The Dr Louise Newson Podcast - 184 - Reflections on 2022 with Dr Rebecca Lewis

Episode Date: December 27, 2022

Clinical Director of Newson Health, Dr Rebecca Lewis, returns to the podcast this week for a special end of year episode with Dr Louise Newson. The business partners and friends reflect on some of the positives over the last 12 months and discuss the continued challenges in trying to help more women with their experience of perimenopause and menopause. Rebecca’s three hopes for 2023: Testosterone needs to be licensed for women (and not just for low libido) Treatment for significant and severe menopausal symptoms in the workplace to help keep women in work Education about the perimenopause and menopause reaching out to other medical specialties so more healthcare professionals understand how it affects the patients they see.  Follow Rebecca on Instagram at @dr.rebecca.lewis

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, as it's in between Christmas and New Year, we thought we'd record a slightly different podcast, really just reflecting on how the year's been and maybe how the next year is going to be, who knows. So I've got with me

my trusted, I was going to say partner, but it sounds a bit weird because I am happily married to Paul, as many of you know, but my business partner, my mentor, my friend, Climmson, director at the clinic, Dr Rebecca Lewis, who's been on the podcast before, and this won't be her last time. So thanks, Rebecca, for recording this with me. Oh, thank you, Louise. It's lovely being here, as always. So it's been a busy old time with the menopause, and it's interesting, isn't it? Because so many times I come running into your room or you come running into my room, and we either are very happy about something, or we're incredibly frustrated about something. And, you know, We're happier because the words getting out, people are talking about the menopause.

But I think it's fair to say we're also very frustrated with the sort of monetisation of the menopause, the marketing of it. The way that women still aren't being listened to and valued properly, would that be fair to say? I agree, yes. I mean, we've come a long way, haven't we, really, in the world of menopause, if you go back 10 years ago to where menopause is now. So there's been so much, you know, great achievements. It's being talked about more and more, which can only be encouraged. And, you know, the media have got onto it. And women are beginning to understand what's happening to them a bit more, which is just fantastic. And, you know, as everyone knows, it's been a constant goal of yours and mine to just improve the knowledge and understanding and get accurate information.

That's the key. It's the accuracy of the information. We've been fed so much misinformation over the last few decades that it's been very difficult. for women to access proper information, but that's coming right now, thank goodness. So that's really wonderful to hear. And actually, some of the positive things, aren't they, Louise? You know, people prescribing more HRT now are really engaged in asking for your advice and lots of healthcare professionals coming up to you and asking, being curious about the

menopause and wanting to help women and seeing actually that this is an enormous problem, really, that, you know, half the population will go through and many will have severe symptoms. that haven't been recognised traditionally as menopause. So I think they're waking up to that, which is just incredibly positive, but there's so much more work to do. But yes, there's always frustrations because there's so much more work that we need to do. You know, still we see in the medical community very sort of, I don't know, conservative really. And we practice in these silos of expertise.

So word doesn't get through to all of the medical community, how important menopause is, whether you be a neurodural, a urologist, a urologist, a migraine specialist, a rheumatologist, it affects every single speciality, psychiatry as well, of course, obviously. And so it's getting a word out there and understanding for other healthcare professionals how important menopause is in their field. And I think this is part of the problem, isn't it? But the menopause in the past has been seen as something that affects our periods, which of course it does. The definition is not having a period for at least a year, but also about whether we're fertile or not, you know, it's talked

about sort of post-reproductive health. Well, for a lot of us, we don't want to be defined by our fertility. And so I think also it's always been left to gynecologists to deal with the menopause. And I've always found that a bit unusual just because gynecologists are dealing with pathology of the gynecological organs. And this isn't a pathology for a start. of the organs, it's actually when our organs stop working. And so like you say, because the hormones go all around our body, then it shouldn't really be left to the gynecologist. It should be like you say, every single specialty, including gynecologists, of course, but it shouldn't be left to just one group of people, should it? Completely. It's a systemic problem, isn't it?

It affects every single organ. I don't know of any other situation in medicine that applies. to such a thing apart from other hormone or problems like thyroid deficiency or diabetes often is multi-system affecting, isn't it? But it's no different. This is a hormone problem, lack of hormones, and it will affect every single organ. Yes. So we're trying to do a lot. I mean, I think if we think over the year, one of the things we've been really trying to do

is obviously educate women, but also anybody actually, because anybody, whether they're man, woman, identify themselves, whatever, it doesn't really matter because everybody, and including children actually, will come across somebody who's menopausal. The information, like you say, has been wrong, actually, or just inadequate. So we've been working really hard through Balance app and also the website. We've got a lot of translations now into other languages, haven't we? That's been an amazing achievement, I think. It's free for women, the Balance app. just full of evidence-based information. I just love it here in when Gail, our CEO,

tells us, and now we're reaching, I think it's over 200 countries now, and we've had translations in so many languages, because actually we think it's bad in the UK. We're one of the best countries in looking after menopause, despite the fact we've got a heck of a lot to do. So one, I can only imagine the horrors in other countries and how difficult it would be for women there.

