Latest / The Body Pod / The Truth About Menopause and Hormones for Women Over 40 with Dr. Louise Newson

Transcript

The Truth About Menopause and Hormones for Women Over 40 with Dr. Louise Newson · The Body Pod

0:00
Speaker 1: Hi everyone. My name is Haley and this is Laura
0:02
Speaker 1: and welcome to the body Pod. Welcome back to the
0:14
Speaker 1: body Pod everyone. Today I have the honor and privilege
0:18
Speaker 1: of speaking with doctor Louise Newsan, who is a general
0:23
Speaker 1: practitioner and hormone specialist and a leading voice in transforming
0:27
Speaker 1: menopause care worldwide. As the founder of the News and
0:31
Speaker 1: Clinic and the not for profit News and Education, she
0:35
Speaker 1: is dedicated to improving awareness, education and access to evidence
0:40
Speaker 1: based care through in person events, a comprehensive library of
0:45
Speaker 1: freely available articles, and an education program for healthcare professionals.
0:51
Speaker 1: She empowers both women and clinicians with the knowledge that
0:55
Speaker 1: they need. A Sunday Times best selling author and host
0:59
Speaker 1: of the UK's number one medical podcast, doctor Newsan is
1:03
Speaker 1: passionate about driving positive change for women's future health. Doctor
1:08
Speaker 1: Newsan has been described as the medic who kickstarted the
1:12
Speaker 1: menopause revolution. She is an award winning educator, podcast and
1:17
Speaker 1: author committed to increasing awareness of hormone health, including perimenopause
1:22
Speaker 1: and menopause. Her mission is to provide inclusive, accessible and
1:27
Speaker 1: evidence based information in formats that suit all women, helping
1:31
Speaker 1: them make informed choices about their health. Through her work,
1:35
Speaker 1: she has empowered a generation to take control of their treatment,
1:40
Speaker 1: bodies and minds, ensuring menopause care is recognized as a
1:44
Speaker 1: vital part of women's healthcare. Today, we dive deep into
1:49
Speaker 1: what each hormone does and the benefits, pros, and cons,
1:53
Speaker 1: as well as common myths that are surrounding hormone therapy.
1:58
Speaker 1: So enjoy this episode with doctor newsan welcome back to
2:12
Speaker 1: the Body Part everyone. We have doctor Newsen here with us,
2:16
Speaker 1: who we've already introduced, and Louise, thank you so much
2:21
Speaker 1: for joining us. We are thrilled to have you.
2:24
Speaker 2: Oh, thanks for viting mat It's great.
2:27
Speaker 1: Well, we have a probably five pages of questions, and
2:32
Speaker 1: then of course I put out on my Instagram story.
2:35
Speaker 1: I was thinking I probably wouldn't, but I love how
2:37
Speaker 1: in your YouTube's in your lives that you always ask
2:40
Speaker 1: questions at the end, and so I was like, I'm
2:43
Speaker 1: going to keep some of these on there if we
2:44
Speaker 1: have time to answer any in the last five minutes.
2:48
Speaker 1: But this is going to be a hefty conversation in
2:52
Speaker 1: all things hormone therapy. So we are going to dig
2:56
Speaker 1: right in. So first of all, when you're called the
3:01
Speaker 1: medical who kickstarted the menopause revolution. First of all, that's
3:04
Speaker 1: a hefty title. Yeah, what sparked your passion for transforming
3:11
Speaker 1: this menopausal care?
3:14
Speaker 2: Yeah, it's interesting because I didn't always have this passion.
3:16
Speaker 2: Like if i'd met you fifteen years ago, I would
3:19
Speaker 2: have gone, what, No, I'm interested in everything in medicine,
3:22
Speaker 2: and I still am. But I suppose it was hearing
3:27
Speaker 2: stories when I'm in When I was in my GP practice,
3:31
Speaker 2: I would only see the patients that came to me,
3:33
Speaker 2: and you're limited in how many you can see. You know,
3:36
Speaker 2: thirty forty patients a day probably ended up about eighty
3:40
Speaker 2: percent of them or menopausa by the time I left.
3:43
Speaker 2: But I'd hear those stories. Women would be suffering for
3:45
Speaker 2: a little bit, and then I'd help them, and then
3:47
Speaker 2: they would start to feel better. And then when I
3:49
Speaker 2: started to do my clinic, I thought it would just
3:52
Speaker 2: be an extension of what it was like in general practice,
3:55
Speaker 2: But it wasn't. Women would travel for hundreds of miles
3:58
Speaker 2: sometimes and they would tell me how they'd been suffering
4:01
Speaker 2: for years because their doctor had given them antidepressants, told
4:05
Speaker 2: it was all in their head that they needed other drugs,
4:10
Speaker 2: and all the symptoms have started since their ovaries were
4:13
Speaker 2: removed in an operation age thirty, or since their period
4:16
Speaker 2: stopped or whatever, and I was like, what, like, how
4:19
Speaker 2: what's going on out there? And then I started, wrongly
4:22
Speaker 2: or rightly, to sort of play with social media and
4:25
Speaker 2: people would message me with these stories. And then over
4:28
Speaker 2: the years, obviously the clinic's busy, My social media is
4:32
Speaker 2: really busy. People stop me in the street and tell
4:34
Speaker 2: me about how they're not being listened to and believed.
4:38
Speaker 2: So what drives me now is just in injustice actually
4:41
Speaker 2: of what's happening and how the medical system is letting
4:44
Speaker 2: down so many women without any good reason. So it's
4:49
Speaker 2: gone from just being interesting to like something that's making
4:53
Speaker 2: me really sad and cross.
4:55
Speaker 1: Actually, yes, and what do you think do you think
4:59
Speaker 1: that one country has has it a little bit harder
5:05
Speaker 1: than others? I mean we're in America actually, lauras in
5:08
Speaker 1: Europe right now, so yeah, nice, But does I mean
5:14
Speaker 1: if we look at the U, don't just take the
5:17
Speaker 1: UK and take America? Are there huge difference? I mean,
5:21
Speaker 1: I know there's a lot going on in America right now, but.
5:23
Speaker 2: Yeah, for sure, for lots of reasons. But you know
5:26
Speaker 2: what every country. It's bad. So lots of people say, Louis,
5:30
Speaker 2: it's what you're doing is amazing. UK is really increasing.
5:34
Speaker 2: HRC prescribing had been increasing, but the last few months
5:37
Speaker 2: it's plateaued again because there's various people who are trying
5:40
Speaker 2: to scare people away again from hormones. But let's think
5:44
Speaker 2: about it. One hundred percent of women will become menopausal.
5:49
Speaker 2: About five percent of menopausal women globally are prescribed hormone
5:53
Speaker 2: replacement therapy and in the UK it's about fourteen percent.
5:59
Speaker 2: But every MENSE guideline, whatever you know, you think about
6:03
Speaker 2: the guidelines, they alsay first line treatment for symptomatic menopause
6:08
Speaker 2: for the majority of women is HRT. So I'm not
6:13
Speaker 2: a mathematician, but five percent and fifteen percent are not
6:16
Speaker 2: the majority. So even if you just look top line,
6:21
Speaker 2: do you know what I mean, then it's bad. So
6:25
Speaker 2: I feel sometimes guilty with my work because awareness is improved,
6:29
Speaker 2: knowledge has improved, but access to evidence based treatment generally
6:34
Speaker 2: hasn't really improved.
6:37
Speaker 1: So let's go to that evidence based treatment. What does
6:41
Speaker 1: that mean to you? Because I'm obviously I am in
6:45
Speaker 1: the strength and conditioning world, but I have partnered with
6:49
Speaker 1: a lot of influential experts, and I feel like there's
6:55
Speaker 1: that while menopause has gotten widely more popularized, there are
7:03
Speaker 1: two camps. Yeah, and the camps are of you know,
7:08
Speaker 1: and sometimes it's loud. But when you I feel like
7:10
Speaker 1: everyone's throwing around evidence based care, what does that mean
7:14
Speaker 1: to you? And what are you providing different?
7:17
Speaker 2: No, it's a great question, and I think women's health
7:21
Speaker 2: in general becomes very polarized. Something about hormone health becomes
7:26
Speaker 2: really quite toxic in summer. You need to look at
7:28
Speaker 2: some social media comments and you're like, hang on, what's
7:31
Speaker 2: going on here? So with obviously, I'm a physician and
7:37
Speaker 2: all my work, whether it's hormonal or not, is based
7:40
Speaker 2: on evidence. And when I say evidence, that's that's scientific evidence,
7:45
Speaker 2: but clinical evidence as well. So we have to remember
7:50
Speaker 2: that medicine is a science and an art. So the
7:52
Speaker 2: science is knowing, you know, the biology, the physiology, the biochemistry,
7:57
Speaker 2: the pharmacology, studies, the trial, the evidence. But it's also
8:02
Speaker 2: the art is individualizing care, and that's sometimes lost in
8:08
Speaker 2: people who don't have a huge amount of clinical experience.
