The Dr Louise Newson Podcast - 156 - Educating women, improving access to treatment and influencing those in power with Dr Sharon Malone

Episode Date: June 14, 2022

Dr Sharon Malone is an eminent American physician who has worked as an obstetrician and gynaecologist for over 30 years in Washington DC. After 15 years of working mostly as an obstetrician, Sharon changed to specialise in menopause care around the time of her own perimenopause. She is passionate about educating women to understand their own hormone journey and empower them with evidence based information about hormone treatments. The experts discuss the challenges of influencing and persuading medical colleagues on the benefits of hormone replacement, the importance of patient choice and agency, and the lack of menopause research and need for government funding. Dr Malone’s advice to women: Find your community of women who will support you and understand what you’re going through Be active, keep exercising regularly Maintain a healthy diet and eating habits; processed foods negatively affect so many aspects of your health To read or listen to Dr Malone’s Washington Post op ed, visit https://www.washingtonpost.com/opinions/2022/04/28/menopause-hormone-therapy-nih-went-wrong/ Dr Malone is the Chief Medical Officer at US based menopause company Alloy, to find out more visit www.myalloy.com

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 Wellbeing Centre here in Stratford-Bron-Avon. 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 on the podcast, I'm really excited, delighted and thrilled actually to introduce to you a very eminent doctor who I've recently become introduced to called Sharon Malone and she's across the waters in America

in Washington. So thanks ever so much, Sharon, for joining me today. Thank you for having me. I really appreciate being here. So actually, I first heard a podcast that you were on. it must have been about 18 months ago. And you were just talking a lot of sense, actually. You were talking to someone I have even more admiration to, no disrespect to you. So Michelle Obama, who is, you know, obviously the most incredible person. And she was talking about the menopause, which actually is a brave thing for anyone to talk about their own experience, but for someone as important as her to be so open, actually really resonated with a lot of people and the response was huge and I listened to you talk and I thought wow this lady has so much sense you know

she's talking from from evidence and also from a place of authority and understanding and then we were introduced actually through Kate Muir who has been the producer of the channel four documentary over here who I've known for a few years now and she has been really amazing actually she's a journalist but she's taken on board all the information and more importantly the misinformation about the menopause. And I know she came on a US trip and met you, didn't she recently? She did. We had a three-hour conversation. She came back and she said to me, Louise, you've got to meet Sharon. So we've had a little chats before and I think it's a start of hopefully a really great partnership, friendship, whatever. There's lots we need to do. So before we talk in

about what you'll want to do now, Sharon, could you just talk a bit about sort of how you got into doing obs and guine and why you're so interested in the menopause? Yes, I started in private practice in 1992, so it's been exactly 30 years ago. I joined a very established group, loved what I did, but for me, as a young doctor, I immediately was immersed into the world of menopause because I inherited a practice from two practitioners who had been practicing for 30 years. So on the day one of my practice, I had 80-year-olds, I had 50-year-olds, and I had 18-year-olds. And so I sort of dove into the deep end of the pool on menopause and menopausal issues. And at that point, 30 years ago, we were really thinking that hormone replacement was the answer to everything. And so I had a lot

of patients who were on it. I had a lot of patients who were very happy being on hormone replacement. And so from that, even though I did obstetrics, the menopausal practice, has always been a part of my practice. And then, you know, as I got older, the funny thing happens when you're in obstetrics and gynecology. The things are most interesting to you when you're actually going through them. And, you know, I did my obstetric years and about 15 years in, I decided that I was going to drop the OB and really do a general gynecologic practice and focus on menopausal women. And that happened just around the time that I was going to drop the OBB and really do a general gynecological practice and focus on menopausal women. And that happened just around the time that I became perimenopausal myself.

So it was of utmost importance to understand what's going on. And you can relate to patients differently when it's something that you yourself have experienced. Absolutely. And it's very interesting, isn't it? Because I think even if you had all the education in the world and all the knowledge, it's very different when you've experienced yourself. And I remember as a GP, I'd not long qualified. And I saw a first lady who came with her baby. And she was a very important. very worried because the baby had a runny nose and was worried that she might have a chest infection or meningitis and she was sensationalising. And I sat there and I saw this child playing in his push chair very happy, very healthy. And I went through the motions to examine and reassured the lady.