Yeah, so we've been up of the day, haven't we? I think twice this year, which is quite an achievement for a small app really, or it started off small a couple of years ago. And so that's been really exciting. Through balance, we've educated lots of people. I know you've spoken at various events for corporates, haven't you and I have too, which is really rewarding, but also I always find it very depressing because it's just full of women who are really struggling actually. And also often women who might not be struggling. themselves, but looking after women who are struggling or line manager for, or men as well. I don't know about you, but I've had a lot of men who've come to these presentations.

Yes, definitely. And the questions are always the same, aren't they, Louise, really? And it's sad, you know, it's like a revelation for many of them still, what menopause means for the men and women in the audience listening. And the preconceptions about treatments are just still very hardwired in brains. It's sort of a moment sometimes where the penny drops for many people in the audience and they sort of can reflect back, I think, oh my goodness, this has been me for the last three or four years in and out of GP surgeries with multiple problems and complaints related all over my body,

muscles, joints, urinary problems, psychiatric problems. And actually, this could all possibly be due to one thing, i.e. my hormones. And when you see the penny drop, it's good in a way, but it's also incredibly sad. that some people were severely effective. They feel they've wasted three or four years of their lives, getting wrong diagnoses. And often on multiple medications, severe sort of side effects from some of these quite heavy duty medications,

which potentially, you know, if there's more knowledge around, they could have been spared. You know, we see the casualties as well. We see casualties from not reaching a timely and efficient diagnosis, you know, not only in terms of the workplace and leaving the workplace and failing to sort of take premed. motion and really crashed through that glass ceiling that we're all talking about and evening up the gender pay gap and the pension pay gap. This is all can't be done unless women's hormones

are sort of considered in the whole round. You know, and relationships, you know, can be really severely affected as well with neither party really understanding why perhaps that their relationship is going through a very, very difficult time due to women's menopause. Yes, and we did that survey didn't we're with Fahana, the lawyer, looking at divorce and relationship problems, which really highlighted that. So we've had some really good responses with various healthcare professionals. I was talking at the Royal College of Psychiatrists annual conference in Edinburgh. And then there's various regional centres for the Royal College of Psychiatrists. So you went down to Bristol, didn't you, and spoke to the faculty down there. I've spoken at various ones, including

I think it was last week, West Midlands. And I love talking to the psychiatrist, actually. We have spent probably three years trying to find the right psychiatrist to talk to. But now there seems to be a bit of a snowball effect actually, because, you know, the feedback we get from the presentations is very positive. Lots of psychiatrists actually say, you have changed my practice. And they've starting to be a lot more aware, aren't they? Yeah, I agree completely. And they're very sort of open to listening to, you know, the role of hormones in their population that they see, and they are very interested. I think they see a lot of patients, you see. So I think they also can see and understand that this can be a big factor. So yeah, really receptive. And that's brilliant news, isn't it,

actually, that we are talking to other specialities and they're listening. And there will be a good conclusion from that, you know, which is hugely exciting. Absolutely. And with Claire Crockett, one of our senior clinicians, who's a menopal specialist, who works in the the clinic, we've set up a group of light-minded people who have an interest in mental health. And so we've got a psychiatrist Louisa, who's hopefully going to start doing a clinic with us next year and do some group work for women as well, which I think is going to be really important. And there are many places where you have a psychiatrist with a menopause specialist helping women. So that's going to be good, isn't it? Yeah, really exciting, actually. And we've come a long way, as you said, Louise,

what things have been achieved in the menopause arena. It's phenomenal. We've seen the documentaries come out. And I think that's really helped women. It's really spoken to women in their living room as they're watching it, perhaps with their partner. I think that is so helpful to discuss it as a couple. Yeah, I mean, Cape Vie is a genius, really.