8:12
Speaker 2: So then well, if we think about what menopause, perimenopause
8:18
Speaker 2: is it's related to hormonal changes. Menopause is when the
8:22
Speaker 2: hormones are low because our avaries don't work for various reasons.
8:26
Speaker 2: So then if we unpick what the hormones are, they're
8:29
Speaker 2: chemical messengers that work in every single cell. So then
8:34
Speaker 2: when I talk about hormone deficiency, there's already people going, no,
8:37
Speaker 2: it's not a hormone deficiency. Well what is it? Then?
8:40
Speaker 2: Do you know what I'm saying? It's low hormones. Therefore
8:43
Speaker 2: it's a low deficiency. So then you have to think, well,
8:47
Speaker 2: how do does our body work with hormones? Well, the
8:50
Speaker 2: cells work better, the tissues work better, the organs work better,
8:54
Speaker 2: the organelles in the cells, like our mitochondria work better.
8:58
Speaker 2: That's just fact. That's not me telling you something I've
9:01
Speaker 2: made up. This is just you know, basic physiology. But
9:06
Speaker 2: then when you think about treatment and individualized treatment, it's
9:10
Speaker 2: about choice, and I often will compare it with things
9:14
Speaker 2: I exercise. I don't need to tell you that exercising
9:17
Speaker 2: is really good, but there are different types of exercise
9:20
Speaker 2: and there's choices. Some people don't exercise at all, and
9:24
Speaker 2: that is their choice. They're not all going to get
9:27
Speaker 2: heart disease. Because they don't exercise. But we know that
9:30
Speaker 2: risk of heart disease, for examples, increases if you don't exercise,
9:34
Speaker 2: and it's the same with hormones. If you don't take hormones,
9:37
Speaker 2: there are risks to your future health. But you might
9:40
Speaker 2: be absolutely fine. But you just need to know and
9:43
Speaker 2: accept what's going on in your body. And knowledge is
9:46
Speaker 2: really important. And I see some people on social media
9:50
Speaker 2: are going, look at me, I'm amazing, and I've never
9:52
Speaker 2: taken a hormone. This is all done like naturally. Well,
9:56
Speaker 2: it's not natural to not have hormones for a start,
9:59
Speaker 2: But do these people want a medal? You know? I
10:01
Speaker 2: see women who are suicidal and falling apart. Do I
10:06
Speaker 2: say to them, oh, do you know what, if you exercise,
10:10
Speaker 2: then you might be fine. Like I don't say that
10:13
Speaker 2: if someone's got other deficiency, if they've got low iron,
10:17
Speaker 2: I wouldn't be saying, well, exercise and you'll be fine.
10:19
Speaker 2: I mean exercise, of course you'll improve with other ways,
10:23
Speaker 2: you won't replace that iron. So I think it's misunderstanding
10:27
Speaker 2: actually about what basic humans do in our body. And
10:32
Speaker 2: then the HRT conversation is really fragmented because people don't
10:36
Speaker 2: seem to often understand there are different types of hormones.
10:40
Speaker 2: Like if I wanted if I was ten years younger
10:42
Speaker 2: and wanted contraception, I'd get it really easily. As a
10:47
Speaker 2: fifty four year old menopausal woman. If I want HRT,
10:50
Speaker 2: everyone's like, what you can't have that that's terrible. But
10:55
Speaker 2: if I wanted antidepressants, it would be very easy for
10:58
Speaker 2: me to get them. So there is this inequality of
11:01
Speaker 2: care that's going on. And my work is really about
11:05
Speaker 2: empowering people with knowledge so then they make choices. You know,
11:09
Speaker 2: it's not saying you have to take this stormont or
11:12
Speaker 2: you have to exercise in a certain way. Just have
11:15
Speaker 2: this knowledge, but the knowledge has been hidden or it's
11:18
Speaker 2: been wrong. And I just to be really clear to
11:21
Speaker 2: your audience, I don't work with pharmaceutical companies. I don't
11:24
Speaker 2: work with supplements or brands or you know. My knowledge
11:28
Speaker 2: comes from reading academic papers and you know, knowing a
11:32
Speaker 2: lot about basic science and then putting that into context
11:37
Speaker 2: for individual patients.
11:39
Speaker 1: Do you think that it's so we will get to
11:42
Speaker 1: what hormones pros and cons and what each one of
11:46
Speaker 1: them do, because I think those are still with all
11:49
Speaker 1: of this information out there. I just know from what
11:53
Speaker 1: I'm getting in my DMS and my groups because I
11:55
Speaker 1: always hire a menopausal like a menopause physician to come
11:59
Speaker 1: into my courses to educate because not my lane. But
12:02
Speaker 1: it's amazing how much of the same questions, yes, homos
12:07
Speaker 1: all of the time. So what would you say, are
12:10
Speaker 1: the three the top three if you could pick two
12:12
Speaker 1: or three misconceptions about HRT that we're still getting wrong
12:18
Speaker 1: today or most people don't understand.
12:21
Speaker 2: I think the biggest reason why people don't take homens
12:24
Speaker 2: and don't prescribe them if they're doctors is the risk
12:27
Speaker 2: of breast cancer. That's the biggest same people are scared about. Now.
12:32
Speaker 2: One of the things to think about is the study
12:35
Speaker 2: that everyone scared everyone away from two thousand and two
12:39
Speaker 2: was using synthetic hormones. So even though it showed the
12:43
Speaker 2: risk wasn't statistically significant, and even though it showed easter
12:47
Speaker 2: and only HRT was associated with a lower risk of
12:50
Speaker 2: breast cancer, you can't compare it with the natural hormones,
12:54
Speaker 2: the body identical hormones we prescribe. Now, there has never
12:58
Speaker 2: been a study to show that our own hormones cause
13:01
Speaker 2: breast cancer like it wouldn't make sense really, even if
13:04
Speaker 2: you think about it as a basic scientist, how would
13:07
Speaker 2: our own hormones? Cause cancer just feels a bit weird,
13:10
Speaker 2: doesn't it. Yes, So that is the biggest myth that
13:14
Speaker 2: scares people away. The other thing is that people think
13:18
Speaker 2: that they're too old to be considered on hormone And
13:22
Speaker 2: let's face it, we've got twenty years of lost women
13:26
Speaker 2: who have been misguided and denied hormones. So now a
13:30
Speaker 2: lot of these women who were forties fifties when the
13:32
Speaker 2: study came out and maybe in their seventies. No one
13:36
Speaker 2: is too old to be considered for hormones. And then
13:39
Speaker 2: the other myth is all about testosterone, what it is,
13:42
Speaker 2: who can have it, what does it mean, because a
13:45
Speaker 2: lot of people think testosterone is the hormone that people
13:50
Speaker 2: inject to be bodybuilders and have like massive muscles, and
13:54
Speaker 2: what those people are doing are giving themselves something that's
13:58
Speaker 2: like testosterone, but it's not the same. So it's like,
14:02
Speaker 2: you know, eating steelbery flavored sweets rather than having strawberries.
14:07
Speaker 2: There's a big difference in the body. So those are
14:10
Speaker 2: myths and not every hormones the same. You know, I
14:15
Speaker 2: contraceptives are very different to homones that we prescribe, and
14:19
Speaker 2: most even doctors don't seem to realize that.
14:23
Speaker 1: Okay, So if I were to come in, so Laura
14:25
Speaker 1: and I are the same age, we're both turning forty
14:28
Speaker 1: eight this year, so it's a good assumption that we're
14:31
Speaker 1: in perimenopause. And I feel like this is almost the
14:35
Speaker 1: I mean, I would love your your advice, but it
14:40
Speaker 1: feels like perimenopause, where everything is really erratic, is the
14:46
Speaker 1: harder section a at least postmenopause. But here we have
14:51
Speaker 1: perimenopausal women the majority, as you said, from the statistics
14:55
Speaker 1: at the first of the call, that are either our
14:57
Speaker 1: metopausal or in this peri face, that aren't taking hormones.
15:01
Speaker 1: And if this is the most dramatic, you know a
15:07
Speaker 1: few years leading up to it. If I were to
15:09
Speaker 1: come in your office and this is generalized, I know
15:12
Speaker 1: it's super individual, but do you normally more than not prescribe,
15:18
Speaker 1: what do you start with? Do you go in and
15:19
Speaker 1: just say, oh, progesterone is like the easiest one, although
15:22
Speaker 1: I heard you say it was the most forgotten or
15:25
Speaker 1: maybe the most misunderstood, and I was thinking that that
15:29
Speaker 1: was the testosterone I feel like testosterone now is getting
15:32
Speaker 1: a lot of love. It's kind of like the darling
15:35
Speaker 1: of the hour. But they each are so individual. Where
15:39
Speaker 1: would you just start someone generally?
