The Dr Louise Newson Podcast - 014 - Getting the right menopause information - Diane Danzebrink & Dr Louise Newson

Episode Date: September 10, 2019

In this episode, Dr Louise Newson talks with Diane Danzebrink, both very passionate campaigners on the subject of improving menopause education for women. The two experts discuss the current HRT shortages and media reports following the recent HRT scare and give women the real facts, talking about their grave concerns that women are going to be denied HRT by their doctors for the wrong reasons and how women need to be given the right information to challenge this. Diane Danzebrink's Three Take Home Tips: Don't panic! Don't believe the headlines - go find factual evidence-based advice Take someone with you to your doctor's appointment if you're feeling nervous, and before you visit, look at the Menopause Doctor website for information, visit the Menopause Support website and download the 'Ten things your GP should know about the menopause'

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 Wellbeing Centre here in Stratford-upon-Avon. Hello, so today I'm talking to Diane Danzabrook, who as a lot of you know how I have spoken to before and we've recorded a podcast together. And in fact, we actually speak most days because behind the scenes, we're doing a lot of campaigning. to try and improve menopause care and education. So good morning, Diane.

Good morning, Louise. So today we really wanted to talk about how women struggle to get the right information for them. And as many of you have heard me speak before, menopause care needs to be individualised. Women need to make the right choices for them. So my job is not to tell women what to do. Diane is not trying to push women into a corner. What we're trying to do, is give women evidence-based, non-biased information so they can make the right choices for them. And the perimenopause, so the time before period stop when symptoms start and the menopause and even the time after the menopause when symptoms can change or even go away, it's a journey and everyone's journey is different.

So as a healthcare professional, obviously I have a lot of knowledge about the menopause because I'm a menopause specialist, but sadly, a lot of people, of doctors, myself included, didn't have training as an undergraduate or postgraduate in the menopause, which is shocking because, as you know, half the population, so all women will go through the menopause. So I set up my website to try and help give women evidence-based information and we're constantly updating it to improve it. So, Diane, I thought maybe at the beginning, we could talk about how you as a lay person before you started to live and breathe menopause, which you're so passionate about helping. So if we turn the clocks back to when you,

or even before you knew you were going to have surgery, as some of you might know, Diane, is very open. She had her ovaries removed in operation. So before you had your ovaries removed, which means that all your hormones or most of your female hormones would go, how did you get information or what did you do to try and educate yourself? Well, to be honest, the only thing that I knew about menopause was that my mother had a hysterectomy 25 years before. She had ovarian cancer and the HRT implant that my mother was given at the time of her surgery was conjugated equine estrogen, so pregnant mares urine. And I am a horse owner, horse lover. And I was horrified by that. So the only thing I knew about HRT was that it was pregnant

MERS urine. And I had made a firm decision. I was never going to have it. Because my surgery happened as an emergency pretty much, once it was decided that there was the suspicion that I also had ovarian cancer, my surgery happened quickly. So consequently, I didn't have a huge amount of time to research any updates. And sadly, nobody gave me any information. None of the team at the hospital sat me down and spoke to me about, I knew it would be menopause having my ovaries removed, but I didn't know what the consequences of that would be for my entire body. And I certainly wasn't told about the importance of me having hormone replacement therapy and what that hormone replacement therapy could look like. So it would have been really useful. Obviously,

when it's an emergency and people are worrying about other diseases such as a varying cancer, I can understand that menopause isn't top of the list, but it would have been useful then maybe to have been signposted to websites or even given a little booklet or written information, do you think? Absolutely it would. And I would also say, Louise, that running up to that surgery, I had many, many appointments. There were lots of opportunities to offer me that information. And even after I had my surgery, before I left the hospital, nobody sat down with me to explain the consequences of that surgery. And nobody gave me a booklet to take home. And actually, it wasn't just for you, was it? It's for your partner as well. It's really,

