The Dr Louise Newson Podcast - 136 - ‘The lack of menopause research is a shocking medical injustice’, with Kate Muir

Episode Date: January 25, 2022

Kate Muir returns to the podcast to discuss her ground-breaking new book on the menopause, which she describes as the most difficult and complex subject she has investigated to date. Dr Louise Newson speaks to Kate about the shoddy science and lies that women have been told over the years and what Kate has learnt about past and current research from speaking to over 100 experts, and the real life impact on women from the conversations she has every week. In this episode, discussion also turns to the ‘Davina effect’, referring to the impact of Kate’s Channel 4 documentary that was aired in May 2021, presented by Davina McCall, and has been a game-changer in raising the social and medical profile of menopause within primary care and in helping to inform and empower women to seek help. Kate’s 3 wishes over the next 3 years: A symptom list to be given out at your local GP practice Good quality research into body identical estrogen and micronised progesterone Research happening in the UK into Alzheimer’s and the role of estrogen and testosterone in women’s brains Kate’s new book is titled ‘Everything you need to know about the menopause (but were too afraid to ask)’ and is published by Gallery UK. A second documentary about the menopause with Davina McCall will be released in May 2022.

Hello, I'm Dr Louise Newsome and welcome to my podcast. I'm a GP and menopause specialist and I run the Newsome Health Menopause and well-being centre here in Stratford-Bron-Aven. I'm also the founder of the Menopause charity and the menopause support app called Balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence-based information and advice about both the perimenopause and the menopause. So today I have back with me in the studios, Kate Muir, who has been before. If any of you haven't listened, you need to listen to the first podcast we did together.

And we're back again. So thanks Kate for coming and joining me today. Thank you. I'm really busy, actually. We're in the middle of filming the next Davina McCall Menopause documentary. And my book's just come out. So in your sort of chaos. Absolutely. It sounds like my life. So perfect. So let's talk about your book for a little bit, which has just come out, which is incredible. There have been a lot of books about the menopause in the last few years, really. Obviously, mine is really important. But yours should have been written by an academic, actually. I think it is incredible. The amount that you've learned, the amount that you've understood, but actually you've not taken anything at face value. So your book, I think is unique to any other.

there books out there in the market, certainly in the menopause space. So can you just explain a bit more about what you write about and why it's so different? Well, what I hope to do was a really, really good piece of investigative journalism, because that's where I come from. And I don't just come from health and lifestyle world. I come from a place where we prove things. And, you know, I've been out in the Gulf War, and I've done quite a lot of dangerous things in my job. But it turned out that this was by far the most complex. and difficult subject I'd ever tackled. And the really shocking thing about my discoveries was,

first, the shoddy science that we were being fed and the lies that women were being fed. And it was really sloppy what we were being told about HRT and breast cancer. But it was just the whole information around menopause was sloppy, and I felt very sexist and missing out on a huge amount of information for women. So that was a key point. The other key point was I didn't know how emotional this would be. And when I met these women and I met women every week and I talk to women, as you do,

Louise, but every day now, I couldn't believe what they had suffered and what they had gone through in ignorance. And what a huge difference on the whole, HRT or even knowing what their symptoms were made to their lives. And just giving women knowledge as well as help, seem to mass. And so I thought, well, I will just find ways to write this book and we sent it out to publishers. And actually, it turned out actually quite a lot of publishers were interested in it to my surprise. Because I thought, no one's going to read this.

But it turned out that there really is a big black hole in knowledge. Yeah, definitely. And I mean, you know, when I first met you, I don't think either of us actually were fully aware of the suffering that was going on. I was only aware of it, or I've only become aware of it, really, the last few years, since I've exposed myself to more women, not just clinically, but women and social media and the stories that we hear. And it's just the tip of the iceberg, I know it is. But you've been exposed as well, like you said,

had you had any idea of the human suffering that's been going on? I had no idea. And I had no idea of people losing their jobs and their relationships and just their whole lives in some cases. And I just didn't understand, I really did not understand the mental health aspects of the menopause and how massive they were and actually how hot flushes are a thing, but what matters is what's happening inside your body and your brain. And I suppose understanding that and understanding really interestingly what happens

