We look back at some of our most popular content – be sure to check out any you’ve missed and if there’s any topics you’d like covered in 2025, let us know at info@balance-app.com.  

Podcast: The menopause brain: why it might be feeling strange and what you can do about it

This was a special episode of Dr Louise Newson Podcast – it was released on the podcast’s fifth birthday, and it quickly became the most downloaded podcast of the year, getting 23,258 downloads in its first week alone. Guest Dr Lisa Mosconi, a world-renowned neuroscientist, shared her insight into some of the fascinating changes that occur to the brain during menopause, and offered reassurance to women who might be wondering why their brain feels so foggy.

Podcast: Testosterone: the missing piece of the jigsaw?

Our second most popular podcast of 2024, with 42,547 downloads to date, this episode featured Anita Nicholson, a nurse practitioner and menopause expert in the US. Anita shared her clinical experience of the benefits testosterone can bring women, particularly in restoring their zest for life. Anita talks about her frustration that testosterone is primarily given when women are deemed to be “suffering enough” from low libido and her belief that it can help women feel re-engaged with their life.

Podcast: Kate Muir: Everything you need to know about hormones but were afraid to ask

This podcast with journalist and activist Kate Muir was downloaded more than 31,000 times in its first month of release, making it one of our most popular podcasts of the year. In it, Kate speaks to Dr Louise Newson about her book Everything Your Need to Know about the Pill (but were too afraid to ask), and shares her knowledge, and women’s experiences, of hormones.  

Article: HRT doses explained

Just like last year, this explainer piece is the most viewed article on the balance website, and it’s only becoming more and more popular (it received 189,000 views in 2024, compared to 113,000 views in 2023). No wonder you like it – it tackles commonly asked questions regarding dosing and explains why dosing can vary from person to person.

Article: Internal tremors and menopause: what you need to know

Our second popular article of the year, this looked into a little-known and poorly understood symptom. Internal tremors (sometimes known as internal vibrations) can be linked to perimenopause and menopause but is not a commonly recognised symptom. There’s a lack of relevant studies on the potential link but this was our most popular symptom-based feature on the year and got a good response on social media so further demonstrated a need for more research.

Article: Heavy periods during the perimenopause: what you need to know

Our third most popular article of the year (and second most popular of all time), this looks into the reasons behind heavy periods – changes to periods are often an early sign of the perimenopause – and offers practical advice and treatment options.

My story: Losing my wife – an avoidable tragedy?

We often share women’s personal stories of perimenopause and menopause on balance, but this one, from Pete, a husband who lost his wife by suicide, was the most read in 2024. It’s a hard-hitting account of what happened to Victoria, and Pete shared his hope of raising awareness of how suddenly and severely mental health can deteriorate during perimenopause. It included sources of support and information.

App article: Perimenopause: a definition and explanation

Concise and informative, this article is the most popular on the balance app, and covers the definition of perimenopause, the symptoms, average age and length of time it can be experienced. You can find it in the app by looking in Discover, then scrolling through The Basics.

Social media post: Testosterone video

Our most popular post on Facebook this year, which reached more than 95,000 people, was of Rachel Dawber explaining the transformative effect of testosterone. Rachel appeared on a Live Q&A with Dr Louise Newson for the balance app, and also shared her story on Dr Louise’s podcast, which you can listen to here. It’s quite a story!

The post balance’s most popular perimenopause and menopause resources in 2024 appeared first on Balance Menopause & Hormones.

Joining Dr Louise on this week’s podcast are US-based Kristin Johnson and Maria Claps, authors of new book The Great Menopause Myth: The Truth on Mastering Midlife Hormonal Mayhem, Beating Uncomfortable Symptoms, and Aging to Thrive.

Kristin and Maria share their own menopause stories, why they wanted to write a book to help others and why menopause can be the best time of your life.

The pair also share the four things, besides hormones, that can help women during this time:

1. Education
2. Exercise
3. Nourishing your body with the right foods
4. Managing stress

For more information on The Great Menopause Myth, which will be released in the UK on 26 September, click here.

For more information on Newson Health, click here.

Dr Louise Newson’s first-ever live theatre tour, Hormones and Menopause – The Great Debate, takes place 27 September to 12 November. For more information and tickets, click here.

Transcript

Dr Louise Newson: [00:00:11] Hello. I’m Dr. Louise Newson. I’m a GP and Menopause Specialist, and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. Today on my podcast, I’ve got two women with me, very excited, people that I haven’t met in real life before who reached out to me because they’ve written a book together and it’s a brilliant book, and I thought that I would have them on the podcast to talk about their work. And like many people, they’re very frustrated with the suboptimal care the majority of menopausal women are receiving. So very keen to introduce to you, Kristin and Maria, who are going to introduce themselves and tell us more about them. So welcome to the podcast, both of you. So, Kristin, do you want to go first and explain a bit more about why you’ve written the book and a bit more about yourself, if that’s okay? [00:01:46][95.4]

Kristin Johnson: [00:01:47] Yeah, sure, no problem. So, you know, this is actually a second career for me. I was a corporate attorney for a long, long time and took a pause to raise my family and do those things. And then I started struggling with some health issues very palpably in my early 40s. My mom had surgical menopause at 32, so I didn’t have kind of a guidebook in terms of what to expect or when this would be naturally, etc. Unfortunately, I’d also been given an IUD after the birth of my last son, so I really had no good eyes on this being anything related to hormones or really understanding sort of that menopausal transition because my mom’s was early. So I started sort of diving into some options beyond the conventional model. To be perfectly frank, I was frustrated with my doctors just sort of telling me, you’re too young to get your hormones tested. This can’t possibly be hormones. Maybe you have an other illness. I was being looked at for autoimmune diseases, Lyme disease, mould. I mean, anything you could think of, they were trying to tell me that was it. And nothing really was coming up with any answers. So I started to first work on kind of the nutrition and lifestyle piece. It drove me to go back to school, and then I thought that I was just going to use this information to sort of help my friends and loved ones. And it sort of became a self-fulfilling prophecy in that I was struggling with things and then women were coming to similarly struggling with identical things. And so I figured out, okay, we’re all about the same age. Something must be common that we’re all going through. And I started to look deeper into how to understand hormones, how to test hormones, how to support hormones, etc. And that’s honestly how I found Maria. And then the two of us ended up together. Maria’s story is slightly different. So I’ll let her kind of dig in with her. [00:03:29][102.3]

Maria Claps: [00:03:30] Yeah, I think I was just as young as you, Kristin, about 43. And I definitely noticed that something was not right. And so I sought out a doctor in New York City, and he put me on a bunch of supplements and hormone replacement therapy at 43, which I am not necessarily against and think I could have even benefited from it, but because I wasn’t really taught what was going on, I gave it up after about six months but I kinda wish I had stayed on now that I know what I know. [00:03:58][27.8]

Dr Louise Newson: [00:04:00] It’s interesting, isn’t it? [00:04:01][1.0]

Kristin Johnson: [00:04:02] Yeah. So we started working together and it was just essentially us deciding there’s this huge need for these women. And this was years ago dr Newson and this was not kind of at the cusp of where we’re all at now. You’ve been in this space for a long time. We have a lot of international clients. We’ve referred them to your clinic for a while, but this is something we’ve been doing for a long, long time, kind of in the trenches. We’re not selling anything. We don’t private label any supplements. You know, it’s literally just supporting women, giving them the education that their doctors aren’t giving them, and then helping them understand what are all their options, regardless if they want to pursue hormone therapy or not. So that’s sort of how we built our business, was just saying, Hey, ladies, we don’t want you to have to go through this transition the way we went through it and sort of building a support network around that. [00:04:50][48.8]

Dr Louise Newson: [00:04:51] Yeah, and it’s such a shame, isn’t it, that people don’t have more information because it happens to all women and has effects on everybody? Yeah, most people have symptoms yet most people don’t know what’s going on. But I think things have changed in that a lot more women are understanding what’s going on, but actually still a lot of healthcare professionals aren’t recognising it. And that’s obviously frustrating for me as a healthcare professional. But it’s probably, I know I hear in your emails some of that frustration that you have and you’re not a healthcare professional. So I don’t know what you think about that? [00:05:29][37.9]

Kristin Johnson: [00:05:30] Yeah, I mean, you just kind of nailed it and said a lot of women have symptoms. And I think that is unfortunately the construct in the United States, at least, that if you have symptoms, you might get a little bit of attention. But if you don’t have the traditional symptoms. Right. And Maria and I didn’t have hot flashes. We didn’t have those typical things. So that’s why it was not obvious to us what was going on. I didn’t know that, you know, my desire to not really engage with my husband might be hormonal. And maybe I just thought our marriage was on the rocks. So there was sort of that phase of life where it wasn’t obvious what was happening. And I you know, we didn’t have osteoporosis. We didn’t have hot flashes. We weren’t seeing these other typical changes. And that’s the thing that frustrates us with current, the medical paradigm is that we have these large medical societies, particularly in the US, creating a narrative around who should be given attention under what situations and then what they should be given. And pretty much if you don’t fit into that construct, you’re not going to be served. And that’s the part that has us so frustrated. [00:06:36][65.2]

Dr Louise Newson: [00:06:36] And that’s actually the same globally and looking historically at what menopause has meant. And obviously it was called the change in the 19th century, in the 1920s, that’s when they discovered hormones. But unfortunately, when they looked at oestrogen, it was associated with hot flushes. Somebody decided that was the big thing. And then and I’m trying to work out who, but there was some pivotal shift between 1900 and 1950 where a lot of the symptoms people knew were due to the change, some change that was happening in our bodies. There were some doctors that decided they could strip a lot of those symptoms and take it right back to the flushes and sweats and any symptoms that were related to the flushes and sweats. So if people were feeling dizzy or had palpitations or were feeling anxious at the time of the flushes and sweats, it was related to menopause and everything else, was it just a either a psychiatric diagnosis or some sort of cardiology diagnosis or rheumatological diagnosis? And that still carried on. Yet we know our hormones affect every cell and every system and every organ in our body. And we know that lots of us don’t have hot flushes. So why are we still talking about this? And I can’t quite understand why doctors should be deciding which symptoms are relevant or not. I don’t know if I’m missing something, but it just doesn’t make sense. [00:08:03][86.6]

Kristin Johnson: [00:08:04] Well, I’ll give a cynical explanation on what I think it is. I mean, you you know, in the early 1900s, what we found interesting in writing the book is that the loss of hormones through the menopausal transition was recognised as predisposing women to a higher risk of disease and hormone replacement therapy in the form that it was used at the time, was which was frequently extracts and different things, was seen and accepted by every major medical society around the globe as being disease prevention. And yet we suddenly then shifted to where we are today. And I think part of the problem is there was a lot of money left on the table. To be perfectly frank, If we just gave women hormones to address their rising blood pressure and their changes in lipids and maybe their, you know, ventricular issues that they were having, or we just give women hormones to protect their bones. And these things, we suddenly didn’t have room for a lot of pharmaceuticals. And there was a huge change post-war where we did have a lot of pharmaceutical interests developing drugs to essentially address every single ailment across men and women. And, you know, women as we were growing older, it was blamed on ageing. It wasn’t attributed to hormones. And so there was a drug for that. And I think that’s why HRT was kind of a threat to that development of sort of a medical industrial complex. And unfortunately, I think that foothold still remains, you know, that there is a very strong resistance against seeing hormones as the potential solution to all these different female ailments. And now we’ve got this huge demographic boom of this age group across the globe where we’re kind of loud. Right. And we’re not wanting to take these drugs any longer. And we’re frustrated with the unintentional consequences and side effects of them. And so people are starting to ask questions more. And finally, we’re starting to hear the narrative again of, gosh, what’s the one thing all these ladies are suffering from? It’s this loss of hormones. But we’re kind of in this position of entrenchment, right? Is that hormones would essentially displace these other solutions. And these other solutions are much more lucrative for physicians. And that’s my cynical take. [00:10:19][134.9]

Dr Louise Newson: [00:10:19] No, I think it’s very interesting. I mean, it’s different in the UK because clinicians generally don’t get paid, you know, incentivised by pharma, but medical societies do for sure, right? And a lot of research is paid for by pharma. So there are needs for pharma and obviously there’s a lot of tax that gets paid from pharmaceutical companies. So, so there is that. And I do really feel, having treated thousands of women in our clinic, I know and most of us know that people who take hormones are less likely to be on other drugs, so they’re less likely to be on anti-depressants, antipsychotics, blood pressure treatment, cholesterol lowering treatment. Sleeping tablets, painkillers, antibiotics for their urinary tract infections, arrhythmia drugs for their heart. It goes on and on. And migraine drugs reduce, all this. So which is great for the individual, actually, and it’s great for me as a doctor. I don’t get paid, you know, depending on how many drugs someone’s on. But actually, you’re right. Those people that do have vested interests, it’s not a great position. What do you think, Maria? [00:11:27][67.5]

Maria Claps: [00:11:28] Well, I think Kristin’s spot on it. And I also think it’s it’s going to be the women that we’re going to have to rise up and demand what we’ve been taught about by physicians such as yourselves. And, you know, the book that we’ve written and other good books that have been put out there that talk about HRT for whole body health. Because I don’t think we’re going to get medical societies to come around, probably not in our lifetime saying that, hey, this is great if you want to age healthfully. And so I think that, you know, it’s women. We’re going to have to be educated and we’re going to have to demand better. [00:12:04][36.1]

Kristin Johnson: [00:12:05] Yeah. I heard someone say the best menopause experience is in a woman who’s empowered. And a woman who is empowered is a woman who’s informed. And so that, you know, that’s kind of what we’re seeing, because I think there’s this fear around menopause. Right? Women, you know, whatever social constructs they’ve bought into about, oh we’re not relevant any longer because we’re not fertile or we’re ageing and therefore we’re not attractive or whatever. Women buy into, Marie and I kind of reject all that. We think it’s a great time of life. We think it’s the best time of life that we’ve had so far. But when you look at the younger generations, they’re scared about this because it’s been now painted as this awful thing. And, you know, we’re like, but you all have an opportunity here. You know, you all have an opportunity to get some things on board and do the right things and not maybe even have to experience hitting the wall during the perimenopausal transition. But it’s going to have to come, like Maria said, from the grassroots movement of women. I just don’t love kind of there’s this tribal attitude, you know, you need to be politically aligned one way or you need to buy into a certain type of feminism or whatever. And, you know, there’s just not enough time for that. We’re all women. We all have ovaries. They’re all going to sleep and we’re all going to experience some form of something. Can we just bound together and demand better from the physicians? [00:13:23][77.9]

Dr Louise Newson: [00:13:24] Yeah, it’s so interesting. And certainly when I went to my first menopause conference several years ago now, I remember sitting in the auditorium. Thinking, what can I do that’s different? Because education is not getting out to people, to the right people, the people that really need information. So I thought, well, I want to just educate people that are suffering. But I can’t do it through a clinic because I’ll only see a small number of people. But I can do it with technology through a website, through the app, through other means. And obviously that’s why I created my podcast as well, so people can be in the comfort and the privacy of their own home. They’re not spending any of their money, but they’re getting information that’s right for them. And the most important thing is being able to make a choice. And what upsets me is that choice is being taken away from them. And I’m still hearing every day on my social media, I get messages from women who have been empowered with choice. They decided they want to take hormones, yet they’re being told, no, you can’t. You’re too young, you’re too old, you’re too whatever. And actually, as a clinician, things aren’t always my choice. It’s about shared decision making and allowing women to choose something made on the information that they’ve had available to them and people are allowed to have different opinions to their clinicians. That’s part of consent. But that seems to have forgotten. So there’s this power going on which I don’t think there is in other specialities in the same way. It’s one thing not knowing, but the next level that you say is women be empowered knowing, but yet they’re being refused. And that is a really awful place to be in 2024 that women are not having a voice when they deserve to be heard. [00:15:17][113.0]

Kristin Johnson: [00:15:18] In the UK. How is it with the NHS? Because I’m assuming, I don’t know your clinic, you know, can women come with NHS coverage and get care from you or is it a cash pay situation? [00:15:27][9.8]

Dr Louise Newson: [00:15:28] No, it’s a private clinic because when I set it up I went to various NHS practices and hospitals and they said there’s no funding for menopause care. We’re not doing it. It’s not a priority. So the only way I could start seeing patients was to do it privately. But I only wanted like three doctors to work with me. I wanted it to be very small and I had no idea how many women were suffering. I had no idea that people would come from all over the country telling me stories. And a lot of them are young women who have really not been listened to, have had their ovaries removed and just been told, see how you get on, and then their life’s fallen apart in front of them. They’ve still not been able to get home. So we see people who are generally underserved by the NHS, but the NHS still say that it’s a natural process. They just say it’s a condition, it’s not a disease. And there’s a big debate, isn’t there, whether it’s a disease or not. But actually it doesn’t really matter what you call it. Like you say, it’s associated with diseases. And this is something that really worries me, actually, because sometimes I’ll put out on my social media something about association with osteoporosis or heart disease. And then people are saying, well, all the menopause societies are saying that it isn’t associated. And we listen to the menopause societies and you can listen to who you like, but you can just look at the evidence and you can actually just read very basic science showng, how important our hormones are for every cell in our body and how anti-inflammatory they are. And I wouldn’t ignore someone with raised blood pressure. I wouldn’t ignore someone with a raising glucose and had diabetes. So why would I ignore someone who had low hormones with an increased risk of diseases? And you know, we’ve known for many years, decades about the protective effects with osteoporosis. That was the first condition that it was documented that people realised could reduce osteoporosis. And that’s when osteoporosis sort of slipped into the guidelines. But even if you only look at osteoporosis, it affects one in two menopausal women who are not on HRT. There’s a big mortality from hip fractures, but also there’s a morbidity as well. So people who fracture their wrist or their pelvis or the hip from a fragility fracture, a low impact fracture, they’re less independent, they’re more dependent on others, they’re more likely to have mobility issues, they’re more likely to have cognitive decline. And osteoporosis is an inflammatory condition. So it makes sense that all the other inflammatory conditions increase and especially in younger women. So obviously, we’ve mentioned midlife, but, you know, one in 30 women under the age of 40 have an earlier menopause and NHS are not prioritising these women because they’re saying it’s not common enough. But actually it is common the diseases that are associated with having longer without hormones. And it’s more relevant, as you say, because we’re living so much longer now. So I don’t think it’s good enough to say because someone says this, I’m not doing it, and we should be looking at the evidence. We should be listening to patients. And I do think women are understanding more that they want to protect their bodies. They want to reduce the risk of osteoporosis, heart disease and so forth. And it’s not a bad thing that we know this because, again, it’s giving us choice. And it shouldn’t be just about symptoms because then, as you say, some women don’t have symptoms. Or even when I see people in the clinic, I saw someone today who has had multiple sclerosis for several years. She has pins and needles. She has coordination problems. She has fatigue. I have no idea how many of her symptoms are due to her MS. or how many are due to her menopause. But I do know that the hormones are very important in the way our brains and nerves work, and it’s likely to improve some of her MS symptoms as well. And she made the decision she would like to try HRT for six months and I can optimise her hormones and then we can review whether she wants to continue or not. But for me as a doctor to say, no, you haven’t got enough symptoms just isn’t right is it? [00:19:52][264.0]

Kristin Johnson: [00:19:53] And you have to ask sometimes where is the chicken and the egg with respect to her development of MS? Because we know so many women are developing autoimmune diseases in their early 40s, mid 40s and beyond. And that’s not a coincidence. If you look at the immune regulation in the body and our, you know, T cells and B cells, you know, all the technical piece of it oestrogen is significantly providing the balance in that system. And as we lose our hormones, we lose that balance and we get these self attacks. And that’s the saddest thing is, you know, do we have to have all these statistics of diseases of ageing if we were to just recognise that the moment the hormones start to decline, that’s the time to act, right? And you know, I think that piece of it is probably fairly far off, sadly. But I think the other side of it then is even women who do start to have hormonal irregularities in their 40s that their doctors recognise they’re not also given great HRT. I mean and you know, they still consider birth control pills for women in their 50s as a form of hormone replacement therapy. And that’s another kind of angle to the problem that we’ve got on our hands right now with how the system is working or not working. [00:21:06][73.1]

