The Dr Louise Newson Podcast - 098 - Davina McCall: Making a menopause documentary left me in tears

Episode Date: May 11, 2021

Davina McCall makes a welcomed return appearance to the Newson Health podcast to discuss what she has learnt from making Channel 4's taboo-smashing documentary, 'Sex, Myths and Menopause'. Dr Newson and Davina discuss a broad range of topics such as the role of estrogen in our bodies, types of HRT, the huge need for more research, and the gaps in menopause care across the country.  If you listen to this episode when first released, please note Davina's documentary airs on Channel 4 on Wednesday 12th May at 9pm.    Davina's 3 reasons to watch her documentary:  Someone you love, someone you know, or someone you work with will be going through what this programme is about. You may end up with a much greater understanding of that person  If you're pro-women, in any way, there are ways you can get out there and make a noise for positive change.  You will be informed about something that half the nation will go through. Everybody should know about it 

Welcome to the Newsome Health Menopause podcast. I'm Dr Louise Newsome, a GP and menopause specialist, and I'm also the founder of the Menopause charity. In addition, I run the Newsome Health Menopause and Well-Being clinic here in Stratford-upon-Avon. So today I'm delighted and excited because I have Davina back on the podcast. She's already been and she's here again. So hi, hi, Davina. I, I, I, I, literally love coming on here. You're like my fountain of knowledge. I've saved up some questions for you. And I know I'm the one that's supposed to be talking about. I've got questions for you as well. So I'm so excited to be back. Great. No, it's really good. And so one of the reasons that I invited about I've obviously, because I want to talk to you, but because there's this great channel four

documentary that, well, we're pre-recording this. When we put it out, hopefully it will be out. And it's the most amazing program. And it's going to really, resonate with so many people. And we've been connected for a while, but Kate Muir, who has written and produced the programme, I have been talking to for the last 18 months or so, is phenomenal. She's amazing. She really is incredible what she has done in an hour. But also, what you do in the programme is incredible. Just the feeling that you have, the empathy, the understanding. It's just fantastic. So if any of you listening, I haven't watched it, you can watch it through Channel 4. But so I just wanted to talk to you to me about how you felt, because the program you didn't know anything about, you were launched in, you talked about.

So obviously I know you're really passionate, really passionate, which is fantastic about helping as many women as possible. But I just wanted to hear from you what you learned with the program and how you feel differently since going through and doing what you've done. I think firstly, through the program, I thought about you a lot because, I would often, and I know that you know, because we've talked about it, what this feels like, but I would go home at the end of the day, and often I was alone, because sometimes I'd be filming and I'd stay up in London or whatever, I'd get back to my room, and I would just sit down and I would just start crying. And I was so angry and upset and absolutely flawed. by the misinformation, the demonisation, the shaming,

and the fact that for something that every single woman in this country, and 51% of this country is women, and 100% of those women will go through the menopause, that if you want to get the information, you have to work so hard to get it. And I don't know any other. It's not like it's a rare illness. You know, I could find out more about Duchens' muscular dystrophy,

which is a really rare illness in adults or children, I think, mainly it hits. But I was thinking, why is it so hard to find trustworthy information about the menopause and why is it so demonised? And, you know, yes, we can always keep going back to this paper from 20 years ago. But it's not been helped by an enormous amount of misinformation and uneducation in terms of health practitioners who, look, I'm not demonising health practitioners either because, you know, I know they've got a very, very difficult job and they have so many people to see with such a huge range of illnesses. But why aren't they learning more about the menopause when half of their practice will go through it? And why is it that if women choose to go down the HRT route, which I did, why is it that it's made so difficult for us when the health benefits are so great? The health benefits way outweigh the bad.

And I don't understand it. Yeah, I mean, it's very interesting. So when I, as you know, when I started my clinic, I just did it to help a few friends who had been given antidepressants because I thought what the hell I'd never. ever given antidepressants for the low mood associated menopause. I didn't even know it was a treatment. And then I set up my website because I was again shocked with the misinformation that was out there. But I, as you know, had no formal menopause training.

But a lot of people just associate the word menopause as hot flashes and they think, oh, it's just women complaining. But actually, when you look at how important the hormone estrogen is for our cell function, when you see that like you say the health risks of not having it, this is where the training has to be. You can forget about symptoms, actually. It's a bit like having other conditions such as raise cholesterol. It doesn't cause symptoms.

