Latest / The Dr Louise Newson Podcast / 38 - Why hormone education matters for every clinician

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38 - Why hormone education matters for every clinician · The Dr Louise Newson Podcast

0:00
Today on my podcast, I'm talking about education for healthcare
0:03
professionals. A lot of my work is educating
0:05
women and men about hormonal changes.
0:08
But we have to educate healthcare professionals because
0:11
if we don't, we're not going to move forwards, We're not going
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to help future health of women if we keep ignoring the
0:18
importance of hormones. So today with doctor Rebecca
0:22
Lewis, who Co founded the Clinic Balance app, our education, our
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research, she keeps me together. She's on the podcast talking
0:30
about the importance of our education program, which we've
0:33
revamped, we've improved, we've updated.
0:36
It's just a really exciting time for healthcare professionals to
0:39
learn about hormones. Rebecca, this is not your first
0:44
time on the podcast, but it's the first time in these lovely
0:47
studios with Jack, who is the most amazing person.
0:51
So I wanted to talk today about education because, well, for
0:55
those people that don't know, First off, you and me founded
0:59
the clinic. We did, yes.
1:01
Many years ago and we founded Balance App many years ago.
1:06
Yes, 2018 and 2019, that sort of era, wasn't it?
1:11
And we also founded nuisance education.
1:15
We also founded the research. We also cemented our friendship.
1:19
Yes. But we work really hard.
1:23
Yeah, and we were just talking before we started, actually.
1:26
Lots of people say you must never mix friendship with
1:31
business. They do say that.
1:33
And I can see why, but actually you need people who really you
1:38
can trust as well. Yes, and we totally trust each
1:42
other. Well, we know each other's
1:43
brains pretty well. We're different personalities,
1:45
aren't we? But I think we complement each
1:47
other really well. And we know I can sort of second
1:50
guess what you're gonna say and and vice versa.
1:52
We finish each other's sentences, yes, which is really
1:55
lucky. I mean, honestly, I was so lucky
1:57
having you and I have said it publicly before, but I would, I
2:01
know, and I'm not just saying it for attention.
2:03
I would have given up many times if I hadn't had you on the end
2:05
of the phone because you know, what we're doing is really hard,
2:09
really difficult. And I didn't think it would be
2:11
this hard, you know, no, I'm from a very academic background.
2:14
I'm from a medical background. Lots I've worked with, you know,
2:18
really top Taipei cardiologist, I've worked with surgeons, I've
2:21
worked with all sorts. You've been an anaesthetist for
2:24
many years, you know, really hard being a woman in medicine.
2:27
And you've been, you've had all sorts of comments when you were
2:30
a junior anesthetist, like females usually, you know.
2:34
Yeah, I've had sort of. But you keep going because.
2:37
But somehow when it's about women and hormones, it's become
2:41
really toxic and horrible. Like I've never, since I've been
2:44
at school when I was bullied, I've never had this.
2:47
It's hostility really. It's very, very strange, isn't
2:51
it? I extraordinary, Yeah,
2:54
absolutely extraordinary. When we're really trying to help
2:56
women and improve. Yeah, the lives of of women.
3:00
It's really simple. People should be greeting with,
3:03
oh, great. This is really pushing the
3:05
envelope and and changing things because there's been so much
3:08
damage over the years. Well, they have to rectify it
3:11
and, you know, but people don't want to hear.
3:14
Perhaps they're wrong. They really find that
3:17
challenging and it's always been so actually, if you look in the
3:20
history of of hormones, I mean, I know you know an enormous
3:23
amount about that, but you know, people who've had new ideas or
3:27
actually not new ideas, but just looked at the evidence properly
3:30
and say, hang on, this is really beneficial treatment for women,
3:34
hormonal treatment. They've had massive pushback.
3:38
You know, we can name the names that's that have happened
3:41
because I don't I can't understand why, but it's really
3:45
toxic for women, yes. And this is the thing.
3:48
So we both went into medicine to help people.
3:51
And when I set up the clinic, well, initially on my own, I was
3:54
just renting a room. And then I said to you, please,
3:56
can you see some patients? Yes.
