The Dr Louise Newson Podcast - 032 - Taking HRT Forever - Ann Newson & Dr Louise Newson

Episode Date: January 28, 2020

In this week's podcast, Dr Louise Newson has an open discussion with her mother, Ann Newson, about her personal views regarding taking HRT. Over 30 years ago, Ann was experiencing symptoms of severe fatigue which were negatively affecting her ability at work, prompting her GP to give her a prescription for HRT. Ann was then told that she was going through “The Change” but had no idea what that meant! The menopause was never spoken about at that time and she was given no information about it. However, taking HRT gave Ann her life back and her energy levels vastly improved. Fast forward to today and Ann is delighted to have learnt so much about the menopause from her daughter, Louise. In this episode, Ann also explains how many of her friends have developed breast cancer over the years despite none of them taking HRT. She strongly feels that women should be given a choice regarding hormone therapy and how she plans to stay on her HRT forever!  Ann Newson's Three Take Home Tips: Carry on! If you're happy with your HRT then you don't have to stop taking it If you are feeling low, don't think that you're not menopausal just because you aren't experiencing hot flushes and night sweats. Don't be frightened of HRT, it can be life-changing!

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 today for this podcast I have persuaded my mother to come and to talk really about her experience of the menopause and HRT. So thank you very much for coming today. Well, I feel flattered to be invited to come. Thank you, Louise.

So my poor mother, all she does is listen to me, talk about the menopause. And yet again, I'm going to be talking to her about the menopause, so the subject doesn't really change. So you have, well, you experienced the menopause quite a few years ago, but the menopause hasn't changed over decades and centuries. It's still affecting women globally in many different ways. And everybody's experience of the menopause is very individual. And as women, any of us,

all our experiences of life are very individual, so we need to think about having the best treatment and options for us that are individualised. So talk me through about how you remember your menopause. Well, it's a long time ago, but I can remember it. It was in my 40s and I was teaching drama to students in London and I just felt extremely tired. It was a real effort. I also had children, as you know, what you've been. one of them to look after. But I just, it was such an effort to get out of bed, to get dressed, and I was just so incredibly tired. And I didn't think about the menopause at all because I didn't get any hot flushes or sweats or anything. And I had seen my mother's friend who used to get

the sweats and it was horrendous. So I just didn't think about that. And went to my doctor and My doctor said, oh, well, you're in the 40s, you must be on, as they called in those days, the change. So, well, he said, you'll just live through it. You'll get better, you know, just sent me away. But I just really found it difficult to cope. So I went to see another doctor, a lady doctor, and she said, well, try HRT. So I did. And I've been on it ever since, and I will stay on it for the rest of my life,

because I think it's the best thing since sliced bread. It's amazing, absolutely amazing. So when she mentioned HRT, did you know anything about it? No, not really. I mean, she didn't really explain. No. I don't think I even knew what HRT stood for in those days, but I was just so desperate for help. And when she said, try it, I did.

And it just made such a difference to me in my life. And I could cope. So she had really transformed your life. So there's a lot to be grateful for that doctor. But when she said the change, thinking about the menopause, did you know anything about that then? Well, I only knew about it because of, as I say, I can't remember my mother going through it, but on reflection she probably got depressed and very low.

But I do remember a close friend of hers, and I remember seeing her going so hot and this perspiration, pouring down her face, etc. But in my day, we're talking about 30 years ago, one didn't talk about medical things at all. I mean, you know, when I was little, you didn't even talk about periods. we whispered the word the curse. And then as I got older, Ewan talked about the change, but I didn't really know

even the word menopause then. Which is very interesting because, as you know, the menopause is still a real taboo, which is quite shocking when it is a natural process. It's not a disease, and it affects all women if they live long enough. Certainly, 30 or years ago, people didn't talk about cancer, did they?

