The Dr Louise Newson Podcast - 002 - Improving Education About the Menopause - PCWHF Director, Karl Hamer & Dr Louise Newson

Episode Date: April 11, 2019

In this episode, recorded in conjunction with the Primary Care Women's Health Forum, Dr Newson talks with PCWHF Director, Karl Hamer about Newson Health Menopause & Wellbeing Centre and her passion and determination to improve education about the menopause.  Primary Care Women's Health Forum

So welcome to the Primary Care Women's Health Forum podcast series. And for this episode, we're going to be talking with one of our board directors and menopause specialists, Dr. Louise News. Hello. Welcome Louise. Thank you, Carl. It's pleasure. So the Primary Care Women's Health Forum, we've really up the game in terms of the quality of education that the forum are doing at the moment. It's really exciting.

I'm really pleased to be on board that, you know, I've been a director for a while. And although I'm not so interested in all general women's health, I'm very interested in the menopause and it's great. So tell us some of the things that you're doing. So we've got a series of events that are happening. We've got eight events happening throughout the country for healthcare professionals to attend. And we've had a fantastic response to that. So that's doctors and nurses, pharmacists, that can be anyone? Anyone at all.

Healthcare professionals across the board. And this year, what we've introduced for the first time, is a membership program. Right. So we've actually got a paid membership program and part of that paid membership allows people, healthcare professionals as members of the Primary Care Women's Health Forum,

to have discounts to some of those events and educational activities that we're doing, which is fantastic. With a journal that we're going to be producing shortly. So an old-fashioned written journal, in-page, brilliant. Old-fashioned written journal rather than an e-version, but you'll be able to access both,

which is important. So people can access their learning how they want it. So that's great. It's good news. So there's lots of activities going on, of which this podcast series is just part of it. Yes, very exciting to be involved. So essentially it's our opportunity to meet some key people across the country who are involved in education, but also who are involved in seeing women and treating women and improving their outcomes and quality of life.

Yes. And menopause clearly is one of the big areas. So how did you get involved in the menopause and becoming a menopause specialist? Well, it's quite a long story, actually. I've always been really interested in the menopause because as a GP, as I'm sure you're aware, there's so much you can't do. You want to help as many women and men as possible, but sometimes you can't change things or can't improve things,

or it can be a bit frustrating. So, for example, if you have a diabetic who you want to treat, but they won't take the medication or they carry on eating McDonald's or whatever. It can be frustrating. Whereas menopause or women often can be in a very dark place, but then when you treat them, they come back and say, thank you, doctor. My life has improved. And it's very rewarding.

And it's a great privilege to be a doctor because you get exposed to so many different types of people. But when women come back and thank you, it makes all the hard worth well. So I've always done it. But actually, as you know, there's a lot of antagonism about HRT. There's been a lot of poor reporting in the media, there's a lot of scare mongering. So I've actually had stand up rows

with partners at work in the past about HRT because I've given it to women and they've said, no, take off because it's gonna give them breast cancer. So it's been quite uncomfortable. And then as you know in November 2015, the National Institute of Health and Care Excellence guidelines came out.

And they were very exciting for someone like me because they show that for the majority of women, the benefits of HRT outweigh the risks, As you know, they go through all the evidence. They're very simply written. But actually, I thought, great. I can do something with menopause work without other people saying, well, it's just your interpretation of the evidence.

So I decided to do some more training. I did my two-day advanced training course, which was fantastic with Sarah Gray, who, as you know, is one of the directors for the forum. And we sat and had lunch. I said, Sarah, I want to see more women. because I feel what I'm seeing my general practice isn't enough. And a lot of my friends, because I'm at that certain age, are menopause, and then they keep getting antidepressants, and I don't think they're depressed.

She said, well, set up a clinic. I said, no, Anne, I can't do that. I'm not good enough. She said, yeah, you can. Call yourself an expert and do a clinic. So I bravely went to my local hospital, who thought I was crazy talking about the menopause, but very kindly allowed me to set up a clinic. I've also always done a lot of medical writing, a lot of education.

