Life Uncut - Hormonal Changes, Menopause and Perimenopause. Uncut with Dr Louise Newson

Episode Date: September 24, 2024

Dr. Louise Newson is a leading expert in the field of menopause and perimenopause. She's a GP, menopause specialist, educator, podcaster and author. She’s the woman in the know of menopause and today we would like to break down the misunderstandings, myths, misconceptions and medical misogyny surrounding menopause. In this chat we speak about: Changing hormones & how it affects our brains and behaviour The tendency for medications like antidepressants or sleeping tablets to be prescribed How the labelling of menopause doesn’t really mean anything How the loss of ‘zest’ for life impacts their relationships What type of hormones are safe to take for HRT and contraception What lifestyle factors largely affect hormones Whether other conditions like PCOS, endometriosis or diabetes can change the onset or ‘severity’ of menopause You can find the episode on PMDD that we mentioned here - PMDD You can find everything from Dr Louise Newson including her resources, podcast and book here! Dr Louise Newson's Website   You can watch us on Youtube Find us on Instagram Join us on tiktok Or join the Facebook Discussion Group Tell your mum, tell your dad, tell your dog, tell your friend and share the love because WE LOVE LOVE! xx    See omnystudio.com/listener for privacy information.

Life Uncut acknowledges the traditional custodians of country whose lands were never ceded. We pay our respects to their elders past and present. Always was, always will be Aboriginal land. This episode was recorded on Cammeraygal land. Hi guys and welcome back to another episode of Life Uncut. I'm Brittany. And I'm Keisha and today we are discussing a topic that so many of you have written into us. The guest has been one of the most requested guests that we have had in a very long time. We are speaking to Dr. Louise Newson. Now, Dr. Newson, or we will refer to her as Louise, I have asked for that permission, is a leading expert in the field of menopause and perimenopause.

She's a GP, menopause specialist, educator, podcaster and author. She's the woman in the know of menopause and today we would like to break down the misunderstandings, the myths, the misconceptions and medical misogyny surrounding menopause. Louise, welcome to the podcast. Ah, thanks for the great introduction and thanks for inviting me. We've done a couple of episodes on the podcast on all things women's health and the current theme seems to be that there's a lot of medical misogyny that we all go through to the point that a lot of people didn't know what perimenopause was and I was one of them. I knew about menopause, I knew that when my mum experienced hot flushes, she would say, oh, I'm going through menopause.

And she had a lot of side effects to do with her mental health and changes to her body. And other than that, I didn't really know much about it. Louise, can you talk to us about the difference between perimenopause and menopause? Yeah, for sure. The whole thing about all of this is there's just a hormonal imbalance. So in an ideal world, I don't think we should be talking about perimenopause, menopause, because then we're forgetting women who have PMS, premenstrual syndrome, or PMDD, premenstrual dysphoric disorder, or even postnatal depression, which is related to

changing hormones. What happens is, usually as we age, but it can be at any age, our hormones fluctuate and reduce. Our hormones are just chemical messengers that go all around our body, but they're really important. So they affect every cell in our body. So when the levels aren't optimal in our body we can get a myriad of symptoms and also some biologically negative effects in our body as well. The whole definition of menopause is a year after our last period which is I just think really just I'm not bothered about my period, I'm not bothered when it is, I'm bothered about my function, I'm bothered about my brain. So the perimenopause is defined as when periods fluctuate and change and people get menopausal symptoms but lots of people don't

have periods or they have artificial periods because they're on contraception and a lot of women are saying well I'm getting regular periods am I perimenopausal or not and that's why I think I don't know I hope you agree as women I'm more than just my periods do you know so it's looking at what are hormones what do they do in our body why are they having this effect and then we can open the conversation to my 13 year old who's started periods and feels terrible a day before her periods to my, I can't tell you how old she is, my mother, who has been menopausal for 30 years. You know, it's sort of, we've got to be changing the conversation because otherwise people are, you know, my doctors tell me I can't be menopausal because it's only 11 months and,

