June 23, 2025

Dispelling Myths About Menopause and HRT with Dr Louise Newson (Part 1)

Dispelling Myths About Menopause and HRT with Dr Louise Newson (Part 1)
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Dispelling Myths About Menopause and HRT with Dr Louise Newson (Part 1)
Dispelling Myths About Menopause and HRT with Dr Louise Newson (Part 1)
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Apple Podcasts podcast player icon Spotify podcast player icon Castro podcast player icon PocketCasts podcast player icon Podchaser podcast player icon
Season 15 Women's Health And Wellbeing Physical Health

Dr. Louise Newson is a physician, hormone specialist and one of the world's leading voices in transforming menopause care. We discuss the misconceptions about menopause and hormone treatment, the benefits that HRT can provide even for women without overt symptoms, and how it can play a significant role in maintaining long-term health. Dr Louise highlights that hormonal changes affect every cell in our bodies, leading to surprising symptoms that women may not initially connect to their hormonal shifts. We explore the lesser-known effects of menopause that are frequently overlooked. Hormone replacement therapy (HRT) is a vital, but often misunderstood topic for women navigating the confusing journey of perimenopause and menopause. Dr Louise answers all my questions.Takeaways:

  • Hormonal changes during menopause can lead to a wide range of symptoms beyond hot flushes.
  • It's crucial for women to understand that many common symptoms are often misattributed and could be linked to hormonal changes.
  • Hormone Replacement Therapy (HRT) can significantly improve quality of life by alleviating symptoms and reducing long-term health risks.
  • Many women remain unaware of the benefits of HRT, even if they don't have obvious symptoms, making education vital.
  • Testosterone plays an extremely important role in women's health, affecting mood, energy, and cognitive function.
  • Despite the benefits and advancements in understanding HRT, misconceptions and fears still prevent many women from receiving appropriate treatment.

Connect with Dr Louise Newson
www.drlouisenewson.co.uk
www.instagram.com/menopause_doctor


Connect with Cass:

www.cassdunn.com
www.instagram.com/cassdunn_xo

Contact Crappy to Happy:

Email: hello@crappytohappypod.com
www.crappytohappypod.com
www.instagram.com/crappytohappypod
www.tiktok.com/@crappytohappypod


Are you a coach, therapist, service provider or solopreneur struggling with self-doubt and imposter syndrome? I'd love to talk to you! (for market research purposes only!)

Book a call with me to share your experience.

Want more great content and less ads?

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Chapters

00:00 - Untitled

01:01 - Untitled

01:05 - Introduction to Crappy to Happy

01:40 - Introduction to Menopause and Women's Health

11:46 - Understanding Hormone Replacement Therapy (HRT)

18:42 - The Impact of Hormone Replacement Therapy

25:28 - Hormonal Impacts on ADHD and Women's Health

Transcript
WEBVTT

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This is Crappita Happy and I am your host, Cas Dunn.

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I'm a clinical and coaching psychologist. I'm mindfulness meditation teacher

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and of course author of the Crappita Happy books. In

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this show, I bring you conversations with interesting, inspiring, intelligent

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people who are experts in their field and who have

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something of value to share that will help you feel

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less crappy and more happy. Welcome back to Crappita Happy Today.

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I am very excited to bring you chapter one of

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this guest. This is my first interview with doctor Louise Newsen,

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who is a physician, a menopause specialist, and she's a

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member of the UK Government's Menopause Task Force. She's a

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doctor who is really committed to increasing awareness and knowledge

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of perimenopause and menopause and has really credited with kickstarting

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the menopause Revolution. She is so committed to empowering women

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with choice and control over their bodies, their minds and

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over the treatment options that are available to them. And

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she's also doing a lot of work in educating other

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health professionals as well menopause and hormone health. And I mean,

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if we're honest, women's health issues across the board have

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been under researched and underfunded forever. So this topic, this

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area of health has been really undersupported. There has been

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so little information and treatment available to women, and thankfully

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now we're all becoming a lot more aware, and it's

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largely thanks to people like Luise who have been really

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vocal and publicly sharing information and educating women. So I

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am so excited to bring you today my first interview

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with doctor Luise Nwsen, Doctor Luys Newsen.

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Welcome to Crabby to have you.

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Oh, thank you, thanks for inviting me.

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Yeah, so lovely to have you in the studio. Louise,

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you are obviously an expert in that area of menopause,

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and this is a huge topic for my audience. I've

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got a lot of listeners who are in that age group.

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When we think of menopause, we think of still to

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this day, hot flushes, night sweats. Can you explain what

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are some of the lesser known effects of menopause that

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women need to be aware of.

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Isn't it frustrating? Yeah, it's twenty twenty five and we're

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still talking about flushes and stuffs, which are not the

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most common symptom. Either. Right, the most important thing is

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to think that our homones work on every single cell

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in our body. Therefore, every single cell, every single tissue,

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every single organ can be affected. Right, So it's if

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we think as women about that, then often we'll see, well,

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that's why we've had pins and needles. That's why we've

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had dry mouthsawn mouth, burning mouth, dry eyes, ring in

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the ears, you know, indigestion problems. It's those sort of

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symptoms that are actually quite common but not commonly attributed

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to hormonal changes. Yeah, you see what I mean. So

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when we say surprising symptoms, I think the biggest surprise

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is that they're associated with our hor hormonal changes, do

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you know what I mean?

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So if women are experiencing that, their first thought is like, oh,

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this is y nal, this is to do with the

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menopause or menopause.

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They're looking for some other reason for this.

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Yeah.

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And then there's all the symptoms affecting our brain. So

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we know the commonest symptoms of the brain fog, the

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memory problems, the difficulty word finding, the low mood, irritability, anxiety.

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You know, there's all those symptoms that on their own

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people probably wouldn't even bother a doctor with but then

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they cut together and then what's the first thing that happens.

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We get misdiagnosed as having anxiety or depression, or it's

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blamed on us not being able to cope with our

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jobs or our difficult social circumstances, you know, which is

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so wrong. So that's why it's so important that us

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as individuals try and learn as much as possible.

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Yeah, exactly.

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Insomnia was one that I experienced, actually, so I which

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I spent months trying to figure out why I wasn't sleeping?

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Is that reasonably common?

