It Can't Just Be Me - 34: Menopause Special – with Kate Thornton & Dr. Louise Newson

Episode Date: February 7, 2024

A couple of weeks ago, Anna asked you to get in touch with your questions about the menopause. And, oh boy – did you deliver! We were inundated with your responses – which varied from questions about vaginal dryness, worries about the impact of menopause on libido, concerns around HRT, and experiences of mental health struggles during the menopause. So today in the studio, Anna is joined by broadcaster and presenter, Kate Thornton and GP and menopause specialist, Dr Louise Newson. Together, they’re on a mission to answer your burning questions and share everything they know to support you through the menopause. Please note that advice given on this podcast is not intended to replace an in-person consultation  with a trained professional.—Have questions about sex? Divorce? Motherhood? Menopause? Mental health? With no topic off limits, Anna’s here to prove that whatever you’re going through, it’s not just you.If you have a dilemma you’d like unpacked, visit itcantjustbeme.co.uk and record a voice note. Or tell Anna all about it in an email to [e-mail] podcast contains adult themes that may not be suitable for children. Listener caution is advised. Please note that advice given on this podcast is not intended to replace the input of a trained professional. If you’ve been affected by anything raised in this episode and want extra support, we encourage you to reach out to your general practitioner or an accredited professional.From Podimo & Mags Creative Producers: Laura Williams and Christy Callaway-GaleEditor: Kim MilsomTheme music: Kit Milsom Executive Producers for Podimo: Jake Chudnow and Matt WhiteExecutive Producer for Mags: Faith Russell Follow @itcantjustbemepod and @podimo_uk on Instagram and @itcantjustbemepod on TikTok for weekly updates. You can also watch the full episode on YouTube. This episode is brought to you by BetterHelp. Give online therapy a try at betterhelp.com/ANNA and get on your way to being your best self.  Hosted on Acast. See acast.com/privacy for more information.

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care. So last week, I did a call out on my Instagram inviting you to share your questions, fears, and frustrations about the menopause and wow, did you deliver. We have been overwhelmed by the number of emails we've had on your experiences, from women being gaslit about their symptoms to the endless misinformation and confusion about where to turn to for help. I hear you, I get it, and I'm pissed off as well. So today, we're on a mission to get answers for you, along with my guests, the broadcaster Kate Thornton, who is menopausal herself, and leading menopause expert, Dr. Louise Newsome. Welcome to It Can't Just Be Me, the Menopause Special. Hi, Anna. Hey, Anna. Hey, Anna. Hi, Anna. Hey, Anna. Hi,

Anna. Hi, Anna. Hi, Anna. It can't just be. Hi Anna. Hey Anna. Hi Anna. Hi Anna. Hi Anna. It can't just be me who's really struggling with staying faithful. I definitely got menopause brain. I really want children and he doesn't. I had feelings of jealousy. It's just all around the middle.

I feel like a Teletubby. And then I hated myself for feeling that way. If you've got any advice. I would really appreciate any advice. It can't just be me. It can't just be me, right? Kate and Louise, welcome both of you to the show. I think it's safe to say that listeners are frustrated and confused. So thank you for being here today to help provide some answers. How are you both? How are you, Louise? I'm good, thank you very much. It's a real delight to be here.

Oh, thank you for coming down. And Kate, thank you for dialling in and being there for us as well. Well, thank you. I mean, I'm looking forward to this because I know that there is so much ground to cover. And as much as this conversation becomes better informed with every month that passes, we've still got such a long way to go and your mailbag is testament to that I mean the response I understand it's been quite the mailbag is bursting and I mean mainly it's it's just a sea of confusion is that something that you can identify with Kate not being able to wade through the information so I'm still I wish I was menopausal, by the way.

I'm not there yet. Oh, you're perimenopausal, are you? I'm perimenopausal. And I'm going to say six years in of being aware of my perimenopausal symptoms. I'm five, six years in now and still no closer to being menopausal. But yes, I mean, when I started this, I was met with a sea of misinformation, disinformation and outdated information, which was blurred in a sort of soup of opinion. And opinion and fact are two very different things.

