The Dr Louise Newson Podcast - 061 - The Hormone Pharmacist - Lindsey Lester & Dr Louise Newson

Episode Date: August 18, 2020

In this episode, Dr Louise Newson is joined by Lindsey Lester who is a pharmacist with special interest in the menopause and founder of The Hormone Pharmacist.  Lindsey set up The Hormone Pharmacist, after much encouragement from Dr Newson, to provide affordable expert menopause advice, which enables women to make an informed choice about the treatment they would like. Lindsey offers a 45 minute consultation which covers the risks and benefits of the treatments available, as well as general health advice which ultimately saves the time of women and their GPs and ensures they receive the safest, evidence based options.  In this podcast, Lindsey and Dr Newson discuss the large number of women aged 40+ that are prescribed antidepressants and also older women receiving antibiotics repeatedly for urinary tract infections, both of which are often menopause related.  Lindsey is a member of The British Menopause Society and she talks to Dr Newson about why it's so important that women make sure the health professional they speak to has undertaken specific training in menopause. In many cases, even a GP or Gynaecologist might not have had enough training to give  the right information or treatment.  Lindsey Lester's Three Take Home Tips: Talk! Talk to everyone; friends, family, daughters, nieces. It can be so helpful if your healthcare professional has an interest in the menopause - check their credentials first. Don't suffer - there's no medal at the end! Find the right treatment for you, it doesn't have to be HRT just make sure you have all the evidence before you decide. Take charge of your own destiny and be informed! Lindsey is now offering consultations here at Newson Health, click here to find out more. Find Lindsey on Facebook: @thehormonepharmacistUK Instagram: @thehormonepharmacistUK

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 on my podcast I have with me, Lindsay Lester, who's known as the hormone pharmacist. So she works down in Essex near London, and she is a pharmacist who has a special interest in the menopause. welcome today, Lindsay.

Thank you, Louise. Hi. So we connected, I'm not quite sure how really, but we connected over the internet and we've been liaising quite a lot recently and I'm really interested in your work which I'd like to talk to you about and also the role of pharmacists because as you know, with healthcare professionals it's really important for me. I certainly feel very strongly that women should receive very individualised care and advice about their perimenopause and menopause, and they should be given evidence-based information. And whether that's from their own GP, whether it's from a hospital doctor, whether it's from a nurse, a nurse prescriber,

and also from pharmacists as well. I think any contact women have with healthcare professionals should be evidence-based. And certainly we're doing a lot of work behind the scenes to improve that. So before we talk about your role as their hormone, pharmacists. Talk to me about what you've done in the past and also actually what a pharmacist is because some people don't really even understand what a pharmacist does. Yes, of course, right. Okay, so I have been qualified for almost 30 years. That makes me sound like a dinosaur. Hopefully I'm not. I don't feel like one. And I started out working for boots. And in boots, if they like you, they, in those days anyway, they pushed you towards the management section. And I was quite adamant that actually

I'd been to university to do pharmacy. I wanted to help people. I was more interested in clinical. So I kind of dug my heels in. Anyway, we kind of parted ways after I had my first child. And then I had a little career break. And I came back and worked in a community pharmacy part time. It was really lovely. The last few years, I was doing one-to-one consultations, medication use reviews. So I was talking to people about how they took the medication, making sure that they took it with or after food, if that was what was required, making sure they understood why they were taking it. Some people thought, oh, I'm taking so many. I don't want to take that one. You know, it's fine, it's fine. So my job was to explain why they should take it, encourage them to be able to remember

to take the medication. And it was really nice. I really enjoyed that. And then the NHS kind of phasing out that role. And so let me explain what a pharmacy is. actually does because we're not just there to hand over boxes of pills. We go to university and we have quite a good education. And we end up in a unique position where actually the main part of our role is to check that the GP hasn't made an error in some way. Everyone's human. This can happen.

So we double check the doses, interactions, important interactions. The GP, I think you can override on your computer. But if we know that that's important, we're going to double check. and things like that and look for any alarm signals, any incorrect doses, things like that. So that is the main job of a pharmacist. So we look at a prescription and we can tell what is wrong with the patient or we should be able to in general terms. So once I started learning more about menopause and what to look for, it was actually, I noticed a disturbing amount of antidepressants being prescribed in the over 40s in women in particular.