It might for a few people. But most people don't get any symptoms at all, but we know it's a marker of heart disease. Blood pressure is the same. You don't get symptoms usually. Some people can get a headache, but a lot of people don't get symptoms, but you treat it.

You know, diabetes doesn't have symptoms unless you're really, really, really poorly controlled, but you treat it. And not only do you treat it because you want the sugar level to be normal, but it is a marker of future disease. So if someone's got poorly controlled diabetic, they have an increased risk of heart disease. They have an increased risk of stroke, increased risk of kidney damage.

And menopause is the same. It has a risk of all these conditions and more, because estrogen stimulates every single cell. But no one has been taught about it. So the last few weeks, I've been trying to do some research with some cardiologists, because palpitations, as you know, are very common symptom. Well, I had palpitations. Yeah, and I did too, actually.

And I gave up alcohol and caffeine because I thought they were associated with that. And I'm sure in retrospect, it was my hormones. But so I said to a consultant cardiologist, very eminent cardiologist, who runs an arrhythmia practice. So arrhythmia is an abnormal heart rhythm. And I said, how would you feel if I could reduce the number of perimenopals or women and menopals or women who were referred to your clinics? Oh, my goodness, that we're full of them.

In fact, I can't even see them. There's so many. we send them off to have a tracing and then we'd analyse their tracing and if it isn't anything widely abnormal we just reassure them. I said but they're still feeling those palpitations. What do you do? Well, nothing. I said, why don't you give them HRT?

Oh, I don't know how to prescribe that. I said, well, you do know it reduces a risk of heart disease more than if you gave them a blood pressure lowering treatment and he went, really? Oh my God! This kind of thing, you see, this is just some of the things that I learned

on this documentary where I'd go home, I'd just go, oh my God. I know. So how did that end? I mean, he's fantastic. So we want to do some research, but as you know, doing research is really hard. There's no money in it. There's no funding. If you attach the word woman or goodness only knows the word menopause to a research proposal,

it will be turned down. So, you know, he said, yeah, this is really interesting. We'll discuss it. But it's really hard, Devin. So I, you know, I just think, actually, for those women, And it's really hard when you've got something wrong with your heart, but everyone's telling you there's nothing wrong. But also for the NHS, they're spending a lot of money, actually, on these women.

For every referral to the NHS, for every investigation, that's got a pound sign to it as well. And also these poor women are taking time off work to go to these appointments, to have their investigations. It's just this whole ripple effect. And we know, I mean, I see women in the clinic time and time again have had palpitations and they melt away with HRT. But that's just one thing, isn't it?

Look at the muscle aches, look at the headaches, look at the joint pains. Joint pains. And, you know, people often just attribute a slightly dodgy memory to getting older. But it just doesn't have to, I mean, even with HRT, my memory is a little bit away with the fairies. But it improved so much. I literally did not know where I'd put my glasses three seconds before they'd be on top of my head. It was very scary. It's really fighting.

So many women say to me, I'm really worried I got to make. or I'm getting dementia. And you can understand, but even in the program, you're talking, aren't you, to Michael Craig and looking at the brain and showing how a hormones these students are so important for brain. But I had a meeting recently with Alzheimer's Research Charity, and they've got a whole new research program

looking at preventative treatments for Alzheimer's absolutely crucial. I said, well, what are you doing about female hormones? Nothing. But you're all over your website. It's telling me that women are more likely to have dementia. and women are more likely in menopause of why is this not being looked at? Because it's on no one's radar. No one thinks about it.