3:58
And you know what we know now actually, and how we practice
4:04
medicine and hormone medicine is very different to how it was
4:07
even 8-9 years ago because we've learned in two ways.
4:11
But in parallel we've learnt more about the scientific
4:13
evidence and basic Physiology about hormones, but we've also
4:18
learnt from our patients. And now we run a very big
4:21
clinic. We see thousands of women, but
4:24
we're communicating all the time with our clinicians who work
4:26
with us. And we're constantly changing
4:30
our pathways in our clinic, changing our knowledge.
4:33
I, I often run into your room on a Monday and say, I just, oh,
4:36
I've just seen this patient. What do you think?
4:37
Do you think this is right? And you say, oh, yeah.
4:39
So yeah, we learn a lot, don't we?
4:41
Oh. Completely.
4:42
I mean, for me, this distills what medicine is, It's the art
4:46
of medicine, which I find so much more interesting and
4:49
rewarding because and it, and it, it distills what evidence
4:54
based medicine means, because evidence based medicine is not
4:58
based purely on academic papers. You know, it's one of my, my
5:02
topics, isn't it? It is based on academic papers.
5:05
It is also based on biological plausibility.
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So understanding Physiology, understanding how hormones work
5:13
in the body, it's also based on clinical experience.
5:17
And particularly in our field, when there haven't been enough
5:20
studies, it's been neglected and underfunded for years.
5:23
The the evidence we have is limited to a certain extent or
5:28
they're two smaller studies. But if we keep going back to the
5:31
evidence, we get the same answers and we don't move
5:33
forward what we have to do. And I don't say this to
5:36
patients, look, you've come to see me because you've come to
5:38
see a, a physician, not a computer.
5:42
And what we're going to do is really tailor your HRT, if
5:45
that's what they're on for you, and make it right for you.
5:49
And that is where the art comes in.
5:51
And transferring that sort of knowledge to other people is, is
5:55
usually rewarding. But actually seeing the benefits
5:58
and seeing how patients respond, the individuality for a start,
6:02
but actually how rewarding it is, is the most rewarding
6:05
medicine I've done actually in this.
6:06
Incredible. And, and so This is why
6:10
education of other healthcare professionals is really
6:12
important. You know, I'm not protective
6:15
about my knowledge, as hopefully people listening know.
6:18
I'm very happy to share it not just to women, but also to
6:23
healthcare professionals. And you know, when I started to
6:27
learn more and more about hormones, I, I've been in
6:31
medical education for many years, but I sort of reflected
6:34
as to how am I going to teach in the best way?
6:38
Because when I was doing my MRCP, So remember the Royal
6:42
College of Physicians, there's a Part 1 and a Part 2.
6:45
Part 1 is a, is a multiple choice.
6:48
You have to be like a machine and it's negative marking.
6:50
Just as you know, you get a + 1 for right and a -1 for wrong.
6:55
So it's, it's, it's hard. It's really tough.
6:57
And they're very obscure questions, things they, they ask
7:01
really weird questions. You'll never see patients with
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some of those conditions, but you have to know.
7:05
So I spent hours and as you know, I can spend hours working,
7:09
but I spent hours going through past papers.
7:12
I went to lots of courses where you're in a big lecture theatre
7:15
and you're just learning by rote.
7:16
Learning by rote. And that was wonderful for that
7:18
exam. Part 2 is a practical where you
7:22
have to examine. It's like a theatre show.
7:24
You have to examine the patient, but you have to show like all
7:28
your knowledge. So when you're listening to the
7:30
heart, you really have to make a big.
7:32
So it's. A big flourish.
7:33
It's always like your driving test, isn't it?
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Really look looking in the. Mirror and so I spent a lot of
7:38
time round the bedside with really amazing people in
7:41
Manchester and I always was saying I was to stay behind
7:44
another half an hour, just teach me how to do really good
7:47
cardiovascular examination or really good neurology, all those
7:50
reflexes. It was it's a craft.
7:53
And and you see back then we didn't have the scans that
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people have now or it was harder to get a scan.
