The Dr Louise Newson Podcast - 013 - HRT and Breast Cancer - Liz Earle MBE & Dr Louise Newson

Episode Date: September 3, 2019

In this episode, Dr Newson is joined by Liz Earle MBE and together they discuss the recent research that was published in the Lancet, concerning the link between HRT and breast cancer. They talk about what this research means to women and discuss other evidence regarding the benefits of taking HRT. www.lizearlewellbeing.com Liz Earle's Three Take Home Tips about HRT: Don't believe everything you see in the headlines - do your research and don't panic! Read up on the subject and listen to experts. Look at all of your symptoms - menopause is so much more than hot flushes and it doesn't need to affect your quality of life.

Welcome to the Newsome Health Menopause podcast. I'm Dr Louise Newsom, a GP and menopause specialist, and I run the Newsome Health Menopause and Well-Being Centre here in Stratford-upon-Avon. So today we're doing a slightly different podcast because we're doing it over Skype rather than face-to-face, and I'm doing it with lovely Liz Earle, who has kindly agreed to talk to me late on a Sunday evening, because we want to talk about the last couple of days that's gone mad in the media over this new HRT and menopause research, I suppose, that's come out and hit the headlines hard. So, hi, Liz. Hello, really nice to talk to you.

This is the first one I've done over Skype. Yes, it's a bit weird not being able to see you IRL in real life, as my children say. But let's see how it's awesome. You know, this is topical, and we've just got to jump up. and have this chat, haven't we? Absolutely. So the first I heard about this was on Wednesday night, but it was all embargoed. I heard more on Thursday and read this article that came out in the Lancet, which is a really important, really good journal. And I was really quite surprised and disappointed, actually, to see that it's been published. When did you hear about it? I woke up basically on the

Friday morning to headlines. Like people, just check my news apps and my heart sank. And I thought, oh my goodness, what is this? Obviously jumped on everybody's social media that I respect, people like you and Professor Baum and lots of other leading menopause experts who are at the cutting edge of all of this very quickly realized that it wasn't new research. It's just a study looking at some epidemiological study. So there's no kind of cause or effect. There's no, it's not a randomized controlled trial. There's no news here, really. And again, like you, I just thought, my goodness, how disappointing that somebody like the last said. And I think also putting into perspective where it's come from, it was based on, I gather, quite a sensationalist press release

put out by a cancer charity, which is, it's just so disappointing not to put the whole facts down and just to grab the headlines. And again, we know as people who work, a lot in the media in this area, that the news editors and the online news providers know that if you mention HRT, it's clickbait. You know, you will hire viewing figures, you'll get higher ratings, you'll get more online clicks. And it's obviously very tempting for these types of news providers and broadcasters to think, great, you know, this is a ratings winner story. We can sensationalise it without realizing the devastation of damage that it will do to real women's lives long after they've moved on and gone on to another news story.

Well, yes, because for them, it's forgotten the next day, but this won't be forgotten by lots of women. And I mean, I know we're both very open that we both use and take HRT, but whenever I read something in the media, I do stop and think, oh, should I take my patch off? What should I do? Because you read it and you're quickly, aren't you? skimming the headlines and you think, goodness me, this sounds dreadful. And then for me as a doctor, I'm thinking, gosh, what do I say to my patients? And it's difficult because, you know, as a GP, GPs are really busy.

They're really time poor. There's a lot in the media at the moment about the HRT shortage, which we might mention in a bit. But so they're getting a lot of queries from women who were otherwise quite stable on HRT because they can't get their HRT. And now it's, people are saying, gosh, HRT causes breast cancer. We need to stop it. We need to reduce the dose. And that's not actually quite true, is it?

And like you say, this is from a, it's not from a randomized control study. So a randomized control study is when women or men, whoever is in the study, take a product and they take a placebo and then they follow them up over several years and look to see the cause and effect. So as you say, this is a review of, it's actually a review of published and unpublished data in the past. And that, even looking at unpublished data, you can argue is that a good thing or not?