in the menopausal brain, which are now beginning to understand and I've started talking to researchers about that, once we understand what happens to our brain, we will feel much more confident, I think. Yeah, I think that's so true. And certainly since, I mean, you've done a huge amount. I know everyone does a lot of research for their books, but anyone who's listening cannot underestimate the amount of research that you've done, Kate, because you've read lots of papers, but you've done more than that. You've spoken to the authors from some really key papers, not just in the UK, but abroad. I mean, how many people, how many professors and learned people have you spoken to, do they think? I have no idea, but over 100, I would imagine what you have the

very important people. I have also spoken to all the senior menopause doctors and leaders around the world. So, you know, I've spoken to Susan Davis in Australia about her opinions on testosterone, which are really interesting. I've spoken to Philip Sarell in Yale about things. And I'm now speaking to more and more actually Americans because I'm doing an American version of my book. And I spoke to people at the BMS here. I spoke to Nick Panay. So I spoke to all the experts, but I also learn a lot from women themselves, who are the experts, obviously, and know exactly what happens. And when people say, oh, well, here's a statement saying perimenopause last four years, oh, no, it doesn't. And the idea, you know, that people are citing these statistics,

nobody's done any studies on anything you find. And when you look at some of the studies, like some of the studies in the workplace, they're done on 500 people or 400 people, and often some of them men. And you think, why even cite this study? It's really, really sloppy journalism. So it was really important to go to the horse's mouth on all these very senior academics and menopause specialists all over the place. And I mean, in the end, there is one major opinion, which is that body identical HRT is very, very good, and that transdermal HRC really, really helps, and that the other stuff is not great. But there's still, this is what I don't. get, why are they still talking about the old combined pills, the rates of cancer of

and old combined pills, why are they even giving out pills that are more likely to cause clotting? And why are they giving them out all over Scotland's where I come from? I do not understand why we're using a bad medicine when we have a good medicine in our cupboard, approved by the NHS, and we can hand it out, and it might cost 50 pence more or a pound more. But, you know, in terms of long-term health, it is a good medicine. It is a cupboard. bunkers and I'm just really angry and almost excited to expose this to the world and I know you have in the medical world but I'm very keen to shout about it it's very interesting isn't it so there's still a lot of pushback though and I was actually at a roundtable discussion a couple of weeks ago

about menopause and HRT and I had this horrible flu chest infection thing so I felt like I was menopause actually I had to you know my brain was functioning slowly and I thought right I'm just going to switch my camera off, switch my, I felt like a teenager, I had a set at a lesson in COVID. So I just was listening actually. And towards the end, I'm not going to mention any names, but there were people saying, what's all this push for transdermal estrogen and micronized progesterone? It is ridiculous. And there were two quite well known, but well spoken. They were women actually. And saying, it's ridiculous. It's just a publicity stunt. It should never go to this way. And ordinarily, I would have unmuted myself and taken my camera off and said,

I don't agree. Look at the evidence. But at the end of the day, I was too tired. And I'm actually a bit worn out with all the battering that goes on. So I thought, I'll just hear where this goes. And I was really sad, actually, because this was about personal opinion rather than about evidence. And I think the evidence is really important. If you look at David Sackett in 1999, when he described the term evidence-based medicine,

it was really pivotal, actually. And I was just a junior doctor. then. But actually, it's not just about the evidence that's written in academic journals. It's also about learning from patients and learning from experience. And I think it's really interesting, isn't it? And you've done a bit, like you say, talking to women. And when you can read a textbook and say the average duration of menopausal symptoms is four years, but you've spoken to hundreds, if not thousands of women for your research for your book on the Channel 4 documentary. And most of these are probably telling you that they've had symptoms.

for many more than that. So who do you believe? Do you understand and learn from a textbook or do you learn from experience? And it has to be a combination. Yeah. And I would say that the main menopause textbook that's out is incredibly out of date, although it only came out last year from the BMS. And it cites lots of old studies. So I think nobody has written the really, well, you've written a great menopause textbook, but it's also for women too, Louise. But, you know, we really, really need somebody to do amazing evidence-based work and we deserve money for it and if the problem could look at the amount of money they would save by caring about the menopause just a tiny bit and we all know the kind of statistics which are you know HLT costs around you know 120 pounds a

year for women hip operation replacement costs 15,000 do the maths Boris Johnson you know HRT is going to improve osteoporosis and rebuild bone. Oh, but why don't we just let one and two women, you know, crack their bones? And I think somebody will eventually clock onto the economics of this, not necessarily someone that cares about women, but when they clock onto the economic, they will understand that this is one of the biggest stories anyone's ever sort of lost. Well, it totally is, Kate, and I remember writing probably about four years ago, I wrote an editorial for the British Journal of General Practice called Unpicking the Evidence about HRT. And I was really scared about writing it actually because I was writing to say that the WHOI study actually,