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Really really common? And I had the same Actually, I

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had this overwhelming fatigue, almost like someone had drugged me.

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You know.

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It was awful, And I'd say to my husband about

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nine o'clock, I just need to go to bed. I

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was trying to this is so ironic, trying to develop

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my website writing about sleep problems but didn't really recognize

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them with myself. Then I'd go to bed, go to

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sleep maybe but really peractually, and then I'd be waking up,

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and it's usually three four in the morning, You're ping,

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wide awake. That's often when you need a wei or

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you have palpitations. Or you get these catastrophic thoughts where

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women often ruminate and worry in a way that they

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wouldn't worry before. I mean, I used to worry. But

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am I going to make this school bus? Am I

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going to make the pat lunch? Am I going to

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be able to get out the house in time?

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Like?

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Am I going to be able to feed the cats?

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Why was I worrying? It's wee in the morning.

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You know.

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It wasn't deep thoughts, But that's when our hormone levels

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drop at their lowest in the early hours of the morning.

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And our hormones are related to melotone, in our sleep hormone.

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So if we've got low eastrada, we've got low melotonins.

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So it's no surprise we can't sleepah, but it's very common,

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and then we feel very unrested, of course, yes, and

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then this cycle continues. And it was only when I

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started my clinic. Women started to come back for their

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review appointments, and one of the first things they thanked

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me for and they still do now, is the sleep

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because not sleeping is a form of torture.

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It is.

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That was the first thing that I noticed. Actually, when

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I eventually got onto estrogen patches. My sleep improved immediately.

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Yeah, it's pretty instant. And you know, I mean, gosh,

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we're gas lit all the time as women, and people say, well,

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it's just placebo. Okay, maybe flushes as maybe. I don't know.

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I don't think anything's placebo really to that extent. But

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you don't expect the quality and quantity of your sleep

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to improve so quickly.

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I don't think, yeah, no immediate for me.

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There are many women, even friends of mine, who will say, well,

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I still have regular periods or I don't think I

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have any symptoms to speak of? What are the benefits?

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I want to talk about HRT and I want to

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talk about you know, the misconceptions about that too. But

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even for women who maybe aren't presenting with any of

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these symptoms, is there still a benefit of going on

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h RT.

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Yeah, So we need to be thinking. There's a couple

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of things really in that. First thing is to be

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thinking about why we're taking HRT, which I'll come back to,

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And the second thing is thinking about the whole period thing. Yeah,

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why are we defined by our periods like we have

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so many times with difficult periods that are heavy, painful

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and regular and we're just not given treatments. Suddenly we've

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perimenopause and a menopausal and every doctor seems to want

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to know about our periods because menopause is defined as

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a year since our last period. Like, what the hell

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why is it about periods? So if we take a

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step back and think about our hormones affecting every single

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set in our body. But they're not just produced by

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our ovaries, they're made in our adrena or glads, they're

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made in our brains, they're made in our muscles. Even

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our heart makes estradal, So then like, how does our

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heart know about our periods? Of course it's ridiculous, isn't it.

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So that means there's lots of women who still have

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regular periods, so they're still producing enough estradyn and progesterone

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for their regular cycle, but they've got less amounts of

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those hormones, or they might be testosterone deficient, because we

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know testosterone starts to decline in the late twenties early thirties,

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so many of us will be testosterone deficient before we're

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deficient in estradyle progesterone affecting our mental cycle.

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Interesting, that's one, Yeah, that's one that isn't really talked

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about very Oftenne.

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No, exactly, And we need to be thinking about the

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hormones separately. I mean, why it's just called menopause like

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stopping periods. Why we don't think about it as a

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progesterone deficiency and estradile deficiency, a testosterone deficiency. Almost have

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three different deficiencies. And then we can have the hormones

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at the right dose and type and time for each

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of us. But then your question about HRT I think

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as a clinician, there are two reasons that I prescribe

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HRT and as a menopause woman, there's two reasons why

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I take HRT.

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One is to improve.

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Symptoms, because if the symptoms are related to hormonal changes

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or a deficiency, having the right docent type of hormones,

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of course will improve those symptoms. Now, I went into

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medicine to help people feel better. Isn't it nice that

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people come back feeling better? And as a woman, isn't

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it great that my brain can work, I can function,

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I can be happily married, I can look after my

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children and get to work. But the other thing is

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about helping keep us healthy for as long as possible.

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So as a doctor, Yes, okay, I can treat diseases,

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but I want to prevent diseases. And we know that

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these hormones are biologically active. They have really important roles

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in our bodies, in our organs to keep us healthy,

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like lots of our hormones do. And we've known for

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many years that the longer women take hormones, the lower

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the risk of heart disease or stereoporosis, type two diabetes,

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clinical depression, dementia, and actually we're likely to live longer

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as well, So that's really important. So even if people say, oh,

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I don't have any symptoms, then that's fine. It's a

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choice taking hormones, but we have to know that women

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who take HRT have a lower risk of these diseases,

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a bit like women who exercise will have stronger bones.

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Like people can choose whether they exercise, people can choose

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whether they take HRT. But it's the knowledge. And so

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many times, even now, I still read that menopause is

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a transition, it's a natural process that we go through. Well, firstly,

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it's not really a transition. We don't metamorphosize into something.

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But also you know, whether we have symptoms or not,

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we've still got this bone loss, We've still got this

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inflammation in our body, and that needs to be addressed

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in various ways. But the most obvious thing, if it's

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related to low hormones is give those almos back.

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Exactly So, having said that, given that there are all

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of these other benefits, quite apart from what you might

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consider to be the typical menopausal nice words or what

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insomnia or whatever it is for me, also the word

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losing words, I would yeah constantly. Given all of those

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other benefits, when should women start thinking about taking HRT?

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So? Taking ITH, like I said, is an individual choice,

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but women should be starting thinking about it sooner rather

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than later, right, Like, there are so many women who

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say I wish i'd started this earlier, and I know myself,

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I wish i'd started testosterone probably about ten years before

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I did. But you don't know, you know, you don't

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know what you don't know. The other thing to remember

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is like, not every symptom, obviously, is due to hormonal changes.

