Speaker 2: 0:30

Welcome to the Sunflower Conversations. My name is Chantal and today I'm absolutely delighted to be joined by Dr Louise Newson, who is a GP and menopause specialist. Louise and her team at Newson Health are at the forefront of advocating for women to get the appropriate treatment to support their hormone health, as well as investing in research and training to help healthcare practitioners make the best decisions for their patients, which is crucial. So welcome, Louise. Thanks for joining us.

Speaker 1: 1:03

Thank you for inviting me. It's a great privilege and honour to be here actually. Oh, brilliant Well.

Speaker 2: 1:08

I was having a little perusal of Instagram because obviously it's been Menopause Awareness Month last month, so there's been soopause awareness month last month, so there's been so much out there, which is great, there's lots of noise. But one thing I I saw which kind of it made me laugh but also was like oh, um, it was a post and it's kind of taken from a spoof of the dictionary menopause and the um description that's written underneath is derived from the latin root for w, w, t, f. What the f is happening to me?

Speaker 2: 1:44

The time of life where a woman doesn't know if she is coming or going on fire or freezing, happy or sad, wants to diet or eat everything in sight. Common phrases used during this time include muffin top, hot flash, mood swing, brain fog. Women in menopause may self-medicate with wine, chocolate, vodka, ice cream, carbs, new shoes, online purchases, netflix or by looking at pictures of sam elliott. I did not know who that was so I did have have to Google him, but yeah, I thought, wow, that kind of does speak to a lot of women, I'm sure. Yeah, so can you? Let's start off by explaining what's perimenopause, what is the menopause and what? What changes are occurring in the body to women at this time?

Speaker 1: 2:30

Really important questions for everybody to understand, not just women. Actually, if we break down the word properly menopause meno is the menstrual cycle and pause is stop. And what's very annoying in my mind about the whole menopause conversation is that menopause has to be officially diagnosed when you've had a year without your period. Now there's nothing else in medicine. I have to wait a year before I make a diagnosis. But also a lot of women don't have periods and also a lot of women don't want to be defined by their periods. So then other people think well, it's due to loss of fertility. But it's not always, and actually a lot of people don't want to be defined about their fertile status as well, or identified whether they can be fertile or not. So what we need to then think about, what is it? What happens in our bodies? Now, it's something that happens to everybody and it can happen at different times and different ages. My youngest patient was 12 when she was menopausal because her ovaries didn't develop. My oldest patient, who I've seen in the clinic, is 94. So once a woman is menopausal, she'll be menopausal forever. And what happens is our ovaries either absent, because they might've been removed, damaged, for example, in a with some treatments like chemotherapy or radiotherapy, or they don't. The eggs just run out. We've only born with a finite number of eggs. But it's not about the eggs, it's about the hormones associated with this us. So when our ovaries don't work as well, they don't produce as much hormones. And these hormones are really important. They do help regulate our periods and they do help with fertility, but they do far more. They go into our bloodstream and they affect every single cell in our body. They have biologically active processes in our brains and our muscles, in our heart, in our skin, everywhere they have have really important functions, and these are three main hormones oestrogen, progesterone and testosterone. And this is the problem in that the levels are low and they stay low forever.

Speaker 1: 4:26

In the menopause, now in the perimenopause peri is just a medical term, meaning for around the time of. So what happens for most women not women who have their ovaries removed, but most women the ovaries gradually decline in function and this gradual decline can sometimes take many years, even a decade, and many women who experience perimenopausal symptoms, which are the same as menopausal symptoms, will find that they have some days or weeks or months or even minutes where they feel fine and others where they get an uncontrollable rage or they're tearful or they have joint pains or they have headaches or palpitations. And this is the fluctuating hormones that occur. So they don't just decline sort of gradually, they actually do in a very yo-yo up and down way, and so sometimes people have high levels, sometimes they'll have low levels, and it's this chaos that's occurring with the hormone levels that actually can trigger more symptoms. So a lot of people find that the symptoms of the perimenopause can be more stressful and cause more impact actually physically and mentally, than the menopause.

Speaker 1: 5:36

But it's more than that and that's depressing as well, I know. But when we have low hormones because they're biologically active in our body, we have increased inflammation in our body, which increases the risk of diseases, and they're important diseases like cardiovascular disease, so heart disease and strokes, osteoporosis, type 2, 2 diabetes, dementia, clinical depression, because our hormones work all over our body and for many years the menopause has just been just put up with it. It's okay, it's a natural thing, we all going to have it, have it. When menopause and women have been a bus of jokes, it's always been about flushes and sweats. But we need to take a step further and think we're living longer now because of advances in medicine. Yes, you could argue that it's a natural process, but being in pain in childbirth is natural. Having raised blood pressure as we get older is natural, but we don't ignore these things, and so we shouldn't be ignoring that. We've got a treatment that's available that only the minority of women are receiving, so that that's um.

Speaker 2: 6:36

Obviously significant is the biological. You use that word by biological impact. So what can you talk me through? Some of the um, some of the reports your patients come to you with, like you know what is the implications of these hormones lowering and the fluctuations?

