactly the same.
9:15
But the synthetic ones we know do have risks.
9:18
They have risks of heart disease, risks of clot, risks of
9:22
probably breast cancer, only small risk, but actually we need
9:26
to be thinking about those risks.
9:28
So we mitigate those risks by prescribing the natural
9:31
hormones. The estradiol through the skin
9:34
is a patch or gel and the progesterone is a natural
9:37
micronised progesterone which can be given orally or off label
9:42
as a vaginal or rectal pessary to get absorbed through into the
9:47
bloodstream. And then obviously testosterone,
9:50
which again causes so much confusion.
9:53
Testosterone is a biologically active hormone that women and
9:57
men produce. We produce it from our ovaries,
9:59
our adrenal glands and also it's made in our brains.
10:03
Now, testosterone is more biologically active than other
10:06
hormones in our body. We produce more testosterone
10:09
than estudiol when we're younger, and levels decline with
10:13
age. So actually low testosterone is
10:16
a age-related decline rather than purely menopause.
10:20
But of course, if women have their ovaries removed and become
10:23
menopausal at a younger age, their testosterone level will
10:26
decline quite quickly. So testosterone, when we
10:29
prescribe it, we prescribe it as a gel or a cream, and it's the
10:32
natural testosterone. It's the same structure as the
10:35
testosterone we produce when we're younger.
10:38
But we have synthetic testosterones.
10:40
Some of the injectable testosterones are chemically
10:44
altered, so they're not going to have the same biological effects
10:47
that testosterone does, and they're associated with risks.
10:51
So they are labeled actually as anabolic steroids.
10:54
They can build up muscle in a very unusual way.
10:57
They can increase risk of heart attacks the same way that the
11:01
unnatural, the synthetic progesterone, can increase risk
11:04
of heart attacks. But they're very different.
11:07
And I've spent a lot of time deciphering the differences.
11:11
And it's important that people, women, men, but also healthcare
11:16
professionals know the difference because it's lazy
11:18
medicine to say all oestrogens are the same, or all
11:22
progesterones are the same, or even all testosterones are the
11:24
same because they're not. And one of the things that I
11:28
think is a easy way of thinking about it is what's the
11:31
difference between roast chicken and chicken flavoured crisps?
11:36
The chicken flavoured crisps probably don't have any chicken
11:39
in them at all, but they've been made to taste like chicken, but
11:42
they've been chemically altered of course, and manufactured in a
11:45
synthetic way. The other analogy that I used a
11:48
lot in the tour was thinking about diamond compared to
11:53
graphite pencil lead. And I had a slide showing these
11:56
too, and people probably thought I was mad.
11:59
But actually many of you might know if you've done any
12:02
chemistry, that diamond is made from carbon and graphite is made
12:06
from carbon, and there's just one bond different.
12:09
So there are four bonds between the carbons in diamond and only
12:13
three in graphite. So just adding one extra bond
12:18
can really alter the structure of a substance.
12:22
So when estudiol or progesterone or testosterone is chemically
12:27
altered, just changing 1 bond or adding one different maybe
12:32
oxygen or hydrogen atom is going to absolutely change its
12:35
structure and the way it chemically works in the body.
12:39
And I think for too long people haven't understood this.
12:43
I didn't spend much time thinking about it when I was a
12:45
junior doctor, happily prescribing synthetic hormones
12:48
as contraceptives or synthetic hormones as HRT, because no one
12:52
taught me and I didn't have the time or the energy or the
12:56
knowledge to learn all this. But actually when you one pick
13:00
it, it's really important. So a lot of the debate about
13:03
risks, about hormones when given as a prescription are hormones
13:09
that have been synthetically made, they've been chemically
13:12
altered. And this is really important and
13:15
I will talk more and more about it next year because it's so
13:17
important when we think about reasons for taking hormones.
13:21
So as a menopausal woman myself, I'm very open that of course I
13:25
take HRT because I was experiencing a myriad of
13:28
symptoms, especially affecting my mental health but also my
13:32
physical health as well. So my mood was low, my memory
13:35
was very poor, my concentration was terrible, my sleep was awful
13:40
and I was very irritable, very short tempered, felt very low
13:45
and flat, just wasn't enjoying things, became quite socially
13:49
withdrawn and very lonely. I didn't really know what was
13:53
going on. I thought I was just working too
13:54
hard and that's just my lot really.
13:57
But also I was getting physical symptoms.
13:59
My migraines were a lot worse. They were more frequent, they
14:02
were more severe, had a lot of muscle and joint pain.
