September 11, 2025 • 60 mins
🎉 It’s our 100th episode and Season 4 launch of The Body Pod and we’re marking the milestone with a powerful conversation that every woman over 40 needs to hear. In this game-changing episode, Dr. Louise Newson—known as “the medic who kickstarted the menopause revolution”—joins us to debunk menopause myths, explain hormone therapy (HRT), and redefine what healthy aging looks like.
We discuss:
Dr. Newson’s message is clear: No woman should suffer through menopause without support, education, and choice.
We discuss:
- Why too many women are wrongly prescribed antidepressants for perimenopause
- The essential roles of estrogen, progesterone, and testosterone in brain, bone, and heart health
- The real science behind HRT and who it’s for
- Why individualized, evidence-based care matters
- The dangers of medical misinformation and outdated menopause narratives
Dr. Newson’s message is clear: No woman should suffer through menopause without support, education, and choice.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hi everyone. My name is Haley and this is Laura
and welcome to the body Pod. Welcome back to the
body Pod everyone. Today I have the honor and privilege
of speaking with doctor Louise Newsan, who is a general
(00:23):
practitioner and hormone specialist and a leading voice in transforming
menopause care worldwide. As the founder of the News and
Clinic and the not for profit News and Education, she
is dedicated to improving awareness, education and access to evidence
based care through in person events, a comprehensive library of
(00:45):
freely available articles, and an education program for healthcare professionals.
She empowers both women and clinicians with the knowledge that
they need. A Sunday Times best selling author and host
of the UK's number one medical podcast, doctor Newsan is
passionate about driving positive change for women's future health. Doctor
(01:08):
Newsan has been described as the medic who kickstarted the
menopause revolution. She is an award winning educator, podcast and
author committed to increasing awareness of hormone health, including perimenopause
and menopause. Her mission is to provide inclusive, accessible and
evidence based information in formats that suit all women, helping
(01:31):
them make informed choices about their health. Through her work,
she has empowered a generation to take control of their treatment,
bodies and minds, ensuring menopause care is recognized as a
vital part of women's healthcare. Today, we dive deep into
what each hormone does and the benefits, pros, and cons,
(01:53):
as well as common myths that are surrounding hormone therapy.
So enjoy this episode with doctor newsan welcome back to
the Body Part everyone. We have doctor Newsen here with us,
(02:16):
who we've already introduced, and Louise, thank you so much
for joining us. We are thrilled to have you.
Speaker 2 (02:24):
Oh, thanks for viting mat It's great.
Speaker 1 (02:27):
Well, we have a probably five pages of questions, and
then of course I put out on my Instagram story.
I was thinking I probably wouldn't, but I love how
in your YouTube's in your lives that you always ask
questions at the end, and so I was like, I'm
going to keep some of these on there if we
have time to answer any in the last five minutes.
(02:48):
But this is going to be a hefty conversation in
all things hormone therapy. So we are going to dig
right in. So first of all, when you're called the
medical who kickstarted the menopause revolution. First of all, that's
a hefty title. Yeah, what sparked your passion for transforming
(03:11):
this menopausal care?
Speaker 2 (03:14):
Yeah, it's interesting because I didn't always have this passion.
Like if i'd met you fifteen years ago, I would
have gone, what, No, I'm interested in everything in medicine,
and I still am. But I suppose it was hearing
stories when I'm in When I was in my GP practice,
I would only see the patients that came to me,
and you're limited in how many you can see. You know,
(03:36):
thirty forty patients a day probably ended up about eighty
percent of them or menopausa by the time I left.
But I'd hear those stories. Women would be suffering for
a little bit, and then I'd help them, and then
they would start to feel better. And then when I
started to do my clinic, I thought it would just
be an extension of what it was like in general practice,
But it wasn't. Women would travel for hundreds of miles
(03:58):
sometimes and they would tell me how they'd been suffering
for years because their doctor had given them antidepressants, told
it was all in their head that they needed other drugs,
and all the symptoms have started since their ovaries were
removed in an operation age thirty, or since their period
stopped or whatever, and I was like, what, like, how
(04:19):
what's going on out there? And then I started, wrongly
or rightly, to sort of play with social media and
people would message me with these stories. And then over
the years, obviously the clinic's busy, My social media is
really busy. People stop me in the street and tell
me about how they're not being listened to and believed.
So what drives me now is just in injustice actually
(04:41):
of what's happening and how the medical system is letting
down so many women without any good reason. So it's
gone from just being interesting to like something that's making
me really sad and cross.
Speaker 1 (04:55):
Actually, yes, and what do you think do you think
that one country has has it a little bit harder
than others? I mean we're in America actually, lauras in
Europe right now, so yeah, nice, But does I mean
if we look at the U, don't just take the
(05:17):
UK and take America? Are there huge difference? I mean,
I know there's a lot going on in America right now, but.
Speaker 2 (05:23):
Yeah, for sure, for lots of reasons. But you know
what every country. It's bad. So lots of people say, Louis,
it's what you're doing is amazing. UK is really increasing.
HRC prescribing had been increasing, but the last few months
it's plateaued again because there's various people who are trying
to scare people away again from hormones. But let's think
(05:44):
about it. One hundred percent of women will become menopausal.
About five percent of menopausal women globally are prescribed hormone
replacement therapy and in the UK it's about fourteen percent.
But every MENSE guideline, whatever you know, you think about
the guidelines, they alsay first line treatment for symptomatic menopause
(06:08):
for the majority of women is HRT. So I'm not
a mathematician, but five percent and fifteen percent are not
the majority. So even if you just look top line,
do you know what I mean, then it's bad. So
I feel sometimes guilty with my work because awareness is improved,
(06:29):
knowledge has improved, but access to evidence based treatment generally
hasn't really improved.
Speaker 1 (06:37):
So let's go to that evidence based treatment. What does
that mean to you? Because I'm obviously I am in
the strength and conditioning world, but I have partnered with
a lot of influential experts, and I feel like there's
that while menopause has gotten widely more popularized, there are
(07:03):
two camps. Yeah, and the camps are of you know,
and sometimes it's loud. But when you I feel like
everyone's throwing around evidence based care, what does that mean
to you? And what are you providing different?
Speaker 2 (07:17):
No, it's a great question, and I think women's health
in general becomes very polarized. Something about hormone health becomes
really quite toxic in summer. You need to look at
some social media comments and you're like, hang on, what's
going on here? So with obviously, I'm a physician and
all my work, whether it's hormonal or not, is based
(07:40):
on evidence. And when I say evidence, that's that's scientific evidence,
but clinical evidence as well. So we have to remember
that medicine is a science and an art. So the
science is knowing, you know, the biology, the physiology, the biochemistry,
the pharmacology, studies, the trial, the evidence. But it's also
(08:02):
the art is individualizing care, and that's sometimes lost in
people who don't have a huge amount of clinical experience.
So then well, if we think about what menopause, perimenopause
is it's related to hormonal changes. Menopause is when the
hormones are low because our avaries don't work for various reasons.
(08:26):
So then if we unpick what the hormones are, they're
chemical messengers that work in every single cell. So then
when I talk about hormone deficiency, there's already people going, no,
it's not a hormone deficiency. Well what is it? Then?
Do you know what I'm saying? It's low hormones. Therefore
it's a low deficiency. So then you have to think, well,
(08:47):
how do does our body work with hormones? Well, the
cells work better, the tissues work better, the organs work better,
the organelles in the cells, like our mitochondria work better.
That's just fact. That's not me telling you something I've
made up. This is just you know, basic physiology. But
then when you think about treatment and individualized treatment, it's
(09:10):
about choice, and I often will compare it with things
I exercise. I don't need to tell you that exercising
is really good, but there are different types of exercise
and there's choices. Some people don't exercise at all, and
that is their choice. They're not all going to get
heart disease. Because they don't exercise. But we know that
risk of heart disease, for examples, increases if you don't exercise,
(09:34):
and it's the same with hormones. If you don't take hormones,
there are risks to your future health. But you might
be absolutely fine. But you just need to know and
accept what's going on in your body. And knowledge is
really important. And I see some people on social media
are going, look at me, I'm amazing, and I've never
taken a hormone. This is all done like naturally. Well,
(09:56):
it's not natural to not have hormones for a start,
But do these people want a medal? You know? I
see women who are suicidal and falling apart. Do I
say to them, oh, do you know what, if you exercise,
then you might be fine. Like I don't say that
if someone's got other deficiency, if they've got low iron,
(10:17):
I wouldn't be saying, well, exercise and you'll be fine.
I mean exercise, of course you'll improve with other ways,
you won't replace that iron. So I think it's misunderstanding
actually about what basic humans do in our body. And
then the HRT conversation is really fragmented because people don't
seem to often understand there are different types of hormones.
(10:40):
Like if I wanted if I was ten years younger
and wanted contraception, I'd get it really easily. As a
fifty four year old menopausal woman. If I want HRT,
everyone's like, what you can't have that that's terrible. But
if I wanted antidepressants, it would be very easy for
me to get them. So there is this inequality of
(11:01):
care that's going on. And my work is really about
empowering people with knowledge so then they make choices. You know,
it's not saying you have to take this stormont or
you have to exercise in a certain way. Just have
this knowledge, but the knowledge has been hidden or it's
been wrong. And I just to be really clear to
your audience, I don't work with pharmaceutical companies. I don't
(11:24):
work with supplements or brands or you know. My knowledge
comes from reading academic papers and you know, knowing a
lot about basic science and then putting that into context
for individual patients.
Speaker 1 (11:39):
Do you think that it's so we will get to
what hormones pros and cons and what each one of
them do, because I think those are still with all
of this information out there. I just know from what
I'm getting in my DMS and my groups because I
always hire a menopausal like a menopause physician to come
(11:59):
into my courses to educate because not my lane. But
it's amazing how much of the same questions, yes, homos
all of the time. So what would you say, are
the three the top three if you could pick two
or three misconceptions about HRT that we're still getting wrong
today or most people don't understand.
Speaker 2 (12:21):
I think the biggest reason why people don't take homens
and don't prescribe them if they're doctors is the risk
of breast cancer. That's the biggest same people are scared about. Now.
One of the things to think about is the study
that everyone scared everyone away from two thousand and two
was using synthetic hormones. So even though it showed the
(12:43):
risk wasn't statistically significant, and even though it showed easter
and only HRT was associated with a lower risk of
breast cancer, you can't compare it with the natural hormones,
the body identical hormones we prescribe. Now, there has never
been a study to show that our own hormones cause
breast cancer like it wouldn't make sense really, even if
(13:04):
you think about it as a basic scientist, how would
our own hormones? Cause cancer just feels a bit weird,
doesn't it. Yes, So that is the biggest myth that
scares people away. The other thing is that people think
that they're too old to be considered on hormone And
let's face it, we've got twenty years of lost women
(13:26):
who have been misguided and denied hormones. So now a
lot of these women who were forties fifties when the
study came out and maybe in their seventies. No one
is too old to be considered for hormones. And then
the other myth is all about testosterone, what it is,
who can have it, what does it mean, because a
lot of people think testosterone is the hormone that people
(13:50):
inject to be bodybuilders and have like massive muscles, and
what those people are doing are giving themselves something that's
like testosterone, but it's not the same. So it's like,
you know, eating steelbery flavored sweets rather than having strawberries.
There's a big difference in the body. So those are
(14:10):
myths and not every hormones the same. You know, I
contraceptives are very different to homones that we prescribe, and
most even doctors don't seem to realize that.
Speaker 1 (14:23):
Okay, So if I were to come in, so Laura
and I are the same age, we're both turning forty
eight this year, so it's a good assumption that we're
in perimenopause. And I feel like this is almost the
I mean, I would love your your advice, but it
feels like perimenopause, where everything is really erratic, is the
(14:46):
harder section a at least postmenopause. But here we have
perimenopausal women the majority, as you said, from the statistics
at the first of the call, that are either our
metopausal or in this peri face, that aren't taking hormones.
