The Dr Louise Newson Podcast - 048 - Newson Health in the North - Dr Zoe Hodson & Dr Louise Newson

Episode Date: May 19, 2020

In this podcast, Dr Louise Newson is joined by Dr Zoe Hodson who is the lead doctor at the North West branch of Newson Health. Zoe has worked as a GP and GP trainer for over 15 years and has encountered many hurdles when trying to deliver menopause care; from lack of training as an undergraduate and postgraduate to being told that there wasn't any funding for a GP led menopause clinic in her area.   Dr Newson and Zoe discuss many of the frustrations that GPs and their patients face as well as the work that is being done by Newson Health in areas such as GP education and the provision of evidence based, accessible information for women throughout the world.  The team here at Newson Health believe that menopause consultations should be based on shared decision making and they discuss the importance of women and doctors being able to fully understand the long term health benefits and improved quality of life that HRT and holistic menopausal care can deliver.   Dr Zoe Hodson's Three Take Home Tips: Read or listen to as much evidence-based information as you can about the menopause before booking an appointment with your healthcare provider.   Share a symptom checker with anyone who will listen - we have to start joining the dots and this is a cheap, easily accessible way to start.  Gather your soapboxes! We need everyone to be sharing and signposting to correct, evidence based information. Find out more about Dr Zoe Hodson and our new North West clinic in this video.

Welcome to the Newsome Health Menopause podcast. I'm Dr Louise Newsome, a GP and menopause specialist, and I run the Newston Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. So today I have with me a friend and colleague, Dr Zoe Hudson, who's a GP and a menopause expert who works in the North West. And I'm very excited because she's joined the Newsome Health team, to expand the clinic. So we now have access to women in the North West a lot easier than then coming down to my clinic in Stratford, Parnovan. So welcome, Zoe. Thank you. Lovely to be here,

virtually. Virtually, of course, yes, because we're recording this in times of COVID. So obviously, we're both at home, but we're doing this remotely. But we thought today we would focus more about a GP's perspective of the menopause, because I was a GP for many years. Zoe's a GP. And it can be very easy for women to be disillusioned about their own menopause experience or a family member's menopause experience and be very negative about general practitioners and in fact as a GP it's very hard sometimes to diagnose the perimenopause and menopause and then it's also quite hard for them to be able to deliver the right treatment that's evidence based so we just thought we'd talk through some of this reasoning so zeri before we start could you just enlighten me and

tell me how much education that you received as an undergraduate and also a postgraduate about the menopause? Well, I think at medical school, I really don't. I mean, I know it's quite a long time ago, but I don't remember menopause being mentioned at all. And then in my hospital training, again, I did do work on an obst and guine ward. And again, menopause wasn't mentioned. And although we don't necessarily think that it should be under the guise of gynaecology, because it's a systematic approach. That's why you would traditionally expect it to have been talked about. And then as a GP trainee, I was quite fortunate initially to have my trainer used to fit the hormone implants and was keen on HRT. But unfortunately, it was then just at the time of the WHOI.

So I remember just having this brief six months, lots of healthy women, and they were all on HRT and then suddenly it went and nobody really spoke about it again and that was it. So this is very interesting. So this is in 2002, as you say, the WHOI, which is the Women's Health Initiative study, which before this time, women were generally given HRT most of the time and a lot of women were giving it for healthcare benefits as well, such as reduced risk of heart disease and osteoporosis. And certainly after hysterectomy, women would almost routinely be given HRT, they? Yeah, so it wasn't an uncommon prescription. None of us queried it and looking back. I mean, I was at the time working quite an affluent area, but I just remember these women looking

incredibly healthy and all functioning very well. And then suddenly it just went. And it was almost became the unspoken. We don't go near this. And it was only years later, wasn't it, that they came out and said that that study really should never have been published. Absolutely. With a very tiny apology. Yes. And we've talked to. about this study numerous times before, but the WHOHI, the Women's Health Initiative study, was basically looking at giving very old types of HRT, ones that we don't really use now, to women who had been several years, some of them more than 10 years after their menopause, to see whether it had benefits in the longer term. But actually, a lot of the women were very

