The Dr Louise Newson Podcast - 005 - Comparing hormones in menopausal women to teenagers - Nurse Tracy Rutter & Dr Louise Newson

Episode Date: July 9, 2019

Dr Louise Newson discusses changing hormones with Nurse Tracy Rutter, who has had an interesting & varied career as an army nurse & a school nurse. Tracy talks about changing hormones in adolescent girls & comparisons with changing hormone levels in perimenopausal and menopausal women, her own experience of surgical menopause, how balancing her hormones really improved the quality of her life & her experience of working in the Menopause and Wellbeing Centre. Tracy's Three Take Home Tips: Don't put yourself on the back burner any more! Be brave and seek the right advice and treatment. That 'me time' is really important - remember to take care of yourself. Start keeping a diary to record your symptoms and how you are feeling. It can be helpful for your own mind and also when you visit your GP. Learn more about Nurse Tracy Rutter

Welcome to the Newsome Health Menopause podcast. I'm Dr Louise Newsome, a GP and menopause specialist, and I run the Newsome Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. Today I'm really excited because I've got Tracy Rutter, who's our nurse, who works here with me in the Menopause and Well-Being Centre. So hi, Tracy. Good morning, Louise. So thank you for agreeing.

I've pulled her upstairs into a room, so we're going to just talk a little bit about Tracy's experience and also your professional experience because you haven't been a nurse with an interest in the menopause for very long, have you? No, I haven't. I haven't at all. So just if you don't mind, share with us your journey for coming here, your professional journey, what you've done in the past. When I trained in the army in 1980 and then got married and left and became a casualty reception station sister, which was... amazing from nursing soldiers to the families and that was lovely and then just by chance when we were posted to France I was asked if I'd like to join a school and that was super so from that day on until January of this year I've been nursing children in the last about 20 years it really has been concentrated on caring for adolescent girls in particular

Okay. So to arrive at your door and think, oh my goodness, now having listened to so many young girls who are entering something quite frightful, lonely at times and very painful. Yes. So now listening to people who are my age and younger. Yes. So I'm 57 and the girls, you know, the ladies that are coming are all ages, which. is incredible. And did that surprise you? Oh my goodness. The lady who arrived at the door who was

late 70 years and it was just, you know, I've heard of you and I need some help me be. What do you think? I love that. Open door policy. And then were you surprised also because we do have quite a lot of younger women here as well, don't we? Obviously the average age of the menopause is 51. Perimenopause. so time around the menopause, when symptoms start, usually in the mid-40s. But we have a lot of women in their 30s that come here. Did that surprise you? Well, yes, you know the emptiness syndrome of when their children are leaving to go to boarding school or even going to university.

They had put their symptoms, a lot of them, down to the fact that, where have my baby's gone, where have my chicks, the nest is empty. Yeah. But wait a minute, there's something not quite right with myself. So yes, I'm finding that very surprising. Yeah, and I think because symptoms come on often very gradually, don't they? So it doesn't happen overnight. Obviously, women who have a surgical menopause,

if they have the ovaries removed, it can be very harsh, very sudden. But for most of us, symptoms come. And like you say, it's around the time something happens and with this sandwich generation, aren't we? So our children are pulling us in one way, maybe our elderly relatives another way, our partners and our jobs. So we think, well, that's why we're tired.

That's why we're fed up. That's why we're stressed. That's why we're irritable. And myself included, don't always think about hormones when it happens to us. No, well, that's it. It's just a whole plethora of symptoms and signs that somebody then nails and says, oh my goodness, I'm not going mad. Yes.

I'm not seriously ill with cancer. I haven't got a brain tumour. And yes, these things have to be ruled out, obviously. Yes, definitely. There's an awful lot of reassurance and comfort. Yes. I mean, certainly I see it, but I'm sure you do with our patients, that people feel very relieved.

Oh, yes. They know that there's a reason for them feeling like this, because I think a lot of women feel very vulnerable, don't they, when they're having these symptoms, and they're blaming themselves, and they feel they should pull themselves together. And they feel like they're failing. Yes.

And they're trying to keep, you know, really strong for their children. Maybe their husband's working all ours. Maybe they're working all ours. Maybe they're the breadwinner of the family. And with these pressures, you know, it is just alarming how the menopause is affecting everybody. I mean, I know when I had symptoms, my memory was all over the place. And as you know, I am rather busy. but I kept forgetting the girls' pee stuff or their music.

