The Dr Louise Newson Podcast - 020 - Menopause and Antidepressants - Kim Goulding & Dr Louise Newson

Episode Date: October 22, 2019

Kim Goulding is one of Dr Newson's patients here at Newson Health. In today's episode, Kim talks about her own experience with the menopause how she was offered antidepressants. She has always been the driving force behind her family and became socially withdrawn and very low in her mood. She had no idea initially what was happening to her and her life had really changed. She talks to Dr Newson about how she tried to receive the right treatment and her experience taking HRT. Kim's Three Take Home Tips: It can be difficult when struggling with severe symptoms, but go and find the right help. If your GP can't help you then go private if you can. Women should not have to pay for good quality menopause care, but getting the right treatment is priceless! Get informed and search for evidence-based resources, such as menopausedoctor.co.uk.

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. So hi, today I haven't got a menopause expert with me. I haven't got a doctor with me. I've got a real patient sitting with me. So today I've got Kim, who's really kindly given up her time, come back to the clinic. just to talk about her experience really. So hi Kim.

Hello. So you're obviously really well now, which is brilliant. Yeah. But if you can bear with it, go back. Tell me about when we very first met what had been going on. I think when we met, it wasn't, oh, yeah, I was probably at my worst. But I'd probably be not okay for two to four years. I know now how bad it was. At the time I didn't, it's looking back in hindsight, I realised how bad it was. And it was a gradual progression. It wasn't like overnight instant.

That's exactly. Which happens to so many people. Yeah. How old were you when you first got symptoms now, do you think? It's really hard to say. When I look back, when I was 45, my daughter got really ill. So I was loopy because of that. And then when we came home, I don't know.

But looking back, I think it was definitely starting. starting then, but I just put it all down to her being ill. And then certainly, like, from then till when I was, well, basically till I saw you, it was a gradual getting worse and worse and worse. And at first I didn't even really click it. And then like, oh, it's not that bad. It's just IBS. It's not a big deal.

It wasn't IBS. And then obviously it's gluten, so I cut that. It's not gluten. So literally it was like a checklist, every other. every six months it was getting worse and worse and worse. Then it was joints, then I stopped running. Then to the point where I think it was last September, just before I came to see you,

we went on holiday. And I think I was completely unfunctioning for the whole three weeks that we were on holiday. It was just in tears, just terrible. And I think also, like, when I look back on it, I remember, like, my daughter's saying, like, I was really on it. Not brilliant, but I was okay.

I was homeschooled them and I run my own business and doing it. And then all of a sudden they were like, can you just finish your sentence? So you'd gone from being a real doer in control, everything. Nothing at all. Literally can you finish your sentence? No, I can't. So are you scared about this? Yeah, I was really frightened.

What did you think was going on? I thought there was something really wrong with me. And also I think because like my daughter had been ill and then my mum had died. So I was convinced that. some, I think that exacerbated it as well. So I was convinced that I'd got something similar to that. And then like the IBS obviously was stomach cancer and then it was, you know, but in my head, I'd convince myself that all of these things were really bad.

And I was living on the internet, looking up symptoms all the time, because I didn't know that the menopause, I just thought the menopause was hot flashes. I knew about that. Yeah, yeah. And your period stopped. I didn't know. Well, that's obvious people. And my oldest daughter is 16 and she gets daughter at school.

Menopause is when your period stop, which it does. That's the only, I think, advantage of the menopause. But no one tells us how important hormones are on our brains and our joints, like you say, with the muscle pain. Anxiety. Anxiety. It's really common. But people don't realise that. So had you gone to any doctors to ask for help?

I was frightened to take HRT because it got that stigma. And I was convinced, obviously, that's just an awful thing. So I eventually, I was that bad, and I did have really bad health anxiety, so I couldn't see the wood for the truth. I couldn't get out of it. I couldn't see what to do. And I went to the GP, and she said, and I actually researched it, and there was one that was the menopause specialist there, so I went and saw her.

And she said, trust me, H-R-T, it'll be okay. I'm like, okay. So she gave me a patch, she came home, and I was really frightened. I remember being really frightened. Put it on. And I had a terrible headache. And after two days, I took it off. And I went back and saw her.

I said, no. It's just not working for me. And I said, can I see the NHS menopause? Yeah, the clinic. Yeah. And she agreed. She was so kind. She agreed.