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You know, I might see someone in the clinic they've

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got palpitations, they ratherwise fit and well, and I'm thinking,

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is that a heart condition? Is it hormonal changes? Like

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I don't actually know. Sometimes so often I'll refer people

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to a cardiologist to have some heart tests, but I'll

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also start them on hormones. Now, if within days or

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weeks the palpitations improve, they feel fine, Well, that's answered

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the question, hasn't it. Yeah, if it doesn't, then we

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need to be thinking about what else is going on.

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Or if people don't feel better, then they could stop

216
00:11:43.440 --> 00:11:46.639
taking hormones. You know, the hormones that we use only

217
00:11:46.639 --> 00:11:48.759
work in the body of the day that we use them, right.

218
00:11:48.840 --> 00:11:50.759
I think some people think that once you're on it,

219
00:11:50.799 --> 00:11:53.159
that's it. You're on it for life, and it's you know.

220
00:11:53.240 --> 00:11:55.519
I mean, I don't prescribe implants, which do last a

221
00:11:55.559 --> 00:11:58.240
lot longer in the body. But you know, if I

222
00:11:58.279 --> 00:12:01.480
don't change my patch, I know, like the day after,

223
00:12:02.120 --> 00:12:03.440
or if I forgotten to put a new one on

224
00:12:03.480 --> 00:12:05.440
the day after, I start to get joint pain and

225
00:12:05.480 --> 00:12:08.639
feel worse. So they work very quickly, but they wear

226
00:12:08.679 --> 00:12:11.399
off very quickly as well, which again is quite reassuring

227
00:12:11.399 --> 00:12:12.480
I think for people to know.

228
00:12:12.679 --> 00:12:14.720
Yes, you just raised a good point.

229
00:12:14.759 --> 00:12:18.279
So what are the different types of application I guess

230
00:12:18.399 --> 00:12:19.840
you mentioned and implants?

231
00:12:19.840 --> 00:12:21.159
I know, there's a gel as well.

232
00:12:21.039 --> 00:12:25.200
Yeah, so usually so with HRT, the problem is it's

233
00:12:25.240 --> 00:12:28.200
just three letters or MHT. Some people call it menopause

234
00:12:28.200 --> 00:12:32.480
of hormonal treatment, but it's different hormones and all those

235
00:12:32.639 --> 00:12:35.399
risks that people have worried about in the past are

236
00:12:35.440 --> 00:12:39.600
related to older types of hormones. So as many people

237
00:12:39.639 --> 00:12:42.120
listening might know that the estrogen part used to be

238
00:12:42.200 --> 00:12:46.440
made from pregnant horses urine, so that, I mean, it's natural,

239
00:12:46.480 --> 00:12:49.440
isn't it. But I wouldn't want to have pregnant horses here,

240
00:12:49.519 --> 00:12:53.000
and you can imagine pregnant horses urine contains all sorts

241
00:12:53.000 --> 00:12:55.919
of hormones, not just the estras are that we need

242
00:12:55.960 --> 00:12:58.679
for our bodies to work right action, So of course,

243
00:12:58.759 --> 00:13:01.519
to putting something into your body that isn't natural for

244
00:13:01.639 --> 00:13:05.639
humans and contain and goodness only knows the processing how

245
00:13:05.679 --> 00:13:07.840
they made it into a tablet. You know, it's all

246
00:13:07.840 --> 00:13:10.200
sorts of things in the tablet as well. So I mean,

247
00:13:10.240 --> 00:13:13.240
if you start reading about the history, it's quite mind blowing.

248
00:13:13.759 --> 00:13:18.200
So there's that, But also the progesterone in the big study,

249
00:13:18.240 --> 00:13:21.120
the WHI Women's Health Initiative study that scared everyone away

250
00:13:21.120 --> 00:13:27.279
from HRT, that contained majoxy progesterone acetate. So that's a synthetic,

251
00:13:27.759 --> 00:13:31.039
like an artificial type of progesterone. So it is going

252
00:13:31.120 --> 00:13:33.399
to have risk because it's not made for the body.

253
00:13:33.720 --> 00:13:37.639
It's not the identical structure of our natural progesterone. So

254
00:13:37.840 --> 00:13:41.840
fast forward. Now we prescribed the natural estradyl, which is

255
00:13:41.879 --> 00:13:45.080
a good type of estrogen, usually through the skin as

256
00:13:45.080 --> 00:13:47.600
a patch or gel, so then it goes through the

257
00:13:47.639 --> 00:13:51.480
skin into the bloodstream and stays as the molecule of estradyl.

258
00:13:52.120 --> 00:13:54.919
Progesterone isn't quite so well absorbed through the skin, so

259
00:13:55.000 --> 00:13:56.600
we tend to give it or really or it can

260
00:13:56.679 --> 00:14:00.000
be given as a pessary and then testosterones are same

261
00:14:00.120 --> 00:14:03.399
and we give it naturally. So there's a big confusion

262
00:14:03.399 --> 00:14:06.360
when we talk about hormones because people always think about

263
00:14:06.720 --> 00:14:09.200
all but the risk of clot the risk of this. Yes,

264
00:14:09.240 --> 00:14:12.639
there is a risk with the synthetic, artificially made hormones,

265
00:14:12.919 --> 00:14:15.039
and the same with the testosterone. People think if we

266
00:14:15.200 --> 00:14:18.399
use testosterone, we're going to have this weird body shape,

267
00:14:18.399 --> 00:14:21.840
We're going to be like bodybuilders and gyms using anabolic steroids.

268
00:14:22.440 --> 00:14:27.440
People who inject with testosterone or take testosterone supplements they're

269
00:14:27.519 --> 00:14:32.240
chemically altered. They're not the same molecular structure. So we

270
00:14:32.360 --> 00:14:35.240
have to be really careful in the words that we use, right,

271
00:14:35.399 --> 00:14:36.799
And a lot of women say to me, oh, I

272
00:14:36.840 --> 00:14:40.000
tried HRT, I got side effects that didn't suit me. Well,

273
00:14:40.039 --> 00:14:42.000
they tried it twenty years ago and it was a

274
00:14:42.000 --> 00:14:42.720
different type.

275
00:14:42.879 --> 00:14:43.399
Interesting.

