Language of Love with Dr. Laura Berman - The Definitive Guide to Menopause with Dr Louise Newson

Episode Date: April 10, 2024

If you or a woman you love is in her 40s or beyond, this episode is for you! Going through menopause can feel like walking through a big, confusing and uncomfortable maze with no guidance. The good news is there is help and guidance available! In this Language of Love Conversation, I sit down with Dr. Louise Newson, a renowned medical expert on menopause and author of "The Definitive Guide to the Perimenopause and Menopause," to unravel the complexities of menopause, perimenopause, and hormone therapy. Our conversation is not only enlightening but also deeply personal, as we delve into the evolutionary context of menopause and the myriad of symptoms and treatments associated with this life stage. We chat about the incredible benefits of hormone therapy, and yes, that includes vaginal hormones. It's all about finding what works for you because, let's face it, every woman's journey is unique. Personalized treatment? Absolutely essential. This episode is all about empowering you with knowledge and compassion because navigating menopause is a journey that no woman should have to walk alone. Let's get informed and support each other every step of the way. Here is a summary of what we unpack: The evolutionary context of menopause The different symptoms and treatments associated with menopause The misdiagnosis of menopausal symptoms as depression The impact of menopausal symptoms on sexual desire and intimacy A holistic approach to menopause care and caution against sensationalized or over-medicalized approaches  Remember to check out Dr Louise Newson’s book, The Definitive Guide to the Perimenopause and Menopause, for more insights. You can also visit her website or connect with her on LinkedIn. Additionally, don't forget to explore my brand new course that aims to unleash the passion within and help you enjoy a better sex life. Learn more about your ad choices. Visit megaphone.fm/adchoices

Hey, I'm sex, love, and relationship therapist, Dr. Laura Berman. And for the past 30 years, I've been helping people just like you learn to love and be loved better. Here on the Language of Love Conversations, I'm talking to some of the world's most influential and revolutionary experts, thought leaders, spiritual teachers, and celebrities about love, sex, and relationships from a mind, body, and spirit perspective. and that way my goal is to awaken your mind body and soul it's time to become fluent in the language of life dr louise newson is one of the uk's leading medical experts on menopause she's the

doctor who helped kickstart the menopause revolution and has transformed hundreds and thousands of women's lives and their families lives through her work because she is determined to help women thrive, to debunk the myths and break the taboos around menopause, and to educate everyone, including the guys, about the menopausal transition. I, for one, am passionate about this, have been for decades, and I'm so excited to share this conversation with you with Dr. Louise Newsom. Dr. Louise Newsom, thank you so much for joining us. I'm really excited to talk to you about the perimenopause,

is that menopause is something that hopefully every woman will be experiencing to one degree or another if she's lucky enough to live long enough. Indeed, it's something that's guaranteed actually. Not much is guaranteed in life to happen to us, but this is something that will happen. Yeah, and we're going to get into some of the common symptoms of menopause that most of us probably know about or have heard about, but also some of the lesser known symptoms that often kind of don't get identified by us or often our doctors. But I just wanted to start here because I come from a background of anthropology and evolutionary psychology. And I just think this is a really important context to set this all up for my peeps here. Our bodies haven't caught up

with modern medical technology, right? Like our bodies, evolutionarily speaking, are really not designed yet to live well past our reproductive years, right? Like 200 years ago, 150 years ago, to get to age 50, it's like the equivalent of age 90 today. So I think for many, many, many years of our human history, we didn't have menopause because we didn't live long enough to have it. But now, thanks to modern medical technology, we're living, you know, the life expectancy is 100 right or close to that and so chances are you're probably gonna if you're lucky you're gonna live half your life in the pause absolutely and i think this is really important when people say well it's a natural process it's something that happens to to all women so why are

we making a fuss about it why are we medicalizing it why are we talking about hormones and i think you know you're absolutely right we were not designed to live without our sex hormones that are biologically active that affect every cell in our body and the same way there are other conditions we didn't have as much of we didn't have as much raised blood pressure we certainly didn't have as much dementia as we do now and that's part of our aging population and I'm very interested in longevity and it's not the age we die it's a journey to that age and we all want to prevent disease and be as fit mentally and physically as we can. But that's hard when we have missing hormones. And for so many years, we've been scared. Even today, people across the

world, women, men, healthcare professionals, and others are worried about hormones. And I'm hoping one day people will look back and laugh at what's gone on at them. Because at the moment, it's just becoming ridiculous in many ways, actually. Yeah. I want to talk about this because I guess I'm kind of an old timer in this field. I'm not an MD, I'm a PhD, but I've run many women's sexual health centers, you know, multidisciplinary. And I was one of the first,

we were one of the first groups that was openly and aggressively addressing perimenopause and menopause in women. In particular, the population that I was focused on was sexual health. So I was treated, we were treating so many women from a mind and body perspective, had a whole team of physicians