there were problems with it. It wasn't right. And also it looked at older types of HRT given to a different group of women. And it took a few edits before it got published. But that study then was 15 years old. It's now 20 years old. But we also talk about it. So I would really like to know, and I don't know if you've got any answers,

why has it even taken 20 years for us to be talking like this now, but also the 20 years of a lack of evidence about HRT, you know, about HRT, you know, body identical hormones have been around for a very long time, but no one's done any good studies. And yes, of course, placebo control studies of the gold standard, and they cost a lot of money. But how much has been spent on cardiovascular disease? How much has been spent on diabetes research?

How much has been spent on cancer research? And how much, you know, the menopause affects 100% half the population. So, I mean, have you got any figures for how much money has been spent on research over the last 20 years? Have you got a feel for it? Oh, God, I have no idea. But I would say very, very little. And every time I would go to look for a piece of research, on the whole, it wouldn't exist.

Or there would be tiny numbers of women, like 47 women in a trial. I realize, of course, hormones are not really patentable. You're not going to make any money out of putting two hormones together in a little tube. And so the big farmer has absolutely no interest in financing charities or financing research or anything like that. And so there is no economic incentive for Big Farmer to be kind to us. And there is an incentive for it to sell us the same old crap. And I do not know why we are letting that happen. and it is criminal, I think, of the NHS

not to explain to women on its website the difference between the two kinds of HRT, body identical, made from yams, a copy of your own hormone, and the other stuff which has synthetic progestions in it. And the synthetic progestions have got a record of showing up more in people who have breast cancer. So what are they doing?

So, well, you'd be pleased to hear. that they are updating the NHS website. And I was reviewing it over the weekend, actually. So they've got a group of people on there. And I was looking at it over the weekend and just writing lots of comments because they want my comments, which is a great honour that they want me to be involved.

But they've got three pages on hot flushes. And actually, what I did was that I highlighted it all and deleted it and said, I don't think you need to talk about hot flushes. Because I do not think that is the biggest problem Don't get me wrong. For those of you listening, you've had hot flushes, they can be really debilitating. But as a general symptom, I do not think that's the symptom that women worry about the most. I don't know. What do you think having spoken to people?

I mean, I think hot flushes are obviously a big problem for the one in seven women that get breast cancer and can't necessarily go on HLT afterwards and struggle. So there is a whole other thing. But I think hot flushes are the kind of, you know, the fashion front of kind of menopause, whereas inside is what's going on. And what makes women lose their jobs and walk out of their jobs is not really the hot flushes. What makes women lose their jobs is the brain fog and the stress and the lack of stomach and the anxiety. And the huge effect of lack of sleep and waking up in the middle of the night, I mean, I suppose that is a hot flush. Some of that as well is massive. But we don't, I mean, 90% of women do not need to have hot flush.

do they? But they want to suffer through them. And one of the great pieces of information I found in my book was stuffed by researcher called Pauline Mackey in Chicago, who I think you know. And she researched what a hot flush does to your brain. And she got women to do a little memory test as they were having a hot flush and then, you know, had a placebo of people who weren't having a hot flush. The women who had the hot flush forgot far more and even later on at the time, later on after it, forgot more again. And what was clear was that 5 or 10% of your blood is going to your extremities, it's heating up your skin, you're becoming a human radiator, where does your blood come from, where's your blood working hardest in your brain? Okay, so hot flushes are not a joke. Your blood leaves

your brain, it works not on full power, it's a power outage and it goes to the extremities of your body. In what way is that good? In what ways that's fun? In what ways that a joke that you put on mugs? No. I'm still hot. It comes in flashes now. You know, no, no. We don't need to suffer through the symptoms. I mean,

some people have to tough it out and there are ways, and I know you know, there are ways with good antidepressants and lifestyle changes. Well, it's still not the same though, as you know, and we've spoken about this on several podcasts, actually we've got information for women who have breast cancer because a lot of women still take HR.

But the psychological impact is huge, isn't it? Like you say, not just the memory brain fog. A lot of people just feel very flat, very demotivated, less self-esteem, feelings of no self-worth. And there's been some very interesting research looking at what low hormone levels do in the brain. There's quite good work, and Lisa McCone, I know, has done some incredible work.