And I think that's really important that we have to kind of cut through the two like a sort of hot knife through butter. to like a sort of hot knife through butter. And the fact that it is an ever changing landscape, because finally, finally, money is being poured into research, which means that we can extrapolate data, which means that we can start to better read the female sexual health landscape. But we are literally, and I'm sure Dr. Louise will back this up, in the foothills of that climb. Well, I mean, I'm several years in now. I'm now fully menopausal. I still can't really see the wood for the trees because you still get symptoms. Anyway, let's try and simplify things as much as we can for our listeners. And I want to start with one of the messages that we received as a voice note. Here we go. Hi, Anna. It can't just be me struggling to get good symptom

control with my HRT. I'm maxed out on my oestrogen, but I'm still getting hot flushes at night and I'm feeling anxious. My GP can't up my oestrogen dose and waiting time at the HRT clinic is a year. I can't afford to go privately. Help, please. I mean, Kate, you've just gasped at those waiting times a year, unless women can afford to go privately, of course. And then meanwhile, we're suffering and relying on our GP for support. So Louise, if I can ask you first, is there a postcode lottery when it comes to care and the menopause treatment on the NHS? Yeah, the short answer is yes. Really? It's horrendous actually what's happening out there because although it can be complicated and the symptoms can be very complicated as we can talk about, the treatment's really easy because it's

just related to hormones. So all these women are asking for is just to have their hormones replaced and we're talking about the sex hormones. I don't know why they're referred to as sex hormones because they're not all about sex. They're not even all about gender. They're hormones that men and women have. So we're talking about oestrogen. The active good form of oestrogen is oestradiol. We're talking about progesterone and we're talking about testosterone. They're three hormones that our ovaries produce as females, but our hormone levels fluctuate in the perimenopause and decline and stay low in the menopause. So all we want to do is reclaim our hormones. It's not actually, if I was an alien coming from outer space, I'd be saying, well, what's the fuss about?

Why can't we have them? Because we know our hormones are just chemical messengers. They go into our bloodstream. They go all around our body and they affect every single cell. They improve the way our cells function and work. They reduce inflammation in our body. They work as neurotransmitters. They work with all our other hormones as well. But there's something about them that makes people really scared. So therefore, women have been scared for years. They're less scared now because they're getting more information, which is wonderful. But doctors, nurses, pharmacists, actually governing bodies seem

to be really scared of hormones. And the medical gaslighting that's going on is huge, actually. Let's talk about that. I mean, obviously, you are the expert here, Louise. But as far as you're concerned, Kate, do you think that GPs are sufficiently trained when it comes to the menopause and their knowledge? They're not trained. They're not required to know anything about a life stage that can last beyond a decade and impacts 51% of the population. That in itself is nuts. It's really interesting because I'm not here to be rude about healthcare professionals, because especially GPs are working really hard. The landscape's changed so much since I qualified as a GP in 2000. And it's so different now. And it's so hard. And it's relentless. But you're right, we don't get trained in the menopause. When I had symptoms, I should have been able to

just go to my GP and say, actually, I'm perimenopausal, I'm 45, my life has fallen apart, I'm close to losing my job, my husband wants to leave me, I want to kill my children. Could I just take something that not only will help me feel better and keep my job and my partner and my family, but also it will improve my future health. And that's what's really important. So when we're looking at areas of deprivation, when you're thinking about population health, which is what I do a lot, women that are more likely to have inflammatory diseases, so heart disease, osteoporosis, diabetes, dementia,

clinical depression, we know these diseases are more common in areas of deprivation. And guess what? Women who take HRT have a lower risk of all those diseases and it's cheap and it's effective. So we need to be thinking, why are we taking HRT? Yes, as women, we want to feel better. I don't think that's a bad thing, but even more importantly, we want to keep well. We don't want to be a drain on the NHS. We don't want all these diseases and we don't want other medication for these diseases. So we want to keep

well. I'm going to do a deep dive, obviously, into HRT because, you know, as you say, that's absolutely core and central to treating the menopause and it's our right to replace our hormones. And yet, you said earlier, there's sort of gaslighting going on within the medical community, which is so interesting. I know that you've been particularly targeted, haven't you, as well? You've had such a backlash backlash what the hell is going on because you know that there's us as women in the middle of this going I mean who are we supposed to be listening to a GP will say you're meant to be on the lowest possible dose of HRT other practitioners will say no increase it and we're caught in the middle so tell us about the gaslighting yeah so well I mean there's obviously gaslighting for women has gone on for centuries,

hasn't it? So a lot of women we see and the women I speak to are telling me that they've been told that they've got anxiety, they've got depression, they've got bipolar, they've, you know, they've got fibromyalgia, they've got chronic fatigue, and no one's thinking about their hormones. And in some ways, there is gaslighting when you know you're doing it, but there's also when you don't know. And that comes from, like you've said, poor education. And I know as a doctor, I have missed hundreds, thousands of women, you know, who turned up in A&E with total body pain, with urosepsis, pyelonephritis. People who have had an inflammatory arthritis, people with migraines. Never once did I think about hormones because no one taught me. But now the conversation's there. We need to have this professional curiosity and we change all the time our clinical practice. So we need to be thinking, all right, let's have this joined

up approach. Someone with palpitations and low mood. Maybe they haven't got a heart disease and clinical depression. Maybe it's related to their hormones. And let's ask the women if they think it's related to their hormones. So just to bring it back to this particular listener, where she's struggling, she's been to a GP, she can't afford to go privately, she's still got all the symptoms, the GP can't or won't increase the oestrogen. What advice do you have just for her? What would you say? So I would actually say, I would go back to your doctor and ask exactly why. The British Menopause Society produced a statement with some of the Royal Colleges to say that we shouldn't be using higher doses, but there's no evidence for that.