Because is there a reason why it's not been published? Absolutely. I mean, unpublished data is usually unpublishable. And it hasn't been peer reviewed. It isn't robust enough to make it into a good academic journal. So to lump that in with, previous potentially credible data is quite disturbing that even an epidemiologist should choose to take that route because you have to think what is the agenda here? And as I understand it,

the statisticians here are the same statisticians that produced the study several years ago that was widely discredited. So millions women study it was called, which, you know, sounded good because it had big numbers, million women, but it was a, questionnaire study and there was lots of bias in it. And it's a bit like, you know, asking you what you had for breakfast two days ago, you might or you might not remember or you might be truthful or not truthful on the form. And it doesn't prove a cause and effect. It shows there might be an association, but that's very different to a cause and effect, isn't it? Absolutely. And, you know, looking at the cancer charities, for example, I've been doing a lot of

research recently looking at how protective HRT can be with bowel cancer, for example. Boul cancer is in the headlines at the moment. The rates are dramatically increasing. You know, I would have thought that a cancer charity would have been more interested in putting out a news story to say, isn't it extraordinary, how HRT, we know it protects against heart disease and dementia and type 2 diabetes and osteoporosis and all these other things. One of the other little known benefits is protecting. women from bowel cancer. Yes, and I always tell my patients, because we go through the benefits and potential risks of taking HRT and hardly any of them know about bowel cancer, reduction risk.

And some studies have shown it's as reduces as much as 30%, which is really good because that is a headline. That is, you know, forget the potential 2% uplift risk in breast cancer, which is disputed. A 30% reduction in bowel cancer. That is, that is, that, That's a major, it should be a major headline, shouldn't it? Yes, and I think, I mean, we can talk a bit more about the risk, but I think we need to think about why women are taking HRT, because everyone thinks those three letters are associated with breast cancer. And, you know, I say to all my patients,

one in seven women, their lifetime risk of breast cancer is one in seven. So one in seven women taking HRT are going to get breast cancer, but one in seven not taking HRT are also going to be. get breast cancer. So that means there's going to be a lot of women taking HRT that are going to get breast cancer. And that's not because the HRT has caused it. So this is really important, isn't it? Because I'm sure you do, I certainly most days on my Instagram to say, well, I'm never going to take HRT because my mother took her case in a week later she developed breast cancer. Well, it doesn't occur that quickly. Breast cancer, the changes that occur in the

breast take a long time to develop into a breast cancer. As you say, one in seven women are going to get it on HRT and one in seven women are going to get it not on HRT. Absolutely. And I think with this, even with this study, even if you take these figures as gospel, it's not showing there's an increased risk of death from breast cancer. And I think that's really important for the media, for women, for doctors to know as well. There's never been a study to show that. there's an increased risk of death from breast cancer. And we know around 20% of women die with breast cancer, not from breast cancer. So when they've done autopsies and women in their 70s, 80s, a lot of women have breast cancer.

Like indeed, a lot of men have prostate cancer, but it doesn't kill them. So, you know, it's one of the things that's often discussed when I go to Menopause conferences is, is it that these women are being picked up earlier because a lot of women are more breast-aware, when they're on HRT. So are they just picking up a breast cancer earlier that they would have not noticed if they hadn't been so breast aware if they weren't taking HRT?

That's really interesting. Well, I learned a lot about breast cancer recording my two podcasts with Professor Michael Baum. Yes, which is well worth a listen, if anyone. Well, you know, I have to go back and re-listen to those. A lot of information in them. So much in there. And for anybody listening that isn't aware of Professor Baum,

He is a global breast cancer expert. He did the original trials on tamoxifen. He was a senior breast cancer surgeon at the Royal Marsden and many other places. He lectures globally. You know, there is very little that this man does not know. It's his life's work has been to help women with breast cancer. And he is fortunately in favor of HRT. Yes, what's interesting is he watched his mother die from breast cancer.