Oh, no. You wouldn't mention that word, and maybe you would say the big C. But cancer is. a disease, the menopause isn't, but even then to not even be able to talk about anything that's happening naturally to our bodies is now we think, gosh, how can that happen? But actually, we haven't really advanced, have we over 30 years? Not at all, but I think, again, when I was young, a lot of people, a lot of women didn't work. So they just got through it at home. And their husbands

are out all day and they probably had these problems. Maybe they got irritable, depressed, but the husbands wouldn't be interested, wouldn't understand. And so they had to get through it. Interesting you're saying about cancer, it wasn't talked about. I can remember another friend of my mother's who had cancer and she went to visit my mother and she said, oh, I think people may have been looking at me on the train and they might think I've got cancer, but I don't want them to know. So one didn't talk about those things which is so sad. One didn't talk about sex or anything. And all these things are natural to living and life. And I think it's. It's so healthy.

Yeah. We can talk about it, can be open. Absolutely. With people of my generation, your generation, and with children, because they should know as well. No, I think you're totally right. And I think I've often thought back because people sometimes who criticize or comment about my work say, well, people have always gone through the menopause. Why are you making such a fuss?

Why are you trying to make people talk about it? And I would never make people talk about something they didn't want. But I think I'm allowing. people to talk about it. But I think in the 50s, 60s, people would hide behind their aprons a bit, like you say. The role of a woman was quite different and a lot of women were at home, cooking for their husband, have their husband meal, you know, on the table, slippers ready for when they came home from work. So they didn't have... I'm not talking about the 50s and 60s. No, but I'm talking, you're talking a long way back, but it's not. It's only recently that we've

started talking. Oh yes, but I'm... I mean, I never talked when you were a teenager growing up. I never talked to you about it. You didn't know that I was having these problems. No, absolutely. No, I know, but I'm saying even, you know, in the Victorian times, women used to die quite soon as well. No, of course. But I'm saying in the Victorian times, the average age of the manifolds was older. It was 57, whereas now it's 51. The average age of death was 59. So women didn't really live long enough to experience the symptoms. And then after the war, health improved, life expectancy improved. So people were then suffering for longer. So this is what I was talking about, the sort of old tradition of being at home. And then people started to take a bit

more interest, I suppose, in their longer term health because they were living for longer. And women started working and having a different role in society, I suppose. And for some of you who might know my father died 40 years ago so you were widowed very young so you've always been a very strong person but you had to be stronger because of what you went through so you were a working woman and a lot of your friends I know weren't working at that time and so it must have been really quite scary for you when you were always in control to suddenly feel more tired thinking i've got no husband that can help me at home you've got to keep going so it was probably you know I don't know what you were thinking at that time, but it must have been quite unnerving.

Well, one didn't really have time to think about it. It was just frightening because I thought, you know, something else was going on. And the fact that I was not coping as well as I had been. And there's it. I wasn't mature like the word mature as I am now. And I just think it's really sad that so many people of my generation, I talk to them And they say, well, I got through it fine. And then, well, no, on reflection, yeah, yeah, I did sort of have brain fog.

And I did get very depressed, but of course never realized it. And there was never anyone to turn to, really, to ask about. And it's interesting you saying about the Victorian women in their 50s. But how does one really know? Because these women, a lot of them, were at home and suffering at home, like in my parents, generation. Yeah, I mean, we still don't know. I mean, some studies have shown that 75% of women experience the vaser motor symptoms, so hot flushes and sweats. Twenty-five percent of women have severe symptoms, but I think it's more than 25% of women. As you know, I've done a lot of work

with West Midlands Police, and we did a survey and showed that 78% of women didn't realize that they had menopausal symptoms until they were given information because most people do think about hot flushes and sweats, but like you say, you didn't have them. But because the hormones, estrogen and also testosterone get all over our body, we have cells that respond to these hormones. A lot of women experience symptoms such as, like you say, the brain fog, low mood, reduce motivation, anxiety, joint pains, muscle pains, migraines, urinary symptoms. The list goes on. There's a lot of symptoms. But if you ask these women, are you menopausal? They'll say, oh, no, I've just got worsening migraines or I'm feeling anxious.

And so that's why it's very hard to know how much the menopause is affecting people. Well, I think it's very sad and frightening because I have spoken with my work. I see a lot of younger women and talk to them. And they say, well, no, I'm not menopausal because I don't have, as you were saying, the hot flushes or the sweats.