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So you had to really, really examine.
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Well, yes, but then with hormones I spent a lot of time,
8:04
as you know, I'm picking the literature, writing
8:07
academically, writing and summarising guidelines, which is
8:12
great for the foundations. But then when I started the
8:16
clinic and thought when I want to educate all people, I
8:19
thought, well how did I learn the most?
8:21
Well, actually I learned the most by sitting in other
8:24
people's clinics, you know, late Professor John Studds.
8:28
I was really nervous when I went to his clinic.
8:30
I got, I asked my mum to look after the children.
8:32
They were young. It was in the summer holidays.
8:34
It was many, many years ago. He was quite a formidable
8:37
person. He was very tall physically.
8:38
He had a certain way with patients, but he's very clever.
8:43
And I sat there and I just watched what he was doing and
8:46
after every patient sitting. But why are you doing that?
8:49
Why are you giving this dose? Why are you doing that?
8:50
Why are you starting this? And he was so lovely because he
8:53
did answer all my questions and I sat in other people's clinics.
8:58
And then I've become very inquisitive.
8:59
But then we have people sitting in our clinic initially, but you
9:03
can't teach thousands of people in that way, can you?
9:06
No. But it is the best way to learn.
9:08
It's the best. Way to sit in.
9:10
Front of you. Yeah.
9:10
And then also, you know, we're we're busy as doctors.
9:13
You have a limited time and limited finances to study.
9:17
Yeah. So then I thought, well,
9:19
actually people need to know the basics.
9:21
Great. That can be lecture given.
9:23
But people have to know this art like you're saying.
9:26
And so we decided to do 2 things, didn't we?
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We ran this Confidence in menopause day that we divided
9:32
into 4 big lectures, lots of lots of answers where we talked
9:36
about the basics of hormones, how they work.
9:39
We talked about the health risks of not having hormones.
9:42
So with menopause, we talked about HRT, the different
9:46
hormones including testosterone and vaginal hormones, how they
9:49
work, and we talked about cases to talk through and that went
9:54
really well, but it still didn't feel enough.
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So then we decided to film consultations, didn't we?
10:00
Yeah, I think that was a changing point really.
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We weren't really down that down well that that that lecture.
10:05
But actually seeing a patient in front of you.
10:08
Yeah, is is like trying to replicate your.
10:10
Experience in the clinic. As the professor starred, it is,
10:13
and you can hear of their own their own words, and you can
10:16
just imagine yourself there. We had some actors who came in
10:20
and we gave them little scripts and scenarios and we did some
10:22
role-playing. And I was actually quite nervous
10:25
because we used to video our consultations as part of our
10:28
Royal College of GPS exam. But then they were really
10:32
critical on our, on our consultation technique.
10:35
You know, do I introduce myself? Am I kind, Am I asking you the
10:38
right questions? Am I, you know all that?
10:40
Absolutely. But actually the consultations
10:42
we filmed was more about this art of bringing the patient in,
10:48
making sure that they had time to talk about their symptoms, to
10:52
clarify any questions. Yeah, but also to show other
10:55
clinicians how to prescribe, how to talk, how to talk about
10:59
uncertainty, how to talk about benefits versus risks.
11:03
Yes, long term health benefits of hormones.
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Yes, all of that. Yeah.
11:07
And I think actually being AGP, yeah, has really helped me in
11:11
that skill, hasn't it, because we're used to so many different
11:13
conditions. Yes, we deal with uncertainty
11:16
all the time. It's part of our our job and
11:19
actually our communication skills.
11:21
Yeah, really should be very good as a, as AGP.
11:24
And I think menopause therefore is so well suited, yeah, for the
11:28
General practitioner. But I think people also get very
11:30
scared because there's no diagnostic test.
11:33
Yes. You know, it's talking about
11:34
doing the MLCP. You do all these tendons and you
11:37
do a heart. If you listen, you've got a
11:39
murmur. Yeah, well, you know that they
11:41
need an echo. You know, they might need an
11:42
operation or whatever. Somehow it's a bit.
