What Every Woman Needs to Know about Hormones with Dr Louise Newson (Part 2)

0:00 I'm fifty four, so if I didn't have hormones, this is fact, my risk of heart disease would increase, my risk of heart attack, race blood pressure would increase my risk of osteoporosis, Type two diabetes, dementia, autoimmune diseases, cancer's, Parkinson's disease, nonalcoholic fatty liver disease, inflammatory bound disease. You know, the list goes on or not. The younger woman is when she's menopausal, the greater the risk of all those diseases. This is Crappita Happy and I am your host cast done. I'm a clinical and coaching psychologist. I'm mindfulness meditation teacher and of course author of the Crappita Heavy 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. She is back this week.

1:07 I am joined again by doctor Luise Newsen for Part two of Everything You Ever Wanted to Know About Hormone Therapy. In this conversation, we are talking about how to know if your hormone levels are low, whether it's dangerous to take too much and what the risks are as you heard of not replacing your declining hormones as you age now. In the time since I last spoke to Louise, I have spoken to so many women about this topic, and there genuinely still is such a lack of information out there. Many women still have no idea that there is actually a difference between hormonal contraceptives and bioidentical hormones, and far too many women, in my personal opinion, having now spoken to Luise, are simply not aware of the fact that hormone replacement is about so much more than any symptoms that you might associate with menopause, like irregular period or night sweats or brain fog. I just think that this is so important. We are so in the dark, and I truly hope that this information is of value and of benefit to you, and I hope that you will help to spread this super valuable information by sharing this episode, both of these episodes with every woman that you know.

2:23 Right here is doctor Louise Newsen. Louise, welcome back to Crapy. To Happy Oh. Thank you for having me back. I have just released our first conversation. I've had so much positive feedback already, and people shooting through their questions and their comments just feedback about the impact that you've actually had on them, the positive benefit that they have had from the work that you have done. So I will get to that a little bit later. But the first thing I wanted to ask you today was the question that I didn't have time to get in during our last conversation, and that is, is there a blood test or some kind of diagnostic test that women can take which determines, you know, their homeline levels and whether they are a candidate for HIT.

3:11 No, wouldn't that be nur well, it would be nice or not. But one of the things is is that our wholemones are changing all the time. So I've seen lots of people who have a normal blood test, but they're telling me all the symptoms they're getting and so it's not helpful. They might have had a blood test ten minutes later and it have been abnormal. Momans fluctuate. But the other thing is when we do a blood test, we're only seeing what's in the blood. We're not seeing what's in all the tissues and organs as well. People seem to be very fixated about blood tests, and you know, in medicine there's lots of things we don't do blood tests for. You know, if I was trying to diagnose migrain, I don't do a blood test for that, or brain's gonna take a really good history. So knowledge is most important.

3:59 But blood tests can be useful in clinical context. So my clinic we do do blood tests for two reasons. Firstly, it's quite useful to exclude other things, because if someone's feeling tired, could they have low iron, could they have an undirective thyroid? So we do and I'd like doing those blood tests because it gives me a picture for what's going on. And then when someone's on hormones, it can be useful as well to monitor. So as you know, when we give the hormones through the skin, the skin is a barrier. It's quite thick to get things through, so some people need different doses, so it can help guide treatment. We often do testosterone levels before starting and you know, I've never met a woman with a normal test or stone level. Yeah, especially with older women. But a low level doesn't mean that's the cause of the symptoms.

4:47 And that's where as a clinician I feel very strongly that women shouldn't be self diagnosing, self treating, because you know, I've worn't in medicine for many, many years, so I'm quite good at asking screening questions. You know, if someone had headache and they had memory problems, have they got a brain tumor? Or is it their hormones? Even if their hormone levels below they could still have a brain tumor. I mean this is quite extreme. Yeah, but I'm just trying to highlight to you what we don't want to do as doctors or educators saying, oh, yes, it's all due to your hormones. Yeah, it could be due to your hormones and something else as well, And that's why in clinical context is really important for hormone levels.