we were doing hormone therapy, we were figuring it all out, pelvic floor therapy, all kinds of things. And I had just started this huge center affiliated with Northwestern University in Chicago when that freaking Women's Health Initiative study came out. It was 2001, I believe, I had just opened. I had a board of directors, raised millions of dollars, this gorgeous center. We had all these physicians and physical therapists and talk therapists, but our main medical arm was hormonal therapy. therapy. And that study, one study came out and we're going to talk in a second. You're going to explain to us how flawed that study is. But one study, just one study came out and my board of directors was like, uh-uh, you can't do hormone therapy anymore. And every doctor I knew ripped the women off hormone therapy and set an entire generation of women into horrific symptoms that

we have yet or are just starting to come back from. That was in 2002. That is crazy. That's more than two decades ago. And we're just now coming to consciousness about how crazy that is. It's absolutely terrible, isn't it? And I remember in 2016, so still quite a few years ago, going to a conference where Philip Sorrell was talking, who was one of the investigators in the WHI study and it was around that time that I'd really really unpicked the evidence of WHI because I kept reading different things about it and so I thought right I'm just going to go back and I'm going to just go unblinkered go to my in my own space and be not judgmental and see what I think about the stats about the setup of the study everything else and I was really horrified

actually the more I read and then I would just went back to basic neuroscience neurophysiology and cell physiology as well and thought actually this is absolutely madness but I remember Philip Sorrell talking at the conference and saying the Women's Health Initiative study was the biggest travesty to women's health that there ever has been and let's let's get past this misinformation and hysteria and allow women to have their hormones back and improve women's health and I thought yes actually and that those words really fired me up to my work because I thought it is hysteria and it is misinformation and it's medical gaslighting at its finest actually and it's it's stripping women of a choice and actually the study wasn't even set up to look

at breast cancer that wasn't a primary end point anyway and even now I get so much pushback on my work and people say yes but we haven't got randomized control studies actually the randomized control study that we had which was the whi wasn't set up for breast cancer anyway so if you're a real purist at science and research we shouldn't be using that to make sweeping generalizations but actually you don't always need a randomized control study at all anyway in medicine or in anything if i was designing a new parachute we know parachutes work i wouldn't give someone a placebo and say, jump out of an airplane. But, you know, the Women's Health Initiative, let's just talk about it for a second, because I want my peeps here to be armed when they go to

their doctor. And granted, if your doctor is unwilling to work with you on this, find another doctor. But sometimes you need to have a moment's conversation with them. And one of the things that I, and you'll do this much better than I, because I'm a PhD and not an MD, but the women who were in that study, as I understood, were already well into menopause. So these were women who in their late forties or as they started to move through menopause, they were given hormones to keep their blood vessels clear and to keep all the health issues at bay. They had been off all hormones in menopause for many, many, many years and then put on hormones all of a sudden. And there's lots of things, actually. So you're absolutely right, because what they were seeing, as you know, back in the 90s, they were seeing all the benefits of hormones. Women were feeling better. Isn't that great that women felt well? But also they were seeing the health benefits. They were seeing stronger bones. They were seeing less risk of heart attacks and heart disease. They were seeing less incidence of clinical depression, all sorts.

so then they thought right let's do this randomized control study that's great let's spend a billion dollars on a study that's wonderful that's never happened since of course and then they have to do a randomized control study they knew they'd have to give half the people placebo so a sugar pill essentially but because HRT is so effective because it's treating the underlying cause you have to treat people that don't have symptoms now it's very hard to find people that don't have symptoms so the average age in the study was 64 so these are people you're quite likely say who are very post-menopausal if you like but they were also a significant proportion of these women were obese overweight and they'd had heart attacks before so they were at a higher risk of heart

disease and actually other diseases as well because of their comorbidity so nothing related to their hormones but the other thing which is really important I think the most important thing of the study, is that they gave a type of HRT that we don't routinely prescribe. So it was the conjugated equine oestrogen, so oestrogen derived from pregnant horse's urine, but it was a tablet oestrogen. So we know tablet oestrogen is metabolized in the body, it's broken down in the liver, there's an increased risk of clot, but it also gets metabolized to oestrone, which is a quite inflammatory type of oestrogen. It's very different to the natural body identical oestradiol that we prescribe through the skin but the other thing which is most significant really the people that

had still had their womb they were given a type of progesterone called medroxyprogesterone acetate mpa which is synthetic so it's man-made progesterone so it doesn't have the same biological beneficial effects as our natural progesterone and we know that it has a very small clot risk a very small cardiovascular risk as well so even me who prescribes a lot of HRT who's very pro our hormones would never even now today regardless of the WHI results I wouldn't prescribe that type of HRT to those women because there are risks with it so when they started to see well some of these women had an increased incidence of heart attacks that's no surprise because the type of HRT you know it's not it wasn't surprising at all but it was to the general population and in this

country at least and i'm assuming it's the same in the uk but in america people are so petrified especially in the community of getting sued that this is a real problem you're absolutely right and then this risk of breast cancer that came out that you know you see these little videos of the time when people were going onto television to say HRT causes breast cancer, terrible, terrible. Everyone stopped prescribing it. But when you look at this incidence of breast cancer, there's two important facts.