And when she left, I thought, that's crazy. Why is she so worried? The child's truly well. And then, you know, a few years later, when I had my first child, every single sniffle, cough, cold, you just worry because you've got this instinct. And then you know what it's like. And then when you're real yourself, obviously, you want to get better. And I think the perimenopause and menopause affects us all in different ways at different times, doesn't it? And I think it's not until you've had some insight. I was fortunate.

I only had symptoms for a few months. But they were really awful. And, you know, if they'd carried on, I know for sure I would not be working. It's very scary when things are out of your control. But it's made me realise even more about the suffering that's going on to women. Right. You know, I was at a time, I think it was a time in my life where I have three children and they were middle school age. My husband was working. I was still working, doing deliveries and getting up in the middle of the night. And you realize that it is really, you know, difficult to function. When you're younger and you're up in the middle of the night, it takes you a shorter period of time to recover. And you can't add to that, the sleeplessness and the hot flashes and all of the symptoms that accompany perimen You need to be able to function effectively in the world. And I used to always tease my patients and they would say, well, Dr. Malone, do you take hormones? And I said, well, indeed I do. And I said, and not only for me, but you want me to take hormones. Because you don't want me starting a surgery and forgetting what I came in there for. You know, I need to be a little clear on what I'm doing, how to respond. You know, and for those reasons. And I'm a quick study. You know, I have, the time I went through pari menopause, I had 10, 15 years in of watching and hearing the stories

of women. So I didn't have to belabor the point when the symptoms started for me. It was like, I got it. Not only do I see what's happening here, but I know what the solution is. And I, I too did not suffer for long before I took care of my menopausal symptoms. But we're lucky, aren't we? And we're in the minority, not just in our own countries, but worldwide as well. And I was talking to someone this morning, actually, and I feel there's a few things that I feel very strongly about. And I feel very strongly that women should be allowed to choose what they want. So if they want HRT, for whatever reason, actually, they should be allowed to have it. And this isn't happening enough. There's too many voices we hear of women struggling to get their own hormones.

But the other thing is that I don't know how you feel about this. But I really really, really worry that we have an evidence-based treatment that is being actively refused for too many women. I can't think of any other area of medicine where we refuse. I know in the sort of 80s and 90s, we stopped prescribing as many antibiotics because we were worried about antibiotic resistance and giving antibiotics for viral infections. And that's certainly with good reason and absolutely withholding antibiotics for some people when it's not appropriate, I think is absolutely the right thing. But here we're talking about the majority of women having something that can affect their life because it can cause symptoms, but also can be a risk to their future health. Yet the minority of women are on it and actually the majority of women are often refused it.

How can that be, Sharon? How is it allowed to happen that we're refusing evidence-based treatment? Well, you know, I don't think we can underestimate the damage that was done 20 years ago. with the Women's Health Initiative, that has loomed large because not only has there been a generation of women who's grown up thinking that hormones are bad for them, there's a generation of doctors who feel the same way. And when it comes to women, it's a funny thing. I mean, everybody feels as if they can weigh in on women's issues. And I say from all of the medical subspecialties, I'm a gynecologist. I'm an obstetrician. I'm not a nurse.

I'm not a urologist. So if a patient came to me and they were having a neurological problem, I don't feel that I have the knowledge and wherewithal to overrule what your neurologist said, vice versa. But when it comes to women's issue, even when, and this is the terrible part of it, even when women have gotten the treatment, you've had the discussion, they go to see another doctor. They'll see their internist. they'll see someone else, and they will be actively waved off of medication because they are still

living in the world of 20 years ago. They don't keep up with what's going on. They don't realize that most of the ill effects and the headlines that came out of the Women's Health Initiative, namely breast cancer and lack of cardiac benefit, have been walked back. They don't follow it. But it's quite staggering, isn't it? So I often reflect and think about things. And I sometimes think, if I was a GP and a patient in mind had seen a cardiologist, a heart specialist, and they were started on a new medication, and I'd read that this new medication had some risks, but this person was on it because they were, say, for example, having an irregular heartbeat, and the cardiologist said, if I was a bit concerned about prescribing it,