would have been really important. Yeah, absolutely. And, you know, he came to many of those appointments with me. But at no point was, to be honest, the thing, I mean, I was 45. And the thing, I mean, I was 45. and the thing they were more focused on was, did I understand that I couldn't have children anymore? Now, I made the conscious decision many, many years previously not to have children. That was my choice. But that was really what they were focused on,

was, did I know I couldn't have children? Well, yes, of course I did know that. But was there any focus on looking after my children? physical and as you well know, what turned out very much to be my mental health, post-surgery, but also long-term, no, there was nothing. No. And I think this is the thing, isn't it? For many of you who are listening, I'm sure no, but just to recap, so the menopause is the time,

officially it's a year after your last period, but if you have your ovaries removed, then you get flawed into the menopause. It's a very harsh, unnatural way of experiencing the menopause. a lot of women have symptoms. The most common symptoms that everyone knows about are the hot flushes and night sweats. But women can get symptoms, as Diane did experience, such as low mood, anxiety, reduced motivation, poor concentration, memory problems, joint pains, muscle aches, migraines, headaches, vaginaldriness, urinary symptoms, because we've got estrogen receptors in cells all over our bodies. But actually, the symptoms are one thing, aren't they, Diane, but it's the long-term health consequences.

of not having hormones in our bodies. And this is what women need to be educated. So when we talk about the menopause, often people feel, it's just symptoms, I'll man up, I'll get through them, I'm going to fight my body, and then I'll come out the other side. But unfortunately, we're not designed to live for 30-odd years

without hormones in our body. So evolutionary, we was designed to reproduce. And in the Victorian times, we used to die a couple of years after our menopause. Whereas now, thankfully, due to lots of advances, better health care, we're living often into our 80s. So that means the average woman will live 30 years without hormones. And because of that, there's an increased risk of heart disease, osteoporosis, type 2 diabetes, osteoarthritis, dementia and depression. So it's the health risks, which I'm sure no one spoke to you at all, did they?

No, nobody mentioned anything like that. And the thing that worries me so much now are particularly those women who are even younger than I was who are having this surgery, either a surgical or a medical menopause. And they're equally not being given the right advice and support. And obviously with the work that I do now, I speak to a loss of those women. And it's absolutely shocking that, you know, sort of we're in 2019 and that still isn't something. something that is routinely given. And it's actually not that difficult. No, absolutely. It's quite simple information. I think it's right. And we'll talk a bit about some of the HRT scares in a minute. But one in a hundred women in the UK, under the age of 40,

have an early menopause. Like you say, sometimes it's, um, can run in families. Sometimes it's just one of those things that happens. The ovaries fail early. And often it's because they've had an oophrectomy, so their ovaries removed. Some of them is because they've had a type of cancer and they've had radiotherapy or chemotherapy that's affected their ovaries working. But these women under the age of 40 need to have hormones. So either HRT or the combined contraceptive pill to replace the hormones their body should otherwise be producing. And we know that the health risks for these women are very much increased because they're spending even longer without their hormones. And any type of HRT doesn't have any risks associated with it up until the age of 51,

which is the average age of the menopause. So women under the age of 40 really have to have HRT. And I see hundreds of women in my clinic and liaise with thousands of women who tell me that they've been told they're too young to be menopausal and their symptoms aren't related to their hormones. And I'm sure you must have contact with similar stories. Yeah, I mean, it's really common. So as you know, I run the menopause support network on Facebook and we've got nearly 10,000 members. I counsel women in my clinic every single. day and not a week goes by when I haven't spoken to women who have gone into either a premature or a surgical menopause. You know, I spoke to a lady the other day who's been trying

for 18 months to get HRT from her GPs and she's in a surgical menopause. She doesn't have any ovaries. You know, for me, that's not even about, that's not even about menopause training. That's basic physiology. Absolutely. I think if someone had had their first thyroid gland removed and had been denied thyroxin and being told, well, you are going to feel tired, you are going to put on weight, you're going to feel sluggage, all those symptoms related to not having a thyroid, it wouldn't happen. So it doesn't make sense that women are not counselled and given information. And certainly the nice guidance, the National Institute of Health and Care Actents guidelines are very clear that women who are having hysterectomy

with their ovaries removed need to be counselled. And even those women that are having a hysterectomy, but retaining their ovaries, they have a higher risk of going into the menopause earlier. And as you know, if you don't have a womb, you don't have periods. So then it's very hard to know how many of those symptoms are related to their hormones. And so the nice guidance, just to reassert, really, if a woman has had changing periods and has symptoms and is over the age of 45, then we don't need to do a blood test. So I see lots of women who are having blood tests unnecessarily by their GPs and being told, oh, no, your hormones are normal.

