Latest / The Dr Louise Newson Podcast / 12 - HRT, misinformation and navigating the menopause media minefield with Kaye Adams

Transcript

12 - HRT, misinformation and navigating the menopause media minefield with Kaye Adams · The Dr Louise Newson Podcast

• 0:03
  On the podcast today, I've got Kay Adams, who's a well known
• 0:06
  presenter of Loose Women and a journalist.
• 0:09
  We talk a lot about what it's like being menopausal in your
• 0:12
  60s, whether you should be taking hormones or not, what
• 0:15
  questions you might be asking yourself and your healthcare
• 0:18
  provider. Lots to think about and she's
• 0:21
  certainly gone off after the podcast to reflect a bit more.
• 0:25
  So thank you for coming. Last time I spoke to you was on
• 0:27
  a screen because I was on your podcast, actually.
• 0:29
  Yes, you were, weren't you? That was a couple of years ago
• 0:32
  and you took questions, which was which?
• 0:34
  Was great. Yeah, it's really good.
• 0:36
  Which? Is interesting because obviously
• 0:37
  my postcard is out to be 60, so I wondered how my demographic
• 0:42
  would you know which direction they would go in.
• 0:44
  But there were so many women, as you well know, thinking right.
• 0:48
  OK, here I am at that age, what am I doing?
• 0:50
  Or people who whose symptoms have persisted and we're saying
• 0:55
  I thought we came through this thing.
• 0:56
  Yeah. And they hadn't.
• 0:58
  It was really interesting. Yeah, I think it's really
• 1:01
  interesting because a lot of the conversation, well, it's always
• 1:04
  been, but it seems to be more at the minute that the menopause is
• 1:06
  a transition. It's a process.
• 1:08
  It's something we go through. I've recently been in America
• 1:11
  and I met a whole group of great women in New York, and they were
• 1:14
  like, oh, Gee, I'm through my menopause.
• 1:16
  It's like, are you? Well, you're not dead, so you
• 1:18
  can't be. And they're like, what do you
• 1:19
  mean? And it's like, well, you know,
• 1:22
  if you actually look at the definition of the menopause in
• 1:25
  the traditional sense, it's a year since your last period.
• 1:28
  So it's only one day, right? Do you know what I mean?
• 1:31
  Or is it, is it a day or is it an hour or is it a second?
• 1:33
  Like no one really defines it. I mean, it's just rubbish
• 1:36
  actually being defined by your periods.
• 1:38
  Do you know what I mean? It's mm hmm.
• 1:40
  It's so archaic and it's so somebody in an ivory tower
• 1:44
  deciding this will fit into some diagnostic criteria so we can
• 1:48
  tick that box as doctors. You know, Mrs. Adams, have you
• 1:51
  had your period? No, it was 11 months and you
• 1:54
  know, 2 days ago. We'll come back in 28 days and
• 1:57
  I'll give you this diagnosis. Like it's stupid, isn't it?
• 1:59
  So and also lots of women don't have periods, you know, if
• 2:02
  you've had a hysterectomy or you've got a Marina coil in, how
• 2:05
  then do you know? So, but then the conversation
• 2:08
  is, well, what is menopause? And we know obviously a hormone
• 2:12
  levels decline, they reduce because our ovaries don't work
• 2:16
  as we age usually. So then once those hormones are
• 2:20
  low, they are low forever. So it's not just about symptoms.
• 2:24
  And I think that is a big issue in my mind because I'm a
• 2:27
  physician, not a gynaecologist. So I'm not actually thinking
• 2:31
  about periods all the time. I'm not thinking about the
• 2:34
  gynecological organs all the time.
• 2:35
  I'm thinking about every single cell and it's.
• 2:38
  Really good. That's a very interesting thing
• 2:39
  to say actually, because, you know, it tends to be defined in
• 2:44
  terms of symptoms, doesn't it? Do you have flushes?
• 2:46
  Do you have low mood, you know, and, and are your joints aching?
• 2:50
  Have you got brain fog, etcetera?
• 2:51
  Those are the symptoms of menopause.
• 2:53
  And I suppose for me, one of the big decisions that I had to, to
• 2:58
  take was I, I don't feel the friends contradict me on this
• 3:02
  all the time. I don't feel that I had
• 3:04
  particularly marked symptoms, you know, in the sort of
• 3:07
  terminology that I'm sure you would say is old hat.
• 3:10
  I didn't have a bad menopause, umm and yet I did go on HRT
• 3:18
  relatively late. I think I was maybe 5757 years a
• 3:24
  rollback, umm, you know, but well past that point, umm, and I
• 3:30
  suppose to a certain extent I've always had an element of not
• 3:34
  guilt, but should I really be on this start because I didn't have
• 3:40
  terrible hot flushes, OK, I had a wee bit of night sweats.
• 3:43
  It wasn't too awful. Did, did, did have a bit of
• 3:49
  brain fog, to be honest. But my brain is back.
• 3:51
  My brain is definitely back. I'm always waking up in the
• 3:53
  middle of night. I remember that name and I had
• 3:58
  very low mood for six months. That was the most marked thing
• 4:01
  and that was very much around the time of my period stopping.
• 4:05
  But you know, compared to what you hear from some women, it was
• 4:09
  mild. So why am I on HRT?