15:43
Speaker 2: So it's a great question. The most important thing actually
15:47
Speaker 2: for me as a clinician is really taking a good
15:49
Speaker 2: history and understanding because you know, things have changed. When
15:54
Speaker 2: I started my clinic ten years ago, people come in
15:57
Speaker 2: and say I think I'm perimen of but I'll tell
16:01
Speaker 2: you what. I don't want hormones because they've been so
16:03
Speaker 2: scared away. Whereas now people will come they've got more information,
16:07
Speaker 2: great and they'll say I'm perimenopausal. I've used your balance app.
16:10
Speaker 2: I've listened to your podcards, I would like a gel,
16:13
Speaker 2: I would like the pedesterone and like testosterone dad, And
16:17
Speaker 2: they basically running the consultation. So the important thing for
16:21
Speaker 2: me is a doctor. Firstly is is it definitely perimenopausal?
16:25
Speaker 2: And that's hard because there's no quick test, But also
16:29
Speaker 2: is there anything else that's causing their symptoms? So not
16:32
Speaker 2: everyone who's tired I can blame low testosterone. They might
16:35
Speaker 2: have low iron, they might have low vitamin D, there
16:37
Speaker 2: might be something else going on, they might have another condition.
16:40
Speaker 2: But you know, I've had a lot of good training,
16:44
Speaker 2: very I've done a lot of medicine, and so I
16:47
Speaker 2: can ask those screening questions and do blood tests to
16:50
Speaker 2: try and exclude. So that's really important, and then it's
16:53
Speaker 2: working out, you know, I think perimenopause and menopause a
16:57
Speaker 2: just labels for women. What is going on? Are they
17:00
Speaker 2: gesterone deficient? Are they esterodyle deficient? Are they testosterone deficient?
17:06
Speaker 2: Do they have endometriosis, which is a lot worse when
17:11
Speaker 2: their levels of esterdyle are fluctuating? Do they have a
17:17
Speaker 2: history where they find that they're more intolerant of progesterone?
17:20
Speaker 2: Are there periods regular? Are they heavy? Do they need contraception?
17:24
Speaker 2: So all of these things is working out in my mind,
17:28
Speaker 2: which hormones? What does to start? Sometimes if someone has
17:32
Speaker 2: really bad PMDD pre mensal dysphoric disorder and they're just
17:36
Speaker 2: feeling terrible for those few days before their periods and
17:40
Speaker 2: the rest of the time they're fine, well, then I
17:43
Speaker 2: might just give them some progesterone for those few days,
17:46
Speaker 2: and then I might consider doing their estodyl and testosterone
17:49
Speaker 2: blood test and reviewing them. But other women I might
17:52
Speaker 2: give all three hormones together. It really really depends, and
17:55
Speaker 2: that's where it's very individual. And then we just review
18:00
Speaker 2: people and it's a review consultation that's actually can be
18:03
Speaker 2: more revealing because then we can see are they responding,
18:06
Speaker 2: what other symptoms do they have, what their blood levels doing,
18:11
Speaker 2: and then that will help us guide whether we need
18:13
Speaker 2: to change the dose or the type, or adding another
18:16
Speaker 2: hormone for example, or think about vaginal hormones as well.
18:20
Speaker 2: And then in a review, usually when the hormones are balanced,
18:23
Speaker 2: we spend a lot of time thinking really carefully about
18:26
Speaker 2: nutrition and exercise and whether they need supplements or what
18:30
Speaker 2: else is going on in their lives too, So it's
18:33
Speaker 2: not just the transaction that we just do, and it's
18:36
Speaker 2: a journey. And often in perimenopause you think you've got it.
18:40
Speaker 2: Patient patients feel really well and then suddenly their own
18:42
Speaker 2: hormones drop and they might need their dose changing. So
18:46
Speaker 2: it can be a moving target sometimes as well a movie.
18:49
Speaker 3: You exactly do you think blood tests are useful for
18:56
Speaker 3: perry menopause?
19:00
Speaker 2: So they have to be done. This is what I think,
19:04
Speaker 2: in conjunction with a really good consultation, because it's so
19:08
Speaker 2: easy now to get blood tests, isn't it, And people
19:10
Speaker 2: come in with these realms and reams. A lady came
19:13
Speaker 2: in yesterday. It was almost like a book of blood tests,
19:15
Speaker 2: but she hadn't even had her testosterone level done, and
19:18
Speaker 2: I'm like, oh, you've had all these other blood tests,
19:21
Speaker 2: so you have to be really careful. And our hormone
19:23
Speaker 2: levels do fluctuate and change. So I've seen ladies with
19:29
Speaker 2: really high estradial levels and they're not on any hormones
19:32
Speaker 2: but their own bodies squirting it out. But then other
19:35
Speaker 2: times of the day when they weren't having their blood tests,
19:38
Speaker 2: they have got loads of symptoms of low estrogen. But
19:41
Speaker 2: they've been told of your estrogen dominant or they might
19:44
Speaker 2: be at the time that the blood test was taken,
19:46
Speaker 2: but all the other times of the day they're having
19:48
Speaker 2: low estrogen. So we have to be really careful how
19:53
Speaker 2: we interpret blood tests as well. I think they're useful.
19:58
Speaker 2: I mean, when we start to testosterone, we'll usually do
20:01
Speaker 2: a testosterone level just to see but then there are
20:04
Speaker 2: some women who have polycist over in syndrome who might
20:09
Speaker 2: just be, you know, always run with a slightly higher
20:12
Speaker 2: testosterone than others. So we have to this is where
20:16
Speaker 2: you're tak it in context. But we often do do
20:19
Speaker 2: blood to exclude other causes, like I say, like looking
20:22
Speaker 2: at their iron level. They've been d get their kidneys,
20:25
Speaker 2: the liver and all that as well, so you know,
20:28
Speaker 2: but you can the thing in medicine you only do
20:31
Speaker 2: a test if it's going to change your management. It's
20:34
Speaker 2: very easy now, Like I mean, I've been qualified for
20:36
Speaker 2: many years. It wasn't so easy to access all the
20:38
Speaker 2: scans and things that you can now. But I always
20:42
Speaker 2: ask myself, is it going to change my management? And
20:45
Speaker 2: if it isn't, then I'm not going to just do
20:47
Speaker 2: a blood test for the sake of it.
20:50
Speaker 1: Is estrogen dominance real?
20:53
Speaker 2: It's a great question. Yeah, I don't think really, I think.
20:57
Speaker 2: I mean, there's lots of labels we give women. What
21:00
Speaker 2: does it mean that you're Eastern dominant? Like basically it
21:04
Speaker 2: means that you've got load progesterone and probably low testosterone.
21:08
Speaker 2: The balance of hormones is really important. And Professor Mokhiro,
21:12
Speaker 2: who's a urologist I know well in the US, he
21:15
Speaker 2: talks about the triangle of the hormones and I love
21:17
Speaker 2: that because you've got to get those three hormones balanced.
21:22
Speaker 2: Sometimes I talk about a three legged stool. You can
21:25
Speaker 2: have the right height of one leg, but if the
21:28
Speaker 2: other two aren't there, you're going to be upsided. So
21:31
Speaker 2: often it's because people don't have the other hormones balanced.
21:36
Speaker 2: So also sometimes when people are perimenopausal and their hormones
21:40
Speaker 2: really fluctuate, sometimes if we do give a higher dose
21:44
Speaker 2: of estrogen, which seems a bit paradoxical, but then it
21:48
Speaker 2: stops the ovaries doing this eeyo stuff, you know, and
21:52
Speaker 2: that can be very useful for some women, you know.
21:55
Speaker 2: So this is where it's all very individualized.
21:59
Speaker 1: So if we want to take estrogen, let's start with estrogen, yeah,
22:02
Speaker 1: because I feel like that's the one that gets the
22:04
Speaker 1: most love. Most women are very familiar with estrogen. So
22:09
Speaker 1: if we're taking that, we have vaginal estrogen and then
22:12
Speaker 1: we have systemic estrogen. So what are the different types?
22:17
Speaker 1: Because I was just I was fascinated Lauren and I
22:20
Speaker 1: were talking about this before you jumped on about the
22:25
Speaker 1: transmission of through a patch or through a gel. I
22:32
Speaker 1: didn't even think about like the skin texture and if
22:35
Speaker 1: the skin is thicker, And now I'm questioning is mine
22:39
Speaker 1: getting I've gone the.
22:41
Speaker 3: Gem, I'm parting out in the right place.
22:43
Speaker 2: What it's really interesting today because it's very crude medicine,
22:50
Speaker 2: So we usually use it through the skin so it
22:52
Speaker 2: stays as estradial because there are different types of estrogen,
22:56
Speaker 2: and the estodyl is the anti inflometry, the good estrogen,
22:59
Speaker 2: if you like. And once we've put something in our mouth,
23:03
Speaker 2: things get metabolized through our liver. That's just how anything
23:06
Speaker 2: works that we eat or drink. So if we have
23:09
Speaker 2: esrogen through our mouth, it can get metabolized to different
23:11
Speaker 2: types of estrogen. We put it on our skin, it
23:14
Speaker 2: goes through the skin into the blood stream and then
23:17
Speaker 2: it stays as easter dial. But the ways of getting
23:20
Speaker 2: it through the skin are usually a patch or a gel.