It can't be related to your menopause. It's not about that because our hormones change every day. So we can't make a diagnosis from a blood test. If a woman's between the ages of 40 and 45, the nice guidelines say a blood test may be useful, but in practice it's only useful if it's abnormal. So a normal blood test doesn't actually help. under the age of 40, because it's important to get the diagnosis right, the guidelines say we should be doing a blood test. But again, I see lots of women who have had normal blood tests. I saw one actually last week, who she was 39, had had symptoms for the last 10 years, had some blood tests. They were normal. People were diagnosing her as having fibromyalgia, chronic fatigue and depression. She'd been on five different antidepressants. And I said to her, well, I don't know, but let's try. some HRT. And in fact, I saw her last Monday and on Friday, she phoned the clinic to say she'd

gone to the gym for the first time in five years. Because she was feeling better. So, you know, the proof is in the pudding and HRT is so safe that often I will say to women, I just don't know, but it's quite dangerous. You're not having hormones because of the health risks. So let's try estrogen through the skin as a patch or gel because there's no risk of clot. If they need a progesterone, if they've still got their womb, I give them the micronized progesterone, which is very safe, which is a body identical progesterone, or consider having a marina coil, especially if they want contraception, and then review them. And if they come back in three months time and say, oh, I don't feel much better, then I know it's not their hormones. But most people come

back and say, wow, I feel so much better. So then that's the thing, isn't it? It's a simple possibility, isn't it? So why not try? Absolutely. And HRT is very, very, very cost effective. It's very cheap for the NHS. Each product costs around £4 a month, so it doesn't cost much. And it's very easy to prescribe as long as women are given the right information as well. And usually what happens, I find in my experience that when women have the right dose and type of HRT for them, it gives them a passport to think about their lifestyle because, as you know, managing the menopause is not just about giving HRT. We need to look at our diets. We need to look at our exercise.

We need to look at our sleep. We need to look at our well-being, our mental health. But often it's a real struggle to do that without hormones. And, you know, you were really on the edge when you, before you took HRT. And, you know, I was even worse because I had no idea, even as a men of halls specialist, that's my low mood, my reduced motivation, my muscle aches and pains. Even my night sweats were related to my menopause. I thought I had a lymphoma type of cancer.

I was too scared to get a blood test. I was irritable, but I thought it was because I was tired. And so then I'm denying my body of hormones. It was about six months it went on for. And scared. I was really scared. I had something else going on. And I wasn't able to look after my family.

So I think the other thing is for a lot of women, they will say things like, you know, sort of, well, I just thought I'm so tired. I've got a busy life. I'm trying to work, run the family, look after the children. They might be looking after elderly parents now too. You know, they're very often not prioritising their own health. I'm getting older, so I would expect to feel more tired. And I think, you know, we really need to get over this idea that, you know,

sort of just because you're getting older means that you would expect to feel, you know, sort of to feel tired, to feel exhausted. As you said earlier, potentially we're going to live for sort of 30 plus years post menopausally. And every woman deserves for those years to be happy, healthy and if she chooses, productive. Well, absolutely. I mean, I saw a lady a couple of weeks ago, he was 58. And she had had symptoms for 12 years. And she'd given up her job.

She just had her first grandchild. And she said, I'm too tired to play with my grandchild. I'm just sitting, stare at the walls all afternoon. And she said, yes, but I am old. it's still 58. Wow. You know. But the menopause makes us old.

