The Dr Louise Newson Podcast - 171 - Finding hope with hormones after 20 years of struggling with my mental health

Episode Date: September 27, 2022

Content warning: This episode contains discussion of suicide Vanessa had always suffered with PMS and struggled with her mood and emotions after the birth of each of her children. After her fourth child was born, Vanessa’s mental health took a severe turn and she became suicidal. When her husband intervened and insisted she received specialist care, a psychiatrist realised how unwell Vanessa was and this was the beginning of an eighteen year journey of taking medication and receiving mental health support, including spells of inpatient care. It was all Vanessa could do to wake up every day and look after her children. Vanessa had wondered whether her mood was linked to her hormones as she would have 2 good weeks in every month before two bad weeks would inevitably creep in. In more recent years, friends persuaded her to see a menopause specialist and begin topping up her declining hormones and, as Vanessa explains, this has been lifechanging. Vanessa’s advice: You may not be well enough to go and ask for help yourself, allow family and friends to support you with this. Don’t always accept everything you’re told by healthcare professionals, challenge thoughts and negative attitudes towards mental health and the link with hormones. We develop lots of coping strategies to mask how we are really feeling. Don’t carry on hiding how you really are, speak to someone. Help is available if you are struggling. Please contact the Samaritans by phone on 116 123, download the Samaritans Self-Help app or email [e-mail]

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 and encouraged, actually, that I've managed to persuade someone called Vanessa to come on the

podcast today to talk about her experience. So thanks very much, Vanessa, for coming today. Not at all. As I said to you before, if there's somebody listening that I can help, I'm absolutely delighted. Yes. So, well, this podcast probably comes with a tissue alert, but I'm sure you will help people. And as many of you who've listened to my podcast or listen to some of my work before know that I'm very keen and very committed to helping as many women as possible. But when it comes to mental health and the perimenopause and menopause, it's really key and it's very high up in my agenda because I'm very struck with the stories of how women's mental health can often deteriorate when hormone levels reduce. And that can start quite early actually after the birth of a baby when

hormone levels decline very quickly when women have PMS and then perimenopause and the menopause and some of us term it as reproductive depression. So it's just the way our brains respond to changing hormone levels and we have receptors for estrogen and testosterone and progesterone in our brains. And there's a reason that they're there because they help with the way the nerves work, the way our brain works, the way even our brain metabolizes and thinks and does all the amazing thing our brains do. And for some, Some women, not all, some women really struggle without their hormones. And I see a lot of women in my clinic who have been given antidepressants, sometimes because

they're clinically depressed. But often no one's really thought about hormones as well. And we know that mental health can deteriorate. We know that incidence of depression increases in the 40s. We also know that suicide rates increase in the 40s as well. And we're funding a PhD student with Liverpool University to look into this. more, but some of the stories are very harrowing. And so I've known Vanessa for a little while, and her story has been harrowing, but it has a happy ending, otherwise we wouldn't be talking

here today. But it's quite a long story, Vanessa, so I don't know if you mind just sort of going back of it and talking about what's been happening to you before we met. Yes, okay, I'll try. Yes, I obviously suffered with PMS a long time ago. And then after my third child, I found I was struggling even more. I then went on to have my fourth child and after the birth had the most incredible drop. And I wasn't quite sure what was happening. I thought it was just having a baby.

I just thought it was normal. Anyway, I deteriorated further. I just couldn't go out of my room. I could care for my baby, but I was just completely lost myself. So I went to my GP. I was really basically told that I was making a fuss. You know, everyone copes with having a baby.

It's just completely normal. Basically pull yourself together. I then came away from there. And I think I believed her for a while because we look up to our doctors and, you know, rely on them. And then I just went further down and down. And I then had my first suicide attempt. Thankfully, my husband realized something wasn't right and came to find me. He then took me to the doctor the next day and was quite insistent something was wrong.

I was then referred to a psychiatrist that day. We have private medical care through my husband's work. So I was able to see a doctor within a few days. So I went along and I could see from his face that he thought I was very bad. He then spoke to my husband separately and explained to him what was happening. And I think it was about the 23rd of December. It's just before Christmas. And then I went off, came home, went to bed and just was completely blank.