• 4:12
  See, this is a great question. I'm so pleased that you brought
• 4:15
  it up actually, because lots of people say this and because, you
• 4:19
  know, the percentage of women do have a dreadful time, and I mean
• 4:23
  really dreadful. And we often hear about those
• 4:25
  women because improving their symptoms is literally life
• 4:28
  changing or life saving sometimes.
• 4:32
  Then people that have mild symptoms always feel guilty.
• 4:35
  But you see, the other thing about menopause is it's not just
• 4:37
  symptoms, it's about low hormones.
• 4:40
  And those low hormones are biologically active in our body.
• 4:43
  So with those hormones, it helps reduce inflammation in our body.
• 4:47
  It helps keep our organs really healthy.
• 4:50
  So the other reason for taking hormones is reducing our risk of
• 4:52
  inflammatory diseases, of which there are loads and the
• 4:55
  commonest is osteoporosis. Effects one in two women, but
• 4:58
  also heart disease increases by around a factor of 5 when we're
• 5:02
  menopausal, so we're five times more likely to have a heart
• 5:05
  attack. Commonest cause of death in
• 5:07
  women globally is heart disease and dementia.
• 5:11
  If we don't have our hormones, we have an increased risk of
• 5:13
  dementia as well, but we also have an increased risk of type 2
• 5:17
  diabetes, clinical depression, schizophrenia, autoimmune
• 5:20
  diseases, Parkinson's, cancers, like the list goes on.
• 5:24
  And I'm not trying to take a dig here, but is there a medical
• 5:27
  consensus on that? Yeah, we've known it for
• 5:29
  decades. So, and this is what's really
• 5:31
  interesting actually, because I'm talking about hormones here.
• 5:34
  I'm not talking about HRT, I'm talking about how our hormones
• 5:37
  work in our body. So I've got a pathology degree
• 5:40
  as well as medical degree. Pathology is the study of
• 5:43
  disease. So I spent my whole time doing
• 5:46
  the degree, learning about inflammation and the way that
• 5:49
  our cells work to protect us and keep us healthy.
• 5:52
  I learnt a lot about how when our cells don't work well, we
• 5:56
  have this increased inflammation, we have increased
• 5:59
  risk of cancers, increased risk of cardiovascular disease,
• 6:02
  dementia, like how it works in a cellular level, like really
• 6:05
  geeky, like right down to the cells.
• 6:08
  And we have these cells called macrophages, which really are
• 6:12
  like our gatekeepers for inflammation.
• 6:14
  So if we're fish and well, everything's going fine, then
• 6:18
  it's stopping inflammation. Anything that might eventually
• 6:21
  turn to cancer, it's gobbling those cells up and like giving
• 6:24
  us new ones all the time. Whereas if our environment
• 6:28
  changes, so if you smoke 20 a day, those cells are going to be
• 6:32
  exposed to chemicals that they don't want, then they might
• 6:35
  mutate, they won't work as well. The macrophages become quite
• 6:38
  angry and inflamed and then they turn against us in damaged
• 6:41
  tissue. So we know it's, no, it's not
• 6:44
  rocket science, isn't it? Smoking, too much alcohol, not
• 6:47
  exercising, inflammatory diet. Sometimes genetics, like if
• 6:52
  you've got poor genes, then you're going to have this
• 6:54
  increased risk. But guess what?
• 6:56
  Those hormones will change that microenvironment.
• 6:59
  So if you have low estradiol, you've got increased
• 7:02
  inflammation in your body. And we've known that since the
• 7:05
  80s. We've known that for many, many
• 7:06
  years. That's the way the hormones
• 7:08
  work. We also know that progesterone
• 7:10
  and testosterone are the same, but also in our brains, For
• 7:14
  example, I'm very interested in neurophysiology, the way our
• 7:17
  hormones work in our brains. The hormones are made in our
• 7:20
  ovaries for sure, but they're also made in our brains, and
• 7:23
  that will reduce with age. And our hormones will help the
• 7:26
  nerve pathways to work that help the neurotransmitters, the sort
• 7:30
  of transmission of of chemical messengers from one part of the
• 7:33
  brain to the other that help reduce inflammation in the
• 7:37
  brain. They help the blood flow in the
• 7:38
  blade brain. So that in itself is really
• 7:43
  important. And then when you think, oh,
• 7:44
  hang on, dementia is far more common in women than men.
• 7:49
  Why is that? Is it related to their hormones?
• 7:51
  And we know that men with low testosterone are far more likely
• 7:54
  to have dementia as well. So like, what is going on here?
• 7:57
  So this is where it's like basic science is forgotten because
• 8:01
  everybody's thinking, oh, HRT, should I take it?
• 8:03
  Should I not take it? I'm really confused, all my
• 8:05
  symptoms as bad. What type of HRT am I on?
• 8:08
  But if you go back and think, what do those hormones do in our
• 8:11
  body? And the problem is in some ways
• 8:15
  is that we're living so much longer as women in the Victorian
• 8:17
  times, we didn't really live very much longer past our last
• 8:21
  menstrual period. So we didn't have this like, oh,
• 8:24
  I'm sitting here in my 60s thinking, do I take hormones or
• 8:26
  not? But I sometimes say when I'm
• 8:29
  teaching, like other doctors, when they say, Oh, well, it's
• 8:32
  just about symptoms. I often compare it with raised
• 8:36
  blood pressure. So if someone had hypertension,
• 8:38
  raised blood pressure, they often don't have symptoms.
