The Dr Louise Newson Podcast - 04 - Dr Felice Gersh on oestradiol, natural vs synthetic hormones and standing by your beliefs in medicine

Episode Date: April 22, 2025

In this episode, Dr Louise is joined by renowned American OB-GYN, integrative medicine specialist and globally renowned women’s health expert, Dr Felice Gersh. Together Louise and Felice delve into the science of hormones, how menopause care differs between the US and UK, and the harmful past of women’s medicine – from the vaginal mesh scandal to the 2002 Women’s Health Initiative (WHI) study which continues to impact access to HRT for women globally. Louise also speaks to Felice about the impact of weight loss drugs like Ozempic on women experiencing hormonal changes, and the impact of oestradiol on weight management.  With decades of experience, Felice is Medical Director of the Integrative Medical Group Irvine, which provides integrative services to support female longevity and complex disease management. Having witnessed the changes to women’s health over the years, she speaks candidly about her own concerns about the use of vaginal mesh, before its true harms came to light many years later. Felice and Louise also shed light on the infamous WHI study, which dramatically cut the number of women using HRT across the world.  To learn more about Felice, visit her Instagram here.  Available on watch on YouTubeWe hope you're loving the new series! Share your thoughts with us on the feedback form here and if you enjoyed today's episode, don't forget to leave a 5-star ⭐️ rating on your podcast platform.  DISCLAIMER: The information provided in this podcast is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition. The views expressed by guests are their own and do not necessarily reflect the views of Dr Louise Newson or the Newson Health Group.   LET'S CONNECT   Website: Dr Louise Newson  Instagram: @drlouisenewsonpodcast  LinkedIn: Louise Newson | LinkedIn  Spotify: The Dr Louise Newson Podcast  YouTube: Dr Louise Newson - YouTube  Email [e-mail] for any media enquiries.  LEARN MORE  Sign up to my Menopause Masterclass here  Sign up for my Confidence in Menopause course here  Sign up to my Upcoming Webinar for healthcare professionals here Check out the new edition of Dr Louise Newson’s Definitive Guide to the Perimenopause and Menopause  

So, Felice, you're here in real life because last time we did a podcast remotely, I can't remember how long ago, but it was a while ago because I remember I was sitting in my husband's study and talking about heart disease and hormones. And, you know, you're one of the few people I can really geek out with. I can really talk on a cellular level about hormones, which is great. But now you're in real life. You've been to my house. You've been to my clinic.

And now you're here in the studio. Well, you invited me to come and I just jumped at the opportunity. It's like, this is so fun. And yes, we can talk about everything. And we are so aligned. It's just fantastic. And it's great because tomorrow we've got a conference and you're coming to speak and you spoke. We have monthly meetings for all our clinicians and you came and spoke.

And it was just brilliant because as you were talking, lots of them are WhatsApp in me to go, oh my goodness. How did you meet police? She's brilliant. She's so knowledgeable. Because I think in medicine, and I'm sure it's the same for your training in the US, but certainly us, we're just taught, this is a condition, this is the treatment, ask no questions. And as you know, I've got a pathology degree as well. So I did three years as an undergraduate. Then I took a year out and did a pathology degree. And it was then that I really learned about cell processes. And I

really learned about very basic things, about receptors, about our immune system, about mitochondria, the powerhouse of our cells. And it was, really such an interesting time. And I was saying to my husband, who's also got a pathology degree as well, I forget that lots of people didn't do that degree. They don't have that knowledge. They don't have that basic science. So if I'm stuck in medicine, and I've always done it, if I'm working, why has someone got raised blood pressure, I will go back and work out, how do the kidneys work? What's happening? What's happening with their different processes that are going on in their body? But if you don't have that basic knowledge. It's really hard to move forward, isn't it? It is. And a lot of it,

honestly, I had to acquire by doing a lot of my own reading and research because I went to school a long time ago. And I am so into exactly what you were saying, mechanisms. What's happening at the cellular level? How is this working? Because only then can you really think it through and think independently and not just do what, like, here's the protocol, follow the protocol. And without even thinking, not mindfully, like working it through, like, why is this the protocol? How did it get established? Does it even make sense? Is there a better way?

