Advisory: this episode contains themes of suicide and topics which listeners may find upsetting.

In this week’s podcast Dr Louise Newson is joined by Lisa, who shares her deeply personal and challenging journey through perimenopause, mental health struggles, and the impact of her experiences on her family.

Lisa discusses the devastating effects of her mental health decline, which led to a crisis point and ultimately a prison sentence for attempted murder. She also reflects on her time in prison, the realisations she had about her health, and the transformative impact of HRT on her recovery.

The conversation also delves into the impact of hormonal changes on women’s mental health and the often-overlooked connection between hormonal imbalances and criminal behaviour. Dr Louise and Lisa also discuss the importance of education around hormonal health, especially during perimenopause and menopause, to prevent tragic outcomes such as suicide and criminal behaviour.

Click here to find out more about Newson Health.

Contact the Samaritans for 24-hour, confidential support by calling 116 123 or email jo@samaritans.org

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 them in. So today on the podcast, I’ve got the most incredible person with the most amazing and very inspirational, but also very sad and frustrating story with me today. So someone called Lisa who actually came to one of our events and shared her story. And my staff said, oh my goodness me, you’ve got to talk to Lisa. And so on a Saturday morning, I spoke to Lisa. and said, please, can you come and share your story on the podcast? It’s going to be a hard listen, but it’s a really important story. So welcome, Lisa. [00:01:37][85.9]

Lisa: [00:01:37] Hi, thank you, Louise, for having me today. [00:01:39][1.8]

Dr Louise Newson: [00:01:40] So it’s a long story, so we’re going to try and keep it as brief as possible so we can get as much information out. So if you just don’t mind, just by starting, Lisa, how old are you? [00:01:48][7.9]

Lisa: [00:01:48] I’m 54 now, nearly 55. [00:01:50][1.9]

Dr Louise Newson: [00:01:52] So we’re similar ages, and you’ve got two sons. [00:01:54][2.4]

Lisa: [00:01:55] I have, 22 and 24. [00:01:56][1.8]

Dr Louise Newson: [00:01:58] So tell me about things before it came to the bigger story, how your sort of health was and how you were and whether you knew much about the sort of perimenopause and menopause. [00:02:07][9.4]

Lisa: [00:02:08] I had sort of researched, knowing my age, I had researched about the perimenopause and the menopause and obviously I just did actually visit the GP with my concerns that I might be around the age and I was also struggling at the time I just lost my mum and there was a couple of events going on in the background. But I visited the GP twice, one was five months before what’s happened in this incident and I did request HRT then six weeks before my incident of what the story is about today. I did visit the GP once again, and it was just put down, I did say I was struggling, and they took me off the contraceptive pill and still wouldn’t put me on HRT. I just had a lot of brain fog. I was the one who did the research first around my age, and they just totally overlooked it and put me on antidepressants, for low mood. [00:03:04][55.8]

Dr Louise Newson: [00:03:05] And as we know, the role of hormones, in fact, all our hormones but oestrogen, testosterone and progesterone can have really beneficial effects in our brain. And the more we look at symptoms. the more we understand that obviously hot flushes and sweats can occur, but the commonest symptoms affecting people that we hear in the clinic, we see on the balance app where we’ve had thousands of people reporting their symptom, is the brain fog, the anxiety, the low mood, the memory problems, the poor sleep. [00:03:32][26.8]

Lisa: [00:03:32] That was me. [00:03:33][0.5]

Dr Louise Newson: [00:03:33] And we know that for many women, it’s really important, yeah. And you know, our hormones work as neurotransmitters and they can affect all sorts of pathways and antidepressants can help, of course, with people who are clinically depressed and they help serotonin levels, mainly they can help in other ways, but also oestrogen and testosterone can help serotonin levels, but they also help dopamine and they also help various parts of our brain to light up so we’re more likely to remember, more likely to have pleasure, more likely to sleep, just feel connected with life and our thoughts and our actions as well. So then what happened? [00:04:13][39.7]

Lisa: [00:04:14] You’ve explained it quite well. You do feel quite disconnected. You feel like, you know, you’re not being heard. So six weeks prior to what happened was I did go to the GP and obviously carried on struggling, not aware myself. And two weeks before Christmas, my son became ill and I just had this extreme anxiety off the scale. I cannot explain. I know I’ve always been a bit of a natural worrier, but I just knew this was something, I was just living in daily fear of everything and my mind was overthinking. I started to work in palliative care which was extremely distressing seeing the sights that I was seeing. So I was putting it down to events in life, but I was just so emotional I couldn’t stop crying and total brain fog. You just feel like you’re in a constant hangover state. You can’t explain it to anyone and you just feel completely different, out of sorts, you know. [00:05:08][54.1]

Dr Louise Newson: [00:05:09] So then what happened? [00:05:09][0.4]

Lisa: [00:05:10] So in between Christmas and New Year, something’s just clicked. I don’t know what happened. I beat myself up every day. How I’ve got to this point, but suddenly I was researching about my son’s illness and then there was some searches down in Google on the next rows down about peaceful way out and little did I know I had sort of started with suicidal thoughts, not wanting to die or anything or, but I just couldn’t see. I just got ended up in the darkest place that I can imagine, just thinking it was events. And you feel different and you just want the anxiety to end and I think it’s this irrational fear every day. I could feel myself, my mental health declining. I was looking after everybody at work and at home, but what I didn’t realise was my own mental health was declining and just trying to cope, but I just felt incredibly disconnected, in fear of everything. So I just couldn’t see a way out of everything. And then the suicidal thoughts started to occur. And then I actually contemplated suicide. But I couldn’t leave the boys behind. And I knew my son was struggling at the time. Two weeks before Christmas, I could feel myself declining even more. My son was poorly. So this overthinking just happened even more. I was going into bed overthinking and just really intrusive suicidal thoughts, which I’ve never had. I couldn’t see a way out for all of us. I actually thought I was protecting us all with this irrational thought process that has never been like this at all. And I did actually try to take my own life and my two boys. I’m, I’m totally mortified, ashamed, horrified. I ended up getting arrested and ended up in prison for almost three years. And it wasn’t until I ended up in prison, I didn’t even know then, and all I was doing was beating myself up every day wondering how have I got to this point. I’m in total shock, trauma, disbelief, and it was only when I started to see the TV in prison and ever so coincidentally, the timing of Davina McCall starting to raise awareness. It all started to click into place and I thought, oh my goodness, you know, this is exactly how I felt of all the other ladies. I had books sent in to prison. Everyone said it sounds like you’re on the menopause. I had no resources to research any of this in prison. So I had books sent in and this is when I started to realise the symptoms that other ladies and mainly celebrities were talking about were exactly the same feelings I had had. And it was just that turning point. And then I found out the ages of 50 around this age is the highest rate of suicide in women. And I just cried when I read that. And I thought, I’m in prison, nobody’s listening to me. [00:08:14][183.7]

Dr Louise Newson: [00:08:14] Yeah, I mean, there’s one thing knowing about the psychological impact of the metaphors is something else thinking about suicidal thoughts or feeling very, like you will do want to end your life. And I didn’t realise how common it was until I exposed myself to so many patients and so many women. women. Also, when I did psychiatry many years ago, I never was taught that any of these feelings could be related to hormones. And it’s only because giving hormones back to people and seeing the transformational difference to their brains, to their thoughts, to their intrusive thoughts, their dark thoughts, knowing it’s not just a placebo, it’s actually having a really important physiological effect in people’s brains. So you were in prison and I know in prison it can be very hard to access the right medical health. [00:08:58][44.4]

Lisa: [00:08:59] That’s right. [00:08:59][0.0]

Dr Louise Newson: [00:09:00] But you managed to see a doctor, didn’t you, in prison? [00:09:02][2.6]

Lisa: [00:09:03] I did, yes. [00:09:04][0.7]

Dr Louise Newson: [00:09:04] And they prescribed your HRT, didn’t they? What happened? [00:09:06][2.7]

Lisa: [00:09:07] Yes they did. I was prescribed HRT eventually and within not even two weeks it was just like a switch turning on and I’m in the worst environment, the worst situation, not knowing what I was going to receive as a sentence but all of a sudden I had this urge to fight, I had more energy, less brain fog, I still wasn’t sleeping in prison because it’s so difficult to sleep, you’re sharing rooms, there’s no privacy, but all of a sudden I just had this massive determination that I wanted to live, I wanted to fight but… I was still suffering in silence, I was invisible, nobody would understand. I was trying to convince my solicitor, barrister, all male solicitor, male judge, male barrister and it was brought up in the, I had to have a psychological assessment for the case and even they had mentioned menopause but this was not mentioned in court. [00:10:01][54.2]

Dr Louise Newson: [00:10:02] So did you have your sentence reduced at all? [00:10:04][1.9]

Lisa: [00:10:04] Only because they said to me if I pled guilty, they would consider less time and I would know, I would find out sooner. And to be honest, the state was in, I was in such shock, they said I could go to trial but I just knew I wasn’t up to that. So I did go down the route of pleading guilty. I was completely honest when I did get arrested that I just said I thought I was protecting us all and, you know, I didn’t feel right at all. But none of this was taken into consideration. I was actually initially told it was an eight year sentence, then it was down to five years, four months due to the guilty plea. But even then I was absolutely devastated. I was hoping I might get care in the community that people might realise that it was a menopausal and hormonal issue, which in turn also goes to the mental health side that’s been brought on or exacerbated by the menopause. It’s the fact, it’s the perinmenopause as well, is the fact you don’t, because you’re still having periods, you think you’re not on the menopause. [00:11:10][65.8]

Dr Louise Newson: [00:11:11] Yeah, absolutely. And you were in more than one prison as well, won’t you? [00:11:14][3.0]

Lisa: [00:11:14] Yes, yes, so you’re just transferred five -minutes’ notice, so one minute I’m in one prison in Cheshire, then I’m given five minutes notice, you go into another prison in Staffordshire, then I did open prison for four months in York. I came out of prison and had to go to a female hostel and I had to do that for three months, whether I wanted to or not, in Liverpool, nowhere near home again, and just the mental. It’s the worst environment and the way you’re treated. It’s the worst treatment for any kind of mental health, menopause. And it’s just, you cannot, you just feel invisible. It feels so archaic in this day and age. [00:11:52][38.4]

Dr Louise Newson: [00:11:55] It’s quite something. I’ve, as some people listening, and you know, I worked in Styal prison, women’s prison, many years ago, actually, in 2000. I did a week’s work and I’ve still got my notes there from when I used to admit people that came in. But the stories women told me, and it was very different. I’ve watched, I love Louis Theroux, and I’ve watched a lot of his documentaries about prisons, but it’s been in male prisons, and male prisons are very different. The crimes that they commit are very different. The way that they’ve lived their lives have been quite different. Whereas the women who I met, and I’m sure you met a lot, were quite almost naive, very vulnerable, lots of mental health issues. And also a lot of them had been abused in the past and felt they deserved the life that they lived. They couldn’t see a way out. And the more work I’ve done now about mental health and hormones, the more I’ve read not just about perimenopause, but also about PMS, PMDD. women are more likely to commit a crime in the days before their periods. And that’s because our hormone levels are lowest then. And someone called Katharina Dalton wrote about this many, many years ago. She actually was an incredible doctor that no one listened to and she went to my old school as well. Sadly, she’s died now, but she writes about going to trials, listening to women and knowing that it was related to their hormones and everyone just thought she was being ridiculous and she was ridiculed really. And she wrote some amazing academic papers about this, but people just still laughed about her and she was giving not just oestrogen but quite high doses of progesterone especially to women with PMS and PMDD with transformational results. But again, people didn’t like it. They didn’t like what she was doing, but it’s all there actually. And we also know that if people are addicted to certain drugs, especially class A drugs, more likely to switch off their ovaries, more likely to have lower hormone levels. A lot of these people have very poor diets. If they don’t eat well, then again their periods are likely to go off. If they’ve got sort of just a chronic illness and also a lot of the antidepressants and some of the antipsychotic medication that are often prescribed for the mental health issues will switch off our own hotmones. And so I’m sure most women in prison will have some hormonal issue, which is not being addressed at all. And I’m so keen to try and help educate people, but also a lot of people that work in prisons will be of menopausal age, as they are in other areas of work. And the people that work in prison, it’s a hard, really hard job. It’s a relentless job. They’re trying to do the best they can with very limited resources, with people in very difficult situations as well. And so to be perimenopausal or hormonal or menopausal when you work in a prison it’s really difficult as well. [00:14:52][177.0]

Lisa: [00:14:51] Amongst other women, yes. [00:14:52][1.2]

Dr Louise Newson: [00:14:53] But they’re a forgotten group of people, actually, a lot of the time. And as you say, you know, you put you away, that’s it, but you’re very eloquent the way you talk. You’re not someone who’s ever committed a crime in the past. You know, you love your children. It’s very irrational what you did. And I feel that it’s really sad that so many systems had let you down by not being able to think. [00:15:18][25.6]

Lisa: [00:15:18] That’s how I feel, yeah. [00:15:19][0.7]

Dr Louise Newson: [00:15:19] What’s the reason? Was there something else? And I know since you’ve come out of prison, you’ve had your HRT optimised a bit more. So you’ve got on the right dose and type of oestrogen, you’re on some testosterone and your brain is feeling different to how it was before, isn’t it? [00:15:36][17.4]

Lisa: [00:15:37] Totally. I mean, I was placed, I didn’t have a choice of which HRT I went on in prison, obviously. So I was put on a basic, you know, treatment, but there was still a massive difference and it was that realisation to me as well, that you just can’t explain it, to be honest. You know, when I was put on the HRT, you cannot explain to anyone how the clarity you start feeling, the brain fog has gone, but it’s the intrusive thoughts have gone and the anxiety has gone and I’m in the worst, most intimidating situation in the worst hell on earth situation. And then when I came to consult your clinic and I was placed on the latest treatment again, there was a massive improvement again. I’m now sleeping better, just full of energy. Just back to my normal bubbly self, how I was probably a good four years ago, even before prison. You don’t realise the decline that you’re going under due to lack of oestrogen and, and how it does, you don’t even know your own body and it’s frightening, really can be frightening how I look back. [00:16:43][66.1]

Dr Louise Newson: [00:16:44] Yeah. Absolutely, and I think the problem is we’ve all spoken about the menopause related to periods and so everyone is fixated on periods and when I was working with NHS England, the National Menopause Programme, somebody who was leading it said to me, we’ve spent hours discussing about periods, whether it should be, are they changing in frequency or are they changing in pattern or are they changing in the amount of bleeding? And I said, but do you know what, it doesn’t actually really matter. And he said well you’re telling me that women don’t know about their periods enough, so how do they know about their symptoms? I said because a lot of us have a period, it comes and goes, we don’t mark it in our diaries, we’re not bothered about it. But what we are bothered about is the way our brains work, the way our bodies work, the way we’re changing. So we need to get away from just thinking about periods. Women should not be defined about their periods. And a lot of women don’t have periods, or they might have unnatural periods if they’re on contraception. So what we should really be thinking about is about our hormones and the roles that they have in our bodies, regardless of when our ovaries actually finally stop working, as in the menopause. So it’s that sort of decline and change before, and we know with suicide rates, actually, they increase around seven times in women in their late 40s, and there’s a lot to make us believe that actually it’s worse in the perimenopause or it’s worse when hormone levels are changing. to change. Because our brains like homeostasis. They like everything the same. So that’s why, you know, our bodies are better if we sleep the same, if we eat at the same time, if we don’t abuse our brains, as in if we, you know, drink alcohol, we feel dreadful the next morning, because our brain doesn’t like any sort of metabolic change occurring in our body. But we know in the perimenopause, our hormone levels fluctuate. They go up and they go down, quite quickly sometimes. And so that change can really trigger a lot. So a lot of people, once they’re menopausal and they’ve got very low levels and they last forever, very low, actually their mental health might be affected but not to the way that you’re describing as you were before. And so we’re, as you know, we’re funding a PhD student from Liverpool looking into suicide prevention in the perimenopause and menopause. And she’s been interviewing quite a few of our patients actually and really getting to understand more. Because we need to have ways of being more aware, not just as healthcare professionals, but actually for women and their families and friends to understand so we can recognise it in others as well. [00:19:18][154.3]

Lisa: [00:19:18] That’s right, it affects everybody surrounding yourself. I mean, like you said, I didn’t even have problems with my periods ever, so I only went to the doctor’s thinking I’m around the same age, and even when I researched on the internet at the time, there was nothing about suicidal thoughts. You just see the physical symptoms online at the time, but it only seems now since I’ve come out of prison and I’ve started to do my own research that now, due to lovely, thankfully, people like yourself and other celebrities at the moment raising the awareness. I think the research is now coming out more so and going, you know, informing women about the mental health side. But I still think you don’t realise until you’re going through it how important hormones are. Yeah, you just feel, this is why you feel totally disconnected. [00:20:03][44.8]

Dr Louise Newson: [00:20:04] Yeah, and so many people, including myself, it’s not until we’ve got our hormones rebalanced, the right dose and type for us, that we look back and think, goodness, no wonder things are so hard. [00:20:14][10.0]

Lisa: [00:20:15] And then you start trying to tie everything in, thinking… [00:20:17][1.7]

Dr Louise Newson: [00:20:18] And obviously, you know, you’ve got a son that was poorly, you’ve had things going on, and you always, not ‘you’ always, but people contribute it to other reasons. They’ll say, well, I’m going to feel like that because I’ve had a difficult time or because of this or because of that. But actually, we’re all bad as women. Well not all, but lots of us are that we don’t reflect and internalise ourselves. And I think the other message is if we don’t get the help, care, advice, treatment from the first healthcare professional we see it’s really important to try and it’s difficult, I understand, to be the best advocate so you can go back and ask. And, you know, I think that’s the same with any treatment. You know, if you’re refused a treatment that you think is right for you, it’s okay to say, could you just give me a reason why you’re refusing it? Can you just tell me why I can’t have X, Y, Z? And that’s not just for HRT, that’s for anything. [00:21:10][52.0]

Lisa: [00:21:10] Yes. [00:21:10][0.0]

Dr Louise Newson: [00:21:10] You know, if I had an infection on my arm and the doctor said you can’t have antibiotics and I thought I needed them, I would like to challenge that in a nice positive way. And that’s the same, I think, with HRT and also testosterone. You know, we need to be thinking as women. Why aren’t we allowed our own hormones back? [00:21:27][16.6]

Lisa: [00:21:29] Well, you do trust the doctors too much. You do trust that they know what they’re talking about and you are putting your life in their hands. And this is how, you know, I took their advice. But I do, I know now, if I had have been put on HRT before this, I know I would not have ended up in this situation for definite. And that’s what’s so upsetting. This could have all been so prevented. It’s not just myself who’s suffered, my whole family, my friends. They said, it’s so out of character, you know, I’m so bubbly and caring, absolutely doted on my boys, did everything for them. They said they felt like mum had died when they’d gone into prison. And, you know, they’ve had three years of not being able to see me. We also went into COVID lockdown when I was in prison. So I was on double lockdown, couldn’t see any friends or family. I then caught COVID in prison as well. So I thought I’m going to die in prison. It was terrifying. I’m not an aggressive person. you’re put in with a lot of very aggressive women unfortunately and you know with really very serious crimes, you know, mine was as well but it’s just you just cannot get your head around how am I in this situation? It’s horrific. [00:22:41][71.6]

Dr Louise Newson: [00:22:42] Well, obviously, it’s horrendous. And I can’t, and I don’t think many people listening can really, really imagine what you’ve been through, Lisa. But what I’m incredibly grateful for is that you’ve been strong enough and brave enough to share your story. And what I don’t want to do in this podcast is say that every perimenopausal woman is going to think about committing a crime or end up in prison. Of course not. But there are women who are not being listened to, who we should be thinking more about how to help people in different ways and also how to address this inequality of care in prisons and to improve education about hormones in prisons as well. [00:23:22][39.2]

Lisa: [00:23:23] I think it’s also the NHS as well though because really they should have picked up that it wasn’t the usual, I know it’s a unique, terrible, horrific crime, but really, you know, I think maybe I should have had hospital care at the time or trying to get to the root of what has sent somebody to this extent when, you know, there was no thought gone into it at all, you just suddenly, you know, you’re just sent to prison. And I think they’re so snowed under these health practises that there’s not the correct process there either in place to distinguish, you know, whether somebody should be having care in the community or hospital care or whether they should go to prison, there’s no distinction at all. [00:24:02][39.0]

Dr Louise Newson: [00:24:02] So there’s a lot we need to do, a lot we need to change, and I really hope us all working together can hopefully make a difference. But before we end, Lisa, I’d really like to just ask you three take-home tips. So really three things that you think me, you, us, people listening could do to help the community of people in prisons, including those working in prisons. What three things do you think would make the biggest difference? [00:24:25][23.4]

Lisa: [00:24:27] Information for definitely. More awareness, people not just going off the awareness side of hot flushes, you know, I think there’s so many women suffering in silence, not knowing and you’d feel like you’re going mad, you really do. They need to be more explicit with that information. I think also there does need to be a lot more research of looking at someone’s age in relation to how they’re feeling and not just taking like you said the first answer from the doctor if they’re saying, you know, you’re fine or, you know, you don’t need HRT. Try and get a second opinion and fight for it. I was too soft. Again, just research it yourself more, to be honest. I think a massive point was for me, a turning point was Davina McCall’s Sex, Myths and Menopause documentary that was totally, this is the other reason. I thought, oh my God, this is what’s happened to me. and she’s stated everything in the documentary. How women aren’t getting diagnosed, they’re not being treated. [00:25:29][61.8]

Dr Louise Newson: [00:25:30] So there’s a lot we need to do, we need to educate people, we need to allow people to be advocates of themselves and we really need to just learn and talk and share. And it’s been brilliant having you today and I’m again really, really grateful for your time. Thank you. [00:25:46][16.5]

Lisa: [00:25:47] It’s okay. I’m doing it to save other women’s lives because it’s only when I came out of prison that I realised and I started to have the resources, the internet and everything to do my own research and realise how many women have committed suicide and it’s about raising awareness. If I can save one or two lives. It is horrific. I’m totally mortified having to share the story. I’m so ashamed. But I do realise now I have, it helps to know it was, what the cause was, was down to hormones. I’ve been treated on the correct medication. If I can help other women now, that would be worthwhile, you know, going forward. And I am here to help raise awareness now and work with people. You’re the first person I’ve shared this story with because I trust you so much. And you’re the only one who really understands apart from Davina McCall when I saw the documentary. And I can’t thank you enough for all the work you’re doing. [00:26:41][53.6]

Dr Louise Newson: [00:26:41] Thanks, Lisa. [00:26:41][0.4]

Lisa: [00:26:42] So thank you. [00:26:43][0.8]

Dr Louise Newson: [00:26:48] 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. [00:26:48][0.0]

ENDS

The post Perimenopause and mental health in prison: Lisa’s story appeared first on Balance Menopause & Hormones.

This week, Dr Louise Newson is joined by Professor Cassandra Szoeke, academic professor, general physician, consultant neurologist and multi-award-winning clinical researcher and author. As principal investigator of the Women’s Healthy Ageing Project, the longest study of women’s health in Australia, she authored the book Secrets of Women’s Healthy Ageing and has several hundred published articles in academic journals.

This week’s episode explores the topic of healthy ageing, including the connection between inflammation and chronic diseases, the importance of physical activity, mental health, and the role of nutrition and gut health in inflammation. Dr Newson and Professor Szoeke also emphasise the need for a holistic approach to healthcare and the importance of prevention.

Click here to find out more about Newson Health.

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 another guest from the other side of the world. So in Melbourne, Australia, I’ve got with me Professor Szoeke, who is director of Women’s Healthy Ageing Project, and she is also an author. She’s very active, academic and incredibly clever. So I feel very honoured that she’s agreed to join me on the podcast today, even though it’s very late at night for her. So thanks ever so much, Cassandra, for coming today. [00:01:27][76.7]

Professor Cassandra Szoeke: [00:01:28] My pleasure. [00:01:28][0.2]

Dr Louise Newson: [00:01:30] So I’ve, I don’t know whether you know, but some of my listeners know that I’ve got a pathology degree as well, and I spent a good nine months with a professor of biochemistry, actually. Sadly, he’s died now. I wish I could go back in time and ask him even more questions, because he spent a lot of time talking about monocytes and macrophages, which are types of white cells, and talking about how important they are to fight infection. But when they go wrong, they can become pro-inflammatory, so increase inflammation. And there are various circumstances in our environment that make our body become more against us, really, and increase inflammation. And I was sitting there thinking, oh, what’s this got to do with helping people with heart attacks? Or what’s this going to help people with cancer? Because I wanted to do cancer medicine. And then by the end of the whole course was a year, the BSc, but after nine months, it suddenly clicked. And I thought, actually, this is all related. Like the relationship of heart disease and cancer is there. Like dementia and osteoporosis is there, but no one had taught me this ever before. And that was in 1992, and lots of people still don’t understand. And so there is so much that is really relevant and even more relevant to the work that I’m doing now with hormones. So before we get into all the science, just keen to hear a bit about your background and – how you got to where you are now and what fueled your interest. [00:02:55][84.9]

Professor Cassandra Szoeke: [00:02:57] In Australia we have a very similar system of medical training to the UK. And so that means we do do general training as general physicians before we specialise in a subspecialty area of internal medicine. So I became a physician first, which is a very long, long programme. And then after that, did my training as a consultant neurologist. And then I did an epilepsy fellowship because of course you have to know everything about one little molecule nowadays. But I am a generalist in my heart and in my being. And so when I was moving into academia, I got really interested in healthy ageing because the area I actually looked at, would you believe, after doing an epilepsy fellowship was epilepsy and cognition. I of course had many of the younger patients as a young consultant neurologist. And they were on anti-convulsive medications and they were all at uni because I work at the hospital that’s associated with the university. And they were telling me that on these medications, they just couldn’t think as well anymore. So I got really into cognition. And when you start looking at these diseases, if I could say this, the disease we used to associate with ageing, thought of as ageing diseases. I suddenly realised that it was this whole encapsulated, inflammatory cascade. So all the chronic diseases of ageing have an inflammatory component to them. [00:04:17][80.2]

Dr Louise Newson: [00:04:19] Which is so relevant. And certainly as you might know, I trained as a physician as well. So had a long training and before going into general practice and no one really talked about ageing or what it meant. And even now, I don’t think so because you just Google ageing and it’s always anti -ageing face creams, isn’t it? It’s trying to keep us young rather than prevent ageing. And that’s quite different, I think. [00:04:42][22.9]

Professor Cassandra Szoeke: [00:04:44] Well I think there’s so many funny things about the word ageing and how it’s perceived in Western culture, perceived much better in Eastern culture actually. But I also think we forget that ageing was 27 in the 1900s, and 1960s ageing was 50. And it’s only in the last two decades, the mean age has been over 80, age of death. And so our perception of ageing is entirely different. And I know you’re interested in asking about hormones and ageing today. And I mean, just looking at what I just said, when the mean age of menopause is 50 and the mean age of death is 50, then you’re not getting many post -menopausal women to be able to do any research or do any study or have any knowledge about what is post-menopause for women. And yet today in your country in mind where women’s mean age is over 80. We’re living a third of our lives in post -menopause. So this is an incredibly important part of our lives that we know so little about. [00:05:45][61.6]

Dr Louise Newson: [00:05:46] It’s so relevant, isn’t it? And I think somebody recently actually at a meeting I went to, she said, Oh, it’s interesting, isn’t it? Because orca whales are the other mammal that has menopause and it’s all about nurturing and it’s about you being there for your grandchildren and your wisdom and knowledge as menopauseal women. And I said, I think you’ve missed the point actually, that’s part of ageing is great because when you’re older, you have got more wisdom, more knowledge, you can nurture hopefully better. You’ve got lots of life skills, but that’s not the same as being menopausal without hormones. And we can’t be tortured more than we are already by being not allowed our hormones that do more than just stop a few hot flushes or severe hot flushes for some women, but it’s more than that. And I think for many years they’ve been, because they’re referred to as sex hormones, but they’re not about sex and they’re not about gender. They are biologically active chemicals in our body that men and women. have them, we all, everybody has them in different quantities and amounts. But like you say, it wasn’t so relevant even a hundred years ago because we didn’t live so long without our hormones and the women that did, you know, we only need to look at the number of women locked up in asylums and, you know, mental health that was misdiagnosed perhaps when it could have been related to menopause. But now we look at the huge burden of disease because people are living longer. And sometimes it’s not, I’m not blaming everything on not having hormones, but it’s definitely a contributory factor. [00:07:20][94.9]

Professor Cassandra Szoeke: [00:07:22] And one of the things about the study which I lead here in Australia. It’s the longest running study of women’s health in Australia. And what makes it really remarkable is that we have those, it was a study looking from pre to post menopause, that’s how it was originally designed. And so it’s got all the oestrogen, FSh, LSH, all the measures, menstrual diaries, hormone therapy, all of that. However, It was run by a consortia, led by a psychiatrist, so all the mental health measures. And a consortia of physicians. So bone measures, as well as the hot flushes and all of that, and then also cognitive measures. And we have amyloid scans of these women’s brains. And that sort of study is really rare, actually. So you’ll get the menopausal studies that kind of stopped after menopause, having defined that transitional period. And so it’s actually really rare. I mean, I guess it’s rare to get any study funded more than three to five years let alone the fact for ageing, these chronic diseases of ageing. So I’m talking about osteoporosis, osteoarthritis, heart disease, diabetes, dementia, these take three decades to develop. So if you’re not doing a study for three decades, you can’t possibly see what’s actually going on. You’re taking snapshots here and there. [00:08:37][75.5]

Dr Louise Newson: [00:08:39] So what’s been the biggest things or the most interesting areas that you’ve found with your research so far? [00:08:45][6.5]

Professor Cassandra Szoeke: [00:08:47] Oh my gosh, I mean, our study has got hundreds of publications because it was going for a decade before I joined as a little PhD student. And I personally have more than 200 publications. That’s a huge question. It’s such a huge question. But you know, I will, you know, if there’s a sound bite I can give, it would be this. And it sounds trite, but it isn’t. If there’s one thing you go out and do for healthy ageing, whether it be brain… heart, bone, inflammation, mental health, the one thing you can do that’s best in all of these metrics in all the different papers we’ve done, it’s physical activity. It’s the one thing you can do that is actually the best for healthy ageing. [00:09:34][47.1]

Dr Louise Newson: [00:09:35] That’s so interesting, isn’t it? And I was at an event last night and we were talking about how to make the best of your menopause and make it as healthy as possible. And just as we get older, whether we’re men or women, and it’s something that I don’t think I was taught enough about as a medic. We talked a bit, or we learned a bit about osteosarcopenia, this loss of muscle and bone mass that occurs, but not the importance of exercise and regular exercise as well, which is so important, isn’t it? [00:10:05][29.6]

Professor Cassandra Szoeke: [00:10:05] Yep. Again, I think we have to look at the fact that we’ve increased our mean age of death dramatically, exponentially over the last two decades. And so we’re still playing catch up with what happens when we don’t die of a heart attack at 50 or of an infectious disease at 30. [00:10:23][18.0]

Dr Louise Newson: [00:10:26] Really interesting and relevant and obviously nutrition is a key part as well, isn’t it? [00:10:32][6.4]

Professor Cassandra Szoeke: [00:10:33] Well, you know, talking about inflammation today with you, the gut is a key role player in inflammation, it turns out, which is something that wasn’t known a couple of decades ago. But now we’re seeing there’s a gut brain axis, there’s a gut everything axis, and it’s because of inflammation. So that gut, that good microbiome, that’s actually having anti-inflammatory actions throughout the body. In addition to, of course, we need key nutrients and micronutrients that with the oversupply of food now, we can all get calories, but micronutrients are really important. In the old days, we had to forage for food. We were actually getting quite a few micronutrients in all of that veg that was predominant in our diet. [00:11:16][43.1]

