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

0:04 This is Crappita Happy and I am your host, Cas Dunn. I'm a clinical and coaching psychologist. I'm mindfulness meditation teacher and of course author of the Crappita Happy books. In this show, I bring you conversations with interesting, inspiring, intelligent people who are experts in their field and who have something of value to share that will help you feel less crappy and more happy. Welcome back to Crappita Happy Today. I am very excited to bring you chapter one of this guest. This is my first interview with doctor Louise Newsen, who is a physician, a menopause specialist, and she's a member of the UK Government's Menopause Task Force. She's a doctor who is really committed to increasing awareness and knowledge of perimenopause and menopause and has really credited with kickstarting the menopause Revolution. She is so committed to empowering women with choice and control over their bodies, their minds and over the treatment options that are available to them. And she's also doing a lot of work in educating other health professionals as well menopause and hormone health. And I mean, if we're honest, women's health issues across the board have been under researched and underfunded forever. So this topic, this area of health has been really undersupported. There has been

1:37 so little information and treatment available to women, and thankfully now we're all becoming a lot more aware, and it's largely thanks to people like Luise who have been really vocal and publicly sharing information and educating women. So I am so excited to bring you today my first interview with doctor Luise Nwsen, Doctor Luys Newsen. Welcome to Crabby to have you. Oh, thank you, thanks for inviting me. Yeah, so lovely to have you in the studio. Louise, you are obviously an expert in that area of menopause, and this is a huge topic for my audience. I've got a lot of listeners who are in that age group.

2:18 When we think of menopause, we think of still to this day, hot flushes, night sweats. Can you explain what are some of the lesser known effects of menopause that women need to be aware of. Isn't it frustrating? Yeah, it's twenty twenty five and we're still talking about flushes and stuffs, which are not the most common symptom. Either. Right, the most important thing is to think that our homones work on every single cell in our body. Therefore, every single cell, every single tissue, every single organ can be affected. Right, So it's if we think as women about that, then often we'll see, well, that's why we've had pins and needles. That's why we've had dry mouthsawn mouth, burning mouth, dry eyes, ring in the ears, you know, indigestion problems. It's those sort of symptoms that are actually quite common but not commonly attributed to hormonal changes. Yeah, you see what I mean. So when we say surprising symptoms, I think the biggest surprise is that they're associated with our hor hormonal changes, do you know what I mean?

3:18 So if women are experiencing that, their first thought is like, oh, this is y nal, this is to do with the menopause or menopause. They're looking for some other reason for this. Yeah. And then there's all the symptoms affecting our brain. So we know the commonest symptoms of the brain fog, the memory problems, the difficulty word finding, the low mood, irritability, anxiety. You know, there's all those symptoms that on their own people probably wouldn't even bother a doctor with but then they cut together and then what's the first thing that happens. We get misdiagnosed as having anxiety or depression, or it's blamed on us not being able to cope with our jobs or our difficult social circumstances, you know, which is so wrong. So that's why it's so important that us as individuals try and learn as much as possible.

4:04 Yeah, exactly. Insomnia was one that I experienced, actually, so I which I spent months trying to figure out why I wasn't sleeping? Is that reasonably common? Really really common? And I had the same Actually, I had this overwhelming fatigue, almost like someone had drugged me. You know. It was awful, And I'd say to my husband about nine o'clock, I just need to go to bed. I was trying to this is so ironic, trying to develop my website writing about sleep problems but didn't really recognize them with myself. Then I'd go to bed, go to sleep maybe but really peractually, and then I'd be waking up, and it's usually three four in the morning, You're ping, wide awake. That's often when you need a wei or you have palpitations. Or you get these catastrophic thoughts where women often ruminate and worry in a way that they wouldn't worry before. I mean, I used to worry. But am I going to make this school bus? Am I going to make the pat lunch? Am I going to be able to get out the house in time?

5:04 Like? Am I going to be able to feed the cats? Why was I worrying? It's wee in the morning. You know. It wasn't deep thoughts, But that's when our hormone levels drop at their lowest in the early hours of the morning. And our hormones are related to melotone, in our sleep hormone. So if we've got low eastrada, we've got low melotonins. So it's no surprise we can't sleepah, but it's very common, and then we feel very unrested, of course, yes, and then this cycle continues. And it was only when I started my clinic. Women started to come back for their review appointments, and one of the first things they thanked me for and they still do now, is the sleep because not sleeping is a form of torture. It is. That was the first thing that I noticed. Actually, when I eventually got onto estrogen patches. My sleep improved immediately.