• 8:42
  They might have a bit of a headache, but usually they have
• 8:44
  no symptoms. And as you know, every doctor
• 8:46
  always checks. Your blood pressure.
• 8:48
  So if your blood pressure is high, we give blood pressure
• 8:51
  lowering treatment to reduce the risk of heart disease and
• 8:54
  stroke. So if you had raised blood
• 8:56
  pressure, you probably would feel quite happy taking a blood
• 8:59
  pressure treatment. And I would say to you, well, as
• 9:01
  long as your blood pressure is high, we'll continue the
• 9:04
  treatment and you'll go, OK, it's not causing any side
• 9:06
  effects. I'll crack on.
• 9:09
  So lowering blood pressure will reduce the risk of a heart
• 9:13
  attack by about depends on the drug between 20 to 40%.
• 9:19
  You taking HRT lowers your heart disease risk by about 50%, so
• 9:24
  it's more effective than taking a blood pressure lowering
• 9:27
  treatment. I mean, it's really interesting
• 9:29
  to listen to you rhyme off all those various ways that hormones
• 9:34
  impact on your body and and you know, the beneficial effects it
• 9:38
  can have because, you know, aside from the girl and should I
• 9:42
  be what I mean? And I think a lot of women will
• 9:45
  be my position. The single, single reason that I
• 9:49
  am nervous of it is breast cancer and not even just cancer
• 9:53
  because of course you know, your cells, you know, can any cells
• 9:57
  could sort of turn particularly specifically breast cancer.
• 10:03
  That is my single. You're absolutely right.
• 10:06
  It's the biggest reason why people don't want to take
• 10:08
  hormones. So this again, I really have to
• 10:12
  explain. And I, I sometimes like play
• 10:14
  mind games. And I think if I was a Martian,
• 10:17
  if I was just like from outer space and I came and I didn't
• 10:20
  know the evidence, I didn't know any science, I didn't know any
• 10:23
  medicine, I would then be asking a few simple questions.
• 10:27
  So the here it goes. In 2000, year 2000, about one in
• 10:34
  12/1 in 11 women had breast cancer.
• 10:37
  HRT prescribing was about 30% of menopausal women in the UK,
• 10:41
  about 40% in the US So then this study happened, 2002, HRT
• 10:47
  prescribing stopped because people were scared about breast
• 10:49
  cancer. So now 23 years later, about 14%
• 10:55
  of menopausal women take HRT. So half here in the US, it's
• 11:00
  about 5%. So it's really fallen off a
• 11:02
  Cliff. So do you think breast cancer
• 11:05
  incidences increased or reduced? Well, they they should have
• 11:09
  reduced. Because I see, but it's not.
• 11:11
  It's now about one in seven women.
• 11:13
  So firstly, that tells you that not all breast cancer can be
• 11:17
  related to HRT because a lot of women take it without.
• 11:20
  The other thing is the commonest group of women who get breast
• 11:24
  cancer as a generalisation are post menopausal women.
• 11:28
  So women who are menopausal, not taking hormones, if the hormones
• 11:32
  were a problem, younger people who have higher levels of
• 11:36
  hormones, natural hormones in their body, especially pregnant
• 11:38
  women, would certainly have this increased risk, which we don't
• 11:41
  see. So the other thing is, which is
• 11:45
  the saddest thing in my mind is the misreporting of this study.
• 11:49
  So the WHI, the Women's Health Initiative study, you know, the
• 11:52
  media reports breast cancer, breast cancer, and then they put
• 11:55
  this black box warning in the US and over here we've got this
• 11:58
  warning. You know, you only opened up
• 12:00
  your patches and it says risk of breast cancer.
• 12:03
  And it was the, it's just been the biggest car crash to Women's
• 12:05
  Health because they didn't analyse the data initially
• 12:10
  properly before it went out to the media.
• 12:12
  Like I have never known a media press release of any other study
• 12:17
  that's been done. And was it a single study?
• 12:19
  So it was a big study, it was a big study, it was a billion
• 12:21
  dollar study. But what they did was they will
• 12:24
  try. Everyone knew how beneficial HRT
• 12:27
  was. They knew in the 1940s that it
• 12:30
  was beneficial for bones. In the 1970s, they had this
• 12:33
  great conference showing guys it reduces risk of heart disease,
• 12:37
  diabetes, obesity, dementia. Like I've read all the minutes
• 12:41
  for the meeting. It's like people would just
• 12:43
  bring it on, Bring it. On Wonder.
• 12:45
  Drug it was so people would take it was the IT was the number one
• 12:49
  selling drug in the US. It was just incredible.
• 12:53
  And then they thought, well, actually, if menopausal women
• 12:56
  are doing so well, let's try it in older women.
• 12:58
  So then they decided in their wisdom to give it to older women
• 13:01
  to see if it had the disease preventative effects.
• 13:05
  But the average age of the study was 64, starting HRT.
• 13:09
  But also a lot of these women were overweight, a lot of them
• 13:12
  had had heart disease. And they were given, this is the
• 13:15
  big thing. They were given the wrong type
• 13:16
  of hormones. So they were given the
• 13:19
  conjugated equine estrogens. So pregnant horses urine
• 13:22
  estrogen which contains far more than the estradiol that's in
• 13:25
  patches and gels. But the biggest mistake was they
• 13:28
  were given a synthetic progesterone called medioxy
• 13:32
  progesterone acetate, which is a man made artificial
• 13:36
  progesterone, which by the way is in loads of contraception.