Dr Louise Newson: [00:21:07] And and I wonder again, you know, what the reason is for that. You know, in medicine, I always want to give the safest option, the option with the least side effects, with the most evidence and so why most people don’t need contraception at a certain age or it’s not something on their radar, why just give them a contraceptive if they don’t need it and it’s got synthetic hormones in them, which are different obviously to their natural hormones. You know, years ago, all I could prescribe was Premarin and Prempak-C, which was the pregnant horses urine-derived oestrogen with a synthetic progestogen. But that’s all I had. And it was like a one size fits all. You have it and it either or it doesn’t. But that was 25 years ago. Things have changed. So we have the capacity and the ability to prescribe these three hormones oestrogen, progesterone, testosterone separately so people can have the right dose, the right type, the right combination for them. But it’s still really difficult. And about a third of women who come to our clinic already on HRT and they’re being told, well, none of your symptoms could be due to your hormones because you’re on HRT. And then we see what they’re on and they want a really low dose of oestrogen, no testosterone or they’re on synthetic combination preparation. And of course, it’s not going to have the same effect. So again, you want to be able to make sure women are treated properly rather than a third treating them or half treating them. And women are understanding this. You know, I’ve heard, I’ve been to meetings where they say, well, no, we wouldn’t recommend people have hormones separately because women won’t remember to take their progesterone and then there might be risk. And I find that really quite discrediting to women because allow women the choice. And most of us will remember. [00:23:00][112.8]

Kristin Johnson: [00:23:00] We’re also great multitaskers. [00:23:01][0.7]

Dr Louise Newson: [00:23:02] Indeed. Indeed. So when there’s conversations like this, it really makes you frustrated. And actually, you know, lots of younger women. I’ve got three daughters and my older two daughters don’t really want synthetic hormones. They just would prefer if they’re going to have hormones to have more natural hormones. And so, again, they have to choose. They have to be part of the conversation. And I think that’s going to change more and more over the next couple of decades or so. As younger women become even more empowered and share information with each other, which I think is really important, isn’t it? [00:23:41][39.0]

Kristin Johnson: [00:23:41] Yeah. We say, we don’t have daughters. We have seven sons between us. You know, we’re chomping at the bit for the girls in their lives to listen to us. But yeah, I mean, I think we didn’t have awareness of, let’s say, xenoestrogens. We didn’t have awareness of, you know, PUFAs and different chemicals and GMO issues and whatnot generally across all health aspects. You know, our food, our body products, all of these things. And these younger generations are pretty clued into that. And I think they need to sort of take it the next step as it applies to their hormones and start saying no to this synthetic birth control, say no to this synthetic progestins and that IUD and, you know, find different ways to sort of regulate their body in a much cleaner fashion. But Marie and I go all the way back even to let’s start teaching girls about their menstrual cycle in grade school. You know, let’s change the narrative around even the menstrual cycle and let girls understand what it’s doing for them beyond just fertility and a monthly bleed. And that piece of it, I think, could really blow everything wide open because women would start to then evaluate the choices they’re given in the context of understanding their cycle and their hormone health and everything else. And it would be a much different outcome. But, you know, all we can do is kind of help the women right now who are paying attention. [00:24:58][77.1]

Dr Louise Newson: [00:24:59] Yeah, for sure. And I certainly think with time we should be getting rid of the word menopause and talk about hormonal insufficiencies because then we can quite quickly recognise those people with PMS and PMDD who might be a long way away from their periods stopping, but they might have 20, 30 years of terrible periods and it might just be that they’re progesterone deficient and they don’t need HRT, they don’t need birth control, they might just need a small amount of progesterone, which we’re seeing more and more in the clinic can be transformational. So looking at it across all ages I think is really important. So lots to do. But before we finish, I’m just keen to ask just about the book that you’ve written, the Great Menopause Myth. So what’s so good about it and why do people need to read it, do you think? [00:25:50][51.1]

Kristin Johnson: [00:25:51] You know, I think what’s different is we’re trying to open up the conversation, starting all the way back to when hormones were recognised as very powerful instruments in women’s health. And it actually goes back to, you know, 600 A.D. in traditional Chinese medicine. And I think when women maybe understand the context of their hormones, how they were seen as being so instructive on women’s health, how they were used historically, and then sort of this grey area of about 70 years that we had a big interruption in that across the globe and kind of how we got here, they’re going to start to learn maybe their body wasn’t revolting against them. Maybe it’s not just simply ageing, maybe it’s not that they don’t need to fast more or they shouldn’t be working out more, that this is actually something they can’t overcome necessarily on their own. They need someone to partner with them and help them restore those hormones. So we try and give women that context because I think there’s still a lot of fear around HRT and we want to disband that fear. But also, you know, there’s plenty of what we call low hanging fruit for women to pursue in terms of nutrition, in terms of lifestyle, stress management, movement, all of those things. So we try to cover all of that, but then we do come back around to even in the best pursuits of all those things, most women still will benefit from some restoration of their hormones, but HRT is not one size fits all. It’s not a bottle of Advil on the shelf. Right? We need to personalise that care and we need to make sure that women have true informed consent. So we try to give them a really deep dive on all forms of HRT globally because we wanted to recognise that what’s available in the US isn’t always available everywhere. So we tried to cover everything and just give women this sort of survey and then let them decide, you know, don’t just make it the insurance companies dictating the physicians or the medical societies dictating the phyisicians to determine what a woman gets. Women should be able to say, this is what I want and find a provider to give it to them. So then we try and give tips on that too. And how do you locate providers, you know, many times going to a compounding pharmacy and asking them, who’s writing your scripts? You know, who are the people that are seen to be approaching menopause care from a whole body health perspective and then, you know, try and seek them out. So that’s we tried to make it you know, we call it the great menopause myth because exactly what you just said, which is let’s get rid of the term menopause, it’s nothing to do, there’s no magical moment in a woman’s life where suddenly this is relevant. It’s relevant from the day she’s born and those ovaries start. So we just kind of wanted to bust open a lot of those narratives give women kind of A to Z and understanding it how to address it and then let women hopefully be the change makers by demanding better. [00:28:40][168.8]

Dr Louise Newson: [00:28:42] Fantastic. And it’s so needed because the more people can read and understand every book, people can take things that are pertinent and relevant to them and it’s just brilliant. It’s very easily written. It’s something for everyone. And I think also it’s lovely that it’s not been written by a medical person because you just have a different view, a different perception about things, which I think will resonate with a lot of people. So I’m very grateful for you coming on to talk about not just the book but everything in general. It’s been really great. So before we finish, I always ask for three take home tips, so I will ask for two from each of you and go up to four. Two reasons each, oh really not reasons, actually, two things that you think are going to make the biggest difference to the most women over the next 30,40 years with hormones. [00:29:35][53.0]

Maria Claps: [00:29:36] Besides hormones? [00:29:36][0.8]

Dr Louise Newson: [00:29:37] Just in general, what things, what actions that are going to make a difference, so not what treatment that’s, we know hormones are there and they’re safe, but people can’t access them. But what are the things that are going to make changes that in 20 years we can say, look, because of this, this and this, this is what’s happened. [00:29:55][18.2]

Maria Claps: [00:29:57] I would, so the biggest one for me and I think probably has been my guiding force for maybe for as long as I can remember is is just seeking more education, just learning and becoming educated. That, to me is just one of the biggest change makers. And then I would say physical exercise is probably going to be one of the biggest change makers for women. Whether or not they actually use HRT, I would say it’s, in my own life, besides HRT, it would be like just the most important thing for health and wellness. [00:30:31][34.8]

Dr Louise Newson: [00:30:32] Absolutely. No, I would agree with that. Go on then [Kristin] what are your two? [00:30:36][3.9]

Kristin Johnson: [00:30:37] Yeah. So for me, I would say similarly to Maria and these are just things in women’s control. I think nourishing your body is wildly underappreciated. I think we as women at this stage in life, we’re busy. We’re either, you know, running businesses, having careers, being a partner, raising children, helping parents, you know, whatever. We’re kind of everything to everybody. And we tend to skip out on ourselves. And we see too many women at this age and stage of life, they’re not nourishing their bodies at all. They kind of do enough to get by. And I think women need to start to feed themselves better and feed themselves more. Fun fact is, these declining hormones are probably contributing more to your belly and midsection than what you ate last night. So we really want women to focus more on nourishing themselves. And then the other big thing that I think we’ve seen over the last few years is the management of stress. And, you know, even the best, most individually designed, robust hormone restoration therapy will not work in a woman who is stressed. And, you know, whether it’s getting off devices, whether it’s changing careers, whether it’s getting more nature, whether it’s faith, whether it’s meditation, whether it’s community, I don’t really care. I think we all probably could do a little bit of each of those things, but we need to bring the stress levels down. And it’s not about eliminating it, it’s more about mitigating it and blunting the impact of it. Life is stressful, there’s a lot of things going on in this world that’s kind of coming at us all the time. And I think women need to be more intentional about what they allow into their lives and how they kind of allow their bodies to get stressed and bring it down because we just see it too often. You know, great HRT can suddenly not work in a woman who has a super stressful event. So eat and manage your stress and like Maria said, move and be educated. Those would be our four. [00:32:28][111.2]

Dr Louise Newson: [00:32:30] You couldn’t ask for more really. I think having this holistic approach, looking at every aspect of our life, being really honest with ourselves and with others is really crucial. So we can make it the best time of our lives. Because it should be actually. So lots we can do, but lots we can do working together and helping each other and amplifying our messages. So it’s great to have other people in other countries who are also flying the flag to help women have a positive time going forwards. So thank you so much for your time today. It’s been great. [00:33:03][33.0]

Kristin Johnson: [00:33:03] Thank you. [00:33:03][0.3]

Maria Claps: [00:33:04] Thank you. [00:33:04][0.4]

Dr Louise Newson: [00:33:09] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk and you can download the free balance app on the App Store or Google Play. [00:33:09][0.0]

ENDS

The post The great menopause myth appeared first on Balance Menopause & Hormones.

This week’s episode is all about Dr Louise Newson Menopause Masterclass, a brand-new video-led, one-stop guide to perimenopause and menopause.

In this episode, Dr Louise chats to Kate Muir, journalist, author, documentary maker and menopause activist, who worked with Dr Louise on developing Menopause Masterclass.

Together they discuss the inspiration behind Menopause Masterclass, topics covered, featured experts and why it’s a must watch for everyone, whether you are menopausal, keen to be prepared for the future or simply want to know more to support loved ones.

To find out more and to sign up to the Menopause Masterclass, click here.

Click here to find out more about Newson Health.

Transcript

Dr Louise Newson: [00:00:11] Hello, I’m Doctor Louise Newson, I’m a GP and Menopause Specialist, and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So Kate is back on my podcast. Kate Muir is my partner in crime and I know her very well. We floss and scheme and do all sorts of things. Some we talk about, some we don’t talk about. But today we’re going to talk about a masterclass series that we’ve been working on for a long time, and it’s now been launched. So we thought we’d share with you more information about it. So welcome again to my podcast, Kate. [00:01:30][79.9]

Kate Muir: [00:01:31] Great to be back. I’m so pleased this is going to be out there in the world the Menopause Masterclass, because it’s the biggest thing anyone has ever made on the menopause in terms of the hours of information in it and the hours of film. So it’s like a it’s like a Netflix series, but it’s stars Dr Louise Newson and I really I really love that. I’m so pleased that we’ve done this and that we’ve gathered all these experts to work on it with us. [00:02:02][30.9]

Dr Louise Newson: [00:02:02] It’s been amazing, actually. And do you know what? Every time I watch parts of it, I have this sort of in a warm, as you know, I’m always critical of myself, but actually it’s such a great piece of work. I know I’m featured throughout most of it, but it’s not just me. It’s a voice for everybody and other people’s voices and opinions and like you say, experts as well. And so just to set the scene, really, we decided to do the masterclass because the Davina programme that you were so heavily involved in and created and produced didn’t have enough because it couldn’t, because it was for Channel 4, there were only parts weren’t there. So there was so much information that you learnt over the years. There’s so much information and knowledge that I have obtained, not just from scientific papers, but from patients as well, of course, that we sort of plotted for a while that we wanted to do something bigger, better, more in depth, really, that people could either watch in its entirety or watch parts of it. So it’s been broken up into chunks. But we, I remember sitting down with you, I was probably two years ago now. You came over when we I was in London one time and you’d made notes and I’d made notes and actually they were very, very similar because I was saying I want to have this and this and this. And you said you need to have this, this and this. And they were very similar, weren’t they? Which was really reassuring. [00:03:29][86.4]

Kate Muir: [00:03:30] Yeah. I mean, what was clear was that we wanted to talk about the holistic menopause and holistic midlife, and we’re really talking to people late 30s, 40s, 50,60s, even older. We’re talking to a huge group of women in the middle of their lives who are holding up so much. And what I loved was that it’s not just you and you’re fantastic in it and very calming I feel in your blue dress, but also we’ve got an expert on nutrition, Emma Ellice Flint, we’ve got an expert on midlife psychotherapy, we’ve got an expert on divorce and what happens to women in that period when they’re in menopause at the same time, we’ve got an expert on skin, which I think is so important to women, and we’ve got an expert on testosterone, I mean, and even Alison Macbeth, who is a wonderful doctor from Stobhill Hospital in Glasgow, an NHS doctor, she comes down and talks about breast cancer and dealing with menopause after breast cancer, which comes up, and I’m sure it comes up for you too, Louise, all the time when I am talking to groups of women. Everybody says, but what do I do if I have breast cancer? So it was really exciting to begin to answer those questions with a decent amount of time and amount of care. And I feel people get brushed off in two sentences or go and look at this. And there was an expert talking for half an hour. For instance, Dan Reisel on the brain, you know, a neuroscientist and a gynaecologist, one of the few people who understands what’s actually going on in the perimenopausal and menopausal brain properly. And he’s sitting there holding the plastic brain on the television, and he’s explaining it to us. And I think the visual, as well as giving us the time and respecting women to spend that amount of time because this is, you know, this is ten, 20, 30 years of our health. And the idea that we do it in five minutes is just stupid when we research, you know, buying a second hand car for three days, you know. [00:05:39][128.7]

Dr Louise Newson: [00:05:39] It’s absolutely outrageous, actually. And well I spend a lot of my life frustrated, as you know, Kate, but when you read into history of women, how we’ve been sort of silenced for so long, but also we’ve had knowledge that hasn’t been imparted. So we, as in clinicians and physicians, have known things that patients and women haven’t. And I think this is one of the first times that, like you say, there’s been so much in-depth information that has been shared that people can learn from in ways that are digestible and easy. But it’s if I do a radio interview or something on television, like you say, it’s minutes. Sometimes it’s seconds that you’ve got to portray that information, whereas this is a really relaxed setting. It was really lovely the way it was filmed as well, wasn’t it? They transformed this lady’s house and just the colours that they used of the set, there was something very magical about the way it was filmed, don’t you think? [00:06:41][61.7]

Kate Muir: [00:06:42] We had a brilliant director, Lauren Hawthorne, and one of the things she said to us is just let it run. Just keep talking. And instead of us cutting ourselves off, you know, she carefully cut, obviously, what we said of what you said. But, you know, we were given that space and the space around us and the idea that this, you know, should be trapped in a little studio for five minutes. And actually, there you are in a big living room chair with plants behind you and things like that. And there the person is watching you in their living room and spending time with you and listening and feeling like they’re with you in the room. And, you know, I used to be a film critic before I was a mad menopause warrior. That was my job at The Times for years and years. And it’s really important how you deliver your message, where you deliver it from, what people feel about that message. And instead of it being a kind of doctor’s surgery message. It’s actually an academic with books behind you sitting in a chair like a man would, giving a masterclass, you know what I mean? But it’s really intimate and feminine as well. And I think that’s really interesting. And I think I can imagine, you know, people, you know, because you can buy this, but, you know, people come round, they watch it with their friends. You could easily have a couple of menopause parties around this, you know, and really binge watch it. [00:08:08][85.7]

Dr Louise Newson: [00:08:08] But that’s the whole point. And I have done it in a way, or we’ve done it in a way that it doesn’t have to be the person who is suffering. So I can, and I have watched bits with my children, actually, and my husband and I can imagine watching it with work colleagues as well. You know, parts of it, is really important. And actually, sometimes women say it’s really difficult to describe how they’re feeling because it becomes very woe is me. And they don’t want to be have any sort of self-pity, whereas we’ve got cases that we’ve chosen a selection of women who have had experiences that have been quite different. But actually when you listen to their stories and even one of them is with their lovely partner David, who is just so gorgeous. We’ve got Gwenda and David and listening to his experience of her menopause will resonate with so many people, don’t you think? [00:09:05][57.2]

Kate Muir: [00:09:06] Yeah. I mean, it was so lovely seeing a couple talking about it and how supportive he was to her, and how he’d just sit there and stay in bed with her when she didn’t feel like getting up. And really, they’re so honest, aren’t they? And they’re so in love. [00:09:22][16.0]

Dr Louise Newson: [00:09:23] Yes. [00:09:23][0.0]

Kate Muir: [00:09:23] And it’s actually really, really moving to watch them talking. And they’re very funny as well. And they fell in love at school. [00:09:30][7.0]

Dr Louise Newson: [00:09:31] They are so lovely. They are really gorgeous. But they really share what it’s like for many couples actually, when your life is affected so much by menopause. So it was very brave and bold of them to share in that way. But it really does resonate how menopause affects everybody. And like you were saying at the start, it very is, a holistic programme. So there is something for everybody. It’s not a one size fits all, one experience fits all. And so people can watch the parts that are relevant for them, learn from bits that are relevant for them as well, and probably learn new information as well. And you know, I am talking to someone who has a lot of experience with partners. And certainly when breakdown of partners occurs, relationships, and that’s really important. But we’ve also got a section on testosterone where two sections on testosterone and one about testosterone for women, of course, is that’s important. But I’ve also interviewed Professor Geoff Hackett talking about testosterone for men. And that’s very important too, isn’t it? [00:10:40][69.6]

Kate Muir: [00:10:41] Yeah, because I think in relationships that can be this thing. They’ve started calling the couplepause where, you know, his hormones are down, your hormones are down, your relationship might well be on the rocks. And actually, it just needs a little bit of looking after and bringing back the hormones. And we also talk to Farhana Shahzadi, who is a family law solicitor, but has done amazing surveys on divorce around perimenopause and menopause and just looks into the way that women who you know are going into divorce, typically in perimenopause, suffering from brain fog, don’t quite know why, probably still have their periods and they end up, you know, in a solicitor’s office or in court. They’ve got lots of papers, they’ve got lots of aggressive letters coming into them and they can’t cope. And they find it really hard and they just want to push it all away. And she says, hold on. Think about you. Think about your symptoms. Think about, you know, do you need real help? Do you need medical help? And think about things like the pension gap you’ve worked all these years looking after three children and working part time. Your husband hasn’t. He’s got a huge pension. You have no pension at all because you’ve been working part time. Make sure the divide is fair and will cover you for the years you still often have to look after children. You know, the things like that that we are only beginning to see through hormonal glasses. But she’s also very practical in a wider way. But, you know, one in two people are getting divorced. It’s not nothing. And to go in there confident and armed and calm rather than panicking, I think is really important. And the other thing I like about what we’re doing here is we have a kitchen. So we have Emma Ellice Flint. And she’s a nutritionist. But what she’s great at is debunking all the sort of mad supplements and things like that that people will sell you to cure your menopause for £30. Meno, this meno that the other. And it’s not that you shouldn’t be taking certain vitamins and supplements if you want to, but she tells you the ones that actually scientifically work. And I think that’s incredibly important, don’t you? [00:13:00][139.4]