And if this is the most dramatic, you know a
(15:07):
few years leading up to it. If I were to
come in your office and this is generalized, I know
it's super individual, but do you normally more than not prescribe,
what do you start with? Do you go in and
just say, oh, progesterone is like the easiest one, although
I heard you say it was the most forgotten or
maybe the most misunderstood, and I was thinking that that
(15:29):
was the testosterone I feel like testosterone now is getting
a lot of love. It's kind of like the darling
of the hour. But they each are so individual. Where
would you just start someone generally?
Speaker 2 (15:43):
So it's a great question. The most important thing actually
for me as a clinician is really taking a good
history and understanding because you know, things have changed. When
I started my clinic ten years ago, people come in
and say I think I'm perimen of but I'll tell
you what. I don't want hormones because they've been so
(16:03):
scared away. Whereas now people will come they've got more information,
great and they'll say I'm perimenopausal. I've used your balance app.
I've listened to your podcards, I would like a gel,
I would like the pedesterone and like testosterone dad, And
they basically running the consultation. So the important thing for
me is a doctor. Firstly is is it definitely perimenopausal?
(16:25):
And that's hard because there's no quick test, But also
is there anything else that's causing their symptoms? So not
everyone who's tired I can blame low testosterone. They might
have low iron, they might have low vitamin D, there
might be something else going on, they might have another condition.
But you know, I've had a lot of good training,
very I've done a lot of medicine, and so I
(16:47):
can ask those screening questions and do blood tests to
try and exclude. So that's really important, and then it's
working out, you know, I think perimenopause and menopause a
just labels for women. What is going on? Are they
gesterone deficient? Are they esterodyle deficient? Are they testosterone deficient?
Do they have endometriosis, which is a lot worse when
(17:11):
their levels of esterdyle are fluctuating? Do they have a
history where they find that they're more intolerant of progesterone?
Are there periods regular? Are they heavy? Do they need contraception?
So all of these things is working out in my mind,
which hormones? What does to start? Sometimes if someone has
(17:32):
really bad PMDD pre mensal dysphoric disorder and they're just
feeling terrible for those few days before their periods and
the rest of the time they're fine, well, then I
might just give them some progesterone for those few days,
and then I might consider doing their estodyl and testosterone
blood test and reviewing them. But other women I might
give all three hormones together. It really really depends, and
(17:55):
that's where it's very individual. And then we just review
people and it's a review consultation that's actually can be
more revealing because then we can see are they responding,
what other symptoms do they have, what their blood levels doing,
and then that will help us guide whether we need
to change the dose or the type, or adding another
(18:16):
hormone for example, or think about vaginal hormones as well.
And then in a review, usually when the hormones are balanced,
we spend a lot of time thinking really carefully about
nutrition and exercise and whether they need supplements or what
else is going on in their lives too, So it's
not just the transaction that we just do, and it's
(18:36):
a journey. And often in perimenopause you think you've got it.
Patient patients feel really well and then suddenly their own
hormones drop and they might need their dose changing. So
it can be a moving target sometimes as well a movie.
Speaker 3 (18:49):
You exactly do you think blood tests are useful for
perry menopause?
Speaker 2 (19:00):
So they have to be done. This is what I think,
in conjunction with a really good consultation, because it's so
easy now to get blood tests, isn't it, And people
come in with these realms and reams. A lady came
in yesterday. It was almost like a book of blood tests,
but she hadn't even had her testosterone level done, and
I'm like, oh, you've had all these other blood tests,
(19:21):
so you have to be really careful. And our hormone
levels do fluctuate and change. So I've seen ladies with
really high estradial levels and they're not on any hormones
but their own bodies squirting it out. But then other
times of the day when they weren't having their blood tests,
they have got loads of symptoms of low estrogen. But
(19:41):
they've been told of your estrogen dominant or they might
be at the time that the blood test was taken,
but all the other times of the day they're having
low estrogen. So we have to be really careful how
we interpret blood tests as well. I think they're useful.
I mean, when we start to testosterone, we'll usually do
a testosterone level just to see but then there are
(20:04):
some women who have polycist over in syndrome who might
just be, you know, always run with a slightly higher
testosterone than others. So we have to this is where
you're tak it in context. But we often do do
blood to exclude other causes, like I say, like looking
at their iron level. They've been d get their kidneys,
(20:25):
the liver and all that as well, so you know,
but you can the thing in medicine you only do
a test if it's going to change your management. It's
very easy now, Like I mean, I've been qualified for
many years. It wasn't so easy to access all the
scans and things that you can now. But I always
ask myself, is it going to change my management? And
if it isn't, then I'm not going to just do
(20:47):
a blood test for the sake of it.
Speaker 1 (20:50):
Is estrogen dominance real?
Speaker 2 (20:53):
It's a great question. Yeah, I don't think really, I think.
I mean, there's lots of labels we give women. What
does it mean that you're Eastern dominant? Like basically it
means that you've got load progesterone and probably low testosterone.
The balance of hormones is really important. And Professor Mokhiro,
who's a urologist I know well in the US, he
(21:15):
talks about the triangle of the hormones and I love
that because you've got to get those three hormones balanced.
Sometimes I talk about a three legged stool. You can
have the right height of one leg, but if the
other two aren't there, you're going to be upsided. So
often it's because people don't have the other hormones balanced.
(21:36):
So also sometimes when people are perimenopausal and their hormones
really fluctuate, sometimes if we do give a higher dose
of estrogen, which seems a bit paradoxical, but then it
stops the ovaries doing this eeyo stuff, you know, and
that can be very useful for some women, you know.
So this is where it's all very individualized.
Speaker 1 (21:59):
So if we want to take estrogen, let's start with estrogen, yeah,
because I feel like that's the one that gets the
most love. Most women are very familiar with estrogen. So
if we're taking that, we have vaginal estrogen and then
we have systemic estrogen. So what are the different types?
Because I was just I was fascinated Lauren and I
(22:20):
were talking about this before you jumped on about the
transmission of through a patch or through a gel. I
didn't even think about like the skin texture and if
the skin is thicker, And now I'm questioning is mine
getting I've gone the.
Speaker 3 (22:41):
Gem, I'm parting out in the right place.
Speaker 2 (22:43):
What it's really interesting today because it's very crude medicine,
So we usually use it through the skin so it
stays as estradial because there are different types of estrogen,
and the estodyl is the anti inflometry, the good estrogen,
if you like. And once we've put something in our mouth,
things get metabolized through our liver. That's just how anything
(23:06):
works that we eat or drink. So if we have
esrogen through our mouth, it can get metabolized to different
types of estrogen. We put it on our skin, it
goes through the skin into the blood stream and then
it stays as easter dial. But the ways of getting
it through the skin are usually a patch or a gel.
But you're absolutely right. The absorption can really vary between women.
(23:29):
It can vary because of their skin texture, their thickness
of their skin, their temperature of their skin. You can
imagine if I put it on my bottom, which has
more subcutaneous fat than the small of my back, of
course the absorption is going to change. So and then
we've got the way we prescribe drugs. They're always within
(23:51):
license to certain range, but some women even with the
highest license dose, they're just not getting it through their skin,
and so we sometimes change to a different manufacturer patch
or the gel. But even then you might have seen
on my Instagram every soft and I flap mine in
the camera and just say, like, they really don't stick
very well. So I use more than one. But some
(24:14):
people use a very small dose and they get loads
more through their skin than I do using more than one.
Because we're all different and we've known that for many years,
but we have to have the right amount into our
body so that it works to not only improve our
symptoms but also to improve our future health.
Speaker 1 (24:34):
Well, I'm second guessing everything now. So if you have it,
where's the best place you can put it? On the thigh?
Speaker 2 (24:41):
So really there is It's where it sticks. Really, So
I actually put mine on my lower bat because I
don't have much subcutaneous tissue. I can, like you know,
I can feel my muscles quite easily through my back
and they just stick. They don't wrinkle. If I put
them on my bottom, my bottom I'm sitting and standing,
I'm moving, so they just become a bit more crinkly.
If I put them on my leg, they just come
(25:02):
off in my jeans, like they just once the patch
is edge start rolling, they flick off. So so that's just
for me personally, but other people find different places.
Speaker 3 (25:12):
So the other options like on your head.
Speaker 2 (25:16):
Yeah, so I mean they again the way they're license,
they say put them below the waist, but you're just
using the skin as a vehicle, you know. I sometimes
joke and say to face you should put it on
your forehead, like it's just using your skin to get it.
You wouldn't put it on your forehead, of course, but
it's just about doing that. And then the gel again
it's license for the arms or the legs, but again
(25:39):
it varies on the way that it's absorbed. It can
really change, and that's where the deuce is less important
than the penetration and the absorption.
Speaker 1 (25:51):
Okay, so the gel, the patch, we have that vaginal astrogen,
so that's separate. I was shocked because I was just
hiking with my sister in Europe and she has access
to any of my podcasts and I've had a lot
of experts on I don't think she's listened to one clearly,
(26:12):
but she was like, oh no, you can't take vaginal
estrogen if your if you've had breast cancer. And I'm like,
that's not true, and she was arguing with me, and
I was just it showed me how much misinformation is still.
I mean, it's my sister.
Speaker 2 (26:30):
Yeah. So vaginal hormones are very very firstly, the very
low dose and they only really penetrate the area, so
they'll use their help the vagina and the valve, but
they'll go into the bladder, the pulpit floor uni tract,
so they work for localized symptoms. And there's we've got
(26:52):
vaginal estrogens, and we've also got something called presterone, which
is a hormone called DHGA which converts to estrogen and testosterone,
which can be a lot more effective actually, And these
hormones can be usually very safely used for women who
have breast cancer because they don't get absorbed into the body.
They can really make a difference. But women who take
(27:15):
HRT often still have urinary symptoms or vaginal symptoms. So
then we can use the vaginal hormones as well as
having systemic hormones.
Speaker 1 (27:26):
And you can put it on your face.
Speaker 2 (27:29):
Oh yeah, that's the Yeah, sometimes people use the vaginal
tread put it on their face. But you know, what
if you have systemic hormones. So all three hormones estro down, pedestroone, testosterone,
they work throughout your whole body, so they work throughout
your whole skin. So they will improve collagen deposition, they'll
(27:50):
improve the skin that the blood flow to the skin,
they'll reduce wrinkles, they'll change the texture of the skin.
Now most of us, yes, it's the face is what
we see. But there's no point having a young face
and then like really old hands and dry flaky skin elsewhere.
So if you know, I don't know, people do it,
(28:10):
but then they're not on HRT and I don't really understand.
Why do you know what I mean? So I think
we have to. Of course it's going to probably help.
It won't penetrate very much. But it's the skin, is
it really? It's the biggest organ in our body, so
we want we want it well perfused because if our
skin is healthy, our liver, our lungs, our heart, our
(28:33):
kidneys are going to be better as well. So it's
always well having a nice young face, but we need
to be thinking about getting those womans into our blood
stream and our body.
Speaker 1 (28:41):
Yes, we've all seen the eighty year old that has
the amazing forty year old face. But then the rest
of the PLOODT I remember. So if we move on
to progesterone and the different ways, so we can have
that orally, which I didn't even know. And I have
to tell you, I was training a client and she
(29:04):
was just super she'd gotten on progesterone and she was
super tired when she would show up in the morning
for our training session. And she came back the next
day and she said, oh, well, this is like I
take it rectally. Now I didn't even know that was
an option. So you can take it vaginally, you can
take it rectally, and then you can take it obviously oral.
(29:27):
What's the differences? How would you how would you decide?
Speaker 2 (29:31):
So progesterone, and this is really important terminology. Progesterone is
the same stretch as the natural progesterone we produce when
we're younger. When we use the term progestogen or progestin,
that's a synthetic, chemically altered progesterone that's in all of contraception,
by the way, So progesterone we use as part of HRT.