unhealthy in the study, weren't they? So a lot of them had had heart disease, a lot of them were overweight or obese. So the data was very very, very well, skewed and the results from it were misinterpreted and they were given to the press too early before they had been analysed properly and actually interestingly analysis of the data has shown that women who continued to take HRT for more than 14 years actually had a lower risk of death from all causes including from cancer but initially women were very scared healthcare professionals were very scared and actually those healthcare professionals were the ones that were teaching young the doctors, weren't they? Yeah, this is what I was going to say.

So a few years after that, I started the basic trainers course, and so my cohort have now become the trainers, and we had this very skewed view. And again, it just was something that you could skip over quite neatly, because although it is on the curriculum for GP trainees, the curriculum is vast. So you can find plenty of other things to teach around. and not include menopause. It doesn't have standalone. It's not compulsory for GP to be trained in it. And I think that's another issue.

Yeah, which is definitely sad because obviously the menopause affects all women, if they live long enough, doesn't it? But just talk us through a bit, Zoe, because the menopause isn't a disease, is it? So some women will be thinking, well, why do they need to be taught about it? Because it's not a disease, it's a natural process. So talk us through the importance of healthcare professionals knowing about the menopause. Well, I think from a GP training perspective, it's actually, I spoke to one of the associate deans from Manchester, asking why it wasn't included in the training program. And one of the reasons he gave was that it didn't fulfill the competences. Now, the competences for GP training are very clear. And they cover a really broad range of topics from things like ethics to health promotion, to clinical skills, to consultation skills. And I just looked at him and said, it's probably one of the few areas that cover all of those competences.

And this is why it's so important because we're looking at it's not just something that a few women go through. It affects things like their work. It affects so many systems. As you say, the estrogen receptors are absolutely everywhere. So it is looking at bone protection, at cardiovascular protection, at brain functioning. and I absolutely for a very short moment, speak to us because I thought, how can you not see if you want these competences covered? This is the absolute perfect topic for GP trainees to take a really holistic view of women's lives.

Which is so important because I think some people incorrectly think that the menopause is just defined by the end of periods. And quite rightly that's how you diagnose it to be officially menopause. it's a year since your last period, or if you have your periods artificially stopped by having your ovaries and your womb removed. But actually, it isn't that, is it? Once your periods have stopped, you're still menopausal, you still have low hormone levels, which will never be replaced unless a woman takes HRT. And so this is why it's so important to address. And as you quite very say, these estrogen receptors are all over our bodies. So actually, There's an argument that every specialty, so every doctor who's in any specialty, should know about the menopause, don't you think?

Well, this is the other thing when I started to train up in it. And I think from medical school, I always had this view that somehow the consultants knew more than me because I was a GP. You start to read the letters from the consultants regarding menopausal care from all specialties. So I saw, I don't know how many women who had been diagnosed. diagnosed with fibromyalgia. And this was rheumatology. I said, did the rheumatologist ask you about your periods? And they said, no, why?

And when you asked them, their periods had changed. And again, with people who are going to cardiology with palpitations, and you said, so these were patients that I hadn't met before. And I'd say, well, did the cardiologist sort of clock that you're 47 or 48 and had your periods changed? No. and I think it's such an interesting topic. And this is why we need Dan Brinks campaign.

We need to get it from medical students right the way through. It's this really strange thing that once you see it, it's almost like the switch goes on. Suddenly start to join the dots. And this theme comes through a lot with what we talk about, doesn't it? This joining the dots. For women to join the dots and the clinicians to join the dots and their partners and their work colleagues.