you know, two days since my last period. Therefore, it's like, oh, come on, please, you're having symptoms affecting the quality of your life. You have health risks without hormones. Let's just be a bit more grown up about this conversation. And that's why I think a lot of work has to change. Well, I think that's really interesting because I've always been under the understanding exactly what you just said before, that menopause happens when you have from a year to the day, not had a period. So it's interesting that you say like, that's rubbish. How would you define menopause then? So I don't think I need to define menopause. I think what we need to define is a hormone imbalance in women's bodies and a hormone deficiency or insufficiency,

because the thing about menopause if you take a step back and think actually what happens to our body a year after our last period and if it's a leap year do we do 365 days or 366 days like it's just getting a bit silly now isn't it like I'm trying to read I've read a lot of history books from the 1800s recently for a tour I'm doing in September and I can't work out who actually decided who sat around a table and were it was all men obviously because they were only male doctors then so who actually decided that it's a year like it just doesn't seem right it's another way of sort of gaslighting women and putting us into a box and just making everything normalised when we're feeling terrible so I think we should be talking about a hormone insufficiency I think

we should be realising that the three hormones we're talking about are oestrogen progesterone and testosterone and we can lose or have changes in these levels of hormones at different times so some people are more testosterone deficient than estrogen deficient there's a lot of women out there especially with endometriosis who have progesterone deficiency more than estrogen or testosterone but all these hormones are just derived from cholesterol they're all natural hormones that are made in our ovaries of course but they're also made in our brains and other organs in our body so we have to be thinking about what's going on in our brain because without our brains we're nothing are we and for too long we've just been concentrating on how heavy are your

periods do you get period pain are they regular are they not like it's irrelevant actually I can cope with any periods if I'm functioning as a person if you see what I mean yeah absolutely Louise not many of us would be going for regular blood tests not many of us would have kind of any idea of what levels our hormones of any of the three that you mentioned were at so what are some are the other symptoms that there could be a hormonal change happening yeah and that's a really important question and even if we did go for blood tests you know what i did some blood tests on a patient 10 times in a day and they were completely different every single time wow and so our hormones fluctuate all the time but the other thing is when you do a blood test what hormone is in level of

hormone in my blood is not the same that's in my brain or my tissues and so there's a lot of wasted money on blood tests where people are just going oh no my blood test is normal but I'm waking up eight times in the night and I've got night sweats and I can't concentrate and my bladder shot to pieces but you know my horse so we have to be really careful but we also have to remember in medicine not everything needs a test like I have migraine I don't need a brain scan or a blood test to diagnose migraine I need somebody who's an expert and me as an expert patient to make that diagnosis if i've got the right information if there's certain classic symptoms of migraine which enable me to make the diagnosis myself actually as a patient but also as a doctor if

i'm seeing women with migraine it's exactly the same with hormonal changes and what we have to do is which is what's forgotten for many years actually is talk to women properly ask them to help with the decision making about the diagnosis and often when people have the right information and that's one of the reasons I developed the free balance app that people can have information they can look at symptoms and there are lots of symptoms we can talk about and then it's that light bulb moment going oh yeah actually I'm getting those symptoms and they're worse before my periods when my hormone levels are at their lowest that must be somehow related to my hormones might not be everything but it might be 10 or 80 related to my hormones but actually if it is

related to my hormones do i need an antidepressant or a painkiller or a sleeping tablet or do i just need some natural hormones and then you're changing that whole conversation but you've got to put you know i went into medicine to help people feel better but also to have my consultations where the patients are in the center so if a patient's coming in to me and saying do you know what i think this is related to my hormones 99.9 of the time that lady is right and the problem is so many times, every day in my clinic, people have said, but I'm not listening to you, doctor. I've tried to explain and I'm not listening to you. And that's in all countries, not just in the UK. Dr. Louise, this is something that I've been diagnosed with PCOS nearly two years ago. I had

seen three different GPs. For anyone listening who doesn't know, polycystic ovarian syndrome, it's a hormone imbalance. I have fluctuating hormones of all different kinds of levels. And like you said, I've had blood tests that showed things were normal. I've had blood tests that showed that things were excessively abnormal. I saw so many doctors. I presented with so many of the symptoms. I was fatigued. I had brain fog. I had a feeling within my body that something wasn't right. And I constantly felt invalidated. And it took for me to actually go and get Roaccutane. I went and saw a dermatologist and she was the one who led me to an endocrinologist who ended up saying, we need to get to the bottom of what's going on with your hormones.