14:06
I had multiple times where I had awful palpitations, bit of
14:10
indigestion and reflux as well. And all these symptoms really I
14:16
didn't understand because I didn't put them together.
14:19
And I also had recurrent urinary tract infections.
14:23
I had some vaginal dryness. I had reduced libido.
14:26
My hair had changed, became thinner, drier.
14:29
My skin was quite itchy, so lots of things going on and then
14:34
obviously once I realised what was going on and I was
14:37
perimenopausal, then I decided to take hormones.
14:41
But I take HLT for two reasons, of course, to feel better and
14:45
it's taken quite a long time to have the right dose and type of
14:48
hormones. It didn't work straight away.
14:51
I had to increase my dose of estradiol because I don't absorb
14:54
very well through the skin. And I had to, well, I didn't
14:57
have to, but I chose to take testosterone to improve my
15:01
libido. But it's also helped with my
15:03
mood, energy, motivation, concentration and sleep, and
15:06
actually my migraines as well. But it can take a while for
15:10
these hormones to work. But the other reason that I take
15:13
HRT is to improve my future health.
15:16
And that's something that is really important, and we've
15:19
known it for decades, thinking about how these hormones can
15:24
reduce inflammation in our body. And when we think about
15:27
inflammation, inflammation is important because when we have
15:30
inflammation, it can damage tissues and organs and increase
15:34
our risk of diseases. And the inflammatory diseases
15:37
are the diseases that really affect our future health as
15:40
women, but also as men. So if I list them, they're
15:43
diseases that you will have heard of before, and these are
15:46
heart disease, including cardiovascular disease.
15:49
So that's not just our heart, but our blood system as well.
15:53
So cardiovascular disease, dementia, type 2 diabetes,
15:58
clinical depression is even thought of as an inflammatory
16:00
disease, osteoporosis, other neurodegenerative diseases such
16:05
as Parkinson's disease and autoimmune diseases as well.
16:10
Those can all be associated with altered inflammation in the
16:13
body. Cancers can be associated with
16:16
inflammation too. And so we know that I've already
16:20
said that hormones reduce inflammation, So we know they
16:24
reduce the risk of diseases, these inflammatory diseases.
16:28
And we've got many studies for many years showing that women
16:32
who take hormones have a lower risk of these inflammatory
16:34
diseases. And that is important when we
16:37
think about population health. I'm very interested in keeping
16:42
people healthy for as long as possible.
16:44
It's not just helping them feel better, although as a doctor
16:48
it's lovely to help people feel better, but it's about investing
16:52
in their future health. So we know that women who take
16:56
natural hormones have a lower risk of all these diseases and
17:00
actually are less likely to die at an earlier age.
17:03
But it's not the age we die, it's a journey to that age.
17:07
It's thinking about health span rather than lifespan.
17:11
And for too long we don't think enough as healthcare
17:15
professionals about health span keeping people really healthy.
17:19
And that is so important because we know that the NHS is really
17:24
on its knees. We know that there are a lot of
17:26
people being admitted to hospital all the time with these
17:29
chronic diseases and many of these people are not taking
17:32
hormones to reduce their risk. So it is very important when we
17:37
think about the role of these hormones and how they work.
17:40
And if some of you had come to the tour, you would have seen I
17:43
had a massive slide with a picture of a macrophage, which
17:47
is the cell that reduces inflammation in the body.
17:50
It's really important because our macrophages work better when
17:54
we have estradiol, progesterone, testosterone on them,
17:57
stimulating them. We know in the presence of
18:00
Easterdale, the macrophages work better.
18:02
They can genetically be reprogrammed, they can increase
18:05
the number, they can improve the efficiency of how they work.
18:09
And I also had a slide of mitochondria because we have
18:12
trillions of them in our body and we know that those hormones
18:16
will improve the way that they function as well.
18:19
So I spoke to thousands of women on the tour and men, actually
18:23
men, came to and it was such an incredible experience that I
18:27
hope I can repeat again. I was incredibly nervous, the
18:31
thought of having 34 tour dates all around the UKI went up to
18:36
Scotland, I went to Wales, went down to the South Coast, all
18:41
around meeting people and I had sessions before with small
18:45
groups of women. Obviously the theatres were very
18:49
full, or some of them were full, and then I saw people afterwards
18:53
because I did book signing as well and it was amazing.
18:58
I was very fortunate in that I had a lot of support.
19:02
I worked with Angilda, who's a comedian who lightened it a
19:07
little bit for me, which was great.
19:09
The team that came with me were very, very professional, very
19:13
supportive, and I never thought I would be on the stage.