We know that estrogen actually is the best anti-aging treatment in the body. So it helps reverse some of the aging processes in our systems, in our body, as well as, obviously, it can help our skin. But internally, women who take HRT have a better life expectancy, especially young women as well. Yeah, I think that's really important. I think that's been the most interesting thing is, you know, sort of just how much. how much of the body's functioning, estrogen has a part to play in. Yeah. You know, sort of, it's so hugely important.

I was just reviewing some literature about the risks of not having hormone replacement therapy, so the low estrogen with increasing risk of dementia. And there's been very few good randomized control studies. So we're just looking at other studies. But we do know that estrogen is very important for glucose metabolism in their brain. So if we have estrogen, our glucose metabolism is better in the brain. And obviously, glucose is the fuel for the brain to function. Yeah.

So it's very interesting. So we're both talking about HRT and how wonderful it is. But there's a lot of women out there who are very scared. And there's a lot of healthcare professionals that are even more scared about HRT. Particularly now. Yeah. So we're saying particularly now because we're recording this at the beginning of September. And just over a week ago, there was a publication in the Lancet saying there was an increased risk of breast cancer with taking HRT.

And this risk continued even in women who stopped taking HRT. And if some of you have heard my podcast that I recorded last week with Lizell, if you haven't, it's worth listening. Because we review this paper. And it was a epidemiological review. So it wasn't a gold standard randomized control study. So it didn't prove anything. It showed that there might be an associate. So that's really important to realize.

And really frustratingly, for me and for lots of women, is that the MHRA actually produced a warning. These reports of the government, and there is now a warning about HRT, which has gone to all healthcare professionals. And that's just based on this one meta-analysis, Louise, isn't it? Can I ask you a question about it? So I still can't, as a non-clinician,

as a non-doctor, I still can't get my head around how one meta-analysis of essentially information that some of it isn't even published studies and one particular part of it, the Million Women's study, which is not a gold standard randomized control study, there are already many questions from other academics about that study. I don't understand why this particular meta-analysis has been given such gravitas, I don't get it. What's, is there a, am I missing something? Yeah, no, I don't get it either. Diane, so it was published in the Lancet and when a, when a paper comes out that they think

will have media attention, a press release is written. And sadly, the press release, because I've read it, looks very much about the risks of HRT. And it misinterpreted some of the information saying that. that it's been proven there's a cause with breast cancer, which it hasn't. It also doesn't mention anything about the benefits and the established benefits. It mentioned in this study that there wasn't enough data to look at heart disease risk in this review, but we have got randomized control studies.

We've got other reviews. It's a Cochrane review showing that women who start taking HRT within 10 years of their menopause have a reduced risk of her heart attack by about 50%. So we have got evidence. but not in this Lancet one. And they've lifted this in the media, as we know, but they've also lifted it for the MHRA report. And I'm not sure, I agree with you,

there's lots of studies that come out all the time, and they're not fast-tracked through the MHRA. No. So I have my own theories, but I don't know for sure. But I know that the International Menopause Society have written a review about this. The British Menopause Society of World College of Guiney have written, and it's all on their websites.

to show how misinterpreted this study is and how it's sending the wrong messages. But the problem is, yeah, go on, sorry. For women, that's really, no, I was just going to say, you know, sort of for women, that's really difficult. Absolutely. Unless they've read, and I know that you and I have shared them widely, you know, sort of the information from the IMS, etc. But unless women have read those, and let's face it, you know, sort of,

of when I was at my absolute rock bottom, as many people feel, the last thing you want to do is sit down and read all this stuff. Well, your brain doesn't work, so it's hard to... No. You know, that's a really difficult situation because now women are wondering, well, do they believe the MHRA? Do they believe the BMS, the RCOG, the IMS, you, me? Well, that's really hard.