So for me, that was a really frustrating experience. And I can only imagine that women going through the period of being maybe 40 into their 50s, you know, this either perimenopausal or menopausal state, because of how many of us are going to experience this, I would have hoped that doctors would be a lot more receptive to these concerns and these symptoms that so many of us are going to present with. Is that the case? Yeah, you'd hope. But I think there's many problems in traditional medicine, actually.

One of it is that we've been trained, and we still are, to treat disease rather than prevent. We also have become more and more siloed, so that if I was a cardiologist, I would only be looking at the heart. If I was a neurologist, I would only be looking at the brain. And, you know, I'm a general physician, so I have been trained to look at every organ. And because they're called sex hormones, it's almost like they're an optional extra, but they're not about sex, they're not about gender. Men have oestrogen and progesterone. Testosterone is the most biologically active hormone we have. So they're heterosexual hormones, they're health hormones, but they've almost been put to the bottom of the pile. And the other thing in medicine, we're often so busy thinking about how to prescribe a medication that we're also not thinking holistically about treatment options

because hormones often are really important but so is everything else as well so it's not just take the hormones and and go away and enjoy your life it's like let's rebalance your hormones when I see you again let's then talk about your lifestyle your exercise your sleep your stress everything else and that's often forgotten because in medicine it's quite a conveyor belt you know you're in and out you deal with one problem one consultation but actually if you spend time helping people as soon as they start to have symptoms you know we're investing in future health and people that I see in the clinic it's transformational medicine because with hormones if their symptoms are due to hormonal changes their symptoms improve they feel better which

is wonderful but more importantly they are improving their future health they're reducing risk of disease keeping away from doctors and enjoying their lives and that's what we all should be working towards as doctors. Dr Louise what was it that made you so passionate about hormones and this research that you're now conducting with perimenopause and menopause as a GP what was it that made you go down this path? It's mainly I was working part-time as a GP but I was also a medical writer for many years unstripping sort of evidence looking at all diseases and conditions and writing about them so that doctors and patients could understand more and I was asked to write a review on the guidelines for menopause that came out in 2015 so I reread all the evidence and I was shocked

by how it's been misinterpreted by so many people and I thought this is outrageous and then I started to experience symptoms but didn't realize I spent six months shouting at my husband having urinary tract infections, worsening migraine, putting on weight, just feeling miserable, but thought I couldn't cope with my third child and my job and everything else. But the biggest thing that drives me is that I decided as an individual to take hormones, including testosterone, but I can't get them from my NHS doctor, the dose and type I'm on. So if I can't get them, like that's really hard for others. And so every day I speak to women who don't come to the clinic, you know, women who are very disadvantaged and they're being sidelined in society they've been given

these other drugs this cocktail of antidepressants antipsychotics painkillers they know it's their hormones but they can't access it in the way that I can't access it so I'm determined not to stop until every woman who wants to get the treatment that's right for her is able to because it's such an injustice to women. As a GP were you specifically like when you went through med school and I guess even when you were practicing, are there things in place to educate GPs that this is something that half the population are likely to experience? No, not properly. Certainly I didn't get any education as an undergraduate or a postgraduate. And I did a lot of hospital medicine before general practice. So I did psychiatry, I did cardiology, I did rheumatology, I did gastroenterology,

I did cancer medicine jobs. No one spoke about hormones at all then. No, I mean, we've created a confidence in menopause education program which is a remote program where we've videoed ourselves doing consultations with actresses we've got links to the available evidence and you know that's had over 33 000 downloads so it's a really sort of different course that's available to people in australia to people in any country to learn from because you have to learn the evidence but you also have to be able to put the evidence into clinical practice and that's the art of medicine is individualizing care. So education has to be completely transformed for everybody, not just GPs, not just nurses, not just pharmacists. Every single healthcare practitioner