Speaker 1: 6:56

yeah, so everybody's different. We're all individual and so everybody's experience is different as well. And the most important thing, I think, for people listening really is to know that you don't have to compare yourself with others. You need to think about what is what's happening to you and what's what symptoms are you experiencing that are having an impact on your life? A lot of women we speak to say, well, I'm not too bad, because I'm not as bad as my friend or my sister or my auntie, but I still can't sleep or I'm not functioning very well at work. But actually it's about you as an individual, so that's important.

Speaker 1: 7:30

Um, now, most women so 98 of women we see in our clinic have psychological symptoms, and these are symptoms such as low. They are not just hormones, but they're chemicals in our brain that light up our brain and have really important functions in our brain. And for many women not all, but many women find it very difficult for their brain to function when they haven't got the right hormones, and then it can also trigger migraines, headaches, palpitations, muscle and joint pains. Um, some people find their skin becomes very dry and and itchy there's some people find that they have dry eyes, dry mouth, burning mouth, tinnitus.

Speaker 1: 8:24

You know the list goes on and on um, flushes and sweats are there, um and um that can really affect people, um, but they're not the main symptoms that are really affecting people. And then there's also other symptoms that are more local symptoms, if you like, that affect the vagina, the vulva, the surrounding areas, and that's not just causing painful sex. Actually, a lot of women we see find it very hard to wear underclothes because of the discomfort or sitting down, find that really quite painful. Discomfort or sitting down find that really quite painful. Um, and if they've got a desk job, for example, then yeah, how do you say to your line manager oh, it's really uncomfortable, it's quite a hard conversation but very intimate as well, isn't it?

Speaker 2: 9:05

and personal it's very difficult to share that with anybody, apart from, maybe, your loved one well, that's right.

Speaker 1: 9:10

But also urinary symptoms are very common. So a lot of women get urinary tract infections, but also some people get increased frequency of needing to pass urine or a bit of incontinence. They might leak a bit if they cough or sneeze or run, but it's so normalized in a conversation that people think, well, that's just what, what's going to happen because I'm older.

Speaker 2: 9:29

And it's not.

Speaker 1: 9:30

They're usually related to low hormone levels.

Speaker 2: 9:36

Not, they're usually related to low hormone levels. I mean, I can know from my own experience and it's interesting you say about these fluctuations because that is definitely how it's felt for me. So almost it's been difficult to put a pin in it and say this is what's happening to me and maybe it's the perimenopause, because that's happened for some time and then that stopped and something else has happened. But, um, the frequent urination during the, the night has definitely been something and then obviously that has an impact on your sleep and then how you're functioning the next day. You are listening to the sunflower conversations with chantal. To learn more about the sunflower, visit our website. Details are in the show notes. This drop in in these hormone levels, I mean it must presumably have an impact on women's lives, home life, social, you know, socially at work.

Speaker 1: 10:27

I did read that I think was 900 000 women have kind of left work because of their menopause symptoms yeah, we know around 10% of women give up their jobs because of the direct cause of, you know, those symptoms of the menopause and the main symptoms are anxiety, memory problems and fatigue actually. But we also know from some of the research that we've done that people really struggle to perform their job properly. A lot more women go part-time, a lot of women take time off a sick leave and often it's quite for long periods of time. You know a significant proportion a study we did about 25 percent of women have taken at least eight weeks off work and that really is quite disruptive. You can sort of shoulder a colleague if they're away for a week or two, but eight weeks is a lot. But it also a lot of people.

Speaker 1: 11:20

We did an NHS survey of over a thousand people working in the NHS and 37% of women wanted to change their hours but couldn't afford to.

Speaker 1: 11:30

And I get that.

Speaker 1: 11:31

No one wants to reduce their hours and have less pay and less status and so forth, but but actually if you're going to work and you're wanting to reduce your hours, you're not going to be doing the same job, you're not going to be giving it all, and you know.

Speaker 1: 11:42

And so there's a lot of unspoken problems in workplace because it's firstly, women don't realize often that they're perimenopausal, so they'll put it down to stresses or put it down to a job change, maybe a new boss, maybe changing hours or maybe something going on at home, so they won't realize it's related to their hormones, the way they're feeling, but also when they do. It can be quite difficult, as you say, to bring up in a conversation at work. But, most importantly for me as a doctor, these women are unable to receive the treatment that they should have for their perimenopause and menopause, and if more women had treatment there'd be less suffering and less of this conversation, because women would be able to work, but it'd also be feeling better and be more productive and be more healthier as well yeah, there is, there is.

Speaker 2: 12:33

it seems like there's such a simple fix to this crisis period that can occur for many women and then presumably that obviously that has an impact on their home life, not just at work breakdown of marriages, relationships with friends, etc. Children.

Speaker 1: 12:54

Yeah, I mean we see a lot of women in our clinic who sadly they've left their partners and they said I didn't want to, I still love them, but I'm just not the same person.