5:29 Yeah, that makes sense to me as a psychologist who you know, everything that we treat is based on presenting problem called patient describing what they're experiencing. There's no test for any of those things as well. Yeah. Yeah, And I think also one of the things which I'm sure you see in your work as well, is that women often aren't believed. The first thing as a doctor I was really taught in medicine is listen to your patients, believe them, try and understand what's going on. You might not have the right diagnosis for them, but there's something happening, and so women often know if it's related to their hormones. The problem is is that the women aren't being listened to and believed. Yeah, picking up also on what we talked about last time. We talked a lot about this idea of bio identical hormones, which are the new HT, which is very different from the old HRT. I'm curious to know are there is there still a non bio identical version of HT for example, as I mentioned last time, like I have the Marina for the progesterone that was recommended. It's the easiest, simplest, you never have to think about. It won't get periods hopefully.

6:36 So are there non identical version options? Yeah? There are, So there are synthetic versions. There are some combination tablets. So the combination patches that contain estrogen and a progesterone is a synthetic progestogen. And you know, even the pregnant horses you're in. Estrogen is still available in some countries as well. Is that right? Yeah? I know the Marina coil is synthetic progestogen to some people elect to take the natural progesterone as a tablet oral capsule or a peasany as well as having the marina coils to get the benefits of progesterone in their bodies. So most types now, certainly, all the types that I prescribe are the natural hormones. It's taken a massive shift for people to think differently, and for many years, certainly in the UK, lot of doctors have been quite cross that women have been asking for the patches or gels.

7:34 And I was out a meeting recently and a very eminent gynecologist said, we're really not happy prescribing the estrogen and progesterone separately because women might forget to take their progesterone pill at night. And I thought, firstly, this was from a woman, and firstly, like, women are not stupid. Secondly, lots of women like taking us at night because it helps them sleep. Thirdly, stop being so patronized, and yeah, I know it is, isn't it. God. Yeah, So they're saying give them the combination because it's easier for them. We'll give them a choice. So that's interesting that it is beneficial. This is interesting to me personally. It's beneficial to take progesterone in even if you've had rain coil.

8:16 Yeah, so lots of people and I was taught it as well, So I feel a bit embarrassed that I didn't know it before. I think the progesterone is just to protect the lining of the womb, but of course it's not. It's a hormone that's made in our brains, it's made in our tissues, it's made in our ovaries as well, and it's very important hormone to reduce inflammation in the body, to help our brain function, our bones strong, our cardiovascular system and so forth. And some women miss it. You know, some women feel a lot calmer when they use progesterone, They sleep better, their mood is better. So this is where it's a choice. You know. Some women say, oh, I feel great, I don't think I need another hormone, and other women say, well, I'm going to try it and see and if they feel better then they can continue with it.

8:59 And so, just like there is no blood test to determine whether you need hormones, there's also no test to say whether you're on the right dose. It really comes down to well, how how do you feel in yourself? Yeah, do thing. It can be useful to have a blood test. So say, for example, I used more than one patch, and when I started my HLT nearly ten years ago, the one patch wasn't enough. I was feeling bad. I was not really feeling much better. I was still getting night sweat, so my Easterdar level was low. So then I knew I wasn't absorbing it properly, and I tried a different patch, but it didn't stick on. I tried the gel and it literally floated off my skin. So then my consultant increased my dose. So that could be quite useful because if I see someone who's getting symptoms and their levels normal, then I think, well, is there something else that's causing their symptoms. So that's why it's useful as a guide really, but the easter of DOAR levels and testosterone levels progesterone can be harder to monitor, so we often don't do progesterone levels.

9:58 Yeah, you know, after I ask conversation in particularly as I listened to it bag, I was thinking that when I was about maybe I don't forty five forty seven or something. I remember getting online and ordering these like hormone Happy hormone, I don't remember the brand name, but some kind of supplement that was meant to support me through perimenopause. And I know that a lot of women. I was thinking, gosh, so many women were all about these supplements because they're natural. And there's this mindset that natural is better than using a drug, which just now I haven't talked to you, seems insane. Is insane, isn't it? Because you can argue, like, how do you define natural? What does it mean? Because anything, whether it's a supplement or a prescription that I prescribe, it's still been may hasn't it. It's the only natural thing is if you're eating plants that are you know, or herbs, if you see what I mean. Yeah, And so then people get very concerned that somehow, because it's on a prescription, yes, it's not natural, Whereas there's lots of things in a health food shop that I would never touch or maybe not need. And there's lots of things that I've prescribed that are not nearly so natural as the hormones that I prescribe. And so we also need to think, like I've just said in the past, the estrogen was made from pregnant horses urine. Now, pregnant horses urine is natural, but it's not natural for the us as humans to have Do you see what I do?