And are they doing anything about that? No. I mean, when Michael told me that when I was talking to him about Alzheimer's and the connection to estrogen, and obviously he's coming from a physician's point of view, and he was just telling me the scientific facts. And I was saying, but does this not feel to you like an enormous kind of hole? And he said, look, since the WHOHI paper that came out 20 years ago that said that HRT caused breast cancer,

no funding into this research has been done, even though it can now be proven that that paper is incorrect. That this HRT that women are taking now is safe. Oh, I just, you know, my dad's got Alzheimer's. I want to do everything that I can. I mean, thankfully, I'm on HRT and I know that that's going to kind of, you know, provide me with a bit more protection than it would if I wasn't. But other people, it's just about getting the message out there, but it's crazy that me, I'm getting the message out there on Twitter one tweet as a time. What the hell? So this is a question I've got for you. Tell me, because I know

that transdermal estrogen is the best form to take. It's body identical. It's completely plant based, it's a natural product and it's by far and away the best way to ingest HART. Why are there pills if the pills aren't good for you? Well, it's very good question. When HRT started, as you know, it was this conjugated equine estrogen, so this was derived from the pregnant horses year. Yes. It was in the big study that you've believed in the WHI study. And that was all that there was. So it was a tablet and it was a synthetic progester. So some of the progestogens that are in the contraceptive pill, exactly the same,

which I hasten to add that everyone takes the pill with no problems, but it's still got the same risks as the ones in HRT. But anyway, so that was all they had. And then they found that the more natural-type oral estrogen that wasn't derived from horserine, put that with the synthetic progestogens. And there's a whole range now. And if you open the BNF, the British National Formula, that book that we all use to look up drugs, they're all there listed.

and I can't tell you half of them and I can't pronounce some of them, you know, but they're all different combinations. So it's a natural. So it's more of a natural estrogen with a synthetic progestogen. And that was sort of... But it's still not as good as taking. No, it's not body identical. So when I qualified in 1994, so before the WHO study,

we used to give some of the horses your mom because that was all it was. And then they had these others. So I thought, all this is a bit more modern. So we gave those in the early 2000s. And then the study came out, as you know, in 2000. and two, everyone got scared, but I carried on prescribing it because I thought, well, actually, there's still evidence that it's good. And then the jails and patches, and now we've got the spray that, like you say, go on to the skin, they go straight into bloodstream, came out.

But then no one was interested in HRT. They thought, well, what, it's just going to give cancer? Don't do it. So this is still there. And then we've got this micronized progesterine that's been available for many years, actually. And I remember writing an article about it. I must have been about eight or nine years ago. So before the NICE guidance came out, I wrote this article, because I've spent many years writing for doctors and different journals, and I wrote this article about why estrogen through the skin and microRNAs progesterone is best and the gold standard,

because it's body identical, it's got lower risk, it's got no risk of clot, it's got no proven risk of breast cancer. And a doctor then wrote and complained and said, I really like reading Dr. Newsom's work, but I really don't like this article because she's put in drugs that we can't prescribe. And I said, well, just open the BLF and educate yourself because it's there. And then when I started my clinic, as you know, I've had lots of people telling me off for various things, a lot of healthcare professionals, but someone contact me and said, how dare you prescribe this fancy private HRT?

And I said, but it's not fancy private HRT. It's a baby on the NHS and it costs the NHS about four or five quid a month. It's not expensive. It's slightly more expensive than the tablets, but, nice, as you know, the National Institute of Health and Care Excellence guidance, when they compared the cost, they said actually when you look into the cost of investigating and managing a clot associated with a tablet, the actual cost is very similar for a tablet and a patch. So this slightly increased price, you're not going to have this increased risk of clock. So it offsets it if you like. So it's still really cheap.

But people just haven't been taught about it. It seems insane that anyone would prescribe a tablet that has an increased risk of clot when you can on the NHS prescribe a transgender. Yeah, and I remember going to a meeting a few years ago now with some people, I won't mention their names, but very key menopause specialists. We had to write down what we would prescribe. So if it was a tablet, which tablet we would prescribe, if it was a patch, which patch, they were trying to work out the site

things. So when they said which tablet, I left it blank. And then we had to give in ours and there was only about eight of us. We had a discussion. And everyone said to me, goes, well, what are you doing? What do you mean nothing? I said, well, I wouldn't prescribe it. I've got probably two patients who are on it who don't absorb it very well through the skin and they don't have a risk of clocks. They're slim, they're fit. They don't have migraines. So I have given them as the tablets. But otherwise I wouldn't, so I wouldn't give it. And I wouldn't give a synthetic progestogen unless a woman had side effects to the utergestin or couldn't have a marina coil. So very few people would have it. And they were really pushing back at me. And I think it's because medics are the same as any other people. They don't like change and they

don't like challenge. And also when you're very busy, you know what it's like to be. If you're busy, you just do what's easy for you. You just go to your default setting. And you don't sit back and think, oh, actually, there's these new types of medication. And because no one's interested in in HATI, a lot of education, wrongly or rightly, is through pharma. As you know, I don't. do any paid work with any pharmaceutical companies. But if you go to any company, you go to a cardiology conference or an osteoporosis confidence, it's funded by pharma.