Dr Louise Newson: [00:13:01] Absolutely. Yeah. We I remember talking with her when we choosing the supplements that we use for health. So they’re not supplements for menopause. And that is a big difference actually because there’s all this menowashing where we’re told that we should have this supplements and that to help our hot flushes or, you know, menopause shampoo to help our dry hair or whatever. Whereas we’re talking about supplements such as magnesium, which can help with our health, help with our sleep, help with migraines, for example, but also looking at probiotics and prebiotics, how to get better nutrition in simple, effective ways. And it’s really great, actually, to be there in a real kitchen with real food with Emma. I really enjoyed doing that as well. And she’s a fount of knowledge. I you know, she’s got so many quick, easy, simple, cheap recipes up her sleeve. She’s always got tricks that we can learn from. And then we also we’ve got yoga haven’t we? We did a section on on exercise. So I had Lucy Holtom, who’s a yoga teacher who I do yoga with every week. And we dressed up or down, depending on how you look at it, into our yoga outfits. And we actually did yoga in front of the camera, didn’t we? [00:14:17][75.4]

Kate Muir: [00:14:17] We do have the Dr Louise Newson headstand, and I think that will be the key image on Tik Tok from this entire film. I think it’s fantastic. And you just think, well, you know, people have often talked about you as only interested in the medical side and only interested in HRT. And you go, well, she standing on her head and she’s talking about yoga and exercise. I think that is really important, that image for us to understand that our doctors are also human and that menopause is a big human event and not just a medical event. So I really love that. [00:14:54][37.0]

Dr Louise Newson: [00:14:54] Absolutely. [00:14:54][0.0]

Kate Muir: [00:14:55] I must say, I found the filming hilarious being there. I just loved that leg up higher and. [00:15:01][6.2]

Dr Louise Newson: [00:15:02] Well, I tell you what, it was funny because, you know, obviously I just free-libbed. I didn’t have a script for anything that I did. I knew roughly what I was going to say. And it’s often the case, it’s not until a camera’s on me that I know what’s coming out of my mouth. It’s just the way my brain works. But I found the week quite exhausting. And when it’s not live, obviously you can retake. Maybe a hair’s out of place. Or maybe I need to reword something or rephrase something. So there was quite a lot of stopping starting, and I remember us doing the yoga one on a Thursday of quite a busy week. And each morning I, especially if I’m doing something public facing, I’ll always do a yoga practice and it will always end in a headstand, because it’s a really great way to start the day. And I was in my hotel room doing headstands and thinking, please can I do the headstand well? And because I was doing with Lucy because we’re opposite and we go up together, I just thought, oh no, it’s going to be so obvious that she’s a yoga teacher and I’m just someone who enjoys yoga, but actually it was quite interesting. All the camera guys and the crews’ reaction. I got so much cred for doing a headstand, more than like imparting quite difficult scientific knowledge, more than interviewing other people. It was the headstand that made it for them wasn’t it? [00:16:21][79.3]

Kate Muir: [00:16:22] Yeah. No, we loved that. That was just such fun. The other thing I think a lot of women will be interested in, I certainly learned a lot was Dr Sajjad Rajpar doing skin and the stuff he told you about the ingredients in these things that cost £150, and how you could get exactly the same ingredients for £3. 50 in Boots or wherever. And he takes that apart. But he also tells, you know, what really does work, what you really need for menopausal skin, obviously oestrogen, you know, replacing your oestrogen is important, but there’s all the other things you can do. But I feel in that area in particular, we are really sold a pig in a poke all the time. And, you know, menopause, this menopause shampoo that, you know, and he just took it all apart and made it absolutely clear what was worth buying and what simple face washes, for instance, with nothing nasty in them, you know, were really worth buying rather than soap, things like that that I just didn’t know. But I sort of followed on once I’d heard him speak and I just did them and they were tiny changes, but they were good. [00:17:33][70.9]

Dr Louise Newson: [00:17:33] Yeah, he’s really great. We just did a podcast recently about acne, and he makes everything so simplistic, whether it’s for yourself or your teenage daughter, who’s influenced on TikTok to buy these ridiculous products. So he actually just goes straight back to the basics and is really good because it all makes sense because so much in menopause, not just skincare, but menopause in general, it’s been made really complicated because people have tried to be helped for centuries on something that is not a difficult problem, but because there’s so much marketing involved, of course, and so much potential money to be made. So him just talking basically about skin and also reminding us that the skin is the biggest organ we have, it’s really, really important that if our skin looks well and healthy, it’s far more likely that our internal organs are well and healthy. So it is a window into our system. And this is really important, I think, when so many people say, oh, HRT is a lifestyle drug, it’s because women want to have nice skin. And it’s actually, we should think about it in the other way and think, well actually, if women have good skin, isn’t it a reflection of how their body and their organs are internally? But also, we shouldn’t be just thinking of skin as something on our face. It’s systemically as well. And so many women who are perimenopausal and menopausal have dry, itchy skin. And if any of you have experienced itchy skin, it can drive you to distraction. It can stop you sleeping, stop you thinking, stop you working. And it’s not just about putting on a fancy cream that might irritate it even more. Obviously, it’s looking at the root cause and then looking simply what else we can do? And so not underestimating what skin is and how much it can affect people when it’s not working properly, if you like, and what Saj is really good about because he’s a general dermatologist, he’s got general medical training. It’s not just what we put on the skin, it’s what we, how we feed ourselves or how we drink all internally as well. You know, exercise obviously improves our skin. Drinking the right fluids improves our skin. And he’s very much looking holistically. And that’s why we work together so closely because it’s so important. But yeah, his session was great wasn’t it? [00:20:06][152.6]

Kate Muir: [00:20:07] Yeah. And again looking from the inside out I mean obviously there’s the vaginal biome and we know we’ve got to look after our vaginal biome. My favourite new subject is vaginal biome or vaggiebiome. And you know just making sure you give yourself that topical oestrogen or oestrogen or whatever in tiny amounts. And also Alison Mabeth, the cancer specialist, saying it is safe for those who have had breast cancer. And I think it’s great to hear that direct from her and the idea that we can just, you know, spend all that money on Chanel for our faces, but nothing for down there. And the idea that we all use the word down there and not vulva or urethra or, you know, all the proper words we should use, but it can just make such a difference and be so comfortable and be so lovely and be so enjoyable for sex as well. And. And the idea that, you know, we get that free, we can get that free on the NHS. You can get it, you know, and use it every week, every couple of days. And it’s such a simple thing and it’s such a gift to give to women. And I also think women watching this who are menopausal but have mothers who are older, or people who know people in nursing homes, it is really worth getting the message out to them, to that they don’t need to be in so much pain. And, you know, we’ve got experts talking about that and you talk about it. And it’s just a really important part of, you know, women’s story over 50. [00:21:35][88.8]

Dr Louise Newson: [00:21:36] Absolutely is so. [00:21:37][0.9]

Kate Muir: [00:21:37] Important. And the other thing, microbiome too, if we’re on biomes and we do the microbiome too, and just everything in your stomach really, really matters. And that I didn’t realise till I read all the stuff that oestrogen of course, feeds all the sort of happy bacteria in your microbiome. So it’s so important to look after that. But we all get such changes. I know I had to go and get various probiotics to get it all in the right order, and it took me a while, but I think we kind of addressed that as well in the set of programmes, which is, you know, I think really important. You know, you can’t just get everything right with a dob of HRT, but you can if you kind of put your mind to it. [00:22:20][42.3]

Dr Louise Newson: [00:22:20] And it’s a combination of everything, and it’s often doing it in the right order in the right time. That’s right for you as well. And even the exercise I know we joke about yoga, but obviously yoga isn’t for everyone. And we do talk about just the importance of movement and exercise and making choice as well. There’s also a section talking about workplace in general, the impact of workplace for that person directly who’s suffering, but also what employers can do to help, which I think is so important as there are so many women living longer and working longer as well. You know, most of us, when we enjoy our jobs, don’t want to retire at a certain age, but we want to give back as much as possible. We want to be good when we’re working. We don’t want to be going to work and not remembering things and not being able to function. So that’s really important. [00:23:10][49.9]

Kate Muir: [00:23:11] I so agree. And we, you know, we got all those statistics that one in ten women are leaving their jobs due to menopause symptoms. I hope that’s less now given the work that’s being done. But you know, it really is hormones in your head and in your career. And I know with, you know, I often give presentations on the menopause in offices, you know, big PowerPoints. And I know if I forgot the name of the person on the next slide and I pause for like one second, I would feel like the world had come to the end. I exposed myself in public, I feel shame. And lots of women do when they suddenly can’t remember a name. And it’s just something they’ve just lost for a second because of brain fog and the kind of humiliation, the self kind of humiliation is terrible. And so it’s so important to be able to talk about that work and be able to leap over that moment and be able to help people get whatever advice they need, medical or otherwise. And, you know, when I talk about that, people go, oh my God, yes, I know what that feels like, you know, and I had COVID last week and I was just realising what brain fog felt like again, because I haven’t had it for years and years. And I was thinking, I have to remember five things. I have to go to the shop and, you know, mask on. And I went to the shop, but I had to write a list. And normally I can remember five things to pick up in the shop. And then I’m doing my work and I just couldn’t remember what order I was doing things in. And then I passed out and fell asleep in the library. And that was exactly what brain fog felt to me. And what actually COVID, you know, felt like in later life. And it really humbled me for a couple of days. And I thought, oh my God, this is what a lot of people go through until they get HRT. So I was really profoundly affected by that. What about the other mental health aspects, because you talked to Holli Rubin, our psychotherapist, about midlife? What what were the things you thought she was good at talking about? [00:25:06][115.0]

Dr Louise Newson: [00:25:07] Well she was brilliant because we’re also talking and thinking about families as well, and the impact of menopause and perimenopause on families, but not just perimenopause and menopause, hormones in general as well. Because if you’re at home with teenage children, who will invariably have changing hormone levels, how that can have an effect and how when it’s not recognised, you know, I was really irritable and really cross and I sort of didn’t care when I was perimenopausal. And it was like someone could just allow me to shout as loudly as I could and hate my husband as much as possible in front of the children. But, you know, we’ve had our odd bickers over the years, but we’re not a door slamming family. We’re not a shouty family. We might discuss something and disagree. That’s fine, but not in the way that I was becoming when I was perimenopausal. And, you know, [Louise’s daughter] Jessica writes about it in my book, she was really scared. But this was only for a few months. But you know, how would it have been if it had been for longer? And how is it in families when it really does affect? And how does the partner bring up to the person that’s suffering? Could it be your hormones? How do you start that conversation? Because if they’re not realising it’s related, it can be a very difficult conversation to initiate as well. And then how do you help your partner to receive the advice, support and treatment that’s right for them as well. So it was really, she Holli is brilliant. She’s got a lot of knowledge working with individuals and with children and with families, and hopefully that comes across really well in that part of the Masterclass. [00:26:49][101.7]

Kate Muir: [00:26:51] I was sort of thinking about how you would use this because, you know, it’s hours and hours and hours. And I was thinking a lot of women might want to just because sometimes there’s a ten minute little bit on something or there’s a little case that you can listen to, or sometimes there’s half an hour on testosterone or on something longer. And I just think you could probably sit and watch this in bed and just watch that 30 minutes that you want to see about a specific subject, and then, you know, you’re travelling on the train and you can watch a ten minute blip on, you know, how to use HRT or whatever. But I think it’s nice that it will fit into people’s lives. You know, it doesn’t involve a consultation or being anywhere, and you can just pick up on these little films here, there and everywhere and pick out the ones you want and watch them in the wrong order if you want, which is rather nice. [00:27:41][49.9]

Dr Louise Newson: [00:27:41] Yes. And that’s what I hope, because you can see an index of what it is, and some of them are really very short and some of them are a little bit longer, but they’re very bite sized and manageable. And so I’m hoping people can start with what they know that they want to know, and then they can delve into other areas as well. And that way you don’t have to do it in the right order. Like you said before, you could watch some with some friends or colleagues or relatives, or you could just watch them on your own. And I’ve done it in a way that I’m hoping it’s quite timeless as well. And also it’s quite country-less, as well as in any country, wherever you are, you will be able to learn. There is one area where I do demonstrate some hormones, but I’m not talking about drugs in particular. I’m not mentioning drug names, I’m not mentioning formulations or dosing. So again, it’s very generic because we wanted it to have longevity. There’s obviously more research coming out, but this is very much a basic you know, so we’ve known about hormones for centuries. So this is just inparting the knowledge that people can use and then use that knowledge to then get more information if they want. So there really is something for everybody. Like you say, even if you’re not menopausal or never going to be if you’re a man, for example, you should still watch some of it. I think it’s there really is something for everybody. [00:29:07][86.3]

Kate Muir: [00:29:08] I also think talking to businesses myself quite often, that people are slightly afraid of talking about the really personal stuff in a work atmosphere. Of course they are. But this is something businesses can do. They can say, look, you can watch this package. We will, you know, give you this and you can watch this at home in your own time. But we are providing this brilliant, accurate menopause resource for you. And I think that gets through the oh, we’ll just talk about it for an hour at HR in front of everybody and people get embarrassed. And here is a chance to have your own thoughts, your own decisions and research things. And I think this is giving women power. [00:29:50][41.3]

Dr Louise Newson: [00:29:50] Absolutely. And also, you know, it’s a lot cheaper than getting someone to come in and give hours and hours and hours of lectures. Of course. But it is. This is all about choice. This is all about giving people information so they can make the right choices for them. And I’m really hoping it’s going to enrich people’s knowledge, but their lives as well, it’s hopefully going to allow people to think differently about what hormones are, what menopause is, and how people can receive advice and treatment and usually treatments actually, that are right for them, including lifestyle as well. So lots and lots that there is in this Masterclass series and I’m very grateful for you, Kate, to helping, you know, you produced it, to help me write it and just bring it out so that it actually happened, rather than something that I was just talking about for ages. So before we end, three take-home tips and of course I’m going to say three reasons why people should be downloading it and watching the Masterclass series. [00:30:52][61.6]

Kate Muir: [00:30:53] I think because women really like to research their health properly, and this is a chance to get right down into the nitty gritty. With an expert that you trust, and it’s not what you’re going to get in an hour long documentary. So you’ve got that depth. And secondly, you’ve got the width of the people talking about it. And also I would say my second point is you’ve got the lovely Dr Isaac Manyonda talking about testosterone as women’s cardinal hormone. He has the most beautiful voice as well. You want to listen to him before you go to sleep, if I may say. And then third. You know what? You’re there, Louise. And I am so glad to put a frame around you and see you talk to people and let people really understand you face to face. So I’m very proud to have been involved in that. [00:31:45][52.2]

Dr Louise Newson: [00:31:46] Oh, that’s so lovely, Kate. Thank you ever so much. And I really look forward to hearing people’s feedback about it. And, I just want to publicly thank you for allowing me to work with you so closely and to develop something that I know will help so many people. So thank you very much. [00:32:04][18.3]

Kate Muir: [00:32:04] Thank you. [00:32:05][0.3]

Dr Louise Newson: [00:32:09] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk, and you can download the Free balance app on the App Store or Google Play. [00:32:09][0.0]

ENDS

The post Introducing Dr Louise Newson Menopause Masterclass appeared first on Balance Menopause & Hormones.

This week on the podcast, Dr Louise is joined by Dr Ceri Cashell, a GP in Australia who specialises in female hormonal health.

After completing Newson Health’s Confidence in Menopause course, Dr Ceri became passionate about educating both patients and fellow healthcare professionals about the importance of hormones, and busting myths around HRT.

Here she talks about the advantages of longer consultations with patients and shares the things she thinks it’s important for healthcare professionals to know so they can improve their care of perimenopausal and menopausal women:

1. Understand that menopause can affect women of a wide range of ages, and to consider perimenopause when you are presented with multiple-system symptom clusters.
2. Simplify your HRT regime. Use body identical hormones, oestradiol patches, gels or sprays, micronised progesterone and consider testosterone. Understand that women don’t all absorb medication through the skin the same so you may need to tweak the doses.
3. Know that not all oestrogens and progestogens are the same. The oestrogen in body identical HRT on its own has been shown to reduce the lifetime risk of breast cancer, while the body identical progesterone is not associated with any increased risk of breast cancer in the best data.
4. Testosterone is licensed for loss of libido, but in clinical practice does seem to really help other symptoms of perimenopause and menopause and can really be a gamechanger.
5. If you do prescribe more HRT, you’ll see the most transformational medicine that you’ve probably ever encountered.