276
00:14:43.720 --> 00:14:46.559
Do you see what I mean? And that's I think

277
00:14:46.639 --> 00:14:50.480
crucially important because for some reason, I don't know why

278
00:14:50.519 --> 00:14:53.600
the whole world is scared of HRT to the extent

279
00:14:54.039 --> 00:14:57.440
only five percent of menopause or women have prescribed it, really,

280
00:14:57.519 --> 00:15:03.279
whereas globally look at conscious, Look how many millions of women. Yeah,

281
00:15:03.399 --> 00:15:07.200
I'll prescribed birth control. It's all synthetic, it's all been

282
00:15:07.279 --> 00:15:10.879
chemically altered. It's all got risks with it. But somehow

283
00:15:10.919 --> 00:15:14.360
that seems okay. But as soon as we become hormonal

284
00:15:14.360 --> 00:15:17.679
and menopausal, suddenly we can't have our own hormones back.

285
00:15:17.879 --> 00:15:19.360
That's madness, isn't it.

286
00:15:19.440 --> 00:15:20.759
That doesn't make any sense.

287
00:15:21.120 --> 00:15:23.919
But now that you've mentioned that, so you the the

288
00:15:23.960 --> 00:15:26.279
point that you just made was even the hormones that

289
00:15:26.320 --> 00:15:28.840
are in Because I know some people also will say, oh,

290
00:15:29.120 --> 00:15:33.879
I couldn't take the pill either, like anything hormonal, it

291
00:15:33.919 --> 00:15:36.360
doesn't agree with me very well. But what you're saying

292
00:15:36.480 --> 00:15:39.360
is this, it's very different, very different.

293
00:15:39.480 --> 00:15:39.720
Yeah.

294
00:15:39.720 --> 00:15:42.679
So sometimes when I'm sort of trying to explain to people,

295
00:15:42.840 --> 00:15:46.159
I'll say, if you think about strawberries, we can have

296
00:15:46.200 --> 00:15:49.240
the fresh strawberries grown in the fields, or we can

297
00:15:49.279 --> 00:15:53.039
have strawberry flavored candies or sweets. So if my daughter

298
00:15:53.080 --> 00:15:55.000
comes home from school and says, all, Mummy, I've had

299
00:15:55.000 --> 00:15:58.600
some strawberries today, I really hope that it's nice fresh strawberries,

300
00:15:58.960 --> 00:16:01.480
but she might have just had and for her they've

301
00:16:01.519 --> 00:16:05.120
tasted pretty good. But we know quite readily in their

302
00:16:05.159 --> 00:16:09.000
body they'll have different effects. Or if I'm having chicken

303
00:16:09.360 --> 00:16:13.080
roast chicken dinner or I'm having a packet of chicken crisps,

304
00:16:13.480 --> 00:16:15.039
of course they're going to be very different in our

305
00:16:15.080 --> 00:16:18.200
body because one's the real deal and one's synthetic. It's

306
00:16:18.240 --> 00:16:22.200
been made to look like. So these hormones in contraception

307
00:16:22.279 --> 00:16:25.120
and older types of HRT are made to look like

308
00:16:25.480 --> 00:16:29.159
but our body knows the difference. So we have receptors

309
00:16:29.159 --> 00:16:32.840
on all our cells made for the pure hormones. We

310
00:16:32.960 --> 00:16:36.720
suddenly chemically alter it. The structure changes, so it won't

311
00:16:36.720 --> 00:16:40.519
fit in that receptor, it won't have the same biological effects.

312
00:16:40.639 --> 00:16:43.080
And what's worse is it blocks the receptor, so if

313
00:16:43.120 --> 00:16:45.720
there is any of the nice hormone around in the body,

314
00:16:46.120 --> 00:16:47.600
it won't be able to get in and help the

315
00:16:47.639 --> 00:16:48.759
cell to work properly.

316
00:16:49.080 --> 00:16:49.639
Rare right.

317
00:16:51.200 --> 00:16:53.080
So, given that all we're doing is putting back into

318
00:16:53.080 --> 00:16:55.600
our body something that it would normally naturally produce, and

319
00:16:55.679 --> 00:16:57.519
then it just stops producing it and therefore it has

320
00:16:57.559 --> 00:17:00.440
all this long on effects, do we need just taking

321
00:17:00.519 --> 00:17:02.840
it or can continue to take it?

322
00:17:03.320 --> 00:17:05.720
So it's a great question. Yeah, of course we can

323
00:17:05.759 --> 00:17:08.240
continue taking it if we want to. So that's the

324
00:17:08.279 --> 00:17:10.960
important that's the crooks of all of this is about choice.

325
00:17:11.480 --> 00:17:14.039
We know from the guidelines the evidence that women can

326
00:17:14.359 --> 00:17:17.200
be reviewed every year if the benefits out weigh any risks,

327
00:17:17.200 --> 00:17:20.480
and usually it is, you can continue taking it. Why

328
00:17:20.480 --> 00:17:22.279
would you stop something that was good for you. It's

329
00:17:22.279 --> 00:17:24.640
like saying, right, you've reached a certain age, don't eat

330
00:17:24.640 --> 00:17:27.680
any more fruit, don't drink water again. You know, we

331
00:17:27.720 --> 00:17:30.559
don't do that with people with type one diabetes, with

332
00:17:30.640 --> 00:17:35.559
insulin or with any other you know, hormonal supplement. We

333
00:17:35.880 --> 00:17:38.519
just need to be thinking about it differently, and it's

334
00:17:38.519 --> 00:17:41.400
all stems from the concern about breast cancer. Yeah, does

335
00:17:41.599 --> 00:17:43.519
that's the biggest that's the problem.

336
00:17:43.799 --> 00:17:43.960
You know.

337
00:17:44.000 --> 00:17:47.519
In the seventies and eighties, women were actively encouraged to

338
00:17:47.640 --> 00:17:51.000
be taking HRT for their bones. You know, one in

339
00:17:51.079 --> 00:17:53.519
two women over the age of fifty who don't take

340
00:17:53.680 --> 00:17:57.640
HRT will have our stereoporosis. So in the forties it

341
00:17:57.720 --> 00:18:01.920
was discovered about the bone density increasing with hormones, so

342
00:18:02.000 --> 00:18:04.400
there was a big move. There were no other treatments,

343
00:18:04.799 --> 00:18:07.000
so it's like, come on, let's keep your bone strong.