So I think that's what both of us have been striving for, looking for, are there better ways and not being stuck in established protocols without, like, thinking them through and looking at the foundational pathways. and mechanisms and so on, which makes it so exciting and really fun trying to figure out how a woman's body works, for example. And it's so true. I mean, you've been a gynecologist and OBGYN for many years, and then, you know, sort of reinvented, reeducated yourself quite a few times on your professional journey, haven't you? I have. I call it my different chapters.

So there was a chapter when I did thousands of deliveries. I was just a prolific surgeon and always learning and different techniques and working with new medical devices, some of which were horrible and now we're off the market, thank goodness. And then when I moved on from doing obstetrics and lots of surgery, I went back to school and I did a two-year fellowship in integrative medicine at the University of Arizona School of Medicine and really took a lot of other courses in functional medicine, learning about mitochondria. and never look back. So I just say that I have what I call my expanded therapeutic toolbox.

Which is amazing. It makes it so much easier to practice too when you have more resources to draw from to help your patients. And it really is, I love my new chapter, educating, traveling, writing, writing papers. And I'm still a clinician, though. I work every day when I'm in my office. I'm working every day, which I think, like we talked about this earlier, keeps us really grounded and really understanding what it means to take care of patients. So many people make recommendations about patient care,

and yet they're not even seeing patients and haven't for many, many years. I totally agree. And, you know, being a doctor with such a privilege, seeing patients is the best part of the job. But it does keep it real. And also, individualization of care is so important. So you might know all the biology, all the physiology, all the pathology, and then you have a real patient who has real, you know, they have different diets,

they have different stresses, they have different things going on in their lives. And individualisation of care is so crucial. One of the things that I, there's lots of things I respect you for, for, but one of the things you were saying the other night, it just makes me realise how strong you are. And when we're talking about health of women, hormonal health, I think you have to be really strong to really be, stick to your principles when you know you're right. So you were saying to me the other night

about the mesh. So some of people might have heard of the mesh repairs that were now been taken off market, but these mesh for gynecological surgery. And you were going to train other people. So you were taught how to do the mesh. And so that's quite a privilege being selected to be a teacher. And then you were taught. And then what did you do? I said, way this stuff is going to harm women. Just feeling it and looking at it and the kits, they had blind with trocards, like these like pokers that you would blindly poke to establish, like the, try to secure this mesh into the tissues. And it was a synthetic material that was really thick and harsh. And putting it into really fragile, delicate tissues, I said,

this is going to erode, which it did. And so I was taught on all these different mesh kits from many manufacturers, and I said, I'm not going to use it. I'm not going to, I absolutely won't use it. So I walked away from the opportunity to train and use it, and I said, I'm going to use native tissue repair. Sometimes I'll use bovine or cadaver fascia when I really need to, but I'm not going to put all this artificial tissue and implant it permanently into women's delicate tissues. And that was a good decision because there are many, many lawsuits, many women were harmed. Many women live a chronic pain and disability and many really tragic stories and many, you know, just sad tales.

And it was finally taken off the market. And this is part of really what I'm scrutinizing. So I am, I used to be once upon a time an early adapter of new pharmaceuticals. Like, I know about it. I'm like so trendy. about everything. But now I'm really not. I look at it and I want to know everything about the drug. How does it work? What's the mechanism? And there's always collateral issues. There has to be because you can't interfere with an enzyme pathway or a peptide. You can't and then think it's only

going to work in one part of the body because everything has multitasking. There's not one thing that's in one place doing one thing. And sometimes you have the same peptide, for example, doing different things simultaneously you'll have high levels in one part of the body, low levels in another part. So I'm very cautious now. Yeah, which is so interesting. And it's the same US and UK with the meshes. You know, it was a massive scandal, actually. And Chris Hardy, who's been on my podcast before, he has taken out so many meshes.