It's really difficult because then they're seeing... a doctor maybe they've known for 20, 30 years who's saying, no, H&T is too dangerous. And the Lancet paper is very heavy read. I'm not a statistician. So I've taken some really good advice from people who do know what they're talking about. But for busy GPs, they get this ruling from the MHRA. As GPs, we have to act on things that the government send us. So this report from the MHRA clearly says HRT should be taken for the lowest dose, the shortest length of time. Now, this calls. contradicts the guidelines that NICE have produced and the International Menopause Society and the British Menopause Society have produced. And I've been liaising with very key people who are involved in these other guidelines. And they all have said that these guidelines don't need to change. So we can still take HLT for as long as the benefits outweigh the risk. So for most of us, that's forever.

Because of the bone and heart protection it affords. We also know it's really important for women to have adequate doses because women who are still having flushes and sweats, despite being on HRT, have an increased risk of heart disease, osteoporosis and depression. We know that from studies. So it's not good enough to say, oh, I'm only having three hot flushes. I used to have 23. Actually, you shouldn't be having any. You need to replace the estrogen to have maximum future health benefits. So this... And surely the point of good HRT prescribing is to make the woman as asymptomatic as possible. Absolutely. Absolutely, because all we're doing is just replacing those hormones.

And as you know, younger women often need a lot higher doses than older women. And it's very important that we match the amount that they're using. And hormone need can change if someone's stressed or if they're on other medication. So this is why the nice guidelines are clear that women need an annual review. And a lot of women come back and say to me, oh, my HRT is not working. Well, it is working because you're better than you were, but we need to change. the dose, sometimes change the type of estrogen, so change it from a tablet to a gel maybe. And sometimes we also consider testosterone and other hormone. So there's always choices.

But talking about choices, as a woman, as a person who's needing medical help, what our role is as a doctor is to inform our patients and allow them to have a choice. We choose whether we go in our car or not. We choose what we eat. We choose whether we exercise or not. And taking medication needs to be a choice as well if a patient is consenting. So some women, for example, might choose that they never want to take antibiotics for chest infection, for example. But they're making that choice because they know there's risks of not taking something. Now, with the menopause, we should be allowing our patients to have a choice based on the evidence.

If they want HRT, they should be allowed it. They shouldn't be given antidepressants or fobbed off to say, well, they don't need HRT. And likewise, if a woman doesn't want HRT, then it's not for us to say you have to have it. No, absolutely. Yeah, and at the moment, what we hear time and time again, and this is why you're so busy, I'm so busy, is that women are being denied HRT. And there is no good reason why women are denied HRT, even women who have high risks. if they understand the risks and they want to have it,

then as long as it's reasonable clinical practice, then they can still have HRT. And I think that's the thing we're both so passionate about, isn't it? It's about informed choice. And it's making sure that women have that information so that they can make that informed choice. Yeah, absolutely. And on my website, Manifoldsdoctor.com.

There's lots of information on the news section written articles from me, but from other people, about this Lancet review and what it means and looking at the bigger picture as well. Now, just finally, before we sort of round up, it's all very well saying how good HRT is and it's all very well saying that we should get it. But there's an HRT shortage, isn't there? So just when we thought we were doing really well, educating women. And now we're told every day that there's a shortage of HRT. So I've been liaising very closely with the Department of Health who are working behind the scenes to try and change this. Some of it is due to a manufacturing problem, we know. And some of it is due to increased demand, which is good because it means that our work is finally working. but it's bad because the manufacturers haven't kept up with the demand. They hadn't realised there would be such a demand for...

Which is quite shocking, really, when you think about the size of some of those companies. Absolutely. You'd think that they would be monitoring, yes. Massive, massive organisations who employ people to do forecasting. You know, this hasn't happened overnight. This has been going on for the last few years. Yeah, I think it's snowballed and I think some of our messages are coming. and out. And also, as you know, I do a lot of training for GPs and education. So it's not just about

empowering women. It's about educating doctors as well, which is great. But not all types of HRT are affected. It's mainly some of the older combination tablets. And I have said before, this should be seen as an opportunity to optimize your HRT. And having estrogen through the skin as a patch or gel is safer than a tablet because there's no risk of clot. But a lot of the patches are affected and every day I'm getting different reports from people about which patches. Yeah, I think the really tricky one is Everell, isn't it? Because so many people were using it. Absolutely. So Everell at the moment is very hard to get hold of. Easter dot is variable. There's Eustoderm and Fem 7 that is available in some areas. Some women are finding just

their local chemists don't have it. And then if it is just the local chemist, then they should go to an an online pharmacy because they often have bigger stock. Yeah. But then the other thing is different chemists use different wholesalers, don't they do? So it's worth, even in your own town, it's worth checking with several. Yes. And it's also trying to speak to the pharmacist as well because they might have other wholesalers that they can access. And some of the companies have said on you, we can order from the companies direct.