344
00:18:07.519 --> 00:18:11.079
Replaced with hormones, and people were encouraged to take HRT

345
00:18:11.799 --> 00:18:13.240
and then it all went wrong.

346
00:18:13.400 --> 00:18:15.559
With that one. Wasn't that one study that?

347
00:18:16.119 --> 00:18:17.680
Yeah, well, there were a couple of studies.

348
00:18:17.720 --> 00:18:20.279
So there was one in the seventies because they used

349
00:18:20.279 --> 00:18:22.200
to just give estrogen on its own because they knew

350
00:18:22.319 --> 00:18:25.599
estrogen was really good. And then there was some reports

351
00:18:25.640 --> 00:18:28.440
of some increase of cancer of the lining of the womb.

352
00:18:28.599 --> 00:18:31.400
It was a really really small number, like one in

353
00:18:31.440 --> 00:18:34.119
a thousand women. Of course, we don't want to increase

354
00:18:34.119 --> 00:18:37.160
the risk of anything, so then they quite quickly realized

355
00:18:37.160 --> 00:18:41.480
if people had progesterone as well, then they wouldn't get bleeding,

356
00:18:41.519 --> 00:18:43.359
they wouldn't get built up the lining of the womb,

357
00:18:43.400 --> 00:18:46.920
their risk of cancer reduced, which is great, makes sense

358
00:18:46.960 --> 00:18:49.599
of course, So then they gave it, but it was

359
00:18:49.640 --> 00:18:53.359
the synthetic progesterone, don't forget. And then the study came

360
00:18:53.359 --> 00:18:57.559
out in two thousand and two looking at it was

361
00:18:57.599 --> 00:19:01.039
actually trying to look at the benefits for bones brain

362
00:19:01.200 --> 00:19:04.559
of HRT and older women, but they used the wrong

363
00:19:04.599 --> 00:19:07.559
type of women. They gave the wrong type of phones

364
00:19:07.720 --> 00:19:10.359
and the wrong dose as well, so it was sort

365
00:19:10.400 --> 00:19:13.960
of made to fail almost And then they thought there

366
00:19:13.960 --> 00:19:16.759
was an increased risk of breast cancer, but they hadn't

367
00:19:16.799 --> 00:19:19.680
studied the data properly, they hadn't gone through it all,

368
00:19:19.720 --> 00:19:22.200
but they'd already pushed it out to the media, the

369
00:19:22.240 --> 00:19:25.599
medical press and the lay press to say everyone should

370
00:19:25.640 --> 00:19:28.599
stop taking HRT. There's this risk of heart attacks, theres

371
00:19:28.640 --> 00:19:32.400
a risk of breast cancer. So the whole world literally

372
00:19:32.640 --> 00:19:36.799
and doctors were encouraged to stop HRT prescribing. It was awful,

373
00:19:37.400 --> 00:19:41.279
and so since then everybody goes back to that. But

374
00:19:41.440 --> 00:19:43.960
it's still even if there was a risk.

375
00:19:44.039 --> 00:19:44.759
Now, when they.

376
00:19:44.680 --> 00:19:48.319
Studied the data properly, it wasn't statistically significant. Women who

377
00:19:48.400 --> 00:19:51.200
only had estrogen so not a progesterone. Women who had

378
00:19:51.319 --> 00:19:54.519
a hysterectomy had a twenty two percent lower risk of

379
00:19:54.559 --> 00:19:57.519
breast cancer, right, and that's really significant. That never made

380
00:19:57.519 --> 00:20:00.599
the front pages, of course, did it. But even then

381
00:20:00.720 --> 00:20:04.039
it's like you're comparing apples and bananas and saying, well,

382
00:20:04.039 --> 00:20:07.119
they're all fruit, therefore they're all yellow. Like you know,

383
00:20:07.599 --> 00:20:12.759
even even like the worst type of HRT still has

384
00:20:12.839 --> 00:20:17.559
got bone protection, still helps people feel better, So it's

385
00:20:17.599 --> 00:20:19.680
still not as bad as half the things that I

386
00:20:19.759 --> 00:20:22.519
have prescribed as a doctor over the years. Yeah, you know,

387
00:20:22.599 --> 00:20:24.759
we need to be looking at what are the harms

388
00:20:24.759 --> 00:20:29.079
of prescribing antidepressants because it's easier to get antidepressants in HRT. Yeah, right,

389
00:20:29.160 --> 00:20:31.279
do you know what I mean? So it's like, you know,

390
00:20:31.319 --> 00:20:33.720
what are the harms of getting in your car? What

391
00:20:33.759 --> 00:20:35.039
are the harms of you know, I've just got a

392
00:20:35.039 --> 00:20:36.920
taxi here and he was driving quite fast as I

393
00:20:36.960 --> 00:20:39.559
was late, and you know there are risks, but you know,

394
00:20:39.759 --> 00:20:42.359
I'm an adult. I can decide if I want him

395
00:20:42.359 --> 00:20:44.759
to drive a bit faster or not, you know, yes,

396
00:20:45.480 --> 00:20:48.279
Whereas somehow that decision has been taken from us, and

397
00:20:48.359 --> 00:20:51.440
women across the world have been told no, sorry, talk

398
00:20:51.440 --> 00:20:54.119
to the hand, you can't have hormones. That's what's this about.

399
00:20:54.319 --> 00:20:54.920
That's true.

400
00:20:56.079 --> 00:21:00.160
Are there any women who shouldn't who would be an

401
00:21:00.240 --> 00:21:02.960
increased risk of a type of cancer for example?

402
00:21:03.119 --> 00:21:05.599
Yeah, So the only group of women that we're still

403
00:21:05.680 --> 00:21:09.119
uncertain of women who've had an estrogen receptor positive breast cancer.

404
00:21:09.440 --> 00:21:11.559
But one of the things really to add for that

405
00:21:11.799 --> 00:21:15.440
is that just because they've got estrogen receptors on their

406
00:21:15.440 --> 00:21:18.119
breast cancer doesn't mean it's been caused by estrogen, because

407
00:21:18.119 --> 00:21:20.759
we've got estrogen receptors on every cell in our body.