• 13:40
  And that is the hormone that increases clot risk, increases
• 13:46
  stroke risk, and probably because it wasn't statistically
• 13:49
  significant, increases breast cancer risk when they followed
• 13:53
  the women who'd had a hysterectomy and only had
• 13:55
  estrogen, even though it was a pregnant horses, you're an
• 13:57
  estrogen, they had a 22% lower risk of breast cancer.
• 14:03
  But that didn't make a press release.
• 14:05
  It wasn't on the front page of the papers.
• 14:07
  But that's, you know, good quality study.
• 14:09
  But also the other point that you make about contraceptives, I
• 14:12
  mean, I went on the pill when I was 17 and I think I was on the
• 14:16
  pill until my mid 30s. Never gave it a thought, you
• 14:22
  know, never give it a thought. And clearly it's, it's a hormone
• 14:25
  treatment, isn't it? But absolutely no point did I
• 14:28
  concern myself. I think younger women think
• 14:31
  about it differently. And I don't know what's happened
• 14:33
  because that boat has sailed for me.
• 14:35
  Clearly, um, because my daughters talk about it
• 14:38
  differently from the way that I did.
• 14:39
  But when I was going to university.
• 14:42
  What was the same? You went on the pill.
• 14:43
  Yeah, I mean, I was the same. I went on it and I look back and
• 14:46
  I was like, why? Why was that?
• 14:47
  Because I didn't know. But even as a doctor I didn't
• 14:50
  even realise there was a difference between natural and
• 14:52
  synthetic hormones because no one taught me, you see, Because
• 14:56
  it's called progesterone only pill, but it's not progesterone,
• 14:59
  it's a synthetic progesterone. We talk about combined pill
• 15:02
  estrogen and progesterone. It's not.
• 15:05
  It's, well, there's one type that contains estradiol, but
• 15:07
  most people don't use it, so most of it is synthetic.
• 15:11
  So it's even worse because it blocks the receptor.
• 15:14
  So your natural hormone doesn't work and it doesn't help the
• 15:17
  inflammation in the body. So it's actually greater risk.
• 15:21
  Yeah, I know. It's incredible.
• 15:23
  It's but the other thing about the study, what they didn't say
• 15:26
  and they did have the data from the start was breast cancer like
• 15:30
  this breast cancer risk was so not, it wasn't statistically
• 15:33
  significant anyway, but there was a 30% reduction in bowel
• 15:38
  cancer in this study. Like that's really important.
• 15:42
  No one talked about that. But they also showed that there
• 15:44
  was a reduction in osteoporosis that affects one in two women.
• 15:49
  And you know, osteoporosis is really important we that we need
• 15:53
  to protect our bones because if you have an osteoporotic hip
• 15:56
  fracture or you were diagnosed with breast cancer, which do you
• 16:01
  think has got the worst outcome? Well, I, I think it's the, the
• 16:04
  hip fracture, yeah. You then one in five women after
• 16:08
  an osteoporotic hip fracture die in that first year.
• 16:11
  That's far greater mortality than any type of breast cancer,
• 16:15
  yet you know it because we're not thinking about it the same
• 16:20
  way. So was it a great conspiracy?
• 16:22
  Or what? Yeah, well, wouldn't.
• 16:23
  Yeah. We can talk about that.
• 16:24
  Yeah, yeah. Yeah, but it's, but it's, it's,
• 16:28
  but also now we don't even prescribe those types of
• 16:31
  hormones. But the problem is when you look
• 16:34
  at some of the guidelines, you look at some of the evidence,
• 16:36
  they'll lump it all together and they'll say there's a risk of
• 16:40
  stroke and and clot and breast cancer in HRT.
• 16:44
  And then me being really geeky is like, hang on, which type of
• 16:47
  hormone replacement are you talking about?
• 16:49
  The synthetic or the natural? And it's completely different.
• 16:53
  The other thing that they found in the study, which again,
• 16:56
  wasn't really reported externally, very much this.
• 17:00
  If women did develop breast cancer taking HRT, their outlook
• 17:04
  was better, their prognosis was better, which again, is really
• 17:08
  important. You know, if one in one in seven
• 17:10
  of us are going to get breast cancer, like it's one thing
• 17:13
  having the diagnosis, but there's another thing actually
• 17:16
  dying from it, so. I think the other thing that
• 17:18
  contributes though to the fear factor is that generally you
• 17:21
  hear if a woman is taking HRT and then is diagnosed with
• 17:25
  breast cancer, the immediate advice is to come off the HRT.
• 17:29
  So I mean that signals to people that that is the.
• 17:32
  Course it does. Course it does.
• 17:34
  But again, that's fear mongering because everyone thinks that
• 17:38
  estrogen causes cancer because we talk about estrogen receptor
• 17:43
  positive breast cancer, but we have estrogen receptors all over
• 17:46
  our body. So if you have an estrogen
• 17:48
  receptor negative breast cancer, it's actually worse prognosis
• 17:52
  usually because the cancers mutated the cells, so the
• 17:56
  receptor status has lost. So we've got estrogen receptors
• 17:59
  everywhere on our body. And then some of the treatments
• 18:03
  for breast cancer do block estrogen, but there are
• 18:06
  different types of estrogen and that's where it gets more
• 18:08
  complicated. So the type of estrogen that's
• 18:12
  in pregnant horses urine, but also a type of estrogen that we
• 18:16
  produce if we don't have our natural estradiol is estrone,
• 18:18
  which is very inflammatory. So some studies have shown that
• 18:22
  it's the estrone, not the estradiol.