And you can criticise that, but actually the NHS can't fund everything. So the pharmaceutical companies are actually very good at getting information out there. Now, with HRT, because it's so cheap, the pharmaceutical companies actually aren't that interested. So they don't provide as much information. Right.

And then we've got the whole MHRA thing that you know about them. medicine's health, regulating authorities. So the inserts that women get. Yeah. So if I open my gel or my patch, it will tell me there's a risk of clot. And that's linked with how we prescribe HRT. So if a doctor, you come and see me and I prescribe you some estrogen gel for arguments and it will come up as a warning to say risk of clot. And that will come up the same warning if I prescribe you an estrogen tablet. So if I had no knowledge or training of the menopause, the only bit I'm getting is from the BNF, from my linked computer system. Well, actually, it's telling me the risk of plots the same. So then I think, well, I might as well, I'll give you the tablux.

It's cheaper. And I can understand why doctors do it because you would have thought what the MHRA is telling us is right, but it's not. So this is a real problem. And we had a problem talking about this on the documentary because obviously lawyers have to double check everything. and it's hard to challenge a company that has got the documentation wrong inside the leaflet. I think they are and have changed or they are changing the vaginal estrogen pestries, but that's slow on the update. But as we filmed the documentary, that was beginning to happen. But that has zero risk of anything.

And inside the leaflet, it said risk of breast cancer. I mean, it was horrific. But it's like you said, you know, every single medicine comes with quite a sturdy list of risks. And yet here we are with a medicine that has so many benefits and it's still demonised. And shaming, there's so many people shaming people for taking it. And I want to talk about that for a moment. Well, quickly I want to touch on the oral estrogen because another excuse, just while we were on that, that I've heard lots of doctors giving people, just from women that have contacted me on Twitter,

is that they've been put on oral tablets, firstly because it's the first one that comes up. When the GP types in HRT, the oral tablet comes up first. And secondly, because they say, oh, well, I can't get you any transdermal anything because there's a problem with the manufacturing. Yeah, which is rubbish. There was. About 18 months ago, there was a real problem. And some of it, I was sort of laughing a little bit because it was due to increased demand,

which is great. And some of it was due to some manufacture problems. But that's fine now. So it's not a problem. Some people find because HRT is so poorly prescribed, there are some areas where chemists just don't have it in stock. So they might go and they have to get it in. But there's always place.

And there's actually a company called finderfarmor.com. Which is run by a lovely pharmacist called Daniel, who does this for free. And he will find out where your nearest pharmacist is or if you can't get it, where you can get it sent through the NHS, of course. So that's just a poor excuse, actually. Some women tell me that their GPs aren't allowed to prescribe it, and it's not on their formulary.

And this is a real problem. So you would have thought, you know, you living where you live, I live, I live, we could get the same. No, it depends on our formulary that is run by our CCG. And where I live, we're not allowed to prescribe the natural body identical progesterone. It's like blacklisted, if you like. Why? I don't even get me started to be in a bit.

Because when it first came out, it was more expensive. And so they decided to have exclusions on it. And now it's come down in price and it's got more evidence to its safety. And I have been working with our local pharmacy group for the last three years. And when I first did it, they said, oh, it's because you're running a fancy private clinic. You want people to have this. And I said, it's nothing about my fancy private patients. It's about women and it's about what's available on the NHS.

And most women who see me in my clinic, I encourage to get their HRT from their NHS. I don't want them to get it from me. And I gave them all the evidence and they still were pushing back and pushing back. And then there was a shortage, so they were forced to prescribe it. But actually, even when I was working in that area as an NHS GP, I still prescribed it even though it came up with a big warning on a blacklist. Because I always think as a doctor, what's the worst thing that's going to happen to me if I do something wrong? Okay, I'll end up in court.