11:26 And they are plants in my garden that are natural, I wouldn't want to have them, do you know what I mean? Yeah? So then what we need to be thinking of, well, what is you know, what's happening in our bodies, what our hormone levels are reducing. So it's more natural to just top up those hormones than to take something else. And people might need to take vitamins or supplements to help the way their hormones are metabolized, or to help our bone strength or our heart function, but we shouldn't be taking them instead of And that's the problem. It's the marketing of them that is exactly very misleading. And the problem is is that you know, women are let down by medicine. Often they're let down by doctors saying you don't need or you can't have hormones.

12:09 So they're desperate for help. And these people often have a lot of marketing budgets so they look great. Some of them are the most beautiful packaging and you sort of think, oh, maybe maybe I'll feel better. So I understand why people take them, but we have to be thinking about the evidence and what there is. Yeah, and I think you know, when there was that mindset which still persists. I know that it was dangerous and that it caused breast cancer. That's when women were scared off of PHRT and therefore looking for these supplements as well. And I'm always curious to know, like whether there is a role for them even alongside. Yeah. So no, I did a YouTube recently about supplements. I kept it quite basic, but you know, as a rut of if they it's got the word menopause on the label, then don't take it, really, yeah, because it'll be a marketing thing. So now I take some supplements, but it's for my future health, not because I'm menopausal.

13:05 Good note, say's menopause. It's probably overprized and it's much skin Yeah. Yeah, yeah. Is there any risk and given that there's my blood test, is there a risk of taking too much of something? Is there a consequence of having too much estrogen or too much progesterone for example, if. We're giving our natural hormones, then not really, Just to sort of compare rely, you know, the levels that we work for usually in the clinic of between two hundred and fifty and one thousand. When women are pregnant, the levels about fifty five thousand. It's a massive difference, massive difference. We're also talking about natural hormones. People sometimes get confused because with the contraceptive pill, for example, when it was first launch in the sixties, the doses were very high and it caused all sorts of side effects and problems and health problems as well, and the dose was lowered.

13:57 But that's a chemical. It's been synthetically all. You know. People worry, you know what about if you have too much incident, of course, it can cause problems. We're not giving mega doses. If you compare the doses that we give compared to say, the synthetic hormoson contraception, it's significantly lower. Even the higher off label doses are still lower than contraceptional and they're natural, so you know. But also when we give higher doses, it's because we want to get it through the skin. We're not giving it as an intravenous infusion to get higher levels in the body. Right And also you know, I've done levels of women who aren't on hormones who are perimenopausal, and their levels of esta dial are like four or five thousand just because their bodies like doing all this yeo yo ing. So we don't know what the best level is for each person because we we're all different. Yeah, but no, we're not giving mega doses, so it's be very unlikely. The big problem is a lot of women aren't having enough or they're not having any. Yeah, most women globally are having no hormones at all.

15:05 Which leads me to what's the consequence of not having hormoness. A great question because I think we need to be thinking about this more late for years. What if we have hormones? What about the breast cancer? What about what about Actually, let's think, so I'm fifty four, if I am clearly menopausal. So if I didn't have hormones, this is fact. You know, my risk of heart disease would increase, my risk of heart attack, race blood pressure would increase my risk of osteoporosis, type two diabetes, dementia, autoimmune diseases, cancers, Parkinson's disease, non alcoholic fatty liver disease, inflammatory bound disease. You know, the list goes on and on, because my body would go from being a sort of hopefully neutral anti inflammatory state to pro inflammatory. Now, of course I can mitigate some of those risks by nutrition and exercise and maybe the odd supplement, but it's still goes to be switched on because we need those hormones to help our immune sales to work well. So we know that we've known it for many, many years. You know, the younger woman is when she's menopause, all the greater the risk of all those diseases, but also mental health. You know, there's a risk of increased risk of depression, increased risk of psychosis, increase risk of drug addiction. Wow, a lot of people turn to alcohol and drugs. So we can't just be thinking about diseases. But also it's increased risks.

16:31 You know, you'd lose your job. I wouldn't be able to work as a doctor if I wasn't taking hormones. I just wasn't safe to practice without memory and people do you know we know at least ten percent of women give up their jobs. Wow, and give up their relationships as well. Wow. So you know that's where some people will be fine, and we've all met them, and some of them are very vocal on social media to say people are fine, I'm fine, look at me. Yeah that's fine, Yes you are. But I see and I hear from thousands of women as you do, who aren't fine and they're struggling and they want hormones, which are first line treatment in all guideline. Yeah. I think that is such important information for women to hear and understand that risk of not taking it, because that's not out there at all.