Yeah. And that's really triggered him to think about the whole person, not just breast cancer. And he's got a daughter, Katie, who you've met, who, so he's very aware of breast cancer. And I don't know if he's his teenage daughter on to HRT. Absolutely. And I don't know if you saw their interview. They did an interview together on Sky television, which was incredible. And he wrote some notes, actually, which I've just put on the news.

news section on my menopause doctor website so anyone can go to and look because it's his interpretation of this Lancet publication which is worth a read and he even mentioned the word irresponsible he said it was irresponsible reporting which i think is that is that is quite strong and i now follow him on twitter i don't like twitter very much because it can be quite shouting there's a lot of shouting going on over there but what is good about twitter is that you do get a lot of academics and senior researchers and they put links up. The one good thing I think about Twitter is it's linkable. So he can share a lot of research papers and views and I think even his clip from Sky is actually on Twitter. If I really wants to go and have a look and you can download it

and hear it for yourself. Yes. And I think it is important because I don't know if you read the press release that came out with the Lancet article and it was not great. And the problem is with the actual article is it's very wordy, it's very complicated, I'm not clever enough to understand it at all, and most doctors would take a few days to really absorb it and reflect and consider what all the information in this study means. And so for, I'm not being disrespectful for journalists, but they're not scientists. No, it's been used to their time pressured to get a story out quickly. Yeah. So that hasn't helped. But let's go back a bit, and because I did mention a bit earlier about

why women take HRT. So clearly we don't take it to increase our risk of breast cancer, do we? So most of us take it because we have symptoms affecting the quality of our lives. And as you know, the symptoms vary. They vary with time. They vary between women. And as you also know, a lot of women don't recognise their symptoms to be related to the menopause, do they? I think that's so interesting. You know, I was actually reading the article that you did for the telegraph this weekend, saying that the numbers of women that you see in your clinic who've been misdiagnosed. Fibromyalgia, because they've seen rheumatoid specialists, knee grains, they've seen neurologists,

depression, they've seen psychiatrists and psychiatric help. Cardiologists are treating them for palpitations and an increased heart rate. Urologists are treating them for bladder infections. I've had women who've had tinnitus, who've been in audio clinics. And all of these are symptoms of menopause, which you can ease. And when I look back on my own history, you know, I went through my mid to late 40s. I used to get terrible debilitating headaches. And it was stressful time for me.

We were selling the beauty company. I was living on airplanes and working really hard. And I just thought I was stressed. I just thought that I, you know, overworking. And I would take painkillers, but they wouldn't touch it. And my hearing began to go. I used to get side effects. I used to get tinnitus.

And I was thinking, oh my goodness, am I going to end up with this lifelong hearing complaint? And I used to get lots of pelvic infections. I had recurrent UTIs. I was on lots of antibiotics. I never clicked, never joined the dogs. And did any doctor ever talk to you about your bones? No, absolutely not. And I just thought, well, I'm not in my menopause because I still have periods.

Nobody had even talked to me about perimenopause. I didn't even understand the word. And I've written about health and well-being for 30 years. And I still didn't understand what the paper. It's quite incredible, isn't it? As a female who's super educated, you know, you're always up to date with the evidence, but you hadn't, it wasn't in your, on your radio at all, was it? Not at all. I mean, I've had five children. So I've had five sets of gynaecologists, obstetricians, midwives, health visitors, GPs, all the rest of it. nobody at any stage said to me, you know, oh, by the way, Liz, you know, when you get into your 40s, you'll like to experience all sorts of changes in your body, you know, achy joints, headaches, you might get hot flushes, you might not. And these are all signs of declining estrogen, not to mention all the mental side effects, you know, the women, the number of women on antidepressants because it's suffering with low mood and rage and anxiety. And actually

antidepressants are just going to numb you. They're not going to top up estrogen receptors in your brain and actually help you. No, and a lot of women, no, they're not depressed. You know, the women that come and see me, they say, look, I've got low mood, I've got reduced motivation, I'm not sleeping well, I'm very tearful, I'm very anxious, but I know I'm not depressed. And some of these women have had clinical depression before, so they really know the difference. And like you say, the antidepressants, just know women.

One lady told me recently at my clinic that she'd crashed her car, but she didn't care because she was on antidepressants, and she said, I'm just, nothing affects me anymore. And that's bad. You need to have emotions. We all need to have emotions. So, but, but yeah, like you say, people, we're not educated enough to know. And it's great the campaign with Diane Dandibut, the hashtag, Mepause Bata campaign is great because we've managed to get menopause education

into secondary schools. But I think, I know you've seen the green characteristic questionnaire, you know, this idea in my clinic, which has a lot of questions about symptoms. And I feel if every woman in their 40s and younger, if they're experiencing symptoms or have had a operation to remove their ovaries, for example, are given that questionnaire, it might ring some bells, mighten it and make people think that hormones. That would be the most fantastic health benefit for women. Because when I hit 50, I got my call in for a mammogram and routine screenings and all of this.