I would write to the cardiologist and say, could I have a conversation, could I have some more evidence, but I wouldn't stop it. I had an email a couple of days ago from a GP who has been emailing and writing to me for the two months because he refused to prescribe HRT for one of my patients who actually was suicidal before she came to see me. She'd been given antidepressants. She'd been misdiagnosed with ADHD. And she finally got better and her life was turning around but she can't afford HRT on privately. So she's on some estrogen quite reasonably. She's on some progesterone because she's got her womb. She's also using some vaginal estrogen because she was having a lot of urinary symptoms

a lot of difficulty sitting down actually. So I gave her these three hormones and the GP refused to prescribe them and said it's illegal for me to prescribe three different products. This is not standard practice and I refuse. So I wrote to the doctor and said it would be really, I'd like to have a conversation with you because it's very reasonable to have three different preparations and it would be really, I'd be very grateful if she could have this on the NHS because it's likely she'll be on it in the long term.

So then he said to the patient, absolutely not. I'm not giving you this. And in fact, I'm not giving you any hormonal treatment at all. So I wrote back again and I said, this is actually common sense medicine. We're just replacing what's missing. And often women need two or three preparations. So he's now reported me to the head of obsengine, to the head of pharmacy and to the local MP as well.

So I've had a very, very upsetting, if you like, letter from the GP within the whole narrative from the MP. as well and said that because of my wording in my letters, I've ruined the doctor-patient relationship. So I phoned up the lady to see if she was okay. And she said, Dr. Newsom, the patient-doctor relationship had been ruined long ago the very first time I saw him and said, I think this is menopausal. And he said, no, not at all, you're depressed. So there's lots of layers and layers of complicity. But what I'm saying is I am a menopause specialist. I have a huge amount of experience. I have many qualifications, yet I'm not being believed. And I, every time I've written to

this doctor, I said, I would like to talk to you about what I've done. And, you know, because sometimes I phone DPs or other doctors and they then say, gosh, I hadn't realized things have moved on in 20 years. Can you send me some literature? This is great. And I love those conversations because not only am I helping my patient, I know that doctor will help hundreds of other patients. And so the majority of people I deal with who are healthcare professionals, it's the most amazing feeling because I feel we're helping. But this resistance, which sounds like you get it as well over in the US, is quite something from different healthcare professionals. Well, you know, this is a funny story. I've been on hormones, you know, since menopause. And I'm now not afraid to say I'm 63.

And I've been on my hormones. I'm doing well. I have no problems. And I will continue until or unless I have a reason why I should stop. But I switched internists, and I went to a new, which would be a GP. I went to my new GP to get my regular checkup. And she was going through the medications, and she says, okay, what do you take? And I told her when we got to my estrogen and progesterone, she looked at me. Now, she knows I'm a gynecologist. She said, she looked at me.

She says, you know I'm not a fan. And I was like, do you know what I do for living? You know, it was just, it was jarring to me because if she would say that to me to actually discourage the use of hormones, then imagine what she is saying to people. They are actually acting on that. And I just think we've got to get to a point where we've got to fight this battle on two fronts. We have to educate women because I think more than anything, and I think that what you guys are doing there in the UK has illustrated the point, once you educate women about menopause and show them what the options are and the safest and most effective treatment

is estrogen and progesterone for the majority of healthy women, guess what happens? They want it. Yeah. They say, oh, and then they take it and they realize it works. So we've got to educate women, but we can't leave behind our colleagues because I think, think that, you know, there's a certain amount, again, of arrogance of physicians who would come, you know, behind someone else and change their medications. As I said, I would never do that. I know that I don't keep up with the literature on any number of medications that are out there. And it's a little bit of hubris to say to someone that you know better than the specialist than the person than your patient is actually seeing. And so that's the first. And so that's the first. And so, that's the