As you know, I've done a lot of work with the Royal College of GPs, and I still do. But I've also done a lot of patient writing as well, which is quite different, as you know, to doctor writing. So I decided to set up a website to have some really good evidence-based, non-biased information for women, based around the nice guidance and other evidence about the menopause. So I set up a clinic to help a few local people a couple of years ago, and it spiraled out of control. I went from one day to three days a week, six-month waiting lists, and I thought, I'm either going to have to run away or do something more. So hence I've set up a menopause and wellbeing centre to have other GPs working with me.

And it's been very interesting, but it's also quite frustrating because training in the menopause is quite varied. There's a big demand for training. There's a big waiting list. So to do the specialist certificate has been a lot of hard work. I've got the advanced certificate, which is great. But I hear all the time that GPs are struggling with education. So I'm always trying to think of savvy ways of trying to educate healthcare professionals, certainly through the forum, and also to empower women.

Because when you're in general practice, you're just speaking to that one person, and you treat them, they carry on. And then suddenly I'm exposed to women from all over the country who come, and they're telling me these stories, Carl, about how they've been suffering for 10 years because no one's listened to them. They keep giving them antidepressants or... You've done a survey on that, haven't you? I have, yeah.

So we did a survey just online. We put it through social media. We had nearly 3,000 replies in a couple of weeks, so good numbers. And it was just to tease out people's experience with the menopause. And it echoes what I see in my practice. So the majority of women had had a poor experience. They'd had to see more than one doctor.

They had felt, if they did have HRT, They found the actual giving of HRT very frustrating. Some of them. In what way? A lot of people, because there was a lot of free text comments, were saying that they didn't feel that their doctor had confidence. And that echoes some research we did through the forum a year or so ago, looking at it doctors felt not very confident,

especially with younger women about what to prescribe. A lot of them said that the doctor didn't know what to prescribe. They're opening that book, you know, the BNF and they're going through. So they felt that they, you know, HRT is something you could potentially take forever. So it could be decades for a lot of women. They want to get that choice right. So they didn't feel very comfortable. And then the most shocking thing really from the study for me was that 66% of women

had been offered or given antidepressants instead of HRT. So there's one thing not treating the menopause because you're not sure what to do. But there's another thing giving antidepressants. As I'm sure you know, the guidelines are very clear that antidepressants shouldn't be used for low mood associated with the menopause. We do use low dose antidepressants for some women who can't have HRT, for example, some women who've had breast cancer. But that's a minority of women. This is the majority of women who could take HRT, and it echoes what I see in my clinic. Time after time I listen to women who tell me that their doctor's given them two, three, four, five different types of antidepressants.

I've seen women that have been sectioned. women that have had really bad mental illness. No one's considered their menopause. And I know it's related because when I give them a right balance of HRT, they come back and their life's improved. So why are GPs and healthcare professionals in general? Why do they seem to have this lack of understanding about HRT? You know, I reflect about it a lot. And partly, I had no undergraduate training about the menopause. I did, Obes and Guiney, as we all do, I learned how to deliver babies. Great, but not very useful now. No one really talked about menopause. And then my postgraduate, as you know, I did a lot of hospital medicine. There was nothing mentioned then,

but actually I was dealing with people with osteoporosis, heart disease, palpitations, urinary symptoms, all those things that can be related migraines. And then I did my GP training. I think we've made me had one-a-half lecture, you know, not very much at all. And then, as you might know, I started to experience some symptoms related to my perimenopause, didn't recognise them, thought it was because I was working too hard. And then actually when you sit in someone else's clinic, when you have something that happens to you yourself, you know, that brain fog, I can't tell you how horribly is. You're just waiting through treacle trying to think about dates and what your children are going

to have for supper or how you're going to prescribe the next medication because your brain's not working. Then you suddenly think, actually, I can't function. And then you know there's a treatment. And I suppose I'm even more passionate because I'm very open. I take HRT, but I wouldn't be working without it. My joints were stiff. My migraines were worse. So I've got a hidden agenda because I know how much better I feel.