Once you hit 50, it triggers something. well wouldn't it be amazing if once we hit the age of 45 again it was reviewed you know every two years perhaps until our mid-50s we're just given this questionnaire yeah one of the things when I've been at meetings at the point for the health that we're trying to get would be for every woman to fill it out when they have their smear test because they're seeing a healthcare professional then if the nurse said to them well have your periods been changing at all in nature or frequency and if they say yes, then, oh, would you like to feel like this questionnaire?

And you can pick up women early because, as you know, it's when we pick up women early, obviously if we can help them, it will reduce the severity of their symptoms. But also if we pick it up early and they start HRT, then it reduces their future risk of all these conditions we've talked about, such as heart disease, osteoporosis, diabetes, etc. It just needs to be more joined up, doesn't it? You look at the cost of pelvic fractures and hip replacements alone from osteoporosis. And that's running into hundreds of millions. And that's just one of the conditions.

That's just osteoporosis. That's not mental health, heart disease, diabetes, you know, all the other things that can be helped. I mean, we would be saving the NHS a fortune, not to mention improving the quality of life. and the benefits. And we are living longer as women. We're expected to work longer. Our pensionable age is going up. And the cost of business.

I talk a lot. Business community about keeping senior women in work and able to work, feeling able to work. And I know you've done a lot of work with the police force in retaining senior valuable women who don't. And people don't recognize it. You know, one of the studies we did show that 25% of women in the police have given up work and 78%, so the vast majority of menopause women had had symptoms that had interfered with their ability to work. And it's shocking because it's very easy.

If you're pregnant, you can go into work and say, I feel really tired. I've had a bad night's sleep and people will sympathise and empathise with you. But that doesn't happen when you're menopausal. And people just laugh often, don't they? They don't read. And you're reticent. You know, I'm quite vocal, as you know, and you know, my Instagram now is full of menopause information. But I have to admit that even just a couple of years ago, I didn't particularly want to talk about it.

I felt even associating myself with the word menopause was automatically categorizing myself as old and passed it in some way. Yeah. And I didn't feel that way. I didn't feel that that reflected who I am as a woman. I mean, I feel, especially now I'm on HRT, you know, I feel very vibrant and active. I feel better in my 50s than I did in my 40s, no question. And I've decided to put my head above the parapet because I just feel, I have a strong sense of injustice that's being done to life women.

And we tend to be the caregivers. We are the ones who give birth to children. We are often the care providers in homes, often having to hold down jobs as well, and look after elderly patients, parents, and we are just being short change. We're being let down. Absolutely. I just feel a burning sense of injustice,

and we need to work just to save the sisterhood, you know, to really. No, I think so. I mean, we both, you know, the stories that we read on, on Instagram, the stories that I hear my clinic every day, just make me want to cry and weep because I feel it's disgusting that women aren't allowed to be given the right treatment And we're not here saying HART is the only treatment or the best treatment. Certainly holistic care is key.

And as you know and practice, you know, eating healthily, sleeping well, exercising is really important for us, even more so when we're menopausal. But often replacing those hormones is really the missing link. And I've certainly been sort of talking to some of my colleagues and talking to the people at the Royal College of GPs recently about even thinking about changing the term menopause because menopause just really is meaning the symptoms, there's got so much stigma and taboo with it. And it should be thought of as a female hormone deficiency syndrome because it lasts forever. So even if you are having no symptoms or your hot flushes had improved, you've still got the effects of low hormones in your body, which is what a lot of people

don't realize, I think. We've all heard women who say they're going to battle through their symptoms and they'll come out the other side as a stronger, more empowered woman. But you can't replace those hormones that your body isn't making. No. So you may feel that you are a strong empowered woman, but actually your inner fragility and your risk factors for so many diseases that we simply can't control will be greatly increased because we don't have the estrogen And it's very interesting. This study, obviously, one of the new things, or probably the only new thing that it talked about, was the increased risk potentially of women who come off HRT 10 years.