But actually there's very little work showing what happens when they've always come back. There's lots of studies, not great, But there are some studies saying about different diets, exercise, sleep and help with our brain function. But there's little. I know you've spoken to Professor Roberta Brinton, haven't you? Yeah. I want to talk a bit about her research because that's very interesting.

That's really interesting. So Professor Roberta Diaz Brinton is in Arizona. She's done research with Lisa Moscone, who wrote the book, The XX brain. But what is absolutely gripping about Brinton's research is she wanted to see the effect of a on Alzheimer's actually and in the brain. And she went back to the records, the insurance records of almost 4,000 women in Kentucky over, I think, 10 or 20 years. And she went through those records.

And what she showed was that if you were taking transdermal estrogen, you were 73% less likely to get Alzheimer's. Now, obviously, women who take HRT tend to be middle class, tend to be insured, etc., in America. So there is that slight bias, but 73% less likely to get Alzheimer's. I think that is a huge thing. And they were less likely to suffer from multiple sclerosis as well than various other of those sort of neurodegenerative diseases. And so you think, well, what is estrogen doing in my brain? And for me, and I've written a whole chapter on this, and for me, it's more than science, it's emotion. And actually, that's why I researched the science so carefully, because I was emotional

because my mum died of Alzheimer's in 2015, and I was aware of exactly how her brain decayed over about actually seven, ten years. I really, really noticed it. And when, you know, proper nouns would disappear from her vocabulary, and then eventually she thought I was her mum, or sometimes she didn't. And, you know, and it was just one of the worst experience, probably the worst experiences that I've been through in my life. and the idea that we possibly have hormones that could stop other people experiencing that

is to me the most important thing I can talk about. Because, you know, Alzheimer's is not the person just having Alzheimer's. The whole family gets Alzheimer's and the partner gets Alzheimer's and the children gets up. You know, we all suffer from it because it is the worst thing, seeing someone die bit by bit in front of you. So I think knowing about what estrogen does in the brain and it's not going to stop Alzheimer's necessarily, if you've got the AP, your four gene, but having a brain in incredibly good health and having it all flowing and the petrol working in your brain means you're much, much less likely to get Alzheimer's or dementia. And that's massive for me. Well, it's massive for everyone,

isn't it? Because one of the commonest causes of death in women as Alzheimer's, Alzheimer's Research Charity, talk about how common Alzheimer's and dementia is in women. They've got a big program at the moment with their research looking at prevention but when I spoke to them a few months ago they said they're doing nothing into female hormones. Me too. I'm in their press office and they sent me a statement saying we're looking into various things but nothing special on hormones but Roberta for instance been given $15 million in America to look into HRT and Alzheimer's in a much bigger than a high control trial so that will be I think what people will be waiting for but we can't really weight. And I can't have 10 years to hear about this. And not. Women should go with the observational

evidence we have now. That's what I do. I take it. And I think some of it's common sense evidence as well, but we also do have evidence from someone called La Rocha. And I'm sure you've looked at his work as well, where he's taken ovaries. Well, he hasn't taken, but women who have had their ovaries removed at a young age. He's looked to see how diseases progress. And not just dementia, but other, psychiatric diseases as well. So even manic depression, psychosis, drug addiction, obviously clinical depression, anxiety. All those increase. And what's a common denominator with all these is obviously the brain is not working well. And we know that the hormones get everywhere in their brains. And it's not just estrogen, it's testosterone as well, isn't it? And

just because there's not been research done to say that having these hormones will definitely reduce risk or prevent this disease, we have got some, like you say, softer research. But actually a lot of medicine is about not doing harm. So I don't know what have you found, Kate, that's harmful about having body identical hormones. Have you found anything conclusive that shows that these hormones are dangerous or harmful? No, the only thing I've been able to look at, because there is no, there are no studies really. There are three French studies. One is very large of French teachers. E3N study, which shows that over five years, and it tests the different kinds of hormones, which is really interesting, so it tests different preparations of HRT, and the micronized progesterone

with the body identical transdermal estrogen shows no cancer, no breast cancer over five years, and possibly a tiny amount over 10, but this is very unclear. But it looks, if you're looking at it, you're looking at a very clean slate. There are two other smaller French studies, which shows that actually taking transdermal estrogen and my client's congestion seems to reduce your chances of breast cancer by a small amount. And in general, as we know now, if you take HRT in the UK anyway, UK statistics or patients show, you live nine years longer. I mean...