(29:54):
And historically I was taught people are taught that you
only need if you have your womb because it protects
the lining of the womb from eastrogen. But actually it's
a really important hormone in our organs and our brain
as well. So many women, including those that have had
a hysterectomy, still take progesterone with good effects. So we
(30:17):
can have it orally. It's quite hard to get absorbed orally,
so it's made in a way it's called micronized, so
they basically make it very small and suspend it in
an oil so it can get absorbed through the body.
But like I've said before, anything that gets absorbed through
the mouth gets digestive metabolized through the liver, so it
(30:38):
can get broken up into different types of progesterones, and
some of those metabolites can cause side effects for some women.
Whereas if we use it as a peasuri so as
a vaginal u rect or peasurie, it gets absorbed through
the mucous membranes. It's a bit like you know, putting
any anything sort of inside, like through our mouth, the
(31:02):
blood supply will take it away. Progesterone doesn't always get
very well and reliably absorbed through the skin, so that's
why putting it in the vagina or the rectum will
just get absorbed through the through the mucous membranes into
the bloodstream as the pure progesterone, so it doesn't get
chemically converted, if that makes sense. So some people who
have side effects with the tablet the capsule oral capsule
(31:26):
find that they tolerate it really well vaginally, especially women
if had PMS or PMDD or postnatal depression. Having the
doses vaginally can be a lot better.
Speaker 1 (31:40):
Okay, that's fascinating. So then if somebody comes in and
says they're progesterone intolerant, they.
Speaker 2 (31:47):
Might yeah, and that's that's really interesting. I have done
a YouTube about progesterone intolerance because we suit a lot
and there's a couple of things there. One is a
lot of women are intolerant of progester gins or progestines,
the artificial So they'll go, oh, do you know what
I had contraception? I had a marina coyle and I
had to take it out it was so awful. So
(32:09):
they are intolerant of a synthetic chemical hormone, not progesterone.
Most people aren't intolerant of their own hormone, but what
they can be intolerance is of changes of those hormones levels.
So women with maybe PMDD who are more sensitive to
that drop of progesterone before their periods, if we give
(32:31):
them progesterone, sometimes people feel worse. And I saw a
lady in my clinic yesterday who really can't tolerate progesterone,
but she's still having regular periods, so she's still producing
progesterone herself. So it's like I'm giving a progesterone and
she's producing it herself and it's just not suiting her.
Once she becomes menopausal and her periods stop, her own
(32:53):
natural progesterone will decline and she'll probably be okay on
a low dose of progesterone. So it's again individualizing the
care and really working out is it progesterone intolerance or not.
And some people, actually it sounds a bit paradoxical need
a higher dose of progesterone, especially as a pesari. So
they have a load dose and they feel awful. You
(33:16):
increase the dose, it stimulates the receptors better and then
they feel quite different and better.
Speaker 1 (33:22):
Wow.
Speaker 2 (33:22):
Yeah, So it's options and choices really, but a lot
of people are not as intolerant as they think of
the proper progesterone, if that makes sense.
Speaker 1 (33:32):
So do you recommend cycling it or just taking it daily?
Speaker 2 (33:36):
So it really farries again because we're all so different.
If people are still having periods, we often cycle it
just because if they had it all the time, they
often get breakthrough bleeding. And it could be no one
wants to have break through bleeding. Really, some people have
it all the time and feel great. They have no bleeding,
They feel great, so why would I change it. Other
(33:57):
people find that they feel better after having a few
days break maybe every month every three months. So again,
it really really varies.
Speaker 3 (34:08):
Which is why it's hard because there's so much trial
and error.
Speaker 2 (34:12):
Yeah there is, and also there's so much out there
on social media. Some people say you have to have
a few days off. You don't, you do? And and
the thing is you learn by experience. But this is
why everyone is different. And like what suited me nine
years ago, I'm not on the same dose in type
of homaones nine years ago than I am now. So
(34:32):
it's evolving all the time. You know, I started HRT
when I was perimenifausal, I'm fifty four, I'm going to
be menifausal now. So things change, don't they. So that's
why it's really important to make sure that you see
someone who understands it's not just a one size fits all.
Speaker 1 (34:50):
Well, then the level of care for the general physicians,
the general practitioners, that's what is probably holding up a
lot of this because I mean, women ask at least
I don't know, Laura, if you get asked, but all
the time, who should I see in Colorado for instance,
and everyone asks me, yeah, I mean it just there's
(35:13):
not like a long list, or at least I don't
I don't know a long list. That makes it tricky, Yeah,
to get it really dialed in if we move on
to testosterone. So again I say it's the darling of
the hour because it's getting a lot of love. But
I think that it's the most feared out of all three.
(35:33):
It seems like, well, at least in the United States
from my insurance company, personally, it's been a doozy to
even get. But then you go to Australia and you
can get it fairly easy.
Speaker 2 (35:45):
Well you can and you can't. It's licensed for women
in Australia, but most doctors don't prescribe it. So it's
really ironic, isn't it. They've got a product we can't
prescribe it, or that women can't get it. And we
can prescribe the female testosterone cream that's licensed in Australia
over here, but it has to be privately, or we
(36:07):
can prescribe the male testosterone like you can over there
with you in different doses. But the thing is it's
a female hormone. It's an important female hormone, yet we
can't get it. Like it's just madness, isn't it that
we can't have our own hormone back. And then you've
got people telling us that we'll grow beards and mustaches
(36:29):
and it's really dangerous, and you know, our voices will
change and we'll lose all our hair. It's like, well,
most people, when you have the right dose and type,
actually don't have all that. I don't shave every day,
like you know. It's but I tell you what my
brain works, you know. But then it's all denigrated to
it's all about whether you can have an orgasm or not,
(36:52):
whether you're sexually active or not. You know, one of
the doctors that works as me went to see her
GP recently to get her hormones just a repeat prescription,
and that doctors said, well, I know you've recently had
a divorce, so therefore you won't be needing your testosterone.
Stop it. Yeah, yeah, I know. This is to a
medical doctor to another doctor, and you're like, hang on,
(37:14):
it's twenty twenty five. Do you have to have a
husband to have a libido? You know? I mean, I
love my husband, but you know, I still it's really like,
it just feels wrong that we're just talking about women
like sexual objects. And some menopause societies talk about HSDD,
which is hyperactive sexual disire disorder, and one other criteria
(37:38):
to have this condition is that you have to be
severely psychologically distressed with your reduced libido for at least
six months, and then you can maybe have testosterone. And
I'm like, hang on, I'm a doctor. I'm not watching
my patients being severely psychologically distressed. But we know that
the hormone works throughout our body and brain, so we
(38:00):
know that women. We've published data. So if others find
that their mental health improves their mood, their memory, their concentration,
their muscle strength, just their ability to exercise is better,
but then people say, well, it's just perceive it. Well
it's it's not because it's a biologically active hormone and
it's just a hormone. And you know what, if it
doesn't work, people don't have to take it. But most
(38:23):
of us that take it are never going to stop
it because we've it HAPs this function. But again, it
just comes back to choice, doesn't it.
Speaker 1 (38:31):
So how would you determine? I know this might be
going down the rabbit hole again if someone if I
come to you and I say, my main symptom right
now is brain fuck. I can be on a podcast
and mid sentence, I'm like, what was I saying? This
is concerning this has never happened. But that's the main symptom,
(38:54):
is that there's one hormone combat that more than others
or just all the pen on the comedy.
Speaker 2 (39:01):
So it does depend. But you know, if I could
only prescribe one hormone to women, it would be testosterone.
If I could tell you the hormone that has transformed
the most number of lives and probably save the most
number of lives the women I've seen who have had
suicidal thoughts, it will be test us to it. Wow,
you know, I see a lot of women who have
had really sad stories that you might have listened to
(39:22):
the podcast I did with Jay and Haley, the mother
and her son who she'd been in a psychiatric hospital
for nearly thirty years on and off. So we see
a lot of women who are like Hailey. They've had
awful psychiatric histories. They've been on antidepressants, antipsychotics, Lithian electro
convulsive therapy sessions, they've had sometimes they have ketamine, but
(39:45):
no one's thought about their hormones. That often they or
their family have put it together and thought, can I
try some hormones? The HLT can help them, but you
give them testosterone and then wait a few months, and
these women are often transformed and they I've had low
testosterone often for many years. So we have to be
really careful when we think about women not having test us.
(40:09):
To me, and I never thought about testosterone before when
I did psycholatry, I never didn't know women even had
it in their bodies. So you know, I'm as guilty
as any other doctor by prescribing other drugs. But if
someone's got a load test us, doone they've got symptoms?
Suggestive of test ustone deficiency. We should be really replacing
(40:30):
a natural hormone. I don't really understand the dangers of it.
Speaker 1 (40:35):
So for bone health, because that's another huge one. And
I love that osteoporosis and osteopinia that there we all knew.
I mean, this is something that I remember my grandma
couldn't have a hip surgery because her bones were too
soft and she wasn't cleared for the surgery. Do you
(40:55):
see again, is there one? Is it estrogen that helps more?
Is it testosterone or is it a combination of all
of them?
Speaker 2 (41:02):
So often all three actually, because we've got hormone receptors
for all three hormones on our bones, and our bones,
as you know, are biologically active. So we have these
cells osteoblasts that build the build the bone, and osteoclass
that break it down. And we've got androgens, testosterone receptors,
(41:22):
estradar receptors, and progesterone receptors on these sets. So if
they're stimulated the right way, the osteoblasts, they'll build the
bone and keep it strong. If they're not stimulated, the
osteoclass will take over and they'll sort of gobble and
make the bone weaker. So this balance is really important.
So you know, our bones are biologically active, but so
(41:43):
are our muscles as well, So both of those are
really important. And it's almost forgotten. I think people think
osteopiosis is an old person's disease, and yeah, it gets
more common as we age, or they think, oh, it's
just a fracture that will be repaired and then I'll
be fine. But I'm petrified of ostereoporesis. I'm worry about
(42:04):
osteoporosis of my spine because when you see these people
that are stooped, you know, with the curvature of the
spine and due to osteoporesis, it's very painful because they
have lots of little fractors. The coughing might cause another fracture. Sneezing,
they can't digest food properly, they can't breathe so clearly,
but they can't reach for a cupboard in the same way.
(42:25):
You know. So, and we know obviously exercising weight, bioing,
exercise is really important. But we know that hormones, you know,
we've known since nineteen forty one. There was a professor
Albright who said and realized that women's bones were thinner
when they were menopausal, and that was because of the
lack of hormones. So it's nearly one hundred years we've
(42:47):
known it.
Speaker 1 (42:49):
Wow, so every female, I mean, this could benefit the
bond for every female.
Speaker 2 (42:56):
Yeah, for sure, Yeah taking it.
Speaker 1 (42:59):
So look at the counter argument of I guess the
women pushing or anyone pushing not not having hormones for
whatever reason outside of a female's choice. So we all
know that if female has like we have choice, we
can decide whether to take it.
Speaker 2 (43:19):
Round.
Speaker 1 (43:20):
How many women do you see that come in that
maybe aren't aren't taking it, not because they're scared to
or they don't have the information, but are choosing not
to take it for whatever reason.
Speaker 2 (43:33):
So obviously they don't come to the clinic because they
come to the clinic easily because they want hormones. But
you know, I sometimes see women who are mothers of
my patients, so they may be in their sixties, seventies
and saying, do you know what, I've never thought about homones,
but now I've seen how well my daughter is or
my sister is. I'm just wondering, you know, I don't
(43:53):
think I've got any symptoms, but I'm worried because my
mum had us to process or what have you. And
then I'll talk to them and if they want to
try it, they will, and then often they come back
and go, Wow, my sleep is so much better. I
can spring out of bed in the morning. I don't
have to get up at nighttime for a week. You know,
I feel different. But I thought that was just because
(44:14):
I was older. I didn't realize that it was due
to hormones. It's very hard to find a menopausal women
with no symptoms at all. They might think they don't
have them, but you don't know until you have those
hormones back.
Speaker 1 (44:28):
Now, what about the muscular skeletal syndrome of menopauds. I
would say that's what people come to me from the
strength side, and I can work on strength with them.