In the meantime, I started, I had enough, thank goodness, to start research. And so I knew then what I wanted. So I went. And I said, right, I wanted the Eastern Gentleman. I wanted the eugenestion and she was brilliant she went yeah there you go

so that was a real help but then I didn't get on with the eudragestion and I started reading up on it and I was on menopause matters all the time and stuff like that found out that you could take it

different ways so I went back to her because she asked me to go back and we weren't on the sign page at all and she was like you can take your digestion but you need to take

200 milligrams a day every day and I'm like that's so much yeah yeah and it was already messing with me being on just the 100 milligram cell was like I didn't want to do that so I came out and I just I just cried because I really wasn't with it at all yeah and that's when I went on holiday it was in a really bad place then I came to see you it was all lovely I think which which really shows I mean there's different types of HRT and there's different doses but even before you got to the knowing that it was related to your hormones before that. Had you gone to get help or did anyone talk to you about it could be related to your hormones

and what you were feeling? No. I'd done a lot of things like I tried lots of herbal over the counter. My hat looked like boots and tried acupuncture, lots of different things like that. But I still wasn't connecting it, not really. So you were trying things for your symptoms as opposed to for your hormone. Definitely like cutting out of gluten and things like that. And but nothing really, nothing worked.

And had your periods been changing at this time? Can you remember? Yes. And then, but not phenomenally. They literally stopped fairly quickly. I think I was 53 and they literally stopped over. It was like it wasn't that big a deal. So you've had these symptoms before your periods have stopped.

Definitely. A lot. Yeah. Looking back, I didn't know it at the time, but looking back a lot. Which is really common. So for those listening who don't know, the menopause is a year. after your last period, but the perimenopause is around the time of the menopause, and it can go on for several years before the menopause.

Definitely. I saw a lady recently in my clinic who'd had symptoms for 10 years before realising. And it's often, like you say, it's not until you balance your hormones, you realise how long they've been changing for. Because unless someone's had their ovaries removed as an operation, it's a very gradual decline, and you have some months where you're better, some months where you're a lot worse. And it's often, like you say, it's a time of our lives where changes occur. You know, you had changes with your mother, sadly dying, your daughter being ill,

but often it's something going on at this age of our lives. Yeah. So it's very easy to put it down to something going on. You don't realise, and actually as women, we just got on with things, don't we? You know, we're sort of at the bottom of the bottom. And because we're not primed and no one says to us, actually, this might happen. And one of the things that I often talk when I go to meetings is about women being given information even when they have their smear. So, because if you had been given information, you know the questionnaire that we give to our patients in the clinic,

which is available on my website, which is all the symptoms, I feel that if women could fill that out and been given it when they have their smear and say, well, if your period start changing, fill out this questionnaire. If you have symptoms, it could be related to your hormones. because it might have triggered your thoughts a bit earlier, isn't it? For sure. There's no way I would have known that health anxiety or that, I mean, it was crushing or like my stomach being so all out of sorts. And it literally changed. I had no joy.

No. That's the best way I can put it. I had no joy. And when I came to see you and I got it balanced, got the right dosage, the joy came back. And I didn't know it was as bad. as it was until it got sorted. Yeah, no, it's desperately sad, isn't it? Yeah, you know it's bad, but you don't know how bad.

Absolutely, and also you don't know what you can do about it. So then you're trying to live and adjust, but you know that it's not you. And it's hard to live. Even sometimes it's just even getting up. It's hard, hard, hard. And you're exhausted because you're not sleeping. Yeah. For years.

Yeah. And you can see why a lot of people give up their jobs and... Completely. ...drawn life. Completely. And sadly, as you might know, there's a peak in suicide rate in the early 50s in women in the UK. I understand that. You know, the menopause average age is early 50s, and it's not a coincidence.

You can see why people can really consider harming themselves because they don't have anything in their lives because of the way they feel. And you're obviously a really upbeat person. You get on with things. Yeah. It's all just gone, hadn't it? Completely. Have you ever been like this before at all? No.

Never. And I've never had anxiety or. really nothing so that it flawed me didn't see it coming didn't understand it that's why i thought something was seriously wrong yeah because it can't just believe the menopause no well that's right it has to be something really bad yeah and i think because the menopause is natural it's not a condition it's not an illness a lot of people feel that they just something that they've got to go through yeah and what often people don't realize with the low hormone levels because it can cause illnesses so it can cause anxiety, it can cause depression,

but also it can cause heart disease and osteoporosis, as you know. So it's not just about trying to get on with your symptoms because you might feel better eventually. You've always going to have these low hormone levels. I think the other thing for me was as well was going to the GP because I had got such massive anxiety was really hard because I didn't know what was the matter and I was convinced. If I'd have had the information, if I'd have known it was just the main.

Anapause, that would have been okay. But to go, I was cold fear because I knew they were going to tell me something really bad. So that, it took a lot. What did they tell you initially when you first went with the anxiety? I didn't go with anxiety. It was the hot flushes. Right. And I didn't really get, they didn't really ask me anything else.