Say that again, sorry. You live nine years longer. You've seen that, haven't you? Of course I have. I'm just trying to repeat it because I think this is what's really interesting. So I think when you Google HRT or until... the NHS website's updated, which hopefully will be soon. It's all about risks, isn't it? And so sometimes when I see patients and they're really worried and I understand completely

everyone's anxiety is that I say to them, do you think estrogen is dangerous? Well, of course they think it is because they're worried. So then I say to them, do you think estrogen in young women is dangerous because young women have higher amounts of estrogen. And if estrogen cause breast cancer, young women would have breast cancer. Older women who have low estrogen in their bodies, if they're not taking HRT, would not develop breast cancer. So actually, common sense medicine can tell you that hormones have got to be safe, but common sense has gone out the window really, hasn't it? Yeah, no, absolutely. But I think it is changing so much. And I wanted to, one of the things I wanted to say while talking to you on this podcast is think about us three years ago,

because I know Louise that you're exhausted, that you're always struggling, that you're always talking to the authorities and saying we can move forward. There is hope. You know, I run the largest menopause clinic in the world. I see these women. I know what goes on. Here's the truth. Okay. So I know you struggle every day to push this agenda forward and to push the truth forward scientifically. You know, I absolutely understand that. And I was thinking when I met you, which I think was in May or June 2019. which is, seems a very short time ago. And I had no idea I was going to write a menopause book and make two of the mentors with Davina McCall. Did I didn't know anything about anything. And you had a little tiny menopause clinic with about, I don't know, six doctors in it or something like that. And I think, well, if we've done this

and things have changed so much, you know, and 2.5 million women have watched that Davina menopause program. And Davina herself was terrific in it. and the catalyst from that came from you, you know, it was you talking to me about the injustice. And this is about injustice. I think that's absolutely clear to me. It's a medical injustice.

Yes. But isn't it a shame that it's taken a documentary that's not evidence, no, I'm not meaning to you here, Kate, but it's not evidence-based. It's not based on a randomized control study. It's not based on huge research because it's a documentary about people's experiences, mainly, backed up by some research, of course.

But that's been the biggest change, this divina effect because of the documentary, more than anything else. And how outrageous and embarrassing is that for medicine, for research, that that's what's making women change their minds? And it shows the power of media, of course it does, but it also shows how dreadfully behind research is in this area. And we talk about injustice to women, but also this inequality for research in general, not just in menopause to women, is bad, isn't it?

But it's even worse when it becomes into menopause. It's just being neglected for so long. Well, I think you're crashing ageism and sexism together there. And, you know, if this was happening, you know, suddenly women in their 20s, a few of them, obviously, but if suddenly everybody in their 20s suddenly became infertile and suddenly got hot sweats and suddenly could, remember their mum's name, you know, what would happen, you know, or if it happened to men, you always think, what did it happen to men? You know, how would they feel if they lost their car in the Sainsbury's car park? That could happen, you know, and I think we really, really need to

be very strong about asking for the research, because I think that will give everybody much more confidence. I think there's a moral duty or the kind of medical establishment in Britain to do this research, and I think it will save millions of lives. And it will make millions of life much less miserable because when I was researching all the stuff about vaginal estrogen and realizing, you know, that most women just sit there with a driver, but when they're 80, they're in agony, they're sitting on a little rubber ring in an old people's home. And I thought also about my mum, again, who was in a wheelchair in her last sort of year of life and was always really uncomfortable sitting there. And I didn't know, I'd never heard of vaginal estrogen, you know, in 2015,

Didn't know it existed, didn't know what happened to women's valves, didn't know your face gets wrinkly, you know, your bottom half gets wrinkly. Yes, you can put a cream on it. Yes, it will be better. Yes, it will happen really quickly. And I'm horrified when I think of all those women, like my mum, sitting in homes, really uncomfortable every day, you know, with the brain problems that they don't need to have. And, you know, we don't care because it's women, you know, one in five women get Alzheimer's and one in 11 men get Alzheimer's. I know. I take the agree. And I've said this before, and I'll say it again, is, you know, before I left general practice, I did an audit looking to see how many women who were in nursing homes, residential homes, warden control, flat, sheltered accommodation were taking HRT. It was obviously none. A few having vaginal leicrogen, but not nearly enough. And then a couple, well, actually four clinicians who work with them, have done the same for their big practices, and they've found exactly the same results.