23:24
Speaker 2: But you're absolutely right. The absorption can really vary between women.
23:29
Speaker 2: It can vary because of their skin texture, their thickness
23:33
Speaker 2: of their skin, their temperature of their skin. You can
23:36
Speaker 2: imagine if I put it on my bottom, which has
23:39
Speaker 2: more subcutaneous fat than the small of my back, of
23:44
Speaker 2: course the absorption is going to change. So and then
23:47
Speaker 2: we've got the way we prescribe drugs. They're always within
23:51
Speaker 2: license to certain range, but some women even with the
23:54
Speaker 2: highest license dose, they're just not getting it through their skin,
23:58
Speaker 2: and so we sometimes change to a different manufacturer patch
24:02
Speaker 2: or the gel. But even then you might have seen
24:04
Speaker 2: on my Instagram every soft and I flap mine in
24:07
Speaker 2: the camera and just say, like, they really don't stick
24:09
Speaker 2: very well. So I use more than one. But some
24:14
Speaker 2: people use a very small dose and they get loads
24:16
Speaker 2: more through their skin than I do using more than one.
24:20
Speaker 2: Because we're all different and we've known that for many years,
24:23
Speaker 2: but we have to have the right amount into our
24:26
Speaker 2: body so that it works to not only improve our
24:30
Speaker 2: symptoms but also to improve our future health.
24:34
Speaker 1: Well, I'm second guessing everything now. So if you have it,
24:38
Speaker 1: where's the best place you can put it? On the thigh?
24:41
Speaker 2: So really there is It's where it sticks. Really, So
24:44
Speaker 2: I actually put mine on my lower bat because I
24:47
Speaker 2: don't have much subcutaneous tissue. I can, like you know,
24:50
Speaker 2: I can feel my muscles quite easily through my back
24:52
Speaker 2: and they just stick. They don't wrinkle. If I put
24:55
Speaker 2: them on my bottom, my bottom I'm sitting and standing,
24:57
Speaker 2: I'm moving, so they just become a bit more crinkly.
25:00
Speaker 2: If I put them on my leg, they just come
25:02
Speaker 2: off in my jeans, like they just once the patch
25:05
Speaker 2: is edge start rolling, they flick off. So so that's just
25:08
Speaker 2: for me personally, but other people find different places.
25:12
Speaker 3: So the other options like on your head.
25:16
Speaker 2: Yeah, so I mean they again the way they're license,
25:20
Speaker 2: they say put them below the waist, but you're just
25:22
Speaker 2: using the skin as a vehicle, you know. I sometimes
25:25
Speaker 2: joke and say to face you should put it on
25:27
Speaker 2: your forehead, like it's just using your skin to get it.
25:29
Speaker 2: You wouldn't put it on your forehead, of course, but
25:32
Speaker 2: it's just about doing that. And then the gel again
25:36
Speaker 2: it's license for the arms or the legs, but again
25:39
Speaker 2: it varies on the way that it's absorbed. It can
25:41
Speaker 2: really change, and that's where the deuce is less important
25:47
Speaker 2: than the penetration and the absorption.
25:51
Speaker 1: Okay, so the gel, the patch, we have that vaginal astrogen,
25:57
Speaker 1: so that's separate. I was shocked because I was just
26:03
Speaker 1: hiking with my sister in Europe and she has access
26:07
Speaker 1: to any of my podcasts and I've had a lot
26:09
Speaker 1: of experts on I don't think she's listened to one clearly,
26:12
Speaker 1: but she was like, oh no, you can't take vaginal
26:15
Speaker 1: estrogen if your if you've had breast cancer. And I'm like,
26:22
Speaker 1: that's not true, and she was arguing with me, and
26:24
Speaker 1: I was just it showed me how much misinformation is still.
26:28
Speaker 1: I mean, it's my sister.
26:30
Speaker 2: Yeah. So vaginal hormones are very very firstly, the very
26:36
Speaker 2: low dose and they only really penetrate the area, so
26:40
Speaker 2: they'll use their help the vagina and the valve, but
26:43
Speaker 2: they'll go into the bladder, the pulpit floor uni tract,
26:47
Speaker 2: so they work for localized symptoms. And there's we've got
26:52
Speaker 2: vaginal estrogens, and we've also got something called presterone, which
26:56
Speaker 2: is a hormone called DHGA which converts to estrogen and testosterone,
27:02
Speaker 2: which can be a lot more effective actually, And these
27:05
Speaker 2: hormones can be usually very safely used for women who
27:08
Speaker 2: have breast cancer because they don't get absorbed into the body.
27:12
Speaker 2: They can really make a difference. But women who take
27:15
Speaker 2: HRT often still have urinary symptoms or vaginal symptoms. So
27:20
Speaker 2: then we can use the vaginal hormones as well as
27:23
Speaker 2: having systemic hormones.
27:26
Speaker 1: And you can put it on your face.
27:29
Speaker 2: Oh yeah, that's the Yeah, sometimes people use the vaginal
27:32
Speaker 2: tread put it on their face. But you know, what
27:36
Speaker 2: if you have systemic hormones. So all three hormones estro down, pedestroone, testosterone,
27:42
Speaker 2: they work throughout your whole body, so they work throughout
27:46
Speaker 2: your whole skin. So they will improve collagen deposition, they'll
27:50
Speaker 2: improve the skin that the blood flow to the skin,
27:53
Speaker 2: they'll reduce wrinkles, they'll change the texture of the skin.
27:58
Speaker 2: Now most of us, yes, it's the face is what
28:00
Speaker 2: we see. But there's no point having a young face
28:03
Speaker 2: and then like really old hands and dry flaky skin elsewhere.
28:07
Speaker 2: So if you know, I don't know, people do it,
28:10
Speaker 2: but then they're not on HRT and I don't really understand.
28:14
Speaker 2: Why do you know what I mean? So I think
28:17
Speaker 2: we have to. Of course it's going to probably help.
28:19
Speaker 2: It won't penetrate very much. But it's the skin, is
28:24
Speaker 2: it really? It's the biggest organ in our body, so
28:26
Speaker 2: we want we want it well perfused because if our
28:29
Speaker 2: skin is healthy, our liver, our lungs, our heart, our
28:33
Speaker 2: kidneys are going to be better as well. So it's
28:35
Speaker 2: always well having a nice young face, but we need
28:37
Speaker 2: to be thinking about getting those womans into our blood
28:39
Speaker 2: stream and our body.
28:41
Speaker 1: Yes, we've all seen the eighty year old that has
28:44
Speaker 1: the amazing forty year old face. But then the rest
28:47
Speaker 1: of the PLOODT I remember. So if we move on
28:50
Speaker 1: to progesterone and the different ways, so we can have
28:55
Speaker 1: that orally, which I didn't even know. And I have
28:59
Speaker 1: to tell you, I was training a client and she
29:04
Speaker 1: was just super she'd gotten on progesterone and she was
29:07
Speaker 1: super tired when she would show up in the morning
29:11
Speaker 1: for our training session. And she came back the next
29:14
Speaker 1: day and she said, oh, well, this is like I
29:17
Speaker 1: take it rectally. Now I didn't even know that was
29:20
Speaker 1: an option. So you can take it vaginally, you can
29:22
Speaker 1: take it rectally, and then you can take it obviously oral.
29:27
Speaker 1: What's the differences? How would you how would you decide?
29:31
Speaker 2: So progesterone, and this is really important terminology. Progesterone is
29:36
Speaker 2: the same stretch as the natural progesterone we produce when
29:40
Speaker 2: we're younger. When we use the term progestogen or progestin,
29:44
Speaker 2: that's a synthetic, chemically altered progesterone that's in all of contraception,
29:49
Speaker 2: by the way, So progesterone we use as part of HRT.
29:54
Speaker 2: And historically I was taught people are taught that you
29:59
Speaker 2: only need if you have your womb because it protects
30:01
Speaker 2: the lining of the womb from eastrogen. But actually it's
30:04
Speaker 2: a really important hormone in our organs and our brain
30:09
Speaker 2: as well. So many women, including those that have had
30:13
Speaker 2: a hysterectomy, still take progesterone with good effects. So we
30:17
Speaker 2: can have it orally. It's quite hard to get absorbed orally,
30:21
Speaker 2: so it's made in a way it's called micronized, so
30:25
Speaker 2: they basically make it very small and suspend it in
30:28
Speaker 2: an oil so it can get absorbed through the body.
30:31
Speaker 2: But like I've said before, anything that gets absorbed through
30:34
Speaker 2: the mouth gets digestive metabolized through the liver, so it
30:38
Speaker 2: can get broken up into different types of progesterones, and
30:41
Speaker 2: some of those metabolites can cause side effects for some women.