• 18:25
  So if you're not having hormones, a lot of people put on
• 18:27
  weight, the fat cells produce estrone, which increases
• 18:31
  inflammation, more likely to have breast cancer as well.
• 18:35
  So, you know, it's, it's really interesting, isn't it?
• 18:38
  And it's such a shame that our natural estrogen has been
• 18:42
  labeled as a carcinogen. Like, how does it cause cancer?
• 18:45
  Like, do you know what I mean? This outer space sort of, you
• 18:49
  know, Marshall, like, it doesn't.
• 18:52
  Like, why would any other hormone cause cancer?
• 18:56
  And that's been the real problem.
• 18:58
  And you're like, you're right, people, people are scared.
• 19:02
  But I, as a menopause woman, I'm really scared about
• 19:04
  osteoporosis. That's my big fear actually,
• 19:07
  especially of my spine, because if I fall over and fracture my
• 19:10
  hip, hopefully I'll get over it. I'll be the four out of five
• 19:13
  that will keep going. But on the, on my spine, like,
• 19:16
  what do you do then when you've got these micro fractures?
• 19:18
  And I, I also used to every week go and visit women in nursing.
• 19:22
  It's always women in nursing homes.
• 19:23
  And they'd be sitting and they'd be rocking a bit and the smell
• 19:26
  of incontinence and I just thought, I just want to do
• 19:30
  everything I can to. Reduce that.
• 19:32
  Yes, avoid that. Yeah, yeah.
• 19:34
  And they might have dementia as well.
• 19:36
  Yeah, yeah, precisely. And I've just done a
• 19:39
  presentation for some healthcare professionals about the risks of
• 19:41
  not having hormones. And I think this is a
• 19:44
  conversation that needs to be had more, actually.
• 19:46
  If it's like not not controlling your blood pressure, you know
• 19:48
  you don't have to take treatment, but you know your
• 19:51
  risk of heart disease will increase.
• 19:54
  But especially the risk to our brains as well is the the
• 19:57
  biggest, you know, the brain is the most important organ in our
• 19:59
  body and you know the diseases of aging.
• 20:03
  Are the same as the diseases of inflammation are the same as the
• 20:06
  diseases related to low hormones?
• 20:09
  And I think this is the thing when people almost like you're
• 20:12
  saying you feel a bit guilty taking hormones or do I stop?
• 20:15
  Sure, you can stop, but the studies do show that in the
• 20:19
  first year after stopping HRT, there's an increased risk of
• 20:22
  clot and heart attacks. It's almost like the body's used
• 20:26
  to this reduced inflammatory state and then without hormones,
• 20:30
  it increases inflammation, which a lot of people don't really.
• 20:34
  But also you'll have that accelerated bone loss.
• 20:37
  So you know, you'll lose a lot of bone.
• 20:39
  This increased risk of osteoporosis will So would you?
• 20:42
  Take it for life, yeah. Yeah, I mean the guidelines are
• 20:45
  you review people every year. If benefits outweigh risk, then
• 20:48
  you carry on. And for most women the benefits
• 20:50
  do. And it's the same way like if
• 20:52
  you had an under active thyroid gland, we would give it for
• 20:55
  life. If you were type 1 diabetes, we
• 20:57
  would give you insulin for life. Actually, if you had raised
• 21:01
  blood pressure, we wouldn't necessarily do it for life
• 21:03
  because your blood pressure might come down.
• 21:05
  But again, that's why thinking about as our hormones are
• 21:08
  biologically active throughout our body and I think because
• 21:11
  it's always been associated with periods, associated with flushes
• 21:15
  and sweats, people don't realise the other symptoms.
• 21:18
  And we see a lot of women in their sort of 60s, seventies,
• 21:23
  they say, oh, I'm through the menopause.
• 21:24
  I'm fine. And then I say, well, what's
• 21:26
  your sleep like? And do you get off at night time
• 21:28
  to have a week? Oh, yes, oh, I'm a bit stiff in
• 21:30
  the morning. And I I've slowed down a bit
• 21:33
  and, you know, I've had six urine infections this year.
• 21:36
  And, you know, and then you give them hormones because they, you
• 21:39
  know, to try. And then six months later,
• 21:42
  they're like, wow, you know, this is, I never thought I could
• 21:45
  feel like this. Oh.
• 21:46
  My God, you've given me food for thought here.
• 21:48
  I can tell you. Yeah.
• 21:49
  No. Isn't it, I mean, I'm, I'm very
• 21:51
  much like it's about choice. I have.
• 21:53
  I'm not going to lose sleep. I hate to tell you whether you
• 21:55
  take hormones or not, but it's, I would lose, lose sleep if you
• 21:58
  stopped it because you felt bad because you're in your 60s that
• 22:01
  you're taking it. Do you see what I mean?
• 22:03
  Yeah. No, it has to be an informed
• 22:04
  decision, Does it? Absolutely, you know.