Well, I think you would probably say, don't come off it. Yeah, and I think this is a shame because I'm getting a lot of emails at the moment from my colleagues, nurses and doctors saying, or what do we tell patients because it's saying that the increased risk of breast cancer continues up to 10 years after stopping HRT. But as you know, the guidelines are very clear and they're not going to change because of this paper that women can continue to take HRT as long as the benefits outweigh the risks. And women need to have an annual review. So every year we talk to women, we look at their benefits, we look at their risks

and discuss whether the benefits outweigh the risks and whether the benefits outweigh the risks and whether they can continue HRT. And the vast majority of women can because, as you know, the risk of clot isn't there if they have the estrogen through the skin and the natural progesterone if they need a progestogen. And because of the benefits for their hearts, for their brains, for their bones,

and also for their symptoms, usually people carry on. The other thing that wasn't mentioned in this paper, which you might know, is that if a woman stops taking HRT, studies have shown in that first year, those women have an increased risk of stroke and heart attack by about 30%. So it's actually quite dangerous to stop taking HRT, which I don't realize. We don't know. We know that estrogen is very anti-inflammatory. So we know it, obviously, it's anti-inflammatory in our joints. That's why it stops muscle aches and pains. But it's anti-inflammatories in our endothelium, which is the lining of our blood vessels.

and because it produces all sorts of cytokines and chemicals to damp down any inflammation, so reduce atheroma and the furring of the arteries, we think it might be sort of like a rebound effect. So when you stop the estrogen, all those chemicals that have been suppressed sort of going a bit wild. We don't know, but that's a very simplistic way of explaining it, but it sort of would make sense. So actually, we used to say, take HHR,

for the shortest length of time, for the lowest dose, and we don't anymore because you have to have adequate estrogen to reduce this risk of heart disease and osteoporosis. And because we can take it in the long term, and as I mentioned to you before, we went on air, that there's already a warning from the MHRA saying we should talk to women about HRT, consider reducing their dose. And this is really worrying me as a doctor because there's no good evidence to support that statement. And I also found out there isn't a menopause expert who's an advisor at the moment to the MHRA, which is very disappointing. Can they put out statements without an advisor? Well, this is what I'm trying to find out because it's very easy to sit in your office writing things about HRT or about any medication,

but actually it's very different when you're sitting in a clinic and you're listening to stories. And I strongly feel, and I know you agree, is that women should be given a choice. We make a choice about every time we go in a car or an airplane or just going on a bicycle, there is a risk that we might crash. No one's telling us that we can't do this. And the other thing is, even with this study, it's very interesting when you look at other risk factors for breast cancer. So as you alluded to, this study showed approximately a 2% increase

if you're taking combined HRT and you're above the age of 50. But if you're obese and you're over the age of 50, then you've got about a 20% increased risk of breast cancer. And about three or four times increased risk if you have a low fibre intake in your diet or you don't exercise. So these are risk factors for breast cancer, but it's not hitting the front lines of the papers that women who are obese or, like you said before,

women who drink sugary drinks have an increased risk. I mean, I looked at that paper out in the beginning of the summer, and that shows just 100 mils, which is a small glass of any sugary drink. So we're looking at fizzy drinks, even juice. I think of orange juice, a glass of orange juice. Yeah, a glass of orange juice increases your risk of cancer by 18%. Now, that is really quite staggering. I mean, I try and avoid, you know, I mean, I don't drink fizzy drinks.

I might have a bit of tonic in my gin, but that's kind of about as far as it goes. But I know a lot of people are drinking serious amounts of juice and smoothies, even, even these, you know, fairly healthy sounding things with the high sugar content. And that is significantly increasing our cancer risk. And I think, for me, I will never not take HRT because of the protective benefits. I mean, I obviously feel so much better on it and I can function better. everything is better. My health is better. I have more joy. I'm more energetic. Anybody who can see on my Instagram, I'm now doing 50 push-ups in the morning. I'm stronger. I'm fitter.