They just said, here's that patch. So they didn't ask me what the other symptoms were. So even when you were given HRT, you didn't realize it might. No. Anxiety might be as initiated. I didn't. Or anything else. I just thought it was the flushes.

But the flushes were so bad. I wasn't sleeping. So I knew that my health was going to be deteriorating because I'm not sleeping for a couple of years. I knew I had to address that. So how often are you getting hot flushes? Every half hour to every hour. Gosh. Day and night.

Yeah. So could you sleep at all overnight? I would get a little bit. And this always flawed night, like the fact that it would wake me before the flush. Yes, that often happens. What? Yeah. So you're already.

Already wasting. Thank you. So, like, I would get little snippets of sleep, but it wouldn't be a lot. So I knew that I was going to get ill at some point anyway. Because of not sleeping. So how long did that go on for? Definitely two years. Long time.

It is. And you don't realise it because you just adjust and you get on and you carry on. Yeah. But not well. No. Not well at all. And that's what made me decide I had to do something because I knew I would get really ill. Yes.

because you can't survive on now. No, absolutely. And there's a lot of people now talking more about the health risks of not sleeping. Huge. It's a huge thing. And we know that people who don't sleep well have an increased risk of high blood pressure, heart disease, depression, even cancers as well. And when I listen to very inspirational people talking about sleep

and how we can improve and having a sleep routine, not having your phone, having a lavender bath, having no caffeine. But if you're getting hot pressure, every hour. Pointless. How's that going to help? Not so. And it's certainly one of the big things that people thanked me for in the clinic

saying I've got my sleep back. It's everything. And it makes such a difference, isn't it? Yeah, yeah, yeah. Holy grail of health, I think. Yeah, good sleep. Absolutely. And, I mean, I know when I was getting some perimenopausal symptoms

that I didn't recognize myself, I kept waking in the night and about three, four in the morning, which is such a awful time to wake up. And I'd lie there and I think, I'm going to be really tired tomorrow. This is ridiculous. I'm going to be really tired tomorrow. This is ridiculous. I'm going to sleep. and I try and be really calm and do some meditation.

But it's just such a waste of time waking up in the night. But you can't do anything about it. And it's only since my hormones have been balanced. I don't sleep for long, but I sleep really well. And I feel really embarrassed that I'm a bit like a teenager. I go to sleep. Then I wake up and I feel really refreshed. I think that was the thing when like I got my hormones rebalanced again,

it wasn't just, it was sleep was great. But feeling, feeling well. Yes. you forget what that feels like. Yeah, absolutely. I remember saying that, I remember asking that, asking other people saying, do you feel sluggish all the time?

What do you feel, what does it feel like, to feel normal? Because I couldn't remember. And then when I got well again, it was lovely, it was lovely. And I do think one of the other things was the testosterone that you gave,

that was life-changing, the energy. Yes. And I've forgotten. Yeah, absolutely. I thought it was how normal to be sluggy and not, have any energy and be shattered all the time. Yeah. So for those who are listening, so estrogen is the most important hormone. And as you say, estrogen through the skin,

it can be given as a patch or a gel. So the patch you were given initially was a combination patch. So it had estrogen and progesterone in it. But it's usually, the combination patch to have an older type of progesterone. It did. And also the combination patch is a quite a lowish strength of estrogen. So they're fine for some people if they work great. But if they don't, often people need a higher dose. And so that's where some people have the gel, some people have patches or some people have a combination. The gels and patches that tend to be safer because there's no increased risk of clot.

As you know, they're going straight into the bloodstream, whereas the tablet estrogen have a very small risk of clot. So certainly, I, as a practicing physician, will give patches or gels in the first line. And then because you've still got your womb, as you say, you had a progesterone. and the natural body identical progesterone is the safest way of taking it. And there are different ways of taking that. And then for a lot of women, they really miss testosterone, as you say. So testosterone is the male hormone, but it's also we produce.

And it's interesting. So before the menopause, women produce higher concentrations of testosterone than estrogen. Yet we're always grown up, aren't we thinking? Estrogen is for women, testosterone is for men. And we have cells that respond to testosterone all over our body. the same as we have estrogen responding cells all over our body, especially in our brain. So like you say, this sort of mood, energy, motivation,

but our stamina also. So a lot of people find that they can exercise better when they've got testosterone. And you can have all the estrogen you like, but it's not going to wake up those testosterone receptors in the cells. I think that, like speaking to some of women that I know that are my age, they will all try all the different. Yes. But they'll try HRT for a week or two weeks.