You know, it's awful. But it's very hard in medicine. If everyone's saying, well, yes, no, come on, let's do it. and it's sort of a bit of a mess with hormones in that it's sort of gone the other way really that people are now scared of natural hormones which really worries me and in fact my mother who's not a medic said to me a few months ago

Louise I think you need to talk more about what hormones are because most people don't even know we have hormones in our body and I thought oh bless mum I'm sure they do and actually she's probably right you know years ago the first medical writing I did was about breast cancer and I was supposed to be writing about tamoxifen for women. And I spoke to my mum and she said,

people don't know what cancer means. And I went, don't be ridiculous mother. And I said, okay, I'll ask a few women. And the women I spoke to had had breast cancer many for several years. And they'd said,

cancer means death. I said, well, what about chemotherapy? No, that means hair loss. They didn't know. And as medics,

we use all these words and we forget that people don't know. So when people talk about hormones, they often think it means breast cancer because they think it's HRT equals breast cancer. They don't think about hormones such as insulin. They don't think about thyroxin. They just think about hormones.

And I got a message today from someone in Brazil to say there's a big campaign against testosterone in women in Brazil by the gynecologists and endocrinologists because they're so cross that people are talking about testosterone. And I think, goodness me, there's a lot more in life to be cross about than a natural hormone. So we've got in a mess, I think, that is becoming really hard to unpick, and it's gone on for over 20 years since the WHOI, the Women's Health Initiative study, came out. And just to be clear to people listening, this was using synthetic hormones.

They've been chemically altered, and we can talk a bit more about that in a minute. But they're not the same as our natural hormones. The data went to the press far too early. It hadn't been analysed properly. The headline was it causes breast cancer. it causes heart attacks. Terrible. H.R.T. prescribing was about 40% of menopals or women in the US. It was about 30% of menopals of women in the UK. Now fast forward, we've got natural hormones. We know there are plenty of benefits to our future health, symptom control, so forth. In the UK, it's less than

half. It's 14% of menopals or women. And in the US, some of the figures of the licensed HRT or MHT, menopause hormone treatment is like 1.8%. Like it's fallen off a cliff. Everyone's scared, don't they? Well, in my practice, it's extremely high. But from what I'm reading, as well, it's under 5%. Yeah. It's really, and that's the 5% is women like in their 50s.

You go 60 plus. It's nothing. They don't even have data, but it's going to be very minute percentages. Yeah. And that's very sad. I mean, we're both very sad about that. And we're both like really, you know, publicizing, you know, banging the drum to help women to understand that all hormones, the word hormone is also misused. It really drives me crazy, too, because they use the word hormone and they apply it to what technically are endocrine disruptors or xenostrogens.

Like they're not ever found in nature in a human ever. And they actually interfere with real hormone production. or distribution, degradation, elimination in some fashion, or the receptor function, and they're different. And yet they're all put into the same bag as if they're all the same when they're really night and day different in how they, in so many ways. And of course, that's the whole really tragedy

of the Women's Health Initiative, the way the data, which was misunderstood in the very first place and wasn't anywhere near as terrible as they made it out to be, not even close, but it has been applied to different products to our own natural bioidentical hormones. And it's not a fair comparator. It's like totally a different product. So we were talking in the car yesterday about how you chemically alter something and it can make such a huge difference.

And I use the graphite pencil lead compared to diamond. It's just one bond different. They're made of carbon. But you used a great analogy as well. Well, mine was water. So water is H2O. And if you just make a little change and you turn it to H2, that's hydrogen peroxide. You wouldn't want a glass of that. So that's, and I said, you're molecularly like doing your analogy. I'm doing elemental. But, you know, you make the tiniest change. And it's completely different from something that's life-sustaining to potentially

life ending. I mean, a poison from something that's wonderful. Yeah. So we have to really understand that these are different molecules. And if we had a little, you know, whiteboard, we could draw, you know, the molecules, they're not the same. And of course, they have different effects on the receptors throughout the body. And I just wish we could just walk away from that women's health initiative. Like, shut the door, lock it, bolt it and never look back. So why is it so bad, Especially, like it was a US study. It was a billion dollar study. It was probably the biggest study that's ever been done on women's house.

But it still showed that women who took hormones, HRT, had a lower risk of bowel cancer. Like, yeah, it's why are we not, why are we not just like, why aren't there sort of grown up people out there saying, actually, this was the wrong study. It was the wrong type of hormones in the wrong type of women given to the, you know, like, and the results actually were badly reported. I don't understand why we keep going back in time. Nor do I. And you're right. There actually were shockingly beneficial effects that were very minimized. For example, in the group in their 50s, it showed a 30% reduction of all-cause mortality.