The people that took the combination HRT, this increased risk that was reported was not statistically significant. But also women who only took oestrogen who'd had a hysterectomy had a 23% lower risk of breast cancer. and anyone who took any type of HRT had a lower risk of dying from breast cancer as well so actually it's not all bad even when you look at breast cancer but actually the biggest problem

is your FDA, RMHRA, other regulatory health authorities across the world have associated this risk for every type of hormone so anybody who's taking hormonal treatment the insert with their packet, even if it's vaginal hormones that don't even get into the body, it will say risk of clot, risk of heart attack, risk of breast cancer. And that's linked to our prescribing computers. So if I prescribe HRT to somebody, or some low dose vaginal hormones, it will say alert, risk of clot, risk of breast cancer. So that's the biggest problem, I think. So these healthcare professionals will say, oh, my goodness. And the problem is also, is that women will get breast cancer, they'll get heart attacks or they'll have strokes, whether they take HRT or

not. But if they're on HRT and they develop breast cancer, they think they're going to be sued. They think there's going to be a problem. Yeah. And, you know, even for me, I'm in, I guess, perimenopause for many years now and a breast cancer survivor. I am not, my cancer wasn't estrogen or progesterone sensitive and I didn't, I'm not a brat, you know, I don't have the gene, but I had to fight tooth and nail and sign my life away to get. And every time I go for a checkup, my oncologist, she like gives me a line. You really want to be on all I'm on testosterone and progesterone. I don't need estrogen yet, but I'm on bioidentical testosterone and progesterone. And I literally get given the third degree every time I go to the oncologist, even though my cancer had nothing to do with

hormones. And as I've said to them all the way through, to me, I've done the research. I don't think I'm at risk. I'm being monitored. My hormonal levels are being kept within a therapeutic range. And I'm much more interested in quality of life than quantity of life. And the symptoms that happen for so many of us and were happening for me, especially mood-wise with perimenopause and menopause can be absolutely debilitating. And I think because so many doctors have been unfortunately misinformed and scared away from this, doctors in general, this is my biggest problem with the medical profession, and I'm not accusing you. I know you deal with this stuff, But what drives me crazy is that if there isn't a fix in their back pocket, they will not ask about

it. Unless they got a pill or a potion to prescribe you, they aren't going to ask. And if you mention it, hey, I've been having hot flashes. I'm having difficulty sleeping. I've been gaining all this weight around my middle. I feel like half the month, every month, I want to blow up the world. Then they'll just be like, well, this is just a natural thing to accept about aging and just go home and have a glass of water. I don't want to have sex with my partner. It hurts when I do. I have dryness and pain. Well, just tell them to stimulate your clitoris some more. It just is infuriating to me. So I know you have a book that's not only in the UK, but in the United States as well, called The Definitive Guide to the Perimenopause and Menopause. And you go over

a lot of the symptoms and the treatments, but I'm wondering if you can kind of give us a review of some of the ways, because I don't think a lot, because no doctors are talking about it, women now, I mean, I know about it because I'm in my 50s, because I've been doing this for 20 years professionally, right? But for your average woman who's now moving into her 40s, she has lived the past 20 years hearing nothing about hormones in the public vernacular. So let's help them understand what symptoms they may be having, identify them, and talk about some of the treatments available. Yeah, that's great. So, I mean, just before we talk about symptoms, let's remember and remind ourselves what hormones are. They are just chemical messages

that they go into our bloodstream. They go all around our body. They go to every single cell. And we have loads of hormones in our body. Our bodies are really well designed and hormones regulate lots of cell processes. So when we're talking about hormones in this conversation for perimenopause and menopause we're talking about our hormones that our ovaries produce which are oestrogen progesterone and testosterone but they're not just produced by our ovaries actually they're produced by our adrenal glands our muscles but also they're produced by our brains they're actually neurotransmitters so that's a false accusation for many years we've been told there are sex hormones yes they can be important for sex but they don't define us as women because

we have testosterone and men have testosterone we have oestrogen and men have oestrogen as well just different amounts of course so I just think the word sex hormones is really weird and if you just say hormones then actually what about thyroxine what about um insulin what about all these other hormones so so but this conversation is about oestrogen progesterone and testosterone these three hormones together are really important and our ovaries do produce them and they help regulate our menstrual cycle of course they help with fertility but they affect every single cell in our body so they affect really important cell processes and once you realize that then it's easier to understand why we have so many symptoms actually or can have