5:50 Yeah, it's pretty instant. And you know, I mean, gosh, we're gas lit all the time as women, and people say, well, it's just placebo. Okay, maybe flushes as maybe. I don't know. I don't think anything's placebo really to that extent. But you don't expect the quality and quantity of your sleep to improve so quickly. I don't think, yeah, no immediate for me. There are many women, even friends of mine, who will say, well, I still have regular periods or I don't think I have any symptoms to speak of? What are the benefits? I want to talk about HRT and I want to talk about you know, the misconceptions about that too. But even for women who maybe aren't presenting with any of these symptoms, is there still a benefit of going on h RT.

6:37 Yeah, So we need to be thinking. There's a couple of things really in that. First thing is to be thinking about why we're taking HRT, which I'll come back to, And the second thing is thinking about the whole period thing. Yeah, why are we defined by our periods like we have so many times with difficult periods that are heavy, painful and regular and we're just not given treatments. Suddenly we've perimenopause and a menopausal and every doctor seems to want to know about our periods because menopause is defined as a year since our last period. Like, what the hell why is it about periods? So if we take a step back and think about our hormones affecting every single set in our body. But they're not just produced by our ovaries, they're made in our adrena or glads, they're made in our brains, they're made in our muscles. Even our heart makes estradal, So then like, how does our heart know about our periods? Of course it's ridiculous, isn't it.

7:33 So that means there's lots of women who still have regular periods, so they're still producing enough estradyn and progesterone for their regular cycle, but they've got less amounts of those hormones, or they might be testosterone deficient, because we know testosterone starts to decline in the late twenties early thirties, so many of us will be testosterone deficient before we're deficient in estradyle progesterone affecting our mental cycle. Interesting, that's one, Yeah, that's one that isn't really talked about very Oftenne. No, exactly, And we need to be thinking about the hormones separately. I mean, why it's just called menopause like stopping periods. Why we don't think about it as a progesterone deficiency and estradile deficiency, a testosterone deficiency. Almost have three different deficiencies. And then we can have the hormones at the right dose and type and time for each of us. But then your question about HRT I think as a clinician, there are two reasons that I prescribe HRT and as a menopause woman, there's two reasons why I take HRT.

8:40 One is to improve. Symptoms, because if the symptoms are related to hormonal changes or a deficiency, having the right docent type of hormones, of course will improve those symptoms. Now, I went into medicine to help people feel better. Isn't it nice that people come back feeling better? And as a woman, isn't it great that my brain can work, I can function, I can be happily married, I can look after my children and get to work. But the other thing is about helping keep us healthy for as long as possible. So as a doctor, Yes, okay, I can treat diseases, but I want to prevent diseases. And we know that these hormones are biologically active. They have really important roles in our bodies, in our organs to keep us healthy, like lots of our hormones do. And we've known for many years that the longer women take hormones, the lower the risk of heart disease or stereoporosis, type two diabetes, clinical depression, dementia, and actually we're likely to live longer as well, So that's really important. So even if people say, oh, I don't have any symptoms, then that's fine. It's a choice taking hormones, but we have to know that women who take HRT have a lower risk of these diseases, a bit like women who exercise will have stronger bones.

9:52 Like people can choose whether they exercise, people can choose whether they take HRT. But it's the knowledge. And so many times, even now, I still read that menopause is a transition, it's a natural process that we go through. Well, firstly, it's not really a transition. We don't metamorphosize into something. But also you know, whether we have symptoms or not, we've still got this bone loss, We've still got this inflammation in our body, and that needs to be addressed in various ways. But the most obvious thing, if it's related to low hormones is give those almos back. Exactly So, having said that, given that there are all of these other benefits, quite apart from what you might consider to be the typical menopausal nice words or what insomnia or whatever it is for me, also the word losing words, I would yeah constantly. Given all of those other benefits, when should women start thinking about taking HRT?