You can follow Dr Ceri on Instagram @drcericashell

Find out more about the Confidence in Menopause course here and the balance app symptom checker mentioned on the podcast here

Click here to find out more about Newson Health

Transcript

Dr Louise: [00:00:11] Hello, I’m Doctor Louise Newson, I’m a GP and menopause specialist, and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. Today on the podcast, I’m really excited to introduce to you someone called Doctor Ceri Cashell, who I’ve only recently got to know, but I feel like I’m become quite close to her. We WhatsApp each other a lot and actually talk a lot, even though she’s on the complete opposite side of the world to me. So Ceri is a GP in Australia near Sydney, and I had the pleasure of meeting her and and she arranged some great events actually when I was in Australia last year, talking to healthcare professionals, also talking to women and men about the menopause. And she like me, is it fair to say Ceri is on a bit of a crusade to try and help as many people as possible, to lead to our mission of improving the health of women. So welcome today. [00:01:46][95.6]

Dr Ceri: [00:01:47] Thank you. Thank you for having me. [00:01:48][1.0]

Dr Louise: [00:01:49] So you, like me, I think have been exposed to menopause probably a bit late in life in the respect that I spend a lot of my time regretting things that I didn’t know. And I wish I knew as much as I know now, years ago when I qualified. And once you see menopause, it’s really hard to unsee it. It’s like anything, it’s so obvious what’s going on. It’s so obvious what’s causing it. It’s so obvious what the treatments are. But if you don’t know it, you don’t know what you don’t know, do you? [00:02:20][30.9]

Dr Ceri: [00:02:21] Yes. That’s so true. I think I realised how obsessed I was with menopause when I saw my seven year old’s little description of menopause on a piece of paper, how when women go into menopause, they lose their hormones, she got that slightly wrong, and they start to forget things. But it’s good because my mummy gives them medicine and they can remember things again, which is, it’s just so lovely, isn’t it? So my journey really started thanks to a patient and a GP friend who we were just chatting about steps the patient said she’d started on testosterone and what did I know about it? And I obviously, you know, obviously, but didn’t know very much. And then a good friend at home who’s also a GP suggested I also do your course. So then I did your course and then started listening to the podcasts. Yeah. And that was really the beginning of my journey into becoming this hormone obsessed doctor who sees hormones, you know, everywhere. And although that sounds a bit evangelical, it’s equally very scientifically plausible because, as you say, they’re just chemical messengers in our body that go around and tell ourselves what to do, when to do it and, you know, keep us alive. So it’s actually made medicine to me, much more easy to understand. It’s kind of like there was a missing, I don’t know, like a third of the jigsaw. And then somebody just put it in like, oh, so now I find I can manage diabetes a bit better. I can manage weight management a bit better. I understand depression better. You know, chronic diseases make more sense. So it is it’s a very good foundation for understanding all of medicine, not just menopause. And I think with your podcast and the different things you’ve introduced, and this concept of reproductive depression that Jayashri Kulkarni, who’s here in Australia, has been trying to mainstream, I think, for about 30 years, you know, looking at that really from the whole life cycle. So as a GP who sees women of all sorts of ages from, you know, from birth, right through to when they die, you know, seeing teenagers who struggle with adolescent transition, especially ones that are maybe neurodiverse, you know, seeing those people really struggle with their menstrual cycle and their mood disorder and seeing women in pregnancy who have perinatal anxiety and depression, women who get premenstrual dysphoric disorder, women… You know, I had somebody today who came in about her pill and just said, you know, I feel awful, I didn’t say like this six months ago. You know, I’m anxious, I’m hypersensitive. Do you think it might be the pill? And I was like, absolutely. That’s very likely to be. You know, right up to that perimenopause menopause transition and really moving it out of this very classical hot flushes, a bit of irritability that happens when you’re 50 to this whole spectrum of perimenopause and menopause that can happen at any age. And I’ve got teenagers who have got premature ovarian insufficiency so I have people right across the age spectrum who, you know, can benefit from this knowledge. [00:05:16][175.7]

Dr Louise: [00:05:17] Yeah. And I do think I mean in fact I did go to someone at the Royal College of GPs about seven years ago to say, how do you relabel a disease, how do you redefine a condition? Because we should be seeing it as a female hormone disorder or female hormone deficiency, because then you are encompassing people of all walks of life, because to wait until a year after our last period is often quite late for people who have been struggling for many years. And many people, as you say, have PMS or PMDD and even just it’s made to be sort of normal that we can feel a bit rubbish a few days before our periods, but actually that isn’t normal because it’s affecting us. And, you know, just to feel flat and low. I spoke to a patient a couple of days ago and she said to me, I have one day a month where I just go to bed, for 24 hours I just go to bed. I can’t do anything, I can’t focus, I can’t think, I have joint pain. The whole world comes in and I just know it’s easier to be in bed the whole day. Now she’s got three children and a job. Not always easy, unless it comes at a weekend where someone else can look after the children, but why should she be doing that? That’s 12 days a year where she’s literally incapacitated. And then she said, then my period comes and I feel fine again. So even she knows it’s related to her hormones. [00:06:28][70.7]

Dr Ceri: [00:06:28] Yeah. I’ve several young patients here like that, and I would never have thought of using hormone therapy in those and it’s still quite far down the guideline. It’s still after SSRIs, it’s still after the contraceptive pill. But you know I’ve had these young women who have had, you know, a couple of days of feeling, you know, actively suicidal for years and two months of using an oestrogen patch and some progesterone, it’s gone. Like it’s the closest thing I would say to a magic wand sometimes. [00:06:56][28.0]

Dr Louise: [00:06:57] It is very transformational medicine, and I feel like it is quite evangelical. And somebody did say to me a few years ago to meeting, Louise, you’re very evangelical about hormones. Don’t you think you need to slow down and calm down a bit? And I was like, no, I want to shout from the rooftops, actually, because it’s not fair that it’s only my patients that are getting this feeling or, you know, there’s only a minority of people we know who can access really good evidence-based treatment globally. It’s a real issue. But also I’ve always had a beauty as you know, I’ve worked part time, doing many jobs. I’ve always worked more than full time when they’re added together. But I’ve had a lot of time for this sort of blue sky thinking, if you like, I’ve been able to get off that hamster wheel of medicine and reflect and read and digest quite difficult scientific literature, and I’ve worked for many years to sort of just translate it into short sentences so that people can understand. And I worked for a company called Patient.info for many, many years, and we started off initially just writing for patients because it was just before the internet started or around. We didn’t have Dr Google. And it was quite a revelation to be able to print off a patient information sheet and give it to a patient in front of you, because before that, all we would do is print off a prescription and just give it to a patient. So to do that and then after a few years we dovetailed and we wrote for patients, but we also wrote for healthcare professionals in a more detailed way, added more references and everything else, and people found that really useful. So if you had a patient with raised blood pressure, it would give you a summary of all the guidelines. It would give you summary of the literature, give you a summary of the treatment options. And then as a doctor, you could either Google it or print it off and it would be a really quick guide. Rather than having to go back and read the guidelines, read the evidence, work out which papers were good or not, you know. And so I’ve always done that. But I think what has happened, and I’m sure it’s the same in Australia, that doctors are really, really busy. And so you haven’t got, even if you’ve got all the will in the world, if you’re working full time as a doctor, it’s impossible to go home, read all this information, really unpick the evidence and even the guidelines are a guide written by a committee looking at the best available evidence on the day the guidelines come out and evidence changes all the time. And so I think more and more when I’m looking and thinking about the menopause, I’m thinking about, why is it that other people don’t know what we do, and it’s because they haven’t got the beauty of being able to assimilate all this knowledge, isn’t it? [00:09:34][157.3]

Dr Ceri: [00:09:34] I mean, I think that’s, you know, for the past couple of years, having turned into a menopause obsessive, but, you know, reading, going back and reading all of the papers in their original format and looking at the content and what was actually found, and often comparing that to the conclusion or the abstract, which was often very different. And you realise that a lot of the time, the conclusion is not a summary of the data or the results, but somebody’s opinion. And that has probably been, you know, partly one of the biggest shocks to me, having gone back and suddenly starting to read a lot and realising that if you want to really, really understand something, you do have to go back and read it for yourself. And that is really unfortunate because especially for GPs, you know, and even more so in the NHS where there are doing a lot of the medicine that would have traditionally been done in hospital because of, you know, the system sort of crumbling. I know my GP colleagues at home, what they deal with, it’s, you know, it’s phenomenal, but you can’t be an expert in everything. And you do rely on academic experts pulling some of that information together and giving you a platform, a framework that you can really use in clinical practice. And unfortunately, it often turns into opinion. So what you’re getting from these experts is not necessarily the purest form of facts. It can once again be more opinion. And I think that’s really, really hard. And I’ve noticed that in menopause and menopause, I don’t know, seems to have become this battleground about, you know, is it right to treat women? Is it not right to treat women? And I suppose, you know, I would take my professional lived experience and seeing a lot of women, I see, you know, women all stages of life, but, you know, being able to present them with information that they can make an informed decision based on what’s right for them. And it’s interesting because a lot of surveys say, you know, the majority of women don’t want to take hormone therapy, but unless I live in a bubble, that certainly isn’t my clinical experience. You know, when women are given the facts I suppose, as I see them, you know, that this is just replacing something that isn’t there anymore. It’s very possible to treat a lot of your symptoms with one treatment as opposed to multiple treatments. And there’s really good data that it will reduce the risk of chronic disease for a lot of women. And that women do obviously live longer than men on average, possibly because of our oestrogen advantage up until the point of menopause. But, you know, a woman aged 65 in Australia is four times as likely to be living with a severe, debilitating disease compared to her male counterpart. So we might live a bit longer but we’re often living in nursing homes and, you know, not able to get out and about. And I think what most of us want is if we do get, you know, live until a ripe old age, that is a ripe old age that, you know, that you’re able to get up off your seat and maybe you could walk down the street and that you can still carry out a conversation with your loved ones. You know that you’re not sitting in a nursing home with dementia or an osteoporotic hip fracture or something, you know, akin to that. So I think women are, when they’re given the right knowledge, they’re very able to make a decision. Not all women want to take HRT, but I think they should be given the right info. [00:12:46][191.9]

Dr Louise: [00:12:47] And I think that is crucially important. And especially in general practice, it is about sharing decision making. And I know when I went from being a hospital doctor into becoming a GP, my trainer said, Louise, you’re going to be a terrible GP because hospital doctors just tell patients what to do. And in general practice we share decision making. I’m like, how do you share? Like how did patients know? And he said, because you do, you ask them their expectations and you share with them choices. And I said how can you you know, someone’s got a chest infection they need antibiotics, you say to them, do you want antibiotics or not? He said, well, yes, try it. And actually the more you do and he was very good at teaching me this sort of open consultation, you know, why have you come? What are you expecting? Questions that, if you’ve not asked before, can feel a bit weird. But actually, most people are really keen to be really involved in their consultation. And actually, when you think about menopause, for most of us it hopefully will last for decades so making the right treatment choices is really, really crucial. And it can take a while and everything else. But as you quite rightly say, Ceri people have got to be given the right information. And I was at a meeting recently and some people were saying, well, when people have been given information about HRT and the dangers of HRT, most of them won’t want to take HRT and self-care is more important. And I thought that’s really interesting because it depends on what you’re being told. And HRT is only three letters, in some countries it’s MHT, menopause hormonal treatment. And I feel that if we just talk about natural hormones, it’s really different because most of the studies, when you talk about risks of HRT are related to the synthetic hormones, which we don’t usually prescribe or tend to prescribe because we know they’ve got some risks, especially of clot and heart disease, and they’re not so metabolically active in our bodies, because the synthetic progestogen doesn’t have the same effect as progesterone, as you know. And the tablet oestrogen gets metabolised into many different oestrogens, including oestrone, which is quite inflammatory. But the natural hormones are very different. So you can’t then say all types of HRT is the same. And I think this is where some of this polarised battle that goes on globally about HRT, because every meeting we go to, we’re hearing still about risks of HRT, but we know that they’re talking about the older types of hormones but people on the street… [00:15:13][145.7]

Dr Ceri: [00:15:13] Patients don’t. [00:15:14][0.4]

Dr Louise: [00:15:14] Patients but busy GPs don’t either. And then they’re grouping the natural hormones and even vaginal hormones with the same perceived risk as the older types. And this is a real barrier for women able to access treatment, I think, isn’t it? [00:15:29][14.7]

Dr Ceri: [00:15:29] Absolutely. I mean, the whole case of using vaginal oestrogen is, you know, such a case in point of misinformation from the medical community. Like I say to patients look, this is the safest drug that I can prescribe. I mean, it’s safer than drugs that I don’t prescribe, like paracetamol, because you can overdose on paracetamol. You can’t overdose on vaginal oestrogen, you know. So and I think and I you know I recently audited our practices prescribing of vaginal oestrogen thinking we’d come out brilliantly because I was so female health aware. And as a practice it was only 25% of women over 70 who were getting vaginal oestrogen. So I was yeah, really disappointed because, you know, we know that, you know, something as simple as that will reduce urinary tract infections. And then the consequences, you know, that that can often lead to such as delirium and falling over. [00:16:18][49.6]

Dr Louise: [00:16:19] But you’re saying 25% and that is bad but relatively speaking, it’s really good because we know that some studies have shown only like 7-8% of women, use vaginal hormones. So you’re doing OK. But actually I used to, as a GP, see many women who had recurrent urinary tract infections. They had nocturia, so they were getting up at night-time to pass urine. They were having some incontinence, some stress or urge incontinence. They were diagnosed with overactive bladder. Some of them had chronic pelvic pain. And never once did I prescribe them vaginal hormones because I didn’t realise the importance. And now we’ve got this prasterone, which is Intrarosa it’s called in the UK, which is DHEA, which converts to oestradiol and testosterone, which obviously helps all the testosterone receptor, you know, stimulates testosterone receptors, is transformational for a lot of women. But I didn’t know that. And if you don’t know then you can’t prescribe something and help. So I feel really bad. But you’re in the privileged position that you’re still a GP, so you can see these women and probably treat them different to how you did in the past. [00:17:23][64.2]

Dr Ceri: [00:17:23] Yeah, I do. I’m involved in a group of GPs and we sort of feel like, we have a little HRT support group here in Australia because, you know, there’s Australia specific things. And we always feel like we’re these crazy outliers, you know. And a frequent phrase would be, it’s like you’ve been in the matrix and you’ve suddenly woken up and there’s this whole world of medicine that you knew nothing about. And there’s a brilliant book written by one of our professors in Australia called The Secrets of Women’s Healthy Ageing. And I would say that’s sort of mandatory reading for anybody in the health professional world, because it really shows the lack of research into women’s health over, you know, just and still, you know, the fact that women weren’t included in studies and, you know, until the 1990s, but a lot of preclinical research in animal models that really only changed in the last ten years. So, but it is interesting, you know, there isn’t enough research into women’s health, but in hormone therapy there is a reasonable amount. But it’s in the shadows. So that’s what I find really hard. As you know, when we did our fun advent calendar running up to Christmas with all the symptoms, I would go and research each new symptom and see if I could find some, you know, other papers on each of these, you know, all those random symptoms of tinnitus and hair loss and crawling skin. And I would come across papers, you know, like they’re using oestrogen, you know, as in a phase three trial for multiple sclerosis. I mean, that’s amazing. So why is that not a headline? You know, there’s some really exciting stuff. Or the different oestrogens in breast cancer. You know, this kind of all oestrogens are bad. Well, maybe there’s a good one and maybe there’s a bad one. You know, maybe it’s a bit more nuanced. So when we’re trying to do shared decision making, the doctor does need to have the knowledge to share that with the patient. So I think that’s been a big barrier. And I do look back with horror. And I still see those patients. You know, there’s people that, you know, probably had a good eight, nine years of perimenopause before I saw the light. And, you know, in a few months you know, I had one woman who I would say she really lost about eight years of her life. And so she would have been really sort of premature ovarian insufficiency because her symptoms started about 36 and she had seen multiple specialists and, you know, been put on various antidepressants but had no hot flushes until she was 44. And when she came back in, I’d just done your course. And I felt really guilty, you know, she’d lost, you know, all those years, you know, she’d got divorced, you know, she hadn’t been able to work. I mean, she was lucky because she was financially sort of independent, but she had really lost a lot of her, you know, that were really important years of her life in her late 30s and 40s. And six months of hormone therapy, she felt like she did ten years ago. And, you know, it’s, it is, as you say, it’s just can be transformational. [00:20:07][163.4]

Dr Louise: [00:20:08] Yes. And I don’t think there’s anything else in medicine, you know, I’ve worked in diabetes clinics or asthma clinics, and it really can help, obviously, when you get the treatment right for many people. But HRT, when you get the right dose and type, and that’s really crucial for this conversation as well, can really obviously improve symptoms. But also I sit there quite smug, thinking, well actually these women are going to have stronger bones. They have a lower risk of heart disease. They’ll have a lower risk of all inflammatory conditions, actually. And we know that people live longer but better as well. And that’s what you’re saying. It’s not the age we die as well. It’s really important. [00:20:42][33.7]

Dr Ceri: [00:20:42] I always think, I had a lovely lady who was 92 when she passed away, and she and this is probably about four years ago, and she trained as a midwife in her earlier life, and she was on a few medications by the time, you know, in her last year or two. But I used to say, I think you really need to stop your HRT because you’re 89 or you’re 90. She was like, no. She goes, when you get to my age, you can tell me to stop it. And, you know, I do think that probably allowed her to live this, you know, life where she went in and out of the city centre and went to ladies’ meetings until she was 91. Fabulous. [00:21:15][32.1]

Dr Louise: [00:21:15] Which is perfect, isn’t it? And, you know, we don’t need to stop HRT at any age at all, we can continue, which is absolutely brilliant. But we also, I think, i was interesting, even what your daughter said, right from the start, about it affects memory. And my youngest daughter, when she was seven went to Brownies and they all had to decorate a bag. And she decorated this bag, but it didn’t have drippy glue and sparkles on, I was quite pleased that it was rolled up in her pocket when she came out. But she’d just drawn a lady, and she put a line down the middle with a sunshine one side and a dark cloud the other side, and the lady, half of her was happy, the other half was sad. And over the handle she’d written HRT, HRT, HRT and she said, this is before and after HRT. So for her perception, and it was around the time that I’d started hormones as well, was someone going from very sad to happy and actually so again she’s thinking about the brain. And the more I read, the more I talk to Professor Kulkarni, the more I read her work, the more I read other people’s work, and the more we analyse our results of our symptom improvement in the clinic, menopause really is a cognitive disorder. It’s a brain disorder. I don’t think it is related to our ovaries and periods in the way that we’ve been told for many years, and we also know that our three hormones that we always talk about, oestradiol, progesterone and testosterone are made in the brain, and they actually reduce inflammation in the brain. So if someone has a brain injury, one of the things the brain does is produces more oestradiol, progesterone and testosterone because it helps the way that our neurons like talk to each other and the plasticity of the brain improves. And we know, I was talking to a researcher yesterday in Yale University who does scanning of brains. And you know, how our structure of the brain and the way it works changes when we don’t have hormones. It’s also obvious when we think about the commonest symptoms affecting our brain. And we think about the biology and the pathology, the physiology of these hormones in our brain. Yet we’re still told it’s related to ovarian function. And it’s like the gynaecologists sort of own the menopause. And over here in the UK, most women can’t get testosterone unless they get seen by a gynaecologist. And I do sort of wonder why we have to wait for gynaecologists to be trained. Why can’t GPs or neurologists or psychiatrists be prescribing. I mean, what’s it like in Australia? Who’s in control almost of menopause? [00:23:45][149.6]

Ceri: [00:23:46] Well we have, there are, we are very lucky we have some really good experts who do try and improve education for GPs and all doctors. But one of my big bugbears is that anybody who sees women should understand the effect of sex hormones on their body system, because hormones affect every single body system, which just makes sense. You know, primarily we’re here to reproduce, really like it or not. And so I would love the day that I got a letter back from a specialist saying, I think this woman needs some hormone therapy, and I’ve never received that from anybody. I’ve not received it from a gynaecologist, an endocrinologist, a neurologist, a psychiatrist, a rheumatologist, you know, an ophthalmologist and our hormones affect all of those systems. And so I do really think it needs to be mandatory education in the undergraduate curriculum so that, you know, all doctors in training are aware of it before they come out. GPs are really well positioned, however, to do that beautiful holistic care. You know, so you will see the woman that has all of the symptoms or some of the symptoms that are crossing over multiple specialties, you know, the palpitations, the joint pain and maybe some mood symptoms. And so, you know, that’s why something like your symptom checker is so good, because if women do that before and they’re sort of aware of that, then they can come in and go, I’ve got all of these symptoms. I’ve got five or six of these symptoms. Do you think they might be related as opposed to I remember sitting there, women would come in with their list and this is in the UK, and you’ve got your sort of six minutes left because you’d already dealt with the chest infection. And they go, well, I’ve got this list. And I’d be like, OK, well I’ll do the top three and the next three, you’ll have to come back because I can’t run behind because it’s so time pressured. And I’m really lucky, you know, here in Australia I spend sort of 30 minutes with patients. [00:25:34][108.5]

Dr Louise: [00:25:36] Big difference. [00:25:36][0.4]

Dr Ceri: [00:25:37] And that time, I think what you get out of 30 minutes is a lot more than two, 15 minutes or three 10 minutes. And I’ve got, you know, fabulous nurses who work alongside me, who do a lot of prescreening. So they make sure they’ve done a bit of checking of the blood pressure, when was your bone density, is your mammogram up to date, have you had your cervical screening? You know, let’s do your symptom checker. And what do you know about hormones? So they come in to me and they’ve already really been prepped. And that’s fabulous because nurses, I think especially nurses obviously are mostly women and practice nurses are often sort of in that age range where they’re, you know, they’re really fantastic to understand and empathise and, you know, spend that wee bit more time with women. I think they’re brilliant resource centre to have such a great team. [00:26:20][43.0]