Dr Louise Newson: [00:11:17] I mean, certainly people’s nutrition has really changed even over the last few decades, but we see a lot of women, and I speak to a lot of women, who have symptoms related to irritable bowel syndrome, so bloating, some heartburn, maybe some constipation, just those symptoms where in the past we would have diagnosed irritable bowel and given all sorts of treatments actually often really do improve with hormones and even testosterone can have a massively beneficial effect on people with heartburn and other bowel symptoms. But I do wonder how much is a direct effect of the hormones and how much is an indirect effect because the hormones are affecting the gut microbes. It’s just a really interesting relationship I think that hasn’t been explored enough that I’ve read, but I think it’s something that is so important. [00:12:08][50.5]

Professor Cassandra Szoeke: [00:12:09] I completely agree. We need to do a lot more work in that space. Not just that, but the mental health. So of course, the gut is highly reactive to anxiety. Everyone knows that because everyone gets butterflies in their stomach before they go on stage. So the gut is highly reactive to our mental health status. And of course, there’s a lot of evidence, especially in hormone responsive mental health, which is a new field that’s developed where people have gone through menopause and they’re resistant to some of the antidepressant medications and when put on hormones, actually improve. So it’s very interesting. We never knew there was hormone responsive mental health. [00:12:52][43.0]

Dr Louise Newson: [00:12:52] Hmm. And it is absolutely key. We see a lot of women who are in quite crisis, actually, mentally, when they come and see us and they’ve often been seen by mental health teams and been given different psychiatric medications, some of it quite heavy duty, and no one’s thought about the hormones. And I didn’t realise, even when I did psychiatry as a junior doctor, because no one had taught me. And now with these women, we often give them hormones for other physical symptoms knowing that they’re menopausal or perimenopausal. But the first time I did it, I didn’t really think that it would improve their mental health as much as it does. Certainly having the right dose of hormones but also testosterone as well has a massively, in my clinical experience, beneficial effect on mental health, which was something that has not really been explored much at all. It makes sense when we know the role of testosterone throughout our brains. But I’m not really sure why it’s been neglected so much when we know that our hormones are made in our brains and work as neurotransmitters, yet it’s sort of been all about periods and fertility when we think about not having our hormones. [00:14:02][69.8]

Professor Cassandra Szoeke: [00:14:03] I think there’s a labelling issue with women’s health. So I think often when they say women’s health, you know, people go, oh, right, tell me about boobs and bits. And so, you know, as a neurologist, I can tell you when I’m at a women’s health conference and somebody comes in late to the seminar and they slip in the back and they look up at the screen and they see a brain scan, they think they’re in the wrong seminar. Whereas, you know, to me, the leading cause of death in your country and mine, in women, leading cause of death is dementia. So how we can not understand that women are brains. So I do think a lot of women’s health has been done by obs and gyne, and they’re probably not so focused on the brain, but you know, as generalists, anything that crosses that blood brain barrier, because not everything does. It’s a pretty, that’s why we call it a barrier. You know, not everything crosses that blood bone barrier and oestrogen certainly does and has enormous impact on neural cells. [00:14:59][56.6]

Dr Louise Newson: [00:15:00] Yeah and I think that’s when you say I was at an event and it was about translational research which was great it was a real honour to be invited and they said oh Louise we’ve put you on this table number whatever and it’s with other women’s health researchers I said but I’m interested in health of women not so much women’s health and they sort of looked really and of course I’m interested in endometriosis and fibroids and period problems but I’m more interested actually cardiovascular disease and metabolic syndrome and dementia. It’s that change. I think being a woman who’s interested in health of women, immediately people think it’s gynae problems, or maybe like you say, breast problems, but it’s not. [00:15:43][42.3]

Professor Cassandra Szoeke: [00:15:44] I really liked the way you say that health of women, maybe that’s what we should be rebadging it as because that’s the bit that hasn’t been done really well. You know, you just look at the amazing investment that’s been done in my country. We have an endometriosis action plan. We have a national plan for PCOS. Breast cancer survival rates have been going up every year, which is incredible. So when you focus on things, you can really improve health. So maybe you’re right. We need to rebranding. [00:16:13][29.4]

Dr Louise Newson: [00:16:16] I’m pleased you agree. I totally think it’s so important when we look at, like you say, the diseases that are causing mortality, but also morbidity as well, you know, the longer we live, the more likely we are to have diseases and they are the diseases that are affecting us day to day. So it’s not so much, of course it is the age we die, but it’s our journey to that age and it’s how many times are we going to be admitted in our 70s and 80s to hospital? How is our cognitive state going to impair us? What about our physical state? Am I going to be dependent on a carer in my 80s? I absolutely don’t want to, I want to keep strong and physically and mentally healthy. And that’s what’s draining our healthcare system and I’m sure yours as well, is people who have diseases associated with ageing, but then there are other people that have accelerated ageing and more inflammation which is compounded by not exercising adequately, not eating the right foods, not having the right hormones and also looking at stress, looking at our gut microbe. There’s everything together. And I think so much in medicine, we can’t be siloed. You know, you as a neurologist, stopping your work at the blood lane barrier would be completely wrong. But there are a lot of neurologists that don’t look at the body. [00:17:38][82.7]

Professor Cassandra Szoeke: [00:17:40] I think you’re so right. Often when we say healthy ageing, people say, what does that mean? Because they’re so caught up in the word ageing. And I think ageing is something that’s a chronological measure of how many years we’ve been on earth and that doesn’t harm you. So there’s many people who die at 99 still carrying some logs up mountains in those so-called blue zones. where you can find people who are living very functionally and well into their 90s. So it’s not the age that’s the issue. We forget sometimes that age is also a measure of how many years we’ve been smoking, how many years we’ve had high blood sugars, high blood pressure, high stress, as you mentioned. I mean, the stress issue isn’t trivial. I know when we say stress, people might think we’re talking about being stressed out, but people who are lonely, who say that they’re lonely, we can actually measure that the immune system is depressed. They’re more likely to get infections. We can actually physiologically measure the damage to the body from people feeling lonely. So this idea of stress, I think we’re just scratching the surface of what that means for our long-term health. [00:18:51][71.6]

Dr Louise Newson: [00:18:53] Absolutely. And there are certain things that will increase the amount of stress that we have. So if we don’t sleep, for example, that’s going to increase stress, which is also going to have metabolic changes in our body. And I feel a lot of times, especially as a physician in the past, I’ve been just putting sticking tape on things. And I was reflecting recently about the medications that I prescribe now as a physician, and they’re very few. And it’s not because I’ve forgotten how to prescribe. But actually people I see don’t need as many medications. Whereas in the past, you know, I was prescribing a lot of statins, a lot of blood pressure lowering medication, a lot of painkillers, a lot of antidepressants actually for people because I was seeing things in isolation and I was very reactive in what I was doing because I was, you know, treating a raised blood pressure or treating a raised cholesterol. Rather than what I do now is taking a step back and thinking, well, why have they got raised blood pressure and why have they got raised cholesterol and what is their nutrition like? What’s their exercise like? What’s their hormonal status like? And yes, they might need short term some medication to lower their blood pressure to allow for their exercise, their nutrition, their hormones to be rebalanced properly. But I don’t start medications like that thinking I’m going to carry them on for decades. And certainly as an older GP, I would spend a lot of time deprescribing, which sounds a bit weird, but actually stopping medication is really rewarding, actually as a doctor, because it’s so easy, isn’t it, to add on more and more medications. And a lot of most medications actually do have side effects and a lot of them, we don’t know the long-term effects, do we, especially on cognition and our brain, but also on our bones and cardiovascular system. [00:20:39][106.6]

Professor Cassandra Szoeke: [00:20:40] Yeah, exactly. And I think the point you raised about sleep is so key. People don’t think of sleep as important, but as a neurologist, it is immensely important for the brain. And when you were talking about it causing stress, and it’s not just the kind of, you get stressed out if you haven’t slept, but we can look at people sleeping and then becoming sleep deprived, and again, measure their blood, measure their cerebrospinal fluid and actually show there’s more inflammatory markers. There’s more byproducts that haven’t been cleared because during sleep, those byproducts get cleared. So, you know, it’s stressing the system as in pushing a plank too hard so it breaks, not just some sort of mental concept of stress. It’s a physical stress to the system as well, not having sleep. And, you know, on the medications, you’re so right. I think, you know, what do they call it? Band-aid medicine where, you know, people keep getting cut and then you put a band-aid on, whereas what we should be looking much more at is prevention. When I worked at CSIRO, which is our Commonwealth agency, we had a preventive health flagship and we demonstrated to the government that they spent less than 1% of the healthcare budget on prevention. You know, and I do think that we have, you know, for good reason when we’re still trying to work out what diseases were, very focused on fixing problems that we were finding and what we’ve got to do is not develop those blocked arteries. You know, not develop diabetes, try and prevent it from happening. I mean, the treatments are getting better all the time. But I think anyone who’s living with diabetes would say they’d rather not have it. [00:22:22][101.3]

Dr Louise Newson: [00:22:22] Absolutely, it’s so important. [00:22:23][0.9]

Professor Cassandra Szoeke: [00:22:24] And we know the chronic diseases of ageing and WHO wrote a report showing 80% can be prevented. [00:22:29][4.7]

Dr Louise Newson: [00:22:29] I totally agree. And, you know, prevention is key to so much. And I remember going to a lecture about eight years ago now with Professor Walter Rocca, who has actually been on the podcast, from the Mayo Clinic, talking about his work, looking at, I’m sure you’re aware of it, you know, women who are young who have a bilateral oophorectomy, so they have their ovaries removed under the age of 40, and the increased incidence of diseases that occur. And I remember thinking, yeah, I know about heart disease can increase. I know osteoporosis, dementia can increase. But then he’s talking about even kidney disease, chronic kidney disease, which I hadn’t realised at the time, but also all the different mental health conditions. So obviously I knew that clinical depression increases the longer we are without our hormones, but schizophrenia, psychosis, drug addiction as well. The COPD, you know, lung disease. And then thinking, gosh, this is massive, actually. And that’s when I think you sometimes do need a light bulb moment, don’t you, when you’re reading things. And I suddenly then went back home and got my pathology notes out. And one essay I had to write, it was a three hour essay, and I had to write, is atheroma a marker for cancer? Now, for those of you who are not sure, atheroma is the, you get this sort of fatty deposit lining the blood vessels that accelerates and then that increases risk of cardiovascular disease. It’s often the start of cardiovascular disease or heart disease. And so I read this title, we had like 20 different titles, we could choose one three hour essay and I had this and I was like, oh, this is so exciting. But actually, it’s connecting this inflammation. So the inflammation that occurs in the endothelium, the lining of the blood vessels, which increases atheroma is actually very similar to this inflammation that occurs with cancers as well for many cancers. And like I said before, when you think about our immune cells that fight infections, especially our monocytes and macrophages, they all can be really, really protective. They’re like our army that protect us, not just from infections, but from disease. But if they’ve got the wrong microclimates, the wrong conditions, they will turn against us and they will become very inflammatory and produce all sorts of cytokines, chemicals that will worsen. And I remember thinking, actually, this is all related Because if you’ve got low hormones, oestradiol, progesterone, testosterone. You’ve got the wrong nutrition. So you’re eating the wrong chemicals, if you like, going into our bloodstream. You’re not exercising. You’re not sleeping, you’re stressed. And then you add, you know, your poor gut microbes. You can see how the poor body gets completely confused and starts being inflammatory. And then that’s really hard sometimes to take back because it’s a slow process, isn’t it? Getting back and reducing inflammation. [00:25:20][170.4]

Professor Cassandra Szoeke: [00:25:24] It is and one of the things about inflammation in the body is it is a cascade. So once it gets started, it can actually build on itself and get out of control. And every one of these chronic diseases that are ageing has inflammatory mediators. [00:25:37][13.0]

Dr Louise Newson: [00:25:38] Totally. And I also think, you know, I spend lots of time with my patients explaining it is going to take a long time. There’s not a quick fix and you can’t, you know, do an exercise class and then expect to feel amazing the next day. Of course you might a bit, but you have to, your body has to relearn. You know, if you break a bone in your body, it takes several weeks to improve. If you have a bruise on your arm, it can take quite a long time to really improve properly. And I think internally, sometimes we’re quite impatient with our bodies, aren’t we? And we expect things to happen quicker and then people can get disheartened and then think, well, what’s the point of exercising or what’s the point of stopping all these fizzy drinks that I’m drinking? Because it’s not really having any short-term effect. But longer term, it really can make a huge difference, can’t it? [00:26:30][51.3]

Professor Cassandra Szoeke: [00:26:32] Oh, absolutely. I mean the research absolutely shows that. I think, again, you know this focus we’ve had on the band-aid approach, if you break your hip, you get a titanium new one, stronger than the one you had before. And if you block every vessel around your heart and manage to survive, they’ll just do bypasses. So we do have this kind of attitude of the quick fix, but again, anyone who has had bypass surgery. you know, that is no small thing. And it’s much better to what we’re now able to do, even with some of our newer medication, is remodel those arteries. So actually reverse some of the damage that’s been done. Yeah, absolutely. And I mean, some of the incredible research they’ve done in the brain, they’ve shown that exercise can actually increase hippocampal size. [00:27:17][45.2]

Dr Louise Newson: [00:27:21] Yeah, I mean, our brain is quite plastic in some ways, but it will respond. And even just looking at the blood supply through the brain, if we reduce inflammation in our endothelium, we can open up our blood vessels a bit more. Even that will make a difference, but actually our brain really does respond to a different environment, which is something that we don’t always think about, actually, and it’s so crucially important. So we’ve got a lot to do and a lot of it is I feel a lot of my work is educating people so they can make decisions that are right for them and we are all different. We all know that we could do certain things differently or better and it’s just picking what’s going to be the best thing for you at the stage of your life to improve your future health and hopefully prevent as many diseases as possible. So I’m really interested to hear about your research over the next few years and how things change and improve. So I’m very grateful for your time today, sharing some of your incredible knowledge. But before we end, I’ll always ask the three take home tips that I’m going to focus on the brain, actually, because obviously, you being a neurologist. So three things that we as women should really focus on when we’re thinking about keeping our brain as healthy as possible as we get older? [00:28:42][81.0]

Professor Cassandra Szoeke: [00:28:45] So I would say the three things to do, one, the physical activity that I already said, and it is just by far and I mean, we’ve looked at cholesterol and HDL and LDL and blood pressures, and you can imagine a thousand different things we’ve looked at and every time physical activity comes up way in front in terms of its impact on improving brain. The second is to talk about cholesterol. So there’s a lot about cholesterol. However, in women, it’s not cholesterol. You know, there’s the good cholesterol, which is HDL cholesterol and the bad cholesterol, which is LDL cholesterol and cholesterol. But for women, it looks like in all the research for heart and for brain, and of course the two are interrelated, HDL is really important for women. So that’s the good cholesterol and keeping it up. And in fact, because most of the studies were done in men for heart disease and for men, because they had to have large vessel disease, whereas women tend to get small vessel disease. Cholesterol and LDL has been really important for male health and those medications have all been targeted at cholesterol and LDL. There’s now development of medications to target HDL, but the vast majority of our older medications, they actually don’t impact on your HDL, but green leafy vegetables and exercise can increase your HDL. So while we’re waiting for the tablet designed for women, actually that’s the way to improve your HDL. And then the third thing I would say… which women actually do really well, which is probably why we have a survival advantage, is social connection. I think we do underestimate it. And in our increasingly complex and Zoom-related environments and the busyness where now everyone has to do everything, I think it’s really important to remember because it’s not about how many friends you have or certainly not how many Facebook friends you have, but women sometimes feel very alone. They’re looking after a lot of people, they’re in busy households, at busy workplaces, but I think that’s really important for women too, so they’d be my top three. [00:30:52][126.5]

Dr Louise Newson: [00:30:52] I love it. And all of those are achievable and something that we all should continue to work on. So I’m very grateful. And it’s been really interesting talking to you. So thanks so much today. [00:31:03][10.7]

Professor Cassandra Szoeke: [00:31:04] Yeah, you too, Louise. It’s been a pleasure. [00:31:05][1.3]

Dr Louise Newson: [00:31:10] 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. [00:31:10][0.0]

ENDS

The post What is healthy ageing? appeared first on Balance Menopause & Hormones.

Content advisory: this episode discusses themes of suicide and sexual assault.

In this week’s episode, Dr Louise Newson is joining by Christiane Gurner, who shares her story of endometriosis and PMDD, highlighting the challenges many women face in getting a proper diagnosis and treatment. Christiane also shares her experiences of IVF and menopause at the age of 42.

The conversation also covers the importance of listening to patients, individualising care and access to the right treatment, as well as the impact of hormone-related conditions on mental health.

Christiane has written about her IVF experiences in the Sydney Morning Herald here (subscription required) and here, and menopause at 42 here. She can be contacted via email at christianewrites@outlook.com.

Click here to find out more about Newson Health.

Transcript

Dr Louise Newson: [00:00:10] 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. So today on the podcast, I have someone called Christiane, who reached out to me a little while ago from the other side of the world to me. She’s in Australia, and she told me her story, which really resonated because it’s similar to many, stories that I hear all the time, actually. A lot of it is about women not being listened to, but also women who have more than one diagnosis that often aren’t just put into one diagnostic box and given one treatment and off you go. When it’s more complicated, sometimes it can unsettle and unnerve doctors, and sometimes it can be very difficult to be heard to get the treatment. So Christiane’s very kindly agreed to share her story so it can empower others and make changes to other people’s lives going forward. So hopefully they don’t suffer as long as you have, before you finally feel better. So welcome from Melbourne. [00:01:57][106.9]

Christiane Gurner: [00:01:59] Thank you, Louise. And thank you for all the amazing work you’ve done for decades, long before, you know, that menopause was in the zeitgeist or being spoken about. [00:02:08][9.3]

Dr Louise Newson: [00:02:08] Thank you. So you, like many women actually, have endometriosis, which I’ve spoken about on the podcast before, and I’m sure I’ll speak again. And some statistics say that it can take a decade for people to have a diagnosis and many, many consultations before the diagnosis is made. And that’s sometimes because it can be difficult to diagnose, but it’s more commonly because people aren’t understanding endometriosis and the effect that it has on people. So do you mind just sharing a bit about your story? [00:02:44][36.0]

Christiane Gurner: [00:02:48] Not at all. And I just want to point out at the outset that I definitely don’t want to make it just about me. I know there are so many countless women in my position. And yeah, this is the story of so many, which is really sad and actually quite tragic. So yes, you’re right, it took about a decade for me to be diagnosed. And by the time I was, and I just normalised the pain as well. So I just thought it was me and that, you know, my, other people responded to simple painkillers and I must have been in some way defective. So yeah, that was really terrible. And by the time it was diagnosed, I ended up having an ovary removed as well as appendix and also a punctured bladder surgery as well, which also I wasn’t believed about until mum took me back three times to emergency. So yeah, there’s, it is a story as old as time, I think. And that I probably had around 10 laparoscopies after that. And every single time, the sense of not being believed, I also went to a few different specialists, some of them incredibly, you know, at the top of their field and still being told this is chronic pain or, you know, this is normal. And I like to think I have a fairly high pain threshold. So, but as I said, you just normalis the pain, the moods. However, luckily I was very fortunate to come across Professor Jayashri Kulkarni, who, as you know, spoken with and her very important work around women’s mental health and hormones. And I was diagnosed with PMDD in my mid -20s. And that was very helpful, but still despite, you know, the ongoing endometriosis and all sorts of medications, tried HRT before my hysterectomy, but ultimately ended up doing IVF on my own, partly for that, yeah, given the history of all the surgery. I have no doubt that’s why I was single, just feeling, and I still am single, feeling quite, and I don’t mind saying that, I mean, I’ve basically been single for two decades, I think largely given that sense of brokenness that you feel having, you know, that physical as well as psychological disease, I guess. [00:05:09][141.2]

Dr Louise Newson: [00:05:10] So PMDD is premenstrual dysphoric disorder, and it’s a more severe form of PMS. And PMS, premenstrual syndrome, probably affects about 90 % of women. There’s very few women who don’t have any changes before their periods. And before the periods, as you know, is when hormone levels are at their lowest. And so a lot of people I see and speak to who have endometriosis, also do have some PMDD as well. And the more I think and treat and talk to women with endometriosis, the more I think, or I’m interested to know how much of a hormonal disorder it is and how much it’s related to low progesterone and possibly low testosterone as well, because those hormones are very anti-inflammatory. And traditionally, when we talk about hormones, it’s always about oestrogen being the building block, oestrogen is the important bit, oestrogen, oestrogen, oestrogen. But actually, these three hormones are independent. They’re as different as, you know, other hormones in our body. They’re always lumped as sex hormones, but they don’t define us, our sex or our gender, because men have the same hormones, too. And a lot of people I speak to do respond very well to testosterone and progesterone, and maybe less oestrogen or no oestrogen, depending on the individual situation. And it can take a long time, as you say, to diagnose endometriosis. But it also, even when it’s diagnosed, the treatment really varies between women. And, you know, the surgeons will say it’s all about surgery. Other people, if you go to a pain clinic, they’ll say it’s all about pain control. If you go to a psychiatrist, other than Professor Kulkarni, they’ll say, oh, it’s all in your head, so you can just, you know, put up with it. And then other people say, well, just take out your womb and your ovaries. If you take out the ovaries, you’ll have no hormones and therefore you’ll be fine. But actually, that’s not always the right thing either, is it? [00:06:57][106.5]

Christiane Gurner: [00:06:58] No, it’s not that simple. And the reason I ended up fighting so hard to have a hysterectomy was literally listening to your podcast with Dr hannah Short, the GP, in, I looked up this morning, in 2022 it was. And it just gave me, her story was very similar to mine. It was just untenable to live with the PMDD, the way it was for her. And she fought to have a hysterectomy, as I did. Unfortunately, even though my specialist was excellent and very senior, he still, I mean, he had reservations for the right reasons, but just the, I guess the lack of knowledge doesn’t help. But I remember him saying, well, if I do hysterectomy, it will shorten your lifespan by five years. And I said, oh, what? And he said, well, given the cardiovascular risks. And then he proceeded to calculate how old my son would be when I died. [00:07:55][57.5]

Dr Louise Newson: [00:07:56] Oh my goodness. [00:07:56][0.4]

Christiane Gurner: [00:07:57] This is true. And so I sat there and took all that in. And it was only afterwards speaking to someone that I thought, gee, that was a terrible thing to say to someone because it left me in an impossible position of my quality of life being so poor and big surgery that, you know, holds a lot of grief as well. So in the end, he agreed based on the psychiatric support, letter of support, but we retained one ovary. And of course, because the ovary is producing the hormone, that the PMDD continued. And so I fought again a year later to have that ovary removed. And I’m now an HRT and the Prometrium, the bio-identical progesterone. Yeah. So it’s been, it’s been a lot. And that was two years after having my son, I had the hysterectomy after being told that pregnancy cures endometriosis, which is another old wives’ tale because it clearly doesn’t. And, you know, that’s where you almost gaslight yourself, just thinking, is this me imagining the pain and being told by doctors it’s not there? And it was though, as well as adenomyosis. So yeah, you’ve just got to trust your own body, I guess, but that’s impossible in the face of really experts who I’m sure are well-meaning, but it takes a toll. Yeah. [00:09:24][87.4]

Dr Louise Newson: [00:09:25] Of course it does. And I, you know, one of the first things I learned as a medical student is listen to your patients. The patient will always tell you, but you have to ask the right questions. But also, you know, patients don’t come to the clinic or they’ve never come to see me as a doctor, making things up. There’s no psychological advantage of having symptoms. And sometimes it can be really difficult. One of the things I learned, actually in general practice, in hospital, you’ve always got other people you can ask, you’ve got tests, you’ve got investigations really on your fingertips that you can always try and explore more and more. Whereas in general practice, when you’ve got 10 minutes, you can’t order scans left, right, and centre. You don’t always know. But actually dealing with uncertainty is something that’s really, really important as a doctor and sharing that uncertainty. And I’m a very honest person. And so I’m always very honest with my patients. And actually, my trainer, a long time ago, John Sanders taught me that it’s okay to tell people that you don’t know what’s going on. And the first time I did it, I thought, oh, gosh, they’re going to think I’m a really bad doctor. But actually, it’s not that it’s, you know, sometimes you don’t know, or you think, well, there’s maybe two or three different things going on. And so I’ll often say to patients, you know, look, there is a lot going on. I think you might have X, you might have Y, we could do A, we could do B. Let’s just do it in stages. But I might not be able to help everything. But I’m certainly going to work with you. And let’s explore all possibilities. And that way… [00:10:58][93.8]

Christiane Gurner: [00:10:59] That would be a relief. That would be a relief for patients. [00:11:02][2.7]

Dr Louise Newson: [00:11:02] I think people, and I know having been a patient quite a few times, you just want to feel validated. And you want to feel that someone understands you. And also that you’re not making it up. Yeah. There’s nothing worse than being told, it’s all in your head. Yes. Or someone trying to make a different diagnosis to suit their agenda. You know, I know long, well, a few years ago now, my daughter had sepsis in her sacroiliac joint and she presented with awful, awful pain in her hip. And I had to take a casualty at three in the morning because she was in so much pain. Well, I couldn’t take her, she was, I couldn’t mobilise her. She had an ambulance, but we got there and the X-ray was normal. And the consultant said to us, Oh, I think she just needs some physiotherapy. And I looked at her and she’d started vomiting at this time and was in so much pain. And I looked at the consultant and said, what makes you think when she’s had no injury that physiotherapy is going to help this 12 year old girl who’s clearly quite unwell? Could you not even take a blood test? And then she went, Oh, okay. We’ll keep her in until the morning ward round. But it was that whole, and we sometimes talk about this as a family, because if I wasn’t medical, I would have just gone, Oh, okay, then I’ll take her home. And I know she probably would have died because she was so poorly in the days after, but that’s quite an extreme case. But actually it would have been okay for that doctor to say, gosh, I don’t really know what’s going on. Maybe some physio would help, but she doesn’t look very well and she’s got worse in the hour that she’s here. Let’s just keep an eye on things. And I’ll ask my colleagues in the morning. That would have been fine. So it’s the way that we talk. And the more I look at the gender inequality, there’s so much more that women are misunderstood. You know, it’s the women that have multi, you know, system disorders, women who are complex, women who have personality disorders, women who, you know, have all these medications, women, women, women. But actually what’s different about us is that our hormones are often changing all the time and we’ve never really been used in proper experiments or, you know, clinical trials because our hormones exclude us because they’re too complicated. And that makes it really hard. And then with some conditions, including endometriosis, synthetic hormones have been given, which aren’t the same as natural hormones. And, you know, some people say, well, oestrogen will flare endo, which it often can do, but what about the other hormones? What else are we doing? You know, and it’s that individualisation of care that I think has been missing for so long. And women are just given layers and layers of diagnoses, often inappropriate medication. And then what do you do? Who do you go and see if no one’s really addressing the problem properly? [00:13:52][169.6]

Christiane Gurner: [00:13:53] I know. And that’s where people like me end up. I mean, I’m a researcher, but I’m not a doctor, though I feel at times I’ve had to educate GPs. And like Professor Kulkarni has mentioned many times that women like me, thankfully I haven’t, which is why I’m incredibly grateful to her, but being diagnosed with bipolar disorder and put on antipsychotics when it’s a hormonal condition. And that hasn’t happened to me, but the shame of not being believed has a severe mental health impact and I think is traumatic for many of us. I’m sort of coming to terms with it now that I’m looking back, I’m almost 44. And as I was saying to you actually earlier, I’m starting to feel angry. I’m not an angry person, but I thought we’d just got through another HRT shortage. And as of yesterday, I’ve just spent hours on the phone again, trying to source oestrogen patches. I’m on quite a high dose, twice a week. And yeah, the mental load of that for women is enormous. And yes, the good thing is women are speaking about it. And as you’ve said, in Australia, there are a number of journalists who are going through perimenopause and menopause in real time. So like Mamamia, the media company by Mia Freedman is doing a lot of work on that. And obviously Professor Kulkarni, but there isn’t, you know, what do you do? You’ve got nowhere to go if there’s no supply. And it really is a human rights issue. I’m not sure if it’s going too far to say that, but… [00:15:33][99.9]

Dr Louise Newson: [00:15:33] I don’t think it is actually. We’ve had shortages over here and actually in my paperback book, one of our pharmacists Hayley has written about what to do with a shortage. And actually at the minute in the UK, there isn’t a shortage, but I have, I’ve just changed my patches today and I realised I don’t have any more and I’m going away at the weekend. And I mean, I will be able to get a prescription, but it’s still like actually, and it’s not, it’s just the fact that I know that I will get migraines without my patches. I know I won’t be able to think and function. So it’s not, like a lot of people think it’s just a lifestyle drug. It’s just a nice to have rather than a need to have medication. And this is where hormones, I think, are just not taken seriously enough. You know, the work that Professor Kulkarni does is so important looking at the mental health aspect of the menopause and perimenopause and PMDD obviously and PMS. And we’ve just written a paper together because we have to address the importance of mental health. We can’t just be layering on sticking plaster. And a couple of days ago, I did an event for an NHS mental health trust. And it was an interesting audience because there were just women from the public there, there were consultant psychiatrists there, and there were some mental health workers. And afterwards, I spoke to some of the, some of the people and one of them, a consultant psychiatrist who specialises in psychosis. And she was asking me about the role of hormones. And she said, I’ve never really thought about it, but actually I wouldn’t have no idea how to prescribe HRT. And I’m really scared of prescribing HRT. And I’m just like, well, you have to learn. It’s really important because there’s really good evidence. And actually they are safer than a lot of antipsychotic medication. And antipsychotic medication will increase prolactin, which they always test prolactin levels, and higher prolactin will reduce FSH. So it will give people a chemical menopause. So if they’re not menopausal before they will be with the drugs that you’re prescribing. And so she was like, I need to listen. I need to learn. I need to do your education programme. So she went off, you know, wanting to learn more, which is wonderful. And then there was another lady who’s a patient. And she said, I’ve been diagnosed as bipolar. I know I’m not. They talk about psychosis, but I know it’s related to my hormones. It’s taken years to be listened to and believed. How do I get my voice heard? And that’s really difficult, isn’t it? [00:18:06][153.1]

Christiane Gurner: [00:18:07] It is. And people, I mean, I’ve heard, read in some of Professor Kulkarni’s work, there’s suicidal outcomes in these situations. I luckily wasn’t, but I mean, it’s taken years and years and the stress of trying to, I’ve got my son screaming in the background on the phone to the pharmacy who’s basically saying, no, we’ve got none. And of course, everyone will be different in terms of what dose they’re on, but I’m on quite a high dose because I’m young and it seems to be working. I’ve never had a hot flush. And that’s the other thing. It is so individual, isn’t it? I mean, the stereotypes around hot flushes. I mean, what happens to me will be completely different from what happens to another friend. And, but so far it has been really positive and I don’t have endometriosis, you know, and I don’t have pelvic pain, but I was sent off to pelvic physios by surgeons, just assuming it was, which is, you know, a very good resource, but in my situation was inappropriate. And you know, decades ago, it was quite invasive, not around consent and quite traumatising. And that was all to prove that actually, no, there was no issue with my pelvic floor. It was, it was endo. So that’s really devastating, similarly in pregnancy. I was so lucky. And after seven rounds of IVF on my own, I had my son who’s now five and the endo persisted after having him. And that was, yeah, a surprise given I’d been told that pregnancy would cure it. So yeah, you’re just managing it all life stages, trying to, you know, as a younger woman, you know, around sexuality, as a mother, still trying to manage the pain. And now I mean, menopause and, and that’s actually better. And as Professor Kulkarni would say, and we weighed up the options, the PMDD and the pain of endometriosis were worse than the prospect of menopause. So, and that has been the right choice for me. [00:20:13][126.4]

Dr Louise Newson: [00:20:14] Yeah. Which is so important being so involved with decision making than knowing that the treatment that you’re having is right for you. But I mean, having all those rounds of IVF by yourself, just bringing up a child by yourself, it’s not easy, is it? [00:20:30][16.1]