People worry all about the guidelines, but they are just that, a guide. You know, in medicine, not everyone reads a textbook. Not all patients will do everything right. We start off, of course right we start off of course we start off giving normal doses and then we individualize the NICE guidance are very clear about individualization of care and we've also got the shared decision making guidance which this lady can talk about which are produced by NICE to say that care should be individualized and the patients need to be central to that

consultation as well. So if this lady wants to try a higher dose, she could talk to her doctor about it. She could ask to have her oestrogen blood test done to see if she's absorbing. Which isn't done regularly on the NHS. You have to ask for blood tests, don't you? Yeah, and there is a confusion here because a lot of people want to have a blood test to diagnose the perimenopause or menopause. And that is actually a waste of money. And it's not helpful because our hormone levels can really vary. And as Kate said, she's perimenopausal. So her hormone levels might be up one day and low the next day. If you do a blood test and the level's normal, you'll be falsely reassured. So that's why we don't do those blood tests just a snapshot of a moment absolutely and you know I really empathize with this listener because I was her and I

probably am still her where I'm not seeing a specialist and this is where I think what does GP stand for general practitioner we can't expect them to be a specialist in everything when that's not what they're there to do. What we should expect, and we should go in knowing our patient rights, is if you don't feel you can help me, please refer me to somebody that can. Because if you are only going to get a doctor that will only go with the minimum dose, That just isn't going to cut it for some women. I am on a very high dose of oestrogen, which I got to over time. So I'm on the oestrogen spray. There's no way that the basic dose,

the minimum dose of two pumps would be enough to regulate my symptoms. Sometimes I've gone up to as many as five. At the moment, I'm on four. And listen, your symptoms will change across the years. I feel like I'm literally working through some horrific bingo card of just ticking off one symptom after the other. And I'm at the stage now where I understand that they come and go. At the moment, I have a frozen shoulder. And then one day you just wake up and it's gone. It's

hormonal. A lot of doctors will not confidently tell you that that is a possibility because they don't know it to be a possibility because they don't know enough about the menopause. It's really interesting at the very beginning of my perimenopausal symptoms, I was so convinced there was something wrong with me. I booked in to have a private scan. I thought that I had picked up a family illness, rheumatoid arthritis. My joints ached so much. The man operating the scanning machine pulled me to one side and said, I see so many women like you. This is perimenopause. They probably won't tell you that. But you are symptomatic of so many women that come through here, terrified that there's something

really wrong with them at a point when you're already anxious you're already not feeling yourself it's like being burgled the perimenopause it's a burglar that keeps breaking into your home and taking things and moving things around and discombobulating you. And whilst all of that is happening on an ongoing basis, you're being ignored, gaslit, told to wait, not prescribed the correct levels of medication, and then expected to perform at the top of your game in every role in your life, be it as a friend, a partner, a mother, a professional. And it's just too much to ask of women. It just is. Like, it almost broke me. On that note, Kate, you've led us beautifully, actually, into talking about the menopause and mental health, which is a particular passion of mine.

I remember my mother's menopause, which was just horrific. And she was a totally different person. I've really struggled with the perimenopause and menopause with my own mental health, with anxiety and depression. We think that in my family as well, my grandmother was very badly affected. And very sadly, she took her own life. And it correlates with the right age in terms of going through the menopause. So in so many of the messages that we've received,

we are hearing about that emotional toll. Obviously, we know it can range from feeling moody, anxious, depression, to women quite literally fearing that they're losing their minds. One of those people who have written in is Natalie, and her message is being voiced by one of our producers. Lately, I have the worst anxiety where I'm worried about everything I do and whether it's right and good enough. I'm overanalyzing everything, so it's taking me longer to do anything. My brain fog is at an ultimate high to the point I'm convinced I have early dementia. an ultimate high to the point I'm convinced I have early dementia. For example, I will be having a call and my thoughts will just literally fall out my head. And as a result, I feel like I should probably leave my job as I'm not good enough when compared to everyone else. I just don't feel like