She's a person who wrote and produced it. And she's really done it in such an amazing way. And obviously, Davina's been fantastic, as being the vehicle in allowing people to be educated. in a very straightforward way. But it has had a knock-on effect, hasn't it? Because now people talk about the divina effect. And there is this resistance still for people to prescribe HRT,

but also to want to believe women. And, you know, there's a lot of abuse is probably a strong word, but there's a lot of negativity on Twitter and social media. And even I read quite a lot and I speak to women who is told, oh, well, your joint pains won't be. related or your poor sleep won't be related to your hormones and come on you're only 32 why do you think it's going to be related to your hormones that's ridiculous and you just want to look like divina that's why you're coming to us for HRT and i still feel that's quite sad because it does

reflect that women are still not believed and listened to in a way that they should be yeah i agree i mean i think it's years of indoctrination from from society if i think about myself as a GP let's go back 15 years ago. I always thought I was treating people properly with menopause until I really had the luxury of meeting you and being educated by you some years ago. I realised I wasn't touching the sides really. And I shudder to think how many people I have seen probably, and in genuine, honestly, probably thought that they had other illnesses. So I can totally understand why some healthcare professionals are still thinking like this because they've never been taught from when they were a medical student.

Well, that's right. And even now, there's still, you know, I just, I mean, I receive as you do different menopause journals. And it's always about vasomotor symptoms and often about vaginal dryness. And, you know, people don't focus on the other symptoms. And if you're not taught about it, then it's very difficult to not have a diagnostic test for the perimenopause and menopause. It was also quite difficult as well.

And I was talking to some pharmacist last. week from NHS England and there's a lot of move which is going to be fantastic actually helping women by them being able to go to a pharmacist rather than their GP which is going to be great but they were saying they're still going to have to refer to a GP for the diagnosis of the perimenopause or menopause and I said well I think you might be wasting your time because a lot of women can diagnose it themselves but I know some people feel uncomfortable about that, but also if a woman, say, for example, had both their ovaries removed, well, the diagnosis has been made, hasn't it? Yeah, exactly. I think, you know, similarly,

perhaps this was a situation with antenatal care. I don't know, 30, 40 years ago, you always had to see the doctor, didn't you, to be told, you're pregnant. Now, many women know anyway, and they can help by going to boots and buying a testicle, etc. And so that, basically what's happened there is that the ownership and the empowerment has come back to the woman about diagnosing her pregnancy. And then, you know, she can then make a choice of then to attend antinatal care, which most people do, and have a very safe and successful pregnancy, one hopes. And, you know, I'm hoping that in time that that's what will happen with the menopause. Which would be wonderful, wouldn't it? I mean, I do remember as a newly qualified GP,

having probably one or two women most days coming to see me and they'd say I'm pregnant. I've done a pregnancy test and I think what can I tell you? And many years ago it was harder to get information so I would spend a lot of time making sure they were on a folic acid supplement trying to advise them about smoking and alcohol and diets and everything else. But over the years actually the need for me really reduced like you say because they were getting the information themselves. They'd often quite rightly start folic acid before.

before they even conceived. So I was quite redundant, actually, as a GP, unless, of course, they had medical problems. And it should be like that in the menopause. You know, even in our clinic, we should be seeing specialist problems or complicated problems or we do see a lot of women who've had breast cancer and they do need a specialist input then.

But a lot of women, we see are women who've just desperate to get their lives back. And they shouldn't be, well, they certainly shouldn't be paying to come to a private clinic, but they shouldn't really be seeing a specialist either, should they? No, standard care, really, is what they need. And they will respond very well to that. I'm absolutely sure.

But this is the tragedy, isn't it? It's not universal, the care all over the country from that. And then even if they go to an NHS menopause clinic, there's often waiting lists of 18 months. And if you see an NHS menopause specialist because they're so busy, you might have a follow-up in a year's time, which really is going to be very helpful for women. We need to be seen quite regularly to start with just to get the dose stable and then

followed up, you know, once a year, of course, once everything's stable. But this is a problem. It's a difficult time for the NHS, obviously. So we've obviously kept going with our education. We've added more cases into our confidence menopause course and we've had over 30,000 downloads, which is great. It's still a long way to go. It's good though, isn't it? It's a great success. You know, that's great that people are listening and wanting to engage and really, nice feedback about it as well. So I'm very proud of that. It's really good. And then one of the big things we've also been doing is really increasing our research, haven't we? We've managing to build a research team within our organisation,

but also work collaboratively with others as well. So we've got Dan Reisom, who's our clinical research lead, who's very experienced. But he's been reaching out, as have others from our organisation with other universities. But we've been doing a lot of clinical audit as well, haven't we? We've been looking at our own records and we've been focusing on a few really important areas, including the dosing of estrogen we prescribe, estrogen levels in the blood, the effect with testosterone for women who are already on HRT. And we've been also looking at women who are bleeding and having scans as well. And we'll hopefully publish the results next year. and in 2023 for those of you that were listening.