Christiane Gurner: [00:20:30] No, it’s not. And it’s, in some ways, the baby, you know, everyone warns you that oh, you’re not going to sleep again and everything. And I think for the first few years and definitely while I was breastfeeding, my hormones were great for the first time in my life, which I’m sure you know about. And then I fell off when I had to stop because of surgery. That’s when the endo and those problems started occurring. But yeah, he’s amazing. And I used an anonymous donor. Unfortunately, there’s an enormous shortage of donors now in Australia. I’m not sure about the UK, but given in Victoria, at least where I am, the legislation changed a couple of years ago, which meant that donors are allowed, can be identified when the child is 18. So that understandably really deterred a lot of men from donating. And I mean, I think when I was looking at the database, like you’re shopping for something, that’s not a donor. There were about eight donors at that point. And I am very efficient in sort of a bit of a, I don’t know if it was my background in research, but I chose one that was perfect for me. And I’m incredibly grateful. And one nice thing I don’t think I mentioned to you was we’ve met two of his donor siblings who are twins, his age. So the same donor and this wonderful mum, and they live about 40 minutes away. So that’s a really beautiful thing. But yeah, complex and emotional. And I think bringing up a child when I’ve still got residual health issues, given the aforementioned history is tough. I don’t want him to look back and think of me as, my mum is struggling or disabled, but hopefully, all he knows is he’s got a mum and a nana and a donor and he’s happy with that. [00:22:29][119.0]

Dr Louise Newson: [00:22:31] And I think just to pick up on you saying about the consultant that you’ve seen, saying that if you have a hysterectomy, it will shorten your life by five years. Firstly, no doctor has a crystal ball. We have no idea what we’re going to die from and no idea. What we do know from the evidence is that when women have a surgical menopause or a earlier age, the longer they are without the hormones, the greater the incidence of diseases and an earlier death as well. But, and this is a real but, if people have replacement hormones, then that reverses because all you’re doing is not replacing, you’re just giving back what your body would be producing. And actually a lot of people who have an earlier menopause, if they’ve had some hormonal insufficiency, actually you’re giving appropriate hormone doses back, probably their prognosis will be even better because a lot of women are spluttering a bit with their hormones, not producing as much. So you’re giving back a really good physiological dose and our hormones are very active biologically. And so the research hasn’t been done because so little has been done on proper body identical hormones. [00:23:39][68.1]

Christiane Gurner: [00:23:40] I tried to find it. It’s not there. [00:23:43][2.6]

Dr Louise Newson: [00:23:43] No, but it makes complete physiological sense actually. And we know that older women who take HRT have a lower risk of diseases, a lower risk of an earlier death. They usually live longer and healthier because it’s actually not the age we die anyway. It’s our journey to that age. We could all live longer, but be more unhealthy and none of us want that. And so I think for anybody to try and talk about life expectancy to patients, unless they know something I don’t, it’s impossible to say. [00:24:15][32.0]

Christiane Gurner: [00:24:16] It was cruel, yeah. And until I spoke to Jayashri and who said exactly as you did, and the benefits of HRT in terms of cardiovascular health are undeniable in itself. It’s not for the specialist. I remember speaking to a psychologist and her saying, well, it’s not for him to decide whether your quality of life is worth even if it is five years. And in the end, the whole five years thing, as you say, is very theoretical. Yeah, but it was a terrible, the guilt around that was, I’d already had my child. Which mother or what sort of parent would ever accept dying five years younger? And as you say, my hormones are actually more stable now than they have been since I was 12. So there you go, if anyone’s wondering. [00:25:04][48.1]

Dr Louise Newson: [00:25:04] So good news at the end of a very long over 30 year old journey that it’s worth persevering because people can get there in the end. And even when you feel it’s insurmountable or impossible to feel better, often finding the right clinician, finding the right treatment for you as an individual can work. So I’m very grateful for your time, also your honesty as well, because I’m sure your story will resonate with lots of people and hopefully give that fire in their belly to really be listened to. [00:25:35][30.6]

Christiane Gurner: [00:25:35] Thank you. [00:25:35][0.0]

Dr Louise Newson: [00:25:36] So before we finish, there’s always going to be three take home tips at the end of the podcast. So three things that you feel if people have listened and felt gaslit really or cheated on with information or an incorrect diagnosis or something doesn’t feel right from the clinician that they’ve been seeing, what three things would you recommend women to do? [00:25:56][19.6]

Christiane Gurner: [00:25:56] So I think the first one I thought of was just educate yourself or listen to women’s stories. I don’t mean on TikTok. I’m not on TikTok, but I mean listening to evidence -based podcasts like yours and your website and information. And yeah, we need more of that in Australia, but luckily we’re now all connected, which is great. And I think talk to your daughters and nieces and I get on my soapbox if I ever hear young women in pain. And I think it’s sharing stories like women always have is really powerful. And that’s how I came to have the strength. As I said, listening to your podcast and hearing Dr hannah, that was incredibly powerful. And I also think speaking to men, I had coffee with a lovely man in his early 40s last week and mentioned your podcast. And I didn’t say your name because I just was a bit the stigma, I think, of mentioning menopause, even me. And he said, oh, is it Dr louise Newson? And I said, yes. He said, oh, I heard her on a podcast and I forwarded it to my mum and my sister. So there you go. So I think just talking. And the second thing was push, I know it’s easier said than done, but pushing back against that medical gaslighting because the impact, as I’ve tried to describe, is you know, the impact on the trajectory of women’s lives is so pervasive. So don’t let the shame of being not believed stop you from believing in yourself, is what I’m trying to say. [00:27:36][99.9]

Dr Louise Newson: [00:27:36] That’s really important. [00:27:37][0.4]

Christiane Gurner: [00:27:37] Yeah. And the third thing was, which is an unusual thing to say, but you’re not broken and I am trying to take my own advice, but it’s the system and the structures that are often broken. And I’ve come out of this and it’s, as I said, now with hindsight, looking back, doing a lot of work around why I feel like that. And the processes of being misdiagnosed, of not being heard, of the shame, a lot of shame around women’s health anyway, the trauma associated with IVF even can leave you feeling, you know, for men and for women, incredibly broken. And add to that trauma, which I don’t mind saying, I hadn’t connected a sexual assault in my early 20s, add that to the mix of the physical and emotional impact of the other. And I don’t use the word trauma lightly, of the trauma of gaslighting in medical misogyny. I think, yeah, just retain that sense of self and you’re, I’m sure many people do feel broken. I’m sure many, there are many millions of women, or thousands like me. And yeah, just remember it’s the systems and the structures. It’s not you. Yeah. [00:28:57][79.6]

Dr Louise Newson: [00:28:57] I think that’s such a powerful way to end. And thank you so much for sharing so many really intimate things actually about yourself, because people will be able to just think in a different way. And I think just not internalising it and blaming yourself for everything is really crucially important in everything that we do actually, because as women we often take so much. And I think to know that actually it’s not your fault the way you feel. And that there are people that can help you, but it’s fine to get a second, third, fourth opinion. That’s absolutely fine as well. So I’m very grateful for your time today. And I just hope this is going to help lots of people. So thank you again. [00:29:40][42.5]

Christiane Gurner: [00:29:40] No, I’m very grateful and best of luck to everyone. [00:29:43][3.0]

Dr Louise Newson: [00:29:44] Oh, 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. [00:29:44][0.0]

ENDS

The post Getting your voice heard: Christiane’s story of PMDD, endometriosis and menopause appeared first on Balance Menopause & Hormones.

In this week’s episode, Dr Louise Newson talks to Professor Mike Kirby, president of the British Society for Sexual Medicine and author of more than 450 clinical papers and 32 books. He was previously director of the Hertfordshire Primary Care Research Network, visiting professor to the Faculty of Health and Human Sciences at the University of Hertfordshire, and was attending physician to the Prostate Centre, London, where he dealt with complex medical problems until 2020.

Dr Newson and Professor Kirby discuss the importance of hormone health for both men and women, including testosterone. They also explore the benefits of phosphodiesterase inhibitors – which include Viagra – in treating not only erectile dysfunction, but their potential to reduce risk of cardiovascular disease, urinary symptoms, dementia, and even cancer.

Professor Kirby is one of the speakers at the upcoming Newson Conference: The Hormone Blueprint, which will be held in London on 21 March. An event for healthcare professionals, the conference will delve into the far-reaching impact of hormones on the body. For more information and to book your place, click here.

Click here to find out more about Newson Health.

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. So today on my podcast, I’ve got someone I do know very well and I have met in real life, unlike some of my other podcasts. And I’ve got Professor Mike Kirby, who is an inspiration. He’s a real mentor and more of a mentor than he realises actually for lot of my work. But I’ve known him for many years. He is also, like me, very interested in cardiology, cardiovascular disease, disease prevention, keeping healthy and really interested in looking at people as a whole. He does a lot more maybe with men than women, but he still borders on that line with women’s health as well, and works with the British Society of Sexual Medicine, who I’ve had the privilege of lecturing for many times and lecturing alongside Mike. So I’ve been lecturing about the role of female hormones. And he’s been lecturing a lot about the role of testosterone and men’s health. And there is so much crossover. So I’m very honoured to have him here in the podcast. So welcome, Mike, today. [00:02:05][114.2]

Professor Mike Kirby: [00:02:06] I’m delighted to be here, louise. I’m a great fan of yours, so I would never say no to you. [00:02:11][5.3]

Dr Louise Newson: [00:02:13] Very good, I’ve got that on record now, so that’s great. So it’s really interesting because there’s so much misperceptions in medicine where people have been told something and then there’s something else actually and then they’re not really sure and then they don’t want to believe. So even if we start with just testosterone. When you talk about testosterone, people think about male bodybuilders. And that’s probably what people will really think. And most of us as clinicians haven’t been trained at all about hormones, let alone testosterone in women, which I have talked about quite a lot on previous podcasts, but in men as well. And I remember the first time hearing you lecture, coming to one of the BSSM meetings and thinking, Why didn’t I know this? Like, why did we not understand the importance of testosterone to improve cardiometabolic health, to reduce risk of heart disease and dementia and osteoporosis in men. And it’s still something that’s really not spoken about enough, is it? [00:03:16][63.2]

Professor Mike Kirby: [00:03:16] No. There have been a lot of barriers put up to people using testosterone because in America it was used inappropriately, it was being prescribed there without checking blood level, just on the basis of the history, and it was being prescribed for bodybuilding that really got it a very bad reputation. So we tried to overcome that by producing an evidence-based guideline. And the key thing is that it’s actually very common to have a low testosterone, and that is driven by the fact that people are changing their lifestyles. So there’s more people who are overweight, more men with diabetes. And if you gain central body fat, essentially it produces cytokines or hormones that switch off the control of testosterone in the body. So, for example, men with type two diabetes, about 40% of them, if you look, will have a low testosterone. [00:04:19][62.6]

Dr Louise Newson: [00:04:20] And that’s a lot, isn’t it? 40%. [00:04:21][1.6]

Professor Mike Kirby: [00:04:23] It’s a lot. [00:04:23][0.0]

Dr Louise Newson: [00:04:24] Because I remember years ago when I was quite a newly qualified GP, we were asking men with type two diabetes and we were actually measuring their testosterone levels. So we were asking them if they had any symptoms suggestive of testosterone deficiency and measuring their levels. And they mostly, in fact I think it’s really more than 40% came back low. And then we were told to stop doing it because it was so common and the system wouldn’t actually cope with all the testosterone that needed prescribing. And that was about 20 years ago. [00:04:54][29.9]

Professor Mike Kirby: [00:04:54] Yes. Yeah so it takes a long time for evidence to get into practice in medicine. The other problem is that the reference ranges are wrong because when the GPs get the result, there’s a very wide reference range from six to 30 because, you know, if you take blood of 1,000 men, some will be six, some will be 30. That doesn’t mean that’s normal. So we’ve tried to overcome that by producing action levels. So if the testosterone is 12 and above, that’s normal. If it’s between eight and 12, it needs to be repeated, probably, those people might benefit from a replacement. If it’s less than eight, and they definitely would benefit because they will be suffering the complications of having low testosterone, which is increased heart disease risk, increased risk of diabetes, loss of muscle, brain fog, etc.. So there’s a lot of good things you can do. And all we’re suggesting is simply replace this hormone back to the normal level, it should be in that man. There’s nothing special about it. But women need oestrogen to stay healthy. Men need testosterone, but they don’t need more than normal. They don’t need less than normal. They need about right. And it’s similar between men and women that we know we do need to get together and sing from the same hymn sheet. [00:06:24][89.8]

Dr Louise Newson: [00:06:25] It’s exactly the same. I mean, we see lots of women, obviously with oestrogen, progesterone and testosterone deficiency. And I also think about how many men are oestrogen and progesterone deficient as well, because that’s another conversation. But certainly testosterone deficiency is very common. But a lot of people think they can only take it if they want to build their muscles, like you say, and become some body builder. They don’t see it as a treatment that helps reduce risk of diseases. And, you know, like you Mike, I’m very keen to think about longevity. I want to keep my patients living well and disease free for as long as possible. And it’s more important than it was even, you know, half a century or a century ago because we’re living so much longer. But we only need to look at the rates of osteoporosis, heart disease, diabetes, dementia. They’re going off the scale because we’re living so much longer and we have quite inflammatory diets and lifestyles that perhaps we didn’t have 40, 50 years ago. So that’s compounding but also, when you think about how many people have low hormones, it’s quite staggering, isn’t it? [00:07:31][66.1]

Professor Mike Kirby: [00:07:31] It really is. And I suppose because we’re living longer, it’s exaggerated. So for women in their mid-40s to 80 or 90 year you’re hormone deficient. In men, about 75% of men will maintain their testosterone at normal level. About a quarter will become deficient. So it’s not the same in men, but it’s the same risk on their wellbeing really, because, you know, having a low testosterone level and having a oestrogen level really affects wellbeing, it affects sexual function really badly and loss of muscle, osteoporosis, etc.. It’s a big issue and it’s such a simple test to do and it’s a very simple treatment to replace. And there’s just been a large randomised controlled trial which has shown that testosterone replacement is perfectly safe from the heart and from the prostate. And those were two barriers that people had put up saying it causes heart disease and it causes prostate cancer. The TRAVERSE trial published fairly recently, buries that. It is safe for the heart and it is safe for the prostate full stop. [00:08:47][75.3]

Dr Louise Newson: [00:08:47] Which actually makes sense, doesn’t it? Because it’s a natural hormone. So it would be very weird to think that it was dangerous in people when you’re replacing at physiological levels, which indeed is what happens when you give it to men, isn’t it? [00:09:00][12.5]

Professor Mike Kirby: [00:09:00] Yes, Yes. We monitor the blood level and we try and get it in the middle of the normal range. Not too much. Not too little. [00:09:07][6.8]

Dr Louise Newson: [00:09:08] It’s not difficult medicine. So the other area that I’ve learnt more and more from you, from the British Society of Sexual Medicine, but also from my husband, as you know, Paul, who’s a urologist, is about phosphodiesterase inhibitors, so lots of people will have heard of, probably everyone has heard of Viagra, but there are other types as well. And I remember again as quite a young GP when it first came out and it’s really interesting the whole and we can talk about what’s happened with Viagra now being available over the counter, how commonly prescribed it is. And it’s always thought about a drug that’s just for erectile dysfunction that men and only men take for erectile dysfunction. When I talk to people about, ‘Hang on, it wasn’t actually designed as a drug for erectile dysfunction”. A lot of people don’t realise that. They just know the little blue drug that you can buy very easily if you want to have sex. But it’s… Can we just unpick some of that? Because I think phosphodiesterase inhibitors are as undervalued generally as hormones and people don’t understand what they are and the potential of how much benefit they could give to people. [00:10:21][72.3]

Professor Mike Kirby: [00:10:22] I don’t think this blog is long enough to talk about all the benefits of PDE5 inhibitors because they are tremendous. It was interesting because with my cardiological hat on I got very interested in this drug because it was originally used to treat both men and women with coronary artery disease. And it was at the end of the trial that the men refused to give the tablets back so the research nurse could count them to see how many they’d taken, whereas the women were handing them back. And in all other studies, men always gave the pills back so that they could count and see what was done. And it turned out these men were getting better erections. And because these were patients with underlying cardiovascular disease, about 60 to 70% of those men would have had problems getting an erection. And that really got Pfizer, who were producing Viagra, off on the hunt of the opportunity to make money as a very good drug and a very safe drug for treating erection problems in men. And they forgot that they had a cardiac their drug. As did Lilly with Tadalafil, as did Bayer with Levitra. So we had three companies all doing research studies on erection problems, all showing very positive, very effective drugs at curing erection problems. And they completely forgot. And it was a really missed opportunity. They do work extremely well because they work by relaxing the blood vessels to allow blood flow effectively into the penis. But they also relax blood vessels everywhere else, like the heart, the legs, the brain, importantly. So what has happened over the last few years, we have found more and more benefits by looking at databases of people taking PDE5 inhibitors compared to people who don’t. And we published a study where we looked at a very big general practice database of men who had diabetes. And we looked at those men in that practice having PDE5 inhibitors compared them with the same age group of men not taking PDE5 inhibitors, and there’s about a 30% reduction in cardiovascular death in the men taking them. Quite staggering. [00:12:53][151.1]

Dr Louise Newson: [00:12:53] That’s a lot. [00:12:54][0.1]

Professor Mike Kirby: [00:12:54] It is because the men with erection problems theoretically were at the highest risk of dying from heart disease. If you can’t get an erection, your heart is headed in the wrong direction. And another study that we did, we went to cardiac rehab units and asked the men if they had erection problems and 75% did. But less than a quarter had told anybody about it. And they’d had erection problems for five years before their heart attack. So by asking about sexual function, you have an opportunity to prevent a heart attack five years down the line because it tells you they’ve got atery problems and you give them a statin, treat their blood pressure, treat their diabetes, and you prevent a heart attack. And interestingly enough, a year after we published that diabetes study, there was a group in Sweden where they did the same thing with men with heart disease. Those men with heart disease taking PDE5 inhibitors versus those men without, 50,000 patients in this study, it’s big. And they found almost exactly the same figure, about a third reduction in cardiovascular mortality within three years of starting to take a PDE5 inhibitor. Wow. [00:14:14][79.6]

Dr Louise Newson: [00:14:15] Gosh so three years. I mean, that’s better than statins and blood pressure lowering drugs, isn’t it? [00:14:20][4.4]

Professor Mike Kirby: [00:14:21] Much better, much much better. And interestingly enough, the more of PDE5 inhibitors that they took, the better the protection. So if you’re taking it once every couple of weeks compared with taking every day, then you didn’t do so well. [00:14:35][14.4]

Dr Louise Newson: [00:14:36] So your best off taking every day? [00:14:38][1.8]

Professor Mike Kirby: [00:14:38] Yes, best to take it regularly because it is a cardiovascular drug, actually at the end of the day, because it improves the lining of the blood vessels called the endothelium, the vascular endothelium, so ed equals ed: erection dysfunction equals endothelial dysfunction. [00:14:57][18.7]

Dr Louise Newson: [00:14:58] Yeah, And it’s interesting because I’ve talked about endothelium before, which is the lining of our blood vessels, but it’s very biologically active, isn’t it? And any inflammation in our body will often be reflected in the endothelium. So you get this burning of the arteries if you like, but you get this build-up of atheroma plaque and that’s what happens. And like you say, it happens in the penis earlier because the blood supply, the blood vessels are so much thinner than the blood vessels to the heart. So if you’ve got the damage to the endothelium, it will always pick off the finer arteries first. And that’s often why people get eye changes before they have blood pressure changes, for example. So that’s why ophthalmologists or the opticians spend a long time looking at the back of our eyes because it’s a window into our heart system as well. And actually the phosphodiesterase inhibitors will help with something called nitric oxide as well, which is a vasodilator. It opens up the blood vessels and helps to reduce this inflammation as well, which is good for blood pressure as well, isn’t it? [00:15:56][58.6]

Professor Mike Kirby: [00:15:57] Yes, it’s very good for blood pressure. I mean, there’s a very large meta-analysis where they showed that PDE5 inhibitors were protective on cardiovascular health. But also they had beneficial effects on bones, The urogenital tract. The brain had benefits on the metabolic profile of the patients taking it and cardiovascular… [00:16:19][22.0]

Dr Louise Newson: [00:16:21] It’s massive. [00:16:21][0.0]

Professor Mike Kirby: [00:16:23] So these drugs have widespread implications. The problem is that in the early days, a lot of the studies were preclinical. And of course, these are all off label indications. So if you want to use them, but those indications, then the doctor is prescribing off label. [00:16:41][17.6]

Dr Louise Newson: [00:16:41] But we do that a lot in medicine, don’t we? We prescribe a lot of things. My daughter has, as you know, chronic migraine and she’s been given antiepileptic drugs. She’s been given different antidepressants for her migraines. We do it a lot in medicine, but it’s still…people often don’t realise, but sorry, carry on. [00:16:58][17.0]

Professor Mike Kirby: [00:16:59] Well, I think for women you see, women have used Viagra sildenafil, since 2009 because they get treated for pulmonary hypertension. They use a very high dose in pulmonary hypertension, 40mg. And women, of course, are seven times more likely to get pulmonary hypertension. So, you know, women can take it perfectly safely. And actually, there’s no reason why women shouldn’t get all the same benefits as the men. For example, in 2022, there was a study using it in lower urinary tract symptoms and bladder pain in women. It’s very interesting that during the COVID-19 pandemic, the people who were seriously ill with COVID before the vaccination programme, both men and women, if they were taking a PDE5 inhibitor, they did better. So I think, you know, for women, I think particularly for sexual function, there’s two large randomised controlled trials showing that women using PDE5 inhibitors can benefit with increased arousal, increased ability to orgasm. And I think probably most importantly, more enjoyment out of sex. And you know, the clitoris of course is equally affected by poor blood flow as the penis. You see with men, when the penis fills with blood, the blood that goes in stays in because the pressure within the penis blocks off the emissary veins so the blood can’t get out. But for women and the clitoris, they don’t have that mechanism. It’s a constant inflow of blood the whole time. So, in fact, women actually need a better pelvic blood flow than men to some extent. And by improving endothelial function in the clitoral vessels, you increase the perfusion of the clitoris and makes sex much more fun. [00:19:01][121.8]

Dr Louise Newson: [00:19:02] Which is not a bad thing. And it’s something we were talking before I started recording about how few doctors actually talk about sex to patients who often want to. And it’s really, really important. But with this drug, it’s more than I say, ‘just’ in inverted commas, because I’m not belitting sex. But it’s more than that. You’ve already said it reduces risk of diseases. And we said at the beginning how common these diseases are as we get older. I spent a lot of time in the 90s and early 2000s as a medical doctor prescribing aspirin for people to reduce risk of heart disease. And, you know, especially if they’ve had a heart attack and people with diabetes, everybody with type two diabetes used to be put on an aspirin as well. And then we realised there were bleeding effects, there were side effects of aspirin. So it’s not done as much. But I often think of every day phosphodiesterase inhibitor like Tadalafil as a new aspirin really without the risk. Is that a fair way to think about it, Mike? Am I being a bit overzealous, do you think? [00:20:02][59.9]

Professor Mike Kirby: [00:20:02] Well, aspirin works by stopping the platelets being so sticky, whereas Tadalafil works by making the blood vessels more healthy. [00:20:10][7.8]

Dr Louise Newson: [00:20:11] But I’m thinking about just not the mechanism, but the just reducing risk of disease. [00:20:15][4.6]

Professor Mike Kirby: [00:20:16] Certainly in women, there was an Italian study where they used it in ladies with type two diabetes and they got increased control of the diabetes and it reduced the inflammatory markers. So I think that’s another side to the story is that unfortunately, our lifestyle, we gain weight, get diabetes, have high blood pressure. We get inflammation of the blood vessels. And that’s, I think, one of the ways in very much the same way that aspirin worked in heart disease, that PDE5 inhibitors work by making the endothelium more healthy and reducing the inflammation. So it’s, I think it’s lots of data now on prevention of dementia. And how important is that? Geoff [Dr Geoff Hackett] and I are trying to get a randomised controlled trial of tadalafil in patients with severe heart disease. And to look at the dementia data in those patients as well. Because there’s good evidence now that taking PDE5 inhibitors reduces your risk of dementia. That’s a bit of an added bonus, isn’t it? Less heart disease, less urinary symptoms, less dementia, better diabetes control, less Raynaud’s disease. And actually there’s good evidence for reduction in colon cancer as well because PDE5 inhibitors are anti proliferative. [00:21:45][89.2]

Dr Louise Newson: [00:21:47] So I it begs the question, doesn’t it why aren’t more people not taking them for these reasons? Because anything we can do to reduce risk of diseases will help that individual. But it also when you’re talking about population health and drain on NHS resources, but health care systems in any country, we’ve got to be thinking about keeping people healthy. These drugs, they’re actually quite cheap. They’re very low risk. So why are we not prescribing them more Mike? [00:22:18][30.4]

Professor Mike Kirby: [00:22:18] Because they’re off licence programs for all those indications. People are very resistant and nervous about prescribing things. You know, I think Viagra got a bit of a bad name really, because there was a lot of market hype and it got very much associated with sexual problems. [00:22:35][17.5]

Dr Louise Newson: [00:22:36] I was reading at the weekend, you probably know this, but one of the ways they wanted to market it when they realised it had this erectile dysfunction benefit was they got blessing from the Pope to say that it would improve relationships in families and it will keep the family unit together. And as soon as they got that endorsement from the Pope, it just made it even easier to market. And it has been one of the most over, well not over, most prescribed drugs, as you know. But then quite quickly, it became available over the counter. So it’s a lot easier for people to get, harder to monitor, of course. But people still think and of course, it can be taken for when people want sex. But this is taken as a lower dose often but every single day, and that’s the shift that I think people haven’t realised that it can be taken every day. It doesn’t usually interfere with medication, for most people don’t have contraindications so it can be used. And I do think about all the other medications that are prescribed, like the antihypertensives, like statins, that don’t necessarily have the same long term benefits that you’re describing in very good studies. [00:23:48][71.6]

Professor Mike Kirby: [00:23:50] I think so. I think the fact is, over the counter’s a good thing because it’s A: very difficult to get to see a GP these days. B: a lot of people feel embarrassed or they think their GP will be embarrassed and so they’d rather be independent and just talk to a pharmacist in a private room. So Viagra’s over-the-counter, Tadalafil is over-the-counter at a dose of ten milligrams, the Viagra’s 25 or 50. And I think, I flew to Australia for two days to advise the Australian Government about having Viagra over the counter about 15 years ago. It didn’t become available in Australia actually, but it’s been available across Europe over the counter for quite a while now, in Poland particularly. And I think that’s a good thing, particularly as we know that it has all these other benefits. And if it saves marriages, I think the Pope was right. When I was treating a lot of men, their partner would come in and part of the problem was the wife would say, well, I think he doesn’t love me anymore. I’m not attractive anymore because things aren’t working. I would explain it’s not actually the fact he doesn’t love you anymore or you’re not attractive. The problem is that it’s the mechanics of the penis are not working. Because he’s had high blood pressure and diabetes. But we can sort this out. And very few men where we couldn’t find a solution to their erection problems. So, you know, we shouldn’t just be talking about men or women in isolation. We should be talking about their partnership and really supporting a loving relationship. Because I gave a talk the other day about the benefit of continuing to be able to have sex for both men and women and for women it gives them about an extra six years of life and for men about the same. And that’s probably related to the fact that if you have a good, satisfying, enjoyable sex life, then you’re a lot calmer about everything else in your life. And it’s a very good form of exercise. It produces oxytocin, which has all sorts of cardiovascular benefits in itself. It’s a very under-talked about hormone because it improves your immune system. It improved blood flow to the brain. It improves heart. So, you know, there are lots of health benefits from being able to continue having a healthy, loving sexual relationship. And unfortunately, a lot of people are deprived of it because they can’t get access to the drugs, which is ridiculous because, as you say, they’re dead cheap and they’re very, very, very safe. [00:26:44][173.8]

Dr Louise Newson: [00:26:46] And I often. I play mind games quite a lot, but I often think I wonder what the world would look like if people who needed hormone replacement, men and women, had the right doses and types for them and those people that wanted to and were able to take Tadalafil or Sildenafil? you know one of the phosphodiesterase inhibitors, daily as well because I think it would reduce a lot of other medications needing to be prescribed. I think people would be happier. Of course we’ve talked about quality of life, but they would be healthier as well and there’d be less long term problems and diseases as well. But we’ve got a long way to go. I’m quite impatient, as you know, but we have a long way to go before even that’s accepted or thought about in traditional medicine. [00:27:29][42.8]

Professor Mike Kirby: [00:27:29] Well, you’re right. We need to keep talking about it and waving the flag and sharing all the data of safety and efficacy. I mean, for men with lower urinary tract symptoms, they often get prescribed finasteride to shrink the prostate. And that has awful sexual effects. They get prescribed alpha blockers, which make them dizzy. And actually to take daily Sildenafil has virtually no side effects. Actually, most of those men also have erection problems and you’re giving them cardiovascular benefit at the same time. So it’s quids in really, but I think we have a problem getting GPs prescribe it for men, but you have a huge problem getting GPs to prescribe it for women off licence. [00:28:16][46.5]

Dr Louise Newson: [00:28:18] And you’re absolutely right, looking at the lower urinary tract symptoms in women as well. And a lot of women are given oxybutynin which increases risk of dementia. It’s not really a nice drug and even some of the newer drugs still have side effects. So we have a long way to go, Mike, but you are amazing in the way that you educate and share your phenomenal knowledge. So I’m very grateful for you coming today. I always end the podcast with three take home tips. So three reasons why people listen to this podcast, whether they’re male or female, should know more about phosphodiesterase inhibitors. [00:28:54][35.8]

Professor Mike Kirby: [00:28:55] Okay, well, they’re cheap and safe. They reduce the risk of cardiovascular disease. They are probably one of the most effective treatments for sexual dysfunction in both men and women. And for people with diabetes, they actually improve diabetes control. And if you want an extra one, it could well prevent cancers as well. [00:29:25][29.8]

Dr Louise Newson: [00:29:25] Amazing. Amazing. So, well, I hope this has got people thinking and thinking about Viagra and Viagra-like medication, so, phosphodiesterase inhibitors in a different way. So I’m very grateful for your time and thank you so much. [00:29:41][16.0]

Professor Mike Kirby: [00:29:42] It’s a pleasure. Thank you for asking me. [00:29:44][1.4]

Dr Louise Newson: [00:29:49] 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 Viagra: is it time to rethink the little blue pill for future health? appeared first on Balance Menopause & Hormones.

Content advisory: this episode includes themes of mental health and suicide

In this week’s podcast, Dr Louise Newson is joined by Consultant Psychiatrist Dr Rachel Jones to delve into the critical role hormones, particularly progesterone, play in women’s mental health. They discuss the importance of understanding hormonal changes throughout a woman’s life, the differences between natural and synthetic hormones, and the need for individualised treatment plans.

The conversation emphasises the significance of balancing hormones and considering lifestyle factors that impact mental health. Dr Louise and Dr Rachel share insights on how natural progesterone can help with mental health symptoms, including mood and anxiety, and encourage women not to give up on finding the right hormonal balance for them.

Click here to find out more about Newson Health.

Find out more about Dr Rachel on Instagram @the_hormone_clinic

Contact the Samaritans for 24-hour, confidential support by calling 116 123 or email jo@samaritans.org.