And that was an alarm bell. It was like, well, really? Because some of them were also on biroxene tablets. And it indicates that there's something going a little bit wrong with hormones in general. But I've only just started reading and learning and what was going on. The second major area that I noticed was in older ladies, they were getting repeat prescriptions for antibiotics for urinary tract infections.

And the patient history, you can look back on the patient history when you're doing the prescription. And it's like, oh, time and time again, they're getting these antibiotics. And I knew that this was wrong. And then there was another medication for urinary frequency or urge incontinence, women taking that. And it really was mostly women. And it's all connected with estrogen, lack of estrogen. So these are things I was starting to look at. So, I mean, it's so interesting.

isn't it for you as not even putting the two together initially, but realizing that there's this common theme that's coming out. And you may know we did some research of nearly 3,000 women, and we found that nearly 70% of women had inappropriately been offered or given antidepressants for the low mood associated with their menopause. And as you know, there's no evidence that antidepressants will help for this indication. Yet time and time again, women are given antidepressants. And again, with urinary tract infections, like you say, because of the low estrogen that occurs.

And I've done podcasts with Jane Lewis about vaginal dryness, also Jane Simpson, about urinary symptoms that occur. It's very common. And we used to, in our general practice, every Monday morning, have almost a queue of elderly women with their urine pots. And they would be dipped. And the reception say, well, you haven't got an infection. And these women would say, but I'm having all these symptoms. And, you know, I feel really embarrassed that I miss so many of these women. Because I didn't have the, I suppose I did have the knowledge, but I didn't have the experience

to be able to confidently prescribe just some local estrogen, which is incredibly safe, isn't it? It's some vaginal estrogen, which when it goes in the vagina, it seeps into the urinary system as well, doesn't it? Yeah. The urethra into part of the bladder and also the pelvic floor. So urinary symptoms can magically improve, can't they, with a very effective, low-risk treatment. which is actually far safer than having recurrent antibiotics. Absolutely, absolutely. You just reminded me of a lady that came to me.

She was in her 80s and she was going again to see the urologist and they couldn't work out what was wrong with her and there was nothing that was working. And I actually ended up saying, because this, again, this was right at the beginning and I ended up saying to her, have they mentioned estrogen to you at all? I said it's not in doses like HRT

and you just apply it locally. I didn't want to tell her the exact details at 80. And I think she hopefully went off and discussed that with somebody because it's so important. But we're in that position that we can do that if we know, if we have the education and the knowledge. So that's the key point. Absolutely, yeah.

So now you're specialising more, aren't you, and hormones and menopause. So tell me how your trainings evolve. Right. So actually, I'll go back to when, I first sent you an email because this was in January this. It was only January this year, I think. And I mentioned I was in the ideas stages of setting up a hormone advice, a menopause advice service, sorry. And I'd been asked to speak to some GPs about alternatives for HRT because

there's been a shortage, which most people will know about. And I asked if I could use your resource section to speak to them. And I was really surprised. You sent me an email straight back, you sounded so excited, oh my goodness, you must do this. This is excellent work. And I thought, oh, well, I was actually just having a daydream about my ideal job. This is my ideal job, talking one-on-one to someone, hopefully, you know, creating a plan and educating and helping. And you've just told me that's a great idea. So, and this is where it came from, really. So I have set up a menopause advice service called the hormone pharmacist. And the most important factor for me was that it was affordable and accessible because what I was finding were ladies coming into the pharmacy and they might have already been to the GP and they were already on HRT. And it's actually this lady who was a hairdresser that really springs to minds and really changed my viewpoint. And she came in and she said, I really can't afford a private consultation with a specialist. She said, but I'm so desperate, that's what I want to do. Have you got the number of somebody?

And obviously, again, I was at the very beginning stages. I hadn't done all my training. And so I felt that I couldn't at that point help her. But it was so wrong. Like she'd been to the GP. She'd had her 10-minute consultation. She'd been given the HRT, but she was feeling rubbish. And she'd been back to the GP.