But we've got some very reassuring results, actually, haven't we? Which is great. Yes, exactly. And it's just wonderful to see because we see so many patients, we can say this will help. Testosterone will help, yes, libido, but also we know that it helps the mood, the concentration, the memory, the fatigue,

and many things, even muscle and joint pains. We know that from our clinical experience. And that actually is a really valid and valued assessment. of a drug is the clinician's experience, certainly a clinician who sees many, many patients every week with the same condition. We often pick up things much more quickly than waiting for research. However, you know, evidence-based medicine is not just about research, but that is really important. It's about biological plausibility. It's about clinical experience. Does it fit in with the clinician's experience? And then research is there to back that up and to guide as well.

But of course, research is difficult to find in women anyway, and that's an absolute scandal in all specialities. And particularly in the menopause, very limited research has been done and quite often not a very good quality. We're very small numbers. So it's been very difficult to base things on. So once again, the menopause is a very clinical sort of speciality in terms of diagnosis and dose adjustments because there really isn't enough evidence from the research data about what their ideal level is. what the ideal dose to achieve that level would be, you know, problems with bleeding, etc, etc. But we're finding some really interesting results which corroborate with our own clinical experience. For example, testosterone, the addition of testosterone to our patients, yes, it's helped libido quite a lot. But the main thing it has helped was mood, which is really interesting. But no shock to me.

Lovely to see that parallel our own experience. But when we release that, I think that would be very interesting for that. the whole medical community to read about and see, don't you? Absolutely. I think it's so important. And, you know, for a lot of people, they still don't understand how basic some of the work we're doing just because it's with hormones. And I think, you know, sometimes I reflect and think, well, 10 years ago, for example,

I didn't even know women had testosterone in their bodies. And now we're talking about research, looking at our thousands of women that take it. And I think, you know, we've moved at pace very quickly. And I suppose we're very fortunate having a private clinic, for one reason, we can change the pace. We can be very fluid and we can pivot quite quickly and work out what's needed actually from the patients. And they really have helped us shape and mold. What we've done, we've obviously really expanded with over 100 clinicians, but we've also got pharmacists. We've got nurses.

We've got a physician's associate as well as many GPs working with us. But we've also been able to try and shape some research and the education as well in a very sort of dynamic way. And we're not held back like we probably would be if we were in the NHS. Yeah, completely. And it's just the most exciting place for me to be here, not only seeing things clinically, but to be able to sort of start research projects going on, educate professionals. We're not just about seeing patients at all. Some people think just because we have a private clinic, that's all we want to do.

just see patients. We always want to see patients. Of course we do. But we want to actually, because thank goodness, we are reasonably successful in our business, we can use that money then to fund research projects to help fund the free balance up and keep that free. And of course, the Confluence and Menopause course as well, which is free. And, you know, many other projects.

Because we feel that's really important, don't we, Louise, to sort of give back and to sort of help women who can't come. You know, areas of social. deprivation, women, you know, from ethnic minorities and not being able to access the information properly. And we've had the translations, as you've mentioned. And that's hugely important. Or women, you know, who get forgotten. What about women in prisons? You know, we're trying to do some work there to help them. You know, no surprise, reoffending is much more common in terms of perimenopause and menopause. You know, so I think it's just, we've got so much work to do. We're beginning to crack it,

in some areas, but there's a huge amount left, but it's so important that it's looking at women in totality, not just women who come to our clinic as important as they are, but other women as well who can't. And improving the landscape for women coming up into the menopause is hugely important. I know for you and for me, and having that, you know, being able to do something about it, whereas in the NHS we really were paralysed because, of course, the NHS is so enormous, the bureaucracy, getting the administration for all this, we can actually go off in a charitable way and help people, which is absolutely vital to our work, isn't it?

Yeah, absolutely. And we're very fortunate now. We've managed to recruit a chief medical officer, haven't we, Dr. Magnus Harrison, who's very experienced. And one of the reasons that he came on board was so that we can really try and expand in clever ways so we can reduce costs further,

make menopause care more accessible. and at the same time making sure that we are collecting the data being really at the forefront of menopause research and also continuing with our education. And we've got some really amazing clinicians working with us, some of them doing research, many of them doing education, not just for healthcare professionals, but through corporates and through other companies as well. And also they're helping us with reviewing all our information to keep it as up to date we've got Kat Kioff who's leading all our content as well.