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. So today on the podcast, I’m going to talk about an area of hormones that is really, really important. And the more I do work in menopause, perimenopause, but also women with PMS, premenstrual syndrome, PMDD, premenstrual dysphoric disorder, I worry actually about so many people not understanding the role of hormones in the brain. So I’m really delighted today to have with me Dr rachel Jones, who’s a psychiatrist I’ve recently connected with. And many psychiatrists are fantastic in mental health, but they don’t always know so much about hormones. So to find a psychiatrist that not only understands but also prescribes hormones is quite unique. So I’m really, really honoured to have Rachel with me today. So thanks for coming, Rachel. [00:01:51][100.0]

Dr Rachel Jones: [00:01:51] Thank you so much for inviting me. [00:01:53][1.6]

Dr Louise Newson: [00:01:54] So I know when we spoke a while ago, when I first met you, we were both being quite open about we’ve learned so much over the years. And actually, if I had this conversation with you maybe 20 years ago, I think it would be a very different conversation. It would be for me, definitely. But would it be from you as well? [00:02:09][15.3]

Dr Rachel Jones: [00:02:10] Absolutely. And actually, even if I’d had this conversation with you, probably five years ago, it would have been a different conversation as well, because all of my knowledge and interest and learning has occurred since then, since I was working in general psychiatry and I started to see patterns in presentations of women throughout the lifespan. So I’m not just talking about sort of, you know, women in their late 30s, 40s, 50s. I’m also talking about sort of from 18 onwards. So yeah, so I began to notice all sorts of patterns. [00:02:38][28.5]

Dr Louise Newson: [00:02:39] It’s really interesting isn’t think because one of the first things that you learn as a medical student is it’s all in the history. You have to take a really good history. And it’s not just what’s happened to the patient on that day, it’s the lead up. What else has been going on? And I think we sometimes lose that, especially because it’s so easy now to order tests and investigations. Medicine is quite fast paced if you’ve only got ten minutes, so you sometimes forget to put things into context. But I was talking to my daughter. My oldest daughter is 22. She recorded a podcast with me a few months ago now talking about her PMDD. And she uses transdermal oestradiol, so she uses natural hormones. And she said to me yesterday, Mummy, I was saying to some of my friends, I feel the same mentally every day of my cycle. And all her friends, without exception, said, What? What do you mean? How do you do that? And she said, I hadn’t realised and I thought, wow, actually, do we just normalise the fact that our hormones change and affect the way we feel? And it’s often I mean, people can get physical symptoms, but certainly for this podcast, I really want to concentrate on the mental health symptoms because for so long it’s just her hormones. ‘She is a hormonal person. Don’t worry, she’s due on soon’. Yeah, but actually should we be normalising it? [00:03:58][78.4]

Dr Rachel Jones: [00:03:59] No. And also, we know for some women it can be really, really quite severe. So the type of women that I will see in psychiatric services, for example, have made it to psychiatric services. So their symptoms that they’re presenting with very severe and even with thoughts of harming themselves or suicide and they may have harmed themselves and they may have acquired diagnoses such as emotionally unstable personality disorder. But as you say, it’s all in the history. And when you spend time asking them questions in detail and in particular about their menstrual history, which interestingly is not part of the standard history and mental state examination that we use in psychiatry, it’s one that I’ve sort of developed is that you you see a clear pattern where these women are often feeling relatively okay in the first half of their cycle, but will then have thoughts about harming themselves. They may even harm themselves and having thoughts of suicide. But there’s a pattern to it and it’s focusing on that pattern and understanding the pattern in the context of the menstrual cycle, which is really key. [00:04:59][60.3]

Dr Louise Newson: [00:05:00] Absolutely. And I think also we forget don’t we, some of us might remember from biology days at school but our hormones naturally change throughout our cycle. So when people are having, you know, regular periods, we get a peak of the oestradiol, progesterone, even a little bit of testosterone as well, surge when we produce an egg or ovulate. But it’s the second half of the cycle, isn’t it where we have this huge rise actually in progesterone and less so, but still a rise in oestradiol, the natural oestrogen and then they plummet quite quickly, don’t they, before we have a period? [00:05:33][32.9]

Dr Rachel Jones: [00:05:34] Yes, yes they do. And it’s that period where some women just find from a mental health perspective, find it so debilitating. And that’s what I’m interested in, really, certainly seeing the women I see in psychiatric services. And if you can help them from a hormone perspective there, it reduces the need to prescribe other medication, you know, with associated side effects. So I think it’s really important to understand their mental health symptoms in the context of their menstrual cycle. [00:06:02][28.4]

Dr Louise Newson: [00:06:03] Yeah. And I remember sitting in a clinic many years ago, actually, where there was a lady who came in who was quite young. She was a follow up patient and she’d been diagnosed with PMDD, premenstrual dysphoric disorder. She had had a dreadful time a few days before her periods. Very classic history. And the doctor had prescribed her some natural hormones. So oestradiol, progesterone and he’d also given her testosterone, had added that in and she’d been a patient for about a year of his. And when she was being reviewed, she was just saying how her life had been transformed. And afterwards she left the consulting room and I said to the doctor, But what? Why are you giving hormones? Like I’ve always been told, you give antidepressants for two out of four weeks or we can think about lifestyle and everything else. And he said, Louise, you’re just replacing what’s missing. You’re topping up those hormones that have become low and having a problem in some women. And I thought, Yeah, that’s so simple, but it’s almost so simple it’s been forgotten, hasn’t it? [00:06:58][54.7]

Dr Rachel Jones: [00:06:59] It has. In terms with antidepressants, I think sometimes there is a place for antidepressants and they do take the edge off. They will take the edge off symptoms. But then you’re not treating the problem with the right thing. And natural hormones are natural, as you say. They’re replenishing what’s missing, what needs to be rebalanced. And as a consequence, there are minimal side effects. Women respond incredibly well. And as you said and many of my women tell me that it’s life changing and that they will go and not even know that that period is arriving. So they’re surprised they’ll get the period and think. But I had no symptoms leading to this to my period and and they almost can’t get their heads around how how transformative it’s been for them. [00:07:39][40.1]

Dr Louise Newson: [00:07:39] Yeah and it’s interesting because we mentioned these three hormones, but I’d like to just spend a little bit of time, if I may, talking bit about progesterone, because progesterone means different things to different people because we’ve got the progesterone only pill. We know the combination pill contains progesterone and we know implants, Depo-Provera contains progesterone. But and the big caveat here is they are all synthetic so they’re chemically altered. They’re not the same as the natural progesterone, and I can’t seem to say it enough. And even when I say it to doctors, they’re like, Hang on, say that again, because it’s all called progesterone. It’s very confusing, but it’s not progesterone. We have progesterone we produce ourselves. We make it in our ovaries, we make it in our brains, we make it in other tissues, the natural progesterone. But all contraceptives are not natural, are they? [00:08:30][51.1]

Dr Rachel Jones: [00:08:30] Absolutely not. And they are not the same. So I can’t tell you how many women I’ve seen in my clinic who have not tolerated the progesterone only pill. They haven’t tolerated the combined pill. They haven’t tolerated the Mirena coil, for example, evenly. And then you prescribe the natural progesterone and they tolerate it. They respond and their symptoms improve and disappear. So they’re not the same. They really aren’t the same. [00:08:58][27.5]

Dr Louise Newson: [00:08:59] No. And I often say to people, our hormones, obviously are chemical messengers. But I think if you think of them as like a key and the receptors like a lock, which are the receptors on cells, and once the key goes into the lock and unlocks, you have these lovely biological processes that occur. Now, the synthetic progesterone or the synthetic hormones, they’ve been chemically altered so they might fit into the lock. So they might stimulate the receptor, but they won’t unlock it. So we’ve all had dodgy keys in the past where you think oh great, go in and then it doesn’t turn. And it’s that sort of thing. So I think has a double negative effect because it blocks any natural hormone working and it doesn’t have the same effects. And there are a lot of women, certainly in my experience and I’m sure in yours who have quite severe PMDD or PMS, and they tell me that they cannot tolerate any progesterone at all. Like they’ve literally gone mad even with the Merina coil, for example, or tried to rip out their implant. And they’re so scared of progesterone because they think it’s all the same but when they have the natural progesterone, they often respond even better than other women. [00:10:08][69.5]

Dr Rachel Jones: [00:10:09] Yeah, they do. I think that progesterone, for me, it really is the key hormone that is forgotten about from a mental health perspective. It’s just fantastic for mood, for anxiety, for irritability, for rage, for sleep, all of those symptoms. And if you prescribe the natural progesterone, it changes women’s lives. And every single day I’m in my clinic, I’m speaking to women that just can’t speak highly enough of how they responded to natural progesterone. [00:10:40][31.7]

Dr Louise Newson: [00:10:42] Yeah, and it’s very interesting. I mean, when I was first learnt about hormones, it was almost you have oestrogwn as the main hormone. You have progesterone if you’ve got a womb because it protects the lining of the womb. And testosterone is only for really reduced libido when women are taking HRT. But when we look at how our hormones are manufactured, they’re come from progesterone, progesterone is like the main hormone. And then then you get testosterone, which is, you know, gets aromatased to oestradiol. But also progesterone forms cortisol and corticosterone as well. Which are really important, associated with inflammation, but also stress as well. So it’s almost like a seesaw, isn’t it? If your progesterone goes down, your cortisol can go up as well, so your stress hormone can go up. So that’s also like something that I think a lot of people don’t think about. [00:11:31][49.7]

Dr Rachel Jones: [00:11:33] These hormones don’t exist in isolation. They form an equilibrium with one another. And if one gets low, that impacts the other hormones and if one gets too high that impacts the other. So it’s about finely tuning them alongside one another. So I always, as you say, I’ve always got this cascade in my head of what’s converting to what. And understanding that they need to balance. They don’t exist in isolation. And I think that leads me on to saying that progesterone, in my opinion, bearing in mind I’m looking at it from a mental health perspective and as a psychiatrist, in my opinion, should not just be prescribed to keep the lining of the uterus thin. It’s got many, many, many more benefits than that psychologically. [00:12:14][41.6]

Dr Louise Newson: [00:12:16] Yeah, and I totally agree, especially when we think it is a neuro steroid. It’s a hormone that’s produced in our brain. So it’s produced in our brain for a reason because it has these beneficial effects. And like you say, very calming actually, really can help anxiety reduce. It can help with sleep. It can just help with mental thought processes as well, actually, and clarity of thought. And I first sort of saw quite a few people who’d had a hysterectomy. They’d been on HRT and then their gynaecologist said, well you haven’t got a womb now you don’t need progesterone. And they’d come back and say, But I can’t sleep. I’m really anxious… And no one thought about their progesterone, they said, But I had some left over. So I took it and everything improved. So, you know, they learnt themselves almost. But then when you read how the hormone works, so we’ve got a lot of work from Katharina Dalton, who was very inspirational, way ahead of her time doctor who prescribed a loss of progesterone to women with PMS, PMDD and really incredible results. Also postnatal depression as well. Yeah. But you know, she was reported to the GMC, the General Medical Council. The gynaecologists tried to strip her of her registration, but she was quite formidable. I’ve spoken to quite a few people who were her patients and she actually went to my old school, so she came and lectured when I was about 13 and she was quite, you wouldn’t really argue with her. She was very forthright, very outspoken. She was really understood the difference between natural and synthetic hormones in a way that I don’t think anyone has spoken about it in the way she has until recently when we’re all connecting and joining the dots again. [00:13:54][97.7]

Dr Rachel Jones: [00:13:54] Yeah. And I feel the same about the, I have the same issue with women actually, who are on natural oestrogen and have a Mirena coil because that’s not the same as having natural systemic progesterone. And often I will have women come into my clinic who are anxious, they’re low, they’re not sleeping, they’ve got migraines, and they’re not on any progesterone. So I prescribe progesterone and they get better. It’s often as simple as that. [00:14:24][30.3]

Dr Louise Newson: [00:14:25] Yeah, I think we certainly do. And I see lot of women whose sadly, doctors have refused to prescribe progesterone because they’ve got a Merina coil in. But it is a natural hormone and it is really important, but it’s about having the right dose and type because sometimes people take a little while to get used to the progesterone, don’t they? Sometimes when they start it, they can sometimes feel a bit worse and making sure that they have it in the right way, that it’s absorbed in the right way, the right dose for them. Some people need higher doses. Some people prefer as a pessary, there’s options, which I think is also really important as a doctor to allow people to know that there are options even with the progesterone, the way that you can have it and the dose because that’s important too isn’t it? [00:15:12][47.1]

Dr Rachel Jones: [00:15:13] Yeah, I think absolutely and for women not to give up. So another thing, that I will see women coming to the clinic they’ll say, I didn’t. I just didn’t tolerate the progesterone. I had to stop it and that was the end of it. So then to sort of, you know, extend the conversation and say, well, that doesn’t mean that it’s not going to work, that we can’t make it work for you, as you say, in different doses or different forms of taking it. One shouldn’t give up if they’ve just tried it and they’ve said they haven’t tolerated it. That’s not a reason just to give up and not try again. [00:15:42][29.5]

Dr Louise Newson: [00:15:43] Yeah. And I think also, like you said before, these hormones all work together. And so balancing the hormones is really important. So it’s not just about keep going with oestrogen as much as you can and then don’t worry about the other hormones. You know, it is looking at how they balance with progesterone and also testosterone as well. Someone said, a while ago there’s like a triangle really of the hormones. And I think that is really right. And actually, even Katharina Dalton spoke a lot about nutrition and making sure people ate regularly. They weren’t putting too much stresses on their body, especially with glucose and insulin. And I think that’s really important too, certainly looking holistically at how we do anything to reduce anxiety. [00:16:26][42.8]

Dr Rachel Jones: [00:16:28] Very much so. [00:16:28][0.3]

Dr Louise Newson: [00:16:28] But that can be very hard unless you’ve got your hormones balanced. [00:16:30][2.1]

Dr Rachel Jones: [00:16:31] Yeah, and absolutely. And as you said, because you said earlier that testosterone can convert to oestradiol. So whenever I’m prescribing testosterone, I’ve always got in the back of my mind. Well, some of that is converting to oestrogen. So therefore, we’re going to have to balance with even more progesterone than we would have if they weren’t on testosterone. So it’s always considering what you’re prescribing, what doses you’re prescribing and making sure that they’re adequately balanced with the progesterone. [00:16:57][26.0]

Dr Louise Newson: [00:16:58] And I think that is so important because, you know, about just over 50% of people we see in our clinic are already taking hormones. Now they’re not coming because they want to come to our clinic. They’re coming because they’re still having symptoms. And that individualisation of care is really important, isn’t it? [00:17:16][17.8]

Dr Rachel Jones: [00:17:17] It’s so important. Certainly from a mental health perspective. I mean, I, I rarely see if I’m completely honest when I obviously the type of women that I see in my clinic have quite debilitating, significant mental health, psychological symptoms. And it’s never, ever, ever a one size fits all approach. They all respond individually and you have to go very, very carefully with the doses, with the individual hormones that you prescribe and gradually titrate them over time until you get the balance right for them. And likewise with you. So many of the women that come into my clinic have either taken HRT and have given up or are still on HRT and they haven’t got the right balance and are about to give up. And that’s not the end of it. It’s about getting the right doses for them. [00:18:06][48.5]

Dr Louise Newson: [00:18:06] Yeah. And it’s interesting when we think about some of the psychiatric medication that people are taking, and I did quite a lot of psychiatry as part of my training, I’m very interested in mental health, but I hadn’t realised Rachel the impact of mental health on hormones until like you say pattern recognition. So we see a lot of women who are on Quetiapine, an antipsychotic. They’ve been on two, three, four, sometimes five different antidepressants with not good effect. I’ve seen quite a few women. I’ve lost count, actually the number who have had electroconvulsive therapy. Increasingly, I’ve seen women who’ve had ketamine infusions. Yet, like you say, it’s not built into the history taking asking about any potential hormone changes, thinking about periods and so forth. But one of the things that we noticed and we’re just writing up some data is that women, once they have their hormones balanced, obviously we keep them on the same medication because they’ve been on it. They start to then be able to deprescribe some of their medication. And we found that when people on a combination of all three hormones, they can deprescribe better than just on oestrogen, for example. Yeah. And I think that’s really interesting because I think it’s a bit like a Venn diagram with mental health and hormones. I think there’s some people who it’s all a psychiatric condition and it’s nothing to do with hormones. I think there’s some people it’s probably mostly due to their hormones and it’s not been diagnosed. And I think there’s some in the middle that are both, so there… and that’s always difficult, isn’t it, to know which they are. I think getting across everything is so important, isn’t it? [00:19:43][96.9]

Dr Rachel Jones: [00:19:43] Yeah. And the approach that I take, firstly, I always listen to them because they’ve always got usually got a pretty good idea of themselves, of what’s happening with their cycle and their patterns. And they will often come to me and say, I’m sure it’s my hormones, or I’m sure my hormones got something to do with it. So that’s the first thing is I really listen to what they say because they often know deep down. The second thing is I always say I’m not, especially if they’re under psychiatric care from another psychiatrist or another team, and they come to me, and even if they’re my patient, I’ll always say, I’m not going to change your psychiatric medication at the moment and I’m going to just focus on your hormones and balancing, replenishing finely tuning your hormones. And only when we’ve done that and where we see how much improved you are, how far we can go with that, will we then be in a position to even contemplate looking at your psychiatric medication and potentially reducing it and stopping it in a very gradual, controlled way. Firstly, because if you do more than one thing at a time, you never know what’s what’s doing what. No, you just won’t know. And secondly, I think you do have to tread carefully with their medication when you start to address it. I mean, they’re often obviously, understandably, very keen the moment they they feel better once they’re on their hormones, they want to stop it immediately. But I, I really say to them no, it’s got to be done in a really controlled, careful way. Often one at a time and titrating according again to their response. So it does have to be done very carefully. I don’t want to tread on anyone else’s toes, on any other psychiatrist’s toes. I make it very clear that what we’re doing is focusing on the hormones first, and only after that may we start to address that psychiatric medication. I think that’s really important. [00:21:33][109.6]

Dr Louise Newson: [00:21:34] Is so important. And certainly, you know, I did a lot of deprescribing as a GP and in the clinic we do it. But even just I say ‘just’ in inverted commas, antidepressants, I will reduce very, very slowly, especially when people have been on them for a length of time. And actually I have this unwritten rule that I’ll only start reducing them in the springtime when the crocuses come out. Yeah, because like you say, sometimes people are in a real rush to stop but in the winter months, unless there’s a real reason, I would just say, Look, you’ve been on them for a while. Let’s just wait till the clocks have changed. We see some spring flowers and then we do it really, really, really gradually. [00:22:11][37.0]

Dr Rachel Jones: [00:22:12] Really slowly. [00:22:12][0.6]

Dr Louise Newson: [00:22:13] Yeah. And I, I can’t emphasise how slowly actually with these medications, just because just in my clinical experience, people have less problems coming off the when it’s very slow. Whereas when they do it quick that’s when they get more side effects. [00:22:29][15.5]

Dr Rachel Jones: [00:22:29] Yes. And a rebound, a rebound, depression rebound low mood. I’ve seen that so many times. So and I’m exactly the same with you really, really slowly. I mean ofte I do it over a period of nine or ten months and tiny, tiny, tiny bits over a period of time because there’s no harm in doing it that way. It’s important to keep the patient on side because they just often want to stop it and be done with it. But it’s really, really important to do it like that. [00:22:53][23.9]

Dr Louise Newson: [00:22:54] Absolutely. And we have a psychiatrist actually working with us in the clinic. So some of the drugs like Quetiapine and the Pregabalin stronger drugs, I feel a lot confident doing it in conjunction with a psychiatrist, but it’s a team effort as well. So the patients feel really supported. And it’s also looking at what else might be affecting their mental health. And as you know, often when our hormones are balanced, we’re more likely to eat a better diet. And, you know, the effect of the way we eat or what we eat on our mood is huge, but you don’t realise until you sort of start to eat better. And that can have an effect. But if you are very low in your motivation, low in your mood, you’re not going to be thinking about how to have a nutritious meal. So a lot of people comfort eat, don’t they, or snack. And then they have the, yeah. So all of these can make a huge difference. [00:23:41][46.9]

Dr Rachel Jones: [00:23:43] Yeah. And the same with exercising. The last thing that you feel like doing when you’re feeling depressed, when you’re feeling anxious, when you’re feeling irritable, when you haven’t got any motivation is to do any exercise. So I always say when they start to feel better, it’s just little, little steps. Gradual, gradual changes over time build up to big changes. So yeah, but absolutely emphasising that lifestyle changes are also key alongside the hormones. [00:24:08][24.8]

Dr Louise Newson: [00:24:09] Absolutely. And I also think very much with our brain, our brain likes homeostasis, everything the same, doesn’t it? So anything that can be routined is also very important. You know, even the way that some people respond very differently than others. So like you were saying, it’s not everybody that gets PMS or PMDD. Some people have these hormonal changes, don’t notice. And it’s a bit like being hungry. Some people, when they’re hungry, their mood goes and other people, it doesn’t matter. They’ll just eat because they need to, but they don’t have that same, you know, change in the brain. And it’s the same with anything. Is that the way people respond to alcohol, for example, is different. Our brain is so interesting. But there are some people and we don’t know whether it’s a genetic thing or what that are definitely respond more. And those women with PMS, PMDD, more likely, it’s not guaranteed, are going to have a more difficult time in the perimenopause as well, aren’t they, With mental health? So it’s a sort of warning almost, to sort of make sure you don’t want to wait until you’re perimenopausal before you think about hormones. I much prefer helping people younger. [00:25:21][72.0]

Dr Rachel Jones: [00:25:21] Yes, absolutely. I think these, as you call them, hormone conditions, whatever you call them, again, a bit like hormones themselves they all blur into one another. They don’t really exist in isolation. So women who suffer with PMS or PMDD are more likely to have postnatal depression after the birth of a baby and in my experience, are more likely to suffer from a mental health perspective through perimenopause, menopause and out the other side, unfortunately for them. So the earlier that you can get on top of it for the earlier you can balance their hormones and go on the journey with them as they age and go through the different, you know, periods, in their lives, the better the prognosis and the better response they make to the hormones. [00:26:06][44.5]

Dr Louise Newson: [00:26:06] Yeah. I saw someone in my clinic yesterday who’s 30. She’s quite young, and she’d been diagnosed with PCOS, but only on a scan. It didn’t really show the classical. Just one of her ovaries was a little bit enlarged, but she’s got definite PMS or PMDD depending, and she’s responded really well just on a small amount of hormones. And she was worrying about what’s the diagnosis is. And I said, Well, actually it doesn’t really matter. I know she wanted to know, but whether she might have PCOS, she might be PMS. It doesn’t actually, well she has hormonal changes and all I’m doing is topping up her hormones. It’s not going to worsen her fertility. It might improve her fertility if she wants or when she wants to become pregnant. But it’s done in a very natural way. And increasingly, and I understand why younger people don’t want to have contraception, they know more about it. They know that they’re synthetic. And so knowing that there’s a choice, it’s not going to be contraception because the dose is low and it’s a natural hormone. But it doesn’t mean we can’t give these hormones to younger people, does it? [00:27:12][65.3]

Dr Rachel Jones: [00:27:12] No, it doesn’t. And I used to see women in the clinic who would come in with PMS. But actually when you explore and look at their symptoms in detail, they also have symptoms of either PMS or PMDD so, you know, quite debilitating psychological symptoms before their period. And actually they respond very well in my experience, to well, to progesterone again. So absolutely. And often I don’t know whether you found this as well that I find a lot of women’s symptoms of PMS and Pmdd start once they’ve been on the oral contraceptive combined pill for a significant period of time. So they never had it before. They go on the pill, they come off and then all the problems start moving forward for them. [00:27:51][38.8]

Dr Louise Newson: [00:27:52] Yeah, absolutely. And like I say, some of these people, especially when they’re young, they might only need for progesterone, they don’t always need all three hormones because they’re producing them themselves of course, aren’t they? [00:28:01][9.7]

Dr Rachel Jones: [00:28:02] Yes. Yeah, absolutely. For me, progesterone seems to be this wonder hormone that sort of like helps with all the conditions all the way through. And post-natal depression as well, progesterone is very effective in treating that too. So yeah, I think progesterone mustn’t be the forgotten and left behind hormone. It’s absolutely key in treating mental health in the context of hormone depletion or hormone imbalance. [00:28:25][23.6]

Dr Louise Newson: [00:28:26] Yeah, no that’s been so useful. It’s really good just to dig in a bit deeper actually. And like I say, some of it is so obvious, but often in medicine, we forget the most obvious things. Yeah, go for something more complicated. So I’m very grateful for your time Rachel. [00:28:40][14.0]

Dr Rachel Jones: [00:28:41] It’s a pleasure. [00:28:41][0.2]

Dr Louise Newson: [00:28:42] Before we end I always ask for three take home tips. So can I just ask you for three reasons why you think progesterone is such a great and important hormone especially in context of mental health? [00:28:54][11.6]

Dr Rachel Jones: [00:28:55] Because it seems to treat everything. It seems to help with everything. It helps with sleep, which we know can be so debilitating to mental health. It helps with anxiety. It’s a calming, soothing, natural antidepressant and it seems to be a buffer. So it sort of balances everything out. So it sort of changes throughout the menstrual cycle. It seems to balance out changes in mood, mood swings. It balances out anxiety, it calms down, it lifts mood. It seems to have an effect across the whole range of symptoms. That’s the first thing. The second thing I say about progesterone is don’t give up. So women become very disheartened. They often hear that progesterone is good for their mental health. They try to take it. They don’t react well to it. They give up and they say, that’s it, I can’t have it. So that would be the second thing. Don’t give up. And certainly don’t assume that synthetic progesterone and natural progesterone are the same thing because they’re not. And the other thing that I would say is consider progesterone throughout the lifespan. So not just for perimenopause, menopause, certainly not for just maintaining the lining of the womb, but from a mental health perspective. So all the way up PMS, PMDD, postnatal depression, perimenopause, menopause and out the other side. So consider it throughout the lifespan is what I would say. [00:30:19][84.3]

Dr Louise Newson: [00:30:20] Really great advice. So thank you so much. [00:30:22][2.3]

Dr Rachel Jones: [00:30:23] Thank you so much for inviting me. [00:30:24][1.6]

Dr Louise Newson: [00:30:29] 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. [00:30:29][0.0]

ENDS

The post Natural progesterone: what mental health benefits can it bring? appeared first on Balance Menopause & Hormones.

Content advisory: this episode includes themes of mental health and suicide

In this episode, Dr Louise Newson speaks with Rachel Birch, a doctor who shares her personal journey of menopause, mental health and alcohol addiction. Rachel discusses the lack of training on menopause in medical education, her experiences with anxiety and depression, how she found herself using alcohol as a coping mechanism and how she is navigating her recovery. Rachel emphasises the importance of self-advocacy, community support, and self-love in recovery. The conversation also highlights the need for better awareness and understanding of menopause and its impact on mental health.

Rachel also shares the following advice if you find yourself struggling with addiction:

• Listen to your body and trust your instinct
• Be your own advocate – you know your body best
• Prevention is better than cure: be alert to drinking habits
• Don’t suffer alone, reach out for help.

Click here to find out more about Newson Health

Contact the Samaritans for 24-hour, confidential support by calling 116 123 or email jo@samaritans.org.

Transcript

Dr Louise Newson: [00:00:00] 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. So today on the podcast, I’m very excited actually. I’ve got someone who I’ve known for a little while now, and unlike many of my guests I met in real life when I was on my tour. So she is a doctor called Rachel Birch, and she’s got a very interesting, quite emotional story that she’s happy to share about. And it does have a happy ending, I just hasten to add. So welcome, Rachel. Thanks so much for joining me today. [00:01:12][72.1]

Dr Rachel Birch: [00:01:13] Thank you very much. I’m really excited to be here, actually. And I think I think the work you’re doing is great. I love these podcasts. I’m, I’m an avid listener and hopefully, you know, what I’m going to talk about today will, will help others. That’s the aim. [00:01:26][12.8]

Dr Louise Newson: [00:01:27] Yeah. Well, I mean, I set up the podcast because it’s just another forum, isn’t it? And I feel it’s such a privilege actually, because my diary, as you know, is really busy. So to have time with people understanding more, not just from people who are experts, leaders in their field, but also real people with real stories. Because as you know, Rachel, in medicine, you learn a lot from the from the data, from the studies, from the trials, from the academic papers. But actually, the icing on the cake, which really changes our clinical practice is, is clinical experience listening and learning from patients and people. And that’s the most privileged part of being a doctor, isn’t it, is being allowed to listen to these stories? [00:02:11][44.0]

Dr Rachel Birch: [00:02:12] Well, absolutely, yeah. I mean, I think almost everything that I learnt really has come from from patients, from listening to people. You know, you can learn, of course, you know, what books saying what the papers say, but, you know, how it translates to people’s real lives. It’s, you know, that’s that’s the important bit. [00:02:27][15.3]

Dr Louise Newson: [00:02:29] Absolutely. And I’m very fortunate at the clinic that we have we have a lot of time. And the time is something that has gone so much actually over the last 25, 30 years of me being a doctor is that people are so rushed and then you don’t get the bigger picture. So, so tell me a bit about you, if you don’t mind. [00:02:47][17.9]

Dr Rachel Birch: [00:02:48] Yeah. So, So, yeah, a little bit about me. Wow. What to say? I’m 53. I’m a mum. I’ve got two children who are now 21 and 23. I am a doctor. I trained as a GP and worked as a GP happily for many, many years. Now I work for an organisation that actually supports doctors, which is equally rewarding as being a GP actually in in different ways. Hobby wise, I love cold water swimming, I love Pilates. I’ve got two dogs that are very active and keep me out in nature. I practice Pilates. Yeah, photography. Got a lot of interests, but one of my passions is, is menopause as well. And even within my workplace, I’m part of menopause support network. You know, I’m, I’m passionate about mental health and I’m passionate about, you know, women’s health. So, yeah, they’re big interests of mine. [00:03:39][51.0]

Dr Louise Newson: [00:03:41] Really? And probably like me, you didn’t have much training about menopause and certainly menopause and mental health when you were an undergraduate student? [00:03:49][7.5]

Dr Rachel Birch: [00:03:50] Goodness no, no. As an undergraduate, honestly, the message was, you know, when women become menopausal, their periods stop. Like that was it, back in those days, I think we’re the same age. I qualified in ’94. I think maybe you did, too? [00:04:00][10.4]

Dr Louise Newson: [00:04:01] Yes, I did. Exactly the same. [00:04:02][0.6]

Dr Rachel Birch: [00:04:02] Say, well, yeah, we probably had very similar training then, you know? I mean, I think they didn’t know as much. It’s not that we weren’t necessarily it wasn’t hidden from us. But, you know, I really think that, you know, we knew about hot flushes and night sweats. We knew that the periods could become erratic, could become more frequent, could become less frequent, you know, but ultimately would stop. And that was it. You know, a woman was menopausal. They called it post-menopause back in the day. Yeah. Yeah. Mental health as well. You know, I mean, I did have quite a lot of psychiatry training as an undergraduate. And and, you know, there was really no mention of hormones and their relationship with mental health. So that wasn’t really an issue I kind of really got until I became a GP and started seeing for myself, you know, that actually, you know, they were very closely linked hormonal health and mental health, you know, listening to people, listening to patients. [00:04:55][52.6]

Dr Louise Newson: [00:04:57] Yeah. And I didn’t realise either. Like, you know, I’ve done a lot of psychiatry, I’ve done a lot of general medicine, a lot of general practice, but I didn’t put the two together. And it’s only the myriad of people we see who have actually come from psychiatrists and they, they’ve treated as much as they can about their mental health, but they’re still having symptoms as well as physical symptoms of menopause or hormonal changes. And then when we give them the right dose and type of hormones, everything fits into place. And then going back and reading papers, reading how these hormones work in our brain, reading how they affect the levels of, you know, serotonin, dopamine our happy hormone, our reward hormone, you know, it’s all there. But we just don’t, if we don’t teach it, you don’t know. So tell me a bit about your story. We said at the beginning that you had an interesting but not unique story. And actually, I think it’s more common than people were led to believe. So So tell me a bit about what happened with you Rachel, if you don’t mind. [00:05:51][53.8]

Dr Rachel Birch: [00:05:52] My story is not unique, actually. And and also, you know, what I’d like to say is that, you know, when I was working as a GP, I probably heard this story fairly frequently, you know, and perhaps didn’t really quite realise the implication of the story. So, you know, I think this story is a good one to share for, for, for women so that they appreciate, you know, what I went through and you know, for GPs as well, just, you know, to give another, another lived experience, you know, and put that out there. I think I was about 44, I was working as a busy GP, I had teenage children, I’m a single mum. I became really anxious and it was almost overnight, you know, I mean I’ve been quite stable, quite sane. Suddenly I just became really anxious. I couldn’t really put my finger on it. I just felt really on, you know, on edge, ill at ease. I was getting really horrible mood swings. They started to appear. They would occur over minutes. And again, mood swings is something I’d never really experienced before. So, you know, one minute I could be absolutely fine. The next bit I’d be snapping at the kids, you know, really losing the plot. I wasn’t really doing this at work because I think you can maintain a kind of professional persona, can’t you? And you perhaps don’t don’t give into your your personal sort of feelings just quite so much. But at home, I think I was a horror. You know, I was snapping at the kids. I felt really down. The kids started calling me volcano mom, you know, And that was appalling. I couldn’t believe that. Yeah, Yeah. I felt for the kids because, you know, I, I, I realised, you know, I was doing it, you know, it would come from nowhere. I didn’t really have any control. I was forgetting things. I couldn’t think, you know? I just felt like I was losing my mind. I felt quite down. That came later, really. I think, you know, the mood swings and the anxiety were all there, and I just felt helpless. And I thought, what is happening with me? I thought, I have I got dementia? You know, I’m forgetting. [00:07:55][123.6]