And I'm going, but there is more to it because I know so much more now because of you. There is more to it than that. I'm saying it is, you know, this brain fog, this depression. And so many have said, well, yes, yeah, I have, but, you know, I've been to the doctors and I'm on antidepressant because that's what they say the cause is. And because I'm flying the flag for menopause and HRT, because I feel really passionate about it.

And as you know, when I had hip replacements, I had to come off HRT and did get a couple of symptoms, but I had a wonderful consultant so he didn't make me be off. I mean, it was only off a couple of weeks max, but I was so relieved to get back on it. Yes, yes. I think there's a few things there. Firstly, I think when you think about antidepressant prescribing, there's been a lot, hasn't there in the papers recently,

about the sheer numbers of people who take antidepressants, but also a lot of the articles have talked about how many more women than men are on antidepressants and women who are older taking antidepressants as well. And when I trained as a doctor in the 90s, there was a lot of benzodiazepine prescribing. So diazepam and tamazepam, which then we have reduced prescribing of that, which is good. But I've had a lot of patients in my general practice who are now in their 70s and 80s who are really addicted to these drugs such as diazepam. And I know in the 70s, isn't they, people used to have dysopam a lot more.

They were very addictive drugs, weren't they? because I know after your daddy died, I mean, I had them because I was in such an emotional state, but took myself off because I knew that they were addictive and was frightened. But I do have a couple of friends who actually have been on them for many years. And you say, you know, they can't think straight and they're not themselves. So I often think in the sort of 70s, 80s, a lot of women were inappropriately given diazepam because of their symptoms and anxiety, probably because they were menopausal. And now we're not doing that, which is good, but we've replaced it with antidepressants,

and antidepressant use is really high. And we know from the evidence that there is no evidence that antidepressants improve low mood associated with the perimenopause or menopause. And the guidelines are very clear that women should not be receiving them. We sometimes give antidepressants for women who have hot flushes and sweats who can't take HART, or can't take it in the first line, such as women who've had breast cancer, but that's different to giving antidepressants for the low mood. We know that when people go through the menopause,

they have a two to three times increased risk of developing proper clinical depression, and we know that replacing with estrogen actually reduces that risk. So actually, the earlier someone takes HRT, the less likely they're going to have depression, which a lot of people don't realize. So no one knows how to that. how you would have been if you'd carried on and not seen that doctor. Because I do remember you, you were on some tablets called Dixiric. Do you remember before?

They're little white tablets and I remember you say, I remember coming to your bathroom once and saying, what are they and you saw these tablets, but they're not really helping. I think they made you a bit dizzy. And they are used as a, well, they were used as a blood pressure tablet. And we really don't use them at all anymore. Some doctors still prescribe them, but there's no evidence that they help because they're not the hormones.

So that doctor was quite sort of forward-thinking, really, wasn't she? I have a great deal to thank her for. But you mentioned a moment ago about breast cancer. And I remember several years ago when this paper came out and there was this scare. You were actually saying to me, I think it was not longer after you qualified. Anyway, you're saying to be, and I'm saying, what shall I do? Should I come off? And you said, Mum, you've had so many good years.

and enjoyed your life. If you have it tomorrow, you've got no regrets. And I said, absolutely, no regrets whatsoever. And it certainly wouldn't put me off. And can I say to your listeners that please don't be scared about the gossip and the cancer, because I personally have five friends who sadly have had breast cancer, unfortunately, they've all survived. But none of them have been on HRT. And, you know, I feel very strongly, and I suppose it's after your father died, that life is for today. And one has to enjoy the moment because none of us know what's going to happen. And I don't believe, and you can argue with me, I don't believe that there's any proof or can't be that if these women had not taken an HRT who have breast cancer, that they still would have got breast cancer. there's no actual positive proof, is there, that fate wouldn't have breast cancer anyway?

No, and this is what's really hard to prove. So in 1999, a study came out, the million women study. And it sounds really massive, does it? Million women. It's got to be a good study. It involved a million women. But actually, what they did is they gave questionnaires to women who'd had breast cancer. And they asked them, had you ever taken HRT, you know, what did you have for breakfast, various things.