So if I go to court because I've prescribed a medicine that has the best evidence for it, what's going to happen to me? Nothing, actually. So you have to act. We are independent prescribers and we are allowed to act in the best evidence. Not many doctors feel like you. No, it's very hard because you have to know the evidence. You are brave.

Yeah. And it's hard because, you know, people don't always agree. I've had to stand up rounds with partners at my work because they have taken women off HRT. But we've got the nice guidance to support us. And I think when you have good guidance, then actually that's our default. You know, if I read one paper that told me that snake oil is going to cure me of migraines, and I prescribed snake oil to everyone with a migraine, of course, if I went to court, I would say, well, I've only read one paper, and they might go, well, Louise, have you not read the 99 other paper that's saying, look, it's dangerous.

So that's why nice, in Ashley, Institute, Helicoracor, put these guidance together. So it's very easy. So you don't have to read all these individual papers. if you're too busy, you can just look at them. And the nice guidance came out in 2015, so five and a half years ago. But they're still good. You know, there's a bit more evidence to support HRT even more since then.

But even if you just work at that, and I'm doing a lot of work with NHS England and nice as well to try and get their guidelines pushed out even more. If we go back to those, they are very clear, as you quite rightly said at the beginning, the evidence for HRT, the benefits outweigh the risks. and it also says, you know, there are more benefits in prescribing the estrogen through the skin. So actually, you know, thinking of me standing up in court, I'll just say, well, I'm working out of the nice guidance. So no one's going to tell me off. And that's the same on the doctors, really. But isn't it sad when you're prescribing something that you know can help women so much in such a profound way that you have to think about, okay, if I go to court. This is crazy. It feels medieval. It is medieval. And I sometimes do it with my patients.

say, do you know, it'd be a lot easier to get heroin or methadone, you'd get so much more support. You know, so many of my patients say, I just can't get it for my doctor. You know, their doctors are refusing. Well, that's what I'm hearing. Every night, every night, I'm on Twitter. I have my menopause chats every night. And every night, same thing, I've been told I can't have it. They've put me on antidepressants.

And I also wanted to ask you about if women aren't symptomatic at all. So quite a few women have the menopause and they're like, I'm sailing through it, I'm having the best time ever. Is HRT good for them if you haven't got any symptoms? Yeah, I spend a lot of time thinking about this. And the simple answer is yes. As you know, I come at HRT and the menopause thinking of it for health. So take symptoms away, which obviously for a lot of women, the symptoms are absolutely horrendous and really flores. But even if you don't, you've still got the same metabolic protein.

is going on. So what happens without estrogen is that our body goes into this sort of pro-inflammatory effect and inflammation isn't always good. You can get really good inflammation for your immune system, if you've got disease or whatever. But if you've got a low-grade inflammation, it's like a bad bruise in your body almost and it makes everything get a bit toxic. So it increases your risk of weight, increases your risk of heart disease, increased your risk of osteoporosis, dementia, even there's some evidence that depression gets switched on by this pro-inflammation, if you see what I mean. So it's like accelerated ageing. So with aging, it's not about having a few lines on your skin. It's about getting older quicker. So your organs getting older quicker.

So we know from really good evidence that if women have their ovaries removed, their biological age increases very quickly. And that's because you haven't got the protective effects of estrogen. With the menopause, it's more gradual, but you've still got these effects on every single cell. And so we're trying to do some research with, there's a company called Glycan Age where you look at Glycanase. I've done it. I've done my Glycan Age. 36. Oh, mine's 20. Come on. That's so unfair. But it's very interesting. So we're looking at this because I think it's really I've used my body though, there is for years.

So that's still really good, though, 36. And I know you're not 36. It's not bad. It's 53. That's amazing, isn't it? But we had someone recently, actually, who had her glycan age down. She's fit well, vegan, super fit, doesn't drink, doesn't smoke. And her glycone age came back a few years, like four years younger than she was.

She was a bit annoyed because her husband was eight years younger than his. But she wasn't taking HRT because, like some of your friends, she had no symptoms, she was fit and well. sail through the menopause. The period stopped a few years ago, but she was absolutely fine. But so one of the glycanage people said, well, perhaps you need to think about HRT. So she went on it and after three months had her glycanage done again and it reduced by 15 actually.