symptoms some women will say they have no symptoms at all other women will have every single symptom in the perimenopause as some people might know it's the time when people are having very fluctuating levels of hormones often and they're generally on the decline and it might just be that people feel a bit rubbish a few days before their period when hormone levels are naturally lower or it could be some a few hours or a few days or a few weeks and then people feel fine again so it can be very hard to work out what's going on but if you start with our brain because our brains are the most important organs of our body of course because without our brains we're nothing but our brain can be really affected by fluctuating hormone levels as well as low hormone levels

because our brains like everything stable we all know that when we've had this hangry you know when we're hungry and angry together or if we haven't drunk enough fluid or if we've hung over or if we you know all sorts of things our brains don't like they like homeostasis so when we've got fluctuating levels in our brain very common symptoms can occur including anxiety low mood irritability feeling actually really cross and angry and everything is awful short-tempered which I'm sure a lot of people resonate with and also sleep can be affected memory can be affected just that sort of feeling of self-worth self-love self sort of pity can can actually come on but also a lot of people lose confidence they say I just feel a shell of myself I'm just existing

I'm joyless I'm flat all these sort of adjectives I hear every day in our clinic and those are related to our hormonal changes in our brain but our hormones also because they work as neurotransmitters chemicals that affect the way our brains work they interact with other neurotransmitters as well so we've got other neurotransmitters such as dopamine our reward hormone. So if we, I don't know, go for a run or eat some chocolate, we'll feel really happy and gratified. We won't get that same sort of feeling if we don't have enough dopamine in our brain. Serotonin is thought to be our happy hormone. Serotonin levels reduce because estradiol levels are lower. And then we've got noradrenaline, our stress hormone, but it helps

regulate our blood pressure and our heart rate as well. And just the way that we sort of feel more wired, more able to do things. Our hormones are all in a fine tune, but all these other neurotransmitters can have an effect. Are those other neurotransmitters like dopamine and oxytocin impacted indirectly by lowering estrogen, progesterone? Absolutely. Yeah, they do. And they can work in different ways. So if you think of melatonin, it's derived from tryptophan. And actually estradiol is one of the hormones that works in that pathway, but also just the levels of hormones. If one level of a hormone is low, other hormones decline. And that's the same with sort of serotonin and dopamine as well.

And obviously there's the part in our brain, our thermoregulatory zone. So that's why the hot flushes and sweats go, but that's not the commonest symptom actually, flushes and sweats. It's all everyone talks about, but it's not the commonest symptom at all. I've had none of those. I just want to highlight what you're saying here, because what she's describing guys is so often for your 40 something year old woman misdiagnosed as depression. Okay. You can't sleep. You feel lethargic. You feel infuriated and angry and like a shell of your former self. You're having trouble finding joy. You're having trouble staying awake during the day and falling asleep at night. Oh, let me give you an antidepressant.

when that's not real. And then that has a whole other bunch of side effects, right? When that's not what the issue is. Absolutely. And it's so much easier for women to be prescribed antidepressants than it is HRT. And I understand that because in isolation, you could say, well, that ticks every box for clinical depression. But there's two important points here. Firstly, listen to patients and listen to women and listen to yourself. Because a lot of women say, I know I'm not depressed. And when I see people, they would tick a box if I gave them a questionnaire and would come out as quite severe depression. But they have really good insight. They have really good eye contact. They know that they're not depressed because also they'll say some days

I'm fine. Other days it hits me like a bus. And that doesn't happen like that with clinical depression. Every day often is really bad when people are clinically depressed. But also as healthcare professionals we should be asking other questions and it's not just in the 40s one in 30 women under the age of 40 will have an early menopause so that means there will be people in their teens their 20s their 30s who will be having perimenopause or symptoms so if you are experiencing any of those symptoms just take a little time to reflect and think what are the symptoms so there's lots of symptoms the list is as long as you are and it can be dozens and every day I hear new symptoms from women but even if you work through the body the eyes can be affected

people can get dry eyes they can get watery eyes they can get a dry mouth sore mouth even they can get taste changes or smell changes the skin and hair obviously can change the skin can become drier the hair can become coarser people can have hair loss as well people even find that they can have voice changes they can have breathing problems because we've got hormone receptors in our in our lungs and irritable bowel type symptoms are really common and heartburn as well people can feel bloated they can just have digestive problems you can have muscle and joint pains they can have palpitations the list will go on and on and on and so it's very important to just sit and get a symptom questionnaire there's one on the free balance app where people can just like

they're the commonest symptoms just have a little think and if you are getting those symptoms then common things are more common in medicine and so think about could it be my hormones and there's no hormone blood test to do that or saliva test or urine test that's accurate so what we usually do is it's a diagnosis that's made clinically by someone's story and their symptoms and then often what we do is say look I think it's related to your hormones you think it's related to your hormones we can try and give you some natural hormones which is just the body identical hormones and review how you are and we sometimes or quite often do blood tests when people are on HRT to monitor whether they're absorbing whether it's the right dose for that individual but a lot of