Speaker 1: 13:05

Relationships with, with family members, with colleagues, with friends, has been really affected. And and we do know from some studies that domestic violence increases during the perimenopause and menopause and it's no surprise when you think about the symptoms and you think about the feelings a lot of women have of low self-esteem, reduced self-worth, and you know there's lots of issues there as well. And I also, you know I've got three children and I know when I was perimenopausal I didn't have the same motivation to walk in the park and, you know, cook properly for the children and just enjoy having them around, because I constantly felt tired and irritable. So of course you're going to just put the telly on and not play a board game, or you're not going to be as interested in what they're doing for the homework or whatever. So women are, women are not meaning to, but their children are silently suffering as well.

Speaker 2: 13:55

Often yeah, I mean, you can basically slowly retreat from life, can't you? Of course you can, and the joy of life.

Speaker 1: 14:04

Yeah, yeah, and you're absolutely right. And I think we talk often about libido, especially when we think about testosterone, a really important hormone. But if we think about how Freud defined libido, it's not just about a sexual pleasure, it is about the joy of life, and that's quite hard to measure and that's why it's not really been done well in studies. But it is lots of women, when they come back to the clinic and they're on treatment, they say you know, dr Newsom, I look out the window and the sun's shining and I feel happy. Or my children, children have said to me gosh, mummy, I didn't know you could sing. I heard you singing in the shower, or I'm seeing your teeth more because you're smiling.

Speaker 2: 14:41

That's a really interesting one, isn't it? Yeah, yeah, turn that frown upside down. But yes, actually, teeth it does affect your teeth as well, doesn't it? It does, and your gums, yeah. So what will happen then? What would the benefit of taking? Can we go through oestrogen progesterone and testosterone? Because I think that people tend to think that testosterone is something that men have and maybe don't even appreciate that it's in a woman's body that men have and maybe don't even appreciate that it's in a woman's body. Um progesterone, I always kind of relate to um contraception. Yeah, yeah, it is and it's.

Speaker 1: 15:19

It's very interesting actually and it's great you've asked. So these hormones are really important in our body. I said they've had a lot. They have lots of really important biological actions and and they actually work. They help the way our cells work and all our cells work to maintain our metabolism, our growth, everything that we do. So they all have their own roles, if you like.

Speaker 1: 15:41

Now oestrogen is the one we all know is the female hormone and is very important. The best way of having oestrogen as HRT is through the skin, actually as a patch or gel, so it goes straight into the bloodstream and we prescribe the body identical oestrogen, so the same oestrogen as we produce when we're younger. Now, progesterone, again, is very important. It's very anti-inflammatory hormone. It's very good in our brains and our muscles and our joints and our bones and so forth, and and when we prescribe HRT, we always have to give a type of progesterone to protect the lining of the womb and a lot of people say that's the only reason you need progesterone, but actually a lot of women find they benefit from progesterone for all the other reasons as well, and the best progesterone is the body.

Speaker 1: 16:26

Identical ones are the same structure, like I say, say as the hormone progesterone we produce when we're younger. A lot of people say well, I can't take progesterone because I was on the pill and it really didn't suit me. Or the progestogen only pill, or the implant is progesterone as well. But these are all synthetic so they've been chemically modified so they don't stimulate the receptors. In the same way, they don't have the same beneficial biological processes that occur when we take them and they can cause more side effects and actually small risks as well. So it's a lot better to always have the natural hormones. The progesterone.

Speaker 2: 17:02

We are able to create natural progesterone.

Speaker 1: 17:06

Yeah, so there's something called micronized progesterone in the UK it's called eutrogestan, which is a capsule that's taken orally, or sometimes it can be used vaginally as well, but it's the pure progesterone. Whereas any other type is, is this synthetic progesterone? So it's been just modified a little bit so they work differently in the body and they have different side effects and effects as well. And then testosterone is really interesting actually, because it's the most biologically active hormone we have. When we're younger, in our 20s and teens, we actually produce more testosterone than oestrogen and the levels just decline as we age. So it's not really a menopause hormone, it's just a sort of age related hormone and a lot of testosterone is produced in our ovaries. And that's why, when women have, lot of testosterone is produced in our ovaries and that's why when women have a surgical menopause and their ovaries remove, their testosterone goes very quickly. But actually other areas of our body produce testosterone, including our brain actually, and also our brain produces oestrogen and progesterone as well, showing how important it is in our bodies. So it's not just about from our ovaries, but testosterone is very anti-inflammatory, it works all over our bodies and it also works as a neurotransmitter, so we can give all the oestrogen and progesterone we like, but if someone's lacking testosterone and often those symptoms are low mood, anxiety, really feeling quite sluggish, haven't got that stamina, that joy of living like you describe isn't really there.

Speaker 1: 18:35

So much Sleep can be affected, muscle and joint pains with low testosterone. And we also know that testosterone helps build bone as well. So it's good when we're thinking about reducing osteoporosis. But a lot of people find that their muscle strength goes. They have something called sarcopenia, which is loss of muscle mass, and there's lots of reasons why that can occur. But low testosterone can cause that as well. So a lot of people find when they use testosterone and just a normal female doses, that their ability to exercise is better, their ability to have more stamina improves, but also to be able to build more muscle tone. And that's really important when we think about our long term health, because a lot of what we're trying to do in medicine is to reduce disease. But also this whole healthy aging is really important. It's not the age we die, it's our journey to that age, and what we want to do is keep people healthy, to reduce risk of diseases, improve their well-being and keep them physically and mentally strong as well.