And it was only small. I don't notice that. But, you know, or they'd say, oh, I mean, I'm going out tonight. Really? You haven't told me? Yes, I saw it yesterday and I told you the day before. And you said that was fine. Why can't you remember?

And I thought, gosh, this is because my brain's too busy thinking about work. But actually, in hindsight, it was because my brain wasn't functioning because I didn't have the right hormones there. So, yeah, and it's difficult. So I just wanted to tease out. from you if I may. It's very interesting this analogy with adolescent girls and perimenopause or women. And sometimes people say to me, well, the menopause is a natural phenomenon. Clearly we will all go through it as women if we live long enough. So why medicalise it? Why do they need to come to a clinic? Why do they need treatment? Because when you're adolescent, we don't medicalise that. It's not a

medical term, but adolescence and puberty can cause a huge amount of problems and unrest in girls, can't it? Oh my goodness, if only people could see what I have seen in the years I have cared for girls. Okay, I've got two girls now who are 1332, but to, even as young as 11, you know, you can see that things are happening, they're changing and they are not coping. They are low, a lot of them. They're very competitive. But what's happening is mummies are also probably at their stage. So you get the clash of the Titans with mummies and their little pups because they're just at the same stage, but different years. Yes, which can be very difficult because then there's less understanding, isn't there? Because the mothers are thinking, oh, she's really

annoying me and their daughters are thinking, what she turned into? She needs to be a lot. Yes, she's a monster. So it's really hard, isn't it? And then the father or the partner of mummy is just completely an utterly... Wildered. Be welded. Confused. Yes, driven to distraction. But there we go. I think that it is a very harsh learning steep cut. The curve is huge. But certainly at schools, they do get quite a lot of education, don't they, about periods, certainly sexually sexual education, so sexually transmitted diseases. There's a lot of eddivism, a lot of talking, which is great. It's really good, isn't it?

And certainly, I've got three girls and they, older two, have been taught a lot, which is great. But they haven't been taught about the menopause. There's nothing, isn't that? No. And what is really sad, I find, is that with young girls and puberty, there's always hope. You know, they've got their whole future ahead of them, hopefully, and they've got an awful lot of hope. with the people, you know, women who are going through the menopause, they are finding that, wait a minute, is my life over? Where's the hope? Where's the new opportunities?

And I'm going to feel better? And that is huge sadness. Totally. And I think also even when you're in the terminals of puberty as an adolescent, you know it's not going to last forever. That's right. And everyone says, well, just give it a few years, when your periods are more regular, your hormones will balance.

and you'll be better. And it's really exciting time of your life, isn't it? When you're a teenager, I look at my children, I think, gosh, how lovely. You're beautiful, your skin's got elasticity. I know, they're young, they've got lots going on. They've got a whole future ahead of them. It's beautiful and a shiny. Yeah.

So, and also you're only thinking about yourself often as an adolescent, aren't you? Whereas suddenly, 30 or 40, however many years later, it's very different. You're at the bottom of the pile anyway because you're caring for other people, usually. And then this is happening. And then, I'm sure you know, the average length of time for menopause and symptoms is seven years. But it can be decades. I'm sure you've spoken to people who are in their 70s and still have... The odd hot flush. Yes. Absolutely. And the odd feeling that I'm all alone and, you know, frightened. Yes. And, you know, no motivation. And that is really hard. Yes. So it's very different. Although there are...

comparisons as well aren't there and I feel certainly giving women the right hormones can make a huge amount of difference but like with adolescents it's thinking about their diet their lifestyle their well-being their sleep is really important isn't it hugely and but the problem what I'm seeing and you're seeing is the fact that they're because their motivation is so low at the beginning of their time with us, they may be put on weight, they may be not wished to do exercise, they may wish to just keep away from people and just live their own life and just potter. But with the hormonal treatment therapy, the holistic approach, they are then beginning to say, wait a minute, I might just go and mow that lawn. I might just go and do that holiday that I've been

So that is what is just absolutely magical about the clinic is seeing people come back for follow-ups. Yes, because you're doing that. Now you've been here for longer. Oh my goodness, since January even. So for a few months that you've been seeing women who have been probably at the worst time ever in their lives. So now they're coming back. And the HRT works quite quickly, doesn't it? Yes. Did you expect that before you came here that you would have such a transformation in so many women? Well, I haven't had a history to me in April of last year, and I was given an estrogen patch and everything. And I thought, right, okay, bingo, this is me, I'm going to be fine, I've got nothing inside, and I'm just going to need that patch forever. And then come Christmas, I was thinking, oh my goodness, is this it forever, how I feel now that I get good days and then I get bad days, but it is a bit of a roller coaster.

and then having met you in, well, I've known you a long time now, having come to the clinic in January and having everything reviewed and hormones profile performed, I was able to go, that's the science reason that I'm feeling it. And that's the comfort. Because you can actually see it. You know the numbers that should be, you know, treated. This is not acceptable. And that for me was hugely reassuring.

because I could see it. And then having started estrogen and testosterone, it isn't abracadabra. No. But you've also, you have that hope and then suddenly you have that energy. Yes. It's quite, it is interesting, isn't it?