But it's the joint you know, arthritis and just I've
noticed my fingers just yeah, I'm feeling it there. Yeah.
Speaker 2 (44:52):
So it's really important, crucially important, because all three hormones
are anti inflammatory, reduice inflammation in our muscles and joints.
So things like frozen shoulder really really common. Arthritists both
you know, osteoarthritis rheumatoid arthritists. Syrah negative arthritis a lot
(45:15):
more common in women in the late forties. So those
hormones help lubricate the joints as well as reduce inflammation.
They help the cartilage, they help the sinovia, they help
the tendons the ligaments as well as the muscles as well,
and they help the muscles to work better. So it
just seems madness that these poor women are like the
(45:38):
tin man from Wizard of Us, you know, rusty trying
to creak and get their joints. It's you know, of course,
exercising will improve and our muscles will make hormones, so
if they are stronger, they're going to work better and
that will help. But they're not going to replace the
hormones to the level that they were when they were younger,
(45:59):
and they over is working well, m and the brain.
Speaker 3 (46:04):
I listen to one of your posts about just the
effects all three of them have and how important it
is too on our brain, and I mean, I don't
know how you can't listen to that and not think, Okay,
sign me up for all.
Speaker 2 (46:23):
Well, you know, I'm a general physician, I'm not a gynecologist,
and you know gynecologists. Most of them think that the
womb is the most important organ in the body, whereas
I actually, and I think many women would agree, feel
that the brain is the most important organ in our bodies.
And I'm very interested in neurophysiology and so how our
(46:45):
brains work and function. And we've got all the brain
is the most amazing organ in the body. And it
can sort of the cells can grow, they can change
the neuro transmitters, the chemical messengers in our brain. The
levels of those can change all sorts of things we do.
It can alter the function. But these hormones ESTRODIWM, pedesterone,
(47:07):
testosterone are neurosteroids. They are made in our brain. Every
sell in our brain responds to these hormones. There's a
reason that that happens. It's not just to give us periods.
It's to help our brain function, help the other neurotransmitters
to be at the right level. So it helps our serotonin,
(47:27):
our dopamine, our melotonin, our neu adrenaline, our glutamate, all
of those neurotransmitters work better in the presence of our
own hormones. So it goes without saying, really that the
commonest symptoms are those affecting our brains, so you know,
the low mood, the anxiety, the memory problems, fatigue, and
(47:50):
a lot of people have very dark thoughts as well.
But then you can see where they're misdiagnosed as having
depression or psychosis or personality disorders or what have you.
But we have to understand how hormones work in our brains,
because then when we don't have them, our brains don't
work in the same way.
Speaker 3 (48:10):
Our brains are not working the same right now, Heyley,
I don't.
Speaker 1 (48:12):
Think we'll testify to that, So okay, I'm going to
cover some of these quick questions before we wrap up here. Clearly,
we know that you can go through a post metapause
without any HRT, But this person's asking is it a must?
Obviously outside of choice? Would you recommend it for anyone
(48:37):
that's even asking this question.
Speaker 2 (48:39):
It's a good question. I think you also have to
think what are the risks of not having hormones? So
it's an individual choice. Of course, people can live without hormones,
they can live without virroxin hormone, but actually, if you've
got symptoms, why would you suffer? But it's the health
risks as well. We know that the communist cause of
death and women globally cardiovascular disease and dementia, So taking
(49:03):
natural womens will reduce the risk as well as, as
we say, reduce the risk of usityoprosis that affects one
in two women and other inflammatory conditions. So it's a choice,
but a lot of people, you know, make the decision
to take it or make the decision to not take it. It's fine,
but just know the facts really is really important.
Speaker 1 (49:25):
Do you feel like any of these are easy to stop?
That's the next question is if I started test asterone,
is it easy to start?
Speaker 2 (49:35):
Yeah, sure, but most people don't want to stop, you know,
and that's because they're biologically active. So you know, I
take HRT and tossing for two reasons. One to help me,
you know, not have symptoms, because my symptoms were really
affecting me. But secondly, I've already said I'm scared of usteoporosis,
so I'll do anything to keep my bone strong, so
(49:57):
I do weight baying exercises, I take this d you know,
I'm active, But also I take hormones for that one reason,
So even if I wasn't getting symptoms, I don't want
my bone density to reduce, But that's my choice. Other
people might not be on their way down, they might
not mind. So the hormones we use only last in
(50:19):
the body the same day. So if I don't use
my testos to win tomorrow morning tomorrow night, I won't
have any in my body. Doesn't build up in the body.
It's not my antidepressants that it can take weeks or
months to come off them.
Speaker 1 (50:31):
Oh I felt it. I only took a certain amount
on my nine day mont Blanc hike and I ran out,
And yeah, I can tell you. So how do migraines
And this is actually something that a lot of women
ask migraines and how they change over the metopause transition
(50:52):
and when you're post metopausal, when you're officially in metapazzal
do they get Does it get better?
Speaker 2 (51:00):
So yeah, for sure. So again there's information on my
youtubes and podcasts about this. But migrain is a chronic
as in long term and it's usually a genetic condition,
so people will always be predisposed to migraines if they
have them. But the brain likes homeostasis, It likes things
(51:22):
the same, especially in people who have migraine. So anything
that changes in the brain could trigger a migraine, including
hormone fluctuations. Like you say, so, a lot of people
find that they have worsting migraines in the perimenopause, and
giving hormones back at the right dose and type can
really help with migraines. Sure, they might improve in menopause
(51:43):
when the hormone levels are low, but then you've got
health risks, you might have other symptoms, so it's not
really good enough to say to someone just wait until
you're hormone drop and then you might be Okay. That's
not really the way I practice medicine. But also, you know,
I'm a migraine sufferer, and it's looking at everything. You know,
(52:05):
I still get migraines despite taking hormones, So it's looking
at what we eat. I mean, I'm very strict with
I don't drink alcohol, I don't don't eat chocolate, I
don't have caffeine, I don't eat processed foods because all
of those would trigger migraines for me, but other people
might be fine. So it's working out your lifes done.
I mean, I'm very routine. I eat the same time
(52:26):
I get up the same time I go to bed
the same time. If I do too much exercise, it
can trigger migraines. Have to be really careful. But other
people are fine. So it's looking at what you need
in a But hormones have a massive impact, often in
a negative way when they're not balanced properly on migraine.
Speaker 1 (52:44):
Okay, so you've talked about a little bit about exercise
and diet, so that goes into proper mental puzzle prescription.
If you have someone seeing you, you guide them on that.
What are your recommending trends for exercise specifically?
Speaker 2 (53:04):
So I think exercise, well, it's very individual, really really individual.
And for some women, exercise might just be walking to
the bus stop. It might be just parking their car
a bit further away. Other people, it might be changing
their exercise. It might be that they can't exercise the
(53:25):
same because they're getting symptoms. But as they improve, they
might get stronger. You know, I was thinking about this
last night. I'm probably stronger now than I was, certainly
twenty years ago, even thirty years ago, as a student.
I think I'm stronger now, and that's partly because as
a student I was taking contraception, which you know, probably
(53:45):
doesn't means my muscles weren't working as well. But I'm
exercising differently, but I'm able to with my hormone. It's
a combination of things. So I feel sad when people
say you're menopausal, you have to do this exercise, so
you can't do this exercise. You know, people are really
there's no reason we can't do more and more. But
(54:06):
I think the most important thing I don't need to
tell you guys, but it's just doing something that people
enjoy and that they can keep it as a routine
because it's all very well, isn't it. Every January people
want to start running or start doing whatever. You know.
I still enjoy yoga and I've been doing it for
many years, but you know, other people are different. I've
(54:27):
started using doing some weights and I quite enjoy that.
Still like doing yoga as well, But you know, it's
doing what's right and what fits into your schedule. Like
it's although I like cycling, but it's three hours if
you're going out on your bike. I never have three
hours to myself, so I've just got to limit and change,
you know. But so it's you know, some people like
(54:48):
exercising on their own others like doing it together. It
can be really social. I'm not that socially, quite happy
doing it at home, but it's it's you know, I
think looking at it as part of your life, like
we have to eat, don't we You have to drink.
You can choose to exercise, but it should really be
part of your daily routine. And I think that's important.
(55:10):
But it's the first thing that often goes. But I
feel sad when people say, if you exercise you won't
get symptoms, if you exercise, you don't need hormones, because
it's not any either.
Speaker 1 (55:19):
Aw I don't think yeah. So for any parting words
on women that feel like they've been dismissed, maybe they
don't have How does one go about finding good care?
Speaker 2 (55:37):
Do you know what? I wish I could tell you easily,
But I think the most important thing firstly is to
get the information that's right for you. You know, there's
a lot of free information on my website on balance app.
I don't work with pharmaceutical companies. I don't have a
hidden agenda. So work out what's right for you and
(55:58):
then try and find the clinician. And it probably won't
be the first clinician that you see but it doesn't matter,
like none of us as clinicians loose sleep if someone
gets a second, third, fourth opinion, like it really doesn't
matter and we need to remember that that it really
doesn't matter. And then take someone with you and I would,
(56:18):
you know, have a really open conversation. No one wants
to fall out with their doctors, but if they're really
saying no, I would then challenge and say, well, why
are you not prescribing evidence based treatment for me? And
ask them if you could try it, you know, And
some doctors don't like being challenged. I really like it
when patients ask me things but don't give up, you know.
(56:43):
And I think this is and it's really hard, but
I see it over here in the UK and other
countries as well, that often doctors are being educated by
their patients, you know, as a busy DP when I
was working in you know, family medicine. If you've got
many people coming in the same day with the same problem,
(57:05):
you've got to learn about it, you know. If I
see some if I don't know about, I don't know headaches,
and then every day I'm seeing six ten people with headaches,
I've got to really read up and learn about headaches,
and this is sort of happening over here and in
other countries that doctors. Some of them are going, wow,
this is brilliant. I've learned so much. This is great.
(57:26):
So they've done our education program. They're like, brilliant. I
feel really confident now, And others will go, Louise, you
just need to shut up because too many women are
coming through the surgery and they're blocking other appointments. Well,
you could argue, and they're good appointments because these women
you'll transform their future health and lives. So I think
as patients we need to keep the momentum going and
(57:49):
learn from others. You know, there will be others in
your town or area who will know who's good to see.
But I just don't be scared getting another opinion.
Speaker 3 (57:58):
I think, do you have a vision for what menopause
care could look like or should look like in the
next five to ten years ago? Do you kind of
have a dream?
Speaker 2 (58:09):
Yeah? I do, but it's but it's not just menopause.
Actually it's hormone or care for women. Because I have
three daughters and my oldest daughter has PMDD, so she
was dipping really badly. Before her periods in COVID, I
really noticed it. So she has natural body identical hormones
and they've really transformed her life. And I see a
(58:32):
lot of her friends, some of them who have been
given lithium and a lands a pain, horrible drugs, and
no one's thought about hormones. So I'm transforming their lives.
So when you've got twenty two year olds saying, Louise,
is it legal to feel this good every day of
the month? Like this is amazing, Like that's incredible. So
those women or girls, women will never really be menopause
(58:56):
because I will adjust their hormones according to what they need.
So the dream is to stop the suffering, to stop
the gas lighting, to stop this not believing women and
thinking hormones are just something trivial. So I would be
so happy if everybody that wanted hormones could access them
(59:17):
on their first consultation, and everybody who needed them knew
that they needed them and had started that conversation earlier.
So actually menopause wasn't really a thing, and perimenopause wasn't
thinking because people would get going a lot earlier, really,
and you know everybody who's on contraception should be thinking
(59:39):
about hormones in a different way.
Speaker 1 (59:41):
Really wow, well this has been such an incredible conversation.
Most women aren't going to be able to work with
you one on one, So how where are women finding you?
I know you have some books, yeah, podcast.