And that's really important because some of the content now is a few years old. And we're adding more to it. We're adding a lot of resources as well. So people know it's not just our word. And even when I was writing my book that's coming out in March, you know, I've made sure that it's very, very heavily referenced because the more noise we make, the more people want to sort of chop us down and stop us

and silence us because there are people, gladly a minority of people, who don't want to believe that there's any good in us. And as you know, it's very distressing, isn't it, when we try our best and people misunderstand and misinterpret what we're doing? It is. It's very negative and it can bring people down. And I have to try and remember, while we're doing this, we're really doing this to help women. And I think a lot of people know that and understand that.

but some don't and I think it's more reflection of them really than a reflection of you and your work because we will carry on we will continue we've got so much more work to do we're not going to stop we're not going to be beaten by this by these words we're going to carry on because women need us to and you know louise thanks to your work you've made oh gosh such an enormous impact on the lives and the health of women I mean you know without being sentimental about it it's just a fact quite frankly Well, it's a team effort. It's not me on my own because I haven't got the confidence to do it on my own. And I think to have you behind me and others as well.

And actually, you know, we have monthly meetings, don't we, with our clinicians? And in November this year we had a clinicians conference, which was the most incredible day, wasn't it? We had an evening where we all met. Yeah. And a lot of our clinicians hadn't met each other face to face before. So there was a lot of laughter, a lot of chatter. a lot of sharing of stories actually, inpatient stories. A lot of we shared a lot of information.

We've got our treatment pathways that we've had printed out for everybody and lots of troubleshooting tips. But we spend a lot of time talking about breast cancer as well and with some external experts, an oncologist and a menopause specialist, which was really, really great. And then we had lots of time for questions and answers. And there's a real body of some. support and they're very committed, the GPs and nurses and pharmacists and the physician's assistant.

They really get what we're all doing, don't they? And they're really making a difference themselves, which is wonderful. It was a joyous occasion, actually, to have so many people, I think 110 people were there. Yes. Great people outside our organisation, which is really important. You know, the last thing we want to be accused of is propaganda, obviously. You know, these are really erudite clever clinicians from other places. And, you know, really it was a meeting of minds of interesting things and stimulating conversations about problems with menopause. And we felt very comfortable to share ideas and approaches, which I think we all found very, very helpful and uplifting. And yes, to your point, the clinicians are very loyal and, you know, behind you very much. So I think when you

first start working here, after about two months, you just see the enormity of menopause and how you will have seen many, many patients by then, from all walks of life, that they all have these common themes of perhaps not being listened to in the first place, having multiple severe symptoms, infecting many organs, usually not flushes and sweats, although that is a problem, but usually other problems, how their work life has been completely demolished quite often by menopause and relationships as well. So it's, you know, we're all seeing the same thing over and over again. And I think that creates a passion in us all. This can't go on for women. This needs to change. And, you know, what a great vehicle here at Newton Health. We're on to sort of help that change.

Yes. So we've got a lot more to do. We have. So before I finish, normally I ask for three take-home tips, but I'm going to ask you, I put on the spot, Rebecca, and ask you for three things that you'd really like happening next year that would make a difference globally for women? Well, I'd love to have testosterone licensed. I think that's really important. It's our own hormone. It can help women enormously. And I think it just should be licensed, you know, like other medications are helpful. So that's number one. Number two, I think in the workplace, we need to really look into treating people who have severe or significant menopausal symptoms. to help them keep on track because, you know, I feel very strongly about a lot, quite a lot of lip service

gets, you know, to women and progressing and crashing through the glass ceiling and increasing hours and things. Well, actually, we've really got to address manipause if we need to improve the situation in the workplace for women. It will help the economy enormously, of course, as well, as a nice side effect. And thirdly, I think education, continuing with what we're doing, really and the understanding from other healthcare professions that we're seeing from our talks to the Royal College of Psychiatrists, you know, if that could be to all sort of specialities in the UK, really sort of understanding the penny-dropping sort of moment, if you like, to understand more about how menopause affects their own speciality. I think those are my three priorities,

difficult to select three, but tough, but I think those probably are my three priorities. Yeah, no, they all sound good. I would agree with that. So let's come back next year. this time next year and let's see what we've achieved. But we're both determined to keep going and I really look forward to seeing what's in store for us. And just publicly I wanted to say thank you again, Rebecca, for all your hard work and support and propping me up many times. So thank you very much. No, not at all. It's just wonderful to be involved in such an important thing, really, for women.

And it gives me great pleasure. So thank you. Thank you. Thanks very much. And happy New Year to those of you who are listening to it in between Christmas and New Year. So thanks very much. 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.