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

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

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