Speaker 2 (59:58):
Yeah, So the best way is going to my website
Dr Louise Newsen. But Dr Louise Newson one wad dot
co dot uk. Balance app is free, so people can
download that through the app store and Google Play. A
podcast it's called Dr Louise Newssen and then the YouTube
as well, So just furtle around and find something that's
relevant for you.
Speaker 1 (01:00:20):
Great. Well, thank you so much for your time. You
were so respected in this industry and we were thrilled
if you answered our call. So honored. Yank you so
much for sharing your time with us.
Speaker 2 (01:00:32):
Oh well, thank you, it's been great.
Hi everyone. My name is Haley and this is Laura
and welcome to the body Pod. Welcome back to the
body Pod everyone. Today I have the honor and privilege
of speaking with doctor Louise Newsan, who is a general
(00:23):
practitioner and hormone specialist and a leading voice in transforming
menopause care worldwide. As the founder of the News and
Clinic and the not for profit News and Education, she
is dedicated to improving awareness, education and access to evidence
based care through in person events, a comprehensive library of
(00:45):
freely available articles, and an education program for healthcare professionals.
She empowers both women and clinicians with the knowledge that
they need. A Sunday Times best selling author and host
of the UK's number one medical podcast, doctor Newsan is
passionate about driving positive change for women's future health. Doctor
(01:08):
Newsan has been described as the medic who kickstarted the
menopause revolution. She is an award winning educator, podcast and
author committed to increasing awareness of hormone health, including perimenopause
and menopause. Her mission is to provide inclusive, accessible and
evidence based information in formats that suit all women, helping
(01:31):
them make informed choices about their health. Through her work,
she has empowered a generation to take control of their treatment,
bodies and minds, ensuring menopause care is recognized as a
vital part of women's healthcare. Today, we dive deep into
what each hormone does and the benefits, pros, and cons,
(01:53):
as well as common myths that are surrounding hormone therapy.
So enjoy this episode with doctor newsan welcome back to
the Body Part everyone. We have doctor Newsen here with us,
(02:16):
who we've already introduced, and Louise, thank you so much
for joining us. We are thrilled to have you.
Speaker 2 (02:24):
Oh, thanks for viting mat It's great.
Speaker 1 (02:27):
Well, we have a probably five pages of questions, and
then of course I put out on my Instagram story.
I was thinking I probably wouldn't, but I love how
in your YouTube's in your lives that you always ask
questions at the end, and so I was like, I'm
going to keep some of these on there if we
have time to answer any in the last five minutes.
(02:48):
But this is going to be a hefty conversation in
all things hormone therapy. So we are going to dig
right in. So first of all, when you're called the
medical who kickstarted the menopause revolution. First of all, that's
a hefty title. Yeah, what sparked your passion for transforming
(03:11):
this menopausal care?
Speaker 2 (03:14):
Yeah, it's interesting because I didn't always have this passion.
Like if i'd met you fifteen years ago, I would
have gone, what, No, I'm interested in everything in medicine,
and I still am. But I suppose it was hearing
stories when I'm in When I was in my GP practice,
I would only see the patients that came to me,
and you're limited in how many you can see. You know,
(03:36):
thirty forty patients a day probably ended up about eighty
percent of them or menopausa by the time I left.
But I'd hear those stories. Women would be suffering for
a little bit, and then I'd help them, and then
they would start to feel better. And then when I
started to do my clinic, I thought it would just
be an extension of what it was like in general practice,
But it wasn't. Women would travel for hundreds of miles
(03:58):
sometimes and they would tell me how they'd been suffering
for years because their doctor had given them antidepressants, told
it was all in their head that they needed other drugs,
and all the symptoms have started since their ovaries were
removed in an operation age thirty, or since their period
stopped or whatever, and I was like, what, like, how
(04:19):
what's going on out there? And then I started, wrongly
or rightly, to sort of play with social media and
people would message me with these stories. And then over
the years, obviously the clinic's busy, My social media is
really busy. People stop me in the street and tell
me about how they're not being listened to and believed.
So what drives me now is just in injustice actually
(04:41):
of what's happening and how the medical system is letting
down so many women without any good reason. So it's
gone from just being interesting to like something that's making
me really sad and cross.
Speaker 1 (04:55):
Actually, yes, and what do you think do you think
that one country has has it a little bit harder
than others? I mean we're in America actually, lauras in
Europe right now, so yeah, nice, But does I mean
if we look at the U, don't just take the
(05:17):
UK and take America? Are there huge difference? I mean,
I know there's a lot going on in America right now, but.
Speaker 2 (05:23):
Yeah, for sure, for lots of reasons. But you know
what every country. It's bad. So lots of people say, Louis,
it's what you're doing is amazing. UK is really increasing.
HRC prescribing had been increasing, but the last few months
it's plateaued again because there's various people who are trying
to scare people away again from hormones. But let's think
(05:44):
about it. One hundred percent of women will become menopausal.
About five percent of menopausal women globally are prescribed hormone
replacement therapy and in the UK it's about fourteen percent.
But every MENSE guideline, whatever you know, you think about
the guidelines, they alsay first line treatment for symptomatic menopause
(06:08):
for the majority of women is HRT. So I'm not
a mathematician, but five percent and fifteen percent are not
the majority. So even if you just look top line,
do you know what I mean, then it's bad. So
I feel sometimes guilty with my work because awareness is improved,
(06:29):
knowledge has improved, but access to evidence based treatment generally
hasn't really improved.
Speaker 1 (06:37):
So let's go to that evidence based treatment. What does
that mean to you? Because I'm obviously I am in
the strength and conditioning world, but I have partnered with
a lot of influential experts, and I feel like there's
that while menopause has gotten widely more popularized, there are
(07:03):
two camps. Yeah, and the camps are of you know,
and sometimes it's loud. But when you I feel like
everyone's throwing around evidence based care, what does that mean
to you? And what are you providing different?
Speaker 2 (07:17):
No, it's a great question, and I think women's health
in general becomes very polarized. Something about hormone health becomes
really quite toxic in summer. You need to look at
some social media comments and you're like, hang on, what's
going on here? So with obviously, I'm a physician and
all my work, whether it's hormonal or not, is based
(07:40):
on evidence. And when I say evidence, that's that's scientific evidence,
but clinical evidence as well. So we have to remember
that medicine is a science and an art. So the
science is knowing, you know, the biology, the physiology, the biochemistry,
the pharmacology, studies, the trial, the evidence. But it's also
(08:02):
the art is individualizing care, and that's sometimes lost in
people who don't have a huge amount of clinical experience.
So then well, if we think about what menopause, perimenopause
is it's related to hormonal changes. Menopause is when the
hormones are low because our avaries don't work for various reasons.
(08:26):
So then if we unpick what the hormones are, they're
chemical messengers that work in every single cell. So then
when I talk about hormone deficiency, there's already people going, no,
it's not a hormone deficiency. Well what is it? Then?
Do you know what I'm saying? It's low hormones. Therefore
it's a low deficiency. So then you have to think, well,
(08:47):
how do does our body work with hormones? Well, the
cells work better, the tissues work better, the organs work better,
the organelles in the cells, like our mitochondria work better.
That's just fact. That's not me telling you something I've
made up. This is just you know, basic physiology. But
then when you think about treatment and individualized treatment, it's
(09:10):
about choice, and I often will compare it with things
I exercise. I don't need to tell you that exercising
is really good, but there are different types of exercise
and there's choices. Some people don't exercise at all, and
that is their choice. They're not all going to get
heart disease. Because they don't exercise. But we know that
risk of heart disease, for examples, increases if you don't exercise,
(09:34):
and it's the same with hormones. If you don't take hormones,
there are risks to your future health. But you might
be absolutely fine. But you just need to know and
accept what's going on in your body. And knowledge is
really important. And I see some people on social media
are going, look at me, I'm amazing, and I've never
taken a hormone. This is all done like naturally. Well,
(09:56):
it's not natural to not have hormones for a start,
But do these people want a medal? You know? I
see women who are suicidal and falling apart. Do I
say to them, oh, do you know what, if you exercise,
then you might be fine. Like I don't say that
if someone's got other deficiency, if they've got low iron,
(10:17):
I wouldn't be saying, well, exercise and you'll be fine.
I mean exercise, of course you'll improve with other ways,
you won't replace that iron. So I think it's misunderstanding
actually about what basic humans do in our body. And
then the HRT conversation is really fragmented because people don't
seem to often understand there are different types of hormones.
(10:40):
Like if I wanted if I was ten years younger
and wanted contraception, I'd get it really easily. As a
fifty four year old menopausal woman. If I want HRT,
everyone's like, what you can't have that that's terrible. But
if I wanted antidepressants, it would be very easy for
me to get them. So there is this inequality of
(11:01):
care that's going on. And my work is really about
empowering people with knowledge so then they make choices. You know,
it's not saying you have to take this stormont or
you have to exercise in a certain way. Just have
this knowledge, but the knowledge has been hidden or it's
been wrong. And I just to be really clear to
your audience, I don't work with pharmaceutical companies. I don't
(11:24):
work with supplements or brands or you know. My knowledge
comes from reading academic papers and you know, knowing a
lot about basic science and then putting that into context
for individual patients.
Speaker 1 (11:39):
Do you think that it's so we will get to
what hormones pros and cons and what each one of
them do, because I think those are still with all
of this information out there. I just know from what
I'm getting in my DMS and my groups because I
always hire a menopausal like a menopause physician to come
(11:59):
into my courses to educate because not my lane. But
it's amazing how much of the same questions, yes, homos
all of the time. So what would you say, are
the three the top three if you could pick two
or three misconceptions about HRT that we're still getting wrong
today or most people don't understand.
Speaker 2 (12:21):
I think the biggest reason why people don't take homens
and don't prescribe them if they're doctors is the risk
of breast cancer. That's the biggest same people are scared about. Now.
One of the things to think about is the study
that everyone scared everyone away from two thousand and two
was using synthetic hormones. So even though it showed the
(12:43):
risk wasn't statistically significant, and even though it showed easter
and only HRT was associated with a lower risk of
breast cancer, you can't compare it with the natural hormones,
the body identical hormones we prescribe. Now, there has never
been a study to show that our own hormones cause
breast cancer like it wouldn't make sense really, even if
(13:04):
you think about it as a basic scientist, how would
our own hormones? Cause cancer just feels a bit weird,
doesn't it. Yes, So that is the biggest myth that
scares people away. The other thing is that people think
that they're too old to be considered on hormone And
let's face it, we've got twenty years of lost women
(13:26):
who have been misguided and denied hormones. So now a
lot of these women who were forties fifties when the
study came out and maybe in their seventies. No one
is too old to be considered for hormones. And then
the other myth is all about testosterone, what it is,
who can have it, what does it mean, because a
lot of people think testosterone is the hormone that people
(13:50):
inject to be bodybuilders and have like massive muscles, and
what those people are doing are giving themselves something that's
like testosterone, but it's not the same. So it's like,
you know, eating steelbery flavored sweets rather than having strawberries.
There's a big difference in the body. So those are
(14:10):
myths and not every hormones the same. You know, I
contraceptives are very different to homones that we prescribe, and
most even doctors don't seem to realize that.
Speaker 1 (14:23):
Okay, So if I were to come in, so Laura
and I are the same age, we're both turning forty
eight this year, so it's a good assumption that we're
in perimenopause. And I feel like this is almost the
I mean, I would love your your advice, but it
feels like perimenopause, where everything is really erratic, is the
(14:46):
harder section a at least postmenopause. But here we have
perimenopausal women the majority, as you said, from the statistics
at the first of the call, that are either our
metopausal or in this peri face, that aren't taking hormones.
And if this is the most dramatic, you know a
(15:07):
few years leading up to it. If I were to
come in your office and this is generalized, I know
it's super individual, but do you normally more than not prescribe,
what do you start with? Do you go in and
just say, oh, progesterone is like the easiest one, although
I heard you say it was the most forgotten or
maybe the most misunderstood, and I was thinking that that
(15:29):
was the testosterone I feel like testosterone now is getting
a lot of love. It's kind of like the darling
of the hour. But they each are so individual. Where
would you just start someone generally?