needs to know about hormones. Which is absolutely wild to think that something that affects 51% actually of the population is something that's not even taught to you guys when you're practicing. I think people underestimate the impact of hormones. And I'm glad you said what you said before, because I didn't know that, that you tested one patient 10 times in a day and their hormones fluctuated the entire day. How much, scientifically speaking, how does the pill work in suppressing hormones? And I guess I'd love to know your expert opinion on the contraceptive pill. Yeah, it's a really interesting question. And again, I've been doing a lot of reading about history of contraception for this tour that I'm doing,

but I've also got a pathology degree. So I'm very interested in science, how things work in our bodies and how things don't work when we have conditions and illnesses but our hormones estrogen progesterone testosterone are structurally we know the molecular structure so the biochemical structure and all the hormones that are prescribed as contraceptives they're called estrogen progesterone but they're synthetically made so they're chemically altered so if you think about a lock and a key we have like the lock the receptor on every single cell and if you think of the hormone as the key it goes in it fits nicely and then you've got these lovely chemical reactions occurring in every cell that are really beneficial for our body and that's what estrogen

progesterone testosterone we produce as well as insulin and thyroxine and adrenaline and cortisol and all these other hormones they all have the lock where the key can go in and then you know Our bodies are amazing when they work properly. Now, these hormones have been chemically altered, so they might fit the lock, but they're not going to unlock. They're not going to have this lovely cascade of reactions. But also, when they're in that lock, they're blocking another key coming in. So they're blocking the natural hormones coming in.

So it's almost a double whammy often when people are on hormones as contraception, in that they're sort of blocking the natural processes occurring and they're blocking the natural hormones working. now some of them are different to others so some of them will have like a partial turning of that lock so they might have some chemical reaction that's beneficial but a lot of people have side effects we know to the contraceptives like you felt numb you felt flaccid you know a lot of my teenage children friends are just put on the pill and then they're put on antidepressants without anyone thinking oh what's happening why is this happening and when contraceptions were

first brought out in the 60s they had done no studies on contraception they just did studies on the womb and saw that periods became lighter thought great women don't like heavy periods let's give it and then after a year they said let's just market them as contraception but no one did any studies on the metabolism in the body they didn't do any studies on heart or inflammation or the brain function there were some studies where they gave women like a hundred times the dose they do now and women were vomiting had blood clots but they just ignored some of those studies because they wanted to get it out to market because there was a massive market obviously we all want contraception when we don't want to be pregnant and this is part of the problem now

there's a myriad of contraceptives and obviously I'm not saying we can't have them but there are ones that have different effects on different people and we need to be really careful what we give and listen again to women what is the general age guidelines of when women usually stop their period and going to menopause and i know that's not a cut number yeah so i mean it's a great question but on average it's about the age of 50 in the uk probably in australia as well in india it's lower it's about 45 but and this is a really important but about one in 30 women under the age of 40 will have an earlier menopause so I've seen in my clinic this week two women who have never had periods so their ovaries didn't develop properly so they were menopausal age 14 they

were bunged on the contraceptive pill never felt great so they just need proper natural hormones one of them's now got osteoporosis age 38 so lots of women will become menopausal at an earlier age and sometimes it might be because their ovaries are removed in an operation or they've had a hysterectomy or they've had some chemotherapy or drug treatment for cancer that's affected their ovaries working but a lot more women will have hormonal changes so about 90% of us have PMS but like you just oh it's only two or three days a month but actually that's about a month a year that you're not functioning properly you're not performing properly but about one in 20 I think probably more have PMDD, which is a more severe form of PMS. It's really flawing people and they

are just given antidepressants, but that's not treating the underlying cause. Yeah, we've actually done an episode quite recently on PMDD that if anyone is thinking that that could be something that they're experiencing, we'll link it in the show notes. That was with an endocrinologist. Louise, you spoke briefly about these changes in function, saying that at these time when our hormones are acting differently we can be not functioning what does that look like in day-to-day life like how would someone identify that's a symptom maybe there's something going on inside yeah so there's a myriad of symptoms and you'll be pleased to hear not everybody gets every symptom but symptoms can come and go they can change between people but