30:45
Speaker 2: Whereas if we use it as a peasuri so as
30:49
Speaker 2: a vaginal u rect or peasurie, it gets absorbed through
30:53
Speaker 2: the mucous membranes. It's a bit like you know, putting
30:58
Speaker 2: any anything sort of inside, like through our mouth, the
31:02
Speaker 2: blood supply will take it away. Progesterone doesn't always get
31:06
Speaker 2: very well and reliably absorbed through the skin, so that's
31:09
Speaker 2: why putting it in the vagina or the rectum will
31:12
Speaker 2: just get absorbed through the through the mucous membranes into
31:15
Speaker 2: the bloodstream as the pure progesterone, so it doesn't get
31:18
Speaker 2: chemically converted, if that makes sense. So some people who
31:22
Speaker 2: have side effects with the tablet the capsule oral capsule
31:26
Speaker 2: find that they tolerate it really well vaginally, especially women
31:32
Speaker 2: if had PMS or PMDD or postnatal depression. Having the
31:36
Speaker 2: doses vaginally can be a lot better.
31:40
Speaker 1: Okay, that's fascinating. So then if somebody comes in and
31:44
Speaker 1: says they're progesterone intolerant, they.
31:47
Speaker 2: Might yeah, and that's that's really interesting. I have done
31:51
Speaker 2: a YouTube about progesterone intolerance because we suit a lot
31:55
Speaker 2: and there's a couple of things there. One is a
31:57
Speaker 2: lot of women are intolerant of progester gins or progestines,
32:01
Speaker 2: the artificial So they'll go, oh, do you know what
32:04
Speaker 2: I had contraception? I had a marina coyle and I
32:06
Speaker 2: had to take it out it was so awful. So
32:09
Speaker 2: they are intolerant of a synthetic chemical hormone, not progesterone.
32:15
Speaker 2: Most people aren't intolerant of their own hormone, but what
32:19
Speaker 2: they can be intolerance is of changes of those hormones levels.
32:24
Speaker 2: So women with maybe PMDD who are more sensitive to
32:28
Speaker 2: that drop of progesterone before their periods, if we give
32:31
Speaker 2: them progesterone, sometimes people feel worse. And I saw a
32:35
Speaker 2: lady in my clinic yesterday who really can't tolerate progesterone,
32:38
Speaker 2: but she's still having regular periods, so she's still producing
32:42
Speaker 2: progesterone herself. So it's like I'm giving a progesterone and
32:46
Speaker 2: she's producing it herself and it's just not suiting her.
32:49
Speaker 2: Once she becomes menopausal and her periods stop, her own
32:53
Speaker 2: natural progesterone will decline and she'll probably be okay on
32:56
Speaker 2: a low dose of progesterone. So it's again individualizing the
33:01
Speaker 2: care and really working out is it progesterone intolerance or not.
33:06
Speaker 2: And some people, actually it sounds a bit paradoxical need
33:09
Speaker 2: a higher dose of progesterone, especially as a pesari. So
33:12
Speaker 2: they have a load dose and they feel awful. You
33:16
Speaker 2: increase the dose, it stimulates the receptors better and then
33:19
Speaker 2: they feel quite different and better.
33:22
Speaker 1: Wow.
33:22
Speaker 2: Yeah, So it's options and choices really, but a lot
33:27
Speaker 2: of people are not as intolerant as they think of
33:29
Speaker 2: the proper progesterone, if that makes sense.
33:32
Speaker 1: So do you recommend cycling it or just taking it daily?
33:36
Speaker 2: So it really farries again because we're all so different.
33:41
Speaker 2: If people are still having periods, we often cycle it
33:43
Speaker 2: just because if they had it all the time, they
33:45
Speaker 2: often get breakthrough bleeding. And it could be no one
33:48
Speaker 2: wants to have break through bleeding. Really, some people have
33:51
Speaker 2: it all the time and feel great. They have no bleeding,
33:54
Speaker 2: They feel great, so why would I change it. Other
33:57
Speaker 2: people find that they feel better after having a few
34:00
Speaker 2: days break maybe every month every three months. So again,
34:05
Speaker 2: it really really varies.
34:08
Speaker 3: Which is why it's hard because there's so much trial
34:10
Speaker 3: and error.
34:12
Speaker 2: Yeah there is, and also there's so much out there
34:14
Speaker 2: on social media. Some people say you have to have
34:16
Speaker 2: a few days off. You don't, you do? And and
34:20
Speaker 2: the thing is you learn by experience. But this is
34:23
Speaker 2: why everyone is different. And like what suited me nine
34:27
Speaker 2: years ago, I'm not on the same dose in type
34:30
Speaker 2: of homaones nine years ago than I am now. So
34:32
Speaker 2: it's evolving all the time. You know, I started HRT
34:35
Speaker 2: when I was perimenifausal, I'm fifty four, I'm going to
34:38
Speaker 2: be menifausal now. So things change, don't they. So that's
34:41
Speaker 2: why it's really important to make sure that you see
34:45
Speaker 2: someone who understands it's not just a one size fits all.
34:50
Speaker 1: Well, then the level of care for the general physicians,
34:55
Speaker 1: the general practitioners, that's what is probably holding up a
35:00
Speaker 1: lot of this because I mean, women ask at least
35:04
Speaker 1: I don't know, Laura, if you get asked, but all
35:06
Speaker 1: the time, who should I see in Colorado for instance,
35:10
Speaker 1: and everyone asks me, yeah, I mean it just there's
35:13
Speaker 1: not like a long list, or at least I don't
35:15
Speaker 1: I don't know a long list. That makes it tricky, Yeah,
35:20
Speaker 1: to get it really dialed in if we move on
35:22
Speaker 1: to testosterone. So again I say it's the darling of
35:25
Speaker 1: the hour because it's getting a lot of love. But
35:29
Speaker 1: I think that it's the most feared out of all three.
35:33
Speaker 1: It seems like, well, at least in the United States
35:36
Speaker 1: from my insurance company, personally, it's been a doozy to
35:40
Speaker 1: even get. But then you go to Australia and you
35:43
Speaker 1: can get it fairly easy.
35:45
Speaker 2: Well you can and you can't. It's licensed for women
35:48
Speaker 2: in Australia, but most doctors don't prescribe it. So it's
35:52
Speaker 2: really ironic, isn't it. They've got a product we can't
35:55
Speaker 2: prescribe it, or that women can't get it. And we
35:59
Speaker 2: can prescribe the female testosterone cream that's licensed in Australia
36:05
Speaker 2: over here, but it has to be privately, or we
36:07
Speaker 2: can prescribe the male testosterone like you can over there
36:11
Speaker 2: with you in different doses. But the thing is it's
36:16
Speaker 2: a female hormone. It's an important female hormone, yet we
36:20
Speaker 2: can't get it. Like it's just madness, isn't it that
36:24
Speaker 2: we can't have our own hormone back. And then you've
36:26
Speaker 2: got people telling us that we'll grow beards and mustaches
36:29
Speaker 2: and it's really dangerous, and you know, our voices will
36:33
Speaker 2: change and we'll lose all our hair. It's like, well,
36:36
Speaker 2: most people, when you have the right dose and type,
36:39
Speaker 2: actually don't have all that. I don't shave every day,
36:43
Speaker 2: like you know. It's but I tell you what my
36:46
Speaker 2: brain works, you know. But then it's all denigrated to
36:49
Speaker 2: it's all about whether you can have an orgasm or not,
36:52
Speaker 2: whether you're sexually active or not. You know, one of
36:55
Speaker 2: the doctors that works as me went to see her
36:57
Speaker 2: GP recently to get her hormones just a repeat prescription,
37:02
Speaker 2: and that doctors said, well, I know you've recently had
37:05
Speaker 2: a divorce, so therefore you won't be needing your testosterone.
37:09
Speaker 2: Stop it. Yeah, yeah, I know. This is to a
37:11
Speaker 2: medical doctor to another doctor, and you're like, hang on,
37:14
Speaker 2: it's twenty twenty five. Do you have to have a
37:17
Speaker 2: husband to have a libido? You know? I mean, I
37:20
Speaker 2: love my husband, but you know, I still it's really like,
37:25
Speaker 2: it just feels wrong that we're just talking about women
37:28
Speaker 2: like sexual objects. And some menopause societies talk about HSDD,
37:34
Speaker 2: which is hyperactive sexual disire disorder, and one other criteria
37:38
Speaker 2: to have this condition is that you have to be
37:41
Speaker 2: severely psychologically distressed with your reduced libido for at least
37:44
Speaker 2: six months, and then you can maybe have testosterone. And
37:48
Speaker 2: I'm like, hang on, I'm a doctor. I'm not watching
37:51
Speaker 2: my patients being severely psychologically distressed. But we know that
37:56
Speaker 2: the hormone works throughout our body and brain, so we
38:00
Speaker 2: know that women. We've published data. So if others find
38:04
Speaker 2: that their mental health improves their mood, their memory, their concentration,
38:08
Speaker 2: their muscle strength, just their ability to exercise is better,
38:13
Speaker 2: but then people say, well, it's just perceive it. Well
38:15
Speaker 2: it's it's not because it's a biologically active hormone and
38:17
Speaker 2: it's just a hormone. And you know what, if it
38:19
Speaker 2: doesn't work, people don't have to take it. But most
38:23
Speaker 2: of us that take it are never going to stop
38:25
Speaker 2: it because we've it HAPs this function. But again, it
38:28
Speaker 2: just comes back to choice, doesn't it.