people come to our clinic and say well I've had my blood test and my doctor says my hormone levels are normal oh it can't be and that drives me mad because it's right mad when that happens I get so mad or or yeah they're just like I was told my hormones are fine well your doctor doesn't know your hormones. Hey, it's Dr. Laura Berman. I've been a sex, love and relationship therapist for over 30 years. And the main question I always get asked is how the heck do we spice it up in a long term monogamous relationship? Well, if you want to take your love life, your sex life to the next level, whether you're in a relationship or not, check out my free course on quantum sex. It's going to teach you how to take your sexual response to the next level capable of full body

orgasms, how to use sex magic to manifest your dreams and how to connect on an even deeper level sexually with your partner. Just go to drlauraberman.com and you'll find it right there on the homepage, the quantum sex free course. Check it out. Let me know what you think. and the other thing is is that when i go to when i've been to lots of menopause conferences everybody or every conference i've been to there is always a gynecologist who presents this this chart about the symptoms and they always say that vasomotor symptoms come first and then people get mood symptoms and then right at the end they get vaginal dryness and soreness and bladder problems and actually seeing thousands of women that i have done or we have done through our clinic

I have seen many women who have presented with such bad vaginal dryness they can't sit down urinary symptoms urinary tract infection cystitis they've never had a hot flash and they've never had any mental health issues and so we don't follow textbooks as women so you can have different symptoms at different times your friend's symptoms are going to be different to yours but actually vaginal dryness and urinary symptoms are really common they affect about 80 percent of women and they're progressive which means they will carry on relentlessly until you have treatment so even if people only have one symptom they can still have treatment you don't have to have a certain percentage or number of treatments you don't have to wait till your job is on the line

or your marriage is on the line before you can ask for help so and by the way that's really important and we're going to get into what kind of treatments are best or available now in a second but it's also we got to make sure we mention low desire that's a huge one absolutely and that's really important so on the questionnaire that I ask everybody in the clinic to fill there's a question about libido and sexual desire and as a doctor I can talk about anything it doesn't doesn't bother me but I was really shocked when I started my clinic eight years ago the number of women who said no one's ever spoken to me about sex and I'll say well and they'll say to me do you know what Dr. Neeson I still love my partner I still really adore him but I do not want sex I

would prefer to stick my head down the toilet than have sex yeah I go to bed early I'd hear the telly going and I think good let me go to sleep let me go to sleep before he comes into bed they said and it's not like they said it's just like the lights aren't on down there I'm numb from the waist downwards so there's a physical thing that they they're not getting any clitoral stimulation they're not having orgasm but also it's often really painful because the tissues can become very dry they can become very thin very sore and not stretchy so a lot of women tell me how painful it is which is horrendous but also they often feel rubbish you know if you're pushing on weight if your hair's all lank your skin's all dry you know you're irritable you're shouting at

everyone the last thing you want to do is jump into bed and take your clothes off and but it's not just always about penetrative sex people just don't want to hold hands they don't want to hug they just feel very worthless and they feel that they don't deserve to have this love and this really really upsets me actually because you know life's hard enough we don't want any other barriers stopping us loving ourselves or other people loving us and I think that's one of the symptoms that is not discussed enough because doctors are embarrassed talking about sex or sexual relationships or intimacy and patients often don't bring it up unless we bring it up but it's just not spoken about and it doesn't just affect that individual it affects the partner as

well. Of course it does. And I used to do a lot of work with West Midlands Fire Brigade. So mainly men, but they were men in their forties and fifties who were, when you talk to them about the menopause, they were like, oh, so that's why I'm not getting sex. They don't go down to the pub and say to their friends, hey guys, I haven't had sex for two years. They'll talk about how much sex they do have when they're having it. But, you know, it's wrong, actually. And people in same-sex relationships, often if they're both perimenopausal or menopausal, it's really hard. Yeah. No, that's what so much of my career, especially in the first 10 to 15 years of it, was really focused on because, I mean, and I was training physicians and I was astounded

by how little to no training they still get 20 years later, little to no training on how to talk about these things, what to ask for. And once again, without a viable treatment in their back pocket, not willing to do hormone therapy, then they're not going to ask about it. And they're going to brush off anyone who does because they don't have something in their minds to offer them. So the way that medical training seems to work, which I think is one of the most dysfunctional parts of it is you don't ask about things you can't treat which is awful because actually i i actually totally disagree with that because even if there's things that i can't treat or i can't diagnose one of the things that people say every day in the clinic

is thank you for listening thank you for understanding trying absolutely and you know we've known for centuries actually how women there's gaslighting going on all the time with women we've not been believed we haven't got this voice it's all in our heads we're making it up we're sensationalizing our symptoms and actually ever since I was a junior doctor I was taught just listen to your patients show some empathy and some warmth and compassion and understanding and actually as a GP a family physician so many times I didn't know what was going on with patients, but I'd say to them, look, it could be lots of things. Let's just go through a list and see and try and work out. But I can't help you today because I need to maybe do a test or I