And they don't, it doesn't work for them. It's like, I don't think people also understand, one, like I didn't understand what the menopause symptoms were. Two, what HRT actually is. And three, it takes time. Yes, absolutely. And it's a balancing act. And I didn't realise that. And it's a learning process.

Yeah, absolutely. And I think that's really important. So anyone who starts HRT really has to give it a good three months to try. And if you think you've been experiencing symptoms for a long time, so your body's not going to repair itself and get better overnight. So certainly, and some women say to me they feel worse the first month before they felt better. So it really varies. Some symptoms, I think, can go quite quickly.

Usually hot flushes it will take a few weeks. But to get to the really good stuff you need. to keep with it. Absolutely. So yes, so certainly we always review people after three months, as you know, and then often consider starting testosterone if need be. Now with testosterone, as you know, it's not licensed for women in the UK and that's just because menopause is not a priority, is it? For a lot of people, sadly. And we have a licensed testosterone preparation for men, but not for women. Yet there is still good evidence that testosterone can work. There's a big global consensus statement that's just been produced by lots of

menopause societies across the world to confirm how safe testosterone is and certainly for women who have low libido who are postmenopause or who have been on estrogen it can be considered and it's mentioned in our guidelines the UK-based guidelines as well so but sadly a lot of women still aren't getting it um shame which is a real shame there is a move to get it licensed and I think that will come because there's enough evidence, which will be really good. Because once it's licensed, it means people can get it from their GPs if their GPs have the knowledge and understanding to prescribe it. So that's another

battle. But, you know, there is a move. There's more education. Certainly, I'm doing a lot of education for GPs and nurses. A lot of nurses now will be able to prescribe. So I think as doctors become more confident in managing women in the menopause, then hopefully they will prescribe testosterone. Because, as you know, you have your blood test monitor. So the risks of side effects are very, very low because you're still within the female range. For sure. So some women on the NHS still get the male testosterone at lower doses,

but it's a bit harder to fine tune, whereas, as you know, here in the clinic, we prescribe this testosterone cream called Androfen, which is made for women. It's regulated in Western Australia, so we're allowed to prescribe it privately. Each tube is expensive, but it works out about 80p a day. So it's worth it.

Well, well worth it. It's so easy. Such a small amount. Yes, it's like a piece of time. Each day, yeah. So easy. Yeah. Life changing. And literally, I think with that I definitely felt that you could feel the energy increasing.

But I remember I think it was the nurse, one of the nurses here when I came to have a blood test said, have you been using it? Do you feel? And I was like, yeah, it's okay. It's okay. And then she said like six months. Oh, I haven't been quite six months yet. Six months, ah, yeah, I get it. It literally transformed.

It's very gradual, isn't it? I mean, I'm quite open. I use testosterone. In fact, I use slightly less. It probably costs me 50p a day. Yeah. And initially I started, I thought, oh, not really doing anything. What a waste.

But now, if you told me I couldn't have it, I'd be really cost. No, no, no. My brain is just clearer. Yeah, for sure. I just feel that my energy is better and my focus is better as well. Completely. I think a lot of people say, that they're sort of joy de V.

They're sort of just happiness returns. You can... That's exactly what it is. You know, the colours have come back in life a bit. It's really important, isn't it? Yeah, which is really important, isn't it? You don't know how important it is until you haven't got it. No, that's right.

So I think that's, it's like you say, when you look back, you don't, then you realise how you've suffered and things that you just think a way of life, actually, can improve. I do still think there's a massive stigma. I was talking to a friend the other day who absolutely won't touch HRT because the stigma. She doesn't want to get, you know, anything bad, breast cancer. They still think that's the...

Well, that puts off, absolutely. So you're right. So it puts off women and it puts off doctors from prescribing. And I'm sure you're aware a few weeks ago there was this other study that came out in the Lancet. And all GPs have been sent a warning to say this new study has shown there's an increased risk of breast cancer. it was just reviewing old studies. It wasn't even a new study. And it was looking at older types of HRT.

So there was very little about estrogen through the skin. And there was nothing about testosterone. And even the eutrogest and the natural progester, and the natural progester, very little about that. So they were making very sweeping statements from not really the right studies. But even when you look at those figures that they said, there was a small increase risk of breast cancer, but what they haven't said is that there's a reduction risk of heart disease,

osteoporosis, diabetes, and in fact as women, we're seven times more likely to get heart disease than we are to get breast cancer. Well, when I was in the worst of it, forget exercise, forget moving, forget getting out of bed on a really good day. So, and now to be able to run, move. Yes, because you're back to running. Absolutely. You're loving it. So it's got to be. Yeah, absolutely. And I think this is the one... You feel well. Yeah. And I think that's really important. So even women who don't exercise have a higher risk of breast cancer, which a lot of people don't realize. So actually, even if your HRT is increasing your risk, your lifestyle is reducing your risk. Because you're not going to put on weight. You're exercising. You're probably drinking less alcohol. A lot of women drink less alcohol. So actually, any increase is offset. by their lifestyle changes.