me. I'd like to know if that's normal and if any of you have ever experienced it. I'd like to know if that's normal and if any of you have ever experienced it. Well, I mean, straight off the back of that, Natalie, I can say yes. I still kind of feel like that, actually, even though I'm, you know, I'm on HRT, I'm getting fantastic care. I'm still struggling. And there are days where I can't think straight. I mean, I've definitely lost my confidence. Kate, can you identify with this? You were saying just a second ago, you know, how it feels like you've been burgled. Has it affected your ability to do your job? Listening to that voice note, I could have

written that myself on many an occasion over many a year. But I'm really happy to say I wouldn't write that now because I'm not in that place anymore. I was there and for a very long time and I'd never suffered with poor mental health in my adult life. Suddenly I was having panic attacks, anxiety, questioning my abilities, the words just falling out of my head which when you do this for a living you know I am a podcaster, I'm a radio host, I work in live broadcasting. it was absolutely terrifying I just didn't know myself anymore I didn't I couldn't recognize the woman I'd become I didn't like the way I looked I didn't like the way I thought I became quite

negative I was so negative I was so down on myself I was so down on everything it coincided with lockdown so I kind of know, I became reclusive because I had to. And it got to a point where I just, I mean, I felt broken by it. What fixed it, Kate? Are you on the right HRT now? Or I mean, how are you feeling now? I've just made the decision to kind of break it down into two parts. So I just thought, right, okay, I hate the way I look because my body was just like it just wasn't

it wasn't my own anymore I was just getting bigger and bigger and it wasn't like weight gain it was just inflammation but also my mind was all over the place and my abilities felt like they were in my boots so I thought right how do I tackle this first and with great consultation with a great doctor we decided that I would put my mind first and fix my mental well-being. And then once I'd got that to a place where I felt more stable, I would then go at the physical and the lifestyle changes. So getting the right HRT is key so that you can make clear decisions so that you're sleeping. Sleep is so key. There know, there's a reason they use sleep deprivation as a torture device, because it will absolutely warp your abilities to do anything well. So just eating

well, getting your sleep patterns back, feeling like you again, from there, you can make decisions around things like, okay, diet, exercise. You took the HRT to give you that structure first, and that sort of balance first, and then you addressed the HRT to give you that structure first and that sort of balance first, and then you addressed the rest of your lifestyle. I should caveat again this by saying that makes me sound like I'm a really pragmatic person. I got to that decision after I tried to attack everything at once. And I was literally chaos on legs. So I think when it first happens, I don't know if it's my personality type or if this is all of us,

I would imagine that you were much the same, Anna, because you and I are quite similar in our attempts to solve problems. I just threw everything at it. I was like, right, if I'm going to be perimenopausal, I'm going to be the best at getting on top of this. Don't you worry. I'm going to do everything at once. I was like a woman trying to put a fitted sheet tidily in the linen cupboard. I was trying to fold a fitted sheet. It just wasn't ever going to work, right? You can't fold a fitted sheet. You just end up having a fight with yourself. All of the things that this listener has highlighted about lack of confidence, anxiety, brain fog, HRT fixed a lot of that for me. It restored my ability to recall information,

to remember things. I mean, at one point I was living, I described my kitchen as looking like a police incident room because I just had post-its everywhere. And I also have a notepad that comes everywhere with me. So my day is listed, right, of all the things that I've got to do. But I was then having to do backup post-its to remind myself to do the list. I just lost my self-belief that I could carry out something as simple as fill out the form for Ben's jabs at school, right? Just stuff that normally I could have done literally while I was waiting to pick him up outside the school gates. That stuff became huge, overwhelming. And I think, you know, my lack of confidence was driving everything. So for me, HRT gave me the ability to deal with all of that. And then once you're on a bit of a more steady footing, then you can start to look at the whole picture, but don't try and do it all at once. Let me just throw to Louise here and take it back to Natalie for one second about with this brain

fog, with this conviction that there's early dementia, with the just not being able to cope, what the hell is going on here? Yeah, I mean, there's lots of reasons why people can feel like this. But in the context of the perimenopause and menopause, I've already said we know our three hormones estradiol progesterone and testosterone are neurotransmitters that means they're chemicals that affect the way our brains work they essentially light up our brain in different areas and they are areas that affect our thought processing our personality our memory our, even the way our heart beats, our way we breathe, the way our digestion is. But they also affect the level of other neurotransmitters like serotonin,

the so-called happy hormone, dopamine, the reward hormone, our adrenaline, our stress hormones, our cortisol. They're all in a really fine balance. So it's very simplistic in medicine that we think, oh, it's just one hormone. It's more than that because it's how they interfere and interact with other hormones. But the mental health issues are really, really important to be recognised and they actually can be worse in the perimenopause because our brain likes what's called homeostasis. It likes everything the same. And we all know that if we stay up too late or if we eat the wrong food, our brain doesn't like it, this hunger, this hungry anger feeling that people get. And it's the same with our hormones. When they fluctuate and estrogen levels fluctuate a lot during the perimenopause, it can trigger all sorts of mental health issues.