also between time as well the commonest symptoms and we've done a survey of 6 000 women but we hear it all the time in the clinic too but the commonest symptoms are symptoms affecting our brain so brain fog memory problems fatigue low mood anxiety inability to concentrate irritability this iridescent rage that just comes from nowhere but also just feeling more withdrawn not feeling quite so engaged with people feeling just quite flat quite joyless having very little motivation a lot of people just feel like they're just existing rather than living and then people can get headaches and then you know if you work down the body people can get dry eyes they can get changes in smell they can get sore mouth they can get changes in taste they can get tinnitus in

their ears hearing problems breathing problems people can get palpitations irritable bowels type symptoms people can get dry skin itchy skin they can get worsening eczema they can get this formication this sort of feeling of spiders crawling over their skin they can get pins and needles they can get nerve pain you can get muscle and joint pains so and as i'm working down the body hopefully you'll realize it's no surprise because i said at the beginning of this show that our hormones affect every single cell therefore every single organ in our body so if if that beautiful key and lock lovely chemical reaction isn't occurring then our bodies don't work properly. And especially a lot more symptoms occur before periods actually stop when our

hormones are in flux, they're going up and down. And that's really causes a lot of chaos to our organs, especially our brain. Is there a male version of this? And I don't mean a male version of menopause, but like a huge point in life that their hormones change? Yeah, so testosterone deficiency obviously is a thing, but it's about 30 to 40% of men. And it's usually just as they age their testosterone levels reduce and they can have very similar symptoms the other thing it's not just symptoms because without these hormones our organs don't work as well so we have an increased incidence of heart disease diabetes clinical depression osteoporosis dementia these are all conditions that are inflammatory so they cause more inflammation in our bodies and that's

the same for men as well so louise let's say that someone is let's say hypothetically they're 48 years old they're feeling a little bit checked out of life they're feeling as though they've just lost a little bit of passion and a bit of oomph they go to their GP and they say I think I could possibly be entering the early phases of menopause what happens next well it's a million dollar question because it depends what that doctor says but in an ideal world that doctor will listen talk through his symptoms to talk through what else is going on and often we do do a blood test to make sure there's nothing else going on because I don't want to say oh it's related to your hormones but then find that that woman has an underactive thyroid gland or she's

got low iron or or you know something else going on so often the tests are done to exclude other causes so if in conjunction with a patient as a doctor I feel that it's related to their hormones or I think some of their symptoms might be then I will just say well let's try hormones you know they're very safe we're very fortunate we have the natural hormones available to prescribe which are safer than the contraception they are just the same chemical structure as our own hormones and we have them in different doses we give them individually so some women I think well you might be more progesterone deficient than estrogen deficient or vice versa so we start with some hormones and then review people after about three months and they might say this symptom

has improved but this one hasn't and then we can try and work out do they then need a different dose or a different type or a different formulation and then often do do testosterone levels because it's a guide and if their testosterone level is low and they have symptoms suggestive of testosterone deficiency then we often try testosterone as well and the hormones are very safe you know they don't last in the body they only last the day that you use them so actually a lot of people say, well, I'll try them and see because they're safer than giving an antidepressant or a painkiller or something else that is a chemical in the body. And if they don't work, you just don't continue taking them. It's not difficult, but the hardest thing

is for women to be believed and to see someone who understands hormones. And so natural hormones is a script that you would need to get from your doctor. It is not something that somebody can just go and purchase at a health shop or a pharmacy. No, no, no. You can buy worse things at a health shop, but they are prescribable. But we usually give the estrogen through the skin as a patch or gel because then it gets absorbed straight into the bloodstream, keeps as a natural estradiol.

Progesterone can be given orally or sometimes we give it as a pessary, and the testosterone is either a cream or a gel. So it's very easy medicine. It really is. So after a patient has come in, they've started on hormone replacement therapy and let's say you get the concoction right straight away, what changes do they feel within themselves? So if their symptoms are due to hormonal changes

or lowering of their hormones, then they feel better. And that can take a little while. Sometimes people start to feel better within days. Sometimes it can take weeks or months. And that's partly because the cells, the body, has got to use these hormones in an efficient way. And not only do they have chemical reactions going on in the cells, they can also affect our genes our genetic material and that can just take a bit longer to