Speaker 2: 19:39

And so all these hormones are very beneficial for that as well I'm just thinking because I do reformer palaces and I've done it for years. Yeah, I, you know, I and I'm not saying I'm brilliant at it because I'm still not, I only go once a week, but one of the there's one particular exercise which is with the arms, where you have to pull your, pull the thing back and forth and for reformer pilates for people that don't know is kind of like a resistance based um workout on on a bed and google it. It's quite interesting to look at. And this exercise that I've been doing for ages, I've noticed in the last like couple of years that I'm finding it's so difficult. And it's not, it's not a heavier resistance, it's the same one and but that must be due to the testosterone, I guess, and my muscle um density starting to deplete yeah, absolutely, and um, it can be and it can make a big difference.

Speaker 1: 20:38

We see lots of women who are performance athletes or they just exercise a lot and say, look, nothing's changed, but my, uh, my performance time isn't as good, my, my recovery isn't as quick, I just. And a lot of it is related and we know it's related because when we rebalance the hormones with you know the right dose and type of estrogen and often testosterone and progesterone, they feel better. Nothing else has changed. So we know it and there are increasingly, we're realizing there are a lot of women who are more testosterone deficient than estrogen deficient. So there's no point just giving estrogen and progesterone because you're missing out on another important hormone.

Speaker 2: 21:20

So is that something that you would generally advise, that, if you're going to start on hormone replacement therapy, that you actually go for the three of them?

Speaker 1: 21:29

It depends. Everything's very individual, so having individualized consultations with someone who understands is really important. And one of the problems is is there's no easy test, and this often. We all like numbers. We like to know, you know, what are our hormones doing?

Speaker 1: 21:45

Can I just have a quick blood test or saliva test. And you can't actually, because especially in the perimenopause, as I've said, our hormone levels fluctuate. So you might have a blood test at a time when your levels are high or normal, but just at that time and there will be other times, of course your hormones will be low. But how do you know how to capture them and do the blood test? And even the fingerprint ones you can do at home are just not reliable when it comes to measuring oestrogen levels. Testosterone level you can measure the level, but a low level doesn't always mean that that's causing your symptoms. So it's not as easy as just do a blood test, show it's low and let's just take some testosterone.

Speaker 1: 22:22

And often the beauty of the hormones that we can prescribe, both privately and in the NHS, is that we give them individually. So if I think someone wants more oestrogen, I can increase that without increasing the progesterone. If they need a slightly more testosterone or slightly less testosterone, we can tailor it. And that's really important because in the perimenopause the dose that we start people on is often different with time, as well as their own hormones decline. So having a constant review with someone who understands is important, and we do often do blood tests when we're reviewing patients as well, just to see whether they're absorbing the hormone properly, how it's in line with their symptoms and, obviously, looking at that, their everything else their well-being, their exercise and nutrition.

Speaker 2: 23:08

It's all working together which is really important yeah, and it's important that we mention that about the exercise and nutrition. It's not just take the hormones and no, that's exactly right and it's.

Speaker 1: 23:20

It's very important because there's a lot of a debate as, oh, it's just HRT or nothing, and actually this isn't. Hrt is part of the treatment. Obviously, hrt with testosterone is replacing the missing hormones, but whether we take HRT or not, whether we take testosterone or not, we all need to be thinking about our nutrition and our exercise and everything else as well. But we can't eat our way out of the menopause or exercise our way out of, you know, our low hormones. And that's one of the problems is many people think well, I'm not going to take HRT because I'm worried about the perceived risks, but if I improve my diet or if I do this exercise, then I'll feel better. And often they won't, because the symptoms are due to the low hormones.

Speaker 2: 24:05

So they might improve.

Speaker 1: 24:07

You know their muscle tone. They might improve. You know their well being, but they're not going to necessarily. They might improve. You know their muscle tone. They might improve. You know their well-being, but they're not going to necessarily. They might improve a little bit. Some people say you know, if I exercise I don't get as many sweats or flushes or I sleep better. Of course, but you're not treating the underlying cause, and that's where we need to be thinking about hormones, which are very safe and have far more benefits than risks safe and have far more benefits than risks.

Speaker 2: 24:33

Yeah, I mean that's. That's always the worry, isn't it? I think, for anybody taking any um medication of any type. Um, you know you, if you look at the um side effects, you go to the side effects and whatever it is, in fact, even probably with a paracetamol, but I'm not actually going to take that. You know, I'm really concerned and worried. So has uh, newston Health has been investing in lots of research and what you know. What have you, what sort of have you discovered to sort of put people's minds at rest?

Speaker 1: 25:02

yeah. So there's a few things we know we we've. I fund a small research team. We don't do any paid work with any pharmaceutical companies or have any vested interest. Just to be really clear to people yes um, so, and that's really important.