It was quite impressive. Wow. But she also said, gosh, I've just got a bit more energy and exercise is a bit easier. And this is something I've heard from quite a few women who said my symptoms weren't that bad and I probably could have soldiered on, which is the terrible expression that I hear time and time again.

Just soldier on through, you'll be fine. And she said, I probably could have done, but actually now that I am feeling the effects of the vitality, the spring in the step, the memory, the feeling a bit more on it, the laughing more, that just generally happier, it felt like a no-brainer. And like me, I just was like, It feels wrong, you know, I'm putting something that shouldn't be in my body anymore.

This is a natural process. I had three babies at home, home births, no drug intervention. I've been clean since I was 24. I try not to ever even take urophenol parasitamol. I'm really sort of clean living. And now I can't tell you how right HRT feels. And it feels like it's exactly where I am supposed to be. and that actually aging prematurely at 53 is not the natural process at all.

No, absolutely. It's really important, isn't it? Because people think it's unnatural taking HRT. But actually it's unnatural to not have it. When you look at the diseases that it causes, you know, just looking at osteoporosis, one in two women over the age of 50 have osteoporosis, which is probably related to their hormones. One in three women will have an osteoporchic hip fracture.

You know. On our documentary, we did a really brilliant thing. Kate came up with this idea, using chocolate to show what osteoporosis is like. So people that have osteoporosis, your bones look a bit like an arrow. And people that don't have osteoporosis, your bones look a bit like the inside of a whisper. And there's that density inside your bone. And the arrow means that they're just more likely to break or be vulnerable to fractures. Absolutely, and it is a real hidden disease.

You know, there's a bit more work I've just noticed the last few weeks that the government are putting out to try and improve awareness of osteoporosis. But, you know, I've seen so many women and men with osteoporosis with really bad curvature of their spine or pain because of the fractures. They can't eat food properly. They've got loads of chest infections. They're just, their bones are like twigs. And it can you don't know.

Can estrogen correct? Yeah, estrogen is the best treatment. So it is licensed actually for a treatment of osteoporosis. And it has got really good evidence that it can prevent but also treat osteoporosis. So it can improve bone density. And, you know, the Royal Osteoporosis Society is an amazing charity, but it really talks about trying to find prevention. And it's like, well, we've got it in the form of hormones, actually.

You know, if every woman who had an early manipause, so one in 100 women under the age of 40, if they all took HRT, the incidence of osteoporosis would really decline. So yeah, the answer to question is, yes, there's nothing to lose by taking HRT. And then you could think, well, what about women who've had cancers? Well, most women are cancers, absolutely fine. This is another one that I hear a lot. So a lot of women, when I'm talking about it online, say, well, I can't take it

because I've got a family history of breast cancer. and many women who have a family history of breast cancer might not have the gene for a start, the bracket gene. But even if they've got the gene, they're absolutely fine. It's still fine. Yeah, yeah. But when you say that, people are like, no, no, no, no, you know, well, whatever, that can't be true. But it is true.

Yeah, because I think you have to think about what are the risks with take h13 breast cancer. Well, estrogen through the skin has been shown to have, well, estrogen on its own has been shown to have a lower. a risk of breast cancer. The WHOI study, it lowers your risk of breast cancer with estrogen. And then the progesterone, the natural progesterone has been shown not to have an increased risk for the first five years after that they can't really convincingly show. The WHOI study still didn't show it was statistically significant. So we also know that there are other drugs like a statin.

Some studies show they increase risk of breast cancer. But others say that they don't. So it's not really a big deal. So the risk really isn't there, but women taking HRT will still get breast cancer. Of course they will. If you've got breast, you've got a risk. You know, and that's the problem now is that women who are on HRT who get breast cancer. They've got a school.

It's the school. It's called it. Well, is it because they clean their teeth every morning or brush their hair because they do that? You can't prove it if that's the problem. We did a really interesting sort of visual demonstration of out of 1,000 women, you know, how many people are going to get breast cancer just from that? causes and it was in the 20s just I can't remember the exact number but it was something like 25 women are going to just get breast cancer yes um out of a thousand and then the next or that

maybe a number that was bigger than that was obesity was a huge cause of breast cancer so that I think that was 26 out of a thousand women were going to get breast cancer from obesity and then women that drink two units of alcohol a day or more there were five out of a thousand women that were going to get breast cancer from that. And the women taking HRT was four. Yeah, and that's the old types of HRT, obviously. And that's the old types of HRT, yes. So that's why women can safely take.