• 22:07
  But I think I also say to people that one in seven of us will get
• 22:10
  breast cancer. And if you get it, actually,
• 22:13
  firstly, like I say, your prognosis is going to be better
• 22:16
  and there's always treatment options, but it doesn't mean
• 22:19
  that your HRT has caused it because if you're on body
• 22:22
  identical hormones, there's no evidence to support that.
• 22:24
  MMM. Yeah, it's funny actually.
• 22:26
  Sadly, a friend of mine has been diagnosed recently who was on
• 22:30
  HRT and it was the first question she asked.
• 22:32
  And again, I mean, that's the thing, HRT is always in the
• 22:36
  frame. You know, if they're looking at
• 22:37
  a list of suspects, if you think of it that way, then it's always
• 22:41
  going to be, you know, there in the identification line.
• 22:44
  So that was her first question. And I think the response she got
• 22:47
  was no, it probably didn't 'cause it, but given that it is
• 22:52
  now there, it will feed it that that was the line.
• 22:56
  Yeah. And again, there aren't any good
• 22:58
  studies. There's studies for a while
• 23:00
  actually, that when people have estradiol in their system, the
• 23:04
  cancer doesn't grow quite as quickly and it sort of calms it
• 23:08
  down because it reduces inflammation.
• 23:10
  And before they had tamoxifen, high dose tablet estrogen was a
• 23:14
  treatment for breast cancer. And I've seen these amazing
• 23:17
  pictures of like really quite disfiguring breast cancer.
• 23:21
  It's coming out through the skin and resistant to any other
• 23:24
  treatment. They didn't have the drugs that
• 23:26
  we have now. This was in the 60s and 70s and
• 23:28
  people given really high doses where they felt quite I'll
• 23:31
  because the doses were so high and this cancer just shrunk, you
• 23:35
  know, you can't see it. It's amazing.
• 23:37
  And that's when tamoxifen started because tamoxifen
• 23:40
  actually increases estradiol as well as blocking some of the
• 23:43
  estrogen receptors. But a lot of people don't
• 23:46
  realise that either. I mean, you know, obviously you
• 23:49
  understand it from a medical perspective, but I mean, even in
• 23:53
  the explanation you've given for laypeople, it is immensely
• 23:56
  complex. And at the end of the day, as
• 23:58
  laypeople, we rely on the medical profession to to take
• 24:04
  all the information, to read all the studies and, you know, to
• 24:07
  understand it and then present it to us in in a way that we can
• 24:12
  understand and make sense. Yeah.
• 24:14
  And, you know, well, my job is as I'm a journalist, so I mean,
• 24:18
  my job is to communicate. And I do find it enormously
• 24:22
  frustrating. Like from my, yeah, personal
• 24:24
  point of view and professional point of view that I think most
• 24:27
  women out there will say something's not quite.
• 24:31
  Right. Really hard.
• 24:32
  And they're not entirely sure what's not quite.
• 24:34
  There's just, it just doesn't smell right.
• 24:36
  It doesn't sound right, you know, just something off about
• 24:40
  this conversation. Yes, around HRT, but they're not
• 24:43
  quite. Sure, yeah.
• 24:45
  What? And I think from that point of
• 24:47
  view, I think all women have been let down because at the
• 24:49
  very basic level, you know, I think we're very fortunate in
• 24:53
  this country, aren't we, in the Western world?
• 24:55
  But we're at least entitled to reliable information,
• 25:01
  professionally appraised and, you know, communicated in a way
• 25:05
  we can understand it and believe it.
• 25:08
  Yeah, and. I don't think we're getting that
• 25:10
  I. Absolutely agree with you.
• 25:11
  It's a really noisy space actually.
• 25:14
  And then, you know, we haven't even talked about testosterone,
• 25:16
  which causes even more confusion.
• 25:18
  And you know, I'm like a really annoying, inquisitive 2 year
• 25:22
  old. Like if something doesn't fit
• 25:24
  with me and I've done it in all walks of medicine is I go back
• 25:27
  and look at the evidence, but I also go back and think, how does
• 25:30
  it work in the body? What's going on?
• 25:32
  Like what are the mechanisms? And then it's really easy to
• 25:35
  unpick. But I've worked as a medical
• 25:37
  writer for 28 years and I've written books on evidence based
• 25:41
  medicine. So I'm, I'm like annoyingly fast
• 25:44
  at reading data and, and understanding it and, and
• 25:47
  looking at like, which is the good studies and which are the
• 25:50
  bad studies and who's got bias and who's written this and what
• 25:53
  are their conflicts? Because all of this builds up a
• 25:55
  picture, but most doctors haven't got time for that.
• 25:59
  You're. I mean, you're not a lone voice.
• 26:01
  I mean, there's lots of people who who agree with you.
• 26:03
  But having said that, you're probably slightly outside the
• 26:06
  mainstream. Does it frustrate you or how do
• 26:09
  you feel about the fact that there is still a large body of
• 26:13
  the medical profession that is sceptical despite?
• 26:18
  You know, yeah, yeah. And you?
• 26:19
  Understand that, and I am, I'm sure you know the story of
• 26:22
  Semelweis. Do you know the story of
• 26:24
  Semelweis? He was an obstetrician from the
• 26:26
  late 1800s. All right.
• 26:28
  And so, yeah, so he was very interesting because he, they
• 26:32
  quickly realised that the women who were having babies from
• 26:35
  midwives, the women and the babies had a lower mortality
• 26:38
  than the male obstetricians that were delivering them.