And these women had just been diagnosed with breast cancer. that is on their mind, understandably. So how long they had HRT for, what types is they're not really going to necessarily remember. So it's a retrospective study. It's a lot of reason for error. The gold standard study is a randomised control study where, as you can understand, you have two groups of people. One have the proper drug, one have a placebo. The doctor and the patient ideally don't know which is placebo and you follow those women up. This wasn't. This was retrospective. And when the study came out, there was a lot of breast cancer risk, worry, it's causing breast cancer. So people were started to worry then. And then they analysed and said, look, actually,

it's not really the best study. We shouldn't be changing women's lives because of this. And things settled down a little bit. And then in 2002, the WHOHI, the Women's Health Initiative study, came out, which was a randomised control study. But it was done in the wrong population of women. It was done in America with women starting HRT and then mid-60s, which was an old. than we normally start HRT. But a lot of these women were obese, they had heart disease, a lot of them have had heart attacks in the past, and they were given tablet estrogen with an older synthetic progestogen. So very different to what we prescribe now. And the results were produced and put out to the media before they were analysed properly. So people were scared for the wrong

reasons. They've since followed those women up who carried on HRT over 14 years and showed women even taking this older type of HRT had a lower risk of heart disease, osteoporosis and death. Pretty good end point death, isn't it? None of us want to die early if we have to do so really good results. And then over the years since then there's been a lot more move to prescribing the body identical HRT. So I mean you've changed your HRT. Haven't you? you were on a tablet for a long time and I've forced you to change because the tablet estrogen, there's a small risk of clot. It's only a small risk, but if there's an alternative, then it's always safer to look at an alternative. But as women age, they have a higher risk of a clot.

So if you're going to be on HRT in the long term, which is possible, then women should really have the estrogen as a patch or gel. And the progestogen, which women need, if they have a, womb, we change usually to the body identical, the micronized progesterone, because it has less side effects, it has less risk of clot and also heart disease, but it also has a lower risk of breast cancer. So we know that women who take the body identical HRT, the first five years, there's no increased risk of breast cancer, and after that time, the risk is incredibly low. And there's never been a study that's really proven this link between HRT causing breast cancer. The other thing is there's never been a study to show there's been an increased risk of death

from breast cancer in women who take HRT. But there have been lots of studies that show that taking HRT reduces risk of death, heart disease, which is really important because most women die from heart disease. So like you say, quite rightly, it's looking at the bigger picture. Yeah, can I just say three things actually come to mind out of what you said was first of all you said you persuaded me to change my HRT, And, you know, I have to get that on private prescription because my doctor won't give that because it's not part of her remit. But she did say, oh, we must have a talk about it at the practice.

And my sarcastic comment was, don't leave it as long as Brexit. You mentioned osteoporosis and I mentioned earlier on that I had hip replacement. And my consultant then was amazed how strong my bones are and my jaw. are and my joints are on a car and I fell if you remember a few years ago I fell in the garden just before you had your hip replace yeah and I had no sympathy from my son-in-law your husband all he said was I mean my face was dripping with blood and I cut my eye and he said well it's a good job and that you're on hr-t or you would have broken your hip I wanted a bit of sympathy but that's but he was he was right absolutely right yeah and the other thing I think and I'm saying that life is today and I can't

see the point of penalizing oneself thinking, no, I'll get through this depression. I'll get through, I'll fall out with my husband, I'll fall out with my children, I'll get through it, I'll come out the other side, but I'll keep going that way in case I get breast cancer. So you can have three, four, five, I don't know, it can take a long time to get through. Decades sometimes. And you can go through hell for those eight years or whatever and still not get breast cancer, But you could fall over or be run over by a cop or something. So I cannot see the point. I absolutely.

And I think it's really important that the menopause is not just about symptoms. So the average length of symptoms is seven years. Some women have symptoms for decades. I see many women who are in their 70s who have had symptoms for 10 or 20 years. Does it really last as long as that? I don't remember when you stopped your HRT for a few days because of your face, you started getting very sweaty, dripping in sweat. And so when you take HRT, it doesn't delay your menopause.

all it will do is treat your symptoms at that time. So once you come off it, that will be how you would have been at that time. So you would have been one of those unfortunate women that would have had symptoms for decades. But even if you weren't, so say you stopped your HRT now, you would then have a rapid reduction in bone density, rapid increased risk of heart disease. And, you know, our brains need estrogen. So you wouldn't be nearly as independent as you are now without your HRT. And it's not only that, it's other things.