Yeah, and I think this is so important because we know how many appointments are wasted because women going back and forth with, like you say, their palpitations, their muscle, their joint pains, their recurrent urine infections, their headaches, their migraines. Some women are worried that they've got dementia because they can't remember properly. Yes, if no one's thinking about their periods or changing periods, then no one's going to join the dots, like you say, and think about it's going to be related to the menopause and how, what the most efficient way of it being treated. And the number of investigations women have is offered an inappropriate as well,

which is a real drain on the NHS, isn't it? And I think, yes. And I think the other thing, I mean, the joy of general practice. And I think, I'm hoping that something has shifted. I know that COVID is awful, but I'm really hoping that something has shifted and we can get back to the essence of general practice. because I know the appointments are very short. And especially with the trainees,

I think there is a real fear about addressing something like the metacores in a 10-minute consultation. And I always used to say to them, it doesn't have to be addressed in one consultation. The patients aren't going to go away. So we used to start off with, let's join the dots to start with. Many of these women that came in assumed that menopause would happen

when they were much, much older. saying to them that I think you have symptoms of a hormone deficiency when they were in their early 40s would often come as a bit of a surprise. And so that was the consultation where you'd say, right, well, we've got some brilliant resources. We've got the Menopause Doctor website, the Haynes Manual, and send them off the Climactaric Green score and say, go and read, just go and read. And I'll book you back in next week, and you can just tell me what you think. It doesn't have to be done in 10 minutes. And this is one of the fears that the training have. And I think that's very important because I see a lot of women who say, well, my doctor says I can only have one appointment, one problem, and they don't know which problem to prioritize because

they have so many symptoms. And then some GPs will offer double appointments, which is good. But as you say, it's often a sequence of appointments that people need because they need the right information, they need the right knowledge. And that will help them make the right decisions, because it's very important, isn't it, that women receive individualised care for their menopause, because a lot of us are going to live, hopefully, for decades, being menopausal. So it's really important that this stage in our life is looked at seriously and appropriately because we've both been pregnant and we had excellent care when we were pregnant or numerous number of healthcare professionals for a relatively short period of time in our lives.

And then suddenly we're menopausal for decades, yet no one looks. after us. It doesn't seem right. I think there's another parallel there as well, because when you're pregnant, you're encouraged to go to groups and to talk to other women of parents, aren't you, and share this. And it's known that it's, you're going into unknown territory. And your peers can often be the best people to speak to. And yet with menopause, I mean, I spoke to someone the other day, and I wanted a photo with her. And she said, I was wearing my Make Menopause matter a t-shirt and she said, are you implying something? And I thought, well, yes, because you, you are quite clearly of an age where you will be menopausal. And I'm standing here with a

great big slogan on my front because I'm not ashamed. Why would I be ashamed of it? It's natural. It's, and this is what we need to move towards. And this is why we ask women to keep talking about it. It's not a shameful thing. It's natural. Yes. And we need to start addressing it. I think so. And it's also, we need to change the perception so it's not thought of as an old person's condition. And some of you might know I recently have done a podcast with Lorraine Candy where we're talking about changing the language associated with the menopause. Because a lot of younger women have menopause. And in fact, I spoke to someone in my clinic last week who's only 18. And she had a very unusual cancer when she was 15. Well, in fact, no, it was diagnosed when she was 13 before her period start.

So she had chemotherapy and radiotherapy. So her periods had never started properly. And now they're not there because her ovaries were damaged so much by her treatment. Yet no one had given her proper information about her menopause. So, and she can't really talk to her friends because she's too young. Why would they know about the menopause? But actually, we should all know about it, shouldn't we? And I think this is, yeah, if we reframe it as a female hormone deficiency. And again, when I've done tutorials, if we call it that, you can see the, you can see the little light bulb come on in their eyes. Oh, I get that. Right. Okay. And you get that that can happen to all ages. Yes, absolutely. And it's like we, as general practitioners, we see lots of women, don't we, who have had a thyroid deficiency. So they have an underactive thyroid. And the thyroxin in the body affects cells all over. So people can have symptoms such as weight gain, lethargy. They can have skin changes, hair changes because of their underactive thyroid.