need to try a medication or something, but let's work together. And I'd share the uncertainty, but actually just having somebody that takes you seriously is really important, actually. It's half the battle, I think. And it's also something that it's something that's affecting women everywhere, couples everywhere. And it's like we said, it's not just the sexual side effects, but that's a huge piece of it, especially when it comes to love and relationships. So let's talk about, I know you mentioned bioidentical hormone therapy, which I am a fan of as well. And in fact, I remember when I went to my cancer doctor after I had, you know, I went through chemo and it put me into perimenopause, not full menopause, but I definitely started noticing

sexual side effects. And I go to this woman and I'm like, and she's supposedly like the cutting edge oncologist in town and blah, blah, blah. And I said, listen, what should I do? Like, what's the story on hormone therapy? How do we handle this? How do we monitor thinking that she'd be totally on board? And she literally looked at me and said, listen, sex isn't that important. And I just said, do you, so you're talking to right now, first of all, second of all, like I started crying in her office. I was so appalled, not for myself. Cause I knew I knew what to do and would find the doctor to do it with me. But because I was thinking about all the hundreds of women that she had probably set that to, and she's a woman. And I don't know,

I was just furious, but let's talk about what treatments, cause there's so many out there, right? There's the synthetic kind, there's the pharmaceutical kind, there's the bioidentical kind. Can you talk about sort of the treatments that are available, at least the ones that seem viable risk factors? Yeah. And I think what, you know, we've already said that the menopause and perimenopause is a hormone deficiency. So number one treatment for the majority of women and all the guidelines say that all the evidence is is that we replace hormones and and I'll talk about the different types but the important thing or the reason that we do this is firstly to improve symptoms because if you get the dose and type of hormonal therapy right you will improve symptoms

and actually number one for me as a doctor I want to help people and make them feel better and so people will feel better if they're on the right dose and type but the other thing that we haven't mentioned yet is that without our hormones there's an increased risk of diseases so there's a real increased risk of all the inflammatory diseases which include heart disease osteoporosis type 2 diabetes clinical depression dementia inflammatory diseases such such as arthritis even parkinson's disease and that is hard to listen to but it's fact we know the longer a woman is without her hormones the greater the risk is so if a woman has an early menopause under the age of 40 her risk really increases we know from the evidence that replacing

those missing hormones reduces the risk of these diseases not rocket science because you're giving those hormones back so it's another reason that we have to listen and think about and I know in America and in the UK that the guidelines say there isn't enough evidence for primary prevention of diseases and that's more of a political thing because if they said they did menopause would have to be covered by insurance and no one wants to insure 51% of the population. So there's a political agenda, but if you look at the science, it's there. So the natural hormones is what you want because anything in medicine you want to replace as naturally as possible. And so when I say natural or body identical, it basically means they look exactly the same as the hormones we

produce when we're younger. So they haven't been chemically modified or enhanced or altered in any way. Now there's a bit of a confusion between body identical and bioidentical and your listeners will realize we both said both. Now in an ideal world we would have proper regulated licensed medications that were the body identical hormones. In the UK we do have a quite a good choice of oestrogen which is the pure oestradiol as a patch or a gel or there is a spray but it's not so well absorbed but certainly the patch and the gel that go through the skin into the bloodstream and we prefer that way of giving the medication the oestrogen because it stays as oestradiol goes into the bloodstream straight away through the skin there's no risk of clot

there's no risk of stroke we can tailor the dose to the individual so that's the safest way of having it now in the US it's harder sometimes or more expensive it can be to get the regulated licensed estradiol so some people have this compounded bioidentical hormones then there's the progesterone and we have the natural progesterone there is this micronized progesterone which basically means it's been ground up very small and suspended in a bit of a oily substance to so it can be absorbed in the body and that can be used orally but we sometimes give pure progesterone vaginally because it gets absorbed as progesterone through the vaginal tissues into the bloodstream. There are synthetic progestogens that we mentioned, like in the WHI study, and

there are others as well, which are usually oral tablets, which we try not to give. There is also the interuterine system, the Mirena coil, which does contain a synthetic progestogen, but it's a very low dose. It works locally on the lining of the womb and keeps it thin. So it's good for women who have heavy periods and also good for women who need contraception. So that can be given as part of HRT but we usually give oestrogen to everybody we usually give progesterone for those women who have still got a womb but increasingly we're giving it to more women even those that have had a hysterectomy because it's a biologically active hormone that's very anti-inflammatory good for our brains good for our bones good for our heart and other areas of our body and then