She still wasn't feeling great. And she was so desperate that she was prepared to spend the few hundred pounds to deal with it, even though she couldn't afford. it and I thought, wouldn't that be great if I could, you know, we are the, we are actually the poor relatives, I think, in the NHS. And so, you know, it'd be great if I could set something up that doesn't cost a lot, that I could give really good evidence-based advice and the person could leave, I'm not a prescriber, so they would still have to go to the prescriber, but they would have the confidence to be able to speak and tell them what they want and know that they have all the right

information, you know, I work off the British Menopause Society and nice guidelines, all the things that are required to give the right advice. So that's where it all came from. So there you go. It came from you. Excellent. I'm very pleased to hear that. And it is really important, as you might know, I did a lot of hospital medicine before I went into general practice. And we had the luxury of having a pharmacist that would come on our ward rounds every day. And I did, obviously pharmacology is part of my degree, but not to the level that you do as you're training to a pharmacist. And the hospital pharmacist was just absolutely wonderful. A lot of people listening,

I'm sure, would have seen the BNF, the British National Formulary in GP practices, which is this Bible really. Now it's online, so they might not see the physical tone so much. But we look up and it says about interactions, contra-integrations. And it was like having a walking BNF with me. it was fantastic to have someone there. And pharmacists are so useful. And even if you go to the chemist, there's always a pharmacist there, isn't there, who's very helpful, friendly,

being able to just advise. And now there's a luxury often of having a private room where people can go sometimes for contraceptive advice. And a lot of the education work I've been doing, I've always been thinking, well, pharmacists can be so useful to give women the right advice. And also in a lot of chemist, now, there's a huge section for female health and there's a lot of menopause supplements there

and every time I go into a chemist I get very twitched because these products are often very expensive, there's very little evidence behind them and a couple of years ago actually I was in boots in Leamington Spa and this lady was looking at all these supplements and she wasn't sure there was a three for the price of two offer and she kept picking one up and this one was 20 pounds a month. So a lot of money. She was looking and putting it back and I don't know why I did it, but I went up to her and I said, oh, I'm sorry to interfere, but I don't think you should really be taking any of that. You're probably better off taking HRT. And she looked at me and I said, I'm really sorry. I am a doctor who specialises in the menopause and she said, oh, that's so

kind that you've said that. She said, my doctor took me off HRT a year ago because I'd reach the age of 50 and it was the best time of my life taking HRT. And I said, well, I think you need to go back and see a different doctor. And she said, well, I think you need to go back and see a different doctor. I'm so pleased. I said, I said, I just worry that you were going to be spending a lot of money. And if there's a pharmacist there to explain, and obviously some supplements are beneficial, can be helpful, HRT isn't for everyone, but it's important to have the right inflammation, isn't it? And it's not pushed by an economic reason to sell a product. So I think having access to a pharmacist is amazing. And I've sort of spoken to other pharmacists and actually like you're saying,

to have a job where you can interact with people and really make a difference is amazing, isn't this? It's a real privilege. And people do actually divulge information that they might not divulge to the doctor. They don't want to bother the doctor or there's something important that might come out of any conversation. And, you know, as long as you have the information. But again, I've heard you talk before about GPs not having any standard formal training on the menopause. And as far as I can remember, although, you know, I've had a few years of brain fog along the way, as far as I can remember, we just learnt that HRT, you needed a progestogen if the lady had a uterus, and, you know, just estrogen only without a uterus if she'd had a hysterectomy.

And I think that was pretty much. most of it, as far as I recall, but there is a lot more, you know, that you can learn, in fact. Absolutely. And it's shocking really, isn't it, that, you know, the menopause affects or women, if they live long enough, yet you're not given much training about it. And yet you can make a huge difference. And it's very important that women get the right advice from all sources. So when I first started my clinic, because I see people from all over the country, I wouldn't have the luxury of being able to dispense their HRT like I do now, so I'd give them a prescription. And then a lot of women were coming back to me, they were emailing me a few days after

their appointment to say, oh, Dr. Newsom, I've really enjoyed my appointment with you, but my pharmacist tells me I shouldn't be using this gel. It's going to give me a risk of clot because I've got migraine. I shouldn't be using it because of this. And all these things were coming. And I realized that they were going to pharmacists where they lived in little villages or the pharmacist wasn't used to HRT. and the pharmacist was looking up contraindications,