But I've had to learn myself. I've sat in clinics. I've gone to conferences. I've read lots of articles. It's been all self-directed, which is wrong because if we live long enough, the menopause affects all women. Yeah. So from a healthcare professional perspective in terms of their education,

What do you think we should be doing? I think, do you know, I think there's two angles really. So there's a healthcare professional angle, but there's a women's angle as well. So, as you know, I do a lot of work trying to empower women so that they can make the right choices for them because medicalis care has to be individualised. We're all different. It's not just a one-size-fits-all. As you know, HART is not just three letters.

There's lots of different types and doses. And also, women can guide that GP consultation. In 10 minutes, it's not long. But actually, if they go and say, look, I've read the nice guidelines, I'm really low mood, I've got these symptoms, I think I'm menopausal, I'd like this type of HRT. What a lovely consultation. Whereas what's happening now is that women are going, they're bursting into tears, they're telling these GPs, they can't sleep, they're feeling dreadful.

So the GP, quite rightly really, is screening for depression, thinking, oh gosh, you're depressed, have some antidepressants. There's one problem, one consultation out the door. but actually there's lots of symptoms all related to one problem. So if the women can help, that's a good thing. But then it's about education. It's got to be more at medical school. It's got to be more ingrained throughout.

My husband's a urologist. He sees hundreds of women with recurrent urinary checked infections, vaginal dryness. He now knows a lot about the menopause, but he should be part of his training too. But it's doing it in easy ways. You know, doctors are really busy. The NHS is nearly broken.

So there's no point saying to people, come on, you've got to learn about the menopause. But if we said to people, we've got a treatment that's more effective than statins and anti-hypertensives for lowering cardiovascular disease risk. We've got a treatment that reduces the risk of an osteoporotic hip fracture by 50% and increases mortality.

People will be lining up the door. But if you say some, that treatment's HRT, oh my gosh. You know. Panic. So it is. So it's, and it's also, you know, in the BNF, there are lots of combination tablets. I can't pronounce half of them.

I don't know what half of them contain. So there's a lot of confusion. So to be able to write this easy prescribing guide, which you very kindly allowed me to do, it's just to try and guide because it's actually very simple if you keep it simple. So as a doctor, a woman comes in, talk me through what they should be doing. So a woman comes in, certainly to my clinic, I get all my patients, Newman follow-up to do this green clemectaric score. You might have seen it's a scoring system, so the symptoms go from not at all to quite severe. And where can they find that?

Well, it's on my website. Yes, it's very easy. Women download it. And it's got symptoms such as concentration, memory, irritability, sleep, headaches, joint pains. It's got something about libido, so they know that I might talk to them about sex. So they fill that out beforehand And actually a lot of women go, gosh, I had no idea My symptoms were all related.

I didn't know. I thought I had dementia. I thought, you know, so actually they're quite reassured doing that. So then they come in and then it's assessing whether they need HRT. Like I say, the majority of women benefit from taking HRT. So if a woman, and most women do, are otherwise fit and well, we've got no contraindications.

And there aren't many really to HRT. Then I'll talk to them about the better. benefits because as you know it's not just for their symptoms it's a reduction of future illnesses such as osteoporosis heart disease osteoarthritis even dementia as well which a lot of women they just say oh I'm gonna get through those symptoms and I'll come out the other side so it's looking at the bigger picture I give them a lot of we've got a lot as you know written information here so I direct them to my website but I give them physical paper we talked

about the journal having physical papers really good because then they leave it around, the children can read it, the husbands can read it. So give them written information and then I usually talk to them about the choices. With the estrogen I usually recommend through the skin as a patch or gel because there's no risk of clot. Also, tablet estrogen can reduce libido by affecting the way our testosterone binds. So women who have low libido aren't going to thank you for something that makes it even worse. So the risk of clot is small with tablets. So it's a double risk, but a double risk of a small risk is still low. But if there's a good alternative, I give them that.