front, but I think it begins actually with, you know, getting medical schools to teach about menopause a little better. But that's going to take a minute because you've got to wait for this whole other generation of doctors to get educated. But getting the base of women activated, you know, getting them to say, I don't have to feel this way, to get women to not normalize suffering. I mean, and that's sort of the natural condition that we expect women. into being, you know, childbirth is terrible. It's all horrible. Aging is horrible. Menopause is horrible and it doesn't have to be. And that's the message. I totally agree. I mean, I actually feel quite guilty though, Sharon. Sometimes I spend quite a lot of time worrying about what I haven't done

and what I need to do. But I sort of worry that I've unearthed this too much, almost. I've allowed women to understand what's going on. And certainly one of the reasons that I created the balance app was so women could get evidence-based information in the website as well, which came first. And, you know, we've now got over 600,000 users in more than 180 countries. But majority of these women are struggling and they're unable to get help. So I feel like I'm dangling a massive carrot to say, oh, look at this. You could get your hormones back and feel better. But, oh, no, hang on a minute, you can't. And as you know, that's why I've got my not-for-profit doing education. but it's really difficult.

But I do wonder, and I've said it so many times, and I will say it again, you know, if you were male or we were male and it was, menopause was a male problem, can you imagine me saying to a male patient, well, Mr Smith, you know, this is a natural aging process that's going to happen to you. And you probably will have symptoms. You probably will forget things. You'll probably have brain fog. You'll probably feel very irritable.

You'll probably have muscle and joint. pains, you'll have some bladder problems. But actually, more importantly than that, your penis probably will stop working. And if it does, it will shrivel and become very painful. But you know what, we've got a treatment, but I'm not going to give it to you. Let's just see how you get on and come back if you feel worse. I don't think that man would leave the consulting room, quite rightly so. But how is it that women can do it? Well, you know what? I think that we have that example right in front of us. I mean, when you look at the erectile dysfunction drugs, there's no overall. arching societal value or health value of taking these medications, it deals with a specific

problem that men find bothersome. And if they tell you, oh, yeah, you could have a heart attack, go blind immediately, men look at that and they go, yeah, that sounds like a reasonable risk. I'll take it. We don't give women the same agency. And the second and just the piece that you touched upon before is that when you do all this educating, then now you've got to give them access to medication. And that's really the reason that Alloy Women's Health, which is the company that I now worked for, exists because we realize that there are many, many, many women in this country who do not have access to OBGYNs. They do not have access to doctors who are, even if they do have an OBGYN, who are educated. And, you know, they said only 20% of OBGYNs feel

comfortable prescribing HRT. And a lot of them are younger. And to be honest with you, they're busy because it's a conversation that has to go on when you're trying to explain to women why the need and how to take hormones. And so there's that time pressure and I get that. But what Alloy is really attempting to do is to take that conversation to a much broader audience. You know, we can leverage the experience of a few doctors and give that to just like what you're doing with the bounds app. You know, you can't get to everybody one-on-one, but I can get to them, educate them, let them know what's available, what treatment options are available, and then make it easy to access. And that's sort of, that is the sole reason that we exist.

educate access and to make sure that women are on the road to feeling better. And to not, just as you're saying, not feel guilty or to think they're doing something dangerous for themselves because they just make the choice that they would like to feel and function better. And that's what we're really working to get women to see and understand. And, you know, for everyone, you know, we know that we don't want to over promise and under-deliver because we don't. We don't, we do have to work on other options. There are going to be some women who are not candidates for HRT. And they need to know who they are too. And we would also like to make sure that they know what things they can do to be healthy. And, you know, I don't think that's asking for a lot,

actually. Well, it's not really. And I think the more I delve into this area, the more I realize that there's a lot of misrepresentation actually and a lot of people who don't understand that women are quite clever actually. And we are able to make our choices. And also, we need to know about benefits as well as risks of HRT because too much over the last 20 years is all being about risks. Now, even if someone said to me, Louise, in 10 years time, you are guaranteed to die because you're taking HRT or you're guaranteed to have breast cancer or you're guaranteed your right arm to fall off because you're taking HRT. Well, actually, if I know that there are the benefits and one of the big benefits for me is being able to work and keep my family and my husband with me,