So I then started medication. And I've tried so many different medications over the years. But it's been a long time. That was, well, my son's going to be 18 next week. So it's 18 years that I've. had medication. It's the side effects. I've had treatment at the hospital. I've been in hospital for a period of time. And I just tried to look after my children and just could not do anything else. So, you know, I've obviously got that tendency to have depression. And I eventually read a report

saying I had severe depression. And through my history with my GP, I would have thought it was quite obvious that this was hormone-related. But at the time, I was quite sick, so I didn't realise what was happening. And did any of the psychiatrists talk to you about potential of hormones at all, Vanessa? No. No, not at all. And over a period of time, I've told you that, you know, I did see a professor at a leading hospital, but still got to have anywhere. And I did talked to him about is the only thing I remember asking him was is it hormones could it be related to the trouble I've had in the past and it was just a blank no did they give any reason why not or is it just no just seemed to think it was depression

you know it's genetic it's the way at the time I was probably you just take what they think well because you do and I think it's it's very different and I'm absolutely not being rude about psychiatrists on this podcast at all because they have such an important role with mental health, of course they do. And you know, you, I'm sure were clinically depressed, but it's about what's causing the clinical depression and what might be contributing to it. And this is where we need to do more research because there are certainly women who are feeling a bit low and they're menopausal or there are people who are severely clinically depressed, but they're also menopausal or perimenopausal or have hormonal changes. And,

you know, the treatment is absolutely. antidepressants can be very, very useful. But we do know that antidepressants work better in an estrogenized woman. That means a woman who's menstruating regularly, producing good levels of estrogen from her ovaries, or a woman who takes HRT. And this is something, it's been well documented in papers, but it's something that's not really spoken about. And certainly the work we're doing with the Royal College of Psychiatists, psychiatrists often don't know about us. If you don't know it, Obviously, you haven't got that understanding, but actually it does have this effect in our brain. And the estrogen can improve serotonin and it can work synergistically with the antidepressants.

And, you know, it's very interesting that almost your senses were saying to you, could this be my hormones? And I hear that a lot from women. There's a whole narrative about women not being heard, about not just menopause, any of their symptoms that they don't fit into a box, but often the diagnosis is in the history, 90% of it, just listen to your patients. And when I trained in the 80s, we didn't have the luxury of doing as many scans and MRI scans, CT scans. They were so expensive and so scarce, we had to use our diagnostic skills so much more than we do now.

And so just listening to patients is number one for being a healthcare professional. So often women know when it's their hormones. I think some of us are quite tuned into our hormones and we often have this, it's very hard to explain, isn't it? But I think you do know. And I think, you know, you've had four pregnancies. In your pregnancies, you would have had very high levels of hormones and I presume you felt better in your pregnancies than postpartum.

Oh, yes, absolutely. But I think as women, as you say, we're so aware of our cycle and hormones is very much in our minds. but at the time I was, you know, obviously very sick. And despite asking, there just didn't seem to be a link between the doctors I was seeing and the menopause or, you know, any sort of hormonal health. And as I went on, it just seemed more and more obvious. And then in my 40s when I dropped even further,

and there were many, many years I just didn't want to be here, you know, just wanted to die. Which is very scary for you, but also your family as well. Yes. My husband is amazing, amazing. And he's kept a very close eye on me. We've just tried to look after our children. But I mean, I don't mean to sound sexist anyway, but with being a woman, we're all so aware. And I think it might be, it's difficult for men to understand.

We feel it in our bodies. and maybe, you know, me too, I don't want to criticize psychiatrists in any way. I think what I would like to do, if anyone's listening today, that, you know, keep asking questions. And also just almost see, it's terrible to say, but if you could see a female psychiatrists, it may be something that might be helpful. But I think it's education. I just think if the psychiatrists are a bit more aware of this possible link, it may be helpful. I totally agree.

Education is really, really important. And some of you might know, we've actually just written an education module. It's the first one on the menopause for the Royal College of Psychiatrists. And they've actually agreed it's going to be free. So they're putting the funding for it to be enabled that any psychiatrists can access it for free without paying for it, which is phenomenal. and actually we're going to do a part two as well. And we're working very closely with psychiatrists as well to help with their education and empowerment

and do this sort of cross-referral. And we're going to have a psychiatrist working with us in the clinic which will be really useful as well because it has to be a joined-up thinking there's not just the menopause in its own and it's just not psychiatry in its own. And I know actually when we first met, it was somebody who we both know had reached out

and was very worried about you actually, wasn't she? we first met and I was worried about your mental health. I mean, I'm a GPI. I've got a lot of psychiatric experience just with my psychiatry training and I remember speaking to your psychiatrist who is amazing, very good, but said he was keen to know how long your menopause would last for in case there was some hormone involvement and I said, well it will last as long as she's alive because it's a low hormones will last wherever and I think that was a concept he'd not really thought about before and I remember saying to him and I know I said to you when we first met I have no idea whether hormones are related to your mental health at all.