38:31
Speaker 1: So how would you determine? I know this might be
38:34
Speaker 1: going down the rabbit hole again if someone if I
38:37
Speaker 1: come to you and I say, my main symptom right
38:39
Speaker 1: now is brain fuck. I can be on a podcast
38:44
Speaker 1: and mid sentence, I'm like, what was I saying? This
38:48
Speaker 1: is concerning this has never happened. But that's the main symptom,
38:54
Speaker 1: is that there's one hormone combat that more than others
38:58
Speaker 1: or just all the pen on the comedy.
39:01
Speaker 2: So it does depend. But you know, if I could
39:03
Speaker 2: only prescribe one hormone to women, it would be testosterone.
39:07
Speaker 2: If I could tell you the hormone that has transformed
39:09
Speaker 2: the most number of lives and probably save the most
39:12
Speaker 2: number of lives the women I've seen who have had
39:14
Speaker 2: suicidal thoughts, it will be test us to it. Wow,
39:17
Speaker 2: you know, I see a lot of women who have
39:20
Speaker 2: had really sad stories that you might have listened to
39:22
Speaker 2: the podcast I did with Jay and Haley, the mother
39:25
Speaker 2: and her son who she'd been in a psychiatric hospital
39:29
Speaker 2: for nearly thirty years on and off. So we see
39:32
Speaker 2: a lot of women who are like Hailey. They've had
39:35
Speaker 2: awful psychiatric histories. They've been on antidepressants, antipsychotics, Lithian electro
39:41
Speaker 2: convulsive therapy sessions, they've had sometimes they have ketamine, but
39:45
Speaker 2: no one's thought about their hormones. That often they or
39:48
Speaker 2: their family have put it together and thought, can I
39:51
Speaker 2: try some hormones? The HLT can help them, but you
39:54
Speaker 2: give them testosterone and then wait a few months, and
39:57
Speaker 2: these women are often transformed and they I've had low
40:00
Speaker 2: testosterone often for many years. So we have to be
40:05
Speaker 2: really careful when we think about women not having test us.
40:09
Speaker 2: To me, and I never thought about testosterone before when
40:13
Speaker 2: I did psycholatry, I never didn't know women even had
40:15
Speaker 2: it in their bodies. So you know, I'm as guilty
40:19
Speaker 2: as any other doctor by prescribing other drugs. But if
40:22
Speaker 2: someone's got a load test us, doone they've got symptoms?
40:25
Speaker 2: Suggestive of test ustone deficiency. We should be really replacing
40:30
Speaker 2: a natural hormone. I don't really understand the dangers of it.
40:35
Speaker 1: So for bone health, because that's another huge one. And
40:39
Speaker 1: I love that osteoporosis and osteopinia that there we all knew.
40:44
Speaker 1: I mean, this is something that I remember my grandma
40:47
Speaker 1: couldn't have a hip surgery because her bones were too
40:50
Speaker 1: soft and she wasn't cleared for the surgery. Do you
40:55
Speaker 1: see again, is there one? Is it estrogen that helps more?
40:59
Speaker 1: Is it testosterone or is it a combination of all
41:01
Speaker 1: of them?
41:02
Speaker 2: So often all three actually, because we've got hormone receptors
41:06
Speaker 2: for all three hormones on our bones, and our bones,
41:09
Speaker 2: as you know, are biologically active. So we have these
41:14
Speaker 2: cells osteoblasts that build the build the bone, and osteoclass
41:17
Speaker 2: that break it down. And we've got androgens, testosterone receptors,
41:22
Speaker 2: estradar receptors, and progesterone receptors on these sets. So if
41:26
Speaker 2: they're stimulated the right way, the osteoblasts, they'll build the
41:29
Speaker 2: bone and keep it strong. If they're not stimulated, the
41:32
Speaker 2: osteoclass will take over and they'll sort of gobble and
41:36
Speaker 2: make the bone weaker. So this balance is really important.
41:40
Speaker 2: So you know, our bones are biologically active, but so
41:43
Speaker 2: are our muscles as well, So both of those are
41:47
Speaker 2: really important. And it's almost forgotten. I think people think
41:50
Speaker 2: osteopiosis is an old person's disease, and yeah, it gets
41:55
Speaker 2: more common as we age, or they think, oh, it's
41:58
Speaker 2: just a fracture that will be repaired and then I'll
41:59
Speaker 2: be fine. But I'm petrified of ostereoporesis. I'm worry about
42:04
Speaker 2: osteoporosis of my spine because when you see these people
42:08
Speaker 2: that are stooped, you know, with the curvature of the
42:10
Speaker 2: spine and due to osteoporesis, it's very painful because they
42:14
Speaker 2: have lots of little fractors. The coughing might cause another fracture. Sneezing,
42:19
Speaker 2: they can't digest food properly, they can't breathe so clearly,
42:23
Speaker 2: but they can't reach for a cupboard in the same way.
42:25
Speaker 2: You know. So, and we know obviously exercising weight, bioing,
42:29
Speaker 2: exercise is really important. But we know that hormones, you know,
42:34
Speaker 2: we've known since nineteen forty one. There was a professor
42:38
Speaker 2: Albright who said and realized that women's bones were thinner
42:42
Speaker 2: when they were menopausal, and that was because of the
42:45
Speaker 2: lack of hormones. So it's nearly one hundred years we've
42:47
Speaker 2: known it.
42:49
Speaker 1: Wow, so every female, I mean, this could benefit the
42:54
Speaker 1: bond for every female.
42:56
Speaker 2: Yeah, for sure, Yeah taking it.
42:59
Speaker 1: So look at the counter argument of I guess the
43:06
Speaker 1: women pushing or anyone pushing not not having hormones for
43:10
Speaker 1: whatever reason outside of a female's choice. So we all
43:15
Speaker 1: know that if female has like we have choice, we
43:17
Speaker 1: can decide whether to take it.
43:19
Speaker 2: Round.
43:20
Speaker 1: How many women do you see that come in that
43:23
Speaker 1: maybe aren't aren't taking it, not because they're scared to
43:27
Speaker 1: or they don't have the information, but are choosing not
43:29
Speaker 1: to take it for whatever reason.
43:33
Speaker 2: So obviously they don't come to the clinic because they
43:35
Speaker 2: come to the clinic easily because they want hormones. But
43:38
Speaker 2: you know, I sometimes see women who are mothers of
43:42
Speaker 2: my patients, so they may be in their sixties, seventies
43:46
Speaker 2: and saying, do you know what, I've never thought about homones,
43:48
Speaker 2: but now I've seen how well my daughter is or
43:50
Speaker 2: my sister is. I'm just wondering, you know, I don't
43:53
Speaker 2: think I've got any symptoms, but I'm worried because my
43:56
Speaker 2: mum had us to process or what have you. And
43:59
Speaker 2: then I'll talk to them and if they want to
44:01
Speaker 2: try it, they will, and then often they come back
44:03
Speaker 2: and go, Wow, my sleep is so much better. I
44:06
Speaker 2: can spring out of bed in the morning. I don't
44:08
Speaker 2: have to get up at nighttime for a week. You know,
44:11
Speaker 2: I feel different. But I thought that was just because
44:14
Speaker 2: I was older. I didn't realize that it was due
44:15
Speaker 2: to hormones. It's very hard to find a menopausal women
44:20
Speaker 2: with no symptoms at all. They might think they don't
44:23
Speaker 2: have them, but you don't know until you have those
44:26
Speaker 2: hormones back.
44:28
Speaker 1: Now, what about the muscular skeletal syndrome of menopauds. I
44:33
Speaker 1: would say that's what people come to me from the
44:36
Speaker 1: strength side, and I can work on strength with them.
44:42
Speaker 1: But it's the joint you know, arthritis and just I've
44:47
Speaker 1: noticed my fingers just yeah, I'm feeling it there. Yeah.
44:52
Speaker 2: So it's really important, crucially important, because all three hormones
44:58
Speaker 2: are anti inflammatory, reduice inflammation in our muscles and joints.
45:04
Speaker 2: So things like frozen shoulder really really common. Arthritists both
45:10
Speaker 2: you know, osteoarthritis rheumatoid arthritists. Syrah negative arthritis a lot
45:15
Speaker 2: more common in women in the late forties. So those
45:20
Speaker 2: hormones help lubricate the joints as well as reduce inflammation.