Speaker 2 (15:43):
So it's a great question. The most important thing actually
for me as a clinician is really taking a good
history and understanding because you know, things have changed. When
I started my clinic ten years ago, people come in
and say I think I'm perimen of but I'll tell
you what. I don't want hormones because they've been so
(16:03):
scared away. Whereas now people will come they've got more information,
great and they'll say I'm perimenopausal. I've used your balance app.
I've listened to your podcards, I would like a gel,
I would like the pedesterone and like testosterone dad, And
they basically running the consultation. So the important thing for
me is a doctor. Firstly is is it definitely perimenopausal?
(16:25):
And that's hard because there's no quick test, But also
is there anything else that's causing their symptoms? So not
everyone who's tired I can blame low testosterone. They might
have low iron, they might have low vitamin D, there
might be something else going on, they might have another condition.
But you know, I've had a lot of good training,
very I've done a lot of medicine, and so I
(16:47):
can ask those screening questions and do blood tests to
try and exclude. So that's really important, and then it's
working out, you know, I think perimenopause and menopause a
just labels for women. What is going on? Are they
gesterone deficient? Are they esterodyle deficient? Are they testosterone deficient?
Do they have endometriosis, which is a lot worse when
(17:11):
their levels of esterdyle are fluctuating? Do they have a
history where they find that they're more intolerant of progesterone?
Are there periods regular? Are they heavy? Do they need contraception?
So all of these things is working out in my mind,
which hormones? What does to start? Sometimes if someone has
(17:32):
really bad PMDD pre mensal dysphoric disorder and they're just
feeling terrible for those few days before their periods and
the rest of the time they're fine, well, then I
might just give them some progesterone for those few days,
and then I might consider doing their estodyl and testosterone
blood test and reviewing them. But other women I might
give all three hormones together. It really really depends, and
(17:55):
that's where it's very individual. And then we just review
people and it's a review consultation that's actually can be
more revealing because then we can see are they responding,
what other symptoms do they have, what their blood levels doing,
and then that will help us guide whether we need
to change the dose or the type, or adding another
(18:16):
hormone for example, or think about vaginal hormones as well.
And then in a review, usually when the hormones are balanced,
we spend a lot of time thinking really carefully about
nutrition and exercise and whether they need supplements or what
else is going on in their lives too, So it's
not just the transaction that we just do, and it's
(18:36):
a journey. And often in perimenopause you think you've got it.
Patient patients feel really well and then suddenly their own
hormones drop and they might need their dose changing. So
it can be a moving target sometimes as well a movie.
Speaker 3 (18:49):
You exactly do you think blood tests are useful for
perry menopause?
Speaker 2 (19:00):
So they have to be done. This is what I think,
in conjunction with a really good consultation, because it's so
easy now to get blood tests, isn't it, And people
come in with these realms and reams. A lady came
in yesterday. It was almost like a book of blood tests,
but she hadn't even had her testosterone level done, and
I'm like, oh, you've had all these other blood tests,
(19:21):
so you have to be really careful. And our hormone
levels do fluctuate and change. So I've seen ladies with
really high estradial levels and they're not on any hormones
but their own bodies squirting it out. But then other
times of the day when they weren't having their blood tests,
they have got loads of symptoms of low estrogen. But
(19:41):
they've been told of your estrogen dominant or they might
be at the time that the blood test was taken,
but all the other times of the day they're having
low estrogen. So we have to be really careful how
we interpret blood tests as well. I think they're useful.
I mean, when we start to testosterone, we'll usually do
a testosterone level just to see but then there are
(20:04):
some women who have polycist over in syndrome who might
just be, you know, always run with a slightly higher
testosterone than others. So we have to this is where
you're tak it in context. But we often do do
blood to exclude other causes, like I say, like looking
at their iron level. They've been d get their kidneys,
(20:25):
the liver and all that as well, so you know,
but you can the thing in medicine you only do
a test if it's going to change your management. It's
very easy now, Like I mean, I've been qualified for
many years. It wasn't so easy to access all the
scans and things that you can now. But I always
ask myself, is it going to change my management? And
if it isn't, then I'm not going to just do
(20:47):
a blood test for the sake of it.
Speaker 1 (20:50):
Is estrogen dominance real?
Speaker 2 (20:53):
It's a great question. Yeah, I don't think really, I think.
I mean, there's lots of labels we give women. What
does it mean that you're Eastern dominant? Like basically it
means that you've got load progesterone and probably low testosterone.
The balance of hormones is really important. And Professor Mokhiro,
who's a urologist I know well in the US, he
(21:15):
talks about the triangle of the hormones and I love
that because you've got to get those three hormones balanced.
Sometimes I talk about a three legged stool. You can
have the right height of one leg, but if the
other two aren't there, you're going to be upsided. So
often it's because people don't have the other hormones balanced.
(21:36):
So also sometimes when people are perimenopausal and their hormones
really fluctuate, sometimes if we do give a higher dose
of estrogen, which seems a bit paradoxical, but then it
stops the ovaries doing this eeyo stuff, you know, and
that can be very useful for some women, you know.
So this is where it's all very individualized.
Speaker 1 (21:59):
So if we want to take estrogen, let's start with estrogen, yeah,
because I feel like that's the one that gets the
most love. Most women are very familiar with estrogen. So
if we're taking that, we have vaginal estrogen and then
we have systemic estrogen. So what are the different types?
Because I was just I was fascinated Lauren and I
(22:20):
were talking about this before you jumped on about the
transmission of through a patch or through a gel. I
didn't even think about like the skin texture and if
the skin is thicker, And now I'm questioning is mine
getting I've gone the.
Speaker 3 (22:41):
Gem, I'm parting out in the right place.
Speaker 2 (22:43):
What it's really interesting today because it's very crude medicine,
So we usually use it through the skin so it
stays as estradial because there are different types of estrogen,
and the estodyl is the anti inflometry, the good estrogen,
if you like. And once we've put something in our mouth,
things get metabolized through our liver. That's just how anything
(23:06):
works that we eat or drink. So if we have
esrogen through our mouth, it can get metabolized to different
types of estrogen. We put it on our skin, it
goes through the skin into the blood stream and then
it stays as easter dial. But the ways of getting
it through the skin are usually a patch or a gel.
But you're absolutely right. The absorption can really vary between women.
(23:29):
It can vary because of their skin texture, their thickness
of their skin, their temperature of their skin. You can
imagine if I put it on my bottom, which has
more subcutaneous fat than the small of my back, of
course the absorption is going to change. So and then
we've got the way we prescribe drugs. They're always within
(23:51):
license to certain range, but some women even with the
highest license dose, they're just not getting it through their skin,
and so we sometimes change to a different manufacturer patch
or the gel. But even then you might have seen
on my Instagram every soft and I flap mine in
the camera and just say, like, they really don't stick
very well. So I use more than one. But some
(24:14):
people use a very small dose and they get loads
more through their skin than I do using more than one.
Because we're all different and we've known that for many years,
but we have to have the right amount into our
body so that it works to not only improve our
symptoms but also to improve our future health.
Speaker 1 (24:34):
Well, I'm second guessing everything now. So if you have it,
where's the best place you can put it? On the thigh?
Speaker 2 (24:41):
So really there is It's where it sticks. Really, So
I actually put mine on my lower bat because I
don't have much subcutaneous tissue. I can, like you know,
I can feel my muscles quite easily through my back
and they just stick. They don't wrinkle. If I put
them on my bottom, my bottom I'm sitting and standing,
I'm moving, so they just become a bit more crinkly.
If I put them on my leg, they just come
(25:02):
off in my jeans, like they just once the patch
is edge start rolling, they flick off. So so that's just
for me personally, but other people find different places.
Speaker 3 (25:12):
So the other options like on your head.
Speaker 2 (25:16):
Yeah, so I mean they again the way they're license,
they say put them below the waist, but you're just
using the skin as a vehicle, you know. I sometimes
joke and say to face you should put it on
your forehead, like it's just using your skin to get it.
You wouldn't put it on your forehead, of course, but
it's just about doing that. And then the gel again
it's license for the arms or the legs, but again
(25:39):
it varies on the way that it's absorbed. It can
really change, and that's where the deuce is less important
than the penetration and the absorption.
Speaker 1 (25:51):
Okay, so the gel, the patch, we have that vaginal astrogen,
so that's separate. I was shocked because I was just
hiking with my sister in Europe and she has access
to any of my podcasts and I've had a lot
of experts on I don't think she's listened to one clearly,
(26:12):
but she was like, oh no, you can't take vaginal
estrogen if your if you've had breast cancer. And I'm like,
that's not true, and she was arguing with me, and
I was just it showed me how much misinformation is still.
I mean, it's my sister.
Speaker 2 (26:30):
Yeah. So vaginal hormones are very very firstly, the very
low dose and they only really penetrate the area, so
they'll use their help the vagina and the valve, but
they'll go into the bladder, the pulpit floor uni tract,
so they work for localized symptoms. And there's we've got
(26:52):
vaginal estrogens, and we've also got something called presterone, which
is a hormone called DHGA which converts to estrogen and testosterone,
which can be a lot more effective actually, And these
hormones can be usually very safely used for women who
have breast cancer because they don't get absorbed into the body.
They can really make a difference. But women who take
(27:15):
HRT often still have urinary symptoms or vaginal symptoms. So
then we can use the vaginal hormones as well as
having systemic hormones.
Speaker 1 (27:26):
And you can put it on your face.
Speaker 2 (27:29):
Oh yeah, that's the Yeah, sometimes people use the vaginal
tread put it on their face. But you know, what
if you have systemic hormones. So all three hormones estro down, pedestroone, testosterone,
they work throughout your whole body, so they work throughout
your whole skin. So they will improve collagen deposition, they'll
(27:50):
improve the skin that the blood flow to the skin,
they'll reduce wrinkles, they'll change the texture of the skin.
Now most of us, yes, it's the face is what
we see. But there's no point having a young face
and then like really old hands and dry flaky skin elsewhere.
So if you know, I don't know, people do it,
(28:10):
but then they're not on HRT and I don't really understand.
Why do you know what I mean? So I think
we have to. Of course it's going to probably help.
It won't penetrate very much. But it's the skin, is
it really? It's the biggest organ in our body, so
we want we want it well perfused because if our
skin is healthy, our liver, our lungs, our heart, our
(28:33):
kidneys are going to be better as well. So it's
always well having a nice young face, but we need
to be thinking about getting those womans into our blood
stream and our body.
Speaker 1 (28:41):
Yes, we've all seen the eighty year old that has
the amazing forty year old face. But then the rest
of the PLOODT I remember. So if we move on
to progesterone and the different ways, so we can have
that orally, which I didn't even know. And I have
to tell you, I was training a client and she
(29:04):
was just super she'd gotten on progesterone and she was
super tired when she would show up in the morning
for our training session. And she came back the next
day and she said, oh, well, this is like I
take it rectally. Now I didn't even know that was
an option. So you can take it vaginally, you can
take it rectally, and then you can take it obviously oral.
(29:27):
What's the differences? How would you how would you decide?
Speaker 2 (29:31):
So progesterone, and this is really important terminology. Progesterone is
the same stretch as the natural progesterone we produce when
we're younger. When we use the term progestogen or progestin,
that's a synthetic, chemically altered progesterone that's in all of contraception,
by the way, So progesterone we use as part of HRT.
(29:54):
And historically I was taught people are taught that you
only need if you have your womb because it protects
the lining of the womb from eastrogen. But actually it's
a really important hormone in our organs and our brain
as well. So many women, including those that have had
a hysterectomy, still take progesterone with good effects. So we
(30:17):
can have it orally. It's quite hard to get absorbed orally,
so it's made in a way it's called micronized, so
they basically make it very small and suspend it in
an oil so it can get absorbed through the body.
But like I've said before, anything that gets absorbed through
the mouth gets digestive metabolized through the liver, so it
(30:38):
can get broken up into different types of progesterones, and
some of those metabolites can cause side effects for some women.