And we know just from people that download our free Balance app, the commonest symptoms are memory problems, brain fog, anxiety. And the anxiety can be really debilitating. People often ruminate a lot. They worry about things they've never worried about before. So I have spoken to people who literally will physically vomit thinking about packing a suitcase for a holiday that they've been looking forward to. Or they will no longer go on the tube or a bus or they won't drive. Or they'll wake up at three in the morning worried that something awful is going to happen to their children. It's not just a little bit of a worry, they catastrophize a lot. But there's also these very deep, dark thoughts. People often tell me they've gone into this cave, this dark hole, and they don't know how to escape. And we know the risk of suicide, the incidence of suicide increases by seven times in the late 40s.

I'm not here saying that every suicide is due to hormones, but a lot will be and it will be misdiagnosed. A lot of women we see and speak to are offered or prescribed antidepressants, which may help if people are clinically depressed, but it won't help if the low mood and anxiety are due to the hormonal changes. We see a lot of women in our clinic, especially, who have been given antipsychotics, antidepressants. They've been given ECT. They've been given lithium, quetiapine. We've seen some recently that have been given ketamine infusions. These are women in their 40s that no one has spoken to about the role of hormones. And a lot of these women, when you speak to them properly, they've also had postnatal depression. They've had really severe PMS or PMDD, premenstrual

dysphoric disorder, which is a more severe form. Those women are more likely to have a stormy, turbulent time in the perimenopause. This is a paid advertisement from BetterHelp. We receive so many messages here at It Can't Just Be Me about the challenges of personal relationships, whether that's with friends, colleagues or romantic partners and the work it takes to make them great. When we chat these things through with our guests and psychotherapists on the show, the thing that comes across clearly is that although it's not easy,

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really important that we all understand there are different types of hormones and even different formulations as well. So when we're talking about benefits and risks, that can vary between the type. So when we're talking about benefits and risks, that can vary between the type. Now, we know that the hormones we usually prescribe now, which are available on the NHS as well, are these what we call body identical hormones. So that means when you look down the microscope, they are exactly the same as the hormones we produce ourselves when we're younger. So we're giving natural hormones back, if you see what I mean. we're younger. So we're giving natural hormones back, if you see what I mean. Now, when people talk about risks, actually, there aren't really any risks with the natural hormones. The risks is

really of not having them as opposed to having them. We're not designed to live for 30, 40, 50 years without our hormones. They are there for a reason. So we've got to remember that we've all been taught and told about risks forever about HRT. This comes from a study, which was the Women's Health Initiative study that came out now in 2002. So many years ago, it was a billion dollar study, like nobody has spent that sort of money on women's health research since and probably never will. And it was a randomized control study. So it was giving women HRT versus a placebo. So just a sugar coated pen, if you like, with nothing in it. But what they did was they had to find women without symptoms because they would quickly know who was in the placebo arm or not because HRT is so effective because you're treating the underlying cause. So they decided to give it to women mostly who were older. So the average age in the study was 63.

So these are people that hadn't been on HRT started on. Now, the important thing to know about this study is the type of HRT they gave was a tablet form of a combination of estrogen and a progestogen for those who had a womb, or a single oestrogen if they had had a hysterectomy. The study had been going along, and then they decided, because it was expensive, it wasn't getting amazing results, they sort of wanted to pull the plug on it. And they saw this little waiver, really, of a line over the breast cancer risk. So they decided to pull it. The investigators said, actually, we need to look and analyse this data really importantly before it goes to the press. And some of the investigators said, too late.

It's gone to the New England Medical Journal. It's gone to the New York Herald. It's out. And this was when? And this was in 2002. Yes. So HRT prescribing was about 30% of menopause. A woman took HRT.

It went down to single figures. People just didn't. I remember this, that women were terrified. Women were terrified. And quite rightly, if you pick up the paper and it's telling you all this risk of breast cancer. But then obviously the study's been analysed and re-analysed and re-re-analysed. And it's very reassuring actually, because firstly, this increased risk wasn't statistically significant anyway. But also actually, when they looked at the women who only had oestrogen, who'd had a hysterectomy, and followed those women up and looked properly,

they found that those women had a 23% lower risk of developing breast cancer. And women in both groups had a lower risk of dying from breast cancer. So there's one thing a diagnosis, there's a second thing dying from it as well. And there was also beneficial for bone strength as well. And we have to remember that osteoporosis affects one in two women over the age of 50. One in three will have an osteoporotic hip fracture. And those women that do have an osteoporotic hip fracture, the mortality, so the death rate after a year is 20%. So it's not without risk.