And that has been made possible by putting the estrogen back into my bones. And I know that I'm protecting my heart. I've got a 50% reduced risk of coronary heart. My bones are stronger. I was talking to an orthopedic surgeon, not long. ago who said that he can absolutely tell on the operating theatre when he's doing hip replacements or fracture repairs the women that have been taking HRT because women who don't take it, their bones, you know, under the, under the knife are like a crunchy bar. You know, they're like honeycrapnel. You know, you can see that from the inside. And that's, that's really quite chilling to think that all that damage is going on inside that we're not aware of simply because we're

losing our estrogen. I mean, as you know, estrogen gets all over our bodies. And I think it's really important for women to know. Like you say, even if this study was a randomised control study and even if it showed this increased risk, most of my patients would absolutely still carry on taking HR team

because they know the bigger picture. And I think this is what's really, really important. I think my sort of big message really is that women should be given evidence-based, non-biased information. They should not be listening to what their neighbours or what someone on Twitter or social media has told them. They need to balance and think about the risks and benefits for themselves, don't they? We're all individuals. And we need to consider ourselves as individuals when we think about taking HRT. And we just need to get that information out there.

and it does seem like rolling a big screen up in a hill sometimes because we are combating the fact that our GPs are not trained, so they're not across the information. Even it seems that the government advisory people are not getting the right information across, the right people are not advising them. And even when you get your HRT, you then read the leaflet. You know, I actually read the other day the leaflet that comes in my Easter shelf. And it said, don't take it, don't use this.

if you have a history of DVT and thrombosis. And I thought, well, that's completely wrong. No, I mean, I've taken that up with the MHRA, and I have got another meeting coming up soon about this, because what they do with a patient information leaflets, so even if you buy paracetamol, there's lots of warnings, and they add to it when something comes up. But they've never actually looked at having a policy for removing things.

So as you know, tablet estrogen has a very small risk of clot. So they have grouped it for all estrogens, But we know now that estrogen to the skin with a patch or gel, there's no increased risk of clot. But they've never taken that bit out of the patch or gel leaflets. It's so shocking. I get comments on questions, you know, on my Instagram all the time from women saying, you said it was fine in your, you know, e-guide to HRT. You said it was fine for me, you know, to talk to my GP and it would be fine if I had a history of thrombosis.

I've got the medication now. And it clearly says that I can't take it if I've got a history of thrombosis. and I have to write back and say, yeah, actually that information is not correct. I'm not a medic. It's the job of the person who's actually providing that. I mean, that is misrepresentation of an important drug. But the problem is, is that as a GP, when we prescribe through the computer, all the information is linked to those warnings. So if I try or if I prescribe a patch of estrogen, it will still pop up saying risk of clot. So that's not something. So that is not helping. So that is not helping to educate doctors. What is it? Because, you know, unless you're a menopause specialist,

you don't know. You just don't know and you're going to be your patient, maybe educated, and maybe saying, actually, I've read about it, I've read all the research, the studies, it's fine. And the GP will say, well, I'm sorry, computer says no. You know, it says that the really Yeah. So this is something else we need to, it needs to address. There's a lot that we need to do. I mean, do you sometimes despair because it's. Every day, every day, I've banned my head against all and my husband's sick of me just saying what's going on? I spent my entire day on Friday firefighting on my Instagram and just replying to every comment because I felt it was really important that we had.

Then I went to a drinks party yesterday and Saturday night and literally every woman I spoke to because they heard me on the world at one on Radio 4. They were all saying, oh my goodness, I'm so worried, I'm so nervous about this and I spent the entire evening talking to women saying, actually, this is this is the truth and this is the evidence and these are the facts. You know, you don't have to take this side for it. This is where you can go. These are the medics you can go and talk to and look up. But tell me, while I've got you here, I'm going to turn the table slightly, what is it with this HRT shortage? What is going on and how worried should we be? We don't need to worry. With the HRT shortage,

just very briefly, some types of HRT, there's a manufacturing problem. A lot of it seems to be the older types of tablet, which is a combination of estrogen and an older progestogen, that they're having problems making. But actually, those women really, if they are taking tablet estrogen as a combination, it's a good time to maybe think about changing to a patch or a jam of the estrogen with a natural progesterone. So I think that's quite good, although it is creating a lot of work,

I realize that. Now, there are some patches that have gone out of stock, and that's because of increased demand. And I think probably some of our work has contributed to that. So I heard that some of the patches, there was a brand that was recalled because the adhesive it wasn't sticking. Yeah, some of them, but they've come back in stock now.