occur so usually people say gosh i started to feel better and now i feel so much better but it's taken three months or so but if they've still got some other symptoms we can change the dose or they might say well i rub the gel on and it just slides off my arm so therefore they're not absorbing it so they might need to use a different dose or change to a patch that's where individualization of dose is really important. Why do you think hormone replacement therapy gets such a bad rap? There's so many reasons. Partly it's because of this study that came out in 2002, this WHI, Women's Health Initiative study, and it showed this breast cancer or supposed breast cancer risk with women who were taking HRT. But the thing about that study is it wasn't giving natural

hormones. It was giving hormones. The oestrogen was derived from pregnant horse's urine, and the progesterone was a synthetic progesterone, which is actually in the contraception. and actually it was only the combination so with the synthetic progesterone there was a small increased risk of breast cancer but it wasn't statistically significant but you know we don't prescribe that so what's the point of even thinking about that study actually we know we've known for 100 years how important our natural hormones are to help our bodies work but you know what they're really cheap they're not very exciting because they're just unnatural hormones so big pharma don't make loads of money from it but there's also this whole thing about the way women are treated

in general and not listened to which I don't know how to change that narrative. Are there any risks associated with hormone replacement therapy? So not when they're natural because why would we have hormones in our body that are at risk to us like it doesn't make sense everyone worries about risk of clot or risk of cancer but that's with synthetic hormones that have been chemically altered because they don't have the same biological effect of the body like why would we be designed to have a hormone that's dangerous in our body if it's given in the right way in the right formulation and the right dose as well so you know of course i mean i use testosterone a lot in my patients i personally use it if i was using 10 times the dose i'm sure i'd get side effects or problems but why

would i do that all we're doing is replacing what's missing so it's very safe yeah interesting have you heard of many i mean i guess this would be anecdotal more than an actual study have you heard of many people reporting changes in their relationship either going through menopause or going through menopause and then going on hormone replacement therapy yeah for sure every day i mean i wrote about it in my book the definitive guide i've got a section about relationships and i talk personally about how much i hated my husband when i was perimenopausal because just the noise of his breathing just triggered me but but yeah a lot because if you think of those symptoms i mentioned especially the irritability you know it's like you've got this demon in your head telling you

you can just shout at anyone especially people that you love and so there's the the mood changes but it's also the physical changes you know if you look down at your body and you're putting on weight you've lost your muscle tone you're feeling horrible like you're not going to jump into bed with your partner and then if you do you often have vaginal dryness or soreness or you know you're going to get urinary tract infection after having sex and you're like I can't do it I can't I'm just going to go to sleep and hope he watches a film and has a glass of wine downstairs and doesn't come upstairs you know when I'm still awake and it just has this massive divide and so most women I speak to in the clinic when they have hormonal changes they're not having an

intimate relationship they do love their partner but they really are having a lot of problems but they're not able to talk about it and the partners don't know how to bring it up because there's so much anger in the person and you know divorce rates increase but it's not just the partner it's the family so children are affected they listen to arguments they're not watching you know even my children said mommy well you thought you were going to divorce you were so cross and we were so scared and we're a really open family and I've been with my husband since I was 18 and but I often think gosh if I didn't have a stable relationship if I had more children and I didn't have a job and I was a single mum like I would be shouting at my children like what's going

on behind four walls of so many homes when there's such a simple answer because I've been told so many times you know Dr Newton you have saved our relationship you have saved our marriage and it's not me I haven't done it but the hormones have because they've become rebalanced with their hormones and they can carry on as they should be so it's awful I've done a lot of work with divorce lawyers and you know they hear the saying women would come into their 40s but then they're blamed on it's their job it's because they've got young children it's because they're trying to work full-time but people don't say that to men do they you know you're not coping with your high powered job therefore well that's the thing isn't it it's because menopause and perimenopause and

what actually happens and what it means isn't spoken about it's definitely not what didn't used to be communicated with husbands and partners so of course they didn't understand they just think she's changed you know you don't love me anymore you don't do this for me anymore there's no understanding purely because there's no education and communication Louise how much does our lifestyle have an impact on our hormones yeah it has a really important effect and so much so that often we don't know because no research is done in it but certainly our what we eat can really make a difference to our hormones we also have to remember that our hormones like these three hormones oestrogen progesterone testosterone