You know, then actually maybe I can make that decision myself. I don't need somebody telling me what I can and can't do. And that's the beauty of medicine is we can make informed choices based on the full knowledge of benefits and risks. But this also brings me down. We were talking before about research about the menopause. And every single menopause conference I've been to, it's regurgitation of the WHOHI study,

the Women's Health Initiative study that was now published 20 years ago, looking at older times. types of HRT in a not a very well-designed study. We all know that. Now, it's been analysed and re-analyzed and we keep going back to the perceived risks or the documented risks, which, while very small, we have got data from the same study showing estrogen-only HRT is associated with the 22% lower risk of breast cancer, but that's not being told to enough people. Right. So you wrote a great opinion piece recently, didn't you? In the Washington Post, called America lost its way on menopause research. It's time to get back on track.

Now, research in menopause in the last 20 years has been shockingly absent. So how do we change this, Sharon? You know, we spent, I didn't spend any money, but a billion dollars was earmarked to spend on the WHOHI study 20 years ago. So that's a lot more money now. We don't need a billion dollars, but we need money to do proper research looking at the proper types of HRT, how do we do it? What's your dream? If you could, you know, choose something about research, what would you do? Well, you know, that was actually the call to action at the end of that op-ed was to say the beauty of the women's health initiative, the study,

but, you know, it was reported 20 years ago, but, I mean, it was started almost 30 years ago. I mean, and here's the tragedy. If we had had 30 years of research, to look back on. We wouldn't be in this mess. The big questions, the big questions, cardiovascular disease, Alzheimer's, you know, prevention, all of that, we would have answers. And the premature stopping of that study did just so much harm to women, to academic research, and just the study of women's health in general. So that, unfortunately, we can't reclaim. But I think that what the answer to this is, is to realize that the government really has to fund a study. We cannot turn to private industry to do this because there's a profit motive

for whatever their particular drug is, and that's how most research is funded these days. But the government really owes us this because they created misinformation that has persisted for 20 years. And I think that we do have the bandwidth. What we need is the will. We need the political will for legislators to say, yes, women's health is important. Women will spend, you know, a third of their lives in this post-menopausal years. And it is not just, you know, oh, let's make women feel better. This is an economic issue for this country. Because as women age and the health problems that ensue after menopause, be it cardiovascular

vascular disease, be it osteoporosis, Alzheimer's, it is a tremendous drain on our economy for having to care for those people. And if we don't understand that we've got something here that may be helpful at our fingertips that's been around and all we need to do to convince people is to have definitive evidence to say so, then why wouldn't we? It's in everyone's best interest. And we've got to make the issue larger than this is just an old lady's problem. It's a problem for all of us, for our mothers, for, you know, our sisters, people for whom we will be caregivers. Our children will be caregivers for us. So I want to make the issue that big, you know, and take it out.

Absolutely, it's so true. I mean, you know, if you think about the billions of, well, pounds for us, but dollars for you that is spent in Alzheimer's and residential care, Right. Just before I left general practice, I did just a search of all our patients that were in nursing homes, residential homes, sheltered care accommodation, ward and control flats to see how many of those women were taking HRT. And of course, the number was zero. And I've had a few of my other doctors who work here with me doing the same. So big practices. It's not saying that HRT will keep you out of these places. But actually, the people that I know who are on HRT who are elderly, they're shopping independently. They're shopping independently. They're looking after their grandchildren, they're helping, you know. And so actually, if there was a treatment that could just reduce even 10% of people going to these care homes or looking at eunary sepsis, you know, it's very, very common. UTIs and elderly women, you know, we need to just have some quick fixes because we're hemorrhaging money for healthcare and for just a society in general,

less alone people giving up work and everything else, but looking at the aging population, I don't want to. to live to 90 because the last 10 years of my life is staring at four walls in a care home, I'd much prefer to live to 80 and be fitting, well, it's not a number. It's we want to live not exist, don't we? Right. And I think that, you know, even if you went for the lowest hanging fruit available, and let's just even talk about vaginal or topical estrogen, just right today, what we know for a fact, you know, if you look at the number of, as you say, urinary, tract infections in elderly women and the complications that ensue from all of that incontinence issues.