11:45
Oh, they've got headaches. Could it be migraines?
11:48
Could it be a brain tumor? Could it be hormones?
11:51
But we're used to asking and asking and asking and, and most
11:55
of their diagnosis is always in the history, isn't it in
11:58
medicine? Always.
11:58
I mean, we were taught that when we when we're training, yeah, I
12:01
think it's like 90%. Yeah.
12:03
It's from the history. Yes, but only if you ask the
12:05
right question. Yes, of course.
12:06
And this is where I realised as AGP my questions were quite
12:10
closed because I didn't have the symptom questionnaire, Yes.
12:13
So if someone came in with yeah, itchy skin, yes, I would only
12:17
focus on the skin. Well, we.
12:19
Also only have 10 minutes, don't we?
12:20
So yes, immediately they're sort of we're into dermatological
12:23
sort of scenarios in our brain. Why would you ask about
12:26
palpitations cause headaches or flushes or sweats or whatever?
12:30
Because you wouldn't be thinking about hormones.
12:32
Yes. And so all our consultations we
12:34
filmed started with the symptom questionnaire.
12:37
Yeah. And started with the patient
12:39
almost working it out, which made it a lot easier.
12:42
So when we did this, it was great, but I didn't have like a
12:45
platform to put it on and I needed somewhere that we would
12:48
get good reach of doctors and also it would be technically
12:52
quite easy for them to access and watch everything.
12:55
I ended up partnering with 14 Fish, which was an appraisal
12:59
company actually. So doctors did their annual
13:02
appraisal through 14 Fish, really amazing company.
13:06
So they had lots and lots of different videos, lots of
13:09
different education. And Mark Coom, who was the
13:13
education director who used to work through our closure of GPS
13:16
as well, said this is brilliant. So we've put it on.
13:20
Yeah. And we charged a small amount,
13:22
didn't we? And we got really good feedback.
13:23
Absolutely. And to start with, we didn't
13:25
charge. Actually, well, no, we, we did.
13:26
And then we changed because this Davina's documentary, remember,
13:29
came out. So, so we were charging a small
13:32
amount because we had to cover our costs because we don't do
13:35
anything that's funded by pharmaceutical companies.
13:38
So we needed to cover our costs. So we did it.
13:42
And then as you know, I was very heavily involved with the Devina
13:45
documentary with Kate Muir. And I knew that one of the
13:48
statements from the Royal College of GPS, because they
13:51
were approached by Kate Muir's team to ask about education for
13:55
GPS and the Royal College of GPS said improving education for GPS
14:01
is unworkable. Gosh, and they were the quotes
14:04
and they used that. You know, if any of you've
14:05
watched the programme, who's listening, you might remember
14:08
it. And it was that.
14:09
So I knew it was that was coming out.
14:11
So do you Remember Me saying, do you know what people really need
14:14
to know? Because this programme is going
14:16
to really show the enormity of poor menopause care in the UK.
14:21
So we said let's make it free to every GP practice.
14:25
We'll do one free for every GP practice and let's see the
14:28
response because I feel really embarrassed that we spent the
14:31
money. Let's just get it out to people
14:34
and after the programme it was huge, wasn't it?
14:37
It was. I mean the.
14:38
Response. So many people, and this was
14:40
before COVID when we first launched the programme, the
14:45
education programme. So it was very unusual to do
14:48
remote learning actually because it was all face to face, wasn't
14:50
it before. And I know people were thinking,
14:54
oh, but actually they liked being able to just watch a 10
14:57
minute consultation at home. I know.
14:58
It wasn't some dry lecture for 8 hours, you could just take
15:02
snippets and modules and if you have family life at home, you
15:06
know, you could just do a little half hour here and there and add
15:09
it up. And, and I think what happens
15:11
also because we had, you know, Mrs. Smith with migraine, Mrs.
15:15
Bloggs who was young with POI, premature of own insufficiency.
15:19
In fact, my mum was one of the actors.
15:21
She was and. I was interviewing her.