And actually, they might even have a lower risk because a lot of women have a lower risk of breast cancer who take HRT because of the estrogen, but also because their lifestyle is usually better. So they're less likely to be overweight and less likely to drink alcohol. That was something I wanted to say that you said the other day where I was like, oh, my God, this is brilliant.

Because often people go, oh, am I going to put on weight with HRT or will HRT help me lose weight? And you said something brilliant the other day, which is HRT won't make you lose weight, but it will make you want to exercise. And I was like, oh my God, that's it. Because when I was perimenopausal, I just lost all of my oomph, all of my mojo. I didn't really want to get out of bed. I felt lazy. I felt demotivated. I felt the minute I started taking HRT and it started taking effect, I started wanting to exercise again and feeling the joy of it, you know. Yeah, absolutely. And people do. And so they do exercise more,

but also women who go through the menopause without estrogen, their body changes, so they produce more fat cells. And a lot of people find the fat starts in the midline. And the estrogen that's reduced by fat cells is not the same as estrogen that we rub onto our skin with the gel. So it's a very, again, pro-inflammatory type of estrogen. It's quite a nasty yeast. And this is what's interesting as well. So we see a lot of women who've had breast cancer who are really struggling with symptoms and they have estrogen in their body. And actually, lots of them tend to put on weight. So if I measure their eustodial level, it will be higher than

if I gave them just some natural body identical estrogen at a low dose. So there's a lot more to, and it all boils down to research. We need more research. We need to look at research for women who've had breast cancer, you know, because these women are denied estrogen for no good reason, actually, because we haven't got good studies to show that it's dangerous. And estrogen used to be a treatment for breast cancer. So it might even be beneficial. So there's a lot of work that needs to be done. And especially women that get plunged into early menopause. I feel very, very sorry for any woman that is, you know, sometimes in their 30s and they have their womb taken out and then kind of just left with no advice or help or guidance.

But I think what we do really need to also campaign for is a lot more NHS menopause clinics. Look, I totally understand if GPs are really nervous about it, then why don't you have a local menopause clinic? You can go, look, I'm going to refer you to the menopause clinic and they can help you out. Well, to be honest, they just, the GPs need more training because actually it's one of the easiest,

most straightforward things I've ever prescribed as a doctor. Really? Yeah, yeah. If you were diabetic, it would be almost inexcusable for me to say, I don't know anything about diabetes. I'm going to have to refer you to a clinic. Yes, if your diabetes became very difficult to manage and control, of course I would refer you to a specialist. But actually, diabetes doesn't affect, as you say, 51% of the population. So for some women, you know, there's women with higher risks, for example, who've had an estrogen receptor positive cancer in the past, they should be referred to a specialist clinic and absolutely there should be more.

Can I ask you something? So somebody that's had an estrogen positive cancer, can they take HRT? Yeah, again, it's very individualised. But yes, they can. I mean, I saw someone in my clinic recently who said, I now have a choice actually, I had breast cancer and I'm not on any HRT and I used to be on it. And then I had a breast cancer five years ago. So she said, I have a choice, really. I could go and live with my mother in Highlands of Scotland and vegetate and stay at the full walls because that's what my life is like. and probably think about ending it because I feel so low. Or I could take my HLT back again. I could carry on working as a paramedic. I could enjoy the rest of my life knowing it might have a detrimental effect on my breast

cancer, but I would make the most of every day of that life. And I'm choosing the latter because I want my life back. And she's decided to take HRT. So I feel for those people, I'm there as their advocate, I'm not there to tell them. I'm not God. I can't tell them what they can.

can't do. She might get run over by a bus tomorrow. So her breast cancer is, you know, irrelevant. You know, women aren't defined by their disease or their breast. There's more to it. And actually, this woman knows that she had a family history of heart disease. She's probably more likely to die from a heart attack. And that's where you have to be individualized. So I'm not here on the podcast to say, yes, definitely. No, no, they can't. But actually, it's about choice. But those women should be referred. But it shouldn't just be doctors. It should be nurses. You know, for years, nurses have run contraception clinics. They've run blood pressure. clinic. So, you know, it's very easy to prescribe. You just need to improve the education.