have an impact on cortisol because they're all made from the same cortisol is very similar structure to these other hormones and so if we're stressed it can affect our hormone levels certainly what we eat or what we don't eat or if we don't sleep well all our hormones are very closely linked they work very closely together so it's like a big seesaw really we've got to look at everything together but the problem is a lot of women have said or told well if you improve your diet if you exercise you know I'm sure you've been told with PCOS oh just you know change your diet and everything will be fine well actually rebalance your hormones and then it's so much easier to look at your nutrition look at your exercise look at everything else together when

you say diet and food is a huge thing that can impact it is there something specific or you just mean overall healthy eating do you like is there a study that says that sugar is a trigger yeah so often with nutrition and exercise it's just very simplistic you know i'm not a nutrition expert or sports you know coach or anything but a lot of it is trying to avoid processed foods it's looking at not just what we eat but what we drink because alcohol obviously has an effect on our metabolism but also any fizzy drinks any drinks that aren't water or herbal teas are going to have an effect even caffeinated drinks can have an effect. We know that people's nutrition generally is nowhere near the same as it was 30 years ago. And of course, that's going to have an effect

on our hormones as well. Even just the quality of our sleep is really important. You know, we're all different. Some people need eight hours. I can survive quite well on six, six and a half hours sleep. But it's not just how long you're asleep for. It's how are you relaxing? How are you switching off? Are you waking up several times in the night or are you sleeping all the way through? And all these things work together. If I ate, I don't eat caffeine, but if I had a chocolate bar before I went to bed, I know I'll be awake all night because it affects me and then that will have a detrimental effect on my hormones. But other people can eat chocolate and go straight to sleep. So that's why we have to be looking what's right for us, not judging ourselves with

other people. Louise, in terms of other hormonal conditions, things like diabetes, things like PCOS, I mean, hypothyroidism, whatever it might be, does that change the onset or the severity of the symptoms in terms of menopause? Yeah, it can be. I've just recorded a podcast actually with a lady with type 1 diabetes and her glucose control really changed when she had a surgical menopause when her hormones plummeted which just shows actually in real time how our hormones are very closely linked but it's not just about symptoms it's about the metabolic effects in our body it's obviously important to talk about symptoms but we have to be beyond that like when we talk about diabetes we have really good control of sugar to improve that patient's future health

we don't ask them ad nauseum about every symptom that they have it's more about let's get your metabolic processes improving to reduce your risk of heart disease and kidney disease and stroke and everything else and that's what we need to be doing with hormonal imbalances we need to be balancing their hormones to improve their future health reduce inflammation improve metabolic changes going on in the body and the problem is for decades centuries it's been gynecologists controlling our ovaries and gynecologists are very good at controlling ovaries and womb but they're not thinking about the body as a whole and the metabolic processes that are going on and that's why i feel very strongly us as women who are experiencing these hormonal changes need

to have the information and education so we can make the right choices for ourselves about our hormones about our lifestyle and everything else together do we come out the other side louise uh well the day we die is the day our menopause ends you know when we're menopausal we have low hormones and they last forever not everyone has symptoms a lot of people have less symptoms because they're not having this fluctuation but without their hormones they're still having this metabolic process and that's why one in two women for example who are menopausal who don't take hormones have osteoporosis you know incidence of heart attacks increase we know that women have a reduced health span as they age they have more chronic inflammatory diseases but it's a choice

some people say well I've got such an amazing lifestyle I feel I won't get anything out of my hormones but far too many women are scared of hormones but their bone loss is increasing their inflammation in their body is increasing they've got a cognitive decline and dementia but they're not having hormones which will improve a lot of this. Thank you so much for your time today and helping educate people on menopause and perimenopause and hormone replacement therapy and everything we discussed. There is so much more to the conversation. So if anyone does want to know, we are going to link all your podcast show notes, your website, everything that people need in our show notes. So please go and find out more if this is affecting you or maybe it's your mom

or a friend or a sister and everything will be in one place. Thanks for inviting me. I really enjoyed it. Thank you.