15:23
With a Welsh accent. And she had a Welsh accent and I
15:26
dipped into a Welsh accent. Embarrassingly and she she was
15:30
different scenario. So she was someone who had
15:32
urinary tract infections. She was someone that wanted to
15:35
start hormones at an older age. You know, she was and actually
15:39
it was it was great. It was a lot of fun doing it,
15:41
but it meant that if I was a doctor, well, I haven't talked a
15:44
bit. If I was AGP, didn't know so
15:46
much about hormones. I'd seen a lady with urinary
15:48
tract infections, yes, that day. And I was thinking, well, I'm
15:51
not sure about vaginal hormones. I could watch that little
15:53
consultation. Yes, yes.
15:55
And we'd linked it to patient resources.
15:57
We'd linked it to all the evidence, yes.
16:00
And then people were just, the feedback was phenomenal,
16:02
actually. Well, it's in your memory then,
16:04
isn't it? Because you're memorising the
16:06
the two people there. You remember, the consultation,
16:09
you remember. Much easier to remember than a
16:10
dry old lecture. I think it and you know, we're
16:13
talking the same language, both GPS, we, we wrote this for other
16:18
GPS or healthcare professionals and so.
16:20
It was great. And I remember going to the.
16:22
I've tried to go to the Royal College of GPS annual conference
16:25
and usually we present some of our research there.
16:27
Yeah. And I remember going and like
16:30
people stopping me. Do you remember we were both
16:32
together and people stopping us to say I'd just like to say
16:34
thank. You.
16:35
I know. And.
16:36
We what I know though the especially the younger
16:38
generation actually. We're not really.
16:40
Interested and thank you so much.
16:42
And they were. They're great fans.
16:44
And saying you've transformed the way we practice.
16:46
I understand. Hormones and now I'm
16:48
prescribing. But they also said, But when
16:51
women come back, they're so happy, they're so grateful,
16:54
they're so much healthier. Well, it's the reason they went
16:56
into medicine. Yeah.
16:57
I mean this. This will make women much better
17:00
so they all enjoy learning about.
17:04
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17:08
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18:00
I've got something really exciting to share with you.
18:02
Every Thursday I'm going to be releasing an extra episode for
18:06
those of you that sign up. It's an opportunity that I can
18:09
have more guests share more information, dig deeper into the
18:14
research that I can share with you.
18:16
And when you subscribe, this money is going to be used to
18:19
help with research, much needed research that's away from
18:23
pharmaceutical companies. So information is down in their
18:26
show notes. So have a look and subscribe and
18:30
enjoy. So it went very well and we had
18:36
like 10s of thousands of people who downloaded it with
18:40
phenomenal response, not just from GPS but from nurses and
18:43
pharmacists and some other specialties.
18:45
But then sadly, really, and I think it is sad and quite tragic
18:49
that 14 Fish was taken over by another company, EMIS, which is
18:53
a very big company that do a lot of the computer systems, the
18:55
software for GPS and somebody. And I'm not pointing any
19:00
fingers, but there was a body of healthcare professionals who
19:04
went to EMIS and said we're concerned about this course
19:07
because it doesn't, it doesn't work out of the guidelines.
19:11
And so I remember because I was doing a webinar that evening and
19:15
literally just before I logged on like 10 minutes early for the
19:19
webinar, I got looked on Twitter.
19:21
Well, it was Twitter then it's now X people saying where's,
19:24
where's the where's the 14 Fish menopause course?
19:26
Where's it gone? Where's it gone?
19:27
So what? And I got a text from Duncan who
19:30
was the CEO of Pouring Fish and said Louise, didn't you know,
19:35
your program's been taken down. And I phoned him very quickly.
19:38
I said I've only got 5 minutes Duncan, I'm dyslexia webinar.
19:40
But what's happened? He said, oh, you need to speak
19:43
to Remus, but they're taking it down.
19:45
So the next day I spoke to them and said, well, what's happened?
19:49
They said, oh, we some medical, a society phoned us and said
19:55
that it doesn't, it's not in line with the guidance.
19:57
So we've taken it down. It's absolute rubbish.