they were looking up risks of HRT and advising their patients, they thought, rightly, because of how it was documented. But actually, we know after the documentation associated with hormone products is not correct and outdated. And I then realized, actually, gosh, this is very hard for a patient because they're being told two different things from two different healthcare professionals. And obviously, sometimes they'll go,

or not obviously, but sometimes they'll go back to their doctor who will say, gosh, why are you taking HRT? There's a risk of breast cancer when they might be on estrogen-only HRT, which doesn't increase their risk of breast cancer. So obviously I do a lot of work educating doctors, but then I sort of thought, actually, pharmacists really need to advise because if they can work together with us and work out of the guidelines, like you say, it will give women a lot more confidence, won't it to. take their medication and continue it, which is really important, isn't it? Yeah. Because as you say, like the pharmacist that you referred, you know, they're looking at the information that they're given, and that's part of our job. We can't give something and be responsible for that if we've gone against what the guidelines say. And, you know, in the information, the product information is incorrect. Yes. I mean, you know, it's a

minefield. If you don't know. Absolutely. And it's a real problem. So for those of you, you're listening, there's quite a few problems with the product information, and that's linked with how doctors prescribe and the information that pharmacists have. So, for example, if I was prescribing vaginal estrogen, so this is either a pezzary or ring or cream, to a lady, for example, this 80-year-old lady you said she had urinary symptoms, when she opens the packet, it would say risk of clot, risk of breast cancer, cannot be taken if you have heart disease. and that is linked with the prescribing information for me as a physician is prescribing. And this is completely wrong because vaginal estrogen is not the same as systemic HRT.

It can be given even in women who've had an estrogen receptor positive breast cancer in the past because it doesn't get absorbed to the rest of the body. Whereas if you don't know that because you've not had the right training as a pharmacist, obviously you're going to go with the written information. But it's out of date and completely wrong, which is absolutely wrong. which is absolutely, well, it's just sad and outrageous, really. And the same with estrogen as a patch or gel, there's no risk of clot. And it can be safely taken by women who have migraine,

which is very different to tablet estrogen. Yes. And once you know that and have had the training, you've read the evidence, then it's obvious, isn't it? But when you're... It all becomes clear. Absolutely. But when you're a busy pharmacist, it's very hard to know, isn't it?

Because you just go with what information you've been given. at that time. Yeah. I mean, it took me till I was approaching 50 before I sat down and decided to do my learning. I mean, really, I should have done that learning years ago. But first of all, there wasn't anything really good available, kind of readily at hand. And secondly, it's just like you're busy doing what you're sent through or something else, but it's so important. Yes. I mean, half the population are women, actually more than half the population are female, And I think this is also a problem because the menopause is a natural process. For most of us we go through and it's because our ovaries stop producing eggs and we are the resulting hormones that associated reduce.

But because it's a natural process, a lot of people don't want to pester their GP by something they think is just going to happen to them. Yet when people understand it is a hormone deficiency that is long term and there are health risks such as increased risk of heart disease and osteoporosis, with it, then they will try and get more information. But this is why I think a lot of women want to access information in different ways and they'll feel less threatened maybe if you like seeing a pharmacist than they would maybe seeing a GP taking a lot of their time, feeling they're wasting their time. So to have the right information is really important, isn't it? Absolutely. But then again, it's also important as long as you know that the GP's or pharmacist or other health professional,

you need to know that they've had specific training, really. And I know you're passionate about that, but I think I like all your statistics. I've got some here. So I think a third of women had to wait at least three years before perimenopausal symptoms were correctly diagnosed. That's one of your statistics. It's like, how?

That's just shocking. It is shocking. And it's really sad, isn't it? Because it means that that's three years of someone's life. And I recently spoke to a lady in my clinic who's 62, and she started to experience symptoms when she was 40. So she's had 22 years of symptoms, and she's really struggling with her job.

She hasn't got a partner anymore because they've split up, partly because she was so irritable and argumentative. She's not slept properly for years. And that's really sad, isn't it, that? You don't need a fancy blood test to make the diagnosis, certainly women over the age of 44. what you do often need is time, isn't it? Time with someone who understands.