Speaker 1: 25:15

So, but what we have also been doing is looking objectively at the evidence and that's really important, and I'm picking some of this um, scaremongering. That's happened for 20 years actually, and what we do know is that HRT is very safe. The study that showed this increased risk of breast cancer used older types of HRT that are synthetic, that we don't usually prescribe, and even if you look at the worst interpretation of this study, this increased risk of breast cancer wasn't statistically significant, and oestrogen on its own was shown to have a 23% lower risk of breast cancer and a 40% lower risk of death from breast cancer, which is really important for people to know, because we've always thought, oh, oestrogen equals breast cancer and it doesn't, because it's very anti-inflammatory. But we've also know that taking any type of HRT reduces the risk of all the diseases that I mentioned and improves quality of life, of course, so that's really important. Also, we've been looking at our patients on testosterone and looking at symptoms other than improved libido.

Speaker 1: 26:23

So, like I said before, the anxiety, the low mood, the poor sleep, and we've shown that those improvements are actually more statistically significant than the libido improvements, which is no surprise, but we've got big numbers of data and then we're also looking at doses of HRT, because using the skin to get the estrogen through is good, but the skin is still a barrier and we know from from some very small studies, in fact, the studies where the dose of HRT was was licensed and that there is a real variety of variability of absorption, and so our data we've got big numbers because we've got so many patients is showing that women do really vary with the way that they absorb, so therefore the dose that they need, and this is really important.

Speaker 1: 27:11

So we're writing all that up to put it for publication so we can share with others, because learning from our clinical experience and learning through our patients is really crucial to get the agenda forwards and also show that we're improving symptoms for women, as well, a lot of people have reached out to us to say you need to talk about chemical menopause, surgical menopause, it's.

Speaker 2: 27:53

You know this is huge and you know we need some support as well, and so I wonder if you could just quickly just explain for our, our audience, what that is.

Speaker 1: 28:06

Absolutely so. Chemical menopause basically means, obviously menopause has been caused literally by chemicals, but it's usually by drugs. Now, when you're looking at it in context with PMDD, which is a severe form of PMS, some women, especially their brains, are very sensitive to changing hormone levels. So quite a few of us will have known the day or two before our periods we just feel a bit flat, not quite right, and period comes in. Oh good, I feel a bit better now. But actually for women with PMDD, these symptoms can be really awful and have very, very dark thoughts, very low mood, and so one of the treatments is to stop the ovaries working. So then, if you don't have your ovaries working, of course you have no fluctuation in hormones. So theoretically you think, well, people will feel better. But I've already said, you can get symptoms when you don't have hormones and there are health risks as well.

Speaker 1: 28:59

And they do give an injection of something that stops the hormones in our brain that sort of have a feedback with our ovaries. They stop them working to induce the menopause. But actually actually a lot of women still need add back hormones. So we often give what's called add back HRT, but at a constant level. So rather than these women having fluctuating levels, you just give back a low dose of the hormones they need, often a combination, but sometimes just one of them oestrogen, progesterone, testosterone and and add that back and then women get the benefits of hormones without the fluctuations.

Speaker 1: 29:38

Now, women with pms and pmdd have been neglected for centuries. It's the same in almost the menopause where people say, oh, it's just normal to feel a bit rubbish before your period, but it's not actually because these women, even if they only have symptoms for two or three days a month, there's 12 months in a year, so that's nearly a month a year that they're out of action and often not working and not able to talk about it, because people say it's just your periods, that everyone gets periods yeah but actually it's a hormonal problem and we see a lot of women in the clinic who have had a history of PMS and PMDD.

Speaker 1: 30:12

They're perimenopause. They really struggle because they're so sensitive to hormonal changes. When we give them hormones they say I wish I'd started this 10, 20, 30 years ago. So increasingly we do see women with PMS and PMDD in the clinic because it's just a variation of a hormonal problem. And when you look at the guidelines they do mention hormones. They also mention antidepressants and various other treatments. But in medicine we should treat the underlying cause. So I always feel let's just try hormones first and these are the natural hormones, not the synthetic hormones, because some people with PMDD are put on the pill and they feel worse because it's synthetic hormones. So it's really important that it's not normalised, that it's actually treated with someone who really understands what it means.

Speaker 2: 31:00

Thank you. Thank you for explaining that. So NICE has recently issued some new guidelines talking about well, recommending talking therapies as a form of treatment. What is your opinion on that so it's just a draft consultation.

Speaker 1: 31:17

So we've just registered actually as a stakeholder so people can put in their comments, which will be listened to. So and that's just using comments at newsandhealthcouk, because if you go through a stakeholder then they can publish comments as well, which is really important. I think it's really disappointing. Actually, their press release did say CBT can be used as an alternative for HRT. Now, for some women who really don't want to take HRT, then absolutely look up every treatment. But having a cup of tea often will help with the menopause because you're sitting down and chatting with a friend, but actually that's not as an alternative to treating with hormones.

Speaker 1: 31:56

And and so I do have a bit of an issue because women have been gaslighted I've used the word gaslighted before and it is really. Women haven't been listened to for decades and actually hundreds of years, so we've always been oh, they're there, don't worry. And this is another thing. Actually, actually it's not just about how we feel mentally, and the cbt research actually has looked at flushes and sweats, but actually it's more than that as well, and even if we don't have symptoms, we've got these health risks as well. Cbt will not strengthen your bones, whereas taking hrt will reduce the risk of osteoporosis, which affects one in two women who are menopausal. So we have to be thinking beyond just some cognitive behavioral therapy, which is really hard to access, by the way, and CBT can be really good for some people, but it is a form of psychological treatment. Some people need psychotherapy, some people need other types of treatment.