And then if they've got a womb, they need to have a progesterone. The body identical, natural micronized progesterone is the one that I give because there's better evidence for it. Or a coil, like a marina coil, which can provide endometrial protection. But then I also looking at any other symptoms, if they've got vaginal dryness, which is very common. I talk about local treatments, moisturises, lubricants, even local estrogen. And then it's usually when they come back,

I'll then focus on their diet, lifestyle, exercise, that side of things. Because when you're menopausal, you can say to someone to the blue in the face, you need to eat better, you need to exercise. But, you know, when I was there, I just couldn't bother what I ate. My joints were sore and stiff. I didn't want to do any yoga. You know, it's hard. So when people get their hormones balance, that's when the clinic gets even better because

women come back and say, I've just started exercising, I'm eating better, what can I do to improve my health? So it's looking at that whole holistic approach is really important. So what are the options that women should be considering as part of that holistic approach? Definitely diet. I mean, I'm very interested in the whole gut microbes. So looking at anything that's going to balance our gut microbes improve because we know that If our gut health, they're happy, it improves our serotonin, our happy hormone.

And it can help reduce inflammation in the body, all sorts of things. So looking at not having processed food, not having sort of sugar is quite bad, as you know. But being sensible, you know, food that we used to eat in the 70s and 80s, you know, food that we make from home is important. And then looking at exercise, anything that's going to help our bone strength reduce our risk of heart disease. of exercise? It doesn't matter. There's no point saying to me, go and run three times a week, I'll never do it, whereas you like running, do you know? So it's something that works for the person. I really strongly feel anything that works is good, anything that gets the heart rate. You know, for some women, just running up the stairs, it's better than getting a lift.

Yeah. So it's being realistic as well. There's no point being unrealistic and then gradually increasing and making sure it makes you feel happy, you know, even if it's just walking outside. Yeah. I think it's really important. Just going back to the HRT treatment, how long can a woman be on HRT? Because I think there's some myths around there about some of those issues. So the guidelines are changed. So what we used to say to women is it's the lowest dose for the shortest length of time. So like get through your symptoms and then you can stop.

Whereas all the evidence is there and the guidelines clearly reflect it saying that women can need to have the amount for them. So it's not good enough to have a few symptoms. They should minimise the symptoms or reduce them because women who have flushes and sweats have an increased risk of heart disease and osteoporosis. So they need to have the right amount for them and they can take it for as long as the benefits that way, the risks. So that means they can take it in the long term.

So my oldest patient is 93, who has some estrogen. She had a hysterex woman when she was 38. So she doesn't have any risk of breast cancer. Eustrogen only, no risk of breast cancer. through the skin, no risk of clots. She has a very small amount, but she's well. I personally would never stop my HRT because I don't want to get osteoporosis. I've seen so many women with osteoporosis of their spine.

We know one in three women have an osteoporotic hip fracture. I don't want to be one of those women. So it's about why they take it. Whereas other women say, I only want to take it to get through my worst symptoms. So they might only take it for a few years and then stop. But it's great to have these guidelines that we can work towards. Okay. So there's the HRT treatment and there's the pathway around other options within that. There's the holistic therapy part as well, which I think is really important and seeing outcomes.

Is there anything else that you do with women that helps? Yeah, it depends. Sometimes it's about mindfulness. It's about sleep. It's about head space. You know, we're all so busy. We're also stressed. And some women come back and they say, oh, I'm still anxious. I'm still this. and then maybe their dogs died or maybe they've had a bereavement. And it's not all about hormones, so it's looking at the bigger picture. I do talk to them sometimes about supplements, things like magnesium can help with sleep and anxiety. A good fish oil can be really good for reducing inflammation, heart disease, probiotic, again, looking at their gut health.

So I will look at those things as well. And then, as you know, there's some women who don't want to take HRT or who can't for medical reasons. So again, it's looking at alternatives for them. That's where low-dose antidepressants can have a use of some other drugs, but we're often limited by side effects. Some of the herbal supplements can be beneficial, but there's not good evidence. So I tend to look more about their future health rather than just their symptoms,

because some of these things might help their symptoms, but they won't help their bone strength or reduce their risk of heart disease. So it's trying to just educate, really, and give women a choice at the end of the day. How often do you review women? So in my clinic, I review people after three months usually. And then it depends. I do prescribe testosterone, which is another hormone, which isn't licensed for women in the UK, which hopefully will be in the future.