and we don't expect them to soldier on with their low thyroid. We give them thyroxin replacement and they usually feel a lot better. And they also know that they continue their thyroxin replacement forever because their thyroid will always be underactive. And this is the way that we need to think about the menopause, isn't it? And I think that's another thing as well. I think there's a real fear. I think if you go to the usual book that we use to prescribe things,

it's called the BNF. and I struggle to find HRT in that. The chapter, unfortunately, is not user-friendly. And I think, again, so you're starting off from a point of uncertainty because you've never been taught about it. You then go to your big book that normally gives you some guidance, and it's impossible to try and find a sensible regime. Until you wrote the prescribing guidelines, they were quite difficult to find.

There wasn't any rationale. And then there's this thing of, well, I've given you HRT, why isn't it working? Again, you wouldn't do that with diabetes and you wouldn't do that with thyroxia. Tinker around with it until you found the right level that suited the patient. But we have to start taking some of the fear out of that to get some sense back into it so they can approach it logically. But this is the problem. The resources haven't been there to go to.

Absolutely. And I think like you say, the BNF, the British National Fund, formula is associated with warnings, isn't it? And so certainly in general practice, we're all computerised, so we use a computer system. So when we prescribe a type of HRT, it will come up with a warning, won't it? And the problem is, is there are different types, there are different doses of HRT. And certain types of HRT, for example, the estrogen through the skin is a patch or gel, has no risk of clot. Yet it warns you that there's a risk of clot when you try and prescribe. So this has got to be a barrier, hasn't it?

it for the trainees sort of for the well for the trainees especially because i've seen quite a few of them over the years and so there's me sort of saying to them go forth and right you've now seen the symptoms go forth and prescribe and as soon as they put a prescription in this great big red warning comes up they do do not proceed any further and again they've never been taught the difference between transdermal and oral no so it's it has to be and again with teaching as well conditions such as diabetes. It would be the same with you. You were taught them over and over again at medical school, and then you would taught them again, and then you were taught them probably three or four times a year during your GP training, and you become comfortable with them, and you see the effects and you see

the results, and then you learn a little bit more. So there are so many stumbling blocks, but I think you've been doing the work with 14 fish, and that's a platform that all of the trainees are linked to, and I think that's going to make a huge difference to this, that they will actually have evidence-based information in a range of form. So I think videos are a really good way of learning. And it will just give them that backup that what they are doing is the right thing to do. I think that's so important because certainly whenever I lecture and teach healthcare professionals, a lot of them don't have the confidence.

They know quite a lot of the theory, but they still don't have the confidence to put it into practice. As you say, we're working with a company called 14 Fish to develop a menopause education program that a lot of people will be able to access online. So it will make it very easy. And we've done lots of consultations with actresses pretending to be patient. So they can see how much they can get out of a 10-minute consultation. So we're really excited about this being delivered because I feel really sad for a lot of GPs, but also nurses, pharmacists, other healthcare professionals,

because a lot of people I speak to really want to help these women, yet they don't know how to, whereas they know how to manage diabetes or high blood pressure or heart disease, but if they've never been taught or they've been taught incorrectly, then it's very hard to change. And it's very difficult, isn't it, to keep up to date with guidelines in general practice, because there are so many.

Yeah, and I think the other important factor in this and something that has become rightly so, more popular over the last sort of five to ten years are the expert patients. And I think we really want all women to become expert patients in this. It is, it should be a shared consultation. I think it isn't at the moment because of all the issues that we've talked about. And this is something that I would always sort of say to people, go and read, read as much as you can, read the excellent book, Estrogen Matters that you did on one of your part. That's, an absolutely brilliant place.