408
00:21:21.319 --> 00:21:24.480
But the oncologists, the cancer doctors have known for years

409
00:21:24.519 --> 00:21:27.960
that if we block estrogen, then the prognosis is better

410
00:21:28.039 --> 00:21:31.079
for some women who've had an estrogen receptor positive breast cancer.

411
00:21:31.640 --> 00:21:34.359
But that doesn't mean estrogen is bad. There are different

412
00:21:34.359 --> 00:21:37.079
types of estrogen, So what we don't know is it

413
00:21:37.160 --> 00:21:41.079
blocking one type of estrogen, not the Easter's dial Estrogen

414
00:21:41.119 --> 00:21:44.119
actually used to be a treatment for breast cancer, so

415
00:21:44.319 --> 00:21:46.599
we don't know. But also I see women in my

416
00:21:46.839 --> 00:21:51.640
clinic who have testosterone not estrogen after breast cancer because

417
00:21:51.960 --> 00:21:54.480
some studies have shown that's beneficial for breast cancer, but

418
00:21:54.519 --> 00:21:58.119
it can also help symptoms. And you know, in medicine

419
00:21:58.160 --> 00:22:00.200
we often don't know the answer because the study these

420
00:22:00.240 --> 00:22:02.559
haven't been done. No, it wouldn't be great if someone

421
00:22:02.559 --> 00:22:05.000
did a study for women who'd had breast cancer. I

422
00:22:05.039 --> 00:22:06.960
think a lot of women would want to be recruited

423
00:22:06.960 --> 00:22:09.799
into those studies. But we see women in our clinic

424
00:22:09.880 --> 00:22:13.119
who have had breast cancer, you know, twenty years ago.

425
00:22:13.400 --> 00:22:16.559
They're on their knees and they say, I just want

426
00:22:16.599 --> 00:22:19.240
to use my brain, even if I have breast cancer again,

427
00:22:19.640 --> 00:22:21.960
even if I have to go through treatment again, like

428
00:22:22.000 --> 00:22:25.839
I've tried all these alternatives. I just want or I'm

429
00:22:25.880 --> 00:22:30.039
worried about osteoporosis or whatever. They make a choice and

430
00:22:30.079 --> 00:22:33.599
then they can that's fine. So many times they've just

431
00:22:33.680 --> 00:22:37.519
been told no, there's nothing in medicine that's an absolute. No,

432
00:22:38.039 --> 00:22:39.480
everything is individualized.

433
00:22:40.759 --> 00:22:42.160
Yeah.

434
00:22:42.640 --> 00:22:44.799
You made the point that there has been this real

435
00:22:44.880 --> 00:22:49.759
gender gap in science and in medical research.

436
00:22:50.319 --> 00:22:51.440
Is it catching up now?

437
00:22:51.599 --> 00:22:56.720
No? No, I don't think it is. Actually, I think

438
00:22:56.759 --> 00:22:59.359
we're more aware of it, which is good. I mean

439
00:22:59.359 --> 00:23:03.319
it was only nineteen ninety two. It might be in

440
00:23:03.400 --> 00:23:06.880
nineteen ninety four, depending which country that women had to

441
00:23:06.920 --> 00:23:10.279
be included in studies. So I started at medical school

442
00:23:10.279 --> 00:23:14.039
in nineteen eighty eight, so all my medical training was

443
00:23:14.079 --> 00:23:18.240
about studies based on men. Like it's just madness. So

444
00:23:18.279 --> 00:23:24.200
I'm happily prescribing blood pressure, lowing treatment statins, antidepressants tested

445
00:23:24.240 --> 00:23:27.720
on men, right, Whereas we've got all this great data

446
00:23:27.799 --> 00:23:31.279
about testosterone and men. Somehow we're not allowed to use that.

447
00:23:31.519 --> 00:23:35.839
Everyone says there's not enough data. So it's like people

448
00:23:36.440 --> 00:23:39.759
cherry pick evidence for their own agendas often and that

449
00:23:39.799 --> 00:23:42.920
I think is a real shame. But often like, some

450
00:23:43.000 --> 00:23:47.240
of this doesn't actually need great, big studies because we're

451
00:23:47.279 --> 00:23:50.400
just talking about our hormones. So what we need to

452
00:23:50.519 --> 00:23:54.079
understand more as women and as clinicians is just how

453
00:23:54.119 --> 00:23:57.160
our natural hormones work in our body, and then we

454
00:23:57.200 --> 00:23:58.960
can join the dots a lot better, I think.

455
00:23:59.160 --> 00:24:04.359
Yeah, speaking of gaps in research, so many women in

456
00:24:04.400 --> 00:24:07.519
their forties and fifties are being diagnosed with ADHD, yeah,

457
00:24:08.119 --> 00:24:08.960
including myself.

458
00:24:09.000 --> 00:24:11.720
I was diagnosed only at the end of last year.

459
00:24:13.079 --> 00:24:14.279
How do the.

460
00:24:16.200 --> 00:24:23.400
Does the hormonal changes of menopause exacerbate symptoms of ADHD?

461
00:24:23.640 --> 00:24:25.359
I mean quite apart from the fact that we didn't

462
00:24:25.400 --> 00:24:28.640
really know what ADHD look like within women, there is

463
00:24:28.720 --> 00:24:30.960
this There does seem to be an increase in the

464
00:24:30.960 --> 00:24:31.880
presenting symptoms.

465
00:24:32.440 --> 00:24:36.799
Absolutely, yeah, yeah, especially in the perimenopause as well. So

466
00:24:36.839 --> 00:24:39.720
we need to remember that the hormones estronel, progester and

467
00:24:39.799 --> 00:24:43.720
testosterone are neurosteroids, meaning that they are made in our

468
00:24:43.839 --> 00:24:46.759
brain and they have important functions in our brain. But

469
00:24:46.839 --> 00:24:50.839
they work as neurotransmitters, so chemicals that send a signal

470
00:24:50.880 --> 00:24:53.200
from one part of the brain to another. And we

471
00:24:53.279 --> 00:24:58.759
have other neurotransmitters, so serotonin, dopamine, glutamate, They all have

472
00:24:58.839 --> 00:25:03.680
really important functions our brain. People with ADHD often have

473
00:25:03.880 --> 00:25:08.079
altering levels of these neurotransmitters, but our hormones can change