45:24
Speaker 2: They help the cartilage, they help the sinovia, they help
45:27
Speaker 2: the tendons the ligaments as well as the muscles as well,
45:31
Speaker 2: and they help the muscles to work better. So it
45:35
Speaker 2: just seems madness that these poor women are like the
45:38
Speaker 2: tin man from Wizard of Us, you know, rusty trying
45:42
Speaker 2: to creak and get their joints. It's you know, of course,
45:47
Speaker 2: exercising will improve and our muscles will make hormones, so
45:50
Speaker 2: if they are stronger, they're going to work better and
45:53
Speaker 2: that will help. But they're not going to replace the
45:56
Speaker 2: hormones to the level that they were when they were younger,
45:59
Speaker 2: and they over is working well, m and the brain.
46:04
Speaker 3: I listen to one of your posts about just the
46:09
Speaker 3: effects all three of them have and how important it
46:13
Speaker 3: is too on our brain, and I mean, I don't
46:18
Speaker 3: know how you can't listen to that and not think, Okay,
46:21
Speaker 3: sign me up for all.
46:23
Speaker 2: Well, you know, I'm a general physician, I'm not a gynecologist,
46:28
Speaker 2: and you know gynecologists. Most of them think that the
46:32
Speaker 2: womb is the most important organ in the body, whereas
46:35
Speaker 2: I actually, and I think many women would agree, feel
46:38
Speaker 2: that the brain is the most important organ in our bodies.
46:41
Speaker 2: And I'm very interested in neurophysiology and so how our
46:45
Speaker 2: brains work and function. And we've got all the brain
46:49
Speaker 2: is the most amazing organ in the body. And it
46:52
Speaker 2: can sort of the cells can grow, they can change
46:55
Speaker 2: the neuro transmitters, the chemical messengers in our brain. The
46:59
Speaker 2: levels of those can change all sorts of things we do.
47:02
Speaker 2: It can alter the function. But these hormones ESTRODIWM, pedesterone,
47:07
Speaker 2: testosterone are neurosteroids. They are made in our brain. Every
47:12
Speaker 2: sell in our brain responds to these hormones. There's a
47:15
Speaker 2: reason that that happens. It's not just to give us periods.
47:19
Speaker 2: It's to help our brain function, help the other neurotransmitters
47:24
Speaker 2: to be at the right level. So it helps our serotonin,
47:27
Speaker 2: our dopamine, our melotonin, our neu adrenaline, our glutamate, all
47:32
Speaker 2: of those neurotransmitters work better in the presence of our
47:35
Speaker 2: own hormones. So it goes without saying, really that the
47:39
Speaker 2: commonest symptoms are those affecting our brains, so you know,
47:44
Speaker 2: the low mood, the anxiety, the memory problems, fatigue, and
47:50
Speaker 2: a lot of people have very dark thoughts as well.
47:52
Speaker 2: But then you can see where they're misdiagnosed as having
47:55
Speaker 2: depression or psychosis or personality disorders or what have you.
48:01
Speaker 2: But we have to understand how hormones work in our brains,
48:04
Speaker 2: because then when we don't have them, our brains don't
48:07
Speaker 2: work in the same way.
48:10
Speaker 3: Our brains are not working the same right now, Heyley,
48:12
Speaker 3: I don't.
48:12
Speaker 1: Think we'll testify to that, So okay, I'm going to
48:18
Speaker 1: cover some of these quick questions before we wrap up here. Clearly,
48:25
Speaker 1: we know that you can go through a post metapause
48:27
Speaker 1: without any HRT, But this person's asking is it a must?
48:32
Speaker 1: Obviously outside of choice? Would you recommend it for anyone
48:37
Speaker 1: that's even asking this question.
48:39
Speaker 2: It's a good question. I think you also have to
48:42
Speaker 2: think what are the risks of not having hormones? So
48:46
Speaker 2: it's an individual choice. Of course, people can live without hormones,
48:48
Speaker 2: they can live without virroxin hormone, but actually, if you've
48:52
Speaker 2: got symptoms, why would you suffer? But it's the health
48:56
Speaker 2: risks as well. We know that the communist cause of
48:58
Speaker 2: death and women globally cardiovascular disease and dementia, So taking
49:03
Speaker 2: natural womens will reduce the risk as well as, as
49:06
Speaker 2: we say, reduce the risk of usityoprosis that affects one
49:09
Speaker 2: in two women and other inflammatory conditions. So it's a choice,
49:14
Speaker 2: but a lot of people, you know, make the decision
49:19
Speaker 2: to take it or make the decision to not take it. It's fine,
49:22
Speaker 2: but just know the facts really is really important.
49:25
Speaker 1: Do you feel like any of these are easy to stop?
49:30
Speaker 1: That's the next question is if I started test asterone,
49:33
Speaker 1: is it easy to start?
49:35
Speaker 2: Yeah, sure, but most people don't want to stop, you know,
49:38
Speaker 2: and that's because they're biologically active. So you know, I
49:43
Speaker 2: take HRT and tossing for two reasons. One to help me,
49:47
Speaker 2: you know, not have symptoms, because my symptoms were really
49:50
Speaker 2: affecting me. But secondly, I've already said I'm scared of usteoporosis,
49:54
Speaker 2: so I'll do anything to keep my bone strong, so
49:57
Speaker 2: I do weight baying exercises, I take this d you know,
50:01
Speaker 2: I'm active, But also I take hormones for that one reason,
50:06
Speaker 2: So even if I wasn't getting symptoms, I don't want
50:09
Speaker 2: my bone density to reduce, But that's my choice. Other
50:14
Speaker 2: people might not be on their way down, they might
50:16
Speaker 2: not mind. So the hormones we use only last in
50:19
Speaker 2: the body the same day. So if I don't use
50:21
Speaker 2: my testos to win tomorrow morning tomorrow night, I won't
50:24
Speaker 2: have any in my body. Doesn't build up in the body.
50:26
Speaker 2: It's not my antidepressants that it can take weeks or
50:29
Speaker 2: months to come off them.
50:31
Speaker 1: Oh I felt it. I only took a certain amount
50:34
Speaker 1: on my nine day mont Blanc hike and I ran out,
50:38
Speaker 1: And yeah, I can tell you. So how do migraines
50:43
Speaker 1: And this is actually something that a lot of women
50:47
Speaker 1: ask migraines and how they change over the metopause transition
50:52
Speaker 1: and when you're post metopausal, when you're officially in metapazzal
50:57
Speaker 1: do they get Does it get better?
51:00
Speaker 2: So yeah, for sure. So again there's information on my
51:06
Speaker 2: youtubes and podcasts about this. But migrain is a chronic
51:10
Speaker 2: as in long term and it's usually a genetic condition,
51:14
Speaker 2: so people will always be predisposed to migraines if they
51:17
Speaker 2: have them. But the brain likes homeostasis, It likes things
51:22
Speaker 2: the same, especially in people who have migraine. So anything
51:26
Speaker 2: that changes in the brain could trigger a migraine, including
51:29
Speaker 2: hormone fluctuations. Like you say, so, a lot of people
51:32
Speaker 2: find that they have worsting migraines in the perimenopause, and
51:36
Speaker 2: giving hormones back at the right dose and type can
51:39
Speaker 2: really help with migraines. Sure, they might improve in menopause
51:43
Speaker 2: when the hormone levels are low, but then you've got
51:47
Speaker 2: health risks, you might have other symptoms, so it's not
51:49
Speaker 2: really good enough to say to someone just wait until
51:52
Speaker 2: you're hormone drop and then you might be Okay. That's
51:56
Speaker 2: not really the way I practice medicine. But also, you know,
52:00
Speaker 2: I'm a migraine sufferer, and it's looking at everything. You know,
52:05
Speaker 2: I still get migraines despite taking hormones, So it's looking
52:09
Speaker 2: at what we eat. I mean, I'm very strict with
52:12
Speaker 2: I don't drink alcohol, I don't don't eat chocolate, I
52:15
Speaker 2: don't have caffeine, I don't eat processed foods because all
52:18
Speaker 2: of those would trigger migraines for me, but other people
52:21
Speaker 2: might be fine. So it's working out your lifes done.
52:23
Speaker 2: I mean, I'm very routine. I eat the same time
52:26
Speaker 2: I get up the same time I go to bed
52:28
Speaker 2: the same time. If I do too much exercise, it
52:30
Speaker 2: can trigger migraines. Have to be really careful. But other
52:33
Speaker 2: people are fine. So it's looking at what you need
52:36
Speaker 2: in a But hormones have a massive impact, often in
52:40
Speaker 2: a negative way when they're not balanced properly on migraine.
52:44
Speaker 1: Okay, so you've talked about a little bit about exercise
52:48
Speaker 1: and diet, so that goes into proper mental puzzle prescription.
52:55
Speaker 1: If you have someone seeing you, you guide them on that.
52:59
Speaker 1: What are your recommending trends for exercise specifically?
53:04
Speaker 2: So I think exercise, well, it's very individual, really really individual.