There are so many podcasts that you can listen to so that you can get so much information and you can also take a big part of deciding what your care is going to be. And I think, again, we see lots of women on your social media sites that have signed posted their GPs and I'm sure the GPs are equally grateful

to have finally found something that's evidence-based. And I think it's really important, isn't it? So the Royal College of General Practitioners are very vocal about patient experts and patients being empowered in all diseases, because it really makes a difference to the consultation. And I'm sure you're the same. Over the years, I've had people that come with daily male cuttings because they've read that there's a transformational treatment for a really obscure condition. And it's been done in a study of three people in an obscure place in America and they want that treatment. And my heart sinks and I think, oh my goodness. Whereas there are other people that come and they've read some of the studies or they've read the nice guidance or they've read some really good literature. And then the level of consultation that you have is very different, isn't it?

Because as a doctor, it's very important that we're not paternalistic, that we share decision making. And we share uncertainty. And certainly a lot of women come to my clinic and they're really scared of HRT. They don't want it. They say they want something natural. They want something that's not going to cause breast cancer. They want something that's going to help, but only in the short term, because they've read so much wrong information. And actually, once they've been given the right information, they often say,

my goodness, I have no idea that HRT was derived from the ham, the root vegetable. I had no idea. It was just replacing the hormones and how safe it is to use in the long term. And so, like you say, it's very important, isn't it, that women, but also their partners, their children, their relatives are given the right information. so they can share the decision-making process with the healthcare professional. Yeah, and I think so. And I think, again, once you put it all into perspective, I think many women are shocked that having a glass of wine each night

carries more of a risk of breast cancer. And carrying a bit of weight will double your risk. And these are still all very small numbers. But what we look at is that whole thing of, well, this is the stepping stone. So if we get you on the right HRT, you will feel better. And then it's the next consultation, because at the first one, they feel so rotten that trying to talk them into changing their diet is pointless a lot of the time. And then by the time they come back, they feel so much better.

And it's then sort of saying, well, let's have a look at these. You're still a little bit overweight. So let's just discuss what you can do to address this and change your nutrition. And lots of them by that time have cut down their alcohol, haven't they, because they feel so much better. They don't need to. Absolutely. And a lot of women I speak to are actually scared of taking HLT because they think they're going to put on weight. And as a lot of you who are listening, know that it's very common for women to put on weight during the perimenopause and menopause because of the metabolic changes that occur in our bodies.

And often people put on weight in the midline and find it really hard to shift. So as a doctor, if I sit there and say, you need to change your diet, you need to lose weight, they would just cry because they have tried often. But once they have their replacement of hormones and they start working for them, these metabolic changes are reversible. So women often find it a lot easier, don't they, to lose weight? Yeah. And the other thing as well that we have to touch on, even though it's a huge frustration to us both, is the testosterone.

Which is, it should come. It's the triad, isn't it? On the vaginal preparations. But this is another, we're so far behind where we should be. And again, I think with all the enthusiasm in the world, I think we have to accept that it is going to be a long, slow journey to get it into the NHS because it should be. I was nervous about prescribing it. I sat there. I'd read about it for a couple of years and had all the usual fears that I was going to just have all these bearded women coming back in. Because again, I had no backup. I had no guidelines to go to. I'd never been taught about it. So I thought, well, it only comes from these specialist clinics,

therefore it must be really hard to prescribe and monitor. And then you start prescribing it and think it's the same monitoring as thyroxy. What's all this fear around it? What's driving this? And you go right back, and it's back to the beginning again, that nobody recognises that women need it. Absolutely. Because a lot of women, or a lot of people, incorrectly think that testosterone is only important in men,

whereas actually in women we produce more testosterone than estrogen before the menopause, yet as you say, I certainly wasn't taught anything about it. And neither were you and neither are most doctors. And it was only the last few years that I've started prescribing it and seeing the transformational results it can have. And then I think it's absolutely outrageous that we're not allowed to prescribe our own hormone in the NHS. And I think this is important to say,

because I know women get really, really frustrated with this. I think each of us in our own area, so I've approached the Manchester formulary. A friend of mine is working in Wales at the moment, and I know you're campaigning as well, that there are lots of us that are really trying to get this address. And it's a bit of a postcode lottery, so we know that women is not even considered. I couldn't find it on the formulary. And we're going to at least try and get it changed to the status that if a specialist has initiated it, the GP can continue with it, which will get GPs comfortable with the concept.

