The Dr Louise Newson Podcast - 21 - Breaking barriers in women’s health: Hormones, education and HRT with Dr Fionnuala Vernon

Episode Date: August 19, 2025

“The fire in the belly is coming from people’s want and need to help patients and to make a change”   This week, Dr Fionnuala Vernon, Medical Director of Blackwater Private Clinics and GP trainer in Ireland, joins Dr Louise Newson for a compelling conversation about breaking down barriers in healthcare and addressing the ways in which the system often fails women.  They discuss how global gaps in training for healthcare professionals can result in women’s health needs – particularly during menopause – being overlooked and highlight the critical role of education in equipping clinicians with the skills and confidence to ask the right questions and connect patients with the support they need.  Fionnuala also outlines recent developments in women’s healthcare in Ireland, such as the introduction of free hormone replacement therapy (HRT).  We’re delighted to have been nominated in the Listeners’ Choice category for the British Podcast Awards. There’s still time to vote - ⁠click here⁠      Email [e-mail] with suggestions for new guests!    Disclaimer    The information provided in this podcast is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition. The views expressed by guests are their own and do not necessarily reflect the views of Dr Louise Newson or the Newson Health Group.           LET'S CONNECT     ·        Website: Dr Louise Newson    ·        Instagram: The Dr Louise Newson Podcast (@drlouisenewsonpodcast) • Instagram photos and videos     ·        LinkedIn: Louise Newson | LinkedIn    ·        Spotify: The Dr Louise Newson Podcast | Podcast on Spotify    ·        YouTube: Dr Louise Newson - YouTube      RELATED RESOURCES (TBC) How to talk to your doctor about HRT – and get results Find out more about Newson Education’s education programmes here  

In my podcast today, I've got Dr. Fenula Vernon with me, who's a GP and educator from Ireland. We have a really open conversation about how the healthcare system is failing women and how we need to improve education for all healthcare professionals. So hope you enjoy it. So exciting, you're over from Ireland. Yes. Last time I saw you was in the conference, I think. Yeah, so we were in the Royal College Surgeons.

Yeah, which was great, actually. This is a conference that I'd organise. for healthcare professionals and we had people from 18 different countries and it was like yeah I did say to someone it felt even more exciting

than my wedding and they said that probably wasn't the right thing to say yeah Paul was really reassured by that I'm sure my husband was there yeah it was he spoke who was good but it was what I found about that day

I don't know what you felt sort of sitting there was that everyone had this fire in their belly everyone was like looking at hormones in a different way there were gynaecologist there there were psychiatrists there

there were GPs there nurses, pharmacists, people coming from all sorts of educational backgrounds. But there was this real and it got noisier and noisier actually as the day went on, didn't it? It did, yeah. It was a kind of an unruly bunch at the end. We're there with very like-minded people, cardiologists, surgeons, gynaecologist, GPs, nurses, as you say. And the fire in their belly is coming from people's kind of want and need to help patients and to make a change. And I think that momentum was very palpable on that day for sure. Yeah, I mean, I was really honoured because we had great lectures,

including, as you know, from US and Singapore. And they came because they wanted to, the conference was not funded by pharmaceutical companies. So, you know, we had a really lean budget. Everyone knew that. And that was fine. But also, I've been, and I don't know if you have, but you probably have, been to conferences where in the break,

people are just a bit awkward. They're not really chatting. They're not talking. you know and it's almost a bit hostile whereas here it was very inclusive wasn't it was lovely it was lovely and it was just great even just to get kind of anecdotes from other clinicians and yeah it was a really really great day yeah because you know medicine i've said before is a science and an arts so the science is looking academically at the papers we have guidelines which are as as the word implies a guide but also it's a patient experience this is the art of medicine isn't it And I made sure that the lectures all spoke about patients because I've been to many menopause conferences where it's all about slides and figures and statistics. Never once about Mrs Smith, 49-year-old lady,

who's given up her job, who's struggling with brain fog and memory problems and sore joints. So that brings it back to the reason that we went into medicine, isn't it really? Well, that's the reason. I mean, certainly that's where the conference really resonated with me. We see patients all day, every day. patients who are really struggling and I loved

Haley and Jay. That was such a great conversation and they were so brave to come and tell their story and I know patients like that and it's lovely for patients, for your listeners, to hear their story and lots of that is going to resonate.

So as doctors, we, and especially as GPs, we are best placed. 90% of all of the work of the NHS happens in primary care. So we live with patients. We're in their communities. we know the difficulties you're facing and conferences for me

are bringing our patient experience meeting the experts having then those connections that if we are struggling with evidence or we're not too sure or we need a little bit of support to treat maybe difficult cases we've got those connections

and I think that's why it was such a lovely lovely banter, great rapport because it was very open and people were very generous with their advice and support which is great. Which is great. And it's also, you know, we know it's a global problem

that hormones are not being addressed enough for women. But when you talk to other healthcare professionals in other countries, you know, in Iceland, in South Africa, in Netherlands, they're all experiencing the same. And actually when you say, oh, I, you know, what's your experience of testosterone with your patients or what are the symptoms that they get? You know that it's, you know, women are the same, really.