And I think even having been there myself, you don't know how much is related to your hormones and how much is related to life. But as you know, we don't do a blood test to diagnose menopause or perimenopause. Certainly women over the age of 45, it's a waste of time. And I'm sure you've seen women, and we certainly see a lot who have been tested by their GP or their nurse and said, oh, your hormones are normal, therefore you can't be menopausal. But hormones fluctuate so much.

So to make a diagnosis, we don't do a blood test. But like you rightly say, we do blood test to monitor and to see, because, you know, Women absorb estrogen at different rates and at different amounts. So we want to know, firstly, that a woman's absorbing the estrogen, and this is women who have estrogen through the skin as a patch or gel, which is the safest way. You know, there's no risk of clot that way. And also we want it above a certain level to help protect the bones and heart,

because as you know, it's not just about symptoms, it's about improving future health and reducing this risk of heart disease, osteoproarose. diabetes, arthritis that we get when we go through the menopause. So that's the reason we do blood tests. You said quite openly, which is very kind of you, that you are taking testosterone. Now that's obviously a male hormone,

and you're having a male hormone and you're female. So I will talk a bit about it to explain to listeners, but just what was your feeling when I said to you about testosterone? Did you know anything about it? Well, I knew that our body produced us all about naturally, but wait a minute and got the hysterectomy and now I'm empty

I had a testosterone implant Oh did you? Yes I did And then that self-exploded Which sounded pretty ghastly But that's what I was taught Is that after your operation? That was during the operation Okay

And then I think it lasted 12 weeks That might be incorrect I bet it was something about that Yes You can see it was a bit of fog then But then I thought, well, hold on a minute. Maybe because it's now gone, come December, that is what I needed. I was what I was missing.

But, well, if I thought about it carefully, I was thinking, wow, you know, what's going to happen? Is my voice going to get deep? Am I going to get hairy? You know, all of these things? You know, am I going to have the hugest sexual drive that I really don't really want? Yes. And, but seriously, I felt very positive. Yes.

You know, I had an awful lot of faith that actually, it's ying and yang with the hormones. Yes. And I was very sad to lose everything, if I'm honest. And you didn't feel very much like a woman for a while. Yes. But then you have your babies to remind you kind of for you who come home. But actually it was really, it was, it was a, it was a woman. missing piece of the jigsaw.

Well, it's a big thing. I mean, obviously you had a hysterectomy when you're a bit older and you've had, luckily, you say you've got two daughters. Whereas for a lot of women, we see, don't we, women who have had cancer for various reasons and they've had everything taken away and they haven't been able to have children. And then suddenly you're flawed into a surgical menopause. When your hormones have been working absolutely fine and then bang it happens. It's very harsh, isn't it?

Certainly the guidelines, we here work out of the Nice and National Institute of Health and Care Excellence guidelines, which are sort of government-endorse guidelines. They came out in November 2015. And they're very clear that if a woman has a surgical menopause, so has their ovaries removed, they should be spoken about beforehand and counsellors about hormones and about the potential of HRT. And most women should start HRT after to replace the hormones that your body would be producing. but sadly often this isn't happening and certainly if any women listening out there

haven't had good advice then they need to get it certainly if women are young so under the age of 45 and have a surgical menopause then it's essential they have hormones because we're designed to produce hormones until our late 40s, early 50s and then over that age there's still HRT has more benefits than risks

and the good thing as you know about having a hysterectomy is that having estrogen and even testosterone, but you don't need a progestogen, usually when you've had a hysterectomy, you've got no risk of breast cancer, which is really reassuring. Having said that, I've just read an article that if I drink, an awful lot. Indeed. You know, what is it, four women out of five, they don't, they're unaware of the link between a breast cancer.