10:48 So? Taking ITH, like I said, is an individual choice, but women should be starting thinking about it sooner rather than later, right, Like, there are so many women who say I wish i'd started this earlier, and I know myself, I wish i'd started testosterone probably about ten years before I did. But you don't know, you know, you don't know what you don't know. The other thing to remember is like, not every symptom, obviously, is due to hormonal changes. You know, I might see someone in the clinic they've got palpitations, they ratherwise fit and well, and I'm thinking, is that a heart condition? Is it hormonal changes? Like I don't actually know. Sometimes so often I'll refer people to a cardiologist to have some heart tests, but I'll also start them on hormones. Now, if within days or weeks the palpitations improve, they feel fine, Well, that's answered the question, hasn't it. Yeah, if it doesn't, then we need to be thinking about what else is going on.

11:41 Or if people don't feel better, then they could stop taking hormones. You know, the hormones that we use only work in the body of the day that we use them, right. I think some people think that once you're on it, that's it. You're on it for life, and it's you know. I mean, I don't prescribe implants, which do last a lot longer in the body. But you know, if I don't change my patch, I know, like the day after, or if I forgotten to put a new one on the day after, I start to get joint pain and feel worse. So they work very quickly, but they wear off very quickly as well, which again is quite reassuring I think for people to know. Yes, you just raised a good point. So what are the different types of application I guess you mentioned and implants? I know, there's a gel as well.

12:21 Yeah, so usually so with HRT, the problem is it's just three letters or MHT. Some people call it menopause of hormonal treatment, but it's different hormones and all those risks that people have worried about in the past are related to older types of hormones. So as many people listening might know that the estrogen part used to be made from pregnant horses urine, so that, I mean, it's natural, isn't it. But I wouldn't want to have pregnant horses here, and you can imagine pregnant horses urine contains all sorts of hormones, not just the estras are that we need for our bodies to work right action, So of course, to putting something into your body that isn't natural for humans and contain and goodness only knows the processing how they made it into a tablet. You know, it's all sorts of things in the tablet as well. So I mean, if you start reading about the history, it's quite mind blowing.

13:13 So there's that, But also the progesterone in the big study, the WHI Women's Health Initiative study that scared everyone away from HRT, that contained majoxy progesterone acetate. So that's a synthetic, like an artificial type of progesterone. So it is going to have risk because it's not made for the body. It's not the identical structure of our natural progesterone. So fast forward. Now we prescribed the natural estradyl, which is a good type of estrogen, usually through the skin as a patch or gel, so then it goes through the skin into the bloodstream and stays as the molecule of estradyl. Progesterone isn't quite so well absorbed through the skin, so we tend to give it or really or it can be given as a pessary and then testosterones are same and we give it naturally. So there's a big confusion when we talk about hormones because people always think about all but the risk of clot the risk of this. Yes, there is a risk with the synthetic, artificially made hormones, and the same with the testosterone. People think if we use testosterone, we're going to have this weird body shape, We're going to be like bodybuilders and gyms using anabolic steroids.

14:22 People who inject with testosterone or take testosterone supplements they're chemically altered. They're not the same molecular structure. So we have to be really careful in the words that we use, right, And a lot of women say to me, oh, I tried HRT, I got side effects that didn't suit me. Well, they tried it twenty years ago and it was a different type. Interesting. Do you see what I mean? And that's I think crucially important because for some reason, I don't know why the whole world is scared of HRT to the extent only five percent of menopause or women have prescribed it, really, whereas globally look at conscious, Look how many millions of women. Yeah, I'll prescribed birth control. It's all synthetic, it's all been chemically altered. It's all got risks with it. But somehow that seems okay. But as soon as we become hormonal and menopausal, suddenly we can't have our own hormones back.

15:17 That's madness, isn't it. That doesn't make any sense. But now that you've mentioned that, so you the the point that you just made was even the hormones that are in Because I know some people also will say, oh, I couldn't take the pill either, like anything hormonal, it doesn't agree with me very well. But what you're saying is this, it's very different, very different. Yeah. So sometimes when I'm sort of trying to explain to people, I'll say, if you think about strawberries, we can have the fresh strawberries grown in the fields, or we can have strawberry flavored candies or sweets. So if my daughter comes home from school and says, all, Mummy, I've had some strawberries today, I really hope that it's nice fresh strawberries, but she might have just had and for her they've tasted pretty good. But we know quite readily in their body they'll have different effects. Or if I'm having chicken roast chicken dinner or I'm having a packet of chicken crisps, of course they're going to be very different in our body because one's the real deal and one's synthetic. It's been made to look like. So these hormones in contraception and older types of HRT are made to look like but our body knows the difference. So we have receptors on all our cells made for the pure hormones. We suddenly chemically alter it. The structure changes, so it won't fit in that receptor, it won't have the same biological effects.