Whereas if we use it as a peasuri so as
a vaginal u rect or peasurie, it gets absorbed through
the mucous membranes. It's a bit like you know, putting
any anything sort of inside, like through our mouth, the
(31:02):
blood supply will take it away. Progesterone doesn't always get
very well and reliably absorbed through the skin, so that's
why putting it in the vagina or the rectum will
just get absorbed through the through the mucous membranes into
the bloodstream as the pure progesterone, so it doesn't get
chemically converted, if that makes sense. So some people who
have side effects with the tablet the capsule oral capsule
(31:26):
find that they tolerate it really well vaginally, especially women
if had PMS or PMDD or postnatal depression. Having the
doses vaginally can be a lot better.
Speaker 1 (31:40):
Okay, that's fascinating. So then if somebody comes in and
says they're progesterone intolerant, they.
Speaker 2 (31:47):
Might yeah, and that's that's really interesting. I have done
a YouTube about progesterone intolerance because we suit a lot
and there's a couple of things there. One is a
lot of women are intolerant of progester gins or progestines,
the artificial So they'll go, oh, do you know what
I had contraception? I had a marina coyle and I
had to take it out it was so awful. So
(32:09):
they are intolerant of a synthetic chemical hormone, not progesterone.
Most people aren't intolerant of their own hormone, but what
they can be intolerance is of changes of those hormones levels.
So women with maybe PMDD who are more sensitive to
that drop of progesterone before their periods, if we give
(32:31):
them progesterone, sometimes people feel worse. And I saw a
lady in my clinic yesterday who really can't tolerate progesterone,
but she's still having regular periods, so she's still producing
progesterone herself. So it's like I'm giving a progesterone and
she's producing it herself and it's just not suiting her.
Once she becomes menopausal and her periods stop, her own
(32:53):
natural progesterone will decline and she'll probably be okay on
a low dose of progesterone. So it's again individualizing the
care and really working out is it progesterone intolerance or not.
And some people, actually it sounds a bit paradoxical need
a higher dose of progesterone, especially as a pesari. So
they have a load dose and they feel awful. You
(33:16):
increase the dose, it stimulates the receptors better and then
they feel quite different and better.
Speaker 1 (33:22):
Wow.
Speaker 2 (33:22):
Yeah, So it's options and choices really, but a lot
of people are not as intolerant as they think of
the proper progesterone, if that makes sense.
Speaker 1 (33:32):
So do you recommend cycling it or just taking it daily?
Speaker 2 (33:36):
So it really farries again because we're all so different.
If people are still having periods, we often cycle it
just because if they had it all the time, they
often get breakthrough bleeding. And it could be no one
wants to have break through bleeding. Really, some people have
it all the time and feel great. They have no bleeding,
They feel great, so why would I change it. Other
(33:57):
people find that they feel better after having a few
days break maybe every month every three months. So again,
it really really varies.
Speaker 3 (34:08):
Which is why it's hard because there's so much trial
and error.
Speaker 2 (34:12):
Yeah there is, and also there's so much out there
on social media. Some people say you have to have
a few days off. You don't, you do? And and
the thing is you learn by experience. But this is
why everyone is different. And like what suited me nine
years ago, I'm not on the same dose in type
of homaones nine years ago than I am now. So
(34:32):
it's evolving all the time. You know, I started HRT
when I was perimenifausal, I'm fifty four, I'm going to
be menifausal now. So things change, don't they. So that's
why it's really important to make sure that you see
someone who understands it's not just a one size fits all.
Speaker 1 (34:50):
Well, then the level of care for the general physicians,
the general practitioners, that's what is probably holding up a
lot of this because I mean, women ask at least
I don't know, Laura, if you get asked, but all
the time, who should I see in Colorado for instance,
and everyone asks me, yeah, I mean it just there's
(35:13):
not like a long list, or at least I don't
I don't know a long list. That makes it tricky, Yeah,
to get it really dialed in if we move on
to testosterone. So again I say it's the darling of
the hour because it's getting a lot of love. But
I think that it's the most feared out of all three.
(35:33):
It seems like, well, at least in the United States
from my insurance company, personally, it's been a doozy to
even get. But then you go to Australia and you
can get it fairly easy.
Speaker 2 (35:45):
Well you can and you can't. It's licensed for women
in Australia, but most doctors don't prescribe it. So it's
really ironic, isn't it. They've got a product we can't
prescribe it, or that women can't get it. And we
can prescribe the female testosterone cream that's licensed in Australia
over here, but it has to be privately, or we
(36:07):
can prescribe the male testosterone like you can over there
with you in different doses. But the thing is it's
a female hormone. It's an important female hormone, yet we
can't get it. Like it's just madness, isn't it that
we can't have our own hormone back. And then you've
got people telling us that we'll grow beards and mustaches
(36:29):
and it's really dangerous, and you know, our voices will
change and we'll lose all our hair. It's like, well,
most people, when you have the right dose and type,
actually don't have all that. I don't shave every day,
like you know. It's but I tell you what my
brain works, you know. But then it's all denigrated to
it's all about whether you can have an orgasm or not,
(36:52):
whether you're sexually active or not. You know, one of
the doctors that works as me went to see her
GP recently to get her hormones just a repeat prescription,
and that doctors said, well, I know you've recently had
a divorce, so therefore you won't be needing your testosterone.
Stop it. Yeah, yeah, I know. This is to a
medical doctor to another doctor, and you're like, hang on,
(37:14):
it's twenty twenty five. Do you have to have a
husband to have a libido? You know? I mean, I
love my husband, but you know, I still it's really like,
it just feels wrong that we're just talking about women
like sexual objects. And some menopause societies talk about HSDD,
which is hyperactive sexual disire disorder, and one other criteria
(37:38):
to have this condition is that you have to be
severely psychologically distressed with your reduced libido for at least
six months, and then you can maybe have testosterone. And
I'm like, hang on, I'm a doctor. I'm not watching
my patients being severely psychologically distressed. But we know that
the hormone works throughout our body and brain, so we
(38:00):
know that women. We've published data. So if others find
that their mental health improves their mood, their memory, their concentration,
their muscle strength, just their ability to exercise is better,
but then people say, well, it's just perceive it. Well
it's it's not because it's a biologically active hormone and
it's just a hormone. And you know what, if it
doesn't work, people don't have to take it. But most
(38:23):
of us that take it are never going to stop
it because we've it HAPs this function. But again, it
just comes back to choice, doesn't it.
Speaker 1 (38:31):
So how would you determine? I know this might be
going down the rabbit hole again if someone if I
come to you and I say, my main symptom right
now is brain fuck. I can be on a podcast
and mid sentence, I'm like, what was I saying? This
is concerning this has never happened. But that's the main symptom,
(38:54):
is that there's one hormone combat that more than others
or just all the pen on the comedy.
Speaker 2 (39:01):
So it does depend. But you know, if I could
only prescribe one hormone to women, it would be testosterone.
If I could tell you the hormone that has transformed
the most number of lives and probably save the most
number of lives the women I've seen who have had
suicidal thoughts, it will be test us to it. Wow,
you know, I see a lot of women who have
had really sad stories that you might have listened to
(39:22):
the podcast I did with Jay and Haley, the mother
and her son who she'd been in a psychiatric hospital
for nearly thirty years on and off. So we see
a lot of women who are like Hailey. They've had
awful psychiatric histories. They've been on antidepressants, antipsychotics, Lithian electro
convulsive therapy sessions, they've had sometimes they have ketamine, but
(39:45):
no one's thought about their hormones. That often they or
their family have put it together and thought, can I
try some hormones? The HLT can help them, but you
give them testosterone and then wait a few months, and
these women are often transformed and they I've had low
testosterone often for many years. So we have to be
really careful when we think about women not having test us.
(40:09):
To me, and I never thought about testosterone before when
I did psycholatry, I never didn't know women even had
it in their bodies. So you know, I'm as guilty
as any other doctor by prescribing other drugs. But if
someone's got a load test us, doone they've got symptoms?
Suggestive of test ustone deficiency. We should be really replacing
(40:30):
a natural hormone. I don't really understand the dangers of it.
Speaker 1 (40:35):
So for bone health, because that's another huge one. And
I love that osteoporosis and osteopinia that there we all knew.
I mean, this is something that I remember my grandma
couldn't have a hip surgery because her bones were too
soft and she wasn't cleared for the surgery. Do you
(40:55):
see again, is there one? Is it estrogen that helps more?
Is it testosterone or is it a combination of all
of them?
Speaker 2 (41:02):
So often all three actually, because we've got hormone receptors
for all three hormones on our bones, and our bones,
as you know, are biologically active. So we have these
cells osteoblasts that build the build the bone, and osteoclass
that break it down. And we've got androgens, testosterone receptors,
(41:22):
estradar receptors, and progesterone receptors on these sets. So if
they're stimulated the right way, the osteoblasts, they'll build the
bone and keep it strong. If they're not stimulated, the
osteoclass will take over and they'll sort of gobble and
make the bone weaker. So this balance is really important.
So you know, our bones are biologically active, but so
(41:43):
are our muscles as well, So both of those are
really important. And it's almost forgotten. I think people think
osteopiosis is an old person's disease, and yeah, it gets
more common as we age, or they think, oh, it's
just a fracture that will be repaired and then I'll
be fine. But I'm petrified of ostereoporesis. I'm worry about
(42:04):
osteoporosis of my spine because when you see these people
that are stooped, you know, with the curvature of the
spine and due to osteoporesis, it's very painful because they
have lots of little fractors. The coughing might cause another fracture. Sneezing,
they can't digest food properly, they can't breathe so clearly,
but they can't reach for a cupboard in the same way.
(42:25):
You know. So, and we know obviously exercising weight, bioing,
exercise is really important. But we know that hormones, you know,
we've known since nineteen forty one. There was a professor
Albright who said and realized that women's bones were thinner
when they were menopausal, and that was because of the
lack of hormones. So it's nearly one hundred years we've
(42:47):
known it.
Speaker 1 (42:49):
Wow, so every female, I mean, this could benefit the
bond for every female.
Speaker 2 (42:56):
Yeah, for sure, Yeah taking it.
Speaker 1 (42:59):
So look at the counter argument of I guess the
women pushing or anyone pushing not not having hormones for
whatever reason outside of a female's choice. So we all
know that if female has like we have choice, we
can decide whether to take it.
Speaker 2 (43:19):
Round.
Speaker 1 (43:20):
How many women do you see that come in that
maybe aren't aren't taking it, not because they're scared to
or they don't have the information, but are choosing not
to take it for whatever reason.
Speaker 2 (43:33):
So obviously they don't come to the clinic because they
come to the clinic easily because they want hormones. But
you know, I sometimes see women who are mothers of
my patients, so they may be in their sixties, seventies
and saying, do you know what, I've never thought about homones,
but now I've seen how well my daughter is or
my sister is. I'm just wondering, you know, I don't
(43:53):
think I've got any symptoms, but I'm worried because my
mum had us to process or what have you. And
then I'll talk to them and if they want to
try it, they will, and then often they come back
and go, Wow, my sleep is so much better. I
can spring out of bed in the morning. I don't
have to get up at nighttime for a week. You know,
I feel different. But I thought that was just because
(44:14):
I was older. I didn't realize that it was due
to hormones. It's very hard to find a menopausal women
with no symptoms at all. They might think they don't
have them, but you don't know until you have those
hormones back.
Speaker 1 (44:28):
Now, what about the muscular skeletal syndrome of menopauds. I
would say that's what people come to me from the
strength side, and I can work on strength with them.
But it's the joint you know, arthritis and just I've
noticed my fingers just yeah, I'm feeling it there. Yeah.
Speaker 2 (44:52):
So it's really important, crucially important, because all three hormones
are anti inflammatory, reduice inflammation in our muscles and joints.
So things like frozen shoulder really really common. Arthritists both
you know, osteoarthritis rheumatoid arthritists. Syrah negative arthritis a lot
(45:15):
more common in women in the late forties. So those
hormones help lubricate the joints as well as reduce inflammation.