474
00:25:08.079 --> 00:25:11.319
the levels of these neurotransmitters. So you can imagine if

475
00:25:11.359 --> 00:25:14.880
you've got up and down yearing of eastra dial for example,

476
00:25:15.440 --> 00:25:17.039
and then you have an up and down yeo year

477
00:25:17.079 --> 00:25:20.039
ring of all these other neurotransmitters, your brains like, oh

478
00:25:20.079 --> 00:25:22.839
my gosh, what's going on, right, And so that's often

479
00:25:22.880 --> 00:25:26.720
why we see people have worsening symptoms or new diagnosis

480
00:25:26.720 --> 00:25:30.839
of ADHD during perimenopause. With this time of hormone or havoc,

481
00:25:31.200 --> 00:25:33.960
but also women that have PMDD, you know, this big

482
00:25:34.039 --> 00:25:37.759
crash of hormones before their periods that can trigger symptoms

483
00:25:37.799 --> 00:25:43.400
sometimes ADHD like symptoms or OCD, obsessive compulsive disorder, you know,

484
00:25:43.759 --> 00:25:47.680
everything that affects our brain. So it's often people don't

485
00:25:47.720 --> 00:25:51.240
join the dots, and medicine is very siloed. So you

486
00:25:51.279 --> 00:25:53.599
think you've got ADHD, you're going to see a psycholatrist

487
00:25:53.640 --> 00:25:57.000
who specialize in ADHD. They probably have never prescribed hormones

488
00:25:57.000 --> 00:25:59.920
in their lives or thought about hormones. No, you think

489
00:26:00.079 --> 00:26:02.799
you might be menopause. You see a guynecologists, Well, they've

490
00:26:02.880 --> 00:26:06.880
never done any psychiatry. They don't know, and that's the problem.

491
00:26:06.920 --> 00:26:10.400
Then people are having individual treatments, and we see a

492
00:26:10.400 --> 00:26:13.960
lot of women with ADHD who just tell us that

493
00:26:14.000 --> 00:26:17.880
their symptoms improve. They feel calmer, they feel easier to

494
00:26:17.960 --> 00:26:21.880
think and easier to sort of compartmentalize their thoughts, often

495
00:26:21.880 --> 00:26:25.920
when they're taking testosterone and progesterone as well. So you know,

496
00:26:26.240 --> 00:26:29.640
hormones work differently in different people, but testosterone can have

497
00:26:29.680 --> 00:26:32.640
a big effect in men and women actually when they've

498
00:26:32.640 --> 00:26:33.440
got ADHD.

499
00:26:34.079 --> 00:26:35.200
Yeah, that's interesting to know.

500
00:26:35.440 --> 00:26:39.759
So testosterone is not approved for I'm from Australia and

501
00:26:40.519 --> 00:26:44.640
in Australia, but testosterone is approved for use in women

502
00:26:44.720 --> 00:26:45.920
in Australia, right, so.

503
00:26:45.920 --> 00:26:48.559
It's licensed in Australia. You're the only country in the

504
00:26:48.599 --> 00:26:52.200
world that has a female testosterone licensed for you. But

505
00:26:52.480 --> 00:26:55.039
having been to Australia a couple of times, women can

506
00:26:55.079 --> 00:26:55.680
hardly guess.

507
00:26:55.640 --> 00:26:56.440
They can't get it either.

508
00:26:56.519 --> 00:26:59.960
It's madness, right, Whereas over here, for example, in the UK,

509
00:27:00.279 --> 00:27:02.359
it's more of like an off what do you call it?

510
00:27:02.599 --> 00:27:05.119
Off license? But you know what, it's really funny, isn't it.

511
00:27:05.240 --> 00:27:07.160
Loads of things we do as doctors a rough LIFs. Yeah,

512
00:27:07.160 --> 00:27:09.920
so most drugs for when women are pregnant have never

513
00:27:09.960 --> 00:27:13.279
been tested on pregnant women. It's all off licenseribing children,

514
00:27:13.720 --> 00:27:15.559
you know, but we do it all the time. Suddenly

515
00:27:15.640 --> 00:27:18.680
it's a hormone and everyone just seems to be really scared.

516
00:27:19.480 --> 00:27:21.440
So, for example, I went to the doctor and he

517
00:27:22.519 --> 00:27:25.119
prescribed like estrogen, who actually went to a couple of

518
00:27:25.119 --> 00:27:28.160
different ones, but anyway, so estrogen patches and then suggested

519
00:27:28.319 --> 00:27:34.200
the marina to get the progesterone part of it. And

520
00:27:34.200 --> 00:27:36.720
then it was Ah, you might want to think about testosterone.

521
00:27:36.720 --> 00:27:40.519
But what is it that the testosterone does then, and

522
00:27:40.519 --> 00:27:43.160
particularly because you just mentioned that ADHD like, what is

523
00:27:43.200 --> 00:27:44.599
the role that testosterone plays.

524
00:27:44.599 --> 00:27:46.759
So testosterone is like the other two hormones. It works

525
00:27:46.759 --> 00:27:49.799
on every single cell in our body. It's produced about

526
00:27:49.880 --> 00:27:52.799
half of it's made in our ovaries. It's also made

527
00:27:52.839 --> 00:27:56.799
in our adrenal glands and our brain as well. And levels,

528
00:27:56.839 --> 00:27:59.279
just like I say, tend to decline with age. But

529
00:27:59.799 --> 00:28:02.680
if if overy suddenly stop working we have them removed,

530
00:28:02.720 --> 00:28:05.720
we're going to have a bigger decline of our testosterone.

531
00:28:05.920 --> 00:28:08.720
It's the most biologically active hormone that we have actually

532
00:28:08.759 --> 00:28:13.680
as women, and it's really good for mood, energy, concentration, stamina,

533
00:28:14.160 --> 00:28:17.759
for sleep. It helps reduce inflammation in the body, so

534
00:28:17.839 --> 00:28:20.640
it helps reduce muscle and joint pain. It helps with

535
00:28:20.720 --> 00:28:24.079
muscle strength, It helps with that sort of clarity of

536
00:28:24.200 --> 00:28:27.839
thought as well. But it can help with dry eyes,

537
00:28:28.000 --> 00:28:30.160
it can help with our skin, it can help in

538
00:28:30.160 --> 00:28:31.160
a positive way.