Dr Louise Newson: [00:07:56] It’s very scary isn’t it? [00:07:56][0.0]

Dr Rachel Birch: [00:07:57] It was terrifying, actually. It was terrifying. And I talked to friends about it and nobody at the time had really sort of experienced something similar. So I just thought, gosh, that’s me. You know, What, what’s happening? [00:08:09][12.4]

Dr Louise Newson: [00:08:10] That’s, do you know. Yeah. And that happens so much, actually, Rachel, that people blame themselves because if you don’t understand what’s happening, you know, you’ve already said you’re single mum, anyone knows bringing up children can be very hard. Bringing them up on your own can be difficult too. And then having a job. You know, it’s so easy to internalise and say, well, it’s probably because I’m not coping with my situation. And that happens so much, doesn’t it? [00:08:38][28.1]

Dr Rachel Birch: [00:08:38] Totally. I beat myself up. I thought it’s you. You’re not coping with with having a job and bringing up children. You know, this is a defect in you. This is your problem. None of your friends are having this, you know, totally,, I’m a perfectionist. I think many doctors are anyway, it goes with the territory. And and I did. I just I had a history of mental health, you know, issues. So I just thought, it’s it’s it’s you not coping Rachel. You know, it’s it’s really sad. [00:09:07][29.0]

Dr Louise Newson: [00:09:09] So what did you do? How did you get help Rachel? [00:09:09][0.1]

Dr Rachel Birch: [00:09:11] So I went to my GP and and, you know, explained what was happening. I mean I guess I probably you know, again, I’m not the best person at actually asking for help. And I thought, it’s me, It’s a phase, you know, I think I waited, I had a holiday. I waited to see if it improved when I’d had the rest and relaxation because again, you know, sometimes you’re overworked and perhaps you do need a holiday but, didn’t settle. So I went to my GP and she was lovely, you know, but she said, well, you know, you’ve got recurrent depression. This is another episode. And I said, Well, you know I don’t know if it is. And she said, you know, if you’ve got teenage kids now, this is kind of par for the course. You know, she had kids of a similar age. And, you know, I get that teenage children are challenging. You know, mine were challenging in wonderful ways if you’re listening kids. But you know and again, you know, I don’t blame her. I think, you know, it was it was a fair, it was a fair thought. You know, is is it recurrent depression? I had had three episodes of depression in the past. One was post-natal. You know, I think we all can realise now that that was probably hormonal. You know, the other two were in the sort of ten years before, you know, this episode and, and it could well have been hormonal too. But you know, I kind of, I suppose I’d been labelled and perhaps labelled myself as having recurrent depression, you know, almost like it’s a vulnerability in me. And therefore, of course that’s what it was. Yeah. So, you know, she increased. [00:10:34][83.0]

Dr Louise Newson: [00:10:35] So then what happened? [00:10:35][0.4]

Dr Rachel Birch: [00:10:36] She increased the dose of my medication, which, you know, I was happy to try, but it didn’t help. I just felt worse because I got sort of side effects from a higher dose. I kind of went back to her a few times. So, you know, I, you know, we talked, you know, she said, well, you know, let’s give it a bit more time. You know, do you want to change antidepressants? I wasn’t really keen on that. I went to see a psychiatrist myself privately. I thought, look, I’ll get some some input there. And he suggested changing the antidepressant, you know, which he did. So nobody really thought about hormones. And actually I didn’t think about hormones. So there’s no blame here because, you know, I’m a doctor, my GP’s a doctor, my psychiatrist is a doctor. I do think that we kind of fell into the trap of, it must be depression, you know, and it took four years before I really just suddenly thought. [00:11:24][48.5]

Dr Louise Newson: [00:11:25] Four years? [00:11:25][0.0]

Dr Rachel Birch: [00:11:26] Yeah. I mean, that’s shocking, isn’t it? Suddenly, you know, I just thought, Gosh, you’re 48 now. Hello. You’re perimenopausal age, you know, and I could have kicked myself. You know, I went to my GP and she immediately said, gosh, yeah, you’re right. And we tried HRT. [00:11:43][17.1]

Dr Louise Newson: [00:11:44] And is that because you you went to your, so you went to your GP saying, I think it’s my hormones? [00:11:48][4.3]

Dr Rachel Birch: [00:11:49] Yeah, I did. And she immediately said, No, I think you’re right. You know, I can see you’ve been struggling on, you know, it’s clear it isn’t just depression. You know, I think there’s always this suspicion, isn’t there, that that I that I could have two things going on and maybe I did. But the antidepressant medication and, you know, seeing a psychiatrist and trying, you know, counselling and self-help hadn’t been enough. So she was very open, you know, immediately. You know, she, she she is of a similar age to me, you know, possibly, you know, she she was on her own journey, you know, I don’t know. But she was very open straight away. So HRT that day, you know. And then… [00:12:27][38.4]

Dr Louise Newson: [00:12:28] And then what happened? [00:12:30][1.4]

Dr Rachel Birch: [00:12:30] Gradually, gradually, everything improved. It takes a time. I had a Merina coil, which I think clouded the issue because I haven’t had periods for 20 years because I’ve been one of the lucky ones to be amenorrhoeaic, no periods on the Merina coil. So since my son had been born, you know, so, so there was never that clue. You know, and again, you know, maybe if my periods had stopped I would have thought, or got erratic, we would have all put it together more quickly. But, you know, that clouded the issue. So, so I started on patches gradually increasing the dose and it just gradually got better and better. And, you know, I’m on the three hormones now, actually, I’m on testosterone as well. And and I feel absolutely great. You know, so it’s clear because none of the stresses have changed, really. You know, I still have a really heavy job, a really important job. I work full time, still got children who still need me, you know, got two dogs who need me, the crazy cat, you know, all the same things that possibly could have contributed to, you know, the worry pot in my mind, you know, they’re all there. So. So, you know, the only thing that’s changed is that, you know, I’ve I’ve, you know, I’ve got recognition from myself, from others. And also, you know, I’m on the treatment, which is really helping. Really helping. So. [00:13:49][79.2]

Dr Louise Newson: [00:13:52] But you had a few years of struggling on your own. Which is so hard. [00:13:55][3.6]

Dr Rachel Birch: [00:13:55] Yes. And I have to say, during those years, it was awful and I couldn’t do anything to get relief. And so the only thing that gave me relief was red wine. You know, at the end of the day, when everyone went to bed, I would have a glass of red wine. You know, I self-medicated. You know, it’s clear now to see that I couldn’t get rid of that horrible feeling of snapping. I also had, towards the the latter two years, I started getting quite horrific suicidal thoughts and urges as well. And and they came from nowhere. And again, you know, everything was getting worse rather than better. My confidence was going, I started not believing in myself. I actually changed jobs. You know, that’s when I stopped being a GP. I, I wondered, you know, maybe it was my job, you know, which was a really drastic step, but one I felt that I had no choice to make. You know, I started drinking a glass of wine a night, and it became two glasses of wine a night. Before I knew it, you know, actually, it was nearly a bottle a night, you know, which is a hell of a lot of, you know, if you add that up, you know, I was on 60 or 70 units plus a week, which is which is so damaging. I would wait till the kids went to bed usually. I mean, I have to confess, sometimes I didn’t and I would have a couple of glasses and that didn’t help my memory. That didn’t help my night sweats. That didn’t help the itch. That didn’t help my buoyancy and my mood. I felt more depressed. You know, the suicidal thoughts got worse. But the only thing that would just make everything stop was just obliterating it really, and just numbing everything. And I think that’s quite common. I’ve been reading a lot. I’ve listened to some podcasts, you know, of your on the subject. And I think I think it’s a trap that we can fall into because. [00:15:46][110.8]

Dr Louise Newson: [00:15:47] It’s very common. Yeah. And it’s very common. And I hadn’t realised how common it was until, like you say, before you said at the beginning, you learn from patients. And of course part of the history taking you ask people about alcohol and, and smoking and lifestyle and you can always tell when people are lying as well. And, you know, the beauty of our consultations is they’re confidential so that people then open up in a way that they often haven’t opened up even to themselves before. And so I do have a sort of maybe I’m a bit witch like, but I do have a way of getting things out of people. And when they do tell you and it’s not just often one bottle, it could be two or three, but it’s not just the bottles of of alcohol. People have told me about their drug addictions as well or their gambling addictions. Anything that’s, you know, escaping from reality, actually. And they know it’s not healthy behaviour, but they don’t know how to get out of it because they feel so awful. And actually, it might be a short term escapism, but it’s the reality still there that they’re feeling dreadful. And when I first started to hear these stories, I just thought, goodness, this is a bigger problem. This is a far bigger problem than perhaps people are realising. And last year, as you probably know, we did a questionnaire about addiction and there were free text answers as well. And you know, I still feel very sad when I read those free texts about people that have turned to Class A drugs in their late 40s because they need to escape from what was going on and they knew it wasn’t right. Now, these are highly addictive illegal drugs that women are turning to. And I’m not saying there’s, it’s very common, but it’s still there. But actually, what is very common, like you say, is alcohol, because it’s so readily available, it’s socially acceptable. People laugh about their wine o’clock. You know, children, a lot going on. Yeah. And that’s okay as a glass, but not when you’re using it as a tool. And as many of you know, I don’t drink alcohol at all. And it’s not because I’ve ever had a drink problem. It was because of my migraines. And if you, I, I know that if I had a drink, I’d have a migraine. So it’s easy for me not to drink, but so many times when I’ve been under stressful or difficult situations, either at home or at work, I can see why people go, oh I’ll just have a glass of wine. But I can’t. So I meditate. I do yoga and that’s good and probably a lot healthier, but it’s so easy to do it and it’s I think there’s many reasons. One of them is because people are feeling low and flat, they want to escape. But the other thing is the addiction side because like we said at the beginning, these hormones affect dopamine levels. Now dopamine is our reward, you know, that pleasure that you get opening the curtains, the sun’s shining. Oh lovely day. Now, if you don’t have dopamine, and often when your oestradiol, progesterone, testosterone are low, then you have a negative feedback. So you have low dopamine as well. So when you open the curtains and it’s sunny and you’re like, What the hell, it’s another day. I just don’t want to, I’m just existing, not living. Of course, then you’re going to need that bit more to actually just feel a bit of pleasure from something as well. [00:19:08][201.3]

Dr Rachel Birch: [00:19:09] Yeah, I think you’re right. I mean, yes, the pleasure would be short lived, you know, with that first couple of sips. But but, you know, it was there and I think it probably did give me a temporary dopamine hit. And the more I learn about, you know, chemicals, you know, brain chemicals, the more I realised that that that’s what happened. I mean, I, I, I, then COVID happened to me then while I was, you know, and obviously that, that caused so many challenges to people, I suspect that COVID and menopause and drinking was probably the perfect, you know, bomb but it wasn’t it? It got a bit worse, you know, three years and and two months and a couple of days ago, I. I just actually saw the light and thought, right, you’ve got to stop because I realised I was addicted. So, you know, I think some people don’t become addicted, but many people do. And I did become addicted. I became addicted to alcohol and I realised that I was at the stage where I couldn’t get through an evening without it. And that’s terrifying. There’s a lot of shame. A lot of shame. You know, I thought I should have known better because again, I’m a doctor, you know, forgetting that I’m actually a human and a woman, you know? And that’s okay. There was a lot of shame, and I had to accept it and I had to admit it. And again, that’s a really difficult step sometimes, but. But admit it I did. And then I hit it with everything I had. I told my GP, I went to Alcoholics Anonymous, I got lots of books and downloads, and I had started practising mindfulness by then and meditation. So I did lots of that. I just did everything that I could. I got an app on my phone, which was really helpful. That tells me how many days I’ve been sober. All of this, like I just used every tool because I didn’t want to fail. I wanted it to be the the only attempt. And it was really hard. I have to say, I did not know how hard it would be. I, I did have quite a lot of physical symptoms. I had crazy psychological symptoms where I just felt I really need to drink, kind of peaked around day 18, 19, 20. It was, it was it was unexpected. But Alcoholics Anonymous got me through that. I mean, I’m really grateful to all my all my colleagues and friends and pals there because, you know, they were really helpful and I managed to do it first time, you know. But, but I’m mindful that, you know, it’s it’s day by day. In the early weeks and months, I replaced my alcohol drinking with eating chocolate. Okay. So I couldn’t have a drink and I just needed something to get through those evenings so I would eat chocolate. And that definitely helped my dopamine levels, but gradually I weaned myself off that. And now, you know, hopefully the levels are a little bit better. I’m going out in nature loads more and cold water swimming even more than ever. Mindfulness, I think really does help with the whole dopamine thing as well. Some practices of self-love, self-compassion, you know, just giving myself love, give myself a hug. It all helps, actually. [00:22:09][180.4]

Dr Louise Newson: [00:22:10] I think that’s really important. And I think it’s something, this is a generalisation of course, I think it’s something generally people, especially women, don’t do. And, you know, the last few months have been quite difficult for me for various reasons, and I’m trying to teach myself some more self-love. And it sounds really cheesy when people talk about self-love because I don’t look at myself and think I’m the most amazing person or the most beautiful or the most lucky or the most whatever, or talented. But actually, deep down, there’s something inside everybody where there’s a bit of something that needs loving. And whether it’s related to past trauma, whether it’s related to a poor relationship, whether it’s related to just how you’re feeling. But it’s that deep down self-love. It’s not that, I’ve got a new dress on. Don’t I look lovely? That’s too superficial for me. It’s more something within, isn’t it, that I think even more when you’re on your own, even more when you’ve got lots of stresses. It’s actually two things really, taking time for yourself, but also acknowledging that a bit of you somewhere needs a bit of a cuddle and warmth and you’re not going to get that by drinking or talking or offloading to someone else. You’ve got to do it from within. And that’s quite a hard thing to do I think. [00:23:26][76.3]

Dr Rachel Birch: [00:23:27] It’s really hard and it’s taken me a while. I have been practising mindfulness. I’m studying it as well and I’ve been practising it for about two and a half years. And I can say actually on camera now that I do have self-love, I can say I love myself, which, you know, honestly, two years ago, there’s no way I would have dared say that. But, you know, and I do give myself hugs and I do gratitude journals and put myself in the journal. You know, I think it does make a difference. It does sound cheesy, but but it does help if you keep going and you get used to doing it. We are great, women are great [00:24:03][35.9]

Dr Rachel Birch: [00:24:05] I think you’re absolutely right… yeah we are and we shouldn’t be we shouldn’t be stripped down and we shouldn’t be gaslit and we shouldn’t be accepting something that isn’t right. But we have, it’s society. It’s history, but we shouldn’t. But one of the things I noticed when I was on the tour and you came to watch, you were with a group of other people. And there was a lot of, you give so much positive energy. And I wonder whether it’s come, I have didn’t meet you before all of this, but I wonder whether it’s come because you are in a better place physically, mentally, spiritually, that you are able to give others even more. You’ve probably always been that sort of person, but you’re just there’s something that’s coming out of you that I think is incredible. And it could feel other people picking up on that, too. [00:24:50][45.0]

Dr Rachel Birch: [00:24:51] That’s a lovely thing to say. Thank you. And I think you’re right. I think you’re right. That’s a really lovely thing to say. And I believe you’re right. I do think that if you exhibit positivity, you know that there is research that has been done. I mean, we have these things called mirror neurones in our in our brains. And and you tend to mirror other people’s sort of behaviour and, and, and, and affect, you know, mood. And so I think that has an effect. But also I think in a greater than that, I think, you know, I think we are all interconnected, you know, we are all human, we do have common humanity here. And I think positivity has a ripple effect. You know, my my, my Pilates class, I will shout out to them, Bev, Diane, Kirsty and Viv. Hello. They are brilliant and they have helped me as much as I have helped them because we are a small group that meet every week and we talk about the menopause, we talk about our mood, we talk about how we’re feeling. I think we all buoy each other up. So I think once one person is positive, the next person, you know, perhaps becomes more positive. And again, that ripple effect happens. So, you know, I do think being positive about the menopause as much as we can and being positive about our mental health and just thinking, look, let’s do our best, let’s let’s not shy away from talking about it. Let’s, let’s, let’s, you know, not embrace it because, you know, but but go with it. [00:26:12][80.7]

Dr Louise Newson: [00:26:12] But it’s so, it’s so important because I think so often people have, this conversation’s been normalised about menopause. Oh you will feel like that. You will feel that or you won’t feel like that and we’re all different. But also there’s this big conversation as you either take HRT and you feel wonderful or you don’t take HRT and you’ve got to try all these other things. But actually in my mind, whether you take HRT or not, you’ve still got to be thinking about ways to improve your mental and physical health. And that’s so important. You can’t just use HRT as something that’s going to turn you into this amazing person because you’re still going to have challenges in your day, whether it’s work or home, or you’re still going to be making food choices. You know, you’re still going to be making choices about doing exercise. You know, this morning I woke up and I’m really tired, but I still got up to do 20 minutes of yoga before I got in the shower. And I feel better for it. You know, it’s only 20 minutes, but actually it would have been really easy to have just set my alarm 20 minutes later. But, you know, I feel better. I ended in a headstand. I did some meditation and and I’m like I can fight this day, but that’s not HRT. HRT is good, but it’s not everything. But on the flip side, there’s so many women who aren’t able to access HRT who, like you were, thinking, this is just my lot. And this is nothing to do with my hormones. And this is also, and it’s sad because you were blaming yourself. But actually you saw different doctors. So how we do this joined up process where we can empower women, but also we can educate healthcare professionals from every speciality. Just to think, could any of Rachel’s problems been related to her hormones? And even if it was only 5 or 10%, treating your hormones might have been enough to stop you becoming, you know, having problems with alcohol. [00:28:01][109.0]

Dr Rachel Birch: [00:28:02] Yeah. [00:28:02][0.0]

Dr Louise Newson: [00:28:03] Or just having a better time with your children or just not giving up or changing your job. There’s lots of little things. And I think as doctors, we need to tease out every single bit. We’re not just blaming one part, but if we don’t have the whole 360 approach, like, you not having the hormones was definitely a bit of the puzzle that was missing. [00:28:22][19.6]

Dr Rachel Birch: [00:28:23] You know, it was. And I think once I got the hormones, I was able to see the bigger picture. You know, I think I think I think my mental health was I guess so impacted by this by the time, you know, I became 48 and I, I had my light bulb moment. I thank goodness for the light bulb moment. But, you know, I had started to make all those wrong choices with diet and with exercise as well. You know. You know, I think, I think, I think HRT just just just improved my my mental health to the, I mean, it improved hugely. But in the early days it improved enough for me to actually then tackle the alcohol. I mean because I am an alcoholic, it’s you know, it’s it’s that that’s what I am. I’m addicted to alcohol. And again, I have no shame in saying that, you know, probably a couple of years ago I might have done. But, you know, it happens. It happens. It’s just something that happens. We’re humans, you know, what can I say? You know, it’s there’s no shame. I, I really want to break down the stigma as you do. I really want to get conversations opened. I think it’s really great work that you’re doing and back at you with the positivity. I mean, your positivity has a massive ripple effect, too. And I think, you know, talking about this has a massive ripple effect. And we have to keep spreading the word because people, you know, women and doctors can be educated. I mean, me, my GP, the psychiatrist back in the day, none of us thought menopause. I would like to think that if the same person had the same symptoms as I had now, you know, nine years on, I would really like to think that maybe it would be different. But I guess it’s only from talking it through more and more that we can get it out there to every doctor and every woman. [00:30:05][102.1]

Dr Louise Newson: [00:30:07] Yeah. Well, it’s been amazing, Rachel, and I’m. I feel very honoured and privileged that you’ve shared your story as well, because I know it’s going to help people, either people directly who’ve been listening or people indirectly who will know, you know, people will know others that they might be able to reach out to and just start that conversation and try and help. So I’m very grateful. So before I end, I always ask for three take home tips. And you’re no exception. You’re not escaping from that. So three things I think that you would either say to your former self or to others that were maybe just realising that they’re on that slippery slope and addicted to, it doesn’t matter what, to anything. What would you say to those people? [00:30:49][41.5]

Dr Rachel Birch: [00:30:49] Yeah. Okay. The first message I think in many ways is the most important message. And I would say, listen to your body and trust your instinct because you know your self best and you know you live with yourself 24/7. Your mind and your body are one. So your body, when it’s telling you things, is as valuable as your mind. And just look at the whole picture. Listen to yourself, notice and and, you know, don’t put them down to anything. Just think. Look, my body’s trying to talk to me and I’ll listen. And what’s it trying to say? And that leads on to number two, because then I think number two is be your own advocate because you’re the one that knows your body most, best. It can be particularly challenging for for people like me who had pre-existing history of mental illness. I had a history of episodes of depression. But if you think this is different, if your body’s telling you this is different, tell your GP and don’t be afraid. As I say, to advocate for yourself and say, Look, I know you think this is depression, but you know, could this be the perimenopause? I’ve done a bit of reading. I’ve listened, I’ve watched podcasts. My body is telling me that that something is different because for me, my mood swings and the suicidal thoughts and all the crazy sort of up and down-ness, that that was new, you know, so new things. I think listen. The third thing relates to alcohol addiction really. Prevention is better than cure. Okay? I wouldn’t really want anyone to get to where I was because it was pretty horrible and a little bit lonely until I accepted it. So be alert to the fact, notice if your drinking is creeping up and tell people, you know, tell people, don’t suffer alone like I did, you know, because there’s help out there. If you want to prevent problems as well as you know, if you find you are addicted and you are drinking too much, there’s help there at that stage too. Hit it with everything. Alcoholics Anonymous, you know, friends, GPs, family, you know, tell as many people as you can to get the help. Don’t suffer alone because, you know, there’s loads of help out there and you know this this can all be better. So that’s what I would tell myself. That’s what I tell myself but she didn’t listen. [00:33:02][132.8]

Dr Louise Newson: [00:33:06] Well, hopefully others will say, thank you so much for your time. I really appreciate it, Rachel. You can find out more about Newson Health Group by visiting www.newson health.co.uk and you can download the free balance app on the App Store. [00:33:23][17.4]

ENDS

The post Alcohol addiction and menopause: Rachel’s story appeared first on Balance Menopause & Hormones.

Joining Dr Louise Newson on this week’s podcast is Suzie Aries, who shares her story of menopause following treatment for a rare and aggressive ovarian cancer in her 20s.

Suzie talks about her cancer diagnosis and treatment, including raising £250,000 to fund treatment not available on the NHS. She also shares the realities of menopause at a young age, how HRT has helped her menopause symptoms, and why she takes HRT for her future health.

Finally, Suzie offers advice for women on how to advocate for themselves during healthcare consultations, and why being knowledgeable, confident and curious is key.

You can follow Suzie on Instagram @suzieclair11 and find out more about her story via her Facebook page Suzie Aries: kicking cancer’s butt.

Click here to find out more about Newson Health.

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. So on my podcast today, I’ve got someone called Suzie who doesn’t look like the average menopausal woman that you Google who’s got grey hair with a fan, who’s middle aged or even in her late 50s. So Suzie is young and she’s going to share her story, which I hope will help to educate and reassure many people. So thanks for joining me today, Suzie. [00:01:23][72.9]

Suzie Aries: [00:01:24] No problem. Yeah, happy to be here. [00:01:26][1.3]

Dr Louise Newson: [00:01:27] So just tell me a bit about you and the age that you were when you became perimenopausal, menopausal, when your hormone levels changed. [00:01:35][8.8]

Suzie Aries: [00:01:37] It was probably about, so I’m 32 now, and it was probably three or four years ago that I noticed a big change in my hormone levels, in my energy levels, getting their hot flushes and all of those kinds of symptoms. That, well I suppose show that you might be menopausal. But for me, it was something that I probably expected because I’d gone through a lot of cancer treatment. I was diagnosed with ovarian cancer when I was 25, so I’d gone through a lot of cancer treatments, chemotherapy, surgeries, various different things. And finally, I was told that the last kind of option was to have full abdominal radiotherapy. And so that was kind of the point where I thought, okay, that’s my, I suppose my fertility journey is ended here. And I suppose I knew I’d go menopausal, but I didn’t expect it to happen in the way that it did, really. [00:02:37][60.5]

Dr Louise Newson: [00:02:37] So yeah, so 25 diagnosed with cancer of the ovaries is not very common, is it? [00:02:43][5.6]

Suzie Aries: [00:02:45] No, no. It’s incredibly rare. I, hindsight is that I had all of the symptoms for it, but I had no idea of them at the time. And I it wasn’t something that was on my radar. I don’t think it’s something that’s on anybody’s radar when they’re 25, I was trying to make ends meet as an actor at the time and, you know, working my day job and then trying to do my dance rehearsals and things in the evening, it’s just, it was a lot. And and then I was feeling really fatigued. I was feeling bloated. I needed to go to the toilet all the time. I felt like an old woman going back and forth to the toilet when I was trying to sleep. And you know, all of the symptoms were there. And then I got the diagnosis and it was a massive life changing experience from there really. [00:03:32][47.0]

Dr Louise Newson: [00:03:34] So was that picked up on a scan? [00:03:35][1.1]

Suzie Aries: [00:03:36] Well, actually, I have to admit, there are a lot of other people that would have a different story. But I cannot thank the NHS enough for my diagnosis because, well, I suppose my, not even my GP. It was a nurse practitioner at my doctor’s who I ended up going to see when I was feeling really poorly and I was explaining to her the symptoms I was having and, you know, tenderness in my tummy and all these kinds of things. And she immediately noted those symptoms as what they potentially were. Even for someone at my age, I’ve heard so many other stories of young people that have been diagnosed with cancer very late because they’ve been turned away and said, well, no it couldn’t possibly be this. I mean, she said, worst case scenario, it could be cancer. And that’s exactly what it was in the end. So I absolutely have her to thank for getting me on that journey very, very quickly, because by the time I was diagnosed, I was probably stage 3 or 4, which for most people is not good at all in terms of prognosis. But somehow I manage to still be here. So thank goodness for that. [00:04:44][68.3]

Dr Louise Newson: [00:04:45] Which is wonderful. But obviously the treatment that you’ve had has stopped your ovaries working and our hormones, a lot of our hormones are produced in our ovary, but as many listeners know, also produced elsewhere. But without your ovaries, whether they’re removed or they’ve had chemotherapy or radiotherapy or damaged in some way, then people do become menopausal. But in a lot of women I speak to who’ve had cancer treatments for different types of cancer that have had treatments that have affected the way their ovaries work, especially when they’re young, the concentration has been on fertility. Menopause might have been mentioned, but there are two things that concern me, and I don’t know whether it was mentioned to you. One is the symptoms, because symptoms can really affect people in so many different ways. But also as a physician, the future health risks of not having hormones is something that I don’t hear spoken about enough. And I understand in the crisis time, the most important thing is to focus on the cancer. Absolutely right. But and the big but is we need to think about after the cancer, beyond the cancer, because hopefully, as you’ve proven, prognosis outlook can be very good. And you’re young, you’re only in your early 30s. So it’s that future health benefits of having hormones that I worry that isn’t discussed enough. So I don’t know was it discussed much with you at all, Suzie? [00:06:09][84.4]

Suzie Aries: [00:06:10] Well, I mean, the only people that spoke to me about my future health was you guys. When I spoke to one of your lovely doctors. I at the time of when I, you know, started speaking to gynaecologists and kind of menopause doctors within the NHS, they just looked to me like I was anybody else going through this, which I really am not. I am a lot, lot younger than most people that do go through this, which means that my hormone levels need to be higher and not just to kind of sort out the symptoms like hot flushes and things like that, but also for the future. As you say, I don’t want there to be a problem in the future where I, I don’t know, as you say, you can get heart disease if your hormones aren’t right, you’re at higher risk of getting dementia if your hormones aren’t right. And I don’t want that to happen. Obviously, I want to try and live as long and as healthier a life as I possibly can. [00:07:10][59.6]

Dr Louise Newson: [00:07:11] Yeah. And it’s really, it can be very confusing for lots of people because actually even if you look at the insert for HRT, I don’t know if you’ve ever done it for your hormones and it will say risk of ovarian cancer. And that’s actually come from a study, an observational study that was done quite a few years ago, but it was using older types of synthetic hormones. And even then, the risk is probably not there. It’s so small. But when it’s observational, it’s not really good data. But we don’t use those types of hormones. We’re just using natural. We’re just replacing like for like. And so we know the hormones are very anti-inflammatory. They’re likely to reduce any inflammation, any cancers going forwards as well. But if, when we don’t have really robust evidence, certainly in my clinical practice is we share uncertainty with patients and we say there may or may not be risks, but we know that there are benefits and it’s up to that individual. But if you haven’t had that conversation with anyone and haven’t been allowed to have a choice, then you’re very much left on your own, aren’t you? [00:08:10][59.6]

Suzie Aries: [00:08:11] Well, yeah, absolutely. And it was only I think it was when I spoke to you guys or I questioned about the risk of cancer returning based on having HRT, because that’s one of the things that the doctors say to you is that if you take too much of this HRT, your risk of getting cancer. And one of the biggest kind of takeaways that I’ve had from you guys is that actually I think it was someone said there was no, the risk of getting cancer was no higher than that of getting cancer when you are older anyway. [00:08:44][32.8]

Dr Louise Newson: [00:08:45] Yes. So people are still going to have a risk, but that doesn’t mean it’s related to the hormones. And I think that’s really important because there will be people that will get recurrances, that will have a new cancer on HRT, but there will also be people that will trip down the stairs or, you know, fall over and that’s not related to their HRT. So but because I think everyone is so scared, if something negative happens, it’s easier to blame the HRT. But the problem is all hormones have been grouped together as evil, whereas our own natural hormones, you know, you’re designed in your 30s to have hormones and they’re very beneficial for your future health. So to have them taken away and not replaced without good reason could affect your future health and day to day functioning if you were getting symptoms as well, which it sounds like you were. [00:09:35][49.3]

Suzie Aries: [00:09:36] Yeah, absolutely. And interestingly, I work as a sign language interpreter, which means that you need to have your processing there. You need to be able to process information from one language to another. And if you’re suffering with brain fog, like I know a lot of women do when they’re menopausal, that processing becomes that much harder and it’s already hard anyway. I was working with a lady who was struggling to do her job and she said, yes, I’m in the menopause, I’ve got brain fog. And in my head I was going so Why are you not doing anything about it? This is your job and it’s starting to affect your job. And she’s probably freelance like most interpreters are. And so there’s no way that, you can’t, like, take a day or there’s no policy, there’s no menopause policy to protect her if she’s free;ance. So, that really hit me bad because I went, gosh, okay, well, if that was happened to me, I’m a new interpreter. I can’t, I don’t want to blame anything on the menopause, especially when there’s something you can do about it. [00:10:38][62.8]

Dr Louise Newson: [00:10:39] Yeah, and that’s so important, Suzie, because we know the conmmonist symptoms are those affecting our brains. Because our hormones work in our brain, as you know, but especially memory processing and cognition, but even, you know, our mood as well. So a lot of people feel quite flat. They feel quite joyless, they have less motivation and they’re more tired. But we know that actually the way our brain works is really crucial for the way we function, especially in our work. And if you have a job where you need your brain to work very quickly and process things very quickly, and you’ve been used to having that, when it’s taken away from you, it can be very difficult. And for so long we’ve forgotten that our hormones have a role in our brain because it’s been about flushes, it’s been about fertility, it’s been about periods. But actually, you’re absolutely right, because so many people are giving up their jobs or reducing their hours or taking different jobs, often at lower pay, because they can’t function at the level that they’re used to. And we see it time and time again. And it’s very sad when they think, well, that’s just my lot. That’s just because I’m menopausal, without having those hormones back, because we know they improve the connectivity of the neurones in the brain, they help the brain to function. We’ve known this for many years. It nearly a hundred years we’ve known the effect on the brain, but it’s been ignored. And I can’t quite understand why. [00:12:06][86.7]