We're going to test them next week, actually, just to see out sticking they are before we give them out to our patients. But there are random patches available. And I've been speaking to the Department of Health most days last week. And they're working really hard, actually, with the drug companies to try and rectify this. The estrogen gel is still widely available. They're pooling on some of their global stock and European stock

to get more in stock for the UK. And the micronized progesterone, again, it's the same company that make that in the estrogen gel pump. They've got plenty of less in stock as well. Well, for those women that use testosterone, as you know, the safest way of having testosterone is the androfem, which is available from Australia, and there's no supply problem with that. Some women are finding that even these types, they can't get from their local chemist. And that's sometimes just because some local chemists aren't used to prescribing or dispensing some in large numbers. So then they should try to go maybe more centrally with an online pharmacy or go to a bigger branch of a, pharmacy. So I have got an article on my website about it that people can go to and I'm updating it as soon as I get more information. So it's actually not as bad. I'm not sure how much Brexit. There was something in the paper today about lots of medication not being available because of

Brexit, which is a real, real concern. So we just keep listening about that really. Yeah, and just make sure that you've got your prescription up to date. Although of course now, sadly, with these headlines, many women may not be going back to renew their prescription, which is a tragedy. Well, I hope after listening to this, they might change their mind. So we've come to the end, but I'm not sure if you're aware, but traditionally at the end of my podcast, I ask the person that I'm interviewing three take-home messages. And I know we're not really, I'm not really interviewing you because we're chatting together,

but I'm going to put you on the spot, Liz, and say, from what you've learned over the last few days about this study, what are the three take-home messages that you would give to women and men listening about HRT? Well, I think the first thing is to say, you know, don't believe everything you see in the headlines. You do have to do research and go behind that. Headlines are very often clickbait and sensationalism. That's the first message. Don't panic.

So the HRT, I'm not panicking about it. The only thing it's done is make me even more enraged and even more determined to get this message out there to help the injustice that's being done to midlife women. I think it's really important to read up on the subject. And there are some fantastic people out there like yourself, like Diane Danza Brink, like Michael Baum. There are just so many good experts. And we need people like you to be doing what you're doing. And the more we can do to support you guys, the better,

because you're the medics, you're at the sharp end. I mean, I'm just a researcher and a writer. So I'm just, you know, really. You know, I'm somebody who's just sort of on the journey, really relaying all this good stuff that you experts are putting out. And I think really look at every other symptom that you might have. It's not just all about hot flushes. I've never had a hot flush.

And yet my privacy of life overall has been improved so much, so greatly. And just one little story that I'll leave you with. My mother was on HRT for many years. And she came off it in her early 70s just because her GP said, oh, I think actually it's time. you stop now. And I had done so much research into the benefits and long-term health benefits, you know, things like dementia, osteoporosis, things that really hit you in your older years.

And so as her 80th birthday present, I encouraged her to go back on to HRT. And it did take three doctors. And it was the third doctor who was actually able to prescribe it to her for her. And I spoke to her recently and I said, how's it going, Mom? And she said, well, she said, oh, no, not really. much different. You know, I feel great, but actually, I don't get up five times a night now. And I said, what do you mean five times a night you were getting up? And just, oh, yes, I just, you know, pot her off to the loo five times a night. I said, that is an absolute shocker because

we know that for your mental health and for dementia, you need good sleep. So I am so thrilled that my 80-year-old. And she is going to stay on it until her dying thing. So that's my lasting message for everybody listening. Well, I think that's a good message. Because it's also showing that if you don't get what you want or you think you should receive from the first healthcare professional you see, you keep trying until you get what you think you deserve. To be persuaded, because she went first of all to her local GP and maybe she's of that generation where if your GP says, no, you just accept it and go away. And I said, let's go and see a different GP. So she went to a different GP who also said no.

And I said, no, I think we need to go and see a specialist who of course said yes. Yes, so it just shows. So, oh, well, thank you ever so much for your time, Liz, on a Sunday night. Yeah. But I hope this has been really useful for many women out there who have been worried about the last few days in the media. So thank you ever so much. Pleasure. See you soon. For more information about the menopause, please visit our website www.