So even if you're, that you say you're not prescribing, that's the last part. It's the initial part, isn't it, of being acknowledged, putting all the symptoms together, you know, like the joint pain, like the migraines, like the urinary symptoms, someone can realise it's related to the hormones. And then giving the right information, and certainly a lot of women I speak to or liaids with,

once they've got the right information, it makes a consultation with their doctor a lot easier as well, doesn't it? It does. And I feel that by doing what I'm doing, I'm actually saving every one time. So let the GP have 10 minutes, but the person has had 45 minutes with me to discuss absolutely everything and ask all the questions they want to. Hopefully, I know, probably know a little bit more than their GP unless the GP has done the same training. And they go to the GP, empowered, they've got the right information. The GP doesn't waste their time. The patient hasn't wasted time. And it's all hopefully sorted. Which is fantastic. And have you been having some good feedback from women? I really have. I really have. And people not realizing that, you know, if you're in peri menopause, perhaps then the oral contraceptive pill. Combined contraceptive pill might be a good idea to keep everything steady throughout that process. I mean, I started this just before lockdown.

It was tricky timing, but the people that I have seen, and I've been having Zoom consultations, which has been really great. But a lot of people initially, if they're having symptoms, I think initially they're not even thinking of HRT, they're thinking, I'm going to say inverted commas, of natural ways of dealing with it. So, you know, I'll listen to that and that's absolutely fine. And as long as you understand the risks and benefits of everything, but in the back of your mind, you know, or I tell you that HR, is actually the most effective treatment in the end. And, you know, don't be afraid of it. Yes.

If that's what it comes to. And it's also, you know, a lot of HRT is more natural than a lot of products that can be bought. And when people often come to me also and say, I want something natural, I don't like taking drugs. Well, actually, when you think about what natural means, you know, there are a lot of poisonous plants that are still naturally growing. Oh, yeah. But we wouldn't want to ingest them. And because when a lot of women, realize that the body identical HRT is derived from yams, the root vegetables, it's just replacing.

And it's interesting actually at the beginning you were talking about women with thyroid conditions. And if women and men have underactive thyroid glands, then most of them, pretty much, all I would say, would be quite happy taking thyroxin to replace that missing hormone. Or if they had diabetes, they would take insulin to replace that hormone. yet they still see that HRT is some sort of poisonous drug that is a last resort treatment. Yet we know the earlier we take it, the better it is for our future health, as well as minimizing our symptoms. So I think I'm sure you spend time, like I do, explaining the difference.

And people then, it's like a light bulb moment, isn't it? They suddenly think in a different way, perhaps, than they had before. Yeah, and yeah, absolutely natural. I don't know if you want to talk about bioidenticals because I think we should because I've had a couple of conversations with like a nutritionist and a PT like a personal trainer all asking me oh you know do you know much about bioidenticals and it's like okay I haven't had a proper conversation because I think face to face I could probably do a better job but it's like I presume they mean compounded yeah either compounded

or even worse, the progesterone creams available on the internet. I think that's what they're talking about. And, whoa, not proven, no safety profile, and don't go there. Absolutely. I think that's the take-home message is not to go there. But they have a lot of very good advertising associated with them. So like you say, it can be confusing because actually the body identical HRT, some people refer to as regulated bioidentical HRT,

whereas the products we're talking about are compounded bioidentical HRT. We often just stick to the word body identical for the regulated products because it's less confusing. But there are, like you say, some progesterone creams that can be bought very freely, or not freely, obviously, pay for them, but readily over the internet. And some women do find they have some benefit, but there's very little evidence that progesterone gets absorbed.

reliably through the skin and also if you're taking estrogen with it, there isn't any evidence that it helps protect the lining of the womb adequately. And then some women go to private clinics where they get given, it's marketed as a bespoke bioidentical HRT. Yet we know that actually there's not any evidence to support its use and it's potentially dangerous as well. And so it's very important that women know what type of HRT they're getting, isn't it? Absolutely. And it does sound attractive because it is sold as natural, bioidentical. But actually you can get the natural bioidentical and proven safety products on the NHS.