Suzie Aries: [00:12:06] So one of the jobs that I did as an interpreter, of course, I adhere to a code of ethics and you have to remain impartial is one of them and interpret as accurately as you can and this, that and the other. And it was a GP appointment and I go to GP appointment and this woman is reeling off what I know to be menopausal symptoms. Of course she doesn’t know that. And the GP kind of says, okay, how old are you? Let’s have a look at how old you are. Okay. You’re this old, right? That’s probably a box ticked. It could be menopausal symptoms and. Okay, well, I think we could try some HRT, But, you know, I do have to warn you that, you know, there’s this, that and the other, and that’s the risk of cancer in there’s. And I was there interpreting this information to this person through gritted teeth going I, I just I can’t say anything, you know, because this is a medical professional, but I know this to not be the case. So it was a bit of a tough ethical moment for me I think, having knowing what I know about HRT and the menopause and then having to give what I thought was incorrect information to this person with very you know, you must be cautious. And after a month they said, I think they said after a month, if your symptoms don’t go away, I think we should probably stop. And again, I was going, no, that’s not long enough. [00:13:26][80.1]

Dr Louise Newson: [00:13:27] So did you say anything at the end to that doctor? [00:13:30][2.7]

Suzie Aries: [00:13:32] I didn’t feel I had the place to. But I think if it were to happen again, I probably would. Actually, I take that back. I actually said it’s worth looking on Newson Health if you want to get up to date, accurate information. They have a lot of information on there. I think I signposted to you guys because I know that you are the best, you’re kind of a specialist at it. But yeah, that was a bizarre, a bizarre situation to be in. [00:13:56][24.2]

Dr Louise Newson: [00:13:57] Absolutely. And it is very difficult for people because they’re told different things. And every day in the clinic we see and speak to women who have been told different information. And there is confusion because of this, lumping all the hormones together, thinking they’re all the same and metabolically biologically, they’re very, very different in our bodies. And our own natural hormones, of course, are not made to be detrimental because of course they’re not. We’ve got hundreds of hormones in our body and they work very well and especially when people are younger. I did some work with NHS England a while ago. It was a big national programme for menopause and they said that they were going to focus on women over the age of 51. And I actually put my hand up and said, Actually, if you’ve got limited budget, I would focus on the one in 30 women who are under the age of 40 who have an earlier menopause. And they said, well, it’s not common enough, Louise, to worry about. And actually, I sort of thought, but I kept my mouth shut because I often get, you know, misinterpreted sometimes. But actually it is common enough. One in 30. So in your average class at school, that’s one child or, you know, it depends if they’re mixed classes of course, there might be one in every two classes, but that’s a lot of people that will grow up and become menopausal at an early age. Far more common than other conditions. But the health risks associated with it are huge and we know from some studies that women who have an early menopause don’t have typical symptoms so a lot don’t have flushes or sweats, but they still have these low hormones. And so we should be more proactive as health care professionals. We should be going in to companies and organisations and talking about hormonal health, because a lot of people, if it happens without having something like cancer treatment, it can be more gradual. But there are signs there. They might have had worsening PMS or worsening PMDD. They might have skipped a few periods, they might know that they’ve got a condition that might increase their risk of having an earlier menopause or they might have lots of family members that have had early menopause as well. So we need to be really proactive in picking these people up to reduce suffering, but to improve future health. Because if you don’t have your hormones at a young age, you’re more likely to drain the NHS at an older age because you’re more likely to have more conditions. So it is cost effective, but it doesn’t sound very exciting. And I know when I was a junior doctor, someone said to me, If someone comes in, Louise, who hasn’t had their period and young, just make sure she’s not pregnant. That’s all you need to do. So I hate to admit, but for many years that’s all I did, because I didn’t even think about women who are young menopausal because no one had taught me. So I’m making up for it now. But there will be other doctors who will have been taught by the same people and my age who won’t be thinking. So how do you think we can get more information out? And how do we empower clinicians when we’re the patients? Because as you say, even just interpreting, you can feel quite threatened when you’re, not threatened, but quite, it’s difficult when you’re, I’m talking now as a patient, but when I go and see a doctor, I know their time’s precious. I feel a bit nervous. I take every word they say very literally, and it’s very difficult to have a discussion depending on the doctor, especially if they’re very closed and quick in their consultation process. Some doctors are very open and reflect and say, What do you think? Are you happy with that? Is there anything you want to ask? And then it makes it easier for you. But I do feel as patients, we have to be our own advocates. Many people know I can’t get the dose and type of hormone I’m on on the NHS and I’ve given up trying, but it’s still very difficult. But how do you think that we should be better advocates as patients? [00:17:48][230.5]

Suzie Aries: [00:17:50] I think from my own experience, and that’s including my cancer journey, I have been a huge advocate for myself. I don’t think I would have been had I not had my mum there with me. She advocated for me and we advocated for me together and throughout the whole thing. But I think it’s just it’s having the knowledge yourself rather than going in there with no idea. I think it’s that thing of empowering yourself with knowledge and getting the knowledge and kind of knowing the symptoms, knowing, you know, what’s wrong with you and getting the information about what potentially you need before you go in. Because otherwise you’re going to be sat there nodding your head at whatever this professional is telling you. And of course, they’re a professional. They’ve been through years and years of training, but they don’t have the, especially the GPs, the specific knowledge base to know what you need in this situation. And then it might take a year to be referred to someone who may well be a specialist, but is following these very specific guidelines which aren’t going to match you. And so I think is having that knowledge, but also being able to be quite assertive. In the deaf community, it would be this sign [signs]. It’s one of my favourite signs, I think. It’s that being confident and being assertive to back yourself when you’re speaking to someone and say, Well, for me, for a young person, I am not your usual. I’m not the most common person that has the menopause, but it’s just backing myself to know there’s something not right. And I don’t want this to bother me forever. I think it’s a mixture of those two things. Going in with knowledge and having the confidence to back yourself. [00:19:35][104.9]

Dr Louise Newson: [00:19:35] I think that’s so important because I know certainly with some of the treatments that you had for cancer, you had to really be your own advocate, didn’t you, and seek the right treatment for you? [00:19:46][10.7]

Suzie Aries: [00:19:47] Yeah, absolutely. There was one particular treatment wasn’t on the NHS for me, which was immunotherapy. I think it’s becoming more widely used now, but still not for my cancer. I mean, my cancer was incredibly rare anyway. It was a small cell ovarian cancer of the hypocalcaemic type. Bit of a mouthful, but that treatment wasn’t available on the NHS. There was a very small study of four women that had gone through radiotherapy plus immunotherapy as a combination, and three out of four of them had come out cancer free long term afterwards. And we just went, Well, that’s good enough for me, let’s give it a go. But the NHS were incredibly reluctant to do it. They did send off funding applications and things, but everything was turned down, so we had to fundraise £250,000 for it. But I mean, that’s where I start to believe in humanity again because I got, you know, video went viral. I had people from all over the world donating to me. And so it was incredible. It was, that was a case where the NHS were very reluctant or very sceptical about this treatment because there wasn’t 4,000 trials of it. There was four. But I think it was where both me and my mum went, This is the right thing to do, this is what we want to do. There’s what, what are the other options? We’d say to them. They didn’t have any other options and so we just pushed and pushed and pushed until they said yes. And I think that’s something that you also have to do for HRT and for menopause treatment. I’m actually now, having pushed a lot and having, as I said, used the knowledge that I’ve got from speaking to you guys and from my own body and my own experience, I’ve now managed to convince the NHS to fully prescribe my HRT for me now. The testosterone was only recently added and I’m absolutely thrilled about that, and that’s a large sum per year that I’m now not going to have to pay for. Well, hopefully not. [00:21:51][124.6]

Dr Louise Newson: [00:21:52] Which is wonderful. And a lot of people come to our clinic and increasingly GPs take over their care for their HRT, not always testosterone, but increasingly it is, which is so important because it’s very easy to get other drugs such as antidepressants or blood pressure drugs or statins or whatever. And they’re not even drugs, they’re just natural hormones really. We need to think very differently, change our language and think about the benefits. And actually, if you’re feeling well, which thankfully you are, if you’re healthy, which you also are, you’re less likely to go back to your GP, you’re less likely to be referred to the NHS. You’re saving money even though they’re spending money on HRT, which is actually quite cheap. So it is a cost effective thing. And when you’re young you know you’re going to be on HRT hopefully for decades, you know, for many years. So it should be available for you. It shouldn’t be something you have to come to a private clinic for. It doesn’t make sense, does it? [00:22:51][58.9]

Suzie Aries: [00:22:51] No. No, absolutely not. And I think most specifically, testosterone. I think that was the turning point where I started on a bit of progesterone and a bit of oestrogen. And then it was… It like got to the point where I was having enough oestrogen and I was feeling fine. But I’m a very sporty person and I was still feeling a bit unmotivated and a bit, just a bit lazy and not full of enough energy for myself to want to actually go out and do the exercises. And I think at the time, I think one of the big ones was that I just didn’t really want to have sex with my partner, which, you know, it’s not something you want as a 30 year old. You don’t want to just be there feeling like a cabbage. So and it was the testosterone that immediately well, not immediately. It took a little bit of time to work, obviously, but it just, that was the change. But then when I did initially ask the NHS, they were saying, no, no, it doesn’t fit in with our guidelines of anything. And I just went, I want to throw your guidelines out the window. Your guidelines are just this one size fits all thing, and that’s not the case here. But now they don’t. [00:24:01][69.8]

Dr Louise Newson: [00:24:02] Yeah. And I think that’s very important when we do mention guidelines, because there’s guidelines in everything that we do as healthcare professionals. But they are a guide. They help assist in a general population. But the thing is, is that we are all individuals. We have individual lives. We have individual choices. We have individual decisions about what risk or benefit we’re prepared to take. And we all have our own lives. But also we can make our minds up if we’re consenting adults. And we also have the ability to change our mind. So if you wanted or read something, you can stop your treatment, you can restart it. It is up to you as a individual. And what really saddens me with so much in hormone health is that that decision isn’t even there. It’s not allowed almost. It’s sort of felt like you really have to plead and justify to have something that could make a real difference to you. And if it doesn’t make a difference, then don’t continue. And but people often aren’t even able to start or like you say, optimise that dose because it can take a while to be on the right dose and type. And then that’s why it’s important like you say to see someone who’s really knowledgeable, but works together with the patient. You know, it’s not very rewarding as a doctor to be in a uni-directional relationship where you’re the person in control, you’re the person as a doctor who is basically telling the patient what to do. I do not like those consultations. Very different for my husband, who’s a surgeon. He has to be in control in the operating theatre. Very different. But actually, when it’s a consultation it’s a two way process and even for him, it’s a two way process when he’s deciding the operation. And often a patient might want one operation and he’ll advise something else and they talk it through. But somehow we’ve lost the ability to talk and share, especially when there’s uncertainty. And that’s a great shame. So it’s amazing that you’ve been such an advocate in so many ways. You know, hormone health is just one part, but you have been a huge advocate for your health and you’re living proof, how healthy you are now, aren’t you? [00:26:15][133.6]

Suzie Aries: [00:26:16] Yeah, yeah, absolutely. And I think there’s also well, I suppose on a slightly different note is that obviously women, I’m a woman in my 30s and I am on HRT and in the menopause, which is obviously, as we’ve already said, a unique situation. And I recently met my, who will now be my lifelong partner, the love of my life. And I knew the moment, it was probably it was like our second date or something. And I’ve been dating for, you know, a few months and hadn’t said anything to. I think I’d said something about it to one person who I thought, they seemed quite nice. And as soon as I mentioned it to them, they couldn’t run fast enough. Whereas as soon as I told my current partner, this is the situation. I can’t have children in a biological way. I’d like to have children in a different way. I do have to take HRT every day, you know, rub this gel on my legs, you know, and things like that. And he came back with the most amazing response to it. And he’s been nothing but supportive and kind and where a previous relationship where I’d started it, would always say, have you washed your hands, make sure, you’ve got to wash your hands afterwards. And of course I’d wash my hands afterwards. But it was that. It was almost like a punishment, which wasn’t particularly nice, whereas I’m just, I’m accepted for who I am. And I have to be honest, I get the odd, not brain fog, but the odd kind of like thing where my brain is a bit meh and I don’t know whether that’s just something that comes up every so often. Whether it’s the menopausal symptoms, I don’t know. But I’m given nothing but love for that and appreciation. And I think that’s one massive thing that’s helped me accept where I am, is that I am now with a person who accepts me for who I am, for the gel that I rub on my legs, for the tablets I take at night, and for the fact that we’re going to either adopt children or go surrogacy route and and we’re going to have a lovely family at some point in the future anyway. And so I think that has that has been a huge help to me, kind of on my journey is just being accepted for who I am now. [00:28:24][128.5]

Dr Louise Newson: [00:28:26] What a brilliant way to end being accepted for who you are. I think we all should think more about that. There’s so much I realise as I get older we can’t change about ourselves, so we just have to embrace and make the most of it. So I’m very grateful. But before we end, three take home tips and I think it should be three tips about how to be the best advocate for yourself for whatever treatment you want or you don’t want, you might be refusing treatment. So what are the three things that you’ve learned that you can share about being an advocate for health? [00:28:56][30.6]

Suzie Aries: [00:28:58] So firstly, as I said before, the gaining knowledge yourself, because you know, you’re an example of where there’s incredible knowledge there and resources that people can use to gain that knowledge before they go to an appointment. I think being confident and backing yourself with that knowledge. So I suppose those two come hand in hand. And I’ll add just off the top of my head probably being curious as well, rather than just kind of like taking your lot and just going, oh okay, well that’s going to happen. It’s that thing of, but what if, what if it could be better? What if life could be better? And what if I could feel better rather than just, oh I’m just going to have to feel like this now. I think it’s curiosity is another big one as well to just be curious as to whether things could be better, because they probably can be. Testosterone, you know, being that example for me. So those are my three. What wa it? Knowledge, confidence, curiosity. [00:29:55][57.2]

Dr Louise Newson: [00:29:57] Love it. Very good. Thank you ever so much, and keep going. [00:29:59][2.5]

Suzie Aries: [00:29:59] Thanks you much. Yeah, will do. Thank you. [00:30:02][2.4]

Dr Louise Newson: [00:30:07] 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. [00:30:07][0.0]

ENDS

The post Navigating menopause in my 30s after ovarian cancer: Suzie’s story appeared first on Balance Menopause & Hormones.

Joining Dr Louise Newson on this week’s podcast are Jane Hajduk and Shari Dolan, the real-life friends behind Thee Third Act, a YouTube comedy series about women’s third act: menopause.

Thee Third Act follows Jane and Shari’s characters, Josephine and Lauren, in their search for answers during menopause. From life coaches to hormone replacement therapy, they strive to conquer or at least ease hot flushes, sleepless nights, and astronomical mood swings.

Jane and Shari discuss their own menopause experiences, their off-screen friendship, and why sisterhood, laughter and honesty are key when navigating menopause.

Catch with Thee Third Act on YouTube here – season two premieres 27 January.

Click here to find out more about Newson Health.

Transcript

Dr Louise Newson: 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 my podcast, I’m very lucky because I have two guests, so I have two for the price of one, as it were, and they’re two ladies from America. I seem to have a little run of American guests, which is great because the menopause doesn’t just affect UK women. There’s 1.2 billion menopausal women globally. They’re in every single country and it’s going to affect all of us. So it’s really important in my mind that it’s the most positive time of our lives, because it lasts a lot longer than many other things that happen to us. So I’ve got Jane and Shari who have known each other for many years, who are going to just introduce themselves, and then we’ll talk about what they’re doing. So welcome to the podcast. It’s very exciting to have you here even though it’s remote. So go on then, Jane, you go first. Explain who you are and where you’ve come from.

Jane Hajduk: Okay. I’m Jane Hajduk, I’m originally from Pennsylvania, and, now I’m in Los Angeles, California, and. Yeah, this is my partner. Go ahead, Shari.

Shari Doran: Hi, I’m Shari Doran and I’m originally from Michigan. And, the quick backstory of Jane and I, we actually met in college in Ohio at Wright State University. We are both working in the industry out here as far as producers, writers, actors, directors, doing a little of everything. And we made friends and are going through menopause like the rest of the world. And, came up with this idea to have a show about menopause. And it’s really about friendship and menopause. It’s about two best friends in the throes of menopause, and they decide to journal it, which is funny as we’re on our phones right now. The exploits of trying to find anything, as you know, in the market, there’s everything out there right now and misinformation and great information to try and ease their pain into what we call our third act. And that’s what the show is called. It’s called Thee Third Act two ees Thee we’re Shakespearean in our menopause, as I like to say.

Dr Louise Newson: Yeah, and that’s on YouTube, isn’t it?

Shari Doran: Yes. So that would be on… it is on YouTube right now. And if you go to @theethirdact. And it’s funny, you know, Jane, tell them, will it actually help them with their menopause symptoms?

Jane Hajduk: Absolutely not. But, you know, laugh and hopefully it’ll open up conversations with your girlfriends and possibly even a male who also has to kind of go through it in a different way. All our, husbands and boyfriends and whoever else we’re dealing with in the male industry. So yeah, but I will tell you too, the episodes are 2 to 5 minutes. So usually and it’s this first season is really about the insane things or the really cool things. We try to just relieve some of the symptoms we have of menopause. So a lot of times my partner Shari, who in the series is, sorry, Lauren, she’s walking out because she’s had enough of it. And so we usually because it is 2 to 5 minutes, we’re usually starting right smack in the middle of a class or of a massage or of, whatever it is that we’re going through, and then we get to the end and, so, yeah, it’s kind of wrapped up quick.

Dr Louise Newson: And it’s great, isn’t it? To have these conversations. So when I started my clinic and I Googled menopause and nothing came up, really very little. And I’ve been a medical writer for many years as well as a doctor. So I set up a website which was then called MenopauseDoctor.co.uk and I set up my Instagram account just because my daughter said, Mummy, you’re telling me all these stories about these women like you’re coming home and saying, you know, this woman feels like she’s been hit by a bus. She feels like the shutters have come down. She doesn’t know what to do, like because she said, this is just awful, right? But why don’t we all know about it? Why aren’t we all taught it at school? Like, why do we have to wait until we’re feeling really awful? You’re telling me these people, their jobs have gone, their partners are leaving them, they’re in crisis, and they’re coming to see you. And it’s the menopause which affects every woman. I don’t want to wait till I’m like, suffering like that. So I decided to set up this website and I literally I didn’t have any money. And I went to the web designer and I said, I all I want is five pages, like, what is menopause? What is HRT, what is testosterone? And just a symptom questionnaire. That was all I wanted on it. And then every week I’d go, Alan, could we just add this for so menopause and younger women, could we add about urinary symptoms? Could we add about brain fog. Could we add and then in the end he’s like, ah Louise you’ve blown your budget like this is ridiculous. So we then that’s when I decided to develop the balance app to get more people out there. So it was just easier. And, you know, the information is increased, but not just my information. Now, if you Google menopause, the first thing that probably come up is some menopause shampoo or some face cream or some supplement or some like, you know, my husband found some menopause chocolate the other day in a health food shop and it’s like, oh my God, oh my God. Like, are we just a marketing commodity? Is it always just something to laugh at and even somebody who’s very high up in finance. Many years ago, they wouldn’t get away with it now saying that the UK economy was menopausal. Like because it’s up and down like, and it’s like, hang on. We’ve always been a butt of jokes and now we’re a butt of jokes in the menopause like. Oh, don’t go near her. She’s a bit moody. She’s got a fan. Well, actually, this poor woman is suffering. She’s got something going on, and she doesn’t want to be moody. She doesn’t want to be shouting at her husband, but she has no idea what’s going on. And for too long, we’ve been told it’s either all in your heads and it can’t be the menopause because you haven’t got to flush or sweat or that, oh well, it’s because of your work or it’s because of something else. So actually, to allow women, the biggest thing that we find when people come to our clinic is they thank us for the time and they thank us because they’ve been listened to and understood. And I think what’s really important, what you’re doing with humour is good, because when you’re happy, you learn more, don’t you?

Shari Doran: Right.

Dr Louise Newson: And so there’s a balance between making fun of something and being happy and entertained and learning through it. And I think what you’re doing is the latter to have this fun. But actually then hopefully women who watch the episodes will feel really empowered and that sort of kick ass generation. Yeah. Come on. Why are we feeling like this? What can we do about it? And and learn, like you were saying from girlfriends who are watching it with you or your partner when you say, actually, I didn’t realise that was a symptom of the menopause. I just thought it was, you know, you were annoying me. But actually, maybe my irritability is due to my hormones changing in my brain and what can I do about it? So it’s really great.

Jane Hajduk: And going through it. If you are that of that, you know, person, you can make the joke. But if you’re not and we’re going through it. So there is laughter but there are tears. And like we said at the beginning, it will open up conversation.

Shari Doran: Right. And I think too another big thing that it opens up is that sometimes seeing other people having the same thing that you have going on or that you tried something really silly and you’re like, oh my gosh, I did that, I did that, I tried yams on my body. I thought it would do something. Yeah. And it just gives you permission to kind of go, oh, I’m not alone. I am not alone in this. Because really, if you think about it, how many women you just said billions, right, are already in menopause? There’s a sisterhood. There’s a sisterhood out here that I think we haven’t touched on. And you had said also about mothers. My mother never spoke of it. Jane, did your mom ever speak about it?

Jane Hajduk: Never, never.

Dr Louise Newson: You see I’m quite lucky because my mother’s on HRT, I can’t…she’s forbidden me to say how old she is. And she’s very strong. But actually, many years ago, when she was in her early 40s, my father died and she went to a GP and said, I’m really struggling. She was a teacher and she said, I just can’t remember things…and the GP said, oh, I think it’s your menopause. He didn’t use the word menopause. He said, it’s that you’re going through the change. And she was like, oh, I don’t know it is, have these tablets. And it was dixarit, which is like it’s not hormonal, it’s called clonidine. It doesn’t really work. But he gave it to her. She went back and then saw a female doctor who said, oh, you don’t want that, you just need some of this. And gave her HRT. And this was in the 80s, so no one questioned the doctor then in the 80s, you didn’t have Doctor Google, you just did what you were told by your doctor. So she went off, took these tablets, and she said within days her memory was back, her mood was back. She felt great. She could carry on. So she’s just carried on taking HRT. Many years ago that was the pregnant horse’s urine HRT, the synthetic hormone. So she has been converted to the natural body identical hormones which are lovely and safe. But many times she’s gone back to the GP for repeat prescription and they’ve said, no, you can’t have it, you can’t have it, you’re too old. And she said, no, no, I’m not stopping it. I am absolutely not stopping it because I know it’s keeping my brain and my body… and now she does sometimes say, do you know who my daughter is? Have you seen my surname? Actually, she knows quite a lot, but it’s still really hard. But she’s…so I know like and I look at some of her friends who haven’t been on hormones and some of them have dementia, some of them have had osteoporotic hip fractures. They’re sort of more crumbling. And I’m sure a lot of how she is is because she was very fortunate. She just saw the right doctor at the right time, but it would could have been very different for her. But we are lucky now that we’ve got access to more information. But there’s also more misinformation as well. And that’s what really worries me. And I hear stories of women who are spending hundreds of pounds a month or hundreds of dollars on hocus pocus stuff, you know, and you think, actually, you should be spending that money going out with your friends or going out with your partner or going on holiday or whatever. Work out is it worth taking? Is it really worth putting yams all over your body? How is it going to really help, you know, but so we can allow women to be educated through these sorts of platforms. It’s really important, isn’t it?

Jane Hajduk: It is. And it’s really not a one size, as you know, fits all. Like what might work for someone doesn’t work for another. And I mean, it’s crazy because I have had exercise in my life throughout so that, you know, it’s not like somebody is telling me at age 57 to go and work out, you know, I’ve already done that. So it can be different things. But even with our show, we do ridiculous things. But then you’ll see Lauren go through…our characters names are Josephine and Lauren. You’ll see her in a boxing class and she’s just it just works. It works. And then all of a sudden, because it works. Because what do we do? We overdo it. And then a few episodes down, you see, she’s ready to kill me and anybody walks in front of her. She is so, so, so it’s it’s things like that. It’s just not a one size, you know, one pill fits all, one activity fits all. So although we’ll make some crazy episodes where it’s like, what are we doing? One where we’re in a class talking about sex and how to have outercourse instead of intercourse, and Lauren leaves right away. I end up staying, but quickly get out of there. So it’s it is fun, but hopefully we’ll also see some things, like the boxing class where oh my gosh, somebody wouldn’t expect at all that connected with her.

Shari Doran: Right.

Dr Louise Newson: Which is great. And I think having these conversations is actually sometimes it’s easier to listen to other people’s conversations that have themselves. And actually, as a doctor, I’m not. I can talk about dry vaginas. I can talk about sex. It doesn’t embarrass me. It’s very easy. But actually, the more I talk to women about sex or usually the lack of sex that they’re having, the more they say, you know, I’ve never spoken to anyone about it. I didn’t realise other people were not having sexual intercourse or not having any pleasure when they had sex or just going through the motions. I had no idea because I haven’t spoken to anyone. And it’s one of those things that you think, actually, they do need to listen and hear that they’re not alone, that other people are experiencing difficulties as well, because the number of relationships that break down during the menopause is huge, and it often can start with a very small thing that escalates, but not being able to listen to other stories or not being able to talk can be really isolating for women.

Shari Doran: And I think too Jane and I have found as we start, every time we tell people oh this show’s coming out, women are just beside themselves to share their story. I was like, oh, I have this going out. Every time I speak to someone, I’m like, oh, that’s an episode. You know, I have a friend that went to, she’s a therapist. She’s a therapist for sex, but it’s a physical therapist. It’s like, how do you get that job? I’d like to know, you know, like, what’s the qualification for that? And my friends, she goes, I don’t even know how to dress. She goes, I took a bottle of water, do I wear workout clothes? Do I, like what do I do? And I go, oh, this is an episode. I mean, here’s this woman, you know, just trying to she’s struggling. She’s dying. You know, her vajajay is not doing well. And she needed help. And she saw a physical therapist for it, which I didn’t know there was. I was like, really? You could. But again, giving permission, you know, and it came through humour of the stories that we hear that Jane and I have heard just blow my mind. Again, starting that conversation, thank goodness. And I think women are better at that, too. I mean, I think we’re a little more open to each other.

Dr Louise Newson: We totally are. I mean, when I started my clinic, I, believe it or not, I was only wanting to do one day a week as menopause work. That was all I wanted to do, and I had no idea. I had no idea the suffering. I had no idea the refusal for treatment for so many women without any evidence base. And I had no idea how sort of education for healthcare practitioners hadn’t caught up with the evidence as well. But I did see somebody and he said, oh, you need a marketing plan for your clinic. I said, no, I only want to do one day a week, I don’t want to market, anyway I haven’t got any money for a budget for marketing plan. I’m a doctor, like I’m not going to market myself. And he said, oh, well, you’ll never get busy. I said, that’s fine. I don’t want to do more than a day a week. And then I said, but you know what? Actually, because this was he was obviously a man. I said, look, if I do well like people will talk. They’ve got all got hairdressers, they all go out for coffee, you know, they, they meet, they socialise. Women are quite sociable, actually. And actually if it doesn’t do very well, that’s because I’m not doing very well and it’s not right. So I don’t want to advertise something that’s not right or if there’s not a need for it. And then my husband met him at a meeting a year later and he said, oh, I can see she’s setting up my own clinic and she’s really busy. But it’s about women. And most people who come to our clinic is from recommendation from a friend or a colleague or this or that. Whereas if I was doing a men’s health clinic, men would just… their pride wouldn’t let them often to sort of admit that they’ve gone somewhere or that they admit that they had a problem. And in men’s health, it’s another conversation. But it can be very difficult for them to come and see us if they’ve got a problem. Whereas I think women, once they’ve know what the cause of the problem is, they’re really eager to get help and talk about it. But in my experience, listening to thousands of stories is that it’s a long journey before they get help because they’ve often not realised what’s going on. They feel very isolated. They’ve got all these psychological symptoms so that they’re feeling low self-worth, low self-esteem, low confidence, anxiety, low mood. They have no idea that hormones even work in their brains, so they’re not aware that that could be a possibility. But then suddenly this light bulb moment, someone says, actually, you sound like you could have some hormonal changes. It’s like, wow, actually, okay, I haven’t got dementia, I haven’t got clinical depression. I don’t have to, you know, my whole family fall apart. There’s something I can do about it. So that is that first journey that you’re really helping with. And after that, it’s up to the women to decide, do I want to take hormones? Do I want to do whatever? It doesn’t for me, it doesn’t matter as long as they’ve got the right information. But it’s recognising those symptoms. Because women in your country, in my country, across the world, are being misdiagnosed with depression, fibromyalgia, chronic fatigue. You know, these labels that we’re giving women without excluding their hormones being a cause, and it’s making women feel even worse, actually, you know, you know what I mean?

Jane Hajduk: I think there is that noise that this is one of my things, when you’re emotional, it’s just like, oh, am I just being a woman? Because of that noise we’ve heard, oh my God, look at her. She’s like getting all hyper and that and I, I really do question when I started to really, you know, like I would just immediately get upset and go, wait, is this just, just a woman thing? And so I think we do hear so much, I’ll call it noise, whatever. I can’t call it information. But another thing that you were talking about is, yes, men don’t come. But how quickly did we have that blue pill out?

Dr Louise Newson: Oh for sure. Don’t even get me started about that. Like.

Jane Hajduk: Okay, good, because I have another friend come to me and say, well, you know, when men go through their menopause, they go, wait a minute, wait a minute. I mean, that blue pill was out so quick. Please find me a pill where I just want to have sex all the time with the man I love, with the man who’s done so much. But I mean, give me that. I’ll take a pink pill. I’ll take a yellow. Yeah, yeah, I’ll take half of your blue pill.

Dr Louise Newson: Well it’s so interesting, isn’t it? Because the blue pill Viagra that we’re talking about is actually very effective. It’s very safe, but it’s still a medication and it does have some contraindications. And since very small risk. But you can buy it over the counter if you’ve got money you can buy Viagra. Now the natural hormones we prescribe are just natural hormones. They are very, very safe. And even if we’re just talking about vaginas because we’ve been talking about sex, vaginal dryness, soreness, irritation, urinary symptoms affects the majority of menopausal women. Putting some hormones in your vagina. Anybody can do it because it they’re such low dose. They’re very safe. Can we get them, can we buy them with money? No. Course it’s really difficult and even to get them prescribed whereas it just doesn’t make sense really. And also we have a really good treatment hormone, testosterone, that we know can improve libido. And 25% of women have what’s called HSDD, which is hypoactive sexual desire disorder. So we have to be diagnosed with this disorder. And you have to have symptoms for a minimum of at least three months, say the guidelines. So it doesn’t even… and you have to be severely psychologically distressed. It has to be no other reason and you have to have done all this. And then I can assess you and say, right, you’ve got HSDD, you could try testosterone, whereas men like HSDD doesn’t really, you know, it’s like, yeah, you’ve just had a couple of nights where you don’t feel great, just try this and it might help get your libido back, your erections harder and you can go forward. For us, we have to prove that we’re really distressed because we’re not having sex. I don’t really understand it.

Shari Doran: Well, and I think I’m kind of going on top of that. And, Jane, I know you’ve found a wonderful doctor right away. So in my experience, you know, in our country, the insurance system, how it works, that’s a whole other, that’s a whole other podcast. But, you know, it’s amazing the doctors that I’ve gone to, three or four, which I’m sure you hear all the time before I found and it ended up being a male doctor, a gynaecologist, and he was about. Let’s talk about the quality of your life. Let’s talk about the things that can make that happen. That’s what we need to get to. And I was like, how can my general practitioner, who’s a woman does not have this philosophy? And she didn’t. And whatever the reason is and it’s not, she’s, I love her, she’s been my doctor for years. But it just it wasn’t there. Whether the knowledge wasn’t there or whatnot. So it’s interesting as women, you know, we kind of have to sift through, sift, sift, keep going. You know, you had to be a detective almost to do it.