That we know. We don't need women. NIH doesn't have to go and fund another study for that. And those women are not even being treated adequately today, right now with what we have and what we know. Osteoporosis. I mean, that's another fact. These are things that we, again, we know right now today that estrogen, decreases the risk of osteoporotic fractures. And yet, here we are. And we also know that, you know,

once a woman has an osteoporotic fracture or hip fracture, that is often the penultimate event in her life. Because the immobility that results from that, then there's immobility, then there's weakness, then there's pneumonia. And that is frequently that downward spiral that leads a woman to, unfortunately and untimely death. And these are things we know today. So yes, we need to have the answers to some long-term problems. We still have a black box warning on very low estrogen products that even when I, and you know what, Louise, and I'm sure you've had this before, where I would prescribe women, estrogen cream or, you know, a tablet, whatever. And they fill it. They go home. And then a year later, I say, well, how are we going with that? Oh, I read the box and I decided I didn't take it

because it was going to give me, you know, breast cancer. And it just makes me want to scream. I'm like, why is that warning still there? I totally agree. I mean, I had this conversation yesterday with NHS England for a meeting that I was at to say, because for us it's our MHRA. And they're telling us that it increases, as you know, risk of breast cancer, but also risk of clot, risk of heart disease. How can a vaginal hormonal preparation cause a risk of anything the same way it doesn't have any benefits it's not going to strengthen your bones it's not going to do any system because it doesn't get absorbed systemically so while i have these sort of warnings you know it's absolutely ridiculous i would say that subtlety is really not in the uh the list of things that the FDA is known for you know

they give you the same warning whether you take a little or a lot and that is an easy fix too Yeah, totally agree. And I feel really sad about it because it's your FDA, it's our MHRA. And the people that are making these decisions will be either menopausal women or women who are going to become menopausal or there'll be men who will either be married or have mothers or sisters or working with these people. So we're not talking about an unusual condition where they might never have experienced that. So I'd love to change things and there's so much we need to do. But it's great. talking to you and there's a huge amount of global work that we need to do together and I'm I'll be very keen to invite you back in a couple of years time and maybe let's talk about what we have managed to achieve because you're pretty unstoppable and no one stopped me yet so I'm on a mission so let's see what we can do together so before we end though if you wouldn't mind I always ask for three take-home tips and I'll be very keen to hear three things that women who are struggling who haven't got the privilege of going you know they haven't got

money, they can't just go to a private clinic and get HRC. What would you recommend three things that women could do to really try and help their future health and help them with their menopause? Well, you know, I think that first and foremost, I don't know how I would have gotten through any of these past few years without having a community of women who support you, who understand what you're going through and, you know, can be there for you when these things happen. And of course, you know, understanding that for your long-term health, you know, being active, exercise, you know, and then maintaining a healthy diet, because we would have a whole other conversation just about, you know, the issues that ensue with the processed foods and the unhealthy

things in terms of how that adversely affects just about every aspect of aging, you know, from cardiovascular disease to cancer. You know, but I think first and foremost, and I think for women because we are by nature, I think, cooperative, and we learn best from each other, from our elders, from our friends. So find that group of supporting women. And then start engaging in healthy behaviors because we spend too much time talking about weight, which annoys me, but we need to spend time on working on just the exercise, just adopting healthy eating habits.

And these will put you in good stead as you age, regardless of whether or not you do formal replacement or not. Really great advice. And what is really important is a lot of this narrative that we've been talking about is women taking control and women being in charge of their own health and their future. And I think that's really important. So thanks ever so much for your time today, Sharon. It's been great.

Thank you. Thank you for having you Louise. It's a great time. 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.