They help the cartilage, they help the sinovia, they help
the tendons the ligaments as well as the muscles as well,
and they help the muscles to work better. So it
just seems madness that these poor women are like the
(45:38):
tin man from Wizard of Us, you know, rusty trying
to creak and get their joints. It's you know, of course,
exercising will improve and our muscles will make hormones, so
if they are stronger, they're going to work better and
that will help. But they're not going to replace the
hormones to the level that they were when they were younger,
(45:59):
and they over is working well, m and the brain.
Speaker 3 (46:04):
I listen to one of your posts about just the
effects all three of them have and how important it
is too on our brain, and I mean, I don't
know how you can't listen to that and not think, Okay,
sign me up for all.
Speaker 2 (46:23):
Well, you know, I'm a general physician, I'm not a gynecologist,
and you know gynecologists. Most of them think that the
womb is the most important organ in the body, whereas
I actually, and I think many women would agree, feel
that the brain is the most important organ in our bodies.
And I'm very interested in neurophysiology and so how our
(46:45):
brains work and function. And we've got all the brain
is the most amazing organ in the body. And it
can sort of the cells can grow, they can change
the neuro transmitters, the chemical messengers in our brain. The
levels of those can change all sorts of things we do.
It can alter the function. But these hormones ESTRODIWM, pedesterone,
(47:07):
testosterone are neurosteroids. They are made in our brain. Every
sell in our brain responds to these hormones. There's a
reason that that happens. It's not just to give us periods.
It's to help our brain function, help the other neurotransmitters
to be at the right level. So it helps our serotonin,
(47:27):
our dopamine, our melotonin, our neu adrenaline, our glutamate, all
of those neurotransmitters work better in the presence of our
own hormones. So it goes without saying, really that the
commonest symptoms are those affecting our brains, so you know,
the low mood, the anxiety, the memory problems, fatigue, and
(47:50):
a lot of people have very dark thoughts as well.
But then you can see where they're misdiagnosed as having
depression or psychosis or personality disorders or what have you.
But we have to understand how hormones work in our brains,
because then when we don't have them, our brains don't
work in the same way.
Speaker 3 (48:10):
Our brains are not working the same right now, Heyley,
I don't.
Speaker 1 (48:12):
Think we'll testify to that, So okay, I'm going to
cover some of these quick questions before we wrap up here. Clearly,
we know that you can go through a post metapause
without any HRT, But this person's asking is it a must?
Obviously outside of choice? Would you recommend it for anyone
(48:37):
that's even asking this question.
Speaker 2 (48:39):
It's a good question. I think you also have to
think what are the risks of not having hormones? So
it's an individual choice. Of course, people can live without hormones,
they can live without virroxin hormone, but actually, if you've
got symptoms, why would you suffer? But it's the health
risks as well. We know that the communist cause of
death and women globally cardiovascular disease and dementia, So taking
(49:03):
natural womens will reduce the risk as well as, as
we say, reduce the risk of usityoprosis that affects one
in two women and other inflammatory conditions. So it's a choice,
but a lot of people, you know, make the decision
to take it or make the decision to not take it. It's fine,
but just know the facts really is really important.
Speaker 1 (49:25):
Do you feel like any of these are easy to stop?
That's the next question is if I started test asterone,
is it easy to start?
Speaker 2 (49:35):
Yeah, sure, but most people don't want to stop, you know,
and that's because they're biologically active. So you know, I
take HRT and tossing for two reasons. One to help me,
you know, not have symptoms, because my symptoms were really
affecting me. But secondly, I've already said I'm scared of usteoporosis,
so I'll do anything to keep my bone strong, so
(49:57):
I do weight baying exercises, I take this d you know,
I'm active, But also I take hormones for that one reason,
So even if I wasn't getting symptoms, I don't want
my bone density to reduce, But that's my choice. Other
people might not be on their way down, they might
not mind. So the hormones we use only last in
(50:19):
the body the same day. So if I don't use
my testos to win tomorrow morning tomorrow night, I won't
have any in my body. Doesn't build up in the body.
It's not my antidepressants that it can take weeks or
months to come off them.
Speaker 1 (50:31):
Oh I felt it. I only took a certain amount
on my nine day mont Blanc hike and I ran out,
And yeah, I can tell you. So how do migraines
And this is actually something that a lot of women
ask migraines and how they change over the metopause transition
(50:52):
and when you're post metopausal, when you're officially in metapazzal
do they get Does it get better?
Speaker 2 (51:00):
So yeah, for sure. So again there's information on my
youtubes and podcasts about this. But migrain is a chronic
as in long term and it's usually a genetic condition,
so people will always be predisposed to migraines if they
have them. But the brain likes homeostasis, It likes things
(51:22):
the same, especially in people who have migraine. So anything
that changes in the brain could trigger a migraine, including
hormone fluctuations. Like you say, so, a lot of people
find that they have worsting migraines in the perimenopause, and
giving hormones back at the right dose and type can
really help with migraines. Sure, they might improve in menopause
(51:43):
when the hormone levels are low, but then you've got
health risks, you might have other symptoms, so it's not
really good enough to say to someone just wait until
you're hormone drop and then you might be Okay. That's
not really the way I practice medicine. But also, you know,
I'm a migraine sufferer, and it's looking at everything. You know,
(52:05):
I still get migraines despite taking hormones, So it's looking
at what we eat. I mean, I'm very strict with
I don't drink alcohol, I don't don't eat chocolate, I
don't have caffeine, I don't eat processed foods because all
of those would trigger migraines for me, but other people
might be fine. So it's working out your lifes done.
I mean, I'm very routine. I eat the same time
(52:26):
I get up the same time I go to bed
the same time. If I do too much exercise, it
can trigger migraines. Have to be really careful. But other
people are fine. So it's looking at what you need
in a But hormones have a massive impact, often in
a negative way when they're not balanced properly on migraine.
Speaker 1 (52:44):
Okay, so you've talked about a little bit about exercise
and diet, so that goes into proper mental puzzle prescription.
If you have someone seeing you, you guide them on that.
What are your recommending trends for exercise specifically?
Speaker 2 (53:04):
So I think exercise, well, it's very individual, really really individual.
And for some women, exercise might just be walking to
the bus stop. It might be just parking their car
a bit further away. Other people, it might be changing
their exercise. It might be that they can't exercise the
(53:25):
same because they're getting symptoms. But as they improve, they
might get stronger. You know, I was thinking about this
last night. I'm probably stronger now than I was, certainly
twenty years ago, even thirty years ago, as a student.
I think I'm stronger now, and that's partly because as
a student I was taking contraception, which you know, probably
(53:45):
doesn't means my muscles weren't working as well. But I'm
exercising differently, but I'm able to with my hormone. It's
a combination of things. So I feel sad when people
say you're menopausal, you have to do this exercise, so
you can't do this exercise. You know, people are really
there's no reason we can't do more and more. But
(54:06):
I think the most important thing I don't need to
tell you guys, but it's just doing something that people
enjoy and that they can keep it as a routine
because it's all very well, isn't it. Every January people
want to start running or start doing whatever. You know.
I still enjoy yoga and I've been doing it for
many years, but you know, other people are different. I've
(54:27):
started using doing some weights and I quite enjoy that.
Still like doing yoga as well, But you know, it's
doing what's right and what fits into your schedule. Like
it's although I like cycling, but it's three hours if
you're going out on your bike. I never have three
hours to myself, so I've just got to limit and change,
you know. But so it's you know, some people like
(54:48):
exercising on their own others like doing it together. It
can be really social. I'm not that socially, quite happy
doing it at home, but it's it's you know, I
think looking at it as part of your life, like
we have to eat, don't we You have to drink.
You can choose to exercise, but it should really be
part of your daily routine. And I think that's important.
(55:10):
But it's the first thing that often goes. But I
feel sad when people say, if you exercise you won't
get symptoms, if you exercise, you don't need hormones, because
it's not any either.
Speaker 1 (55:19):
Aw I don't think yeah. So for any parting words
on women that feel like they've been dismissed, maybe they
don't have How does one go about finding good care?
Speaker 2 (55:37):
Do you know what? I wish I could tell you easily,
But I think the most important thing firstly is to
get the information that's right for you. You know, there's
a lot of free information on my website on balance app.
I don't work with pharmaceutical companies. I don't have a
hidden agenda. So work out what's right for you and
(55:58):
then try and find the clinician. And it probably won't
be the first clinician that you see but it doesn't matter,
like none of us as clinicians loose sleep if someone
gets a second, third, fourth opinion, like it really doesn't
matter and we need to remember that that it really
doesn't matter. And then take someone with you and I would,
(56:18):
you know, have a really open conversation. No one wants
to fall out with their doctors, but if they're really
saying no, I would then challenge and say, well, why
are you not prescribing evidence based treatment for me? And
ask them if you could try it, you know, And
some doctors don't like being challenged. I really like it
when patients ask me things but don't give up, you know.
(56:43):
And I think this is and it's really hard, but
I see it over here in the UK and other
countries as well, that often doctors are being educated by
their patients, you know, as a busy DP when I
was working in you know, family medicine. If you've got
many people coming in the same day with the same problem,
(57:05):
you've got to learn about it, you know. If I
see some if I don't know about, I don't know headaches,
and then every day I'm seeing six ten people with headaches,
I've got to really read up and learn about headaches,
and this is sort of happening over here and in
other countries that doctors. Some of them are going, wow,
this is brilliant. I've learned so much. This is great.
(57:26):
So they've done our education program. They're like, brilliant. I
feel really confident now, And others will go, Louise, you
just need to shut up because too many women are
coming through the surgery and they're blocking other appointments. Well,
you could argue, and they're good appointments because these women
you'll transform their future health and lives. So I think
as patients we need to keep the momentum going and
(57:49):
learn from others. You know, there will be others in
your town or area who will know who's good to see.
But I just don't be scared getting another opinion.
Speaker 3 (57:58):
I think, do you have a vision for what menopause
care could look like or should look like in the
next five to ten years ago? Do you kind of
have a dream?
Speaker 2 (58:09):
Yeah? I do, but it's but it's not just menopause.
Actually it's hormone or care for women. Because I have
three daughters and my oldest daughter has PMDD, so she
was dipping really badly. Before her periods in COVID, I
really noticed it. So she has natural body identical hormones
and they've really transformed her life. And I see a
(58:32):
lot of her friends, some of them who have been
given lithium and a lands a pain, horrible drugs, and
no one's thought about hormones. So I'm transforming their lives.
So when you've got twenty two year olds saying, Louise,
is it legal to feel this good every day of
the month? Like this is amazing, Like that's incredible. So
those women or girls, women will never really be menopause
(58:56):
because I will adjust their hormones according to what they need.
So the dream is to stop the suffering, to stop
the gas lighting, to stop this not believing women and
thinking hormones are just something trivial. So I would be
so happy if everybody that wanted hormones could access them
(59:17):
on their first consultation, and everybody who needed them knew
that they needed them and had started that conversation earlier.
So actually menopause wasn't really a thing, and perimenopause wasn't
thinking because people would get going a lot earlier, really,
and you know everybody who's on contraception should be thinking
(59:39):
about hormones in a different way.
Speaker 1 (59:41):
Really wow, well this has been such an incredible conversation.
Most women aren't going to be able to work with
you one on one, So how where are women finding you?
I know you have some books, yeah, podcast.
Speaker 2 (59:58):
Yeah, So the best way is going to my website
Dr Louise Newsen. But Dr Louise Newson one wad dot
co dot uk. Balance app is free, so people can
download that through the app store and Google Play. A
podcast it's called Dr Louise Newssen and then the YouTube
as well, So just furtle around and find something that's
relevant for you.
Speaker 1 (01:00:20):
Great. Well, thank you so much for your time. You
were so respected in this industry and we were thrilled
if you answered our call. So honored. Yank you so
much for sharing your time with us.
Speaker 2 (01:00:32):
Oh well, thank you, it's been great.
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Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.