testosterone a hormone that actually is the most biologically active hormone that we have in our bodies and that level of testosterone declines as we age so it's not really a menopause related hormone it's just something that reduces as we get older and our ovaries do produce it now testosterone can help with libido but it can also help with mood energy concentration stamina muscle strength bone strength as well not much research because no one's done it most of the research has been done in libido but we know that it's an important hormone now we can't get a licensed preparation for women over in the UK we have the licensed preparation of course for men they they are able to get testosterone so we can prescribe it off license there is a licensed

cream called androfem in Australia that we can prescribe off license but it's still a regulated product. In the US I know it's harder to get this regulated product but there are good compounded bioidentical hormones and there are those that are not so good even in the US as well. So if you're getting the pure hormones in that way so testosterone through the skin as a patch or gel the oestrogen through the skin as a patch or gel and the progesterone either orally or vaginally or the coil, then that's good. There are some compounded formularies where they have a mixture of all sorts and it's often sort of all together. It can be a lozenger. And I worry about those because we don't really know the actual concentrations of each. And because they're

not regulated, you could get two from two different compounding pharmacies and they'd have different concentrations. And some of them are really expensive. Now, some people do use pellets or implants and they've been around for many years actually and you know there's nothing wrong with them if they work I tend not we don't use them in our clinic because we find through the skin is so easy and women can be in control if you have the implants you have to go back to a doctor you have to pay more money and I really don't like the fact that women have to come back can pay more money and also some people find that as they reduce then they're sort of left with not with more symptoms and so at least with the patches or gels or the the creams and gels of

testosterone women can be in control more of their dosing and how they take it so there is a choice but they're all the just the hormones so there's just the three hormones and then vaginally there are vaginal oestrogen preparations and we have a choice of a vaginal tablet a vaginal pesary a vaginal cream a vaginal gel there's even a little ring that can be used and we've also got something called prasterone which is in cheroza which you have in the US as well which actually contains DHEA which converts to oestrogen and testosterone in the vagina and the surrounding tissues and I use that a lot more than I ever did in my patients because you're then treating the whole person whereas if you just give vaginal oestrogen you're not going to stimulate the testosterone receptors

that are in the vulva, the vagina, the urinary tract, around the clitoris so people will only be half treated. So the intrarosoprasterone can be really good as well and the vaginal hormones don't get absorbed into the body so women who maybe have had an oestrogen receptor positive breast cancer, who don't want to take HRT or have chosen not to, they can still safely use vaginal hormones. That's so important, guys, to hear. It's really important. There's no one who cannot have vaginal hormones. And that's really important to know that, actually. And you don't have to wait until your symptoms are really bad. And about a fifth of women, so about 20% of women who are on systemic hormones still need to use vaginal hormones and that's very safe as well

so some people come and say oh it can't be my hormones that i'm having some leakage or getting up at night to pass urine or having some pain on intercourse because i'm on hrt yes you can still have vaginal hormones that can work very well for some women yeah really really good advice and what would you say is, I mean, I refer people often to, at least in this country, to the American Academy of Anti-Aging Medicine. And you can find people on their website who, you know, I tell them to look for someone who's like a diplomat or a well-established member in the organization who does hormone therapy, bioidentical hormone therapy. Like, ironically, that is where I can find the physicians to refer to rather than in the OBGYN community. And so that is one place,

guys, you can go in this country, maybe internationally too, but the American Academy of Anti-Aging Medicine. But I'm wondering if you have any advice for how to find a physician. I mean, obviously they can come to you in the UK, but in the United States or in general, what recommendations do you make to people about how to find a doctor who really will take them seriously and work with them? It's really, really hard for something that affects 1.2 billion people in the world. There's banishingly few healthcare professionals who are really good. And as in they're really specialized in the menopause and traditionally the menopause has been looked after by gynecologists and some of them are excellent, but sadly, some of them

don't think above the ovaries so they're very good if you've got bleeding they're very problem good if you've got a gynecological problem they're not so good if you've got low mood anxiety joint pains or whatever and that's the way they've been trained I just through social media are in contact with people from all over the world and it's really embarrassing when I say sorry I don't know someone in South Africa sorry I don't know someone in Japan or Hungary or even well Italy I do know one person who's excellent but there's not many people and we've got an education program it's called confidence in the manifolds that we created a few years ago and we've just recently relaunched it we've had 32 000 downloads of it people that have done the course and those are

people from across the country so sorry across the world so we're increasingly getting a directory of people but I you know we see about a third of people we see in the clinic are already taking HRT but they're coming to us because they're not feeling better and they're not on the right dose or type of HRT and there are a lot of women I speak to who have been told oh well you're still getting symptoms they can't be due to your menopause because you're on HRT and then we look at their prescription and they're on a really low dose of oestrogen they're not on testosterone that are not on vaginal hormones. And I always say to women, I cannot tell you how much of your symptoms or many of your symptoms are related to your menopause until I've optimised your hormones.