Dr Louise: [00:26:20] Yeah, no, we have nurses and pharmacists that work here and it’s brilliant. But but I think also as GPs we’re used to diagnosing more than one condition. We used to managing more than one condition. And we’re also used to sharing uncertainty with our patients. And you know, as you know, we don’t know how many of people’s symptoms are related to hormonal changes. And that can be really difficult for patients when they’ve got a myriad of symptoms. You know, if they’re getting joint pain, could they have an arthritis or could it be menopause? If they’re having palpitations, could it be a cardiac problem? Or could it be just related to their hormones? And often we don’t know. But it’s OK. And that’s one of the things I learned very early on training as a GP, you can share uncertainty with patients and we can prioritise as well. You know which of the symptoms are affecting you the most, which are more likely to be related to hormones? Yes, I can give you hormones, but let’s also keep an eye on this symptom or that symptom, or maybe refer you to a test or maybe give you two treatments as well. And as general practitioners, I think we are really well placed to do that because we’ve had such great broad training in multi-systems, and menopause is a multi-system disorder, but menopausal women can have other conditions as well. You know, I have migraines which are exacerbated by my hormones if they’re out of kilter. But I still have migraines and still need treatment for my migraines. And you would be wrong if you were my GP saying no, your migraines are only due to your hormones. [00:27:45][84.2]

Dr Ceri: [00:27:45] Absolutely. Yeah. [00:27:46][0.6]

Dr Louise: [00:27:46] And that’s the same with lots of conditions, isn’t it? So I think we are very privileged, but I feel sorry for GPs who have got that missing piece of the puzzle almost, because you’ll never get people as better as you could if you weren’t thinking about hormones. But I think there is a big shift. And certainly when I came to Australia, I was a bit nervous coming as an English GP trying to train. And you were great because you’d organised this lunch where there were lots of different specialties as well. It wasn’t just GPs and the energy in the room was incredible actually. And people were talking. And one of your male doctors who works with you was brilliant because he’s just, his eyes have been opened and he’s got this inquisitive brain and wants to learn. And I was recently chairing a meeting in London, and there was a huge thirst and appetite, and people come up to me to say thank you, because we’ve done your education programme and we just change the way we practice and we can see the effect it has. So I think that things are changing. [00:28:44][57.8]

Dr Ceri: [00:28:45] Absolutely, yes. [00:28:45][0.3]

Dr Louise: [00:28:45] Slow, but things are definitely changing. [00:28:47][1.4]

Dr Ceri: [00:28:47] Yeah. No. My colleagues, you know, I work, I’ve got two younger male colleagues and sort of they’re like, is this it? Is that all there is to it? This is dead easy. And I’m like, yeah, if you just removed like everything, if you remove some of the noise, some of the older types of HRT, you forget about trying to use the contraceptive pill, if, you know, if the person doesn’t need that as contraception and you just focus on, you know, your oestradiol patch or gel, your progesterone and maybe some testosterone, you know, it becomes as simple as ABC. You know, and there is, there’s tweaking and there’s other things you have to consider, other disorders. You should check somebody’s bloods because often women have something like iron deficiency. It’s often a time that the thyroid starts to misbehave. You do need to check that there’s not a cardiac condition. You do want to check that they haven’t developed immature arthritis. But all of that, as you say, can happen while you’re trying. [00:29:34][46.3]

Dr Louise: [00:29:35] Alongside, yeah. [00:29:35][0.1]

Dr Ceri: [00:29:35] And then they often come back. And even the tinnitus is gone. And I think that’s one of the most unexpected symptoms to improve. But yet again there’s multiple studies showing that hormone therapy treats and prevents tinnitus. It’s just, they’re just there in the shadows. [00:29:49][13.8]

Dr Louise: [00:29:50] They’re hidden. [00:29:50][0.2]

Dr Ceri: [00:29:51] Yeah. [00:29:51][0.0]

Dr Louise: [00:29:51] Absolutely. So there’s great that we need to do. Between us we can conquer the globe because we, you know, you’re the other side. Although as people can hear, you’re not from Australia. So before I finish today Ceri, I always ask for three tips. So I’m going to just ask you what three things do you think would be really important for healthcare professionals to know so that they are less scared of the negativity about hormones? So three things that will encourage them to learn more and help patients going forwards. [00:30:23][32.3]

Dr Ceri: [00:30:24] So I think the key things for me were to understand that menopause can affect women of quite a wide range of ages, and to consider perimenopause when you get these multiple-system symptom clusters. The second thing would be to really simplify your HRT, your MHT regime, down to trying to use body identical hormones, oestradiol patches, gels or sprays in the UK. And micronised progesterone and then considering testosterone and understanding that women don’t all absorb medication through the skin the same. And so you may need to tweak the doses. And the third thing is that all oestrogens and progestogens are not the same, and the oestrogen in body identical MHT or HRT on its own has been shown to reduce the lifetime risk of breast cancer. The body identical progesterone is not associated with any increased risk of breast cancer in the best data. Still got a risk of below one. And testosterone is licensed for loss of libido, but in clinical practice does seem to really help other symptoms of perimenopause and menopause and can really be a gamechanger. And I suppose if I’m allowed one more thing, if you do start to prescribe more MHT, you’ll see the most transformational medicine that you’ve probably ever encountered. [00:31:49][84.2]

Dr Louise: [00:31:50] Absolutely. So really great advice. And obviously we’ve got our Confidence in the Menopause course which is always being updated. We’ve got new consultations that have been filmed that are going out as well over the next few weeks and months, so plenty to learn. And so thank you so much and keep in touch, keep doing your great work and hopefully we can entertain you over in England at some stage. So thanks Ceri. [00:32:13][22.8]

Dr Ceri: [00:32:13] Absolutely. Thank you very much for having me. [00:32:15][1.7]

Dr Louise: [00:32:19] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk, and you can download the free balance app on the App Store or Google Play. [00:32:19][0.0]

ENDS

The post Easy when you know how: menopause care in Australia appeared first on Balance Menopause & Hormones.

‘During my late 40s and 50s, I considered myself lucky that I did not suffer from any menopausal symptoms. But back then, I thought symptoms were limited to sleep disturbances and hot flushes. 

‘I’m unclear on when my actual menopause was because in my mid-40s I had a Mirena coil fitted to control heavy bleeding, which I’d experienced for 10 years. I think my menopause was probably sometime in my early 50s.

‘When I was 47, we moved to Canada, where I registered and worked as a pharmacist. I am utterly amazed at how little I knew about hormones considering I worked in a pharmacy. It just seemed of no relevance to me, and I was busy navigating working in a new healthcare system.

‘Now when I reflect on this perimenopausal time, I can now see that I actually did suffer many issues, including recurrent UTIs, burning mouth syndrome, travel anxiety and a plethora of IBS symptoms, all of which were new to me. However, I didn’t realise their significance and I dealt with them myself.

RELATED: burning mouth syndrome and the menopause

‘We returned to Scotland in 2019 when I was 57 and all was well until November 2021 when I started to develop pelvic and abdominal pain radiating down my legs, which was severe enough for me to admit defeat and speak to a GP.

‘The GP thought I had developed diverticulitis and prescribed me antibiotics. This made me feel worse and did not resolve my pain. I knew it was not gut related. Over the next six months, I was sent for two ultrasounds, an MRI and a referral to gastroenterology. I was given multiple prescriptions for codeine and amitriptyline, hyoscine and mebeverine.

‘The pain in my thighs and legs was the worst symptom, but nothing was really helping. I didn’t take many of those medications as they didn’t help or just made me more tired. 

‘By February 2022 I thought I was going to have to give up work, aged 60, but I struggled on and just came home to bed every night with a hot water bottle. It was a very grim time. 

RELATED: when menopausal symptoms persist: with Dr Anna Chiles

‘In May, I got a letter to say I’d been referred to the persistent pain clinic and a recommendation, in the meantime, to try the low FODMAP diet. I cried when I got that letter as I knew I had no gut issues and felt abandoned.

‘We went on holiday with my daughter’s young family and I remember sitting on the plane thinking I wouldn’t care if we crashed as at least the pain would be gone.

‘In July I was desperate for help. I have a good friend who is a GP and although I don’t like mixing friendship with health needs, he offered to see me privately. We had a great talk about persistent pain and got to the subject of HRT. At the same time, one of the pharmacy technicians I occasionally work with said to me ‘you need HRT!’ and told me to download the balance app.

‘My GP friend prescribed Oestrogel and Utrogestan and within a week, I was completely better! All my pain had gone and my life resumed! My palpitations, which I hadn’t realised were a symptom, disappeared too.

RELATED: hormone replacement therapy (HRT): the basics

‘I was worried my own GP wouldn’t continue my HRT, but she agreed to continue it. She wouldn’t give me Utrogestan as she said it wasn’t transdermal and increased stroke risk – I knew she wasn’t correct, but I thought I’d rather have her on board than argue at this point.

‘I’ve been on Evorel Conti for almost two years and it suits me perfectly. Since I started HRT, I have lost about two stone with the Full Diet, but it was honestly pretty easy as I’m a very healthy eater. I feel full of energy too, so I’m not going to retire yet.

‘In autumn 2022, I did the Confidence in the Menopause online course as I realised I have so many opportunities in my job to help peri and postmenopausal women. Many of my friends have now got HRT as I can’t stop myself talking about it.

‘In Scotland, community pharmacists can prescribe Trimethoprim/Nitrofurantoin as appropriate for UTIs, however I find most of the UTI consultations I have involve women between 40 and 70 so I take this opening to discuss use of vaginal oestrogen and genitourinary syndrome of menopause (GSM).

‘I do worry about the 60-80-year-old group as they totally missed out and so many suffer from pains, insomnia and GSM. I know there isn’t much research in this age group but many are being denied even a trial of HRT if they are over 60.

‘I cannot believe I was so ignorant for so long, and I’m a bit ashamed of my lack of awareness. I am making up for lost time now though and spreading the word. I get colleagues calling me now asking for advice and am encouraging lots of conversations about it. I’m pretty passionate about all this and would like to share my tips with other women:

1. Talk to other women – a lot!
2. Educate yourself – balance is a great resource
3. Talk to the next generation down so they will recognise the less common symptoms.’

To find out about the Confidence in Menopause course see https://newson-health.teachable.com/p/confidence-in-the-menopause 

RELATED: starting or continuing HRT in later life or after menopause

Would you like to share your experience of perimenopause or menopause? Write to us at shareyourstory@balance-app.com

The post My story: I started HRT when I was postmenopausal appeared first on Balance Menopause & Hormones.

• Little research exists on menopause experiences of women living with FGM
• Women affected by FGM share the impact of menopause
• This guide offers advice on symptoms, treatments, lifestyle changes and sources of support

Every woman living with FGM will become menopausal.

If you’re under the age of 50 years, even if it feels like this will be some years away, if you have experienced FGM, it’s important to be prepared for perimenopause and menopause and know how you might be affected.

But what is menopause, and how can FGM impact your menopause?

This guide has been written healthcare professionals (menopause specialists, general practitioners and gynaecologists), and includes valued contributions from women living with FGM, and from FGM advocate and survivor Sarian Kamara from charity Keep the Drums, Lose the Knife.

More than 200 million girls and women have undergone female genital mutilation (FGM).

A deeply rooted cultural custom involving the partial or total removal of external female genitalia or other injury to the female genital organs for non-medical reasons, FGM is recognised as a human rights violation [1]. Complications can include severe bleeding and problems urinating, cysts, infections, complications in childbirth and lasting psychological trauma.

If you are living with FGM and are unsure of what to expect, you aren’t alone: Sarian Kamara says many women affected by FGM don’t know the signs and symptoms of menopause, and that more information is desperately needed.

‘They first notice it affecting their relationship with their partner, their children and their wider family,’ she says.

‘Some women tell me they all of a sudden feel anger at small things, and it affects their relationship with their children. ‘Many women don’t go to their GP, not because of fear, but because they don’t know what menopause is, they don’t know that the problems they’re experiencing, hot flushes, sleep problems, weight gain, mental health issues, are actually due to menopause.’

Researchers at Newson Health are working with FGM advocates and survivors to understand the impact of menopause on women living with FGM. For an in-depth look at the health needs of women living with FGM going through the menopause, you can access the paper for free here.

Over the last two years, Newson Health and Keep the Drums Lose the Knife have arranged several menopause workshops for women living with FGM.

Among those who attended was Amina, a 52-year-old woman from Somalia.

She says of her menopause symptoms: The hot flushes and night sweats are really hard, but the pain from my scars made it even worse.

‘It felt like my body was punishing me all over again.’

What is perimenopause and menopause?

Menopause is when your ovaries stop producing eggs and levels of hormones oestrogen, progesterone and testosterone fall. Once the hormones are low then they stay low forever, so menopause essentially lasts forever (although the impact of low hormones can be corrected, as this guide explains).

The definition of menopause is when a woman hasn’t had a period for 12 months, and the average age of the menopause in the UK is 51. However, it doesn’t just happen in mid-life, all women are different and they can experience menopause at very different ages. Menopause before 45 is known as an early menopause, while menopause before the age of 40 is known as premature ovarian insufficiency (POI). POI occurs in around one in 30 women under 40 so is actually very common.

Perimenopause

Perimenopause is the time before established menopause, when you are still having periods, but the fluctuating and low hormone levels can cause numerous symptoms, including hot flushes, brain fog and mood changes. Periods may occur further apart or closer together; they can be more irregular, or heavier or lighter in flow. The perimenopause can last for several years, and the length of this period varies from woman to woman.

The role of oestrogen, progesterone and testosterone – and symptoms you may experience

These three hormones have important functions in every cell of your body. Throughout your body, cells have hormone receptors waiting to receive instructions from these hormones to tell them how to work properly. During your perimenopause, levels of oestrogen, progesterone and testosterone fluctuate and reduce. These changes can lead to a wide variety of symptoms including:

• If you already suffer from premenstrual syndrome (PMS), you may find symptoms before your period become more severe during perimenopause
• Mood swings, low mood and/or anxiety
• Memory problems
• Hot flushes and night sweats
• Joint aches and pains
• Brain fog
• Sleep disturbance
• Headaches and worsening migraines
• Dry and itchy skin

Menopause and your vagina, vulva and surrounding tissues

Oestrogen, progesterone and testosterone keep your vagina, vulva and surrounding tissues healthy. They act as a natural lubricant, maintain vaginal and vulval tissue and give flexibility to the wall of your vagina. They also stimulate the cells in the lining of your vagina to encourage the presence of ‘good’ bacteria that protect against infections and keep the lining of your urethra and bladder healthy, helping to reduce bladder and urinary tract infections.

Hormone changes during perimenopause and menopause can trigger a range of symptoms affecting your vagina, vulva and urinary function, known as genitourinary syndrome of menopause (GSM).

The tissues lining your vagina can become thin, inflamed, drier and less able to stretch. Scar tissue may become more painful and tears in and around your perineum may occur. This often makes the area feel sore and itchy (you may also find your skin feels itchy in other areas too). Scratching usually leads to more soreness and inflammation – often making the problem worse.

Your urethra (opening where urine flows) and bladder can also become thinner and weaker, leading you to pass urine more often and feel very desperate to go. You may also experience some urine leaks or accidents – especially when you cough, sneeze, laugh or during exercise – and you may also experience more frequent episodes of thrush or cystitis.

Pain is another common symptom. This can impact everyday activities, including how long you can sit down for, and the type of clothing you wear. You may feel discomfort or pain when the tissues are stretched, such as during sex or during cervical screening.

Replacing the low or missing hormones can help to improve these symptoms. Vaginal and urinary symptoms can occur before other symptoms of perimenopause or menopause start so it is important to be aware that they could be related to low hormones and not due to worsening of the scars from being cut in the past. The sooner you receive treatment, the better you will feel and the less likely you will suffer.

Menopause experiences of women living with FGM

‘I don’t know what is going on…one day my mood is fine and the next I’m screaming at everyone for everything. I have a lot of pain and dryness down below.’

Kadiatou (49) from Guinea

‘I struggle with urinary problems and it hurts a lot down there. I don’t know how to talk to my doctor about it. No one understands my pain.’

Zahra (51) from Sudan

‘I haven’t had many problems with intercourse before, it now it’s getting worse. I don’t understand the menopause or what treatments are there or how to even access them. We, as a community, need more support with this.’

Mariama (52) from Sierra Leone

How FGM can affect my perimenopause and menopause?

An earlier menopause: Complications from FGM, such as pelvic infections or surgery, may mean you will experience menopause at a younger age.

More susceptible to GSM symptoms, such as vaginal dryness: FGM can cause scarring and the tissues in your vagina to become stretched or thin. Early treatment with vaginal hormones could help to improve this. Vaginal hormones can be prescribed as creams, pessaries or a soft ring that sit in your vagina. The hormones will thicken your tissues, reduce pain and also encourage blood flow and healing to these areas.

Your periods might worsen during perimenopause: You may already have painful or heavy periods because of your FGM, and changing hormone levels during perimenopause can lead to heavier periods.

A bulge or sensation of dragging might be a symptom of a prolapse: Some types of FGM can increase the risk of developing a vaginal prolapse, particularly if FGM was performed at a young age [2]. During perimenopause and menopause a decline in hormones can also increase the risk of prolapse. A combination of pelvic floor exercises with use of vaginal hormones can help to improve this.

Menopause might be a time when you need to take extra care of your mental health: It is well-known that FGM can cause lifelong anxiety, depression and PTSD [3]. Perimenopause and menopause can trigger or worsen these conditions, and this is often due to fluctuating or low hormone levels in your brain.

Experiencing new symptoms? They could be hormone-related If you have symptoms that are changing it is important to consider reducing or low hormones and not assume it is as a result of FGM. Many symptoms caused by low hormones overlap with symptoms from FGM including vaginal pain, discomfort or altered sensation, urinary problems and uncomfortable sex. It’s important to speak to a healthcare professional to discuss further.

Caring for yourself

It’s important to care about yourself, and to find ways to get help. This might mean speaking to your GP, or reaching out to friends or family. Let them know what is bothering you. Try to find a way to ensure your partner is aware that you’re having symptoms that might impact your relationship. Be caring towards yourself, but don’t suffer in silence.

Try to keep a broad approach as there is no single ‘right’ way to improve perimenopause and menopause, just bear in mind that they can affect your physical and mental health and how you feel will often vary from day to day.

Rest well: you may be managing along hours at work and/or caring responsibilities, however getting a good night’s sleep is crucial. Try to aim for seven to eight hours every night by having a consistent routine of going to bed at the same time every night and getting up at the same time too.

Stay active: exercise is important for your general health, and it helps keep your bones and heart strong too. This doesn’t mean you have to spend lots of money on an expensive gym membership, or spend hours a week at classes: it could be walking more, or doing free workouts at home. If fatigue is a factor, start with a lower impact activity that is slow and gentle, and gradually build up the duration and frequency you are active for.

Make time for you: spending time doing things you enjoy helps you feel better. Whether that is going for a long walk, or spending some much-needed time with loved ones. Learn to value time just for you.

Eat well – foods that are important are those rich in calcium and vitamin D for your bones, friendly to the gut like pre- and probiotics, carbohydrates that have a low glycaemic index (GI) and are broken down more slowly, and foods rich in omega 3 oils.

Hormone replacement therapy (HRT)

HRT is the most effective treatment for perimenopausal and menopausal symptoms as it replaces the missing hormones, and for most women, the benefits of taking HRT outweigh any risks.

HRT is a term for the different hormonal treatments you can take for perimenopause and menopause. It usually contains the hormone oestrogen – the key hormone that affects so many different parts of your body when you don’t have enough of it.

If you take replacement oestrogen, you need to take another hormone to protect the lining of your womb (if you still have one) and this is known as progesterone or progestogen.

There is a third hormone, testosterone, that you naturally produce when you are younger, that can also be used as part of HRT.

How to take HRT

Oestrogen: the safest way to take oestrogen is through your skin, via a sticky patch, gel or spray. There is also a tablet form. You will need to take it every day, and the dose often varies depending on how you absorb the oestrogen through your skin.

Progesterone: this is usually just for women who have their womb to protect the lining of your womb from the effects of oestrogen but it can also be taken by women who have had a hysterectomy.

The preferable type is micronised progesterone and it comes in a capsule form that is taken daily, often in the evening, as it can also have a mildly sedative effect. The capsule is usually swallowed but it can also be inserted vaginally. An alternative type of progesterone is via a Mirena coil, a small plastic device inserted in your womb that stays there for five years and is then replaced.