But we do know that there is future benefits for HRT, for your bones and your heart, for example. So it's no harm trying and seeing. So you obviously took HRT, but you didn't have this miracle effect after a day of taking it, did you? It's been a slow and steady winning the race, would you say? Yes, I was so fortunate that somebody I knew for a long time. did advise me to get in touch. And if it hadn't been for her, I wouldn't be speaking to now.

And I was so fortunate. I can't, you know, it's absolutely changed my life. And, you know, that's something that, you know, I'm so grateful for. And what you're doing is just extraordinary. It really is.

Yeah, but it's so sad because you're just one person, you know, we were talking earlier, you know, how many other people are suffering. And some of you might have heard the very, emotional but very brave podcast that I did with someone called Pete, whose wife, Vic, sadly, did commit suicide and she tried to get help. And she was really, really struggling and knew that it might be her hormones. And we want to prevent as many suicides as possible. And, you know, I think a lot about disease prevention for the menopause. And obviously, we want to reduce osteoporosis. We want

to reduce heart disease. And all these have got mortality associated. with them, but the mortality from suicide is 100%, isn't it? So we really got to look at this in a lot, I think it's a real urgent priority actually, because we have to allow, not just psychiatrists, for anyone who works in mental health, whether it's nurses or allied healthcare professionals, we see a lot of people who come from crisis or from relate or they've had psychotherapy or counselling or CBT and no one's really been thinking about could it be a hormonal effect. So the power of estrogen and often testosterone, which again we urgently need to do research on because all the studies have just looked at libido and no disrespect to you, but I'm sure your libido wasn't

number one priority when you're thinking about how to kill yourself. No, you know, as anyone experiences those thoughts, you know, you just, you don't care about anything. You're just, that's all you can think of it's just the only way you can get out really you know you get to the end and you've tried and tried but as you say once I started seeing you and taking the gels it's been quite a long time but I can honestly say I never expected to be here I never had any plans for my life because that's what happens and and now I wake up and I think I'm alive and there's things I want to do today. And I think I just enjoy things that my psychiatrist said is, you know, he'd say time and time again,

do you enjoy anything? No, literally, no. But I think the point in that for other women is that if they can, if they get, you know, the message about HRT, they could at least try it, try and learn about it. I think that's very important. I'm not here saying HRT is a cure for depression, of course I'm not. And I'm not here saying everyone has to have HRT. But I am here saying that it is a hormone, or it's a combination of hormones,

and they can be tailored the dose to each individual. And it can be used in conjunction with other treatments, as in psychiatric medication, lifestyle, you know, exercise, nutrition, everything else as well. It's a very holistic thing. But often it is the missing piece of the jigsaw that people have, lost that piece of the chigsaw. They're ignoring it. They're in denial about it. And it's almost like it's a shame to consider HRT and it's a failure to think about it. Whereas if someone, I often

think about an underactive thyroid gland, you know, if someone had an underactive thyroid gland, they're going to feel slow, they're going to feel sluggish, they might be okay. But actually, why are we doing this? Why are we denying our body of a hormone that metabolically is very active and important in our bodies. And evolutionary, we were not designed to work without our hormones. You know, so it's really important that we think more about why are women not having HRT as opposed to, oh, should we really give it because we're so worried about it. And I think the whole conversation is starting to change.

But I do think mental health is something that often isn't thought about enough. And it's only because I've seen the very. volume of people that I have and heard the harrowing stories that I do and see the improvement actually with HRT. And I know it's not a placebo effect because I don't give it to people who are mentally unwell telling them that I'm going to cure you because that would be so wrong of me, absolutely wrong. And it's often as a gradual thing. It doesn't work overnight, but the body has to learn how to adjust and the brain has to learn to adjust with hormones that haven't had for quite a long time. But we see a lot of women who aren't clinically depressed. They just say things like

my zest for life has gone. I feel joyless. I feel lifeless. I have no joy in my life. I just know spring in my step. And, you know, even a few people have said very little things like, you know, I found myself singing in the shower the other morning and I didn't, you know, no, I had a voice or one patient a few years ago said to me that my children said, I can see your teeth, mummy. I didn't know you had teeth because you never normally smile. And it's very little things. But actually, you know, I think a lot about marginalized communities. I think a lot about minority groups. And then there is some studies say that domestic violence increases during the perimenopause and menopause. And domestic violence isn't just about beating someone up. There's this low-level