• 26:42
  And they couldn't work out why. My mum was a midwife.
• 26:44
  I think I might know the end of this story.
• 26:46
  So they didn't know about germs then either.
• 26:48
  But what the male obstetricians of course did all the the
• 26:53
  autopsies, they did all the post mortems, but they weren't
• 26:56
  wearing gloves and they had very dirty aprons.
• 26:59
  But then when they would deliver them the babies from the mother,
• 27:02
  they wouldn't wash their hands and they would keep their aprons
• 27:05
  on. So I don't need to tell you that
• 27:07
  there were germs flying everywhere.
• 27:08
  So he suddenly realised that the women, obviously the female
• 27:11
  midwives were not allowed in the autopsy room.
• 27:14
  And so they, you know, usually washed their hands and did
• 27:17
  whatever. So then he just said, well, hand
• 27:19
  washing is going to make a big difference.
• 27:22
  And they said he was mad. They said he was ridiculous.
• 27:25
  They stopped him going for medical conferences.
• 27:27
  They stopped him working. They stripped him from his
• 27:30
  licence. He ended up beaten to death in
• 27:32
  an asylum, actually in a straitjacket.
• 27:35
  And look what's made the biggest difference, you know, And so
• 27:39
  with a lot of this, you know, a lot of it's just basic science.
• 27:42
  I'm not talking about a new drug.
• 27:44
  I haven't, I haven't, you know, made pregnant horses urine.
• 27:48
  I haven't made an artificial hormone.
• 27:50
  I'm just talking about how natural hormones work in our
• 27:52
  body. So I have enough insight to know
• 27:54
  that I'm not doing anything like out there.
• 27:58
  I'm not controversial. I'm just stating facts, but I
• 28:01
  can see quite sometimes how he went mad because I do drive
• 28:06
  myself mad sometimes thinking well what am I?
• 28:09
  What have I like learnt that others haven't?
• 28:12
  Like it's almost like there's this wilful blindness where
• 28:15
  people don't want to like look at the evidence.
• 28:18
  They don't want to look at basic Physiology because they're too
• 28:21
  busy saying HRT is dangerous without actually understanding
• 28:25
  why they're saying that. I do think about that with you
• 28:28
  sometimes, though. I mean, it's interesting.
• 28:30
  That you say no. No, no, you're going mad, but
• 28:32
  that there is a sense of frustration from you because
• 28:35
  you've kind of been on, yeah, the scene for quite a while.
• 28:38
  They've been so, you know, different documentaries.
• 28:40
  And of course the Venus documentary was, it was, was a
• 28:42
  big one. And, you know, I think there is
• 28:45
  a much bigger conversation out there than there was certainly
• 28:48
  10 years ago. But it still feels as if there
• 28:51
  is a level of resistance and to be, you know, upfront about it,
• 28:58
  you know, maybe looking at you, you're like, oh, ladies,
• 29:00
  whatever. And I just wonder how you
• 29:02
  respond to that. Yeah, I probably won't answer
• 29:04
  you honestly because I'll just get upset.
• 29:07
  But you know, I think the other thing is, you know, I don't work
• 29:10
  with pharma. I don't have any conflicts.
• 29:12
  I'm I haven't got another agenda for any of this.
• 29:15
  And I think that's a really big issue.
• 29:17
  And, you know, you can just see the number of menopause
• 29:20
  supplements and everything else that's going out there.
• 29:24
  I think the big thing that is changing, though, is that women
• 29:26
  are making choices for them. Yeah.
• 29:28
  And, you know, I do yoga most mornings and do a head stand.
• 29:32
  I don't expect people to do that.
• 29:33
  But if they do, they'll feel great and it will really help
• 29:36
  them. I take hormones because I want
• 29:38
  my brain to function. And I'm scared of osteoporosis.
• 29:40
  I don't. I don't mind whether people do
• 29:42
  it or not. Do you know what I mean?
• 29:43
  I think, and I think this is where medicine is changing
• 29:46
  because, you know, as a journalist, you see like people
• 29:49
  who have access to information they didn't have before.
• 29:52
  And for some doctors, they find that very threatening.
• 29:54
  Almost. Yeah, we do have access to a lot
• 29:57
  of information, but we don't always have the skills and
• 29:59
  knowledge to interpret. That information.
• 30:01
  And that's where we need, you know, the medical profession to
• 30:05
  do that job for us and to do it in a way that we can trust.
• 30:08
  And I, I don't think we're getting that, to be honest.
• 30:14
  And, and I think that is a, a great shame.
• 30:16
  And and it just, I'm sure it happens in other spheres of, of
• 30:20
  health, but I can't think of one that's quite.
• 30:22
  No, it's not wide-ranging. I can't tell you another medical
• 30:25
  guideline that is mostly ignored.
• 30:28
  You know a guide all the guidelines, national,
• 30:31
  international, doesn't matter what you read are menopause,
• 30:32
  they will say first line treatment for menopause for the
• 30:36
  majority of women is HRT. Globally, 5% of menopausal women
• 30:40
  are taking it. So if you read a, you know blood
• 30:42
  pressure. OK, Well here's the thing from a
• 30:44
  journalistic point of view then what stands out to me on that is
• 30:49
  why because as you say, the pharma business is the most
• 30:53
  lucrative, isn't it? I think in in the world.