So if I start then, then I'll review them after four or five months. So most women, I see then annually. So the guidelines say they should have an annual review. But my clinic's private. It's private because it's very hard. to get good menopause care on the NHS. So I'm always trying to get them to carry on with their GP. So I will, once they're stable, then I'll get them to go back to their GP.

And I write very detailed letters. So hopefully the GPs are learning as well. And so the annual review can be done by the GP. So I try not to see women too often, to be honest. You've talked to us about how dark it is for some women when they first come in to see you. Tell me about some of the positive outcomes once they've, been treated with HRT or the holistic approach that you have. What sort of response do you get? Do you know, it's quite overwhelming. When I do my, when I started my clinic, I had a notebook and I was

writing down quotes and I would literally go home and feel like sobbing because people would tell me that they felt the shutters had closed, that they would no longer go out. Women tell me they've stopped going on holiday. They don't want to pack their suitcases. A lot of women have given up work. We've shown with the West Midlands Police, 21% of women have given up work because the symptoms related to the menopause. And then when they come back, they're telling me they're going on a holiday. You know, a lot of women go home and they say they have a cup of tea on the sofa fall asleep.

That's it. End of their afternoon. Yeah, that's wrong. One lady told me she sells homes for a company and she used to go to the show home and every afternoon fall asleep on the bed. It's convenient. And that was, you know, she said it was awful. I just feel so tired.

And then six months after having HRT, she came back and she said she'd won. show person or salesperson of the year award for for the company and she said it was just incredible she's back to how she was she's sparky she wasn't tired she's exercising and her life has been transformed and it's it's an incredible thing to give something that costs the NHS about four pounds a month so what what I'm doing isn't expensive and actually most women then have such better quality of a life so they're not going back and forth to their doctors they're saving money for the NHS as well. So it's, it, it just shocks me that these women can't get something that's so easy. So what does the future look like? What does he look like, you know, what's the

ideal for primary care, particular? Well, most, when we did this through this survey, 92% of healthcare professionals agreed it should be primary care that menopause is managed. So, so most women are low risk, so we should be able to manage them in primary care. My idea, was would be even initially that every GP practice had somebody who was an expert in the menopause working with them but then those women off those well they're not often women female GPs they often get very booked so then that's hard I'd like to everyone to just be familiar with some basic menopause care it would be ideal if every woman could get the right treatment for her but that's going to

take a while but then there's a bigger picture as looking at menopause in the world workplace, there's looking at menopause education, you know, school children should know about the menopause. My teenagers get told, it's when your period stop. Well, yeah, that's the best bit. That's the easy bit about the menopause, isn't it? So, you know, the other day my daughter came home and she said, she said, her friend's mum is crying all the time, really moody, really irritable, shouting at her all the time, bearing in mind the teenagers, so, you know, it's that. But then Jessica said, I think your mum's menopausal. She said, what do you mean? What does that mean? She said, I got up your website, Mommy.

I show my friend, and then she said, her friend went home, showed her mom, who burst into tears and said, oh my gosh, this is everything about me. I had no idea it was my hormones. You know, and then Jessica said, well, and I was telling her about different types of HRT and about this, that thing. And I thought, Jessica, isn't that brilliant?

I feel like I've helped someone. And I thought it should be that it's open. We're so open, aren't we now, the way we talk about all sorts of things. So there shouldn't be the taboo. You know, so it's not just healthcare professionals, but it's wider. Everyone, men should be talking, you know, it's great that you're a man sitting talking about the menopause. But, you know, it's really important because we've all got partners, we've got brothers, sisters,

we've got aunts, you know, somebody knows someone who's menopausal. And it's quite isolating and scary when your body changes. So how do we get to that point? by all working together making a big noise. You know, I'm doing some work with an MP, so it's going in their house as a parliament, which is good. I've met with Dame Sally Davis, Chief Medical Officer. It's making a noise.