Testosterone: this comes in a cream or gel that you rub into your skin every day. Testosterone can help to increase libido and many women find that it can also improve symptoms of low energy, mood changes, poor sleep, fatigue and poor concentration.

These three forms of HRT are called systemic HRT, meaning they are absorbed into your bloodstream and make their way around your whole body.

Benefits of systemic HRT

Your symptoms will improve: usually within three to six months of starting HRT.

Your risk of developing osteoporosis reduces: your bones will be protected from weakening due to lack of oestrogen.

Your risk of cardiovascular disease reduces: you will be less likely to develop heart problems, stroke or vascular dementia.

Your risk of other disease reduces – those who take HRT also have a lower future risk of type 2 diabetes, osteoarthritis, bowel cancer, clinical depression and dementia.

Risks of systemic HRT

Deciding to take HRT should be the result of an individualised conversation with your healthcare professional based on your medical history and personal preferences. You can find out more about risks and benefits of HRT here.

What about side effects?

Side effects with HRT are uncommon but can include breast tenderness, leg cramps or some vaginal bleeding. If side effects do occur, they usually happen within the first few months of taking HRT and usually settle as your body adjusts to taking the hormones.

Vaginal hormones

Women living with FGM often have scar tissue or skin changes that can change during the menopause. As tissues become less lax and often less lubricated, new pains can occur. Vaginal hormones (also known as local or topic hormones) can help with symptoms affecting your vulva, vagina and surrounding tissues, including alleviating painful sex and preventing infections.

Vaginal hormone treatments can be taken safely for a long time, with no associated risks, and can be given with or without HRT. The majority of local hormone treatments are currently only available via prescription – your healthcare professional should be able to advise on which type would be best for you.

Different types of vaginal hormones

Pessary: this is inserted into your vagina, often using an applicator. Pessaries contain either oestrogen or a hormone called DHEA, that your body naturally produces. Once in your vagina, DHEA is converted to oestrogen and testosterone.

Cream or gel: these can be useful if you are experiencing itching or soreness of the external genitalia.

Ring: a soft, flexible, silicon ring you insert inside your vagina, which releases a slow and steady dose of oestrogen over 90 days. Needs replacing every three months. A health professional can insert the ring if you do not feel confident or able to do so. You can leave the ring in position to have sex, or remove and reinsert it, if preferred.

Symptoms of GSM will not resolve on their own, so vaginal hormones are safe to use long term. Women who cannot have HRT for clinical reasons can still use local hormone treatments in the vagina.

Non-hormonal treatments

Whether you take HRT or not, it is worth considering lifestyle options or treatments to optimise your symptoms. There are many things that may improve your symptoms, including taking non-hormonal medications, talking and alternative therapies.

Vaginal moisturisers and lubricants

Vaginal moisturisers and lubricants do not contain hormones but can work to keep the tissues well-hydrated and feeling less sore. Moisturisers help throughout the day and are longer lasting, so you may only need to use a moisturiser every two or three days. Lubricants are for using just before sex or any other activity that penetrates your vagina.

Both moisturisers and lubricants can be used alongside vaginal hormone treatments.

Prescription medicines

Some prescription medicines could help to relieve your perimenopausal and menopausal symptoms. Certain types of antidepressants, the high blood pressure medication clonidine, and the epilepsy medication gabapentin, may help with symptoms like hot flushes, night sweats, low mood, anxiety and vaginal dryness. Although these can work for some women, they might not be suitable for you, and they can have some side effects.

Cognitive behavioural therapy (CBT)

CBT is a talking therapy which has been shown to help reduce some mental health symptoms, including depression and anxiety. It works by helping you to identify your thoughts and feelings and teaches you coping skills so that you’re more able to deal with them.

Herbal medicines

Herbal medicines like St John’s wort, black cohosh and isoflavones like red clover, which are available to buy over the counter in chemists and health food shops. Although some claim to ease menopausal symptoms it’s important to remember that just because a product is natural, that doesn’t necessarily mean it’s safe. Scientific evidence is mixed on how effective these treatments are, and they can have side effects or interfere with other medicines you might be taking.

Alternative therapies

You might find that massage, acupuncture or aromatherapy help to relieve your menopausal symptoms. There’s little scientific evidence to support their use, but these therapies are likely to help you relax so could be worth a try.

Sources of support

Keep the Drums Lose the Knife

Womankind worldwide: list of FGM support organisations

References

1. World Health Organization (2022), ‘Female Genital Mutilation’, https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation
2. Birge, Özer et al. (2021), ‘Female genital mutilation/cutting in Sudan and subsequent pelvic floor dysfunction’, BMC Women’s Health, 21(1), doi:10.1186/s12905-021-01576-y
3. Reisel, D.,  Creighton, S. (2015), ‘Long term health consequences of Female Genital Mutilation (FGM)’, Maturitas, 80(1), pp.48-51, doi:10.1016/j.maturitas.2014.10.009

The post FGM and the perimenopause and menopause appeared first on Balance Menopause & Hormones.

Clinicians often talk about the relative risks and benefits of HRT – but what do the numbers actually mean?

And what are the benefits of using transdermal oestrogen and body identical progesterone compared with the more old-fashioned HRT formulations (oral oestrogen and synthetic progestogens)?

We have created two visual aids to help you understand the long-term risks and benefits of HRT. These aids can be downloaded and printed and used by clinicians in consultations to inform shared decision making based on the best, currently available evidence.

The aids will be updated as and when new evidence comes to light.

Understanding the major long-term benefits of HRT covers the following topics:

• All-cause mortality
• Coronary heart disease
• Diabetes
• Osteoporosis
• Dementia

Understanding the risks of HRT covers the following topics:

• Breast cancer
• Venous thrombosis (blood clots)
• Stroke

The post Understanding the benefits and risks of HRT: downloadable visual aids appeared first on Balance Menopause & Hormones.

This booklet is designed for support workers and family carers – it offers information on the perimenopause and menopause and how it can affect women with learning disabilities, plus gives guidance on how best to offer support.

The booklet is downloadable and has been published to coincide with Learning Disability Week 2024.

Our previous booklet, Easy read guide to the perimenopause and menopause, is also available.

The post Learning disabilities and the menopause: for support workers and family carers appeared first on Balance Menopause & Hormones.

This week on the podcast Dr Louise meets comedian Anne Gildea, who will be joining Louise on her 34-date theatre tour this autumn, Hormones and Menopause: The Great Debate.

Anne, a founding member of Irish musical-comedy trio The Nualas talks to Louise about her diagnosis of breast cancer, aged 45, and her ensuing menopausal symptoms, which she was unprepared for. She explains how her research inspired her to create her own show, How to Get the Menopause and Enjoy It.

Louise and Anne discuss why they’ve come together to create a new show that will take you on a journey through the history of women’s health and lead you to see menopause and hormones in a whole different light.

Finally, the pair share some of the reasons they think people should come to the show:

1. It’ll be a wonderful night out – a real sharing experience where you can also have a laugh.
2. There’ll be lots to learn with new content and a sharing of knowledge.
3. You’ll be able to ask questions and gets answers. Some shows will also have doctors available in the interval but Louise will answer questions on the stage as well.

You can follow Anne on Instagram @annegildea  

To buy tickets to the show click here

Click here to find out more about Newson Health

Transcript

Dr Louise: [00:00:07] Hello, I’m Dr Louise Newson, I’m a GP and menopause specialist, and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon -Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. Today I’m doing something slightly different. I’m recording my podcast in the studio, so I’m going to be filmed in real life with proper equipment, not just on my screen. And I’ve got a special guest here today Anne Gildea, who’s come over from Dublin. Difficult journey, which will explain in a bit, but she’s here in real life. We’re going to be talking about the tour that we’re doing, soon, which is going to start in the autumn. So welcome Anne, thanks for coming today. You’ve seen the clinic, you’ve seen my second home, and we’ve got loads planned, haven’t we? [00:01:29][82.1]

Anne: [00:01:29] Yeah, I’m really excited about it, Louise. And it’s amazing. There’s nothing like meeting in person. And you just… There’s something magic about picking up the energy people, I think that’s beginning to be lost and there’s so much Zoom and everything now. It’s just… [00:01:43][14.0]

Dr Louise: [00:01:44] It’s exactly the same for when I see patients. It’s very convenient. It’s very easy to do things online. But actually you just the energy, the warmth, everything. You just learn different things about people. [00:01:56][12.3]

Anne: [00:01:57] You do and you just get a feel. And it’s an intuitive thing. It’s an animal thing. [00:02:02][4.8]

Dr Louise: [00:02:02] Yeah. Absolutely. Totally. So I’m very grateful because there’s a train strike today so you haven’t had the best journey! [00:02:09][6.9]

Anne: [00:02:11] My God Louise! Like I had my whole journey planned. I got my tickets and I had them already to go and I went to the train station and it’s like there’s no trains today. I had a real menopausal moment. It was like oh, it doesn’t compute. It was so funny that it took me. I thought oh well I’ll get the bus into Birmingham. There’s bound to be loads of coaches to Stratford. I took an hour and a half on the bus, so I’ve seen all the suburbs of Birmingham. And then it was funny because I, I just had to make transport decisions and think my brain was… [00:02:45][33.7]

Dr Louise: [00:02:45] So you’ve used your brain well. Despite being menopausal. But really it was great because when Chris Davis, who’s organising the show, said, I want you to meet Anne, I want you to look at her work. I had a little Goggle, had a read, had a watch, had a listen, had a laugh. And what you’ve done has been incredible. But I’m really keen to hear, like, how you got into even thinking about menopause and let alone doing a stand-up comedy show. [00:03:11][25.4]

Anne: [00:03:12] Well, I’d had this act and this reason I know Chris through other producers I’d worked with in the UK before, this act called The Nualas, and we were a comedy musical trio and we turned, we toured a lot in the UK and that was my Chris connection. And then we had come off the road, we’d finished doing that and so I needed to do something else, and so was in my 50s by then and I thought it would be really interesting to write something about being in mid-life, but it was going off in every direction. So it was my partner Paul, who said to me, he gave me, he just gave me the title. He wrote it on the whiteboard, how to get the menopause and enjoy it. And he went, that’s your title. And I was extremely resistant. [00:03:53][41.2]

Dr Louise: [00:03:54] Were you, why? [00:03:54][0.3]

Anne: [00:03:55] Yeah, I just felt such negativity around the word menopause. Now, this is several years ago, it was during lockdown, and there is a real moment where everybody’s talking about menopause now. But back then it was still a little, a lot of silence around it. And I just thought, well, at that point I was post-menopausal and I thought, I just I don’t want to go there, it’s medicalised. It’s just like, kind of sweaty, irritated women. That’s the image you get. And then I started reading about it and, the scales fell from my eyes. I kind of went into shock for a while. [00:04:28][33.0]

Dr Louise: [00:04:28] Did you? [00:04:28][0.2]

Anne: [00:04:29] Yeah, because I realised all I didn’t know, and I realised I knew nothing about my body. And I thought menopause was something that you just went through and then it’s over. I didn’t realise that the long-term effect of that hormone depletion and so one of the first things I did, was I went on HRT, I just thought… [00:04:53][24.2]

Dr Louise: [00:04:53] So you hadn’t thought about it before? [00:04:54][0.3]

Anne: [00:04:54] I absolutely hadn’t. I think I had this, I’d heard something about the Women’s… or the World… [00:04:59][5.7]

Dr Louise: [00:05:00] The Women’s Health Initiative. [00:05:00][0.0]

Anne: [00:05:02] Yeah. Women’s Health Initiative study. So the shadow of that was definitely still hanging over the whole HRT piece. So I thought, well, I can’t, I’d also had had breast cancer. So I just thought, not for me even though my cancer wasn’t oestrogen positive, it was triple negative. But I just thought no, it’s there’s too many negatives around it. But it was just a received opinion without looking into it. And then when I just got all the facts, I just I was yeah shocked that I had such ignorance. That there’s such general ignorance around what happens in our bodies. And I think particularly now, because, we all live longer and sustaining our health, post-menopausally is so important. It’s not just about treating those symptoms. It’s about keeping healthy into old age. [00:06:00][58.2]

Dr Louise: [00:06:01] Yeah. Menopause has been just portrayed as an annoyance, actually. You know, I knew when I started doing first presentation, like, ten years or so ago just to a group of healthcare professionals and just Googling menopause and thinking about it. It’s always hot flushes, it’s always night sweats, it’s always middle aged whereas we know 1 in 30 women under the age of 40 are menopausal so they’re not middle aged. It’s always like overweight woman with a fan with sort of beads of sweat. And then it’s sort of used a bit as a butt of jokes, oh she’s menopausal. Ignore her. Like, it’s just like very patronising really. And it’s something that actually women are very vulnerable when their menopausal. But they don’t understand necessarily exactly how it’s affecting our brains, how it’s really affecting us the bigger picture, because it’s never been talked about as a brain disorder. It’s a flushes, sweats disorder. And like you say it’s something that we’ll get through. And I think when people realise that you never get through the menopause and you want to make it a really positive experience, but if you haven’t got the knowledge, how can you make something positive when you don’t know what it means? [00:07:10][69.6]

Anne: [00:07:11] Louise, that is exactly the part that I just I had no realisation of that. And I think what I found shocking was I think it’s something that every woman should know and. [00:07:23][11.9]

Dr Louise: [00:07:24] And every man naturally. [00:07:24][0.6]

Anne: [00:07:25] And every man, because, you know, it is an inclusive condition. You don’t have to get it to suffer from it. [00:07:30][5.0]

Dr Louise: [00:07:30] No. [00:07:30][0.0]

Anne: [00:07:31] But it’s not to have negativity around it either. But it’s just, you know, it’s like thinking about the mental health issues around it, the low mood. And, a lot of women, I’m touring this show then, I wrote this show, How to Get the Menopause and Enjoy It, and I’ve actually been on the road three years with it in Ireland now. And, so I talk to a lot of women and it’s not just low mood. A lot of women talk about a lack of confidence then comes along. Like one woman told me she, she didn’t feel confident driving on motorways anymore. Like it begins to, life can begin to contract a little bit. [00:08:10][38.5]

Dr Louise: [00:08:10] It really does shrink, actually. And in fact, in the updated paperback of the book, someone called Joanne Harris, you might know she’s an author, she wrote a great book called Chocolat, talks about women being invisible and how convenient it is for society for women to be invisible. And I think there is a lot of invisibility in menopause and not wanted invisibility. But you’re absolutely right. I know when I was perimenopausal, I didn’t want to go out. I felt really flat, just very joyless. You just, everything’s a bit, you know, it’s not just thinking in treacle, you are wading in treacle. Everything’s an effort. And it’s like, oh, I just don’t want to. It’s just like, and this isn’t me. And then you compound it when people have got anxiety and thinking, like you say, not driving, I see lots of women who don’t go on a bus, they don’t go on the underground. So then they’re like, where they go out is very small. Then they stop going to work. They’ve stopped their identity, as who they are. It’s really awful. And it’s happened for many, many years hasn’t it? [00:09:16][65.8]

Anne: [00:09:16] Yeah, I’ve talked to women too who may be feeling that vulnerability too. And then in their job they’re having to do presentations and suddenly they’re having a hot flush. And you know, as these things build up, women do just go, I actually can’t do this any more. And they just step out of the workforce. They… [00:09:33][16.8]

Dr Louise: [00:09:34] Which you know, it’s 2024. I’m really shocked that we’ve got a treatable condition, that’s treatable with safe treatment. That the majority of women worldwide are not getting. [00:09:47][13.4]

Anne: [00:09:48] As you know, there’s still so many doctors who will say, is it safe? And you’ve all those warnings around cancer that relate to you know, that study? [00:09:57][8.6]

Dr Louise: [00:09:57] Yes. Well the study, the WHI study, which we know isn’t actually relevant because the type of HRT we prescribe is different. But even that study didn’t show the effects that were put in the media and the medical press, actually, because it was reported in the wrong way and reported wrongly, actually. But even this risk of breast cancer wasn’t statistically significant either. So it’s irrelevant. [00:10:21][23.4]

Anne: [00:10:21] Yeah, but you were saying a whole interesting piece too around the anti-inflammatory element of oestrogen and it’s almost anti-cancer rather than oh no it’s bad. When it’s gone it’s gone. [00:10:35][13.2]

Dr Louise: [00:10:36] Yeah, that’s exactly right. So the arm of the study that only gave oestrogen, so women who’ve had a hysterectomy, removal of the womb, often only have oestrogen. Those women when they were followed up, had a lower instance, 23% lower incidence, of breast cancer. So oestrogen seems to be protective of breast cancer, which really blows people’s mind when we’ve all grown up thinking that oestrogen is bad. But then also you think, you know, my 13-year-old daughter who hasn’t learned anything about oestrogen at school, but is like, Mummy, how can your own hormone be a bad thing? It doesn’t make sense biologically that we have something in our bodies that our body turns against us. It just doesn’t work like that. [00:11:18][42.3]

Anne: [00:11:19] Yeah but then that’s another piece around having hormone replacement that, you know, I have met women who go, it’s a natural process, menopause. And that’s unnatural. So why would you, just go with the flow but that, you know, the whole.. [00:11:36][16.9]

Dr Louise: [00:11:36] It’s really interesting isn’t it, the whole natural thing. And I think actually when you unpick what does natural mean because it’s associated with ageing, is a massive philosophical and medical debate. Is ageing natural or not? Which is very interesting. We actually, as we were saying before, our life expectancy is so much greater than it used to be. So actually, is it natural that we live to our 70s and 80s? Who knows? We don’t know but we never used to live that long for sure. But then also there’s a lot of conditions now, for example, raised blood pressure is related to ageing as well. It’s more common as we get older. But I wouldn’t not treat someone’s raised blood pressure because they’re in their 70s, because if I don’t treat it, that person has an increased incidence of a heart attack. So we treat the blood pressure, get it lower to normal range to reduce the risk of a heart attack. With menopause, as you found out when you did your reading, there is an increased risk of a heart attack when people are menopausal. Taking HRT halves that incidence of, or the risk of a heart attack. So actually, you could argue it’s in a similar way that we’re doing it. [00:12:47][71.5]

Anne: [00:12:48] Exactly. And it’s just keeping up. The big part for me was also the link with bone loss, as they call it. I didn’t realise a fall in oestrogen is correlated to that. And I just noticed in the women on my mum’s side of the family is very, you know, we just we’ve accepted this idea of the little old lady, that women would just shrink away. Like I say this in my show, that my mum used to be the same height as me and now she’s just the size of a coffee table. You know, the middle one in a nest. But I actually, I say it in the show and I laugh about it. And then I, I’m based in Dublin, but my mum actually lives in Manchester. And when I go to visit her, I do always do a double take and go, oh, you have, she’s got, she’s really lost so much height. And that is, that’s a real menopause correlation isn’t it. [00:13:43][55.2]

Dr Louise: [00:13:43] Yeah and presumably she’s not on hormones. [00:13:44][0.9]

Anne: [00:13:45] No. [00:13:45][0.0]

Dr Louise: [00:13:45] No. Because there is this shrinkage of the bones, we’ve got loss of bone density, but also the discs reduce in size, so all the discs between. So there’s just a shrinkage of everything, which then can reduce height. But obviously when you’ve got bone loss there’s increased risk of osteoporosis, the thinning of the bones, which is so common, yet we don’t know, well, many people don’t realise how common it is, what it means, but also that HRT can reduce and treat osteoporosis as well. [00:14:17][32.3]

Anne: [00:14:18] That was one of the big reasons I went on the HRT, and because I was, post-menopausal by the time I was reading around it but I just thought, long-term health, but then in particular because I’d really observed it in my mum’s side of the family. [00:14:33][15.1]