• 30:56
  So surely if pharma, if it was 1 entity felt that it could make
• 31:02
  zillions and millions they. Wouldn't make money out of HRT
• 31:05
  though because the natural hormones they are just natural.
• 31:08
  They can't. They can't make a different
• 31:10
  version of them. They're off patent so they're
• 31:13
  dirt cheap, so the only way of making money is a new menopause
• 31:17
  treatment that won't be hormonal.
• 31:19
  Right, so then that puts it. Into another sphere, you see.
• 31:22
  So the HRT in in the form that you would personally recommend
• 31:26
  is not necessarily a profitable drug.
• 31:28
  No, it doesn't cost much money at all because when I if I was
• 31:32
  making a drug like Viagra for example, you have the drug and
• 31:39
  it's called, it's a trade drug. So it's, it's not generic and
• 31:44
  only that drug company can make it.
• 31:46
  They've got their secret recipe and it's usually depending, it's
• 31:49
  usually a couple of years or so and then it goes generic and
• 31:52
  anyone can make it. So the other name for Viagra is
• 31:56
  sildanafil. They always have the weird names
• 31:58
  for the other ones, so no one remembers.
• 32:00
  So you always go to Viagra. But then it means other drug
• 32:02
  companies can make it. They'll still make money, but
• 32:04
  they won't make as much. And it's like any drug treatment
• 32:08
  is like that. But because it's a natural
• 32:10
  hormone, you can't call it something else.
• 32:13
  It's estradiol, it's progesterone, it's testosterone.
• 32:16
  So it's cheap. So why as pharma, you're going
• 32:18
  to make far more money out of other drugs.
• 32:21
  That is really. I've never heard that before.
• 32:24
  Yeah, there you go. So.
• 32:27
  That is interesting because, as you say, when you look at the
• 32:30
  menopause supplement market, it is vast and growing by the
• 32:36
  minute, isn't it? Yeah, so.
• 32:39
  And a lot of money has been made there.
• 32:40
  Absolutely billions and millions because you can sell anything as
• 32:43
  a as a supplement because it's not a drug.
• 32:46
  So there's a lot to think about but I'm wondering at the end of
• 32:52
  this three take home tips. I'm just wondering what 3 things
• 32:56
  you might have learnt on this podcast that you can take home
• 32:59
  with you. OK, well, that is number one, I
• 33:02
  have to say, because, you know, I mean, so I'm a journalist and
• 33:08
  I'm always trying to make sense of stories, You know, that
• 33:11
  that's that's the way that my brain works.
• 33:13
  And I've never been able to make sense of this story, you know,
• 33:16
  in terms of the whole HRT story and the information that women
• 33:20
  are getting and the choices that that we make based on
• 33:25
  information that we're not entirely sure about that, you
• 33:27
  know, I've always felt that that was just unsatisfactory.
• 33:32
  So that overview from you I have found really, really
• 33:36
  interesting. And, you know, they say that
• 33:38
  about so many things in life. Don't they?
• 33:39
  Follow the money? Do you want the answer?
• 33:41
  Follow the money. And so that's my number one.
• 33:46
  That's where the the money is. Well, I mean that in my 60s and
• 33:56
  you know, not conscious of any terrible symptoms of the
• 33:59
  menopause that actually I can still look at it as something
• 34:07
  and I don't I don't know what I'm going to do, to be honest.
• 34:09
  I mean, I will probably go for some kind of I've had blood test
• 34:12
  taken recently actually for a different reason and touch with
• 34:15
  everything seems fine. But, you know, it's good to
• 34:18
  check in with your health. So, you know, and I don't think
• 34:20
  you should be casual about these things.
• 34:22
  So, I mean, it is something that I'm going to think about.
• 34:23
  But you've given me a lot of food for thought in terms of
• 34:26
  where I am right now in my life. And my feeling was, oh, I should
• 34:31
  probably think about coming off it just based on that sort of
• 34:36
  looming shadow. You know what I mean?
• 34:39
  Enough of this now. So there you go.
• 34:42
  That is number 2. And what is #3 well, it's sadly
• 34:48
  it comes down to, you know, women maybe not getting the
• 34:52
  information that they, that they need and deserve, you know, and
• 34:58
  that that's, that's something that we should all be really
• 35:01
  concerned about. Because flipping to the other,
• 35:04
  my two daughters, one's 22 and 1's 18, not going to reveal
• 35:11
  their contraceptive choices. But you know, obviously, you
• 35:15
  know, I'm interested in their health going forward.
• 35:18
  And when I think how casually I took the contraceptive pill,
• 35:24
  really didn't think about it. Has it had any negative effect
• 35:27
  on my long term health? I have absolutely no idea.
• 35:30
  You know, I mean, it was just like convenient.
• 35:32
  Lovely. Thank you.
• 35:33
  Off I go. And for them I would hope that
• 35:36
  they would have more information in terms of the choices that
• 35:39
  they make. And so they sort of feed into
• 35:42
  each other, don't. They absolutely knowledge is
• 35:44
  power at the end of the day. Thank you for joining me, it's
• 35:46
  been great. Yeah.
• 35:47
  No, that's fascinating. Thank you.
• 35:51
  Subscribe to my newsletter for exclusive insights and updates
• 35:55
  on new episodes.