19:59
And I said well, where? Which guidelines, whereabouts, I
20:02
don't understand. We work out of evidence and
20:04
guidelines. And I said if you watched it,
20:06
they said no, but if you want another conversation with us you
20:09
go to lawyers. I said what?
20:12
It's. Obviously awful.
20:13
Do you remember my phone do and I was.
20:16
How based on absolute? Rubbish nothing and and they're
20:20
big organizations so you how can you know we so I would say what
20:25
on earth do we do like it was really the I can't even begin to
20:28
explain the hours that we put into it and.
20:31
So long it. Was so awful.
20:33
So we worked really hard to try and get it back.
20:35
We put it on another platform, but it almost then the damage
20:40
starts to be done for women because people then thought
20:43
something was wrong with the way that I was teaching.
20:46
They thought something wrong with, yes, with all of us
20:48
really, didn't they, That we don't follow guidelines?
20:51
Yeah, I mean, it's it's rubbish. No nice guidance.
20:53
As you know, we we, we happen to follow that completely.
20:56
Nice guidance. As I mentioned doses.
20:58
Too. Really.
20:59
Yeah, precisely. So you've got nice menopause
21:01
guidance, Yes, which has recently been updated since has
21:04
happened. But they're very clear about
21:05
individualisation of care, correct.
21:07
They don't talk about the numbers of, you know, the doses
21:10
at all. No, no.
21:12
They talk about retreating for symptoms, yes, but also the
21:16
other guidelines, which I think are crucially important with
21:19
this conversation. The shared decision making
21:21
guidelines, yes, because even as a doctor, if a patient wants a
21:25
treatment, that might have more risks than you believe.
21:28
Yes. Then they can still choose that
21:31
treatment. So if I said to you, Rebecca,
21:33
you know, I don't think you should have antidepressants
21:36
because I don't think you're clinically depressed and there's
21:38
risks with them. And you say, well, you know,
21:40
I'm. Convinced I really want.
21:41
Them and I want to try them. We would have a very considered
21:44
consultation. We might agree to disagree, but
21:47
you are allowed to be, you know, involved decision making.
21:51
Absolutely so so anyway, I was really, really shocked.
21:54
So we we've moved it and, and since then we're moving it to
21:58
another platform, but we're also updating it as well because I
22:02
feel very strongly that we can't be stopped by others that don't
22:05
agree with what we're doing. Absolutely.
22:07
And it's just, and it's so destructive for women because
22:10
the the GPS were really delighted to learn yes on that.
22:13
And they were communicating with us and we were guiding them a
22:17
little bit. There was a question, yeah, an
22:19
answer session they could have and they love that.
22:20
It's just a quick question. Can you just give me advice on
22:24
this? And one of our doctors, you
22:25
know, they rotated it, Yeah, to, to help and answer.
22:28
Things and we did this for free so it was like an advice and
22:31
guidance people would yeah contact us there I've just seen
22:34
a lady who's 23 could she have hormonal changes I've just seen
22:38
a lady who's 63 she wants to start HRT.
22:41
What would you suggest? And it really, people love that,
22:44
yes, men, they didn't have to come to the clinic.
22:46
No, it really empowered them. And but now we feel like this is
22:51
void really. I mean, there is some menopause
22:54
education, but people that do this to different people,
22:57
different organisations that do it, but they're all got, they
23:01
all are all funded by farmer. Although Farmer supposedly don't
23:04
have any editorial role with their programs, it's still some
23:09
farmers. How many people do it?
23:10
You know, every GP has missed out on education because of the
23:15
WHI report in in 2000 and so they weren't educated in
23:20
medical. School.
23:21
So actually we need something that's really accessible, not
23:25
not horrendously expensive to educate GPS.
23:28
And that was always our mission. It was at the beginning.
23:30
I mean, you were, you're brilliant at educating women and
23:33
in fact, so much so that I've just had a really busy clinic
23:37
and four, four out of, you know, 5 women's constantly say, do you
23:43
know what? I feel I know more than my own
23:46
clinician, my own GP. They have huge respect for their
23:49
GP because they're brilliant. You say going to see them about
23:52
the diabetes, the heart disease, They're really well respected,
23:56
clever doctors, but but they don't know about menopause.