16:40 And what's worse is it blocks the receptor, so if there is any of the nice hormone around in the body, it won't be able to get in and help the cell to work properly. Rare right. So, given that all we're doing is putting back into our body something that it would normally naturally produce, and then it just stops producing it and therefore it has all this long on effects, do we need just taking it or can continue to take it? So it's a great question. Yeah, of course we can continue taking it if we want to. So that's the important that's the crooks of all of this is about choice. We know from the guidelines the evidence that women can be reviewed every year if the benefits out weigh any risks, and usually it is, you can continue taking it. Why would you stop something that was good for you. It's like saying, right, you've reached a certain age, don't eat any more fruit, don't drink water again. You know, we don't do that with people with type one diabetes, with insulin or with any other you know, hormonal supplement. We just need to be thinking about it differently, and it's all stems from the concern about breast cancer. Yeah, does that's the biggest that's the problem.

17:43 You know. In the seventies and eighties, women were actively encouraged to be taking HRT for their bones. You know, one in two women over the age of fifty who don't take HRT will have our stereoporosis. So in the forties it was discovered about the bone density increasing with hormones, so there was a big move. There were no other treatments, so it's like, come on, let's keep your bone strong. Replaced with hormones, and people were encouraged to take HRT and then it all went wrong. With that one. Wasn't that one study that? Yeah, well, there were a couple of studies. So there was one in the seventies because they used to just give estrogen on its own because they knew estrogen was really good. And then there was some reports of some increase of cancer of the lining of the womb.

18:28 It was a really really small number, like one in a thousand women. Of course, we don't want to increase the risk of anything, so then they quite quickly realized if people had progesterone as well, then they wouldn't get bleeding, they wouldn't get built up the lining of the womb, their risk of cancer reduced, which is great, makes sense of course, So then they gave it, but it was the synthetic progesterone, don't forget. And then the study came out in two thousand and two looking at it was actually trying to look at the benefits for bones brain of HRT and older women, but they used the wrong type of women. They gave the wrong type of phones and the wrong dose as well, so it was sort of made to fail almost And then they thought there was an increased risk of breast cancer, but they hadn't studied the data properly, they hadn't gone through it all, but they'd already pushed it out to the media, the medical press and the lay press to say everyone should stop taking HRT. There's this risk of heart attacks, theres a risk of breast cancer. So the whole world literally and doctors were encouraged to stop HRT prescribing. It was awful, and so since then everybody goes back to that. But it's still even if there was a risk.

19:44 Now, when they. Studied the data properly, it wasn't statistically significant. Women who only had estrogen so not a progesterone. Women who had a hysterectomy had a twenty two percent lower risk of breast cancer, right, and that's really significant. That never made the front pages, of course, did it. But even then it's like you're comparing apples and bananas and saying, well, they're all fruit, therefore they're all yellow. Like you know, even even like the worst type of HRT still has got bone protection, still helps people feel better, So it's still not as bad as half the things that I have prescribed as a doctor over the years. Yeah, you know, we need to be looking at what are the harms of prescribing antidepressants because it's easier to get antidepressants in HRT. Yeah, right, do you know what I mean? So it's like, you know, what are the harms of getting in your car? What are the harms of you know, I've just got a taxi here and he was driving quite fast as I was late, and you know there are risks, but you know, I'm an adult. I can decide if I want him to drive a bit faster or not, you know, yes, Whereas somehow that decision has been taken from us, and women across the world have been told no, sorry, talk to the hand, you can't have hormones. That's what's this about.