17:19 No, it's not because we've been sidelined, we've been gas lit, we've been you know, misrepresented, and it's you know, I don't care whether I know I should care more, but I don't care whether women take hormones or not. I don't care whether they exercise or not. You know, this morning, I really wanted a bit of a lion because I went to bed filty late last night. But I got up, I did yoga before I you know, had a shower, and I do it most mornings, you know, But it's my choice. I don't care just to spread if you exercise or not. But I think you should know that exercising is really good for your physical and mental health, and if you don't do it, that's fine. Your physical and mental health might be okay, but it also might not be. And that's all this is about hormones. But it becomes very podomized and a bit toxic, and I don't really know why, to be honest.

18:05 Yeah, getting back to the synthetic hormones. Yeah, So the other thing that occurred to me was that young women as soon as they get their periods, if they're having heavy periods, they're having I don't know, skin problems, all sorts of issues. Typically they have been prescribed the pill. Yeah, to. Even things out, smooth things out, reduce these symptoms. Given what I know. Given, it makes you think, doesn't it It does, Yeah. It really does. So outside of menopause and perimenopause, is there a role that these hormones, these bioidentical hormones should be playing with these younger women. Isn't it danger that we're putting all these young women.

18:47 In there's a danger or there is, because it's well reported that there are risks with the synthetic contraceptives. Don't get me wrong, and they're good as contraception. We know that they're effective because they stop ovulation. But let's think two things. Really, if you stop ovulation, you're stopping your own hormones, aren't you. You're giving yourself a chemical menopause because those own hormones will go because you're not having ovulation, right, So the contraceptors will stop your own hormones working. But they're also they're chemicals. They've been chemically altered, so they're not going to have the effects of beneficial effects to our health in the same way. And we know that because there are risks, and they're small risks, but they're still there. So we know the contraceptors have a risk of clot and stroke and heart attacks and breast cancer, but it's small. But that's where I feel that we should be educating people. You know, I've got three daughters, and my oldest daughter takes hormones, but she takes natural hormones because she has PMDD, so she has a drop in her mood before her periods, so she has transdermally stera dial. She has, you know, natural hormones and natural progesterone, and that's fine because it's her choice. She uses different type of contraception, but somehow it's like it's not just for contraception that you know, contraception is given. And I did a podcast with my twenty year old daughter Sophie talking about it, and she's saying, yeah, I mean people just got on birth control to control their hormones, but

20:19 often then they feel really flat and joy us and then they're given antidepressants, and then they put on weight and then they're not exercising. And you know, we know there's a mental health crisis out there, and how much is related to women being having this sort of chemical menopause from their contraceptives. Yeah, No, one's really thinking about it in the same way. If we can't get a lot of gps out there to be willing to prescribe bio identical hormones for women in menopause, how likely are we to get them to prescribe and for younger women for PMDD. Yeah, it's really hard. I've got a patient who's twenty six and she's had really bad PMDD for many years.

20:59 She's house band for three days a month because she has really dark, deep thoughts. She can't go to work, and she'd tried different contraceptives, it hadn't worked for her. She was even given a lanzapine by a psychiatrist, which is heavy duty medication, and that made her feel dreadful. She was too scared to tell the psychiatrist she'd stop, but she did. And anyway, I saw her and I just gave us some progesterone, some natural body identical progesterone, just for those three or four days a month. And she came back after three months and said, wow, I didn't even know it was legal to feel this good. And she said, I've gone back to work, you know, I feel great. So I said, oh, can you get it from your GP now, because you don't really want to come and pay for it for me? And she said now. I went to my GP and they said, no, we can't, but we can give you an other synthetic hormones.

21:48 And that's really sad because this isn't expensive medicine. It's very simplistic medicine actually, and it's transforming her life. And it makes sense because all I'm doing is topping up you know that graph where the gesture and goes down. So but when I've spoken to some of my friends, I was speaking to a GP colleague last week, telling him about the synthetic and he was like, oh, Louis, you've lost me. Now I don't understand, and I'm like, well, it's not difficult. My fourteen year old understands. You know. It's basic chemistry really, but it's it's hard because you know, once you told something, it must be hard. When they realized the earth was round and kind of convert people, you know, and it feels a bit like that. Yeah, yeah, yeah, I just want to quickly share with you.