There's no pharmaceutical that lowers your risk of dying by 30% from everything overall. I mean, so and yet that wasn't talked about. And like you said, colon cancer was reduced. and bone health was dramatically impacted in a beneficial way. And that is really a very leading cause of morbidity and mortality in women is everything related to muscular skeletal health. And yet that was downplayed. So the benefits were ignored.

Yes. And the negatives were completely misconstrued. In fact, the whole thing about it increases, myocardial infarctions was dropped. and the issues with strokes and dementia was related to the extra really high increase in clotting from using the conjugated equine estrogens, which increased clotting, spontaneous clotting risk 400%. So not too small, shabby an increase. So if you increase clotting, then yes, you're going to increase potential strokes and macovascular clotting can cause vascular. dementia. Yeah. So it's no surprise. I mean, it's that hard to explain. And also the synthetic

progestogen because the progesterone they use is not a very nice progesterone at all, myoxyprogesterone acetate. It's too. Too thumbs down. Yeah, totally. So, so it isn't a surprise, but I don't know why we're just translating that, if you like, to 2025 when we've got natural hormones. But when I started HRT nine years ago, I was 45. So if I went to go and see a doctor, even today, if I was 45, which, I'm not now, but if I was age 45, going to see an average US doctor with some hormonal change, am I more likely to be put on the contraceptive pill or hormone replacement? Oh, by far more likely on the contraceptive pill.

Absolutely. And in fact, the pills are used up until, it's supposed to be for lower risk women, but I've seen women on blood pressure medications and have insulin resistance. but presumably lower risk women up to the age of 55. Yes. And that is the preferred US approach to perimenopause. And why is that? That plus some antidepressants like we were talking about.

Yeah. So if I had started, we can't go back on time, but if we did, and I was in US and didn't see you, hasten to add another doctor, was given contraceptive. Now, that is synthetic. That's the graphite or the hydrogen peroxide or whatever you think. So it's synthetically manufactured. So it's going to block my eustodial receptor. It's going to block my progesterone receptor.

It's going to stop any testosterone I have working in my body pretty much. And it's also going to increase my risk of heart attack, stroke, cancer, only small amount. But then if I went to go and see you, age 45, and you gave me natural oestadial, natural progesterone, natural testosterone, if I needed it, then there isn't a risk of clot there isn't a risk of stroke there's a lower risk you say 30%

mortality probably at least it will reduce inflammation in my body like you can tell me on a molecular level how those hormones work because I've had them in my body for years we know how they work don't we but I don't understand why as a doctor would you give me something

that's more risky not you but a doctor right it's just pervasive lack of understanding And after the Women's Health Initiative came out, and it just created just a fear. It was unbelievable. I was in practice at the time, and I begged my patients to stay on hormones. I was so opposed to these widespread negative conclusions about the use of hormones.

And about half of my patients stayed on hormones, and about half of them didn't. Some of them started having terrible symptoms, and then ultimately, a year, two, three later came back to me, but some didn't. Some came back 10 years later and said, I wish I had never gone off the hormones, but I couldn't convince him. The fear was so powerful. And after that, the newer doctors and the studies say that currently 80% of medical practitioners, so would be nurse practitioners, doctors, and so on, 80% of them were not in the midst of practicing.

medicine. Maybe some of them were in the beginning of training, but they weren't actually practicing medicine 23 years ago when the Women's Health Initiative came out. And the education that followed since then has been marginal to zero. So they know nothing. The doctors, nurse practitioners, who are currently in practice, were taught nothing. Literally, and what they were taught was all negative. And many of them just don't seem to have the curiosity that you'd like to have them have. to go and learn it on their own. But they're not. They're like, and then they're just embedded in this institutionalized medical practices that are, you know, that are all in the U.S., most of the doctors are employed now, working for big entities that create protocols.