We're all different, but I'm going to give you back the hormones that you need through a physiological range, and then we'll see what's left. And if you're still getting palpitations, of course, let's see if there's a heart problem or if you're still feeling low, there might be something else going on and of course women can have two pathologies you know we've seen people I saw one lady in the clinic not so long ago who had a brain tumor as well as being menopausal she she but she was getting some absent seizures which weren't fitting in with the menopause she had a brain scan but she still was menopausal a lot of her other symptoms were and I think sometimes in medicine people are scared to to sort of think about hormones and

then there's this whole thing as well you're putting everything down to the hormones you know if I've had an argument with my husband because he's really frustrating me I can't blame that on my husband on my hormones you know or if I'm not sleeping well at night because I don't know the cat's jumped on the bed because I forgot to lock the cat out into the kitchen that's not my hormones fault but we can look very holistically at everything and so I think actually having a family physician is better than having an you know ob-gyn because we have very holistic training and that's probably why you're going to the anti-aging group rather than to obs and gyne and traditionally the menopause societies are set up by gynecologists and some of them like I say are

fantastic but if I was a gynecologist I would want to do operations I would want to do look at gynecological diseases. And if I'm a menopause woman, I don't have periods, my ovaries aren't working. So why would I want to see a gynecologist? It doesn't really make sense to me. It doesn't make sense when you put it like that. I think at least in this country, we think of gynecologists as sort of the gatekeepers of our women's health. You know, we sort of put everything female-centric in there. Well, that's right. But I've already said at the beginning of this conversation, the most common symptoms affecting women affect our brain.

If we're going to see a specialist, we should be seeing a neurologist or a psychiatrist, but psychiatrists often aren't trained in female hormones. No, they're not. I did find a neuropsychiatrist out here in California, and he's the one that actually treats my hormonal issues. But it's hard. It's hard to find someone. So you often, just like with dating, have to kiss a lot of frogs before you meet the

prince or princess of a physician that's going to be able to help you. And the goal here is to arm you. And hopefully this has been an amazing, informative conversation. Hopefully you've got a lot of information about what to look for and what to ask for. And let me just ask you, if you're advising someone, if someone's calling around, calling the anti-aging medicine, calling endocrinologists, neuropsychiatrists, you know, seeing, asking around, what kind of questions should they ask to see if this position is a good person to see? It's a great question. I think it's really important to ask, firstly, have they got an interest in hormones and the perimenopause and menopause? Because if they're not interested, it doesn't matter how good they are, then I

wouldn't be that bothered. Whether they prescribe body identical natural hormones and whether they, you know, how many women they see, because I see some people and they say, well, our clinic's really busy but they see like four people a week or three people a fortnight actually you have to be seeing lots of people to really make a difference and are they looking at long-term health risks as well as symptoms as well I think it's really important to look at too so you don't want to just a quick fix you want to be looking into the longer term too and those are really the most important questions I think if people are trying to sensationalize or even over-medicalize the menopause in the way that I've seen. I went

to a conference a few years ago and there was an American doctor there and we were just discussing cases and he was discussing a case of a young woman who was 38 who had her ovaries removed because she had endometriosis. And he said, right, and she's now on a bisphosphonate for her bones because she's got osteoporosis. She's on a statin for her cholesterol because she's got raise cholesterol she's on citalopram for her depression that she's got she has sleeping tablets she has painkillers for her joints and I just sort of stuck my hand up and said what about HRT oh no no no we wouldn't give that that would be last resort because breast cancer la la la la and I just thought hang on a minute so he would say that he was a

menopause specialist and he gave treatment but as a 38 year old woman I would be mortified to receive all that medication instead of hormones. So this is where we have to be really savvy. And I think the most important thing we can do as menopausal or perimenopausal women is to be armed with information. And, you know, a lot of my job as a practicing healthcare practitioner has been an advocate for the patient is talking about sharing the decision making and talking about treatment choices. So if someone comes to me and doesn't want HRT, that's fine if someone wants to talk about which exercise to do that's fine but I think it's worth making the patient central but you have to know what's going on and you have to understand the

benefits of hormones because for so long we've been scared away from hormones and the media have tried to scare us away the healthcare practitioners have tried to scare us away because they haven't have the right training but we need to be grown up because as you said at the beginning it might be half our lives we're without hormones it's often many decades so this isn't just a short party that we're having it's really important and we have to remember that once we're menopausal we will have low hormones forever whether we have symptoms or not we will have low hormones and those low hormones give us an increased risk of diseases. And the commonest cause of death in women is heart disease and dementia. And we know taking HRT reduces risk of those diseases. So we

have to be integral to making our decision for our hormonal health. Yes. And they aren't a menopausal expert if they aren't open to exploring that. So that's great advice. The book we'll put in the show notes, Dr. Louise Newsome, the definitive guide to the perimenopause and menopause. Thank you so much for joining. Thank you for inviting me. We really appreciate the advocacy and the work you're doing in the world. Oh, thank you. me a prescription but there is no

cure for crying