emotional sort of neglect that can occur. And I do think a lot about children growing up in families of women who are in a proposal and you know you had your adoring husband if you were a single mom I don't even want to think about it but also even people who just feel a bit rubbish you know not clinically depressed not as extreme as you were but they just haven't got that energy and umph to take the children to the park to go for a walk to cook them supper you know their default would be just watch tally and i'll get you a takeaway because i'm just so exhausted with everything And that is actually a form of child, I mean, abuse is a strong word, but it's neglect, really, isn't it? And we know I've got three children, goodness, you've got four, it is hard.

Even if you're feeling mentally brilliant, you've got the best support network and everything else. But it doesn't take much for us to just think, oh, I can't do it. And some of my children, my older two children have persuaded their friends, mothers or stepmothers to take HRT. and a few of them have come round to the house and said, Louise, I just want to thank you because I've dreaded going to my stepmother's house every other weekend because she was so vile and it's gone on for years and suddenly she's happy, she's taking me out, we're going shopping together, we've bonded. And then she said, oh, you know, I've read this book by Dr. Newsomor,

I've asked my GP and I've got some HRT and they're just thanking me. And I think, wow, isn't this amazing actually? So these are teenagers who are scared to go to their staff. mother's house. That's awful. It is awful, isn't it? And you can't measure that on research. You can't write a paper about it.

But day to day, this is happening a lot. And I do often wonder what women would be like if they all had their hormones back that they needed. Because I think the world would be a lot different place. And, you know, when I was a junior doctor, one of the treatments for heart attacks was to give aspirin and tuck people in bed. you know, we would just started giving the bloodthinous, kinases, and now obviously they do the angioplastys, and it's amazing, you know, how, and stroke as well, we'd never used to admit some patients who'd had a stroke, and now it's a medical emergency. And isn't that fantastic that we've got these advances in medicine and, you know, obviously sepsis is massive, so important. But we seem to have neglect very basic medicine. And I don't know whether it's because it's women. And I don't know whether it's because it's all women, so therefore any treatment is going to be expensive because it's multiplied by 13 million men and falls of women that we have in the UK. I'm not quite sure why there's so much neglect for us, because surely as women, aren't we quite productive when we're well?

Aren't we able to give back to society more when we're well? And, you know, not draining the resources of healthcare. I know you said you've got private health insurance, but if you were on the NHS, how much would your hospital admissions and your various appointments of cost and your lost productivity to society? Yes, I think we hear about it, you know, so much now, which is fantastic. But I think, you know, I think we compare ourselves as mothers to other mothers around us. And, you know, we're all trying to do our best. But, you know, we do compare and think, you know, I'm just not good enough. I'm not good enough as a mother.

And I'm sure as it's, you know, people at work, they almost more capable people think, why is this happening to me? I've just got to get on. But as you say, if we had had that help, we would be more effective. Yes. At home or at work.

And almost it wouldn't get to this stage that, you know, I think I've been surprised by some of my friends. who maybe don't understand or just think the whole talk of periods and menopause is too much. And, you know, I think you have to look at everybody in their situation and just be kind and just see, you know, if there's anything possibly we could do. But for a long time, I've suffered. And now that I can speak properly and speak up, all I want to do really is, well, I worry, worry every day probably about, you know, women who maybe can't afford, I mean, there's millions

probably who can't afford the care that I've had. And I feel guilty, you know, that I, I sit here and I feel well. I totally agree. And, you know, I have, there's a lot of misconceptions about my work because it's a private clinic and I feel very embarrassed at being a private clinic, but I can't get a job in the NHS. I can't set up an NHS men in pools clinic. There's no funding for. And I'm, it. So what I've decided to do is be very philanthropic with my work and give as much as we can to education and research. And we're doing a lot of work to try and help reach other groups and try and get our prices down, trying to educate more nurses, pharmacists, trying to give back a lot to the NHS because it's really, really important that we reach as many people as possible. And as many women as

possible know that it's an option and I think this is really important what you were saying is about and I often do it in the clinic have a trial of HRT you know it's not a wonder drug it's not a sort of fancy new drug it's just hormones but it's completely reversible so if anyone decides they don't want to take it they just stop it I'm not giving anyone an injection or an implant or something I'm not giving them an operation so it's very easy as a woman to be in control. And I think that's what's really important as well, and that then women feel really empowered with what they're doing, and they're also sharing that decision-making. But it's very difficult when people are mentally ill, you know, to actually be able to know and understand all the information.