Now, obviously, we need to look at this research better. We need to match women in nursing home for everything else with women who aren't and see, is there a difference? Because actually if something that costs four or eight pounds a month is keeping people away from these very, very expensive nursing homes, residential homes, well, surely that's a silver bullet, isn't it? You know, because we do need to look at disease prevention. We know the NHS is creaking and the COVID's obviously made it worse. So anything that will stop people going.

And if you look at the number of, you know, overprescribing for antidepressants, it's always in women. You look at osteoarthritis and hip replacements of women. MS, you know, these women get all sorts of problems and not more in women. So there's a lot more disease that's happening, but there's a lot more potential for disease prevention as well, isn't that? Yeah. I mean, the antidepressant thing and the mental health thing, I think we could make a huge difference in that arena in the ages between sort of 45 and 55. And I looked at the statistics, which I think I got up to 2018, which was 16% of women in that age group were on antidepressants. Then I looked at the American statistics and it was 23%.

And that was from ages ago. So I'm reckoning in America a quarter of women of menopausal age are on antidepressants. And what does that tell us? It's awful, isn't it? You know, on the whole, that is hormonal depression because they weren't depressed people before. and suddenly there's incredible rise in the use of antidepressants. And after all we've been through in lockdown and everything else in the pandemic, if we could intervene and if doctors would just say,

oh, you're between 45 and 55, have a look at these 14, 20, 30, 50 symptoms of the menopause, but give them a piece of paper with a list on it and they can tick a box and say, yes, I've got brainful, yes, I have stopped in anxiety. Yes, I feel sad every morning, you know. and it would be really simple to do that when they're in for their cold or they're in for their jab or whatever else and just hand it over and then hand them over a piece of paper

that says this is how you can take HRT it will affect your brain and I mean we could make that simple change just with a printer it's unbelievable yeah absolutely I mean that's one of the reasons that we've created the app because I think that everybody who actually

goes over the threshold of a hospital or primary care centre or any has any medical intervention And if they're an adult woman at any age, they should download it. Or like you say, or have the questionnaire or anything, because women will know they'll get the diagnosis if they've given the tools. And we haven't been given the tools for the last 20, 30 years. And now we need to come back, don't we?

Yes. No, I think the app is brilliant. It's a lot of idea. And I know that women who use the app are much more likely to get HR. Yeah, 65% most recent figures have shown, that we'll get HRT. as only 12% of women currently get HRT. It's helping. I think it really equips women with the confidence, knowledge.

And obviously, there's a whole story coming now because so many doctors have actually suddenly trained in the menopause on your confidence in the menopause goes, I keep hearing of women who go in with 50 sheets of paper, and their doctor goes, oh, of course you can have transgender the HRT, do you want a patch or gel? And they don't even waste any time on it. And they're ready to fight a battle, and there's no battle to be fought.

It's brilliant. And this is really, I mean, it's working all together. So I mean, I'm very grateful for all the work that you've done. And for any of you that want any information about HRT, the controversies, the research, then absolutely buy Kate's book because you won't be disappointed. It really is brilliant. And share it around as well because I think the more people that read it and they realize about the atrocities of what's gone on and the absolute car crash to women's house,

I think everyone will then look at menopoles and women in a different way when they've read your book. So thank you so much, Kate. So I would just like to ask for three take-home tips. And actually, I would like to ask three things that you think are achievable to happen in the next three years, because we've talked about a lot's happening in a short space of time, but what three things would you really like to see happening? I'd like to see menopause symptom list given out in doctor's surgery, an easy one there, win-win. I would like to see research into body identical estrogen and mycanised progester. And I would like to see some amazing research in Britain,

not in America, in Britain, on Alzheimer's and estrogen and testosterone in women's brains. I'm really, really interested. And I think that will be life-changing for millions of people. I couldn't agree more. So really key take-home tips that could be achievable if we have more people listening who are going to do the doing rather than just talking about it.

So we look forward to welcoming you back. sooner than in three years. So we can carry on this conversation. But thank you ever so much for your time today, Kate. It's been great. Thank you, Louise. And thank you for all your work. Oh, thank you. For more information about the perimenopause and menopause, please visit my website, balance hyphen menopause.com, or you can download the free balance app, which is available to download from the app store or from Google Play.