So they showed there was a benefit for our bones. And actually, if you started HRT within 10 years of your menopause, you had a lower risk of heart disease as well. The risks are really with the tablet oestrogen, there's a small increased risk of clot. It's thought to be about double, which sounds high, but the risk for most people is low. So doubling a low risk is still low. That risk is not there with a transdermal through the skin type of oestrogen. And then risk of stroke might be an increased risk with a tablet because clot and stroke can go together, but there's no risk with a transdermal. The synthetic progestogens, so the not body identical hormones,

there's probably a small risk of clot and heart disease in some types of the synthetic, but not with a body identical. So actually risks for body identical, they're not there. So keep your HRT body identical as much as you can. We have had a message in from a woman who's had breast cancer, and she's saying that she's trying to clear her body of oestrogen right now. What do you say to those women who have had breast cancer? Can they take HRT or just not? So this is really individualised actually and we've been looking really closely for the last 18 months at all the data with some really key experts as well

trying to unpick it. The most important thing in this conversation is how is the menopause affecting the woman and what are her biggest concerns? Because there is a lot of people, or there are a lot of people we listen to and hear from all the time who are just told, no, you can't have it. There's nothing in medicine that, no, you can't have. The risks might be greater, but some women say to me, do you know what? I've tried every alternative. I'm existing. I'm not living. I'm more worried about my risk of you can't have. The risks might be greater. But some women say to me, do you know what? I've tried every alternative. I'm existing. I'm not living. I'm more worried about my risk of osteoporosis. My breast cancer was 20 years ago. I just want to try something that I know will help my quality

of life. Now, I don't think as a doctor I can say no to that. The other thing is, is that the local hormones in the vagina are safe. And there are a lot of women who are denied those as well because they've had breast cancer. So that's important for people to know. Okay. Big question. When should we come off HRT? So you know what I'm going to say, don't you? That you don't have to. Why would you? Why would you come off something that has got more benefits than risks? So the guidelines are clear that women should have individualised consultations and be reviewed at least annually and make sure that firstly, the benefits outweigh the risks, which I already said they will do. But more importantly, it's what the woman wants. And it's about her reason for taking HRT. Some women will take it just because they want to improve their symptoms. But increasingly, we've got good evidence that it will reduce the risk,

especially of cardiovascular disease and osteoporosis. We don't need to stop taking it if it's body identical hormones and it's suiting us fine. The problem is as soon as people do, and I hear stories all the time of people's mothers who've been told to stop and then they deteriorate. Why do we want this to deteriorate does it make sense that's so interesting to hear because of course I mean Kate did your mother take HRT because my mum gave up with it in the end and I have to say Louise she's fine you know she's 80 so there is there is that question around our mums didn't take it and

they're okay but Kate did your mum take HRT I wish my mum had been offered HRT. She went through it. So she's just turned 76. She was 38 by the time she was through menopause. So she was extraordinarily young. It wasn't discussed. She was given nothing by way of medical support. I know she found it incredibly difficult and working my way through perimenopause now, my heart goes out to her. Thank you, Kate, for that. And you're absolutely right, because it should be an HRT revolution. And as you've pointed out, Louise, as well, that it is our right to have good health. But I must ask you on behalf of women who don't take HRT, clearly there are some women who don't want to.

Absolutely. It's a choice. It's a choice whether we exercise, what we eat, what we drink. No one's going to be judged because they do or don't take HRT. I feel that my sort of remit really is to allow people to have education. And of course, you know, the perimenopause is the most turbulent time. Our body will adjust. It's like anything. Our body will adapt and change and other hormones will take over. So people say, oh, I've got through it. I feel fine. Yes, they might feel fine, but actually they need to know they've got an increased risk

of diseases. It's a bit like saying I'm not treating raised blood pressure because it's not causing any symptoms and it's fine. You know, there are advances in medicine that we do medicalise things, but we also need to look at what are these people doing when they're not taking HRT? They're probably taking some painkillers. They're probably taking an antidepressant. They might be taking a sleeping tablet.

They might be taking a blood pressure lowering treatment. They might be on a statin. So a lot of women I see, they say,, oh no, I haven't really got many symptoms. And then you say, well, what's your sleep like? Or, you know, what's your energy like? What's your stamina like? Or they then say, well, I'll try HRT for three months. And then they come back and go, wow, I can't believe I'm so different. All of this is a choice. Okay. Girls, I want to talk about sex and I want to talk also about vaginal atrophy. Kate, have you found that your sex life has been affected by perimenopause?