And so often that's really important that women and their partners, their families, their loved one, other people are involved as well as much as possible. But knowing that decisions are reversible is really important. But the other thing is we're doing a lot of work looking at this sort of polypharmacy that's going on. Lots of people we see, and we know certainly from disadvantaged groups, a lot of women from low socioeconomic classes are on more medications. And we see a lot of people who are on antidepressants, they're on painkillers. They've had urinary tract infections, so they're on antibiotics. They're on painkillers for their muscle joints. And pains, are sometimes on heart drugs for their palpitations or blood pressure lowering drugs.

They're on statins as well to lower cholesterol. A lot of these drugs have side effects, especially some of the stronger pain killers. Some of the antidepressants switch off hormones in the brain as well. So if you're not menopausal before, you will be after some of the heavy-duty antidepressants. And then no one's thinking about their hormones. And we often find when we give people HRT, one by one, they can reduce their medication, which is just liberating. And it's really important as a doctor.

We're not just layering on more and more drugs, which is sadly what is happening. And so having someone, and I think this is why I'm selling myself, I suppose, as a GP and a physician, that we do have skills to be able to look very holistically at people, whether they've got a mental health issue or a cardiac issue or something else going on.

And we can work out which medication they really do and more importantly, don't need. And I think that's really important as we age. We don't want to be rattling around, do we? We want to have as few medications as possible, but we want our health to be optimal as well so we can reduce future disease and future drain on health services as well, of course.

Yes, absolutely. I remember trying packets and packets of paracetamol, sleeping tablets, just to try and get away. And I remember that when I was with the, the two good weeks I had during my periods and the two bad weeks before. And, you know, it's a long time. And my psychiatrist could see that so clearly. But he's interested in this link.

And he, you know, he finds it difficult to understand it too. But as you say, if somebody around you can guide you to some sort of care. And, you know, as you say, if a doctor has. I suppose it's the time in the NHS to actually look at what might be the underlying problem rather than just describing all sorts of other things that may not actually be the main problem. It's very easy, I think, for doctors to maybe want to do a quick fix and dish out. And the cost of all that on the NHS, as you say, the cost of people being in hospital, You know, it must be extraordinary.

I've no idea. I'm just a normal person, but... You're not normal. You're very special. But you're absolutely right. It's the financial cost and the personal cost and the society cost as well, actually, from losing key individuals.

So there's a huge amount that we need to do. But having this conversation is really good and I'm sure it's very helpful for a lot of people. And, you know, for me, it's wonderful to hear and see you so much better. And, you know, just for you to be able to look forward to your life. and, you know, have interest is just wonderful. So but before we end, Vanessa, I would really like, always do these three take-home tips on putting you on the spot.

But just, if you wouldn't mind, just three tips to women who might have listened and think, oh, yeah, what do I do? How can I get heard, really? It's about being listened to. So how would you suggest women really try and get the most out of the healthcare system to be listened to? That's difficult, quite. It's difficult. I think the main thing that I would say is you may not be well enough mentally to go and ask for help.

But if you can talk to your GP, and now I would mention your name and suggest there's so much information that you're providing, I don't know how you have the energy to do, you know, everything that you do. So I think that's the message I'd really like to get across. And just look at other things that you're doing, other medication that you may be taking and not just accepting that. And I suppose maybe, you know, I'm surrounded by very well-educated people. And between my friends, there's very mixed feelings about it. And I think we have to sort of challenge those thoughts and maybe negative attitudes that go along with, certainly mental health and also hormones. but, you know, I think if you are depressed, you develop so many ways of coping and then

all sorts of strategies to hide yourself and, you know, appear normal. And I think we do this as women, we compare ourselves. And it's very sad. Yes. So I think being focused on yourself, which is quite hard actually when we're all sort of busy and giving and just allowing ourselves to have the information that's right for us and the treatment that feels right for us as well. And it might take a little while and involve others as well is really important too, isn't it? So thank you so much.

I know it's been difficult, but it's been really lovely sharing a very sad but happy ending story. So thanks for so much, Vanessa. Not at all. Thank you. For more information about the perimenopause and menopause, please visit my website, balance, hyphen, menopause, or you can download the free balance app which is available to download from the app store or from Google Play.