Dr Louise Newson: You do. And that’s where women have to be advocates for themselves. It’s really….I was just looking at some guideline pathways that some NHS GPs use with the people, and they’re talking about all the risks of hormones and they’ve got a few symptoms like they’ve got flushes, sweats, vaginal dryness. I think they had low mood, but not many of the thousands or no hundreds of symptoms that people can get. But then we to them what about patient choice? What about what do women want? That should be in my mind, the first part of my consultation is why have you come to see me? What are you expecting to get out of the consultation? And what were you thinking? Because some people say, I just want to make sure that I haven’t got a brain tumor and my headaches are due to my menopause. Other people will say the only treatment I want is X or whatever, and then we can explore that in the consultation. But we’re not just a machine. We’re not a tick box that we can just all go, yes, Mrs smith, you’re going to have exactly the same as Mrs jones, and…Medicine’s not like that. And actually, we can’t blame the menopause on everything. You know, my husband was frustrating me this morning because he just said he’d take my daughter to the bus, and then he didn’t because he was faffing around. So I was like don’t worry. I’ll just do it. It’s fine. And it’s like, I can’t blame my menopause. It’s just because, you know, he was a bit frustrated. But we need to have the right information. We need to listen to the right healthcare professional for us. That’s empathic and holistic and will help us in our treatment decision because like you say, it’s like the third act. It’s not just a couple of days we’re menopausal. For the most women, it’s going to be at least a third of their lives. My youngest patient is 14. Now she’s hopefully going to live for many, many years. So it’s not just like a little thing, like, I don’t know when you’re pregnant. Look how much attention we get in those nine months. But that’s only nine months. You know, this is decades. So it’s so importan the conversation starts and continues, isn’t it?

Shari Doran: Yes. And I want to ask you because we’re going to write an episode probably about it. What is the funniest cure all or something that you heard from a woman? I mean, because you’ve had so much research of something that she’s tried, that you’re just like, this is not really where you want to go.

Shari Doran: Well it’s interesting. So it always sticks in my mind, it’s not really funny. I think it’s a shame, really. So this lady a while ago came to see me and she said, look, I want something natural. I don’t want hormones. I want something very natural. So we have this whole conversation about, you know, there’s lots of natural plants in my garden that I wouldn’t want to eat or have made into tablets. And our hormones are natural because we produce them. And I said, are you on any medication? She was super well, super fit. And but she was getting quite a lot of headaches. But they… and she was feeling a bit sick and I couldn’t quite work out what was going on. So I said, are you taking any other medication? She said, I take vitamin D, I said, great, and she said, oh and I take this menopause support tablet. But it’s really it’s from this amazing health shop up in the wherever and it’s frightfully expensive. I said, well, what are the ingredients? Oh, I don’t know. So okay, well let’s Google it. So we Googled what it was and inside it had.

Shari Doran: Oh no.

Dr Louise Newson: Yeah. It had all sorts of things that I didn’t really know. But they had porcine ovarian tissue. So ovaries from pork. And then it also had bovine pituitary tissue. So, so a bit of whatever and whether it did or not I don’t know. But I said, oh my gosh, just reading that, it’s going to make me feel really sick. Like, so you’re saying you don’t want natural hormones derived from yam plants that are the same biochemical structure as our own hormones. But you’re taking something from. [00:24:45][27.1]

Shari Doran: A pig.

Dr Louise Newson: Like, I just don’t really. And. And she was great because we were just laughing because I thought I can’t laugh at her that’s really rude and disrespectful, but this is absolutely ridiculous to be honest. Like she was so well researched but she hadn’t researched what she was taking.

Shari Doran: Oh I love it [laughs]. But we’ve all done that so she’s not alone in that. I’ve taken things. I’m like, what was I thinking? Yeah.

Dr Louise Newson: Yeah. Well that’s the thing. But we all do because we’re desperate to feel better. And that’s what really saddens me with the sort of commercialisation of the menopause. I sort of feel like I’ve opened this Pandora’s box because I, like I say, the demand is huge. People are thirsty for knowledge, thirsty for information. But if you’re not getting the help that you want from your clinician or your physician, then of course you’re going to go and buy something that’s really beautifully branded or heavily marketed because you feel it might help. And then, you know, there’s the new, I won’t say the product, but there’s another face cream coming out. So the company emailed me to say, are you interested? Could you put a quote? And I said, no, but could you just send me the evidence to support your cream? And a week later I got an email yesterday saying, oh, we just reached out to our research team to see what we can find. It’s like, okay, right. But you’re putting this cream out, and they’re a really well known brand. But I know what will happen it will be one of those stars, you know, research, six out of seven women said that their skin felt glowing after three days of using this cream. It’s like it’s actually quite disrespectful to women. Actually, I think we’re going back in time.

Shari Doran: And I think that’s part of our show too, is that we are just two kind of regular women that made the show. You know, we’re not a star who’s trying to push something or push an agenda. It’s really it helped us get through menopause, and hopefully it’s going to help other women get through and have that conversation and know that there’s a sisterhood. So it’s we’ve had a ball and I have to say, Jane saved me. Yeah, I have friendships. I mean, I’m not kidding there were times I’d I think I was going to jump off a mountain. And she was there, you know, because I had I think I had more symptoms than Jane. I still have belly. I’ve named her. I’ve named my belly. Once, once it came, I was like. And I had done more sit ups than jane, I think at one time, but somehow I got a belly. I was like, what’s just happening? I call her Betty the bitch, Betty the bitch. Yeah, but she’s better now. It’s better now.

Jane Hajduk: Yeah, it is kind of funny because I think as we’ve been writing and doing this and using our own experiences, I don’t we’re we’re very different in what we’ve experienced, you know. Yeah we definitely are.

Dr Louise Newson: And we all are. You know we’re all individuals. If you talk to enough women who’ve been pregnant, they’re all going to tell you different stories. If you have people who have migraines they’re all going to have different experiences. And we certainly all have different relationships. And you know, what are different jobs, different friends. And menopause is individual. And, you know, it should be made into a very positive experience if we get the right support, information and treatments as well. So what you’re doing is part of that help, which is wonderful. So I’m very grateful for you to share what you’re doing. So but before I end, I always ask for three take home tips, and one and a half each is going to be hard, so I will allow you to have two each because I’m feeling quite kind today. So if you wouldn’t mind, just four reasons, so two each, why people should watch the YouTube and what you hope they get out of it. So do you want to go first, Jane?

Jane Hajduk: Yeah, I’ll go first. Laugh. You know, without a sense of humour, it’s hard to get through anything. So, Shari, you want to take a second one?

Shari Doran: I would say friendship and misery loves company: I’m misery. But past that. I mean, we, Jane and I have been through tragedies together. We go through nonsense together. We’ve gone through raising children and all of those things. Without that friend, you know, there’s a sisterhood, there’s billions of women. And I think that sisterhood is the bond.

Jane Hajduk: It is. Shari, give me a third one.

Shari Doran: Well, I think my third for me would be a really good chocolate martini. No, no.

Shari Doran: I agree, I agree with that. Dr Newson I know you don’t drink but we do. But seriously, never underestimate the creative power of a woman. I mean, we give birth, we raise families. We work, we nurture our parents even as they’re getting old and then even out of this world. And I really believe this, and I know my partner does. Shari. We are thriving and creating even more in our third act. And, Shari, you want to end it?

Shari Doran: Well, I think that what women should take away from us and our show, Thee Third Act, is that menopause was the catalyst that made us have this new whole chapter. Menopause is the catalyst.

Dr Louise Newson: Which is wonderful. So it’s a third act for you as well. And I think that is that I mean, I didn’t start my menopause work until I was a perimenopausal woman, so it’s not too late to do something. But having that support, that camaraderie, that friendship is just so wonderful. So I’m really excited to keep watching the episodes and keep doing the great work. So thank you so much for your time today.

Jane Hajduk: Thank you. You guys probably hopefully already saw one. But there’s no problem watching a couple or three at a time because as I said it’s like 2 to 5 minutes. So.

Shari Doran: And we have lots of friends who are having watch parties or they’re five of them and they have all their friends come over because they want to watch them in a row and, and they just laugh and cry and have a ball. So we’re thrilled.

Dr Louise Newson: Fantastic. Thank you.

Jane Hajduk: Thank you for your time.

Dr Louise Newson: 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 Thee Third Act: laughter, friendship and menopause appeared first on Balance Menopause & Hormones.

In this week’s episode of the podcast, Dr Louise Newson talks to Paula, a 76-year-old woman who reached out to share her experience of being on HRT for over 30 years.

Paula explains how she was prescribed HRT after a hysterectomy when she was 44, following a complicated gynaecological history, which included an ectopic pregnancy, ovarian cysts, fibroids and endometriosis.

She had been taking HRT for a decade when the 2002 Women’s Health Initiative study was released. Paula explains how she researched the study, then weighed up her personal risk and benefits in discussion with her doctor and made the decision to carry on taking HRT. Paula was happy to stay on HRT and credits it with helping her to feel better in her 70s than she did in her 30s.

Click here to find out more about Newson Health

Transcript

Dr Louise Newson: [00:00:00] 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 the podcast. I really want to welcome to you Paula, who is someone that I’ve connected with remotely. This is the first time I’m seeing her, speaking to her and she’s approached me because she wants to share a good news story. Sometimes some of my podcasts are quite harrowing or quite negative stories, but actually Paula’s is brilliant and actually she wants to talk about how her treatment has really kept her to be so healthy. So, Paula, welcome today. [00:01:16][76.3]

Paula: [00:01:17] Thank you, Louise. Nice to meet you. [00:01:19][1.6]

Dr Louise Newson: [00:01:19] So you are, you’ve you’ve agreed that I can share your age, which is very good. And and the people that are watching or see a photo, I don’t think you look your age at all, you’re 76 and you’re fit and well. You certainly look very fit and physically but mentally fit as well, aren’t you? Which is wonderful. [00:01:36][16.6]

Paula: [00:01:36] I like to think so, yes. Yeah. [00:01:38][1.8]

Dr Louise Newson: [00:01:38] And and so just and you do take some medication, of course. And obviously goes without saying that you’re menopausal could have 76. So the average age of the menopause is 51. Some people, I have met women who are 56, 57 when their periods stop. But at 76, you would be really, you know, creating history if you were still having natural periods at the age of 76. So you’re definitely menopausal and and you’re very open that you take HRT. But I’m just really keen to hear about how long you’ve been on HRT for, how you started it and how you’ve managed to keep going with so long taking it and what you think it’s doing for you as a person now? [00:02:18][39.2]

Paula: [00:02:18] Okay, well, I’ve been on it for 32 years since I had hysterectomy when I was 44. And I had a complicated gynaecological history before then, which started it all off when I was 22. I had an ectopic pregnancy, the discovery of a bicornuate uterus. And I was told very clearly, I must not be ever get pregnant again. And I was fine after that. I just I mean, I got on with my life, but I did have two episodes of ovarian cysts. And the second one was what led me to have a hysterectomy. I think it was a combination of the two ovarian cysts plus my previous history, my bicornuate uterus, the ectopic pregnancy, and probably quite a lot of adhesions as well. So it was agreed by a company doctor who happened to be a gynaecologist, which was really handy for us. And the man that he referred me to, which was somebody that he knew, who was a brilliant surgeon, who was also a menopause specialist as well. Which was really a stroke of luck. And he also agreed that that hysterectomy was the only way forward in that situation. [00:03:35][76.7]

Dr Louise Newson: [00:03:36] So you had your hysterectomy [00:03:37][0.6]

Paula: [00:03:38] I did. [00:03:38][0.2]

Dr Louise Newson: [00:03:39] And were you given HRT straight after then? [00:03:41][2.5]

Paula: [00:03:42] I was much to my surprise and when the specialist came and saw me, he first of all reassured me that I didn’t have any cancer because I think that was the biggest worry because the ovarian cyst was quite large. But he said, I had had not only a big ovarian cyst, but I had fibroids and quite extensive endometriosis. And I didn’t know this at all except I didn’t feel terribly well, I have to say, during my 30s at all. So he said to me, I don’t want you to feel unwell going forward. And I think, you know, with that, the result of some sort of a surgical procedure that brings you to immediate, immediate menopause, this will not be good for you without having some some hormone replacement. So he said, I have popped in an HRT pellet, which is what I started with and which will last you for six months and hopefully it will help you get better recover from the operation if you want to use it going forward, you can. And that’s how I got to continue because I felt so much better after the hysterecromy. I can’t tell you. I hadn’t realised how bad I had felt until I felt so much better. [00:04:58][76.7]

Dr Louise Newson: [00:04:59] Yeah. And isn’t that interesting because a lot of people, if they’ve had an ovary removed or they might have had endometriosis or just their ovaries, weren’t working as well, and then they get replacement hormones, they feel so much better often. But it’s, it’s really great that you were offered this, the HRT. And actually many years ago, they did give a lot more implants. So the implants, the pellets, they go under the skin, they’re slow release. And that was really because we didn’t have the patches and gels that we do now. So it was either a tablet and and actually it was it was genius. And so sometimes people gave just oestrogen or sometimes they gave testosterone as well. I didn’t know which did you have can you remember? [00:05:43][44.2]

Paula: [00:05:44] I think I just had oestrogen. I think it was just oestrogen at the time. Yes. [00:05:48][4.0]

Dr Louise Newson: [00:05:49] Which is great. And actually the recommendations now are that if people have had a surgical menopause, so they have their ovaries and womb removed, then they should be offered HRT unless there’s a real reason why not, especially when they’re young. But we’ve recently, one of our research team did an audit on one of the hospitals in London, I won’t say which one, looking to see how many women, after having their ovaries removed who are young, were offered HRT and the number was vanishingly small. And it’s really quite shocking actually. You’re removing their ovaries which are still functioning. So you’re meaning that the ovaries won’t be there, won’t be having any hormones or there will be some hormones, but not anything that was produced from the ovaries, of course. So that can lead to symptoms, but more importantly, it can lead to health risks as well. And the more I understand what menopause really is and what it means, we shouldn’t be thinking about just symptoms, actually. And I’m very interested in, you know, being well, as long as possible. And it’s this whole sort of health span rather than lifespan is so important. It’s not the age we die. It’s the journey to that age. And it’s very hard when you’re in your 40s because you do feel better than you do when you’re in your 50s and 60s because, you know, you’re younger. But actually, like you say, even in your 40s, you were struggling but didn’t realise because you didn’t know you could feel any better. [00:07:17][87.8]

Paula: [00:07:18] That’s absolutely right. And in fact, even now, I’m in my 70s. I still feel better than I felt in my 30s. And I think it was. [00:07:28][10.1]

Dr Louise Newson: [00:07:29] Because you were hormone deficient? [00:07:29][0.8]

Paula: [00:07:30] Probably, yes. I was dragging myself around. I was very tired. I was in quite a demanding role. I worked in the city at a senior level. I didn’t mind it. I was quite enjoying it, but it was full on 100% and and there was no time to breathe, you know, it really was. I know I assume that the tiredness was to do with the long hours and although I did sleep quite well, but you know, it was very long hours and, and the thing is insidious, it sort of builds up. You don’t realise. I didn’t know I had endometriosis, I had bloating. I had been kind of in discomfort during periods. But again, I’d been brought up in an era where women were told or young girls were told, Look, you’re going to have periods, you’re going to feel maybe ropey for a couple of days, take a couple of aspirin, you’ll be fine. Get on with it, which is what we all did. And I don’t knock that because that was how things were handled then. [00:08:25][55.1]

Dr Louise Newson: [00:08:26] But it still happens now. And there’s a very much this attitude that you have to put up and shut up and just get on with it and that’s your lot. And for some things, of course, we have to just put up with things, you know, certain disasters that happen or things that have happened in our life that are out of our control. I do constantly feel having that mindset we can cope with things is really important. Otherwise you dwell. And someone said to me a while ago, You can’t change the past Louise so don’t reflect on it. And I think actually that was a really good piece of advice because I, like many people, can catastrophise. I think I wish I hadn’t said that. I wish I hadn’t done that. If I hadn’t done this, that might not have happened. But you can’t change the past. But you can change the present and the future. And certainly when it’s symptoms or or we know there’s a medical reason for something and what’s happened so much and it still happens now with menopause is normalised. So it’s like, well, you will have symptoms, you will feel tired, you will have flushes, you will have low mood. But that’s just your lot. But that’s not right, is it? [00:09:33][67.7]

Paula: [00:09:34] No, no. And I think it’s it’s far better now. People can speak out, say if they’re feeling unwell. Although to be fair, it wasn’t bothering me sufficiently until I had a particular episode that frightened me. Well I went to see a company doctor about, you know, having this pain again before my hysterectomy because I felt very light headed, too. And this is something I felt when I had an internal haemorrhage when I was 22 with the ectopic, and that worried me. I thought, Something’s not right here. And fortunately, he acted immediately, sent me immediately for a scan. And I was referred, I went and saw him on the Monday and I was in hospital having surgery on Friday, which was fantastic. And you know, both those doctors really, I think, really did a great job for me. Really did. And I’m very grateful for that. And that’s a really good story. [00:10:32][58.4]

Dr Louise Newson: [00:10:34] Of course it is. So you’ve been on HRT, you felt great, and then over the years, I’m sure it hasn’t always been easy to keep HRT being prescribed for you because obviously in 2002, the Women’s Health Initiative study came out, the WHI study, which I was looking at some of the news reports recently. Actually some of the videos were saying HRT causes breast cancer. Everyone needs to stop it overnight. Like it was just awful. Actually, it’s the biggest travesty to women’s health, but you would have been caught up in some of that, I’m sure. So can you remember what happened? [00:11:09][35.5]

Paula: [00:11:10] Yes, I did. Well, when I read it, I thought, okay, I’m not, I don’t tend to panic. I tend to think, what am I going to do next? What, what’s my next course of action? What can I do if there’s something I can do. And I thought well the first thing I’m going to do is talk to the company doctor because he was the one who was prescribing this for me. There was no chance of getting it locally at all, and I was quite happy to pay for it because it worked fine. So I, we spoke about it. I didn’t think immediately, I’ve got to come off this. In fact quite the opposite. It was, my main concern was I hope he’ll be able to continue to prescribe this because I’ve been on it by this time probably for 11 years. And I thought, you know, I feel fine. If anything awful was going to happen, it probably have happened by now. A large part of what might go wrong has been removed in any event. And yes, breast cancer. Okay. It wasn’t in my family. It didn’t run in my family. Doesn’t mean to say it won’t necessarily appear, but it didn’t. And I thought no, I don’t want to panic about this. And I very quickly learned as well that this was a flawed study and it hadn’t been properly peer reviewed. And I thought, no, I don’t, I don’t want to come off it. I’m going to take, yeah, I’m weighed up the balance, I so much better. I don’t want to feel like I felt ten years ago. I want to continue to feel well as I do now. So I stayed on it, didn’t come off it at all. And with the support of the doctor. He said, Well, obviously it has to be your decision, but if this is what you want to do, that’s fine. And he continued to prescribe it until he got to the stage and carried on this, until I sort of retired myself. And and I knew that he would because I could see him privately after that if I wished that it wasn’t a problem. But I thought, you know, there’s going to come a time when it will be so much easier to have it prescribed locally. So I asked him if he would write to my GP, which he kindly did and sent all the up to date information as well, which was available at the time. I told him I’d been on it for a long time and that in his view I needed to continue on, wanted to continue and they did let me have it. But it was quite clear that there wasn’t the standard of knowledge about it within the surgery, although they were kind and they helped and they listened to, which was a good thing. [00:13:43][153.3]

Dr Louise Newson: [00:13:44] Which is wonderful of cause, isn’t it? And it’s very interesting because there are a lot of doctors now have grown up in the area of the WHI study, and some doctors and some practices were actually paid to stop people on HRT. And it was people were actually called in to be stopped because of this study, which is awful when you think about it. And and then then after that, menopause wasn’t a priority because people thought, well, there wasn’t the treatment or the treatments is too dangerous, so people weren’t being educated. So there’s a lot of people with misinformation. And as you might know, I’ve worked as a medical writer for many years, and I started doing my medical writing in 2000 when I was qualified as a GP, and I wrote a weekly column and it was for a GP magazine actually called GP, and it was just a hot topic. So I would choose a topic and I would give them some tips really. So about raised blood pressure or diabetes, and I would scour the evidence, I would summarise it and add a few references so they could see the sources. And so I wrote first about Menopause and HRT in 2000. And it’s one of the first topics I wrote that, said there’s more benefits than risks, it’s very safe, it’s well-tolerated, lower risk of heart disease and osteoporosis with some references. And then it was interesting because then I wrote again in 2002 and the study had come out. But because I wasn’t, I was just in my GP practice, I wasn’t aware of all the take people off HRT, this is awful. I wasn’t aware of all this really, because anything in medicine I’ve always looked at the evidence. So I was looking the articles that I wrote recently and this article basically just said this studies come out the WHI study. It shows that there might be an increased risk of breast cancer, but it’s only with synthetic progestogens. The risk is still lower than if someone drinks wine regularly or smokes or is overweight. So actually, this study’s really reassuring. And the study did show that it reduces risk of heart disease in some women and reduces osteoporosis. And and I thought, isn’t that interesting? I’ve just used what I read from this. I didn’t see all this sensational reporting. And so it was quite interesting that I sort of just carried on regardless. But actually what’s happened is there’s been this big media effect. There’s been this big worry and anxiety in the medical profession, especially by gynaecologists, but some GPs and other healthcare professionals. And when the MHRA took it on board. So they keep pushing all these risks and they still are with HRT. And it’s not just in the UK, it’s been globally. So globally HRT prescribing was really on the increase. It was more than 30% of menopausal women in the UK, around 40% of menopausal women in the US were taking HRT because people understood the disease prevention effects especially for the heart and bones and then suddenly that’s it. The rug’s pulled under a lot of these women. HRT prescribing went down to 4% in the in the US and around probably 5,6% in the UK. So you were very lucky that you were one of the minority that managed to keep going. [00:16:53][189.3]

Paula: [00:16:54] I really was lucky and I can’t be more grateful for this because I really think it’s made a huge difference. And I know I have a number of friends who have had terrible problems trying to get onto HRT and they shouldn’t have to fight. Women shouldn’t have to fight to to do what they think is best for their own body. We’re constantly being told you must take control of your own health, you eat properly. Do this, do that, do the other, but when you want to do something that helps you, then you’re being told no. I mean, what I can’t, I find difficult to swallow is if you had diabetes or a thyroid prioblem, which are hormone related issues, they will be routinely treated. And this is a deficit, a hormone deficit. And I can’t understand why this is done. It would keep so many women, I think, out of the doctors generally, not just for gynaecological issues, but for all sorts of other issues, you know, because they would feel well and feeling well and quality of life is so important. [00:17:59][65.7]

Dr Louise Newson: [00:18:00] I totally agree. And I think there’s been so much sort of debate about it that we’ve lost what we’re trying to do sometimes, and that happens in medicine when we’ve got lots of different opinions. People might have their own agendas as well. But I went into medicine to help people feel better and to be healthier. That was why I went in medicine and most people do actually. But also I’m quite scientific, so I wanted to give people the best treatment based on the available evidence that we have. But the other thing being a GP taught me far more than a hospital doctor, so as a hospital doctor I was for a few years before I went into general practice that was very much about evidence and regurgitating papers and giving the right drug to the right person at the right time. Really important, of course. But my general practice taught me about sharing decision making with the patients and seeing what was the most important thing for them. And even in the clinic now, we ask all our patients and they come back for three, what are the three things you want to get out of this consultation? And it’s been the best thing ever to ask because sometimes it’s not what I want to get out of the consultation and I focus on what the patient wants. And that’s really important. And like you’re saying, you’re really into your health in general. You’ve made an informed choice. And so I don’t feel as a doctor, I can say no to something when someone has made a considered choice about something. And this is where I can’t think of any other medicine that is refused so frequently as HRT. And that’s what’s really sad when we know that there are more benefits and risks for the majority. Most types of HRT actually don’t have a risk, but actually lots of other medicines have far more. [00:19:47][107.3]

Paula: [00:19:48] More risks. [00:19:48][0.0]

Dr Louise Newson: [00:19:48] Risks and less benefits. [00:19:49][0.7]

Paula: [00:19:51] I agree. I absolutely agree with that. It seems that women have had to fight for things for a very long time and it goes on. We’re not there yet. It’s improving, but we still have a way to go. [00:20:04][12.7]

Dr Louise Newson: [00:20:04] We do don’t we? [00:20:05][0.5]

Paula: [00:20:05] Yeah, yeah, yeah. [00:20:06][1.2]

Dr Louise Newson: [00:20:07] And I think also it’s convenient for society for us to be not performing quite on par. I do think it’s become more apparent what a problem it is when you think about the workplace, like you were saying. You had a very high powered job in the city and I wonder aged 44,45 if you if you had had a hysterectomy and not had replacement oestrogen, whether you would have been able to continue to work? [00:20:34][26.7]

Paula: [00:20:34] I don’t think so. I don’t think so, because I got busier after I’d had the hysterectomy. To me, things got even busier. It was a really, really busy period for me. And, you know, I mean, I was surrounded by working mums and what have you, how they managed to do it, I don’t know. Except they weren’t running the show, but they were still working extremely hard. But I had elderly parents at that time who had to keep an eye on as well. So it was, it was all consuming and there’s no way I feel I could have continued in that role had I gone downhill after the, you know, even further after, after having the hysterectomy. And I feel I would have done so. For me, energy levels are there. When I talk to some of my friends or see some of my friends or people that not necessarily friends but aquaintances, they don’t have the same energy level. And I think that’s really important and I believe that’s helped a lot. [00:21:32][57.4]

Dr Louise Newson: [00:21:33] For sure, and I think people underestimate because I was talking to someone the other day who’s doing some research into exercise, which obviously is really important in menopause. And she said, well, if we can just get people to exercise more, then they’ll feel better. And it’s, and their bone strength and their heart disease risk will reduce and they’ll be so much healthier. And I said, have you ever spoken to menopausal women who are really tired and really struggling? Because actually it’s quite cruel for a lot of them because they don’t have the energy and the stamina if they don’t have their hormones. But actually when they have hormones, they often feel more energetic and then it’s easier to exercise and then you feel healthier and you are healthier. And it all works together and it’s really important. But I think looking at workplace again, we know around 10% of women give up their jobs because of menopause symptoms, usually anxiety, memory problems and fatigue. So it’s not about having a fan on your desk or a different uniform. Which still is being told, so much. But we also know we did a survey from NHS, people working in the NHS, but we found just from surveying there’s about 1,300 people we surveyed, 37% said that they would like to reduce their hours, but they couldn’t afford to do so. So those women will be going to work and not doing the job they really want to do or they won’t be going for promotion. And I feel that’s really sad because most of us want do our job and we want to do the best we can do. You know, you turn up, and you know, when you’ve got a job that’s right for you, you’re, you’re excited to get to work. You get to work a bit early, you’re thinking about it on the way to work, you’re going home. And it’s a wonderful feeling to have a job that you really enjoy. Isn’t that? [00:23:22][108.6]

Paula: [00:23:23] It certainly is. Yes. I enjoyed my job, but I’ve never thought of that going part time because it wouldn’t have been a possibility in that role, well I understood that. But as you said, the exercise, that issue when I was in my 30s, if somebody had said to me, you need to go and exercise, I’ll have just said yeah, I’m far too busy, first thing. And secondly, I just don’t have the energy. And that was the thing I really noticed in my 30s. It felt like I was dragging myself around the whole time. So and now I don’t have that. I don’t wake up tired. I wake up refreshed. I get out of bed. I do Zumba twice a week. I took up singing during lockdown and I took my exams last year, my grade eight last year. So I’m really pleased about that. It’s been great and it’s been great fun and I think that’s really what’s important. So now I’m trying to concentrate on doing some of the things I never got a chance to do when I was younger because the world wasn’t like that, but it is now. And, you know, so I did some voluntary work for 20 years. I did 16 years as a trustee at the hospice, a local hospice. And if anything opens your eyes about quality of life, it’s doing that. It’s so important. And I also worked as a an independent specialist for the Association of Anaesthetists too, very interesting work and I really enjoyed doing that. All that was post-retirement and now I’m just having fun, which is great. [00:24:56][93.8]

Dr Louise Newson: [00:24:58] But it is wonderful to have choices as well. And certainly the more I talk and think about menopause, I think about it as a brain disorder, not a disorder of ovaries, because these hormones go into our brains, but also they’re produced by our brains as well and with our brains, obviously, we’re we’re nothing. But we know dementia increases as we age, it’s more common in women. It’s certainly related to hormones. The longer we are menopausal without replacing hormones, the greater the risk of dementia. And obviously dementia can be multifactorial. So having low hormones, eating the wrong foods, not sleeping well, not exercising, not being stimulated, they all go hand in hand, of course, and will increase risk. But isn’t it important that we can light up our brains? We can be taking on new hobbies, we can be keeping our brain active because that’s so important, Especially, you know, as you age. You want to keep healthy, don’t you? [00:25:55][56.9]

Paula: [00:25:56] Yes. And I think you want to keep interested in life as well. You know, it’s you’re quite right. You do want to keep healthy. That’s that for me is the most important aspect because you can’t enjoy your life if you’re not well. Like, you know, nobody can much. [00:26:10][14.7]

Dr Louise Newson: [00:26:10] No absolutely you’re so right. And then I wanted to ask you something, which, putting you on the spot here so you may or may not want to answer me, but you’re taking HRT. What other medications do you take? [00:26:22][12.0]

Paula: [00:26:23] I don’t take any other medication at all. At all. [00:26:26][3.5]

Dr Louise Newson: [00:26:27] So just to summarise this, you are a 76 year old lady who takes hormones but no other medication. [00:26:33][5.8]

Paula: [00:26:34] That’s absolutely right. [00:26:34][0.7]

Dr Louise Newson: [00:26:35] And I am labouring the point here to really, just to highlight, actually, because there are very few 76 year old women, probably less men, but even most people aged 76 will be taking medication, usually for blood pressure, often for cholesterol. They might take some painkillers for some muscle and joint pains at the very least. And then other medications, maybe for bladder problems, maybe for a heart arrhythmia, maybe skin condition. There’s so many things that can happen as we age. And we know that people who take HRT have less biological ageing. I can’t change the number, no-one can change the number of your, you know, your date of birth. But how healthy you are is really important. And when I think about a lot of the work I’m doing is to try and help people keep healthier, as I said at the beginning. And that’s really important when we think about draining health services as well. We’ve got a really difficult time with our NHS, but globally health systems are straining as well because we’re living so much longer with more diseases, more illnesses, more medications as well. We often talk about polypharmacy, lots of drugs people are taking. And my mother was in hospital recently and I’m not allowed to publicly tell you her age, but she is older than you. She takes HRT and she’s only she’s on one heart medication. That’s it. And when she was being admitted, the nurse, yes and what other medications? She said I’m not. Well, you must be. No, no, I’m not. And this nurse was really shocked because she’s not used to seeing people. And it’s not a coincidence. It’s not just good genes and good eating and looking after yourself because we know these hormones. Oestrogen is very biologically active. It helps every cell process to work better. So this is basic science we’ve known for many, many years. So you are just a living proof really. [00:28:35][119.7]

Paula: [00:28:37] Well, touch wood it continues. But yeah, I have to say I don’t have, take anything else. And, you know, I feel fine. Obviously we’re all going to get older, as you say, we’re all going to have to die of something. But I believe that this HRT, continuing to take it, plays a really big part in keeping well for me. [00:29:00][22.3]

Dr Louise Newson: [00:29:01] And so just before we end, just really for those people listening, there is no upper age limit for taking HRT. The guidelines and the evidence are very clear that for as long as the benefits outweigh any risks, we have an annual review if we’re taking HRT and then it’s an informed decision making. But we know that older people, even taking low doses, still has good bone protection, can help keep bone strong so people can keep taking it. As we said earlier, menopause lasts until the day we die. And so if you stop taking HRT, then you’re going to have this increased risk of diseases, possibly symptoms. But it’s not all about symptoms, as I’ve explained already. And then I know you started HRT in your 40s, but some people haven’t been on HRT for decades and they haven’t ever been on HRT or they might have been taken off in 2002 or they might never have thought about it until they reached their 60s, 70s, 80s. We do see people in the clinic who say, Well, I feel I’ve missed out, but I’m wondering whether it would help. And we’re very fortunate. We have the body identical, the natural types of hormones that we can give to women who are older because they can often be very beneficial. And we often start at a low dose, review people and people can really feel very different and healthier. And we know, you know, all the other effects as well. So I don’t want this podcast to be thinking, only listen to if you’ve been on HRT and continue because there are choices and that’s the most important thing. So, so but before I completely finish, Paula, I’d just like your three take home tips, so for three for three things really for women who are listening and when it’s alright for her. But I’m really struggling to continue my prescription. What three things do you think we should do as women to enable us to continue if that’s what we want to do? [00:30:51][109.1]

Paula: [00:30:51] Well, first of all, I said don’t be afraid of trying HRT. I would say, go read up about it, find out as much as you can about it from reputable sources and know that there are different types that you can take. So have a go. You’ll, if you if you want to take it, and you know within a few weeks you will notice a difference. And if it’s not quite right for you or you need that dose adjusted, then go back. Don’t don’t give up. and say oh well I’ve tried it, it’s not… and while we’re on this subject. There are a lot of older women, I’m sure, who would be very interested to hear what you said a moment ago about it’s not too late if you want to start, because a number of them have said, I’ve been told many times, it’s too late, can’t start it now. So that’s the good news. The second one is if you’re taking HRT, this is my view and it works for you and you’ve been through the menopause, the change has actually taken place but you’re well, don’t stop. Say if you had diabetes, you wouldn’t be stopping. If you had a thyroid problem, you wouldn’t be stopping. You’d be carrying on because there’s nothing to be gained from stopping in my view, at all. And a lot to be to be gained by carrying on having the protection against these various diseases, inflammatory based diseases that that that, you know, can make you old before your time. So I would say keep going. That would be. And finally, the third thing will be, I think as you do age and many of the people that are on HRT are much younger than me, that the more important quality of life becomes. Keeping well, feeling well, and having a good quality of life. It really is so important because you can’t enjoy your life without feeling well and also maintain your independence. Most people my age want to be able to maintain their independence for as long as possible and stay out of the doctor’s surgery for as long as possible. And I think that will help them to achieve that. And, you know, unless they’re a very strong contraindicators to say that can’t do that. But then I think, as you’ve said, I think the most women, it’s it’s safe. And for most women, it will be beneficial. [00:33:11][139.9]

Dr Louise Newson: [00:33:13] Yes. Well, thank you so much for your time for us today and for being so transparent and sharing so much information. I know it’s going to help a lot of people. So thank you so much. [00:33:23][10.3]

Paula: [00:33:23] Thank you for having me Louise. Thank you very much. [00:33:25][2.0]

Dr Louise Newson: [00:33:27] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk. And you can download the free balance up on the App Store or Google Play. [00:33:27][0.0]

ENDS

The post ‘I’m 76 and thriving on HRT’ appeared first on Balance Menopause & Hormones.