Speaker 2: 32:48

And so.

Speaker 1: 32:49

I wouldn't want people to think CBT is the only alternative as well. You know, and you know I take HRT but I, you know, I got up early this morning and I've done my yoga practice. I do a headstand most mornings. That's a really important part of me and my well being and my treatment, but I wouldn't call it my menopause treatment. That's just part of me being healthy.

Speaker 1: 33:08

So, I don't want to be defined as a menopausal woman, you know. I just want to be defined as a woman who wants to be as healthy as possible.

Speaker 1: 33:16

And so we shouldn't be just saying to these women and there is a bit of what if you have CBT, dear, you don't need to go and see a doctor yeah actually you often do need to see a doctor to be started on treatment and we know that when women are on HRT they go back to their doctors less because they have less symptoms. They have less diseases going forward. So it's short-term investment for long-term savings actually, if we get menopause treatment right.

Speaker 2: 33:41

I think there's so much with to do with the health care in this country in particular needs to follow that model, I feel very often where there's like firefighting I work now, you're really ill, so let's give you some, some meds as opposed to actually.

Speaker 1: 33:55

Let's look at your yes and there's, there's there's always been a debate, and it's sort of heated up over the last few years, about well, we're medicalizing the menopause and it's a natural process. Well, actually, the menopause is is being medicalized. Already we see a lot of women on antidepressants, on painkillers, sleeping tablets, blood pressure lowering treatments. So let's medicalize it with natural hormones first and then see whether people need all these other medications I think also, it's quite um important.

Speaker 2: 34:24

You mentioned that it's actually difficult to access this um, this counselling. I know that where I I'm in the borough of Croydon and um I tried to access them for myself, they said we've got free therapies, free therapies. So then you do a 50 minute um consultation with somebody who basically triages you and, uh, it's not free because I think you've basically got to be in crisis. Yes, for it to be free, because I think you've basically got to be in crisis. Yes For it to be free.

Speaker 1: 34:52

But I think also often on the NHS you can only have six sessions or there's a long waiting list, and yeah, it's just a shame.

Speaker 2: 35:02

So the things that the conditions that you mentioned at the beginning of this conversation, that HRT can help dementia, osteoporosis um, I'm now having a bit of brain fog myself because I can't remember the other.

Speaker 1: 35:17

Well, there's all the inflammatory conditions. So cardiovascular disease, diabetes, clinical depression, parkinson's disease, inflammatory bowel disease, different cancers, lots and lots of inflammatory conditions that occur. Thank you.

Speaker 2: 35:31

So these are all what we would class as non-visible disability. So what are your thoughts about the menopause being classed, uh, as a protected characteristic under the equalities act, and?

Speaker 1: 35:47

yeah, yeah, I think it's very interesting and it is a bit of a debate actually, and you can argue it both ways, and I can argue lots of things, lots of ways. But actually, if you look at the definition of what a disability is and I don't need to spell it out to you menopause for some women can, because it has physical, psychological, long-term consequences. So it can for some women and so actually, and it has an impact, not just like we've already said, not just at work, but at home and on that person's life, and it is invisible. You don't wear a badge saying I'm menopausal. It's not obvious to look at women to know whether they're menopausal, especially when they're younger as well. But for me there's a treatment, a lot of disabilities, there isn't treatment.

Speaker 1: 36:32

So actually I feel everybody who's thinking about the menopause as a disability number one should be seeing somebody who really understands. And I think I said to you you know, my daughter wears a sunflower lanyard and she has intractable migraines, which I feel very guilty because I've given her that you know, she's an inherited condition. And often she says to me when we're in airports which is an overwhelming environment for most of us, and you've got these bright lights, you've got noise, you've got smells it's impossible to get healthy food. You know, that's where the lanyard comes into its own. And she often says to me mummy, you need one too. And when I traveled by myself, I was traveling to Australia recently and I thought I wish I'd listened to Jessica, because I absolutely feel so sick now and I really don't want to get a migraine because I'm lecturing when I land in Australia.

Speaker 1: 37:22

La la la yes um, but actually it's not always like today. There's no way I'd need one. So if I was perimenopausal, I wouldn't be, you know, needing to tell people or even to think about a lanyard most of the time, but there are times, absolutely, where I would want it to to be. Um, I don't need to explain myself.

Speaker 1: 37:44

And what's been wonderful actually about Jessica or not wonderful, that's the wrong word, I suppose but when she wears the lanyard, no one's questioning her, no one's looking at her weirdly, thinking I wonder what's wrong with her. You know, this is it's just fine, crack on and and quite a lot of respect, because I've got three children, so there's five of us who often go through a fast track lane just with Jessica, but no one's looking at her. And I think that's what's wonderful is that you don't have to justify yourself, because when she starts talking about migraine, it's like, oh, it's just a headache then that you get love. No, it's not, actually, it's really ruining her life. But it's the same with the menopause. I don't want to be saying to people oh, so you're just menopause, oh, why don't you just go and have a fan and sit in a room and it's not that.