If you're walking or running or moving, you're not going to be wanting to eat brown food. You're going to make your vegetables more. Yeah, absolutely. It just follows through. And I definitely felt that. When I was like a slug, couldn't get up, brown food, give me sweets,

give me, you just can't advice anything. No, and lots of people have sugar cravings as well just because of low estrogen levels. For sure. But if you're moving, that goes. It's very different, isn't it? Yeah, yeah. And I think when your mind's full of other things, not thinking about food in the same way.

So, yeah, there's lots of things. And I think what is really important is that women get given the right information so they can make the right choices. I wish I'd know. Yeah. I really do. Yeah. It's very sad, I feel, that obviously my job's lovely and the people that I see often get better.

But then they often, when they're better, like you, will look back and say, I wish I'd known earlier. Like you can't get that back now. It's gone, you know what I mean, that time. and it was so horrible. It was so awful. Yeah. And at the time, it was horrible, but I didn't, when I looked back, it was worse than I thought. Yes.

Yeah. I didn't realize it was bad as what it actually was. No, but it's different when you're in it, day and day out. It's hard to take a step back and see, isn't it? Yeah. It wasn't just the fact that it was like the physical symptoms. I think a lot of it, like the brain fog, like the fact that my daughter's are like, can you finish a sentence. I'd never real, how could you possibly know that that was not?

menopause. Absolutely. No. But you can't finish the sentence. Yeah. But it's very common? Very. So have your family noticed a difference in you?

I think so. Yeah. I think so, yeah. For sure, definitely they have. Yeah. For sure. Thank goodness. Good.

So, just to finish, it's been really interesting, just getting your, you know, real words from real woman talking about... Real human. Well, it is really important because, as you know, I talk nonstop about the men of... but it's very important. I think people will learn a lot from your words. So thank you for sharing them.

Thank you. So just before we finish, can I have your three take-home tips of what you would say to a woman who has been listening to this and there will be people who listen and will be nodding their head and saying, yes, that's me now? What would you say to them? If I could go back to talk to me now five years ago,

I would, it's a terrible thing. I would, you've got to get the help, you've got to go and find out and it's really hard, I know, when you're in that place. And the other thing, people, they don't want to spend the money, and I get that. I do, I understand that. But it's priceless, it's priceless. And even, like, I get my HRT from the NHS, it costs so little. It's so worth it, so worth it.

So, I would definitely, it's worth the money. And it's really difficult. say go to your GP because I did go to my GP but it didn't help me so if you can't get the help from the GP go private and I would yeah I did yeah but again I know it's the cost but it's worth it and get informed get the information yeah although that's not easy I understand that but I would you need to get the information and I think I'm certainly not doing this to promote my clinic because I'm busy enough and as a lot of people know I can't get a job as an NHS management poor specialists because there's no funding, there's not. No. But I think it's really important

that women go to evidence-based resources, so like my website, get the right information, print it off. And if you don't get help from your GP, challenge them, go back, try and find a GP who has a special interest. And I think if you've got more information, even print off the nice guidelines, then GPs can't refuse. Yeah. Because at the end of the day, we as women or as patients we have a choice and if we have a reasonable choice about treatment we should ask for it. So it's hard, isn't it when you're in that place to actually ask? But, you know, people shouldn't be having to come to private clinics. I agree.

Some people come once or twice and we put them on the right road. There might be an NHS menopause clinic close by that someone can go to. Sometimes it's nurses, you know, go and see a practice nurse, go and see anyone who will give you the information and the help. that you need is really important. I think the other thing was when I was at the worst, talking to all my friends, nobody else was on HART and I wish that there'd been other people. So if anybody is, they need to talk about it.

Yeah. Because that would have been really helpful for me. Absolutely. I think going to find other people to talk, but who can talk and help, because sometimes people can talk in circles and that doesn't know. But something like going to Diane Dandemines, It's menopause support.com.uk, her website, she's got a Facebook group, is really useful.

So having the right direction is really important. To know the symptoms. That would have been really helpful. Yeah. So there is help out there, but you've just got to try and find it. Yeah, that's hard. The most important thing for me from this podcast is just don't suffer alone. I agree. So thank you so much for coming.

Thank you. For more information about the menopause, please visit our website, www.menopausedoctor.com.uk