Joining Dr Louise on this week’s podcast is Matt Roberts, one of Britain’s foremost fitness experts and personal training pioneer. Matt opened Europe’s first exclusively personal training gym in 1996, is a bestselling author and is responsible for honing some of the most famous physiques in fashion, sport, film, music and politics.

In this episode, Matt and Dr Louise discuss the importance of strength training, cardio and mobility exercise for health span, as well as some of the key barriers to exercise during perimenopause and menopause –  and how to overcome them.

Finally, Matt offers advice on getting into good habits during menopause, whether you are already active or haven’t exercised for a while.

Find out more about Matt at www.mattroberts.co.uk and follow him on Instagram @mattroberts_lifestyle

Click here for more about Newson Health.

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. So my podcast today, I’m delighted to introduce to you Matt Roberts, who some of you will know and some of you might not. I’ve actually stalked him from afar for many years, actually, watching him long time ago, actually, when personal trainers weren’t quite such a thing, looking at him in various media, sort of newspapers showing how to do very simple exercises, making it look very simple, but very effective as well. And I was very honoured to be introduced him recently, a longevity event. And so now I’ve hoiked him on for my podcast. So it’s a very exciting day for me. So welcome, Matt. Thanks for coming today. [00:01:39][88.3]

Matt Roberts: [00:01:40] Well, thank you. It’s a pleasure to be on. And likewise. I’ve kind of watched all the work you’ve been doing from distance, and it’s an area that is, it has a natural follow on with what I do. And increasingly hormone health overall, this kind of crossover between what’s the fitness and the health and training community do or should be doing is sort of quasi medical, there’s more crossover, more understanding. Yeah, certainly I’ve been doing for a long time, I’ve been doing this for my own 30 years. I’m 51 years old and I set up my first club when I was 22 years old. And from day one it was always about data and there wasn’t much data you could gather at that point in time. But it was very much in my core thinking that it needs to be that we could analyse individuals in a really precise way. And I always had teams of doctors, medics that we consulted with and dieticians and less so hormone specialists at the very start, I have to say it was much more of a thing in the last maybe 15, 20 years we became able to actually really use the data and understanding in a much better way whether that was because of us, whether that was because of the general kind of community understanding. I don’t know where we are now is where I think I always envisaged it should be, is that we have this really interesting, great merging of a whole range of skill sets with our liver specialists that we have on site and our dieticians on site, physios on site and osteopaths. So we consult with homeless specialists like yourself. And it’s something which it’s a really nice place to be, I think, between what medicine and the fitness world are doing, which isn’t in all cases, by the way. It’s very much, I think, in the upper end of it by doing a good job of understanding bodies better. And I think it’s important as well as I stress that, you know, looking at fitness and health, while inevitably fitness is always linked into the body beautiful and building up muscle mass and having a certain shape and being a certain size, it’s not how I view it. I mean, I view that as being the good end by-product of what we do. And what we do is always make sure our body is super healthy and we focus on the wellness end of things. I’d say certainly over the last several years in particular, we really have skewed the business towards being a health span business. And I say health span perhaps as opposed to just longevity. I don’t think we can necessarily extend our longevity from what we do per se, and lots of other interventions can do. What we do is make sure that, you know, individuals function in a way that means they can be unbelievably active, whether they are 35 years old or 95 years old. And yeah, for me, being now 51 years old, my goal when I turned 30 years old, because you stupidly when you’re in your 20s, you think you’re getting old when you’re 29 years old, 30s going to hit and you’re an old person. And I said, Well, I’m going to hit 30 in the same shape and health and wellbeing as when I was 20 years old and because I was an athlete in my teen years, I was a sprinter. There was lots of data collection that I had. So I could actually quite easily look at some metrics around where I was at being 30 compared to being 20 and I was bang on the same, same levels of body fat and blood pressure and blood data and speed and power and so on. So roll forward to ten years ago got to being 39, well, I need to be in the same shape when I’m 40, as when I was 30, and therefore when I was 20 and the same happened at 50 as well. And with all the metrics I got, my data hasn’t shifted. I’m within a fraction the same body percentage, within a fraction the same weight. But it’s not because things just stay the same. You got to work on changing as you change and changing as you age because no doubt at all that if you sit and you’re complacent and you do nothing, you age. It takes consistent work and it takes the understanding of how to use rest and how to understand blood data, how to understand how you view to changes and all of these things. It takes real diligence in doing it. So we’re like a guinea pig to myself over how to ensure we can get the best results. And so for my client base people that you like yourself who see things that I write about in the press do. I try to take things that have complicated science backgrounds and simplify them and make sure it’s case of, okay, what can we actually do? What’s the real things as proper take homes on this? [00:05:43][242.8]

Dr Louise Newson: [00:05:43] And it’s so important. So when I was at medical school many years ago in the late 80s, we didn’t really learn much about exercise at all. And I’m active, but I’m not like, I’m not a runner, I’m not sprinter. I’ve always cycled like as a student, I cycled everywhere because it was so much cheaper than getting the bus or public transport or whatever. And so I was sort of fit just because I was, I even was cycling out to nightclubs sometimes. I didn’t really drink much and it was just easy. And then I would do pop aerobics or step aerobics. You know, that was a really big thing in the 80s and 90s. But that was just my choice. But actually, as a medical student undergraduate, I didn’t really know much about muscles. I didn’t know muscles produced chemicals that were really beneficial. I just thought they were there to move our arms and legs really, literally. I knew a lot about the anatomy, but not about the physiology of muscles. Knew a little bit about bones that they’re metabolically active. But, you know, fast forward 30 years. Obviously, my knowledge is very different because I have self taught. But you’re absolutely right. It’s about how we look after ourselves and keep well. And I think I’m fitter now than I was as a medical student in a different way. You know, just I do a lot of yoga and I’m physically stronger, but actually that helps me to be mentally stronger. And, you know, I still could fit into my wedding dress. And I’ve been married 25 years. You know, quite a few people in their 50s, I’m 54, probably don’t fit. And I, you know, my wedding dress was fitted, but it’s very important that we think about exercise and I think in very different ways because I have patients who are extreme athletes, that’s fine. I have other people that literally find it very difficult to get up from the sofa. And these are often women in their 70s and 80s that haven’t really done much exercise and it’s catching up with them. They have this sarcopenia loss of muscle mass. They might have some osteoporosis, they have muscle and joint pain. They are more exhausted. They might have some urinary incontinence or urgency. Even just getting out of a chair to go to the toilet is massive. And so I think often when you’re young and fit, you could never imagine being that old woman in a chair unable to get up to the toilet. Whereas one of the things that keeps me exercising is like, I don’t want to be that woman. I don’t want to run marathons because I’ll never be able to, well unless I gave up my job and had loads of time or whatever. But I really, really want to be able to get up without a Zimmer frame, not be in a nursing home. And that’s where you’re talking about is health span I think is important because so often you can zone out with personal trainers or extreme athletes thinking, I’m never going to be that person. And one of the things I’ve always liked about your work is you simplify it. So you… it’s something for everybody. And I think that’s really important, isn’t it? [00:08:35][172.1]

Matt Roberts: [00:08:36] Yeah, it is. I think that’s, you know, 99.9, 9% of people and that’s going to be another thing. So you want to focus the work you’re doing not on the 0.01%. Initially it’s focusing on the broad masses of what can we all do to make sure that we have this ability to stay younger for longer. Frankly, that’s the goal isn’t it? It’s retaining as much of the youth and the vitality and vibrance as you possibly can and within that there you feel well, and we have to remember that when someone starts to exercise, whether they have done something before or have not, the percentage growth they can get in muscle size, strength, strength in particular is the same. So if someone has the same inputs in relative terms to their fitness ability, the return they get on that time investment is the same percentage change. So this idea did maybe it’s too late for me or I can’t do it now. I’m too old. I’ve never done it before, is wrong. Whatever you do, you gain. And in fact, actually it’s more chance of you gaining a say, a higher percentage when you haven’t done before with a lower base. Now, clearly the strength changes as percentages are different. If you’ve got high strength to start with or low strength to start with, a percentage of the difference, you going to feel the difference irrespective. And with that difference, with that change in the strength, you get a an absolutely linear response in terms of your mobility. So you’re right to say people struggle to get out of their chair. And that’s a horrifying thought that you actually unaided can’t stand up because that’s when things are starting to slow down dramatically and you start to get secondary illnesses and various issues alongside that. So we’ve got to have that raw basic of what are the functional patterns and movements that you need in your life to not be at risk. And as someone gets older, the problem with sarcopenia is something which is not to do with size or anything else. It’s to do with the risk of falling. So if you haven’t got muscle strength in your glutes and your hips and mobility is poor, you stiffen. But because you sat still for too long, your chance of tripping, falling, damaging the bones is much higher. Combined, of course, with the effects for a female of the menopause on bone health, the effects of not exercising on reduced bone density and health, all of the things that we do that are strength based are all positive for making sure you’ve got greater mobility, greater stability, greater bone density and the risk someone having an issue when they’re 65 and that break of the hip where the mortality rate just go skyrocketing goes away and it’s really about what can you do. And it’s very much that person whose sat in that chair who can’t get up. Well, just put four or five cushions, two cushions on the edge of the chair and just stand up and just literally bend your knees. You can just touch a cushion so your knees aren’t going to go fully down and do it multiple times. Small range of motion squats as an example, and do that for 12, 15, whatever the number might be, 20, 25 reps. So it gives you that chance of re-engaging those muscles. And these are basic basic things that can be done and you get that butt to be stronger the quads, the thighs to be stronger and the amount of stability and strength it gives you in the core key areas is massive and it’s that kind of thing. You just haven’t got to be going to the gym necessarily. Great if you can and you do. But what can you do around your environment to make sure you’ve got the test that you need? We we have to keep testing. And like I said with myself, I mean, as time goes by, what’s noticeable with anybody, anybody is it takes the same amount of work. You get the same gain because I haven’t slipped anywhere, but the rate of which can fall backwards increases, so your retention of muscle strength goes more quickly. It takes an ongoing, diligent approach to ensure you stay on top of it so it can be done and it can be simple. And it does take just this idea of I am a person can do this. You can actually lose track of the idea of It’s not me, that’s not what I am. Well, imagine that you are. Imagine it is. Imagine you are that person. You could do the activities. Imagine that you are the person who is active, and then you have that mindset of I can actually feel as though I’ve got control of me, of my life. [00:12:37][240.5]

Dr Louise Newson: [00:12:38] It’s so easy. I think you’re right to be on that slippery slope. So I’ve had a viral infection over the weekend and so I haven’t done any yoga for three days. For me, that’s quite a long time, at the weekend I tend to a longer practice as well. But I just haven’t felt and it was probably the right thing to rest my body. But it would be very easy to forget that I’ve ever done yoga and not do it. But I know that if I left it a longer period of time, it would just be so much harder to get back into, and I end my yoga practice with a headstand and I very proud of being able to do headstands. But I do sometimes think, God, if I didn’t keep doing it, most days I wonder how long it would take for me to not be able to do a headstand. And it’s a bit of an internal sort of thing, but that’s just a mark of anything like just doing bending down and touching my toes. I can do that very easily because I do it a lot, but it wouldn’t take long at 54 to stiffen up. And that’s where it’s so easy or it’s easy to continue. But then there’s people my age who go, Well, that’s ridiculous Louise, I will never be able to do a headstand, I will never be able to touch my toes. No, but you will be able to walk up the stairs a bit quicker. You will be able to run for the bus. You will be able to walk up the escalator rather than just waiting for it to take you up. And it’s harder, isn’t it, to start, I think when you’ve let bad habit sort of slip and not do as much exercise. [00:14:01][83.1]

Matt Roberts: [00:14:02] It’s human nature to find a shortcut. It’s human nature to find a work around. It’s human nature to go for the comfy option. And we are very guilty of that now because we have the ability to make our lives very comfortable, very warm, very cosy, and not have to exert very much at all. We have to remember what the body is designed to do, the slip off rate if someone stops doing something per your point is that if you do nothing, nothing, nothing for two weeks, nothing really changes. You don’t lose anything at all. It’s a minimal percentage drop in your strength growing year over year to capacity, your heart, lung capacity and strength. Four weeks, it starts to slide. You might lose maybe 5,10%. After eight weeks, you drop off a cliff, you pretty much lose all that you’ve done in the previous six months. All of your fitness work, all effort you put into it. You lose all of it in eight weeks. So you’ve got to stay on it. You have this window, you can get away with, getting a virus and being unwell, it doesn’t make any difference. You feel like it has, but in reality, you’re okay. You can get away with being on a business trip somewhere because you have no time to exercise for two days. No problem. If you decide suddenly just because you forget you need to or you lose the urge to exercise and move and be healthy, eight weeks and you’re back to where you were at the very start of your programme. The longer you’ve been active for many years, you might get a bit of an increase in duration of that, but you still have a huge drop in your capacity and your fitness. So we’ve got to yes, got to stay very, very consistently. Consistency is the key. It’s not necessarily about hitting the high, it’s being consistent all the time. If there was one thing, I mean, effectively there’s one facet of fitness, which is probably the most important thing that anybody must be focusing on. And it’s one that for most, for a lot of females, they tend to avoid the most, which is strength work, strength work is the mainstay of our hormone health. It’s a mainstay of our bone health. It’s a mainstay of our ability to actually physically function and move, without muscle strength our skeleton can’t hold up. It’s a mainstay of all that we are as a being. Without that, we wouldn’t be anything at all. Increasing your strength, I do mean strength rather than size, there’s two very different elements in how we train muscle. We don’t want mass. What we want is highly activated, very strong tissue, which is functioning and able to keep doing all that you need to do and more. And that’s the high metabolising tissue as well. That will burn energy. That should be the the one thing you must, must do. The second thing, is probably quite equal. Second first, in a way, is doing zone two cardio training. So zone two cardio is that thing you must do every other day, four days a week of constant pace. It’s for most people, a fast walk or it’s say, sat in a bike in your gym, ticking along for 40 minutes. It needs to be one speed, one intensity, one pace and it should feel as though we’re having a conversation now and it’s fine. Should feel like we can have this conversation, but we are pushing ourselves a bit harder. Bit breathless. Heart rate’s about roughly 70% of your maximum capability. So it’s definitely overloading, you’re getting slightly sweaty, but you’re not exhausted and it’s sustainable for that 40 minutes. The reason why that’s important is what we’re looking for always is really good mitochondrial health. So mitochondria are the, they decide how cells kind of use energy in a way. So they decide how we utilise fatty acids. That’s how we utilise glycogen sugar and if they’re functioning badly we tend to a propensity towards using up, burning up more glycogen or sugars than we do fatty acids. These are marginal differences, but our insulin resistance then gets tweaked and adjusted and that causes problems. And we’ve got to train our bodies to become very efficient and zone two cardio, this sustained 40 minute spell without changing the intensity. Whether it’s walking or biting. Biking is great. It’s very sustainable, gives you very rapidly a very strong, healthy mitochondrial capability and your body gets very efficient and starts being able to really get used to that burn away and much more fatty acid as an energy source than it does sugar. So you’ve got to do those, those two things are your mainstays to focus on. There’s a whole bunch of other things as well actually, but those are the two things that you want to get right and how we use cardiovascular training, how we vary using cardio work to create cardio strength is different again, that’s interval training. How we give you muscle size if you want it is different again. That’s a very specific training programme, an eating programme to gain mass. In the main, it’s about giving you exercises that give you direct strength and off the bat to give you an idea of the numbers with this, when someone’s going to the gym or doing workouts at home, the amount of reps that you do defines your intensity. So if you can do a an exercise that you can do for around really 8 to 12 reps, that’s in the strength gain zone, you’re unlikely to build up a whole lot of size doing that kind of range. Eight reps. So with that you get really therefore high loading to be heavy enough that you couldn’t lift it more than eight times. That’s a heavy weight and we don’t want a weight that’s light that you do 12, 15, 20 times if you’re looking to try and create strength, gives you probably some strength, endurance, that’s different. We’re looking for direct, pure strength. Now, that means doing a pretty heavy loading when you’re doing a squat with some weights in your hands to the side maybe, or a bar in your shoulders or leg press machine in the gym. It means working up to a level. I wouldn’t say jump straight into this, by the way. You’ve got to work up to that level over some time and at that level where you’re doing 8 or 10 reps, you build such a huge degree of strength and you test the muscles and that’s where the tendons on the muscles and the tendons attached to the bones, you create really good bone density build and this gives everyone phenomenal abilities to burn away calories. It gives you a really amazing change in your glycogen usage and your insulin resistance. It gives you a far better use of sugar and your chances of becoming pre-diabetic are lessened if your muscles get stronger and utilise that programme more quickly. So it’s a must go to, it’s the thing you have to do to ensure we have functional strength, we’ve got therefore hormonal strength for guys who are listening as well. If you want to get some testosterone going and this is a big problem, you know the data on testosterone in males, it’s horrifying. The levels of this generation are less than their fathers before, and less than their fathers before them, which I think is horrifying. Staggering. We’re seeing that with male sperm counts as well. You know, 50% drop in some studies over a 40 year period. I mean, bad data, this is all based on us as human beings, not challenging ourselves in the same way as we need to. And females absolutely need to be physically challenged, need to be pushed. I think that we’ve got to focus on having a box ticking exercise. So in the course of a week in your programming, what do you need to do? We want to work on fundamentally strength first. Cardio fitness, second equal first. Mobility within that mix as well, some way of calming the system too. So within that, what are you going to choose to do? So for strength side, you kind of got to go to the gym, or you’ve got to have some weights at home and do some really big overload. The cardio you can work into a programme and think about if you go to do cardio, how does that work? If you’ve got a dog, well you’re doing it already, you walk in the dog. Are you walking fast enough with the dog to get your heart level to the level it needs to be? We can check it out. You find out, you can do a manual check or get a wearable. I wear a whoop device on my wrist, and look at your data. With the mobility work you do yoga. Yoga’s great example of a thing which is very, very good for us in lots of ways. Mobility, for flexibility, it’s good mentally as well. But it won’t take the box on the strength or on the cardio side and all data shows that as well. We need to do lots of stretching mobility work, but again, it’s not going to give you what you need for stretch, so if you’re choosing your week of workouts and I’d sort of would point towards people perhaps who focus on doing a lot of sessions and yoga sessions and so on and they’re working out. It’s great, but it’s not enough. We need to test you and challenge you and do those things because they’re also great, but they’re not the mainstay. So how you construct your week is about let’s get the box ticking done. Over, we have to do these things over here and the rest you can enjoy because you might not enjoy the weight training, but if you don’t enjoy and say well I don’t enjoy it, I’m not going to do it, that’s fine. But you are probably going to have some issues with the bones and with the hormones and with the muscle structure and shape as time goes by. So there’s a degree of let’s find the things you like to do, but let’s make sure we tick the boxes on and do you do the things you had to do as well. [00:22:38][515.8]

Dr Louise Newson: [00:22:39] Yeah, it’s so important. And it’s the a lot of it doesn’t take that much time. You know, I’ve got free weights at home, which makes it a lot easier so I don’t have to factor in, if I factored in going to a gym, coming home from a gym. That’s probably as long as it is to actually do the exercise. And so it’s very easy to take, make the excuses, you know, depending on, you know, I’m quite happy exercising on my own. I don’t need to be surrounded by other people, whereas other people do need that motivation. But it’s having something that definitely is varied that’s right for you. And, you know, one of the things I see a lot in the clinic is women who are fit and active, but then their fitness falls off a cliff because their hormones drop. And it’s very easy to say to a hormonal woman, you just need to exercise and then you’ll be better. But actually, these women and I found eight years ago when I was perimenopausal, I stopped exercising because I had such muscle and joint pain. I had reduced stamina. I had loss of muscle strength as well. And I knew I was putting on weight, especially in my midline. And so tell me, oh of course, just exercise. Actually I couldn’t physically and I found it really hard. But we know that all three hormones, oestrogen, progesterone, testosterone build muscle as well as bones. But I’m very interested in mitochondrial function. So as you’ve already mentioned, the mitochondria, the powerhouse of all the cells, we have receptors for oestradiol, which is a nice form of oestrogen, progesterone, testosterone on every single mitochondria. There’s a good study showing that our mitochondria work better, especially with respect to sarcopenia and bone strength in the presence of hormones. And so it’s a combination. Obviously our muscles will produce hormones as well as our brain and our ovaries. But it’s that whole thing so often people are told, well, if you exercise, you’ll feel better, but they’re not addressing the hormones. And, you know, hormone prescribing is half of what it was 20 years ago. And no wonder that people are less fit, more obese because, you know, it’s trying to run a car without diesel or oil or whatever, it doesn’t matter, or electricity, depending on your car. But it’s very hard. You’ve got to be looking and, you know, you mentioned about what we eat is crucially important. So many women I speak to aren’t having enough protein. They think they’re eating well, but they’re not. And then they haven’t got hormones, but they’re still trying to exercise and then they end up feeling like failures. And it’s no surprise. And that’s where your work is so important as well, because it’s looking throughout, it’s looking at every single factor. Whereas I think so often you can just be siloed thinking hormones are going to control everything or exercise is going to improve everything. And of course it’s not. It’s a combination, isn’t it? [00:25:23][164.1]

Matt Roberts: [00:25:24] Yeah. So a few points there, absolutely. I think that firstly with the point of when someone is going through perimenopause, menopause and they don’t feel like being physically active, damn right you don’t. I mean, it’s something which is as a male, it’s only an understanding. looking at someone gives me symptomatic feedback. You can see why someone would not feel like doing a great deal. And the answer to that is your pick and choose your moments because some days are better than others. On those days when you feel good, fine use that day. That’s great. And the days when you just don’t feel like that, there’s no way you can push yourself and you’ve got to choose the things on those days that will make you feel a sense of personal wellbeing, personal satisfaction. Feeling whether you want to get some increase in vitality, get some calm, find some time, whatever the thing might be. You find your exercise and your routine to suit that thing. But on those days when you can do something, then you know make the most of that moment. But it might be they’re one in ten or it could be one or two. And that will vary enormously. The prescription of hormones. It’s a minefield, I think something which, you know, you’re a huge expert in this area and one thing from a point of view of me working with clients who go to see specialists is there’s still a great deal of uncertainty over people wait, and they kind of do it without, Can I sort of find another way? Is there a way to do it naturally? And so on and the answer in I think most cases is there’s not. I think that there needs to be intervention. And that’s where the regular testing, the regular consultation, the regular updates and symptomatic checks are vital and there needs to be constant adjustments. I think that the, from my point of view, a way to keep on just micro adjusting over extended periods seems to make absolute sense in response to symptoms, in response to things that we see with performance in people, their ability to be energised in their workouts, in their life, how they’re sleeping, all these things. If you’re sleep is out clearly you can’t do anything. You’re knackered. So the intervention with hormones is vital for males as well as women. So females obviously have much more time, with males. You know, TRT is without question is a huge and positive intervention for lots of males. We’re seeing some new data on males that, as we know personally in our testing in the clubs, but broadly is poor. So we have to have that and combined with that right now, the issue we have increasingly with females who are going through the menopause is the concern over the weight gain, has… point whether they’re using Ozempic and Wegovy and Mounjaro to try to lose weight and it’s just fighting with the wrong tool. And I think they’re an interesting medication, I think they have a place clearly. I think they have some great upsides when used phenomenally tightly within a brief at a low dose, there’s a good chance it gives people weight loss only if they’re doing a very specific strength training programme and only if, as you said, their protein intake is high enough to sustain themselves and their muscle. Otherwise it’s a one way street downwards. And I suspect and I’d love to get your feedback on how much that increased use of the GLP-1 agitators which these products are, is affecting hormone health. It must be surely? [00:28:34][190.2]

Dr Louise Newson: [00:28:34] Yeah. I actually don’t prescribe them and I’m too concerned about the long term risks actually that I wouldn’t be rushing and prescribing them. They probably do have a role, but I’m more concerned about or more interested in prevention actually. But also a lot of women, when they have their hormones optimised, all three hormones actually can really make a difference because obviously menopause is a cardio metabolic problem. People’s metabolism changes. But a lot of people, if they don’t have adequate oestradiol, that active nice form of oestrogen, they’ll produce more oestrone in their body and the fat cells produce oestrone as well as all sorts of other inflammatory cytokines, chemicals. And you know, oestrone is not good, but it’s made in fat cells so people then put on weight because they’re producing more fat. And so I’ll often work very hard with patients to optimise their hormones properly in a physiological way. Think about how they exercise, really look at their nutrition, even, you know, looking at their sleep and mental health, because that can make a difference to their metabolism as well. And then weight because it can take three to six months to really have an effect. [00:29:45][70.3]

Matt Roberts: [00:29:45] Yeah. [00:29:45][0.0]

Dr Louise Newson: [00:29:46] Rather than taking today’s drugs, which someone told me a few days ago, actually, I’m not going to mention names, of course, but a menopause specialist she had seen, she’s absolutely you wouldn’t look at her and think she was overweight. She said oh I’ve got a bit of belly fat. And I went to see this doctor and they said, we could just give you a low dose of, you know, one of these drugs. And I’m like hang on, no, they shouldn’t be used first line. Absolutely. And I think it’s so easy to just do this, whereas actually you want to put in habits that are sustainable, that are going to really make a difference. And also you want to build muscle and you still need fat, as in good fat as well. Whereas I worry about some of these drugs, what they’re doing to bone density, what they’re doing with fat in the brain and the cells as well, and what they’re doing to hormones actually, are they having a negative effect on hormones in men and women? There’s so much we don’t know. And if we don’t know, then it’s actually better to think about the basics. And actually, it’s interesting when people say they want to manage their menopause naturally because it is actually more natural to have hormones than not. It’s not actually natural to live without hormones. So we just need to think, and even for men, testosterone has been labelled or mislabelled because sadly, a lot of men are using testosterones that are synthetic, which are chemically altered, which are not the same, they’re anabolic steroids, whereas the pure testosterone, of course, it isn’t an anabolic steroid, it is a natural hormone that we produce. And a lot of men don’t have it as they age for all sorts of reasons. So there’s a lot we need to think about. But I think the big message of this podcast, Matt, is about individualisation. And that certainly to me as a doctor, every patient is different. Everybody’s journey is different. And when you’re thinking about exercise, everybody’s coming from different beginnings, but also they’ve got different end points. And so making sure everything’s tailored is crucial. So it’s the new year, people are thinking hopefully more about the exercise, movement being healthier. So just before we end, three tips for those people that might be sitting here thinking it’s all very well for them to talk like that, but what am I going to do? So what are the three things that they could do that’s going to start for them to continue? [00:32:01][135.2]

Matt Roberts: [00:32:02] Well, very simply, I mean, the one thing you should definitely be doing fundamentally, because it’s very easy to do, is going doing that zone two cardio we touched upon. So if you can make a goal for yourself for each week, don’t make it too onerous, make it that three days in the next week and thereafter you’re going to to do a 40 minute long, fast paced walk with the level being about that seven out of ten. So you got that slightly puffy feeling and do that. That’s one for sure, because anyone can do that, that’s straight forwards. I want you to think about as well making sure we build on that strength. So let’s choose to do four or five key exercises, simple ones. So probably a squat, probably a lunge, maybe a step up, possibly a form of a press up and you can make the easy versions could be on edge of a table. It can be on the edge of a bench in the park, anything you like and some form of a pull test. Now, that could be ideally some form of a pull up exercise because in the gym it’s a pull down exercise, choose four or five things for the big muscle groups. And when you’re doing those, think as we discussed before, the intensity. Are you doing a level where going to about ten reps roughly is a struggle? Is that where you’re at if you’re starting from afresh, different, fine If you’re into this already a little bit, are you doing that degree of overload for four or five sets of that, that high volume, the four or five sets, ten reps and the last two reps, you’re thinking, I can just about do this and rthat should be a second go to, those things easy twice a week is all I want. If you can do more great, do more, but twice a week and I want you to then focus as well on mobility and the mobility section is straightforward. You choose just probably three or four key exercises. If you only stretch out your thighs and your hamstrings and you do some spinal flexion, lying on your back, pulling your knees towards your chest and some rotation where you put your knees to one side lying on your back. Those four stretches alone give some spinal mobility, some stretching in towards the limbs in the quads and hamstrings. And those alone give you a good start. So you’ve got a little bit of strength work in there, the cardio work in there and your mobility in there. And those are the simplest ways you can do something, beyond that, you can do much, much more. If you do in the next week, the cardio three times, the strength work twice and mobility three times, perhaps post the walking, then you’re doing a pretty good start to your year if you’re doing nothing else. [00:34:27][144.8]

Dr Louise Newson: [00:34:28] Perfect. Great advice and actually hopefully achievable. So thank you so much for your time Matt. It’s been a great pleasure having you on my podcast. [00:34:35][7.9]

Matt Roberts: [00:34:36] My pleasure. Thanks for inviting me. Great to see you. [00:34:38][1.8]

Dr Louise Newson: [00:34:43] 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. [00:34:43][0.0]

END

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