19:18
My mother's an actress, and going on the stage would have
19:21
filled me with horror. But I knew that it felt the
19:24
right thing to do to be able to have a different platform,
19:27
literally, to share some of my knowledge, but in different
19:30
ways. So I had lots of slides.
19:33
I had lots of information in the second-half about, like I say,
19:37
the history of hormones, the history of what happened to
19:41
women. I even had some adverts from the
19:43
50s and 60s about how women were portrayed as well.
19:48
There were a lot of laughs in the audience and there were
19:50
quite a few tears as well, especially talking about mental
19:53
health impact of hormones. But what I wanted to do was
19:57
allow people time to really reflect and think differently
20:01
about my work and what hormones do throughout the body, and
20:05
about ways that women have been almost stopped from having
20:09
hormones throughout history of medicine.
20:12
And there are lots of examples where people have been taken
20:15
down by other healthcare professionals when they've tried
20:18
to help women with hormones. So that's been really
20:21
interesting for people to listen to and to.
20:25
Watch and just feeling the energy from the room has really
20:29
been incredible and I really want to thank those of you who
20:32
are listening who did come to the tour.
20:34
But I also came away very sad because every single place I
20:40
went to, I heard stories from women who were often very
20:43
tearful telling me that they are unable to receive hormones from
20:48
their doctors. Even some of them in Scotland
20:51
said to me there's no point even being referred to the menopause
20:53
clinic because we know they won't prescribe testosterone but
20:57
we know we really need it. We have 0 libido, we feel
20:59
absolutely dreadful. We take HRT and we still have
21:03
symptoms. One lady told me that she was on
21:06
testosterone and she was feeling wonderful.
21:08
Her testosterone level was normal, within normal limits for
21:11
a woman and her doctor said no, you must come off it and then
21:15
don't come back for another six months.
21:16
You don't need to be on this anymore.
21:19
And she was really scared because she didn't want to go
21:21
back to how she was feeling. I also met a lot of women who
21:24
tell me that my work had transformed their lives and
21:27
actually saved their lives. I had partners of women telling
21:31
me that information that I'd shared had given them the
21:36
confidence and the impetus to go and receive help, which had
21:40
transformed and often saved their lives, and they wanted to
21:44
just thank me. And it's very humbling actually
21:48
when people thank me because I'm not really doing anything
21:51
special and all I'm doing is giving them common sense
21:54
information based on the evidence.
21:56
But it's almost as if these people haven't been allowed to
21:58
have evidence before, haven't been allowed to have this
22:01
knowledge. And it makes me realise how
22:04
closed actually a lot of medical healthcare professionals are and
22:08
how they don't empower their patients in the way that they
22:11
should. And it's really sad because it
22:14
doesn't seem to be improving for everybody.
22:18
I went to the Royal College of General Practitioners Annual
22:21
conference in October in Liverpool and presented some of
22:24
our data and there was a lot of people there who were really
22:28
encouraged. They're doing a lot more
22:30
training, they're learning a lot more about the role of hormones
22:33
and health and prescribing more HRT, which is great.
22:38
We have the new NICE guidance that came out in November this
22:40
year. They're updated from the ones
22:42
from 2015, but they don't depict all the evidence.
22:47
They're quite skewed in what they present.
22:50
But even then they'll take home. Tagline, if you like, is that
22:54
HRT is first line treatment for the majority of women, but the
22:59
problem is, is that it's not first line treatment for the
23:02
majority of menopausal women because only the minority are
23:05
receiving hormones. Less than 20%, around 14 or 15%
23:10
of women who are menopausal in the UK are prescribed HRT and
23:14
it's in areas of deprivation. In ethnic minority groups, it's
23:18
a lot lower than this. We looked at some of the data of
23:21
people that have had frigidity fractures, so no impact
23:24
fractures, people who've have osteoporosis, who have
23:27
fractures, and it was less than 1% of those women are prescribed
23:31
HRT, whereas HRT is licensed as a treatment for osteoporosis.
23:36
There's been a lot of confusion about dosing of hormones, and
23:41
we've been working very hard as a group.
23:42
I fund a small research team and we've been showing that we do
23:47
see women who need higher doses, myself included.
23:50
And that's very simple. It's just the skin is a barrier.
23:54
It's harder to absorb estudiol through the skin if the skin is
23:58
thicker, if it's colder, if there's more subcutaneous fat.
24:01
Skin type and texture really varies between people.
24:05
And I know personally my patches do not stick on very well, so
24:08
when I remove them there's still glue on them.