It's absolutely right. So if you look at the risks for breast cancer, the commonest risk. or the common risk worldwide for developing breast cancer is obesity. And as you know, women and men, sadly are getting faster. So there's an increase of incidence of obesity, which is associated with all cancers, not just breast cancer. So also drinking alcohol, like you say, drinking a couple glasses of wine and night increases a woman's risk of breast cancer,

but also not exercising, did you know, increases. Yes. So, good, we've got a big staircase there. I know. But it's really interesting, is it, because a lot of women we see and talk to them, and certainly I'm sure you do as well, they are so worried about this breast cancer risk with HRT. And we can just spend a couple of minutes maybe talking about it because I will keep talking about it because it's the biggest reason that people are scared. And it's also the biggest reason that healthcare professionals are scared about HRT. So when we used to prescribe, so when I was a junior doctor, we used to prescribe HIV.

all the time. People used to come back, love it, love it. And then suddenly, everyone stopped and got very scared. And I'm sure you know, in 2002, there was this big study called the Women's Health Initiative, WHOHI study. It was flawed for many reasons, actually. It was crazy in some ways because it cost a fortune to undertake huge numbers of women in America. But because everyone loved HRT, they thought, right, let's give it to women who are in their 60s. But we'll start giving it to women. So these women have gone through the menopause naturally. A lot of them, their symptoms have gone. And then they give them HRT high doses of tablet estrogen and an older progestogen.

So very old-fashioned HRT that even me, I don't prescribe, I wouldn't prescribe such high doses in women in their mid-60s. And a lot of these women in the study were overweight or obese. And a lot of them had established heart disease. So it's not a true picture. It's not the women we see in this clinic. And so they gave those, and then some of these women did have heart attacks, did have breast cancer, but they had other risk factors. So the initial results were not analysed properly.

They were leaked to the media and even to the medical press saying HRT, risk of breast cancer, risk of... And so awful nail in the coffin for HRT. Since that study, they've reanalyzed the data, looked at it really carefully, and what's reassuring is, well, there's lots of reassuring things. Firstly, women who have had a hysterectomy, such as your... self and have only estrogen. Actually, in that study, they had a slightly lower risk of breast cancer. So that was really good. It also showed that young women who started HRT within 10 years of their menopause,

so usually that's women under the age of 60, those women had a lower risk of heart disease and osteoporosis, which is really good. They've also now, because it's a while ago, followed those women still taking HRT up for 14 years and show that the women on HRT had a lower risk of death from all causes including cancer. So that's quite amazing, isn't it? But that doesn't go to the press, does it? It's all about how bad HRT is. And one of the reasons that women who take HRT have a lower death

is because most of us will die of heart disease. About 45% of women die from heart disease. So heart attacks, strokes, anything that burrs up our lining of our blood vessels, increases our risk and that's what we're more likely to die from. Taking HRT as you know within 10 years, starting it within 10 years of the menopause, when hopefully our arteries are nice and healthy, it keeps them healthy because it's an anti-inflammatory, the estrogen and the lining of the blood vessels. So that was a big confusion and it still is a confusion and we've got other studies

that are well established that show how... To it preserves us? It does really, yes. And, you know, sometimes people will say, well, it's anti-aging, why are you doing this? Shouldn't we age naturally? And of course we're sitting here getting older. Yes, but we don't want to be miserable. But no. And also, um, you could argue that giving blood pressure treatments anti-aging, giving, um, a statin to lower cholesterol is anti-age. You know, so where do you draw a line? And actually, we know that having HRT reduces the risk of a heart attack more than a

blood pressure treatment. Yes. Or a statin for cholesterol. Yeah. Yet doctors actually get, the surgeries get paid for reducing blood pressure and reducing cholesterol, but no one treats the menopause. So it's not quite right. It's not. It's, no. So there's a lot of misunderstanding about HRT, but let's go back to, because I did pick up on it, about testosterone. Yes.

So certainly in my medical training, I had nothing about testosterone. We weren't taught about testosterone. Were you taught anything? No, I was back in the dark ages. No, I was. And clearly testosterone is a male hormone. Yes. But women, interestingly, produce higher amounts of testosterone than estrogen.

And most of it is from our ovaries. So as our ovaries decline in function or get whipped out by an operation, then our testosterone levels reduce. And not everyone misses testosterone. Eestrogen is the most important hormone. And I sometimes feel testosterone is a bit like the icing on the cake. You've felt better, as you clearly described, on your estrogen. but testosterone can make a big difference.

And we have cells that respond to testosterone all over our body, but especially in our brains. So the nice guidelines that I've alluded to already say that if a woman is taking HRT and has reduced sexual desire, so lower libido, they can consider testosterone. So we know it helps with libido, which is very important. It's very important. It's a massive. It's very important. And that's what I'm listening to the ladies. Yes. And often women come here and they say, oh, I've never told anyone that I've not had sex. No.