Dr Louise: [00:14:34] And so you were quite open about having had breast cancer before. And thankfully everything’s fine for you at the moment. But you were, did you have any chemotherapy or treatment? [00:14:47][12.7]

Dr Louise: [00:14:47] I did, I had… Talk about lack of knowledge, Louise. I had a swelling on my breast, but I had this received thing that cancer was a lump, that I imagined it as a discrete lump. So it was kind of a swelling that’s getting, a bit bigger. And I went, oh, that’s nothing. And then one day I showed it to my sister and I went, Do you think there’s anything? And she went, we’re calling the doctor now. And by the time I actually, went to the hospital, it was actually it was stage three. It kind of, it had gone to all my lymph nodes, I had all my lymph nodes removed. And as well as that I ended up having to have a mastectomy. And yeah, that was, that was quite a shock. [00:15:33][46.6]

Dr Louise: [00:15:34] And did you have any extra treatment? Did you have any chemotherapy? [00:15:36][2.0]

Anne: [00:15:37] Oh I did, sorry, yeah I did. I had chemo first. I had eight rounds of chemo and over four months, dense dose every two weeks. And then, I had a mastectomy and then I had seven weeks of radiation. And then, and then I got a fantastic reconstruction. And the wonderful thing about getting the reconstruction is I had a DIEP flap reconstruction. So it’s my own tissue. You just once it’s all done and dusted, you move on and you forget. I forget that I had cancer. [00:16:12][35.1]

Dr Louise: [00:16:12] Yeah. And were you still having periods when you were diagnosed? [00:16:15][2.8]

Anne: [00:16:16] Yes. And then the oncology. I was 45 years of age and the oncologist said to me, now, you know, the chemotherapy is going to shut everything down. And given your age, your periods are probably not going to come back. Now, they did come back a little bit and then they just petered out again. Here’s the thing, I would, and I talk about this on my show too. I would’ve said, you know, I would say maybe about three weeks after I started the chemo, I started having awful night sweats. As I say, every night I was wringing out the bed sheets, my nightie, my boyfriend’s neck. And I didn’t correlate that with menopause, but of course, because it shuts everything down, it had also shut down the hormone production, and I was plunged into menopause, as so many women are when they’re going through chemo. But that was never mentioned. And I suppose there’s so much else going on. I wish it had been mentioned because once I’d been through treatment, I was so relieved. And I actually, I went to this brilliant hospital in Dublin called Saint James’s, and all the doctors were amazing. And I was so inspired by the whole experience that when I came out the other end of it, I just had this new love of life and positivity about moving forward, but I had, terrible low moods and I thought, well, that low mood is definitely not circumstantial. So because I’m so low, this is a disposition, I have a disposition to low mood. This has just been that the cancer treatment had worked so well. So I was applying the science to my own mind. And God, this is dispositional and low mood and I should go on antidepressants. And I actually was on quite a strong dose of an antidepressant called Cymbalta for, for four and a half years because I thought I just had this disposition to low mood and I’ll just medicate it away. I look back and I go, that was totally a menopausal symptom. That’s why my mood was low. And I wish I’d had information around menopause and effects of hormone depletion at the time because I would never have gone on antidepressants. It was totally about that. And that’s why it felt strange. And then, it would have been a good time to talk about maybe some hormone replacement and to try a hormonal way of balancing out the mood. [00:18:52][156.9]

Dr Louise: [00:18:53] Yeah. Which has happened so often. I did a presentation yesterday to women and most of them have been offered or given antidepressants. And it seems so easy to get antidepressants, yet so hard to get hormones, which is wrong. And there’s so much that needs to change. But empowerment is good. Education is good. You learn more when you’re happy, don’t you? [00:19:18][24.4]

Anne: [00:19:18] Absolutely. Do you know with, it’s like medicine looks at women and goes, oh, they’re so complicated. Should we just tranquillise them? You know, it is like that. Just tranquillise them away as they drift post reproductively. They just drift away into the twilight years. [00:19:35][16.6]

Dr Louise: [00:19:35] And there is a bit of put up and shut up because other generations have done it. Why can’t you? And then that makes it harder to ask for help. So yeah, laughter is a great best medicine. You learn more as I said, when you’re happy. So your show, which I’ve seen bits of, people are really happy. They really love it. They love it, I think what I can see and tell me if I’m wrong, is that they they can relate to what you’re saying in a way that they’ve probably not been able to admit before that they’re experiencing similar symptoms. [00:20:07][32.1]

Anne: [00:20:08] That’s what women say to me and write to me. They go, you told my life. And, that relatability piece is so important. And I think it’s it’s coming through just the story of being a woman. And then when I add in the information, it makes it quite compelling. And then I pitch the whole piece around, menopause as reverse puberty. And I just say, think back to when you went through puberty and your body starts producing all these hormones, think of the profound effect and changes that had, that ensued. Well, now, you’re going through the other end of that, you know, you go through this depletion. So it’s a kind of an equal and opposite thing. So because I talk, frame it in that way, then I talk a lot about growing up in the 70s and 80s and I just remind women of things that are, like things like the sanitary products we used to have, like and the intimacy and remembrance of that, always gets a good laugh. [00:21:21][72.4]

Dr Louise: [00:21:22] But it’s important. I think women need to understand that they’re not alone. That’s really, really important because as we’ve already said, it’s really isolating. So your thoughts about the tour that we’re doing. I’m quite… I’ve never been on tour before. I’m feeling quite excited, bit nervous. [00:21:37][15.1]

Anne: [00:21:38] You know what I’m really excited about? Like, I’m really excited. I got really passionate about menopause when I started reading up about it. I’m really excited to be working with you because you’re an absolute expert in the field. And I love hearing the facts coming from the mouth of an expert. And like some of the detail you were explaining to me earlier and the information is still not out there in the full, you know, the full breadth of it. So that’s the thing I’m really passionate about. To be working with you Louise is totally immersed in all the cutting edge research around it and that you’re continually talking to women, with your patients and everything. You just know that… [00:22:27][49.5]

Dr Louise: [00:22:28] Yeah. I mean, I’m looking forward to sharing content that we’ve not spoken about before, that I have not spoken about through my book or other podcasts or other media, because there’s a lot I’ve been reading a lot of women’s history books as well actually, I think it’s so interesting, and medical books from the past as well, mainly written by men, I hasten to add, male doctors, but just people’s perceptions of what menopause is and how it affects women, and the treatments. [00:22:56][27.8]

Anne: [00:22:57] Oh the treatments, like for the what was it, the wandering womb in Ancient Greece or that they used to put leeches on women’s cervix? [00:23:07][9.3]

Dr Louise: [00:23:07] I know, I know, it’s incredible what women have gone through and endured, but what they still are enduring now. So a lot of that we can tease out, which will be great. I’m really looking forward to working with you. And how to again, life is something that can be very sad but also very frustrating. But I want some of that frustration to keep coming out because I think if you’re frustrated, you’re more likely to change things and you change the needle because this is actually something that’s affecting 1.2 billion women globally. It’s not just something that affects a certain demographic or a certain type of woman. We can’t escape from it. But actually to learn and to realise quite the injustice of what’s going on as well. And if you’re feeling alright, you’ll definitely know a friend or a relative or someone who isn’t or is struggling to get help. So I’m hoping it will group and join people together. [00:24:12][64.5]

Anne: [00:24:14] The thing I really like touring theatres is that women really love that environment. They love coming out together in groups. And it’s wonderful to make people laugh. It just opens everybody. And, it’s almost a spiritual experience. So I think it’s there’s that lift too. [00:24:33][19.0]

Dr Louise: [00:24:34] I get that. I’ve done a few book events, and I did one last week actually, down in Henley, and I was with Kate Muir, who’s absolutely brilliant, and we’re waiting to go on and just the buzz in theatre. Normally in theatres people talk or mumble, but there’s this energy where people were really happy and we did a question and answer as well. And this lady she was so lovely she said, I’m 82. I’ve been on HRT 30 years. I’m never going to stop it. And actually, the whole audience just clapped. They were all there with her in the room, you know, really supportive. And I thought, actually, there’s so not many live groups where people are there together. You know, you’re in your own little group, aren’t you but actually, the whole theatre were there by the end of it. [00:25:14][39.8]

Anne: [00:25:16] That is the thing that women say to me in my show that, in the intermission, that it’s like everybody, like the queue for the loo, everybody’s talking to each other, that there is suddenly you’ve opened up the topic, and that 80-year-old woman is lucky because I’ve met 80-year-old women who were, I’ve met 80-year-old women who had hysterectomies in their 50s, and they were and they were allowed HRT for a few years. And then the doctor absolutely insisted that they had to come off it. And you know, that was the received opinion that you couldn’t stay on it long term. That was another revelation I had researching the show that actually, you know, that you could carry on and that it actually does sustain your health. [00:26:00][44.5]

Dr Louise: [00:26:02] Yeah, it’s so important. People don’t realise that so there’s lots of myths that we want to dispel. Lots of facts that people can learn from quite a lot that people hopefully won’t know or won’t have put in context. And I think having the show, the context is really important. But we’re also going to do a Q&A as well. So I’m hoping there’ll be lots of questions from the audience. And that will vary every night, of course. [00:26:28][25.7]

Anne: [00:26:28] And that’s the exciting thing about you bringing your knowledge into that environment, because this specific detail you have… I’ve done a lot of research around it, but I haven’t heard it expressed so clearly and just the nuance around things like cancer, not cancer, the subtle effects of what the hormones are actually doing is really important information. [00:26:53][25.2]

Dr Louise: [00:26:54] Yeah, and I feel cheated as a doctor that I haven’t been allowed to have this information. You know, I wasn’t given it at medical school, I wasn’t given it as a postgraduate. I wasn’t given it as a GP trainee. I’ve searched and researched myself, but it’s all out there. But it’s hard to find something when you don’t know where to go. [00:27:13][18.6]

Anne: [00:27:13] But it’s also you bringing it all together. I think, I’m sure you know, I have never well like when I read your book, I hadn’t seen such a clear, concise, collation of all that detail. [00:27:25][11.9]

Dr Louise: [00:27:27] Yeah. So, well hopefully there’ll be lots and lots and this will, just empower people to think differently I think. And what you were saying even about your show making menopause positive, making it healthy as possible, making it something that is right for each individual as well. Because, you know, neither of us are judgemental about others. We just want women to be able to decide and do what’s right for them. So really great that you’re coming over to do the live podcast, in real life. Just really wanted to ask you three take-home tips. So I always ask for three tips. So three reasons why you think people should either buy a ticket for themselves or buy a ticket for somebody else to come to see us in the show. [00:28:13][46.6]

Anne: [00:28:14] I think that it’ll be a wonderful night out. I think I just know from touring around my own show, it is a real sharing experience. So, I’ve had three generations of families come along, daughter, mum, grandmum. So there’s a wonderful sharing and, have a good laugh, but learn. [00:28:37][23.7]

Dr Louise: [00:28:39] Yeah, yeah. Really good. So I’m going to give my three, which are like I give my three reasons why people could come. I think firstly it’s going to be a different event. It’s not going to be something that people have heard before. So for new content, really important. The other thing is the availability that they will have more of my knowledge that I can share to people, hopefully in a way that people can understand and take home from. And obviously, thirdly, the opportunity that people can ask questions and have answers. Some of the shows I’ve got some of my doctors who work with me are going to be there in the show as well so in the interval, so they will be able to answer questions, but obviously I’ll answer questions on the stage as well. So thanks ever so much Anne for coming today. It’s been wonderful having you here in person to do my podcast. [00:29:28][49.6]

Anne: [00:29:29] My pleasure Louise, and it’s just wonderful to meet you. [00:29:31][2.4]

Dr Louise: [00:29:32] Thank you. You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk and you can download the free balance app on the App Store or Google Play. [00:29:32][0.0]

END

The post All about Dr Louise’s theatre tour Hormones and Menopause: The Great Debate appeared first on Balance Menopause & Hormones.

This week Dr Louise is joined by Aoife O’Sullivan, a family medicine doctor who trained in Dublin before completing a second family medicine residency at the University of Maryland.

After taking some time out to complete extra training in perimenopausal and menopausal care, including Newson Health’s Confidence in the Menopause course, Dr Aoife is passionate about providing more comprehensive and holistic care to women during midlife.

Dr Aoife share the ways clinicians, and all people, can educate themselves in order to improve the health of women in the US, and across the world:

1. Take every opportunity to learn and educate. So join any local healthcare Facebook groups and pass on links to the Confidence in the Menopause website, the balance app, etc. Even if you reach one or two people like that, it will make a difference and they might reach another one or two people.
2. Share small bites of information because it can be a little overwhelming. So when you’re trying to reach somebody, give them small amounts of information at a time.
3. Harness the power of friends. If everyone informs their friends and they all go to their doctors, obstetricians, gynaecologists and urologists, and ask questions, it will fuel discussion and increase knowledge.

You can follow Dr Aoife on Instagram @portlandmenopausedoc

Find out more about the Confidence in the Menopause course and click here for more about Newson Health.

Transcript

Dr Louise: [00:00:11] Hello, I’m Doctor Louise Newson, I’m a GP and menopause specialist, and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So today on the podcast, I’ve got another American guest although she’s not American, she lives in America, she’s Irish and another healthcare professional, another doctor who reached out to me a while ago and just shared some really inspirational words and offered to come on the podcast so we can have a talk about education, about how much we learned when we were younger about the menopause and how much we wish we’d learned and what we’re doing about it really. So Aoife has kindly agreed to come onto the podcast today. So thanks Aoife for joining me. [00:01:34][83.4]

Dr Aoife: [00:01:34] Thanks so much for having me. [00:01:36][1.2]

Dr Louise: [00:01:36] So everyone can hear this in those words that you don’t have an American accent, do you? [00:01:40][3.5]

Dr Aoife: [00:01:42] When I go home to Ireland, people tell me I have an American accent. Yeah. [00:01:45][3.0]

Dr Louise: [00:01:45] Oh really? So you are from Ireland, but where did you do your medical training then Aoife? [00:01:50][5.6]

Dr Aoife: [00:01:51] I did it in Dublin in the Royal College of Surgeons. And then that was back when you could do your own GP scheme after med school. And so I did three years of my own GP scheme and then we moved over here to America, Baltimore, Maryland, first of all. And back then they didn’t accept any schemes done outside America. So my husband and I both had to go back and do residency all over again. [00:02:18][27.1]

Dr Louise: [00:02:18] Gosh. [00:02:18][0.0]

Dr Aoife: [00:02:19] Yes. So I did a second GP scheme there and then have been working since then. [00:02:24][5.8]

Dr Louise: [00:02:25] And whereabouts are you based now? [00:02:26][1.1]

Dr Aoife: [00:02:27] About eight years ago we moved over to the West Coast, to Portland in Oregon. [00:02:31][3.7]

Dr Louise: [00:02:32] Nice. So and you work as a family physician, a GP. [00:02:35][2.7]

Dr Aoife: [00:02:35] Yeah I do, I’m in a clinic with five other working mums and we have our own little clinic just doing our GP thing. [00:02:43][8.1]

Dr Louise: [00:02:44] Great. So I mean healthcare is quite different in America to the UK of course. And every country has its own advantages and disadvantages, doesn’t it? [00:02:52][8.5]

Dr Aoife: [00:02:53] It really does, yeah. The healthcare system is different over here. It’s all insurance based. And so you know there is talk about moving to a healthcare for all system. You know something like the NHS. But there’s always pushback about that as well. There are pros and cons to the government controlling healthcare too. [00:03:13][19.9]

Dr Louise: [00:03:14] Course there is. And you know, actually it’s just five years since we opened our clinic over here, which is a private clinic, which actually causes a lot of aggro, which you picked up quite rightly on, on social media, because there’s something, it’s really, really weird, actually, when I set my clinic up, as I’m sure you know, I wanted to work in the NHS and continue working in the NHS. And then I couldn’t find a job, I couldn’t find a clinic where I could work. And so I started off just one day a week working in a local private hospital. And then we set up a dedicated private menopause clinic. And the amount of flak I get because it’s a private clinic. And actually it’s interesting because if I was still working in the NHS and doing part time NHS, part time private, I think it would be fine. And also if I was an orthopaedic surgeon, earning a lot more than I do doing a lot of private work, it would be fine as well. Or, you know, another specialty. It’s really interesting and I think it’s because it’s probably well it is that I know of the first GP-led menopause clinic that’s private and it’s large. But as many people know, we give a lot of our profit back to education, to balance app, to everything else because we don’t have external funding for any of this. But it doesn’t seem right if people still don’t want to see that it’s a good thing that I’m trying to help as many people as possible with very limited resources. I think it’s harder when you do have this two system, because then it feels like a two-tier system. And I know a lot of people, especially even doctors that come and work with us, are really surprised that actually what we are doing is seeing women from all socioeconomic backgrounds who actually just want choice about their future health. And a lot of people, we see, are very grateful just because they’ve had time. They’ve had someone to listen to, someone who actually understands. But you shouldn’t have to pay for that, really. But it’s difficult, isn’t it? [00:05:07][113.8]

Dr Aoife: [00:05:08] Oh, yes. And it’s absolutely to do with women’s healthcare, because historically, you know, once we’re done having babies, you know, we’re not they’re not very important anymore. Yeah. I came across a meme a while ago, and it was an old lady cleaning out a big bookshelf, and she came across a massive big novel and it said how to incorporate the arms into Irish dance. Because I don’t know if you’ve seen Irish dance, but you keep your arms straight down by your side. And that really made me think about my medical career. I feel like I have been missing this massive volume of information for my whole career. I started med school almost 30 years ago, and I feel like I’ve been working from one volume when it was actually a two-part series and, you know, when I came across you and doctor Heather Hirsch and some other doctors over here who are really kind of fighting the good fight as well. Kelly Casperson, Rachel Ruben and Mary Claire Haver. I mean, this whole other world opened up for me. I just, I thought back over all the women I’ve seen over my career and how I just did not see it was like they were speaking another language and I didn’t know that language. You know and now when I, when I see a patient and I look at their problem list, I’m like, oh, you know, probably six of those things are all to do with lack of oestrogen. It’s really been eye opening and for me life changing. [00:06:44][96.1]

Dr Louise: [00:06:45] It’s quite something actually and I was talking to a big event today and it was for firefighters actually, and for people all across the country that work with the fire service. And when I talk and present and talk about the symptoms, talk about the health risks, talk about the injustice to women not being allowed an evidence-based treatment. There’s a lot of anger actually in the room as well. And I feel quite angry. And I feel like I’ve not been privy, like you say to this information that would have been, made such a difference to patients in the past, and you only know what you’re taught. And so I never knew what the symptoms of oestrogen and testosterone deficiency were. All I was taught about were flushes and sweats and vaginal dryness. And so the number of women I’ve literally sat there and thought, well, they’re not depressed, I’ve done their thyroid function tests, I’ve done their blood count. They’ve been back and forth with palpitations. They’ve been back and forth with urinary tract infections to the hospital. They’ve, you know, it’s awful. And then I remember one of my patients, well, she probably would be about 80 now, but I saw her when she was between 60 and 70 years old, and she was on diazepam, and she was one of the few patients we still had on a sort of almost a repeat prescribing of diazepam. And we were trying to get her off it. And every time we reduced, it was awful for her and she’d have some difficult times. She’d gone through a divorce and various things, and she was having trouble with one of her sons, but never once did I think or say to her, what was your menopause like? What were you like before your periods stopped? It was like she was just that this almost, and I ended up seeing her because everyone was getting annoyed because they said, you’ve got to stop her diazepam. And I said, But I’ve tried and there isn’t any. And she was aware that it was addictive. She’d tried other medications, and so we did carry on in a very low dose of her diazepam. But I just think back, oh my, why didn’t I think, why didn’t I think? And I feel cheated and robbed from that like you say that volume two. But now it’s out there. And as you know, it’s very, very rewarding, transformational medicine. There’s very little in medicine where I can see someone and think, do you know what? I can make you feel even a little bit better. And I know I can improve your future health in a way that no other medicine I can think of that does. We sort of always been told off for it, and sort of every time I go to meetings, I feel like I’m a nuisance because people are now asking for HRT and they’re being prescribed it, and people just say, oh, all she does is prescribe HRT. Well of course I don’t. All I do is listen to women and decide what the right treatment option for them is. And I go by the guidelines that are very clear that it produces more benefits than risks, but it still seems, I don’t know, it’s weird, isn’t it? [00:09:29][164.2]