It's inexcusable that people are denied an effective cheap treatment. Yeah. So Louise, what do you think is the long-term vision for menopause treatment in the UK? So it's not just about doctors. We've talked about primary care, which is essential. really believe that women should get the best treatment in primary care. But it's not just GPs in primary care, of course. So nurses have a phenomenal role. We know how well they've worked for cardiovascular disease, diabetes, asthma. We use our nurses all the time. Not only do they

have longer consultations, they often have 20 minutes rather than 10 minutes, but they're very good, they're very empathic, they spend time. When I lecture nurses, I get a really positive response and also a lot of them in my age, so they do have that whole wanting to know more for themselves. But also, nurses do smears, I've already mentioned how common vaginal dryness is, they often pick up. So it would be great. A nurse, when they do a smear, for example, ask, what do your periods like? Oh, they're changing. Oh, have you thought about it?

Let's give you some information, come back. So nurses are very good. But pharmacists also, a lot of women, well, a lot of people sadly can't get an appointment as easily as they could with their gene. GPs, go to the pharmacists. And sadly I hear a lot, women tell me they go to the pharmacist, say they're having some symptoms and their pharmacists, oh, have you tried some of this supplements? Actually, no, wouldn't it be great for the pharmacists? They've all got rooms that they deal with emergency contraception. It would be great for pharmacists to think about prescribing, even if they can't initiate it, they can talk about treatment options, give them factual information about

HRT. So it's trying to get everyone on board is really important. So you're clearly passionate about it. I mean, everyone knows that and it's fantastic. What we need to do is get everybody else passionate about it. Totally. And I think we need to inspire people and you're inspiring people, which is fantastic. So we can help do that. And I think through the Primary Care Women's Health Forum, we've got an opportunity to do it.

Brilliant. There's so many opportunities, definitely. Yeah. So to finish off, because I think we've probably just about done our time, talk to me about you. What does the typical day look like in this clinic for you? In this clip, we've only been open three months this clinic, so it's busy. You know, it's busy because I'm sorting out patients, but I'm sorting out my staff. You know, to have happy staff is the most important thing for me.

So I'm really lucky I've got good staff. So come in, see patients. Not every day I do patients, see patients, but I see a lot of patients, but we also do training here as well. So we have got six GPs working with. with me so we have meetings regularly to talk about education, talk about different difficult patients, talk about some research that's gone on, so that's really important. I often have research meetings because we're setting up some research here as well. So it's quite varied and I sometimes

do some media work as you know I try and empower women through the media as well. So it's really varied. But as you know, I've got three children so I'm constantly taxying them around, often going to a concert or getting panic phone calls because something else is happening. So, yeah, it's a bit chaotic. Yeah, my life is not that calm. So tell me what you can't get through a week without. What's important to Louise? The most important thing to me is my yoga practice.

So I do Ashtanga yoga, which is quite powerful, dynamic yoga. It's called Ashtanga yoga. So every movement is with every breath, there's a different movement. I do the primary series. It takes about an hour and a half. half to go through. And I do it at least twice a week. So as I think you know, Wednesday morning is my sacred time to do it. But I've got a yoga studio here. So I do it here. And all my staff have yoga too, which is great. So I do that twice a week. And it's a very good, for me,

personally, it's very good holistic exercise. So it's good for my muscles. It's good for my cardiovascular system. But it's also good for my head. When I'm doing a headstand, I'm focused. And to keep focused is really important. So yes, that is my. passion. It's your passion. Louise, thank you so much. Where can healthcare professionals and women find more information? Well, totally the forum's website, because it's been revamped, is brilliant. Obviously, well, obviously, the Menopause Doctor website that I've created does have a medical evidence section. It's been going to be used through the Royal College of GPs, which I'm very excited about, but I try and drip-free the information that's there,

keep it up to date. It's really important to get evidence-based education. That's the key. So working with the forum is definitely the way to go. Fantastic. Thank you so much. Thank you for sparing half an hour in your busy day to talk to me and to talk to the forum about what you're up to. That's great. Thanks, Carl. Thank you so much. This podcast was produced and edited by E4H. All Rights Reserved. This podcast is provided for information purposes only. Please consult your healthcare provider regarding any medical conditions you may be concerned about. Podcast guests, views and opinions are their own.