I think it helps. Again, looking at my friends of my age, I'm fortunate, and I'm sure it's age heart tea, but their skin is very wrinkly, very dry. Their hair's very thin. And, I mean, I'm very lucky. My hair is thick, and my skin is, I mean, obviously I've got the crow's feet and the turkey neck and that, but I mean, my actual cheeks and around it are not shriveled like my friends are. And I think again, is that right?

No, you're absolutely right. Is that affected by menopause skin and everything? Yes, it absolutely is. And some of you might have listened to a podcast. I recently did with amazing dermatologist, Sajd Rajpohen. He was saying 30% of our collagen, which is our building protein of our skin, gets lost during the menopause very rapidly. And because of the bone thinning, often jawline goes very close. quickly as well. And he said it's like trying to put a tablecloth on a smaller table. So there's more

redundant skin if you like on the bone structure and that skin is less elastic as well. And yes, women who take HRT often look slightly different but actually it's not just about cosmetically, wound healing is a lot better. So when you fell for example, your skin was thicker. It had more blood supply on the surface which obviously wasn't great because you bled, but you healed quicker. A lot of older people have very thin papery skin. Yeah. So it's harder to heal. It bruises more.

So there's all these things. Or if you had surgery, you're less likely to repair yourself as well if you don't have the estrogen. So there's all that side that needs to take them. Also, I think skin and hair is affected from within. Yes. So it's not just putting it on the surface, the creams and everything.

So if you feel good within, I'm sure this reflects on your skin and your hair. But if you're depressed and low, that is not going to help. We've all done it, haven't we, when you feel low? In fact, one lady I remember distinctly said to me in my clinic when I saw her again, she said, do you know what? My children have said, Mommy, I haven't seen your teeth for ages. And you've now been showing us your teeth because you're smiling again. You know, it's very rewarding.

As you know, my job, it's very frustrating because I really feel very sad about so many women who are suffering. But for women whose lives come back and they say, my life's now in colour, it's not in black and white. I'm enjoying my life. I'm singing along to the radio in the car. That's lovely. And it's these little things. And we know that if people smile, you're more likely to have a better day. There's so much negativity that's going on. And like you say, if you feel negative within, then it's really difficult and hard, isn't it? Oh, absolutely. I shall be on it for the rest of my life. So I never know by full menoportal problems.

No, and I think it's very important. I mean, certainly, you know, we work out of the guidelines and the guidelines are very clear that if a woman has more benefits than risks from taking HRT, then she can continue on it and you, women need to be reviewed on an annual basis so every year. And for most women, actually, the benefits do outweigh any risks. The main risk is breast cancer risk, but it's reduced by having the safer type of HRT. But the benefits for our bone health, our heart health, our brain house are so much more outweighed. I was at a presentation recently for the International Menopause Society and very eminent doctor said he tells his patients that the best day to stop HRT is the day that you die.

But there's no reason to come off. And I know you've had various healthcare professionals telling you that you need to start thinking of coming off and clearly you're a very strong person and you haven't come off it. But there are a lot of women that I speak to. who have been told to come off it. And my worry is about their future health. And as a doctor, we should be sharing decision-making with our patients and listening to what patients want and giving them the right information to make the right decision. I think you're absolutely right.

And I think as a woman, we should have the right to choose. So you actually are being perfectly honest, you're telling us the pros and cons. You know, I read your new book. And it's not just you've got to take HRT, you explain it all. And so then at the end of the day, as I said, we as women should have the right to choose. There's so much about me too and everything in the media and power of women and everything. But if we're not given that opportunity to make up our own minds what we want to do, we become subservient to the medical profession in a way, don't we?

Absolutely. And it's not right at all. And I think we're very lucky. You know, you were saying, and you started your HRT, there was no internet. There was no social media. It was very hard to access information. Yes, you could go to a library. But how do you go to a library and say, do you have a book on the menopause?

Firstly, there wouldn't be one. No, no, no. You wouldn't mention it. And thirdly, you didn't know that you were. You didn't use that word anyway. Menopause. I don't think I knew what it was. No.