And the protocols are hostile to hormones. Yes, indeed. And they're very limiting or some of them are bending a little bit now, a little bit of softening. But it takes a while. But it's still, the FDA in the U.S., the only use that's approved for hormones, for vaginal, for now called genotourinary syndrome of the menopause, which does not have a level that's enough to get absorbed and create any systemic benefits. So it's a local effect.

And the other is just for prevention of osteoprosis, which almost nobody actually does. It's like even the endocrinologist never even think of. it because they're still afraid. And the other is suppression of the night sweats and hot flashes. That's it. There is not any medical society that's advocating for hormones for cardiovascular health, neurological health, musculoskeletal health, other than not, you know, looking at muscles and joints. None of that is happening. And so when you're protocol driven and you're only using for FDA-approved use, but off-label use is totally legal. So it's not like you're breaking a single law to say you want to use it for something

beyond this limited use. And it's the same here, our MHRA exactly the same. You know, it's licensed for menopause, not perimenopause, for flushes, sweats, prevention of osteoporosis, which, by the way, affects one in two women. So, you know, even 50% of women would be a lot better than we're doing now. But I used to write a weekly column in a GP. It was a magazine that it was gave free to every GP in the country. So I used to write an evidence-based column once a week for them.

And I found some of them recently. And I found the ones from 2002. And I actually found some that I'd written in 2001, so pre-WHI. And I'd written about HRT, about the benefits for bone and heart and, you know, all the things that we knew then. And then 2002, I said, oh, this WHO study had come out. But actually, there's no big deal. It doesn't show us anything that we didn't know. already. Still really good for bone protection, really good for symptoms. But I was in my little

bubble then. I was just working in general practice. There was no social media. I didn't really, like, really wasn't paying much attention to outside what was going on. And my patients just carried on taking HRT because they knew the benefits. They understood. They said, oh, well, this risk of breast cancer fit is there is really small, but I've got all these other benefits as well. Why can't women have a choice? Why is it, like you're saying, the endocrinologists don't like using these hormones or why is some doctors saying have contraception, why can't women decide what they want when they know it's better for them? And, you know, one of the things you said to me a while ago on the phone was we know that eating fruits are really good for us. And no one will

disagree that eating fresh fruits good for us. So do we limit it? Do we say to people you can only eat fruit for a few years? Because, you know, do you remember saying that? And I thought that's great analogy, isn't it? Try to drive home the point in a way. that's simple and really clear. And I think that what is happening in the U.S. is what's driving the increase in interest in hormones and even prescribing of hormones is the groundswell of women. Yes.

It's not from the top down. It's the bottom up. And what this is creating in the U.S. is a business-driven model of hormone prescribing, which actually has some benefit, but it actually makes me very sad in a lot of ways because these new, like a lot of online dispensaries for hormones, they're driven by business people. They're not started largely by anyone who has a medical degree of any kind.

These are business driven. They see that there are a lot of women who want hormones, and the medical establishment isn't providing it. So they're creating these online dispensary companies, and they're hiring different people to them prescribe who don't really have a foundation. Like we talked about, how does the cell work? What is this doing? They really don't have that. They're just given these little protocols.

They're given, like, this is what you prescribe. There's not the individualization that we talked about. They're not monitoring levels. They're not really, they're responding to symptoms when they develop from the treatment, but they don't really know. what to do either. And they're trying to give the very smallest doses to try to have the fewest problems. So they're not about optimization at all. And this is what many women in the U.S. are now turning to because they go to their own gynecologist or a family doctor, and they're told, no, this is going to give you cancer. How could you even think of it? They're still back

in this old wrong thinking, so they feel I have no options. So they turn to these online companies and then they get what I call a whiff of estrogen and a little bit of progesterone, and never testosterone. No. Because they can't do that online. And so it's something. So sometimes I like to think anything is better than nothing. But it's not ideal.

But not even close to ideal. But this is what's happening in the U.S. And it's all business financially driven. And it's, but the impetus is coming from the groundswell. of women wanting hormones, not from the doctors educating from the top down. And the educational environment in medical schools and post-grad work is still really limited. They're not teaching. So when the professors don't know, they're not teaching anything.