Speaker 1: 38:29

So I think, actually the ability for women to decide actually whether it's a disability. I don't need to be registered, I don't need to fill out forms and forms of paper and have something all over my car telling people.

Speaker 1: 38:44

But, actually that's where your organisation, I feel, is so important, because disabilities can be temporary, but also they can be treated, but not overnight. You know, it's taken years for my daughter to have the right treatment and she's still affected at times. And it's the same with the menopause and the perimenopause. It can take a while, and so what do you do in that interim until you're getting the right dose and type of hormones? And so that's where it is really important that we recognize, but not laughed at. I don't want a manopause badge saying give me attention, but there are times that having a sunflower and lanyard for a lot of women, I think, is wow. Okay, I'm acknowledging that I'm struggling, but also I think everyone who applies for a lany should be.

Speaker 1: 39:33

Have you downloaded the Balance app? Do you know that there's evidence-based treatment? Have you seen someone who really understands? Because then it's really. A lot of my work is about empowering women. I'm not here saying you have to take HRT or you have to do headstands most mornings. It's up to you what you do, but just have that information so you can make the decision that's right for you. And if it's not right, from the first healthcare professional you see, you absolutely can get a second opinion and that's really important. And if we've got communities of women who are lifting each other's up and really helping guide to the right resources and the right treatment, then that's going to be really powerful, I think.

Speaker 2: 40:12

Absolutely. And if anybody doesn't know about the Balance app, the Balance app has been created by Louise and her team. It's absolutely fantastic. It's free. You can download it from the app store or Google Play or whatever phone device you use, and can use it to log your symptoms, your mood, your periods, a whole host of things related to you as an individual and how you feel. So we'll definitely be putting that in the show notes and, you know, promoting it because it's it. It is going to help you and also the fact that you're talking about it. Disability can be situational, temporary, etc. You are listening to the Sunflower Conversations with Chantal To share your story and find out more information. Details are in the show notes. I've got some questions. We've got 15 minutes left, so I'll try and get through as many of them as I can. Uh, this is from the sunflower community, but, um, as I was doing this, I was like oh, I need to talk to you every week.

Speaker 2: 41:21

We've got so much, so much to go through. Women talk about hot flashes, but in perimenopause I have had incidents of being freezing, so moments of freezing also. Some foods now just taste terrible. I don't drink alcohol. I eat well, I'm a healthy weight. Lots of random symptoms and generalized body pain. This person also doesn't currently take HRT. Any thoughts? I mean, that's obviously quite a wide any thoughts?

Speaker 1: 41:50

yeah, so lots of people have all sorts of weird symptoms and actually, um, uh sensors sorry, um smell changes often in the perimenopause and menopause, so that can affect taste, but also saliva can change, our mouth can change because our hormones, like I say, get everywhere lots of symptoms. You know, if I see a woman, I don't know how many of their symptoms. You know, if I see a woman, I don't know how many of their symptoms are related to their hormones. Obviously I don't have a crystal ball. I have no idea.

Speaker 1: 42:18

But what I do know from the evidence and the guidelines that for the majority of women the benefits of taking HRT outweigh any risks. And the earlier a woman takes it so ideally in the perimenopause the better for her future health as well. So all I often say to women is look, if you want to take HRT, I'll give it to you. It might take a few months to get the right dose and type and then see what symptoms are left. And so if a woman says, well, all my symptoms have improved, but I'm still getting muscle and joint pains, well then that's when I'll think well, is there another reason? Is she got got an arthritis? Is there something else? So the proof is in the pudding really. So it would be worth going to see somebody and then discussing about systemic hormones and see how many symptoms and probably most on the list will improve.

Speaker 2: 43:05

Thank you. Another sunflower wearer asks I've had a hysterectomy. How long should I continue with my oestrogen? How do I know when to stop taking it that way?

Speaker 1: 43:17

the risks and the woman wants to carry on taking hormones. Of course she can, because it's not just about symptoms, it's about future health as well. Now what's interesting is when women have oestrogen on its own after a hysterectomy, the studies have shown there's a lower risk of breast cancer, like I said. So if you think about the risks for this lady, there's no risk of breast cancer, in fact a lower risk. If she's having oestrogen through the skin as a patch or gel, there's no risk of clot or stroke, so that's good. If she started HRT straight after her hysterectomy and was under the age of 60, there's a lower risk of heart disease as well.

Speaker 1: 44:00

So actually I can't think of a risk of taking hormones, but there are plenty of benefits, and so for most women they can just carry on taking taking it. If I stop taking my HRT today, I might or might not have symptoms. I probably will, because I'm quite sensitive to hormonal changes. But as soon as my patches come off, I've got this increased bone turnover, so increased risk of osteoporosis, and I'm personally very worried about osteoporosis, especially of my spine, and so that's a reason why I will take HRT forever to keep my bones as strong as possible and hopefully reduce my risk of dementia and heart disease and everything else as well, so it's an individual choice.