So then how would you get information? So we've fast forward a few decades. We're in an era where we can. access information, but we're also in an era where we can access incorrect information. Absolutely. And it's not just about the menopause. Anything you read, you don't know the source. And so, as you know, I'm very keen that women and men, if they're choosing to find out information about the menopause, are given evidence-based and non-biased information. So it's really important that people check their sources because so many women are scared because they've been speaking to their

neighbor or their friend or someone they've bumped into in the supermarket who said, oh no, you can't be on HRT. You need to go back and look at the evidence and we've got good evidence and guidelines. So I think we're fortunate in that way, but then it can cause more confusion because you don't know where you're getting the right information from. And that's why we need all the work that you're doing to help us find that information, seek it out and know if we can't get it in the right source, we go elsewhere because it is out there for us. Yes. And we must have the power to be able to run our own lives as we want to.

And life is all about choice, isn't it? Absolutely. And I think it's really important as a healthcare professional, if someone challenges my decision making rather than feeling worried, I feel actually quite empowered myself thinking, goodness, right, I'm going to have to find out more. about what this person's asking me. And a lot of times in the consultation, we don't always have the answers. We're not robots. We're human beings. And I'll often say to a patient, that's a really

good point. I'm going to go and find out more. I'm going to speak to a colleague. Let me see you again. I'll make another appointment or I'll phone you. And patients are fine with that. So I think like when you've been to your doctor, because you know so much, you haven't stepped down and said I'm coming off my HRT, but it was interesting to hear that they're now wanting to find out more. And I think, you know, every doctor who sees a woman has to know about the menopause because we all go through it. So I think if women can be empowered, they can help change their consultation and help education in that way too. Well, you've done all the questioning. I'd like to ask your question, Louise. Would you be so empowered, do you feel, if you personally

weren't on HR? No, absolutely not. No, I think I've learnt more about the menopoles and HRT being with you because seeing how you are compared to a lot of your friends and even a lot of my friends say, wow, your mother, she doesn't stop. She's constantly, you know, you'll still work, you help me with the children, you're constantly in your car, you're very independent. And I think this must be related to HRT. I know you've got certain personality, but I do feel and then when I experienced symptoms I could have easily closed the doors of the house as you know I was getting very irritable with Paul

and my poor children as well and your poor mother and your mother yeah and I was getting back to back migraines my yoga practice was awful I was just feeling dreadful but I thought it was because I was working too hard so I feel I'm very fortunate that I could see the right consultant to get the right help and being on HRT as it let me still lead a really healthy lifestyle

but I was able to make that decision and I feel it's really sad and wrong that women can't have that decision and you're right, it's making me feel even stronger that women shouldn't be suffering and they should be empowered so that they can make the right decisions. I think it's very important

that we're talking about women, women, women, women, but I think it's extremely important that men should understand the menopause, understand what women are going through And also, you know, a lot of these doctors out here are men. Yes. So they haven't suffered. If you hadn't suffered, you wouldn't be so understanding and compassion.

I can just a little story. I can remember before you had children, you got quite impatient. You didn't really understand when a mother would come in and she was a bit frenetic because a child was being naughty and she was breastfeeding or that. And suddenly you had your children. And you understood totally what a young mother goes through struggling with. the young children. So it's like now you understand because you've been through it.

It's like any situation. But a lot of doctors, male doctors, because it hasn't been part of their training and they haven't suffered, they don't fully understand. And I think it's important that they do understand. Absolutely. And as you know, we're doing a lot behind the scenes to try and improve primary care education. So, well, we've run out of time. Thank you very much.

Oh, no. Thank you. And so before we finish, I just want three take-home messages. Mainly, I think, aim for those women who are constantly being told that they need to stop taking HART and feeling a bit inadequate because they want to carry on. So what would you say to those women? Carry on. Just carry on.

If you're happy with H.R.T, you carry on. You insist that you want to carry on. And don't be frightened of taking it. It really is life-changing. and don't just think because you haven't got hot flushes or sweats that you're not menopausal but you feel a bit low. Please, please. I'm a great advocate, as you can imagine, or you know, from HRT, so don't be frightened. Stick to it. And as Louise says, stop when everything else stops in life. Very good. Thank you very much. Thank you for coming today.

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