Not just even for nurses and doctors, pharmacists should be able to be involved more as well. You know, some of the work I'm doing with my not-for-profit education and hopefully the charity as well, we can try and train doctors abroad and nurses abroad, you know, really get it to all these other countries where they're not able to benefit from getting the right education because it's huge. It's crazy that they're making it, or it seems so difficult to get to help the GPs in this country prescribe HRT. It seems insane that you are there wanting to pass on your expertise to GPs to help us and they don't want it. Yeah, things are changing. And there's a lot of doctors that really want to receive education.

I feel like they do. So making it easy, you know, allowing people to have access. to our education program will help. But we've got a long way to go. And I just feel for all these women who are suffering, you know, it's fine talking about helping the next generation. But what about us? What about people now?

And there's a lot we can do quickly because we've got available treatment. We've got knowledge. We've got evidence. We can build on it. But actually, we need to really help now. So it's all a depressing end to the podcast. Can I just say something? Thank you, Louise.

Because thank you for, no, but I send people to you. your resources all the time. I spend my life on News and Health on all the articles. Whenever I type in, you know, endometriosis, breast cancer and HRT, all the different types of HRT, it's all there and the balance app as well. You've got all these resources on the balance app. It's all free, you know, yes, you run a private clinic, but you put so much information out there on the internet that we can all access, that we can all get to. So I just want to say thank you so much for that because, you know, through that, I can help people a little bit. Well, I think it's very important for me. I do not want to be seeing every woman in my clinic.

Absolutely, I don't. I really want to be able to empower women so they can choose where to go and help. It really, it just saddens me. So, but thank you. But before we go, I would like, Jess, I always do these three take-hinkets. And I would like you to say three reasons why people should watch the programme if they haven't watched it, already. Well, if you are a woman or a man, you should watch this program. I'll tell you why, because someone you love and someone you know or someone you work with will be going through what this program is about. And you may end up with a greater understanding of that person. Very quickly, I called my cousin the other day in Paris and I was a bit teary because my mum had a full hysterectomy at 28 and she clearly wasn't put on any kind of HRT and she was a terrible

person but part of her terribleness would have been hormonal and I called my cousin I was like oh my god do you think I just wasn't understanding and I've been hard on her and she must have had this terrible time she said no look she was very troubled before she had a womb taken out but imagine being terribly troubled and then having your womb I mean really horrific anyway you will have a better understanding of people you love. And this goes for men, women and everything. A second reason is if you are out there and you are pro women in any way, whether you're a man or a woman, and you want to support us, there will be ways and I will show you the ways that you can get out there and make some noise because what you will see in this documentary will horrify you.

And these are all things that with our voices and social media and all the ways that we can, we can use this for very positive change. This isn't negative change. This isn't being horrible to people. This is a positive change that will impact women's lives. But now and for your daughters, your friends, your everybody, all women. And let's not forget women in turn, you know, it has an impact on everybody that these women know work with love, care about, you know, anyway. And the third reason is because I think it's

always really, really good to be informed. There's a lot of science in here. There's a lot of information in here. And when you think half the population goes through the menopause, it is important to inform yourself about it. You shouldn't go through life, not knowing anything about something that half the nation will absolutely most definitely go through. Everybody should know about it. and we had a lovely message. I don't know if you heard it, a guy called Mark on Twitter who said, oh my goodness,

I've just seen, I think it was the interview that you and I did before and he said, I'm absolutely moved and I'm really changing the way that I look at my wife and I'm here to support her and I want to help her through it.

I saw it good grief, like more men like that, please, you know. But educate yourself. It's a good thing to do. Documentary is a really good thing to watch. And this one in particular when you think how many people it will affect that you know, educate yourself.

Brilliant. Absolutely. So that's a longer way of just saying everyone needs to watch it. Yes. Indeed they do. Really do because it's just brilliant. So thanks ever so much for your time. Oh, I love you. Really appreciate it. Thank you.

For more information about the perimenopause and menopause, you can go to my website, menopause.com. Or you can download our free app called Balance, available through the App Store and Google Play.