Absolutely. People don't realise that. No. So estrogen and progesterone are both body identical available on the NHS. The problem is the other hormone testosterone that women often benefit from, which is not licensed. yet for women in the NHS, which is, in my mind, absolutely outrageous and appalling that we're not allowed our own hormone back, and I'm hoping this will change. But there is still regulated products, either on the NHS, people can be prescribed male testosterone in obviously a lot

of smaller doses or privately there is a testosterone cream. But these products are regulated. And so it's very different to the compounded testosterone. And I see some women who have been given testosterone lozenges or tablets and certainly testosterone orally has risks such as affecting the liver and clot risks that it doesn't have when it's through the skin. So if you're going to a private clinic, it's really important to find out exactly how they're prescribing their HRT and what it is and it's certainly worth asking before you have an initial consultation with that doctor, nurse or whoever. Excellent. Okay. Very good.

So, no, I think it's absolutely fascinating. And do you think more of your pharmacy colleagues will take a lead from you or be encouraged to do what you're doing, do you think? I think they probably will. I mean, there's a lot of women out there my age, working part-time perhaps. And it becomes really fascinating. I mean, I totally rediscovered my inner nerd. I didn't realize that I actually was one. But yes. I can't get enough of learning. And there's plenty of us out there and it becomes a fascination. And, you know, you just can't stop educating yourself. If that can be translated into helping other people, then that's why we are healthcare professionals, I think. I think that's why we choose our professions because we want to help people.

Absolutely. And, you know, I think it's so right. And, you know, our roles change as we become older either because of families or because of partners or just the way our job evolves and changes. And I think ways that we can help women directly, which clearly, you know, we're both doing, but also helping the NHS as well. As many people know, my clinic's private because I can't get a job as an NHS menopause specialist because they're aren't enough clinics. And, you know, your role would be perfect in the NHS as well, but there isn't such a thing yet. It might come. But actually, I do feel very strongly that we are helping the

NHS because if you can work with a lady who then has a very effective 10 minute consultation and goes on her way, a lot of women who take HRT in the right dose, the right type, only go back to their GP once a year. Someone in my clinic two weeks ago told me that she'd been back and forth to her GP every fortnight for the last two years because she'd had muscle pain, she'd had fatigue, she'd had itchy skin, she'd had dry eyes, she'd had head she'd had tinnitus, all these symptoms, and they were generating a lot of work and a lot of referrals, whereas three months of an HRT, she's a different woman. And so I strongly feel your work is actually reducing work and cost in the NHS as well, which...

Well, that's what I'm hoping, yes. So absolutely brilliant. So I look forward to hearing how you get on, and I'm very pleased that I've sparked you into doing this new role. Well, I'd like to thank you for that very much. So before we finish, do you mind just maybe giving women three take-home tips? So women who maybe are a bit nervous about seeing a pharmacist or seeing someone who isn't their own doctor about finding out more information about their own perimenopause and menopause, what would you suggest? I think the first point is to talk, talk to everyone, talk to friends, daughters, nieces, daughters of friends, especially anyone with PMT, because we didn't touch on this, but it's all the same hormones.

So if you have PMT throughout your life, you're quite likely to suffer at the end with menopause and fluctuations, things like that. But be aware that your GP might not be trained, and even gynaecologist, I had an experience of that as well. It's not their fault, but it just means they won't diagnose your symptoms correctly or might prescribe alternative treatments that are inappropriate or older studies. HART. So check out credentials first. You know, you can tell from your website, you could tell from mine that we know what we're talking about and we've got an interest. Make sure someone has got a special interest in the menopause because there are plenty of women out there who aren't given the correct information, for example, about oral estrogen versus transdermal. So make sure you know who you're talking to for a start. Second of all, don't. Some of all, don't. Some

there's absolutely no need to suffer. There's no medal at the end. And you should know that you've got, you want as lower risk as possible of heart disease, diabetes, dementia, osteoporosis, etc. If you want to try alternatives to HRT, that's absolutely fine, as long as you've got all the evidence and you know the risks and benefits behind it. And take charge of your own destiny and be informed. Brilliant. I think that's so important. We're all responsible for ourselves and having the best future that we can is so important. So thank you so much, Lindsay, for your time today. It's been absolutely brilliant. Thank you. Thank you so much for your encouragement. And thank you very much for having me. For more information about the menopause, please visit our website

www.menopausedoctor.com.uk.