Yeah, absolutely. And I hope going forward, the MHRA will agree to it being licensed because we used to have a licence preparation of a patch a while ago. And there is this cream that we both use that's made for women in Australia, which we're hoping will have their licence. And I'm hoping maybe even in the future some campaigning from women might make a difference as well, because it's very very, important that this is on the agenda and women's health has been neglected in so many ways. And it shouldn't be, should it? There's no reason that we don't have the right care and treatment just because we're getting older. And I think this again with the trainees, once they

have seen the results with a few patients when they've been through these consultations and they have got them on the right preparations of HRT and they come in and they just sort of say this woman, it's just turned her life around. work, her relationship is better, she's got more energy. And it doesn't take many consultations get this. And they need the ongoing support with that. And the more GPs that are skilled up, the more women that are not, it is. And I like the fact in one way that it is all working together in this. It isn't something that is just the medics trying to do, that women realize they are just as important in this, information to the GPs and speaking to their friends.

in really getting to know all of this evidence-based stuff that is out there now. We've got resources. And it's going worldwide, which is wonderful. It's so important. It really is important that we are not neglected and that women feel that they've been listened to as well. Because I feel so sad in my clinic when I hear stories about women who have had to give up their jobs, their partners. You know, they've even thought about ending their lives because of the effects,

the lack of hormones are having, especially on their brains, yet they're not receiving the right treatment. So I really hope some of the work that we're all doing together and joining together in this way makes us a lot stronger and more powerful. So watch out those of you that are listening. And so, you know, I'm hoping I feel very frustrated a lot of the time, but I do secretly feel quite excited because I think things are changing. And I hope the generation of women that are growing with us will really take this forward and notice some changes over the next few years. Yeah, I think the tide is turning, isn't it?

I hope so. So we just keep... I won't see it because we're all locked in at the time. So I'm very grateful for you giving up your time today to talk about this and I hope it will make people understand a bit how hard it is for GPs out there and how keen they really are to learn and we are going to help them and going forward we'll tell you more about our education program as it's launched. So before I finish, Zoe, do you mind just giving three take-home tips to women who perhaps

are struggling with getting the right help that they feel that they should have from their own GP? I think the first one, as I said, was just read as much as you possibly can, listen to podcasts, get the information, you've got the Menopause doctor website, you've got Diane Dan's bring her some excellent stuff on her website as well. So really know the treatment that you are looking for. It's the evidence-based and then you've got resources that you can take to your GP. I think the symptom checker is absolute key. If you can even take that to your GP, either the climate tariff green one or the one on Diane's, GPs may not. I had never seen

that before. And that was a real turning point, having a list of all the things to look out for. So if we can get women to share that with all of their GPs, even that would achieve so much. It starts to open up the thinking. And then the third one has to be get your soapboxes out. So if you have learned about this, you feel better on it. Please tell people, I tell everyone, or be at the checkout trying to shoehorn a conversation about menopause in. The postman gets a conversation about menopause. Women, when you see them, they want to talk and we need to take the stigma out of this.

Brilliant. I love it. Absolutely love it. So for those of you who want to find the questionnaire, if you search questionnaire on my Menopause Doctor website, then it will come up. And as many of you know, we're developing an app called Balance. So if you go to the website Balance hyphen app.com, then you can sign up for information there. And that will have the questionnaire on it. So it will be very easy to track remotely on your phone. So lots of food for thought. We'll keep carrying on our soapboxes and spreading the word. And thanks so much, Zoe, for your time today, but also thanks for joining our team because we're very excited having you on board. I know. I'm quite liking the virtual chat from Manchester rather than driving down Strapin all the time. Yeah. So thanks so much. All right. Take care. Bye. Bye-bye. For more information about the menopause, please visit our website www.w.menopause doctor.com.uker.