Dr Aoife: [00:09:29] It is rage inducing. I mean, just I feel so much guilt and horror when I think back over the women that I’ve seen. And I completely missed the diagnosis because I just did not know it existed. You know, all those years in medical school, two residencies and honest to God, I don’t remember one bit of training apart from, like you say, some hot flashes equals menopause. And, you know, even though I didn’t put the pieces together, you know how we say we think our phones listen to us? I honestly think my phone put things together for me because I, you know, went through a period where I was just so exhausted, my hair was falling out, I had no energy. I was worrying about everything. And I went to my GP and I said, what is wrong with me? And she said, you know, I think you’re depressed. And I said, but I treat women with depression every day. I don’t think I’m depressed. I don’t feel sad. Everything in my life is going great, thankfully. I just don’t seem to be able to actually enjoy it. And, you know, I walked out of there with a prescription for Wellbutrin, just like most women do. And it was after that that things started popping up on my Instagram. So your page started popping up, Heather Hirsch’s page started popping up, and that was when I started to see videos. And that was for me, a doctor with nearly 30 years of training behind me, that was how I learned everything I know about menopause. It all started with that. With your little video clips and some other doctors, and it went from there. And I ended up, I finished a previous job and decided I was going to take some time off between that and my next job and just study everything I could about menopause. And so I did your Confidence in the Menopause course, which was incredible. And then Heather Hirsch over here has a course as well for clinicians. And then the International Menopause Society has a free course that clinicians can do, call the IMPART course. And then I have the NAMs exam coming up next month, the North American Menopause Society. So I just I crammed it all into six months and tried to learn everything I could. And I’m now using all of that at work and also trying to, you know, talk to other doctors about it as well and spread the word a little bit because, you know, a year ago, if you’d said to me something about HRT, the first thing that would have come to mind would be, oh, no, isn’t that dangerous? Like, I don’t know anything about that, but I heard some connection between it and breast cancer. And so that is still invariably when it comes up as a topic, when I’m talking to another doctor, it’s invariably what they believe still too. [00:12:15][166.0]

Dr Louise: [00:12:17] It’s really hard to change people’s perceptions, really difficult. And, you know, nothing we do in medicine is without risk actually. Even avoiding medicine is not without risk. And there’s a lot of pushback in the work I do say, well, what about the harm or perceived harm? And what about the breast cancer risk or womb cancer risk? Well women will develop breast cancer who take HRT, they will develop womb cancer when taking HRT. They will have car crashes. They will, you know, forget to clean their teeth. They will have other issues. But that doesn’t mean the HRT has caused it. And I think this is where it’s really difficult.

Of course, we’ve got a handful of women over seven years who have developed breast cancer, while they’ve been taking HRT, and many of those have chosen to carry on because of the improvements in their health, health improvements. But we can’t prove that it’s been caused. And then we have to think about patient choice as well. But I do think you’re absolutely right. The more you read about the benefits of HRT, the more I think we need to turn things on our head a bit and say, well, what are the risks of not taking HRT as opposed to what are the very, very small risks? You know, a colleague phoned me today and she’s had an abnormal mammogram. And the first thing that the doctor said was, oh, you’ve been on HRT for six years. That’s a real worry because it increases risk. And I said, but actually the type of HRT you’re on hasn’t been shown to increase risk. The study he’s quoting isn’t associated. It’s not relevant for your type of HRT. And she needs more tests, they don’t know what’s going on, but it’s just that knee jerk reaction that they’re, let’s blame the HRT prescriber. And this colleague I know drinks quite a lot of alcohol. She doesn’t quite exercise as much as she should do. Her mother had breast cancer. There’s all sorts of things that might happen that could increase her risk of breast cancer. But then the women are made to feel really guilty. And I think that’s a real problem as well, isn’t it? Because, you know, we’ve all seen people who have had lung cancer who smoked. The last thing I’m going to do is say to person well, if you hadn’t smoked, you wouldn’t have got that lung cancer, because I’ve always also seen a lot of people with lung cancer who have never smoked. So even though we know the cause and effect very different than with HRT and breast cancer, cause and effect with lung cancer and smoking is established. But not every lung cancer is caused by smoking. But actually with HRT there isn’t a proven, with the body identical hormones, associated risk. But it still sort of goes on and it’s this undercurrent, isn’t it? That’s happening. I mean, what’s it like in America? Because American doctors tend to be very risk averse, don’t they? [00:15:46][208.8]

Dr Aoife: [00:15:47] It’s exactly the same, if not worse. And so I really feel like you almost have to change people’s minds one by one. You know, like I make phone calls to if I have a minute. I’ll try and catch someone’s specialist who has said to them, oh no, don’t do that because HRT is dangerous and just even try and chat to them. And you know, I remember what I was like as well. If someone had called me and said, well, hey, you know, did you realise that you know, that information is 20 years old? It wasn’t accurate. We have newer information. It’s better and it’s more accurate. I would have been like, oh, OK, I’ll have a look at that. Thanks very much. You know, I have two separate friends over here. So one of them went to their doctor to talk about HRT and was told, no, that’s dangerous. And, you know, were sent away. And the other one went to their gynaecologist and said, you know, can I talk about HRT? And her doctor said, you know what, I really don’t know much about that. And she had come prepared. You know, she had stuff from the balance website and some other articles and gave it to her doctor, and her doctor was really receptive to it and took it home and went through it all and educated herself. And she went back to her and she left with her HRT, you know. So it’s almost like just doing it person by person to try it. But that’s a very slow process. [00:17:13][85.6]

Dr Louise: [00:17:14] Yes, totally and that’s sort of what I’ve done over here. And it’s interesting. So when I opened my clinic obviously five years ago and then it got very busy and I said to one of the directors, Marcus, we’re not doing enough. He said, well, we are Louise and in business you focus on one thing and you get it right. And I said, no, but I can’t bear all the suffering. I can’t bear what’s going on. And I decided to develop balance, obviously, the website, the app and all the information on the website, of course, as well. And then I said to him, well I want to do this education program and I want to do it remotely so anyone can access it. And he said, and he’s a businessman, he’s not a doctor or a clinician. And he said, but the problem is Louise, if you educate all the women and you educate all the healthcare practitioners, you won’t have a clinic. And I said, wouldn’t that be wonderful? Actually, because I can’t bear the stories. And actually what I hopefully will we be meeting then are the more complicated patients who really need my knowledge and experience and so I can really advise them. So women have had breast cancer or have had complicated medical history. But it’s still not happening. And I think what’s happening certainly over here in the UK, but I can see in some other countries is that women are educating themselves at a speed that’s quicker, but also women are helping other women. You know, at this conference today, there were men as well as women from the fire brigade, but they’re all just the volume, as you can imagine over lunch was huge with women just being it’s like they’ve been allowed to talk. Once I can start to talk about vaginal dryness and libido, but also the anxiety, the low mood, the memory problems they know they’re not alone because they’re looking around the room and going, yeah, that’s me, that’s me, that’s me. But actually what we can do as healthcare practitioners is actually say, but there is a treatment. So I think before they’ve been talking themselves around in circles and say, well, how long do your symptoms last for? How long do yours? Oh my goodness, that sounds awful. Well, hopefully mine will go. Well how much more do I have to endure? Whereas actually today it was a real change to other conferences I’ve spoken at because the women were like, it’s quite outrageous for them because they’re hearing about this evidence-based treatment. And then they say, but why haven’t I been offered it? Why wasn’t I given it? Why am I given antidepressants or and so they’re the ones like you say who I know will go and educate the healthcare practitioners, which is great, but then it has a spinoff effect that the healthcare practitioners just think I’m sort of forcing people to take HRT. And of course I’m not. I’m allowing people the choice to be exposed to that information. And it is that thing like you say, once you see it, you can’t unsee it almost. And even today I was doing a book signing and women were coming up, and even before they open their mouth, I could just look at them and think, oh, this poor lady needs HRT, this poor lady. And you know the stories that they tell me. I saw one lady who was very overweight and she’d waited two years to see a gynaecologist in the menopause clinic, and she’d been given a 25 microgram patch, which is a very small dose. She looked quite young. She looked in her 40s, and she said, I’ve been told I can only have this for a short period of time, and if I don’t lose weight, they’re going to stop it. [00:20:21][187.3]

Dr Aoife: [00:20:21] Oh my gosh. [00:20:22][0.4]

Dr Louise: [00:20:22] She’d waited two years for that advice. And I said, does anyone talk to you about different doses or about testosterone? No, that’s all I can have because of my weight. And I said, well, and she knows like I do and you do that, there is no clot risk with through the skin oestrogen. And some people absorb it differently. Some people do need higher doses. 25 micrograms is a quarter of the license dose. It’s a very, very small dose for someone who looked quite young. And I thought, what a shame. Not only has she waited two years, but it’s been affecting her job as well. And there was another lady talking on the stage today who was in her 50s but she had taken an early retirement. And she now knows the symptoms. She knows what’s going on, she knows she’s menopausal. And she actually said, if I knew then what I know now, I wouldn’t have taken early retirement. And I feel like I’ve wasted these three years. Been always sort of fobbed off with, you know, different diagnoses and everything else. And now it’s happened I don’t want other people to make the wrong decisions about their job. It’s very brave of her to talk so openly and candidly, but we shouldn’t be listening to stories like this. [00:21:31][68.7]

Dr Aoife: [00:21:31] You know, I wonder how many women, if we knew the truth, had taken their own lives, had lost their marriages, had left their jobs because of menopause? I would just say the number is extraordinary. And honestly, I know this is like flogging a dead horse, but we would not be having this conversation if this was about men. [00:21:53][21.1]

Dr Louise: [00:21:53] No. You know, absolutely wouldn’t. And it is really sad that we’re even having to have conversations about the menopause in this way. And there was another lady actually today talking on the stage. She was only 32. She had very severe endometriosis that she had for many years, took a long time to be diagnosed and it was quite severe. So she ended up having a hysterectomy and her ovaries removed to try and reduce her symptoms of her endometriosis. She had to wait so long for surgery they’d stopped her hormones working medically with an injection. So she went into a medical menopause, which was horrible. But she said oh, at least it prepared me for what I was going to have to happen to me. And then she had a hysterectomy. She said she had to battle to get some oestrogen, but it took so long to get that she didn’t dare ask about testosterone. And she said, all my friends, a lot of my friends have, are have been pregnancies, they’ve got young children, she’s got two young children. I’ve had to get my head around the thought of never being able to have children again, which is one thing. But I will say, who do I talk to about my vaginal dryness? She said I adore my husband but my libido is gone. Our sexual relationship is really difficult. And she said, and now I’m thinking about all these symptoms that I will have to endure, that I will have now I’m menopausal. And Rebecca Lewis was there with me because she was talking, and we both looked at each other and I knew we were both thinking, but she doesn’t have to endure those symptoms. She doesn’t have to think like that. Because if you get the right dose and type of HRT, you should have minimal or no symptoms and you should just have a healthy life as much as you can. The same way, if someone had an underactive thyroid gland, they shouldn’t have symptoms of their thyroid deficiency, should they? [00:23:36][102.7]

Dr Aoife: [00:23:36] It’s exactly the same. Yeah, I just think of it like that now. That’s what it means to me. I would never check a TSH on a woman and see it’s sky high and do nothing. You know, I mean, that’s malpractice, honestly, or negligence or just unethical and immoral as well to do that to somebody. [00:23:59][22.6]

Dr Louise: [00:24:00] Yes, yes. And that is a problem. I mean Philip Sarrel over in the USA has been looking at the costs, economic costs actually, of women not being given HRT, especially young women who’ve had an early menopause because of surgery. And still it’s still a small number proportion of women who, once they have both their ovaries removed and have a hysterectomy, are given HRT, which is just dreadful actually. You wouldn’t remove anyone else’s organs that was producing hormones and not allow them to have those hormones back. And some of his work goes back as far away as the 80s and 90s, and it still hasn’t moved forward. So how do you think we can change, like in America? What do you think is going to make the biggest difference to improve health of women so that they can have HRT. [00:24:46][46.2]

Dr Aoife: [00:24:47] Women. I think, like you say, I don’t know if there’s ever been an instance like this in medicine before where our patients know more than we do and come in armed with information and knowing the correct way to manage a disease or a condition and their doctor doesn’t. Like, I can’t think of any other instance, apart from rare conditions where a patient will do a deep dive because they or their loved one has something and you know it’s not well known. [00:25:16][29.1]

Dr Louise: [00:25:17] I think one of the other areas of medicine I was thinking about recently was HIV medicine, actually, which is something that we had to learn very, very quickly because HIV came really quite quickly in the 80s with quite a high mortality and morbidity, which thankfully it doesn’t now. So lots of new drugs were coming on the scene, lots of potential side effects weren’t there as well and interactions with other drugs. Quite complicated medicine to learn in a short period of time. And a lot of people living with HIV got to know a lot very quickly. And they really and I’m sure you have I’ve seen people HIV who literally would tell you the drugs and I couldn’t pronounce some of them. They would know exactly, they’d know what they’d interact with, really empowering stuff, actually. And that was in the sort of 80s, 90s when people didn’t really have the internet, they didn’t have this sort of rich appetite for knowledge, as patients do now. And certainly I don’t know if you know our Confidence in the Nenopause course that we’ve just relaunched, we’re making it available to anybody. So it doesn’t matter whether they’re healthcare professional or not, they can have access to exactly the same information and training about the menopause, which I think is going to be really important. I know some healthcare professionals might not like it, but I feel very strongly as a menopausal women who has been a patient and still is a patient for my menopause specialist and also as a doctor, why should I know different information just because I’ve got a different job? It’s really important, and I think the way a lot of medicine should be going really, don’t you? [00:26:42][85.6]

Dr Aoife: [00:26:44] Yes, absolutely. We just need our clinicians to catch up. And, you know, I can see why it’s difficult. I mean, there’s no time. You know, you see your patients all day, you go home, make dinner for your kids, get back on the computer to finish your notes. It’s just constant and nonstop. There’s no time to stop and study something that you’ve never been taught about and know nothing about. [00:27:09][25.3]

Dr Louise: [00:27:09] Absolutely. And then I think there are misconceptions. So, you know, I’ve been to meetings and people say, well Louise, it’s just a lifestyle drug. People take it because they want nice skin and hair. And it’s really frustrating because of course they don’t. And then some people will say, well, Louise, you know, people are coming to the doctors who had never come before, and they’re now demanding a treatment that they think is going to improve their symptoms. And we should be considering other treatments as well. But then I also think, and I know actually from science that women who take HRT have less risk of disease. They have less symptoms. So actually these women are less likely to go to their doctor. So even if you invest a bit of time and money and effort now, it’s going to reap dividends going forwards, isn’t it when we look at future health economics too? [00:27:58][48.6]

Dr Aoife: [00:27:59] Absolutely. And you know, sometimes when I think about this whole situation, it’s really hard to feel that you are not wearing a tinfoil hat. I mean, it just feels like there are so many obstacles in your way and so many fights, you know, why do you need five years of information on testosterone to get something passed for women and six months for men? You know, it’s just it’s very hard to feel like you’re not imagining some conspiracy. [00:28:27][28.2]

Dr Louise: [00:28:30] Well, someone a while ago, a professor who I know quite well, who’s nearly retired, amazing person, said to me about 5 or 6 years ago, actually, when I opened my clinic, oh no it was seven years ago, I opened my, my website, which I used to call Menopause Doctor, and someone had phoned me up and told me to take it down because they had a menopause website. And I was like, what’s going on? We can have loads of websites can’t we on different conditions? And he said to me, Louise, I think there’s a conspiracy theory. I don’t know why, but I think there is. And I was like, really? But surely as a doctor you just want to help people. And I realised more and more there is and I can’t quite understand why it’s happening, but it does. But I think you’re right. Well, I know you’re right, because women know and actually, the truth always wins, doesn’t it? And I think all we can do is sort of work together. And actually with the work I’m doing, I’ve met some really vile people, but I’ve also met some incredible people. And, you know, they’re the people that will carry on with the messaging and carry on understanding the science, understanding the good of the work that’s being done. And so it is this sort of groundswell of people, which is on a positive day, it’s really exciting to watch actually, I think. [00:29:41][71.2]

Dr Aoife: [00:29:42] It is. It really is, yeah. I suppose I surround myself with that now. So I get that feeling a lot. Where, well, we’re getting somewhere. Something’s happening. The ball is moving. So yeah, it’s nice to be surrounded by that. [00:29:56][13.9]

Dr Louise: [00:29:56] Yeah, yeah. Good. Well, we’ve got a long way to go. But before we end, I’m very grateful for your time obviously, but I’m really keen for three take-home tips really. So three things that you think in America would make the biggest difference over the next five years to improve the health of women. [00:30:13][16.5]

Dr Aoife: [00:30:14] So you know my main thing is how do we educate clinicians? So my top three tips would be you know take every opportunity, every time something comes up with a colleague or you know for me I’m part of a couple of Facebook groups over here. One of them is here in Oregon called Oregon Physician Women’s Group. And occasionally it’ll come up, someone will ask a question about HRT, and I jump straight on it and, you know, give links to the Confidence in the Menopause website, the balance app and things. So just trying to reach even if you reach 1 or 2 people like that, it will make a difference and they might reach 1 or 2 people. And then the second tip is to share, I think, small bites of information because it can be a little overwhelming. And I remember even starting your course, listening to the first few videos, and I was like, I couldn’t even figure out the names of the oestrogen and progesterone and Utrogestan. And like, you have to go kind of slowly. So just when you’re trying to reach somebody to give them small amounts of information, give them a link to the Confidence in the Menopause course or the balance website, something small that they can go to and not feel overwhelmed. And then the third thing for me is what I’m trying to do is harnessing the power of my friends. I have some great groups of friends, big group of Irish women over here, and you know, each of them tells a bunch of their friends, we’re all in different friend groups, and they’re all going to their doctors and their obstetricians and gynaecologists and their urologists, and they’re all asking questions. They may not necessarily want to leave with a prescription of HRT, but they want to know what their doctor knows and they want to have discussions about it. And so they’re my top three tips to how we can get there eventually. [00:32:09][114.5]

Dr Louise: [00:32:09] Perfect. And I think that’s the same in all countries actually. Everything that you said should happen in every country. And some countries are doing it quicker than others. But it’s great. And I think the power of social media, the power of being able to reach, even just doing this podcast, a few years ago, it wouldn’t have been quite so conceivable that we could work in this way. So we’ve got to use it in a very positive way and use this positive energy to really help people and try and deflect the negative energy so we can keep going. So thank you ever so much Aoife for your time today. And maybe come back in a few years and we can see where the conversation’s gone to then. But thank you ever so much. [00:32:46][36.8]

Dr Aoife: [00:32:46] That would be great. I’d love that. Thank you. [00:32:48][2.0]

Dr Louise: [00:32:53] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk, and you can download the free balance app on the App Store or Google Play.

ENDS

The post Spreading the word about menopause care in the US, and beyond appeared first on Balance Menopause & Hormones.