Yes, in as much as I take testosterone, which, by the way, has been an absolute game changer. And one of the sidebar impacts of that was an increased libido. But my libido was pretty good anyway. But what I will say is I kind of resent the fact that the testosterone conversation always sits around libido, but my libido was pretty good anyway. But what I will say is I kind of resent the fact that the testosterone conversation always sits around libido. For me, what testosterone has given me is clarity of thought, productivity, just to be productive again, to have that little bit of va-va-voom back in, that spring in my step. It's returned me to me in so many ways that I hadn't even realised were lacking so libido and sex fantastic did it dial up my libido when I first started taking it hell yes has that abated yes is my libido good yes thank you I'm delighted I'm thrilled to hear

actually that that's all worked for you because my libido and my sex life and also just in terms of vulval and vaginal health Louise again I've really struggled with because of the dryness but let's just let's just get on to one of our listeners so Andrea got in touch with us via Instagram and she's worried that her libido is never ever ever coming back. Hi, will my libido ever come back? Is there anything else I can take or use to help? I'm using the Everol Conti patches currently and was previously taking Femastin. I've been married for 30 years this June. I love my husband so much and thankfully he's very supportive, but I would really like to have the urge again thank you so Louise does HRT diminish or increase libido and in this case what would

you be saying to Andrea yeah it's interesting when we talk about libido isn't it because if you look at Freud's definition of libido it's not just about sexual pleasure it's about pleasure of life and Kate quite eloquently saying about her vavoon back, her sort of joy of life. And that's what often happens, especially with testosterone. But we need to think, obviously, I would be stupid to think that it's all hormones is our libido. We have to be thinking more than that. Of course we do. But we also know that our hormones, oestrogen and especially testosterone can affect our libido. It's like any symptom. You know, if someone's got low mood, if they've got joint pains, if they've got reduced libido, I'll be very clear and say to them, I have no

idea how much is related to your hormones. But I do know there's benefits for replacing your missing hormones for your future health as well. So all I can do is replace your hormones physiologically and then see what's left, if you see what I mean. And especially if this lady doesn't know that there's any other reason for her reduced libido, she loves her husband and so forth, then actually the combination patch she's on, the Everol Conti patch, is a fairly lowish dose. It's 50 micrograms of oestrogen. She might need that increasing a little but thinking about testosterone and testosterone is very interesting it's the most biologically active hormone we have

we have higher levels of testosterone in our body than oestrogen when we're younger and it just reduces with age so it's not really a menopause hormone it's more of an age related that's really interesting it's very interesting and it's produced in our ovaries but it's also produced in our adrenal glands and our brain as well. And so obviously, if someone has an early menopause because they have their ovaries removed, of course, their testosterone is really going to decline. All the studies in women have been done

looking at libido and testosterone, which as cases, I have an issue with it as well, because we're more than just something that's going to have sex or think about sex. But we know it can improve libido from the studies and we know from our clinical practice, of course. So having a trial of testosterone, but it can take three to six months to have a beneficial effect from testosterone. Firstly, because the dose is credibly low that we give and people, because it comes as a cream or a gel, absorb it in different ways. so sometimes the dose needs to be altered

and changed and so it's not a quick fix and then you've got this sort of local problem in a lot of people find that their clitoris atrophies so they can't orgasm so even if they want to have sex when they have sex they can't have the same pleasure with it. This is absolutely crucial. And thank you, Louise, because I also want to play in another message. This is from Perry. And it's really important for us, I think, to talk about clitoral health and vulval and vaginal atrophy. So here is Perry's message. I've had a full hysterectomy taking HRT. I've got crazy vaginal atrophy with fissures, all made worse by prolapse, crazy weight gain and low mood. Should I be taking testosterone? I had my mind blown a few years ago when I met a woman who told me that her vaginal lips had

seized up, had closed together. And I just, I couldn't believe this because I've never heard such a thing. And we don't talk about it. So tell us, what is the atrophy? Yeah, so atrophy, I hate that word, because if you look it up in the dictionary, it means withering and wasting away. Now, I don't want to be thought of any of my anatomy or me withering or wasting away, but it does actually define what happens. So we know our hormones obviously work all over our body. I've said that before. But if you think about our vulva, vagina, but also our urinary tract as well, our pelvic floor, even the cells around our bottom as well, our anus respond really well to oestrogen and testosterone too. So as the levels decline,