It's really sad. It is the same. It is the same in the UK. It is a lot led by women, which it shouldn't be. and so many women are not listened to, they're underserved. So one of the things is, you know, online, lots of people trying to lose weight. They're going to these GLP drugs, these GLP ones, these drugs that supposedly will transform everybody. We've seen a massive surge globally in these drugs, like a Zen pic.

I'm very cautious as a doctor, like you. I've seen a lot of drugs come and go. I want to know how do they work in the body. what are their potential for harm, what are their potential for benefits, what are their long-term outcomes, what else can we do first before we're giving some drugs that's new to the market? People are just getting them, like Smarties, really, online, which I have a worry because it's not individualising care. There's lots of reasons why people put on weight, and there's lots of things we can do. But we know during perimenopause and menopause, it's a metabolic problem.

We've spoken about it before. People will often put on weight. They'll put down. more adipocytes which will produce eustrone and inflammatory type of estrogen. In my mind, maybe I'm too simplistic, so I'm keen to hear what you know. Like in my mind, I will always balance someone's hormones first. I will look at their nutrition. I will look at their exercise. Wait for everything to have an effect. Before I'm even thinking about any other drugs.

I mean, I don't prescribe these drugs anyway, but I wouldn't recommend them first line. Because eustradial, just explain, has some really beneficial effect. doesn't it, on our metabolism? Oh, it's huge. Well, everything in the female body is designed. Whether you want to have babies, don't want to have babies, it's designed for reproductive success. And it turns out that metabolism is critical for reproductive success.

So if you think of metabolism, it's the creation, utilization, storage distribution of energy. So it's critical for any organism to have. have intake of energy, also known as eating, that matches the needed expenditures of energy, creating heat and running all the machinery of the cells and so on. So it's all finely tuned, and there's these different hormones and peptides that are all interconnected in sort of like the yin-yang, you know, like there are hormones, neurotransmitters, peptides that are involved in reducing appetite, and there are others that are involved in increasing appetite, and they're all under the modulation effects of estradiol. So I always think of esteradial as the hormone

of metabolic homeostasis. So to keep things working smoothly and right, when you lose your estradiol, the systems that are involved mostly in the hypothalamus of the brain or become like offline, they're not working properly. So the hormones and peptides that are involved in nutrient sensing and the master clock that triggers the control of the circadian rhythm, which is very involved in metabolism, they all kind of start becoming drifting, so you don't have things quite right.

So you don't have proper appetite regulation, and because the circadian rhythm goes off, so women often will have the change in their cortisol, production. They'll have more at night when they should, like, lose their appetite and want to go to sleep, so they feel energized at night. But the takeaway is that estradiol is key to regulating all aspects of metabolism. So without it, you lose your appetite control, proper control of storing and burning fat, glucose transport, all these things. So absolutely, the first thing is to get women properly hormone balanced and get their nutrition, all of that together, and only then

start thinking of adding pharmaceuticals. Yeah, which is so important for people to know. There's so much that we could talk about. You will have to come back another time. But just to finish, three take-home tips, I would like to know your three top reasons for considering Easterdial. Well, I would say the number one has to be brain health. No matter what the condition of your cardiovascular system is, if you don't have a functioning brain, forget it. So estradial is neuroprotective. That's

another whole podcast we could do. But the bottom line is to have proper mood and cognition, you need estradiol. So that would be number one. Number two would be, actually the musculoskeletal system, such an underplayed organ system that, you know, in terms of muscle and joints and bone, for not just locomotion, but these are, they create kinases, they create like myokines from muscle, they create hormones. Bone makes hormones as well that help control cognition and fat burning and glucose control. So the musculoskeletal system would be my number two. And number three, the cardiovascular system, of course. because you have to have proper vascular health in order to properly nutritionalize and oxygenate.

But I'm going to throw in one more. I just can't stop. The immune system. Well, that's the basis of everything, isn't it? Exactly. I can't leave out the immune system because we have to be able to repair. We have to be able to fight off pathogens. So, you know, we could just go on.

I just love estradiol. Very good. What a great way to end. You'll have to come back for more. but because you've come so far, I will allow you to have the fourth one. So thank you so much, Felice. It's been great. Thank you.

Subscribe to my newsletter for exclusive insights and updates on new episodes.