24:00
Like actually, I didn't really know about the, the impact of
24:04
hormones on women until we got together and we learnt and we
24:09
studied and saw the, the transformational effects when
24:12
they're treated properly. So this was part of our, you
24:15
know, educate women to understand.
24:17
I think we've done that brilliantly.
24:19
But then we wanted to close the loop so that they that they
24:22
could go to their GP and have a good conversation.
24:26
So that we hope that there will be two people in that room who
24:29
would understand about hormones and why they're absolutely
24:33
symptoms of due to. Hormone change.
24:35
So the, the new updated version of course is even better
24:38
actually because we've got more consultations, yes, more doctors
24:42
involved. We've got lectures from other
24:44
people that people can watch. Yes, there's a lot more just
24:48
talking about our experience clinically as well, basing on
24:52
the evidence. And since we started the
24:55
education program, we've actually published quite a lot
24:58
of data as well, which is really important.
25:00
But we've also, like I said at the beginning, we've learnt a
25:03
lot from our patients. So we started calling in the
25:07
course Confidence in Menopause. We want to be thinking about
25:11
confidence in hormones for women because obviously we talk a lot.
25:16
Menopause, perimenopause often go together, but actually PMS,
25:21
PMDD, so premenstrual syndrome, premenstrual dysphoric disorder,
25:25
post Natal depression, even PCOS, polycystic conveyance
25:29
syndrome. We're realising these are all
25:32
due to hormonal changes. Symptoms are the same whether
25:37
it's a hormonal change due to menopause or PMDD.
25:41
Hormones. Really associated to Yeah,
25:43
absolutely. And that's what you were saying
25:45
about people in the past like Katrina Dalton.
25:49
Amazing work about progesterone that we weren't talked about, so
25:53
we didn't know. But we've learned, we've read,
25:56
we've changed our practice, but now we want to share what we've
26:00
learnt that's associated with the basic science and clinical
26:04
practice to others. And you know, I think it's it's
26:08
just a shame because medicine advances, knowledge changes,
26:12
guidelines are updated, education improves, whereas for
26:18
health of women and hormones, we just stuck in the murder.
26:21
It's actually gone backwards in the last few years, actually,
26:24
yeah. And I think we were seeing a
26:26
real traction when we first started out and we're really
26:29
getting some improvements. But actually with recent events,
26:32
it's it's gone. It's gone backwards.
26:35
GPS have become more scared. They're feel much more
26:38
restricted in what they can do. They feel that they will be
26:42
sued. I don't know what it is.
26:43
No, I mean they're. Petrified of hormones, which is
26:45
crazy. Actually.
26:47
We prescribe a lot of off label doses.
26:49
We prescribe a lot of off license medication.
26:51
We've done that all our lives. I mean, as an anaesthetist, most
26:54
of the things he gave are probably not licensed, but gosh,
26:57
we're used to that. Yeah.
26:58
But so you know, Panorama, the effect of our education being
27:02
taken down, all of these things have made a negative effect on
27:06
women. But I want to end talking about
27:08
some good news because the FDA announcement, So in America FDA
27:14
have taken off their black box warning and we don't have the
27:18
same black box warning. Can I just say you and
27:21
particularly have been campaigning for this, what, 10
27:24
years in our own country to deaf ears really, Yes.
27:29
But you have been going, you know, and we all all agree
27:31
because I've had patients, you know, who won't take their
27:35
medication because of the, the, the warnings.
27:37
Written down so we don't have the black box, but we still have
27:40
the warnings. You know, we always see if we
27:42
open any of our hormones, it will say risk of clot, risk of
27:45
heart attack risk. Of.
27:47
Breast cancer, it's just wrong, wrong, wrong.
27:50
And so what's been wonderful for us is and, and women is that the
27:56
FDA have really clearly, they've looked at the evidence and
28:00
they're basically saying estrogen is safe.
28:03
We don't need to have these warnings.
28:05
And that's really, really reassuring, isn't it?