53:11
Speaker 2: And for some women, exercise might just be walking to
53:14
Speaker 2: the bus stop. It might be just parking their car
53:16
Speaker 2: a bit further away. Other people, it might be changing
53:20
Speaker 2: their exercise. It might be that they can't exercise the
53:25
Speaker 2: same because they're getting symptoms. But as they improve, they
53:29
Speaker 2: might get stronger. You know, I was thinking about this
53:32
Speaker 2: last night. I'm probably stronger now than I was, certainly
53:36
Speaker 2: twenty years ago, even thirty years ago, as a student.
53:39
Speaker 2: I think I'm stronger now, and that's partly because as
53:42
Speaker 2: a student I was taking contraception, which you know, probably
53:45
Speaker 2: doesn't means my muscles weren't working as well. But I'm
53:49
Speaker 2: exercising differently, but I'm able to with my hormone. It's
53:53
Speaker 2: a combination of things. So I feel sad when people
53:57
Speaker 2: say you're menopausal, you have to do this exercise, so
54:00
Speaker 2: you can't do this exercise. You know, people are really
54:04
Speaker 2: there's no reason we can't do more and more. But
54:06
Speaker 2: I think the most important thing I don't need to
54:08
Speaker 2: tell you guys, but it's just doing something that people
54:11
Speaker 2: enjoy and that they can keep it as a routine
54:14
Speaker 2: because it's all very well, isn't it. Every January people
54:17
Speaker 2: want to start running or start doing whatever. You know.
54:21
Speaker 2: I still enjoy yoga and I've been doing it for
54:23
Speaker 2: many years, but you know, other people are different. I've
54:27
Speaker 2: started using doing some weights and I quite enjoy that.
54:30
Speaker 2: Still like doing yoga as well, But you know, it's
54:33
Speaker 2: doing what's right and what fits into your schedule. Like
54:36
Speaker 2: it's although I like cycling, but it's three hours if
54:39
Speaker 2: you're going out on your bike. I never have three
54:41
Speaker 2: hours to myself, so I've just got to limit and change,
54:45
Speaker 2: you know. But so it's you know, some people like
54:48
Speaker 2: exercising on their own others like doing it together. It
54:51
Speaker 2: can be really social. I'm not that socially, quite happy
54:54
Speaker 2: doing it at home, but it's it's you know, I
54:57
Speaker 2: think looking at it as part of your life, like
55:00
Speaker 2: we have to eat, don't we You have to drink.
55:04
Speaker 2: You can choose to exercise, but it should really be
55:06
Speaker 2: part of your daily routine. And I think that's important.
55:10
Speaker 2: But it's the first thing that often goes. But I
55:12
Speaker 2: feel sad when people say, if you exercise you won't
55:15
Speaker 2: get symptoms, if you exercise, you don't need hormones, because
55:18
Speaker 2: it's not any either.
55:19
Speaker 1: Aw I don't think yeah. So for any parting words
55:25
Speaker 1: on women that feel like they've been dismissed, maybe they
55:30
Speaker 1: don't have How does one go about finding good care?
55:37
Speaker 2: Do you know what? I wish I could tell you easily,
55:39
Speaker 2: But I think the most important thing firstly is to
55:45
Speaker 2: get the information that's right for you. You know, there's
55:48
Speaker 2: a lot of free information on my website on balance app.
55:51
Speaker 2: I don't work with pharmaceutical companies. I don't have a
55:54
Speaker 2: hidden agenda. So work out what's right for you and
55:58
Speaker 2: then try and find the clinician. And it probably won't
56:00
Speaker 2: be the first clinician that you see but it doesn't matter,
56:04
Speaker 2: like none of us as clinicians loose sleep if someone
56:06
Speaker 2: gets a second, third, fourth opinion, like it really doesn't
56:10
Speaker 2: matter and we need to remember that that it really
56:13
Speaker 2: doesn't matter. And then take someone with you and I would,
56:18
Speaker 2: you know, have a really open conversation. No one wants
56:21
Speaker 2: to fall out with their doctors, but if they're really
56:23
Speaker 2: saying no, I would then challenge and say, well, why
56:26
Speaker 2: are you not prescribing evidence based treatment for me? And
56:31
Speaker 2: ask them if you could try it, you know, And
56:35
Speaker 2: some doctors don't like being challenged. I really like it
56:37
Speaker 2: when patients ask me things but don't give up, you know.
56:43
Speaker 2: And I think this is and it's really hard, but
56:46
Speaker 2: I see it over here in the UK and other
56:48
Speaker 2: countries as well, that often doctors are being educated by
56:52
Speaker 2: their patients, you know, as a busy DP when I
56:56
Speaker 2: was working in you know, family medicine. If you've got
57:02
Speaker 2: many people coming in the same day with the same problem,
57:05
Speaker 2: you've got to learn about it, you know. If I
57:07
Speaker 2: see some if I don't know about, I don't know headaches,
57:11
Speaker 2: and then every day I'm seeing six ten people with headaches,
57:14
Speaker 2: I've got to really read up and learn about headaches,
57:17
Speaker 2: and this is sort of happening over here and in
57:20
Speaker 2: other countries that doctors. Some of them are going, wow,
57:23
Speaker 2: this is brilliant. I've learned so much. This is great.
57:26
Speaker 2: So they've done our education program. They're like, brilliant. I
57:28
Speaker 2: feel really confident now, And others will go, Louise, you
57:32
Speaker 2: just need to shut up because too many women are
57:35
Speaker 2: coming through the surgery and they're blocking other appointments. Well,
57:39
Speaker 2: you could argue, and they're good appointments because these women
57:41
Speaker 2: you'll transform their future health and lives. So I think
57:45
Speaker 2: as patients we need to keep the momentum going and
57:49
Speaker 2: learn from others. You know, there will be others in
57:52
Speaker 2: your town or area who will know who's good to see.
57:56
Speaker 2: But I just don't be scared getting another opinion.
57:58
Speaker 3: I think, do you have a vision for what menopause
58:02
Speaker 3: care could look like or should look like in the
58:06
Speaker 3: next five to ten years ago? Do you kind of
58:08
Speaker 3: have a dream?
58:09
Speaker 2: Yeah? I do, but it's but it's not just menopause.
58:13
Speaker 2: Actually it's hormone or care for women. Because I have
58:16
Speaker 2: three daughters and my oldest daughter has PMDD, so she
58:21
Speaker 2: was dipping really badly. Before her periods in COVID, I
58:25
Speaker 2: really noticed it. So she has natural body identical hormones
58:29
Speaker 2: and they've really transformed her life. And I see a
58:32
Speaker 2: lot of her friends, some of them who have been
58:35
Speaker 2: given lithium and a lands a pain, horrible drugs, and
58:37
Speaker 2: no one's thought about hormones. So I'm transforming their lives.
58:41
Speaker 2: So when you've got twenty two year olds saying, Louise,
58:44
Speaker 2: is it legal to feel this good every day of
58:46
Speaker 2: the month? Like this is amazing, Like that's incredible. So
58:51
Speaker 2: those women or girls, women will never really be menopause
58:56
Speaker 2: because I will adjust their hormones according to what they need.
59:00
Speaker 2: So the dream is to stop the suffering, to stop
59:04
Speaker 2: the gas lighting, to stop this not believing women and
59:10
Speaker 2: thinking hormones are just something trivial. So I would be
59:14
Speaker 2: so happy if everybody that wanted hormones could access them
59:17
Speaker 2: on their first consultation, and everybody who needed them knew
59:24
Speaker 2: that they needed them and had started that conversation earlier.
59:28
Speaker 2: So actually menopause wasn't really a thing, and perimenopause wasn't
59:32
Speaker 2: thinking because people would get going a lot earlier, really,
59:36
Speaker 2: and you know everybody who's on contraception should be thinking
59:39
Speaker 2: about hormones in a different way.
59:41
Speaker 1: Really wow, well this has been such an incredible conversation.
59:49
Speaker 1: Most women aren't going to be able to work with
59:50
Speaker 1: you one on one, So how where are women finding you?
59:54
Speaker 1: I know you have some books, yeah, podcast.
59:58
Speaker 2: Yeah, So the best way is going to my website
1:00:01
Speaker 2: Dr Louise Newsen. But Dr Louise Newson one wad dot
1:00:04
Speaker 2: co dot uk. Balance app is free, so people can
1:00:07
Speaker 2: download that through the app store and Google Play. A
1:00:10
Speaker 2: podcast it's called Dr Louise Newssen and then the YouTube
1:00:14
Speaker 2: as well, So just furtle around and find something that's
1:00:18
Speaker 2: relevant for you.
1:00:20
Speaker 1: Great. Well, thank you so much for your time. You
1:00:22
Speaker 1: were so respected in this industry and we were thrilled
1:00:26
Speaker 1: if you answered our call. So honored. Yank you so
1:00:30
Speaker 1: much for sharing your time with us.
1:00:32
Speaker 2: Oh well, thank you, it's been great.