Speaker 1: 44:41

Some people say I'm only going to take it when I have hot flashes and then I'll stop it. But increasingly women are understanding the bigger benefits of hormones and so you don't have to, even if I always hear every day actually on social media that my doctor's told me I can only be on it for five years or ten years or stop at a certain age that's. That's not actually in line with the guidance at all. So you can contest that and carry on if you want to.

Speaker 2: 45:04

That's really helpful to know that. I didn't know that I've been. Well, it's just a kind of links back to what you were talking about earlier on about progesterone and it just shows this so much knowledge that we all still need to learn from experts such as yourself, because this question is I've been prescribed with progesterone, with my estrogen, because I still have periods, so how will I know when my periods have stopped?

Speaker 2: 45:38

yeah, and just also that's one question. But um, I'm thinking back to when you said about um progesterone, when you can have it locally, I guess, like with a coil that's just protecting the lining of your wound but you're not getting the other benefits for your no, that's right.

Speaker 1: 45:55

Some people don't need progesterone. Some people if they're on estrogen and testosterone and they feel fine. We wouldn't just start progesterone if they're using marina coil or have had a hysterectomy. But if you start hrt when you're perimenopausal so when you're still having periods you won't know when you're officially menopausal the only way to do it is to stop taking HRT, wait a year and see if you have a bleed. But why would you want to do that? The symptoms of the perimenopause and menopause are the same. The health risks are exactly the same. It's just a label. And so I started HRT when I was perimenopausal age 45. I'm now 53, I probably will be menopausal. But there's no way I'm going to stop and say and anyway, I've had a hysterectomy, so I will have no idea yeah but actually age 53, my hormones are not going to be the same.

Speaker 1: 46:42

It actually doesn't matter. Um? So when people are perimenopausal and we start HRT, we do it in the way that people still have periods and then after about six to 12 months, we change it, so it's continuous, so people don't have periods. Some women who are younger might like to have periods, in which case you can continue taking this sort of cyclical HRT for longer, but a lot of us just go. You know, that's the best thing about the perimenopause or menopause is not having period so with regard to that, um, so would.

Speaker 2: 47:18

If you've got the coil though, because you're not getting it, is it? Are you getting any benefit if you've got the coil, but actually you are, yeah, so if you've got the coil, then you're often.

Speaker 1: 47:27

If it's a marina coil, then it. It gives women a small dose of progesterone to the lining of the womb, so it keeps the lining of the womb thin, which is great because it means people don't have periods. It also is very good as a contraceptive. But it's only part of hormonal treatment. So some people say, oh, my doctor says I'm on hormones because I'm using the marina coil. No, you need to have oestrogen as well, but you don't always need to have a progesterone. You can carry on the marina and it will last for five years. So the oestrogen as a patch or gel, and then testosterone as well if needed okay, thank you um next question I've had terrible side effects from oestrogen.

Speaker 2: 48:03

Are there any alternatives? Um so, for example, you know tablets different than gel.

Speaker 1: 48:08

Yeah, so there are differences. So about a third of people we see in our clinic are already on HRT but it's clearly not suiting them um. So some people think they don't doesn't suit them, but they're on the wrong dose or type um. So if somebody's on, for example, a patch and they're getting symptoms, we often then do a blood test and if their oestrogen level is low, we know we can increase the dose and they probably start to feel better. Some people find they feel a lot better if they take a tablet or use a gel rather than a patch, but sometimes it's not an estrogen deficiency symptom. It might be a testosterone deficiency symptom or a thyroid deficiency or an iron deficiency or vitamin b, vitamin d deficiency.

Speaker 1: 48:49

So that's why it's really important to see somebody who understands more than just the menopause as well. You know we're all GPs. I've done a huge amount of hospital medicine. I've been a doctor for 25 years. I don't just look at the woman and say, right, it's all about your hormones. Of course there are other reasons why you could get symptoms. So it's important to just have you know, good conversation with someone who understands thank you right.

Speaker 2: 49:13

Well, I think we've done a really good job. We've um gone through lots and lots of questions, and I do have a hundred more now because of the answers that you've given, but maybe we'll save that for another time. Um do you have a golden nugget of advice for um for somebody embarking on this menopause journey?

Speaker 1: 49:33

absolutely the most important thing is get the information that's right for you, make sure that you are knowing what's going on and know how you want to manage your perimenopause and menopause, and know that you can change your mind as well. It can be quite overwhelming and it's really easy to look at all these people and think, oh, they're great, how do they do that? How does she do that?

Speaker 1: 49:55

But, actually, most of us have struggled to get the right treatment for us and it can take a little while. It's being really patient when you start taking any treatment or start doing a form of exercise or changing your lifestyle lifestyle we have to be really patient. So having information, sharing how you're feeling with others as well, and knowing that you're not alone is really, really important thank you, louise.

Speaker 2: 50:20

Thank you so much. Thank you. If you're interested in any of the advice discussed in this podcast, please follow up with your gp or healthcare practitioner discussed in this podcast.

Speaker 1: 50:45

Please follow up with your GP or healthcare practitioner.