20:54 That's true. Are there any women who shouldn't who would be an increased risk of a type of cancer for example? Yeah, So the only group of women that we're still uncertain of women who've had an estrogen receptor positive breast cancer. But one of the things really to add for that is that just because they've got estrogen receptors on their breast cancer doesn't mean it's been caused by estrogen, because we've got estrogen receptors on every cell in our body. But the oncologists, the cancer doctors have known for years that if we block estrogen, then the prognosis is better for some women who've had an estrogen receptor positive breast cancer. But that doesn't mean estrogen is bad. There are different types of estrogen, So what we don't know is it blocking one type of estrogen, not the Easter's dial Estrogen actually used to be a treatment for breast cancer, so we don't know. But also I see women in my clinic who have testosterone not estrogen after breast cancer because some studies have shown that's beneficial for breast cancer, but it can also help symptoms. And you know, in medicine we often don't know the answer because the study these haven't been done. No, it wouldn't be great if someone did a study for women who'd had breast cancer. I think a lot of women would want to be recruited into those studies. But we see women in our clinic who have had breast cancer, you know, twenty years ago.

22:13 They're on their knees and they say, I just want to use my brain, even if I have breast cancer again, even if I have to go through treatment again, like I've tried all these alternatives. I just want or I'm worried about osteoporosis or whatever. They make a choice and then they can that's fine. So many times they've just been told no, there's nothing in medicine that's an absolute. No, everything is individualized. Yeah. You made the point that there has been this real gender gap in science and in medical research. Is it catching up now? No? No, I don't think it is. Actually, I think we're more aware of it, which is good. I mean it was only nineteen ninety two. It might be in nineteen ninety four, depending which country that women had to be included in studies. So I started at medical school in nineteen eighty eight, so all my medical training was about studies based on men. Like it's just madness. So I'm happily prescribing blood pressure, lowing treatment statins, antidepressants tested on men, right, Whereas we've got all this great data about testosterone and men. Somehow we're not allowed to use that.

23:31 Everyone says there's not enough data. So it's like people cherry pick evidence for their own agendas often and that I think is a real shame. But often like, some of this doesn't actually need great, big studies because we're just talking about our hormones. So what we need to understand more as women and as clinicians is just how our natural hormones work in our body, and then we can join the dots a lot better, I think. Yeah, speaking of gaps in research, so many women in their forties and fifties are being diagnosed with ADHD, yeah, including myself. I was diagnosed only at the end of last year.

24:13 How do the. Does the hormonal changes of menopause exacerbate symptoms of ADHD? I mean quite apart from the fact that we didn't really know what ADHD look like within women, there is this There does seem to be an increase in the presenting symptoms. Absolutely, yeah, yeah, especially in the perimenopause as well. So we need to remember that the hormones estronel, progester and testosterone are neurosteroids, meaning that they are made in our brain and they have important functions in our brain. But they work as neurotransmitters, so chemicals that send a signal from one part of the brain to another. And we have other neurotransmitters, so serotonin, dopamine, glutamate, They all have really important functions our brain. People with ADHD often have altering levels of these neurotransmitters, but our hormones can change the levels of these neurotransmitters. So you can imagine if you've got up and down yearing of eastra dial for example, and then you have an up and down yeo year ring of all these other neurotransmitters, your brains like, oh my gosh, what's going on, right, And so that's often why we see people have worsening symptoms or new diagnosis of ADHD during perimenopause. With this time of hormone or havoc, but also women that have PMDD, you know, this big crash of hormones before their periods that can trigger symptoms sometimes ADHD like symptoms or OCD, obsessive compulsive disorder, you know,

25:43 everything that affects our brain. So it's often people don't join the dots, and medicine is very siloed. So you think you've got ADHD, you're going to see a psycholatrist who specialize in ADHD. They probably have never prescribed hormones in their lives or thought about hormones. No, you think you might be menopause. You see a guynecologists, Well, they've never done any psychiatry. They don't know, and that's the problem. Then people are having individual treatments, and we see a lot of women with ADHD who just tell us that their symptoms improve. They feel calmer, they feel easier to think and easier to sort of compartmentalize their thoughts, often when they're taking testosterone and progesterone as well. So you know, hormones work differently in different people, but testosterone can have a big effect in men and women actually when they've got ADHD.