You know, we're so... It's very privileged. It is. Yes, it is. I mean, as you know, being a health care professional is an incredibly privileged job. And people tell us all sorts of things that they often haven't even told their partner. And so the lack of... It's not just penitative sex.

It's the intimacy that goes, isn't it? People say, I don't want to be hugged or touched. I don't... When my husband holds my hand, I just don't want it. But I think we're very different with sex. sex. Men, I haven't had many men. I don't want to go there. But men, it's more of a function. It's more of a release. It's more. Yes. And for us, it's the whole package. Yes, totally. Absolutely. And we need to look right.

We need to feel right. We need to have had a nice time. We need the whole movie. Yes. It's absolutely. And if you begin to feel good. We need to feel good. We need to be. good about ourselves, then we're going to want to be, well, we immediately feel attractive. The vaginal dryness is a huge, huge problem because that can cause terribly painful sex. And the lubrication and it's so vital. I know you've got some samples on your desk, haven't you? Oh my God. And I love giving freebies out, but I have to be careful because I don't want to insult the ladies.

But we have them in the toilets here as well, do we? Yes, and it's perfect. And that is something that is really important. It was hilarious. I thought, right, okay, this is the evening. There's one called silk that has no paraben's and is very, very fluid. And I went to the bathroom and I ripped it off. I thought, right, this is it.

And Gait has administered everywhere. So I do say to the ladies, be careful. Yes. That's really important. But there's nothing worse than feeling unattractive. Yes, definitely. Invisible. Yeah.

And what's a lot of people say, isn't it? And just feeling unloved and they hope. Yeah. If they came and just sat in where I sit and just saw people from, I've often said about let's take photographs of the people when they arrive. Because I would just love to show them and say, look, this is you in a, you know, look. It's just not everyone.

one is sad who comes through this door on their first. A lot of people I find just go, oh my gosh, why am I making so many mistakes with my job? Yes. Yeah, but people are worried, aren't they? They're hugely worried. They are very worried. Most people are worried. They're quite disappointed into how they've changed and they're scared, aren't they?

But yeah, just very quickly go back to vaginal dryness. We know from studies it affects around 70% of women. And it's one of those symptoms that worsens. And so, as you know, hot flushes, sweats can improve with time. Even some of the fatigue, anxiety, can improve with time. But vaginal dryness, once women have it, unless they get the right treatment, it can worsen. And it's not just about sex. We see women who can't sit down or have stopped wearing trousers or even underclothes because it's so uncomfortable and sore.

And you've already mentioned silk, which is a great vagina moisturiser. We also have Yes, which is an organic product and regal as well. and they're good products we give the samples and just let the women choose. There are a lot out there that you can buy over the internet or in chemists that are very irritant, especially some of the scented products. So KY jelly is something we use for examinations, but it shouldn't be in the bedroom. No. It's very drying, doesn't last long. So it's very important to get good advice.

We also use a lot of local estrogen, which comes as pezzaries or cream, or there's a ring that lasts for three months. And actually the ladies are very... very happy with it. Yes, it makes a huge difference. And that's different to HRT, but it can be used as well as HRT. So there's lots of treatments and what's really great, isn't it, that we can individualise treatment, which is really important. So everyone has a different, a different treatment, a different plan, a different future, which is really important, isn't it? And they are waking up, which is just lovely. Yes. But what is lovely also is seeing their partners with them,

supporting them. That is so important. Totally. And, you know, it's not just male partners. We have quite a few patients, who are in the same-sex relationships. And if they both go through at the same time, then it's really not. Sharing. Yeah, it's really not fun. So thank you ever so much. This has been really interesting and informative. Just before we go, I would like three take-home messages that you could just share with women, three things that they can think and reflect about, based on the content of this podcast? I think don't put yourself on the back burner anymore.

Be brave. Just have that me time is really, really important. And maybe just start keeping a diary. Yes. I find that helped me just to go, do you know what, suddenly getting better. I think that's absolutely right. And also marking way in your periods, you're still having. periods and you can sometimes see a pattern and it's we're so busy aren't we now we get through

the days we're rushing to bed and young girls keep a nap of their periods you know and i think keep a nap and tune in with that brilliant so thank you ever so much it's been a pleasure brilliant thank you for more information about the menopause please visit our website www.meneopause doctor.com.uker.com.