we don't have as much blood supply to that area. We don't have as much collagen deposition. We don't have as much sort of stretchiness going on. And of course, our vulva has to be stretchy for sex. But really, when we're walking, when we're exercising, when we're sitting down, when we're moving, it needs to be as well. So a lot of people get some leakage, a cough, a sneeze. They have more urgency or they have some dribbling. We know that these symptoms, and not everyone gets all of the symptoms, but the local symptoms affecting our genital tract affect about 80% of women. So the vast majority of women, and like you say, Anna, we don't sit down in the pub and talk about what our vulva or vagina look or feel

like, but only around 8% of women get treatment. I saw a lady recently in my clinic who's 38. She's got an early menopause or perimenopause. She's still getting periods. She's getting lots of other systemic symptoms. But she said that she gave up work as a teacher because she feels like it's a blowtorch between her legs day and night, especially nighttime. She's just got no relief from it at all. She'd been seeing gynecologists, urologists. She'd had all sorts of treatment. No one had spoken to her about her hormones and her symptoms did melt away with hormones.

So whether a woman takes HRT or not, giving localised hormones, so you can give it as a vaginal pessary, there's vaginal gels, there's creams, there's vaginal tablets, it can be really, really useful. Okay, we have so much to say. There's so much more we could talk about. I want to wrap up with just a final question to you each. Louise, first of all,

what is on the horizon for us in terms of hope and new medication or research? What have we got to look forward to? I think what is good is that women are waking up and it's not just women our age, younger people are too. So people are more outwardly spoken. They've got this sense of entitlement, quite rightly so. So I think the community of people, women, men, healthcare professionals, there's this momentum of change going on now, which I haven't felt in a positive way before. So I hope that continues. And Kate, for those women who are right in the thick of things at the moment, which is where you have been yourself,

is there one message of wisdom that you could pass on to those women who are listening to you? Educate yourself. One of my coping strategies going through perimenopause was to treat it like a story. The journalist in me just kicked in because then I could start to make sense of it at a time when nothing else was making sense. And to be able to just educate yourself and then make choices. I mean, listen, let's not forget to shout about the progress that we've made, that things are way better than they have been ever, right? That's great. Is there better ahead? Absolutely, because there's an army on its feet now demanding better, demanding more. Women should not be suffering to the point that they

can't sit down or they want to leave their jobs because they feel like they've got a blowtorch between their legs, or that they can't think straight or complete a sentence we need to remove the shame from this but more importantly we need to educate women so that they can go in to a health care provider ask the right questions going armed with information don't expect your gp to know everything but expect to know your patient rights if your if your gp isn't able to serve you ask for a referral you know demand better don't just go home and suffer in silence talk with your girlfriends because we're all in this together and for me where i am right now because i'm so exhausted with all of it is i just hang on to the coattails of women who are like 10 years ahead of me. And they talk about this, like I talk about childbirth. Oh my God,

do I remember that? So I hold on to the hope that one day, I will struggle to remember what has been a really difficult time in my life that didn't need to be that difficult. And I'm determined to make sure that other people around me don't have to suffer in the same way. Kate Thornton, from all of us on the show, thank you for being so open. As always, it is a joy to have a woman like you who's just so honest. So thank you for taking the time to be on the show today. And Dr. Louise Newsome, a huge thank you to you as well for joining us in person to share your expertise. Can I just say a quick thank you to Louise, because honestly, you have been on the brunt

and the receiving end of a lot of, as you say, gaslighting. You've continued to speak up and speak out. You and a handful of doctors out there havelighting you've continued to speak up and speak out you and a handful of doctors out there have really made a significant difference to women like me thank you it's not always easy because at the same time as doing all of this you are also perimenopausal so also lacking in confidence struggling to finish your sentences and you're in the same boat as us but you are definitely the captain of many a big ship. Oh, thank you, Kate. That's very kind.

Thank you. And leading the charge. The pair of you said demand better. And that is absolutely, absolutely right. I'll be back next week with a new episode of It Can't Just Be Me. But we can't do it without you. So please get in touch. You can send us your voice notes via it can't just be me.co.uk or you can email me at it can't just be me at podimo.com and don't forget you can find us on instagram tiktok youtube and facebook just search for it can't just be me

because whatever you're dealing with it really isn't just you. From Podimo and Mags, this has been It Can't Just Be Me, hosted by me, Anna Richardson. The producers are Laura Williams and Christy Calloway-Gale. The editor is Kit Milson. The executive producers for Podimo are Jake Chudnow and Matt White. The executive producer for Mags is Faith Russell. Don't forget to follow the show or for early access to episodes and to listen ad-free, subscribe to Podimo UK on Apple Podcasts.