26:34 Yeah, that's interesting to know. So testosterone is not approved for I'm from Australia and in Australia, but testosterone is approved for use in women in Australia, right, so. It's licensed in Australia. You're the only country in the world that has a female testosterone licensed for you. But having been to Australia a couple of times, women can hardly guess. They can't get it either. It's madness, right, Whereas over here, for example, in the UK, it's more of like an off what do you call it? Off license? But you know what, it's really funny, isn't it. Loads of things we do as doctors a rough LIFs. Yeah, so most drugs for when women are pregnant have never been tested on pregnant women. It's all off licenseribing children, you know, but we do it all the time. Suddenly it's a hormone and everyone just seems to be really scared.

27:19 So, for example, I went to the doctor and he prescribed like estrogen, who actually went to a couple of different ones, but anyway, so estrogen patches and then suggested the marina to get the progesterone part of it. And then it was Ah, you might want to think about testosterone. But what is it that the testosterone does then, and particularly because you just mentioned that ADHD like, what is the role that testosterone plays. So testosterone is like the other two hormones. It works on every single cell in our body. It's produced about half of it's made in our ovaries. It's also made in our adrenal glands and our brain as well. And levels, just like I say, tend to decline with age. But if if overy suddenly stop working we have them removed, we're going to have a bigger decline of our testosterone.

28:05 It's the most biologically active hormone that we have actually as women, and it's really good for mood, energy, concentration, stamina, for sleep. It helps reduce inflammation in the body, so it helps reduce muscle and joint pain. It helps with muscle strength, It helps with that sort of clarity of thought as well. But it can help with dry eyes, it can help with our skin, it can help in a positive way. With our hair. One thinks we lose hair when we're on testosterone. It affects every cell in our body. It's really really important. The problem is is that the studies have been done in men, obviously showing lots of benefits not just for symptoms but also future health, so reducing risk of heart disease, osteoporosis, diabetes, dementia.

28:51 But most of the studies and women have all been done about libido because there's some thing that people think it's all about sex with women, and so we do know that if women are on testosterone and because they've got reduced libido, they're likely to have better libido, they're likely to orgasm better, have increased sexual desire. But you know what, libido and women is not just a hormon like of course it's not, but that's where the studies have been done. So a lot of menopau miracles, I know, but so a lot of menopause society guidelines now say we can only prescribe it for something called hyposexual hypoactive sexual desire disorder, which is HSDD.

29:31 And I don't even want to share the criteria with you because they're so like barbaric. I mean, one of the criteria is that women have to be severely psychologically distressed with their reduced libido for at least six months before they fulfill that criteria, which, like I've already said, I went into medicine to help people. If you were my patient and you said, five months, I'm having a horrendous time with my partner. We're not having sex, I've got no libido, he's an alcoholic, he's beating me up. All these awful things are happening, and I just want my sex life back because it might help well. Firstly, in HSDD diagnosis it says if there's any other reason so alcohol abuse, you cannot make that diagnosis. And then it has to be six months. So I'll say to you, oh, do you know what, I'll come back in a month, and then I might talk to you about it like it's just mad. As well as you know, if men have reduced libido, they can buy some bagro over the counter.

30:30 Like it seems very clinical to make the diagnosis. And I'm not prudish about talking about sex to patients, but I shouldn't be prying into their sex life to such to try and assess how distressed they are, you know. And also I shouldn't be saying to them, do you know what if I give you testosterone, your partner's suddenly going to love you? Forever like Actually, it sounds like there are all sorts of other issues going on if this is going on. But you know, we don't do that in any other area of medicine. And also we know that it has benefits produced to study just before Christmas that was written up showing that women who took testosterone on top of taking HRT or in addition of HRT, their mood improves, their cognition improves. A lot of people I see come from very dark places. They've been under psychiatrists, many have been sectioned in the past. They've been on a LANs apine literally, and they've had ect electric and volsive therapy. They go on HRT and they feel a bit better, and then testosterone is what lights their brain, makes them so much better. And I've seen it so often it makes such a difference, So we need to be thinking about it differently as a hormone always.

31:37 This has been really interesting. Thank you so much for your time. Oh thanks for inviting me. Craby to Habit is created and produced by me Kastan. If you enjoy the show, please hit the follow button wherever you listen to ensure you never miss an episode. Share with a friend, to get me into the ease of more lovely listeners, and I would love you to leave a five star rating and review. Thank you so much for being here and I cannot wait to catch you next week for another fabulous episode of Crappy to Happy