539
00:28:30.960 --> 00:28:31.400
With our hair.

540
00:28:31.559 --> 00:28:35.039
One thinks we lose hair when we're on testosterone. It

541
00:28:35.160 --> 00:28:38.680
affects every cell in our body. It's really really important.

542
00:28:39.440 --> 00:28:42.200
The problem is is that the studies have been done

543
00:28:42.200 --> 00:28:44.680
in men, obviously showing lots of benefits not just for

544
00:28:44.759 --> 00:28:50.519
symptoms but also future health, so reducing risk of heart disease, osteoporosis, diabetes, dementia.

545
00:28:51.319 --> 00:28:53.039
But most of the studies and women have all been

546
00:28:53.079 --> 00:28:56.640
done about libido because there's some thing that people think

547
00:28:57.160 --> 00:29:00.519
it's all about sex with women, and so we do

548
00:29:00.640 --> 00:29:03.359
know that if women are on testosterone and because they've

549
00:29:03.400 --> 00:29:07.160
got reduced libido, they're likely to have better libido, they're

550
00:29:07.200 --> 00:29:10.440
likely to orgasm better, have increased sexual desire. But you

551
00:29:10.519 --> 00:29:13.200
know what, libido and women is not just a hormon

552
00:29:13.319 --> 00:29:15.839
like of course it's not, but that's where the studies

553
00:29:15.839 --> 00:29:16.599
have been done.

554
00:29:16.839 --> 00:29:20.000
So a lot of menopau miracles, I know, but so

555
00:29:20.079 --> 00:29:23.799
a lot of menopause society guidelines now say we can

556
00:29:23.920 --> 00:29:30.160
only prescribe it for something called hyposexual hypoactive sexual desire disorder,

557
00:29:30.240 --> 00:29:31.319
which is HSDD.

558
00:29:31.839 --> 00:29:34.319
And I don't even want to share the criteria with

559
00:29:34.359 --> 00:29:37.279
you because they're so like barbaric. I mean, one of

560
00:29:37.319 --> 00:29:41.240
the criteria is that women have to be severely psychologically

561
00:29:41.240 --> 00:29:45.720
distressed with their reduced libido for at least six months

562
00:29:45.960 --> 00:29:49.960
before they fulfill that criteria, which, like I've already said,

563
00:29:50.000 --> 00:29:52.440
I went into medicine to help people. If you were

564
00:29:52.480 --> 00:29:55.000
my patient and you said, five months, I'm having a

565
00:29:55.039 --> 00:29:58.079
horrendous time with my partner. We're not having sex, I've

566
00:29:58.119 --> 00:30:01.440
got no libido, he's an alcoholic, he's beating me up.

567
00:30:01.799 --> 00:30:04.400
All these awful things are happening, and I just want

568
00:30:04.400 --> 00:30:07.440
my sex life back because it might help well. Firstly,

569
00:30:07.720 --> 00:30:12.559
in HSDD diagnosis it says if there's any other reason

570
00:30:12.680 --> 00:30:18.759
so alcohol abuse, you cannot make that diagnosis. And then

571
00:30:18.759 --> 00:30:21.079
it has to be six months. So I'll say to you, oh,

572
00:30:21.119 --> 00:30:22.400
do you know what, I'll come back in a month,

573
00:30:22.440 --> 00:30:24.480
and then I might talk to you about it like

574
00:30:25.240 --> 00:30:26.799
it's just mad. As well as you know, if men

575
00:30:26.880 --> 00:30:29.519
have reduced libido, they can buy some bagro over the counter.

576
00:30:30.319 --> 00:30:33.440
Like it seems very clinical to make the diagnosis. And

577
00:30:33.480 --> 00:30:35.920
I'm not prudish about talking about sex to patients, but

578
00:30:36.559 --> 00:30:39.759
I shouldn't be prying into their sex life to such

579
00:30:40.160 --> 00:30:43.160
to try and assess how distressed they are, you know.

580
00:30:43.400 --> 00:30:45.400
And also I shouldn't be saying to them, do you

581
00:30:45.480 --> 00:30:47.960
know what if I give you testosterone, your partner's suddenly

582
00:30:48.000 --> 00:30:50.839
going to love you? Forever like Actually, it sounds like

583
00:30:50.880 --> 00:30:52.640
there are all sorts of other issues going on if

584
00:30:52.640 --> 00:30:55.480
this is going on. But you know, we don't do

585
00:30:55.519 --> 00:30:58.119
that in any other area of medicine. And also we

586
00:30:58.200 --> 00:31:01.759
know that it has benefits produced to study just before

587
00:31:01.839 --> 00:31:04.240
Christmas that was written up showing that women who took

588
00:31:04.279 --> 00:31:07.960
testosterone on top of taking HRT or in addition of HRT,

589
00:31:08.599 --> 00:31:12.240
their mood improves, their cognition improves. A lot of people

590
00:31:12.400 --> 00:31:16.559
I see come from very dark places. They've been under psychiatrists,

591
00:31:16.599 --> 00:31:19.519
many have been sectioned in the past. They've been on

592
00:31:19.920 --> 00:31:22.599
a LANs apine literally, and they've had ect electric and

593
00:31:22.680 --> 00:31:25.359
volsive therapy. They go on HRT and they feel a

594
00:31:25.440 --> 00:31:29.240
bit better, and then testosterone is what lights their brain,

595
00:31:29.400 --> 00:31:32.079
makes them so much better. And I've seen it so

596
00:31:32.240 --> 00:31:35.240
often it makes such a difference, So we need to

597
00:31:35.279 --> 00:31:37.839
be thinking about it differently as a hormone always.

598
00:31:37.839 --> 00:31:40.079
This has been really interesting. Thank you so much for

599
00:31:40.160 --> 00:31:40.519
your time.

600
00:31:40.680 --> 00:31:41.920
Oh thanks for inviting me.

601
00:31:45.880 --> 00:31:48.759
Craby to Habit is created and produced by me Kastan.

602
00:31:48.920 --> 00:31:50.960
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607
00:31:59.640 --> 00:32:01.559
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608
00:32:01.599 --> 00:32:04.079
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609
00:32:04.160 --> 00:32:07.039
Happy