28:08
It's a massive thing. It's a real change.
28:11
You know, America, they were the country that sort of developed
28:14
the WHI and the disaster from that.
28:17
I think it's quite nice actually that they are actually making
28:19
some improvements. It's almost, I think they did
28:22
say I'm sorry, we're sorry. But they did.
28:25
It's good they've. Recognised that at last and
28:27
yeah. Absolutely.
28:28
And they talk about, you know, we're sorry for the millions.
28:32
This is millions of women who have suffered by not having
28:35
hormones and so one of the things in the education
28:38
programme we do talk about is the risk of not having hormone
28:42
replacement, so not having progesterone, not having
28:45
Estrada. Not having the right levels of
28:47
that. Mind and the right dose,
28:48
Absolutely. It's really crucial that we wake
28:52
up and think about the health risks, yes, but also the
28:55
education courses led by GPS like us, because we're thinking
29:00
very holistically and we want to bring in other specialties.
29:03
So cardiologists, neurologists, rheumatologists.
29:07
Every doctor, whatever your special speciality, you're going
29:10
to be touching on hormones on every patient you need to know
29:13
about. And we need to, we need to show
29:15
people our, our knowledge as well.
29:17
Because, you know, for many years menopause has been sort of
29:22
given to gynaecologists. And some people listening might
29:25
know. But when you train as a
29:26
gynaecologist, generally you just do a year of medicine as a
29:30
very junior doctor and then you go straight into gynaecology.
29:33
So a lot of gynaecologists haven't been trained in
29:36
cardiovascular health, osteoporosis, bone health, brain
29:40
health, you know, they haven't done the different specialities.
29:43
And then they literally see humming changes through the lens
29:47
of a gynecologist, which is basically the wood gyne and the
29:51
wood and the bleeding or whatever.
29:52
Yes, exactly. Whereas we see it affecting
29:56
every. Multi organ problem, isn't it?
29:58
Multi system problem, Absolutely.
30:00
And I think that's why GPS are so good at that, because they
30:03
they deal with that day in. And day, yeah, absolutely.
30:06
So I'm, I'm really looking forward to how the education
30:09
program, we can really go for it.
30:11
Yes. And we've got great teams
30:13
supporting us this time. I feel that we're stronger, yes.
30:17
I feel like we can't be taken down like we were before and so
30:20
definitely not. It's great, it's exciting.
30:22
Time oh it's really exciting you know I think I think all these
30:25
changes and positive changes with the FDA announcement it's a
30:29
real sort of a global awakening if you like about actually hang
30:34
on these hormones are really important to women and women
30:37
deserve the right to understand that and make their own choice
30:40
they could they don't want the hormones that's fine but make it
30:43
based on correct evidence and. So three things that I want to
30:49
ask you. So there's look, quite a few
30:50
healthcare professionals that listen to this podcast.
30:53
I know a lot of women, men even who are listening.
30:56
You can all share this episode with your healthcare providers.
31:01
So, 3 reasons why healthcare professionals should be doing
31:05
our course. Because they'll be dealing with
31:06
hormones all the time. They may know about the fact
31:09
that they're dealing with hormones like GPS, or they may
31:11
not like rheumatologists and psychiatrists.
31:15
So if you see women in a medical capacity, you need to do the
31:19
course because it will touch your speciality.
31:21
Because so much misinformation #2 is so much misinformation
31:26
over the years, and people haven't had a chance to be
31:29
taught because the medical schools didn't even have it
31:31
really on the curriculum, maybe an hour's lecture.
31:34
So this is a chance to understand why #3 you want your
31:40
patients to get better. It's the most rewarding medicine
31:43
I've ever done. It's the safest medication I've
31:46
ever prescribed. And as I said, the most, the
31:50
most rewarding. Not, not every single person,
31:53
but the vast, vast majority gets so much better when their
31:57
hormones are balanced. And I think this is really
32:00
important as a doctor, it's exactly what you want to see.
32:04
Brilliant. Thank you so much.
32:05
So thanks for coming again. Thank you, Louise, lovely to be
32:08
here.