22:30 So a friend of mine who is also Australian, but she lives in London, so she listens to your podcast. You know, she's seen your information. So she twigged that her issues were probably to do with hormae. She was having anxiety, she was having panic attacks that she'd never had before, and so she sort, I'll go back and see my GP in Australia because you know, she's more comfortable with her own medical kind of system. And she saw the GP and said she asked specifically for estradele and the natural progester, and the GP said no, that she would be putting her. She recommended that she would go on to some anti anxiety medication or some SSRI or something. So my friend stood her ground and said, no, I really want to take the hormones. And so then the GP said, I'm going to put you on the pill.

23:17 I don't know why, but so to her credit, she stood her ground and eventually the GP prescribed what she asked for. And she said, to me, the most infuriating thing was while the GP's like tapping away at the prescription, she happened to say in passing, oh this is what I'm on. Oh no, the GP said, this is what I'm on. So why couldn't she give it? But for some. Reason went through all of this rigmarole before she would prescribe it for my friend anyway, I'm conscious of the time. But she had some other questions actual because she said she was told she got the eustrade. But she said she was told because she has anxiety, that she should take continuous progester and she should take it all through the month, or as some women are told to take it half the month, and she was told to take it until two days before her period. But her periods aren't that regular, so she's all confused about well, hell, and so she was wanting to know, like, yeah, it should she be taking it all month? Is there a risk if she doesn't stop it two days before her period.

24:13 No, so when we start HRT if people are still having their periods. We often recommend the progesterone for two out of four weeks, just because the womb can respond to changing hormone levels, and when people are perimenopause or they've got their endogenous their internal hormones as well, so it just makes it's just easier. So hopefully bleeding becomes more regular when people take it for two out of four weeks, but quite quickly. I usually convert people to one at night for two reasons. Firstly, because most of us don't really want to have periods. There's a few women that like periods, but most of us just go, do you know what. The sooner they go, the better. But secondly, our body is like everything the same, and a lot of women say they, you know, they feel different on the two weeks on and two weeks off, and it's harder to remember, So just taking one at night is easier. So often people then change after a few months. If then they get troublesome bleeding, then I'll say we'll go back to the two out of you know, four weeks for a few more months. Until your own bodies hormones sort of calm down a bit, and then you might find it easier. So there isn't any sort of big scientific reason why they can't have why women can't have one every night?

25:24 Right, good to know. Yeah, and she thanks you for your work. Thank you. And the other question that I got from somebody that I know was in normal cycles menstrual cycles, women who experience PMSPMDD for example, it's often cyclical, like a certain times of the month with perimenopause and the symptoms we experience with that. Is there any cycle called nature to that or is it just pretty much completely Yes, that's what I thought. But some people have had PMDD. You know, the symptoms are very similar, and they do often get worse before a peer, but periods can be quite chaostic, or they might not be happening. So often people find their symptoms are worse and last for longer. But they're very similar in nature. But you know a lot of people, doctors and women spend a lot of time thinking is it PMDD, is it perimenopause? What is it like? It doesn't matter the label. The thing is it's related to changing hormones and having those hormones back at the right dose and type can make a big difference.

26:26 And last question, what advice do you have for women who, like my friend, get resistance from a GP. When they go in, they know what they want, they ask for it. How do you suggest that they advocate for themselves. I think if it's really you're not winning, just go and see someone else, because I think it's so hard. But the other thing is thinking about saying to the doctor they are risks in my future house of me not having these hormones, and I'm a patient advocating for myself. Can you just maybe document why you're refusing or maybe write down the reasons for your refuse because all guidelines in the UK globally say that hormones should be given first line, So I would just sort of spin it and say, you know, could you just explain to me the reason. So now, if your friend's being given or offered an antidepressant, there are risks with antidepressants, so you know it's it's difficult, but I think just maybe challenge a little bit in a nice way. If you're not getting anywhere, just don't waste that person's the time and go and see someone else.

27:26 Yeah, Louise, I really appreciate the work that you have done. You've educated me, You've educated so many people. The feedback is obviously it's phenomenal, and I know you get pushed back and you get some criticism from certain corners, but I really appreciate that you continue to do the work that you do. Oh, thank you very much. Thank you. Crabby to Haby is created and produced by me Castan. 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 ears of more lovely listeners, and I would love you 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