So it would be worth speaking to your pharmacist. and seeing what they say. And then we have heard that the estrogen gel, so estrogen gel and also the micronized progesterone, utogenesstam, is widely available there looking at their global stock and improving it. So they're really on it, the company that make those. So there are choices, but it's important that the doctors are kept up to date, which sadly they're not at the minute.

So I've just put an article on my website, which you can print off and take to your doctor to discuss how to change from one type of HRT to another. So women should not be advised to come off their HRT because of the MHRA report and also because of the shortage. There are alternatives, aren't there? Yeah, and I think one of the, you know, sort of for me, the most worrying thing is having, speaking to women who are going to their doctors and their doctors are saying, well, it's not available, so you can't have it.

Absolutely. It's not, and there is being absolutely. no conversation around changing. And it is having a huge emotional, you know, sort of it's having a huge effect on mental health, people talking of, you know, having real worry, anxiety, concern about this because they know what a difference it's made to their lives. Well, absolutely.

And I know we've spoken before this two main things that worry me. One is that women are going to stop. And I know personally, if I stop my HRT, I would have to close my business because my brain doesn't work. without it. And it's the risk to mental health. So there's women who have been suicidal before. I've got plenty of my clinic. If they stop their HRT, their symptoms will return. But the thing that concerns me probably more is those women that will never start HRT. And as we know, the suicide rate in women peaks in the early 50s, which is the average age of the menopause.

There are a lot of women out there who have low mood anxiety and suicidal thoughts who who are going to be denied HRT for the wrong reasons. Well, it's also those women being stuck on antidepressants for years when antidepressants, A, are not first-line treatment and B, in some cases, actually, you know, can make the situation worse. That's a real fear for me around this. It is for me because doctors will read the MHRA report

and think, oh gosh, antidepressants are safer, let's avoid HRT. So we need to, hopefully this podcast has helped and the information that we're giving out has helped that women should be empowered. And if any of you are listening are having problems obtaining HRT or being told you don't need it and be given antidepressants, then download some of the fact sheets from the website, print off the nice guidance, challenge your decision and it's difficult challenging a doctor or see another doctor or a nurse. But please don't give up. It's really important to get the right help. Absolutely. You're very welcome to come and join the Menopause Support Network, come to the

Menopause Support website. And if you come to the website, please, please sign and share the hashtag Make Menopause Matter campaign petition. Louisa and I have been, as she says, we speak most days. We spend probably far too much time talking about this. You might not see it all, but we are campaigning really hard to change things. And how many people have signed now, Diane? I think we're 32,000. Brilliant. Okay, but we need that to increase more, so our voices are heard. We really do. So thank you for your time, Diane. Just finally, I just wanted to round up by you giving me three top tips for women in view of the HRT shortage, the HRT, scare. What three things that women can do that will really help them in the future?

Okay, first thing is, don't panic. Second thing is, don't believe all the headlines. Actually go and look and find some factual evidence-based advice. And the third thing is, if you're going to go and see your doctor, before you go, have a look at Louise's website, My Menopause doctor. Come to Menopause support, download our 10 things your GP should know about menopause. And if you're going to go to the doctors, if you're feeling really anxious or really nervous, take somebody with you because it can be always fantastic to have a bit of moral support. Brilliant. Thank you. Excellent. Thanks. My pleasure. Diane, for giving me up your time. Thank you. Happy Sunday. And you. Bye.

Bye. For more information about the menopause, please visit our website www. www.com.com. UK.