24:12
The glue contains estradiol so it hasn't all been absorbed
24:15
through my skin. And so my consultant many years
24:18
ago gave me a higher dose so I could get adequate absorption
24:21
and monitored estradiol levels. And I have my estradiol,
24:25
testosterone levels done every year as part of my review and my
24:29
levels are within normal ranges. They're not too high and they're
24:32
not too low and my symptoms are optimised.
24:35
But I use higher dosing because that is the right dose for me to
24:40
get adequate amounts through the skin.
24:43
Many people have been quite scared about these higher doses.
24:46
Now we know it's just a natural hormone and we give higher doses
24:50
to a minority of women who need it because they were just trying
24:54
to get adequate absorption through the skin.
24:57
But I'm very proud of our research team.
24:58
We've had publications accepted. We had a great one about
25:02
testosterone. So symptoms of mood changes,
25:06
memory changes, as well as libido reduction can improve
25:09
when testosterone's added to HRT.
25:12
So this was looking at our patients.
25:13
We had that accepted in an academic journal and now we've
25:17
got one about our dosing accepted.
25:19
It's going to come out any minute now and we've been doing
25:22
a lot of work for women who've had breast cancer.
25:24
So we've had two publications accepted, another one that's
25:27
been submitted for review process and these are in peer
25:32
reviewed journals. We always present our data at
25:35
different conferences and certainly I can't think of
25:39
another menopause clinic that is producing the quality of
25:42
research and data that we're producing.
25:45
We're working collaboratively with different universities as
25:48
well, such as Liverpool, John Moores University, Bristol
25:52
University, King's College London, Monash University in
25:56
Melbourne, and working collaboratively with other
26:00
people's is just wonderful. There's a huge amount of support
26:03
for what we do, not just in the UK but globally as well.
26:08
This year I've been to Norway, which is wonderful, met some
26:12
incredible people. I've got Norwegian blood, my
26:15
grandmother was Norwegian and so it was great my first time
26:18
visiting Norway and I really, really enjoyed that.
26:21
And I hope to go back at some stage next year.
26:25
I am going to Australia, I'm going to go to Sydney, Perth and
26:30
Melbourne. Really, really looking forward
26:32
to that. Talking to women, but also to
26:35
healthcare professionals as well.
26:37
Recording a couple of podcasts over there too.
26:40
So lots of exciting things that are going to happen.
26:43
And on my way over to Australia, I'm going to be stopping in
26:46
Singapore. And Singapore is going to be
26:49
very exciting as well, talking a lot about longevity, talking
26:53
about future health with hormones.
26:55
So that's going to be exciting and hopefully going to go to
26:59
America as well at some stage. So I'm also going to be focusing
27:04
a lot on my podcast, how to reach wider audiences all across
27:09
the world. I'm going to be doing a lot more
27:11
work on balance, enabling people to have balance in many, many
27:15
countries and improve the quality of the information that
27:19
we're giving. I'm doing a lot of work with our
27:22
education programme as well, so that's very exciting.
27:26
We're going to be updating our education, working
27:29
collaboratively with all sorts of people.
27:32
Our research team is going to continue working with other
27:35
people and of course our clinic is still going to be seeing
27:39
people, seeing people who are unable to receive the evidence
27:43
based care and treatment that they want and deserve from the
27:46
NHS. But we work very closely with
27:48
the NHS, so increasingly patients come and see us maybe
27:52
two times, then they're optimised on their hormones and
27:56
then their NHS GP takes over their prescribing, which is
27:59
really great. So we have a great network of
28:02
colleagues in the NHS that we work with, which will continue.
28:06
And we're going to be doing monthly webinars for people who
28:10
are non healthcare professionals and then also monthly webinars
28:13
for healthcare professionals as well.
28:15
So lots of things going on, but I just hope you've enjoyed this
28:19
podcast to learn a bit more about what I've been up to and
28:22
what I want to get up to and what's been going on in my mind
28:26
recently. So I hope you're looking forward
28:29
to Christmas. I'm looking forward to spending
28:31
time with my family. I have three daughters who are
28:34
so inspirational and a lovely husband and the four of them
28:39
prop me up and persuade me to keep going and keep doing what
28:42
I'm doing because it's making a difference to the right people.
28:46
So enjoy your time, keep knowing as much as possible, improve
28:53
your knowledge, try and advocate for other people as well, and
28:56
let's keep going with this massive community of people we
28:58
have who are determined to make changes for the better going
29:02
forwards. Thank you.
29:08
You can find out more about Newson Health Group by visiting
29:11
www.newsonhealth.co.uk and you can download the free Balance
29:18
app on the App Store. Or Google Play.