You know, biologically we're the same. We might present differently, different ethnicities, and also have different health beliefs as well. And that's one of the things that you hear more and more actually from other countries is this, the patients, the women have been scared away from hormones for the wrong reasons often, haven't they? Yeah, I mean, it is absolutely a global problem. And we've always had a very interesting relationship with menopause in Ireland

because traditionally, well, there would have been church views and things like contraceptions, So traditionally we'd have maybe larger families, maybe 10, 12 kids. One of my patients is one of 19 children. Oh my gosh. So you can imagine when his mom got to the 19th baby, when menopause came, it was probably a welcomed relief. Period stopped. There were no more kids.

So for those women, and now they, I mean, we obviously don't have as many kids start per capita, but in other countries and in other tribes, and in other tribes and in other communities that may still be part of their culture. But we didn't know, we didn't know the symptoms, especially the mental health symptoms. They are probably the most prevalent

and the most distressing symptoms that people come to us with. And I think that's probably those are the symptoms that have the biggest impact on relationships, as Jay and Healy chatted us about. In our mail where we have one of our biggest clinics, we have a beautiful Georgian city the top of the city so we have a huge park not just similar to Hyde Park

we have a former women's jail and it closed in the 1960s and then at the bottom of the town we have an old asylum a mental health asylum for want of a better word and the number of patients I see now who with the education

that they're getting on your platforms and other platforms are now joining the dots And while those patients who were in patients in either the jail or in the mental health asylum will never have the opportunity to thank you for all the work that you're doing, some of those women are being exonerated.

Some of those women were now giving an explanation as to how they were there. And we also see, again, as GPs, we see the children of those women. And the children who very often, they'll say, I didn't have a relationship with my mum at all. You know, we didn't get on. there must have been a personality clash

and must have been difficult and now when they're looking back they're saying actually there maybe was a different reason and they interesting have a story to tell when I ask about the older siblings what were your older siblings relationship with your mum

it was great they don't remember difficult times they remember great times so it's us tying that all together looking back over history looking back over generations and certainly as GPs we are interested we want to know we're interested in your social history

your family history and very often as GPs we know the history because we know your families and the communities. Absolutely. It does really connect but the thing is also is it's often all in the history isn't it? And there's something I was taught at medical school. Take a really good history, Louise, listen to your patients. The story is there. You have to ask the right questions. But I didn't ask the right questions for many years because I didn't think about periods. I didn't think about hormones

changing. I never thought about mental health and hormones because doing psychiatry, no one taught me. And I shudder when I look back. But medicine's progressive. You learn by experiences. You share the knowledge. And also you work out, could it be a placebo? Could it be a coincidence? Or could it be that hormones have a role in the brain? So that's going back to the old textbooks really, realizing that of course they have a role in the brain. So therefore it makes sense. And when things makes sense you join the dots don't you and you then think about other patients but Haley's experience was really interesting because

it was so extreme but I've seen a lot of similar patients as have you but then when I met her the first time and I just asked her the very simple question how did you feel when you were pregnant? Yes, that's a real being to changer isn't it? Yeah yeah and then I also the other question was you know how did you feel when you were having your periods that run up to your periods, how did you feel? She said, no, that was the time I was drinking more. I felt awful.

And then it's night and day when my period comes. So sad. So she's told me in a way that my hormones have affected my mental health. I know. But no one had picked up on it. It's so difficult. And that's what this is very frustrating. And I see patients like this.

And we've always great banter in clinics. I mean, the things patient tell me are, you know, sometimes they're hilarious. And I'll say, please can I repeat that? Because that's so funny. And then other times we hear really sad stories. I mean, one patient, not dissimilar to Haley, and we're chatting and the tears just streaming down her face. And I'm saying, is there something, you know,

and she's now connected, maybe his PMDD. And she's saying, have all my admissions to hospital or have my mental health breakdowns, my relationship breakdowns, the ability to not be able to meet someone all being affected by hormones. And that is something that someone could have fixed. Had they realized that? And that's grief.

Yeah. That's a grief reaction for her. I've seen a lot, you know, I'm used to it now, but when I first started, I remember a lady came back to me and she started crying. And on her symptom question asked what everything was better. And she was young. She was only 44 and she'd had symptoms for about 10 years. But before that, PMS and PMDD. And she started crying.

I thought, what if I don't want it? She said, I'm just grieving for those years that I've lost. I could have felt like this. my life could have been different. And I thought, gosh, actually, this is really, really significant. And, you know, as doctors, as GPs, we often only have really short consultations. But I think, you know, we can make a huge difference in 10 minutes. We can.

And to a good or bad, if we get it wrong. And it's a lot of responsibility, actually, isn't it? It's a huge responsibility. And it's probably, you probably, I mean, I went into general practice because I absolutely loved everything. I did loads of Obs and Guine. I'm in my 20th year, as a doctor, I graduated 20 years ago this summer. And I loved psychiatry.

I loved obsengue. I loved it all. I loved pediatrics. And general practice, let me have it all. Which was amazing. So it means that we can call on our experiences and lots of other aspects of our learning. I'm a GP educator.

I train GPs and I'm really passionate about education. And I'm really passionate about about kind of encouraging our GP trainees to stay in the workforce, to be interested, to ask these questions. And if we can educate patients to know what to look for, we also want to educate.

We're educating men. We do a lot of work in industry. So we want to educate men. And I know that there are people out there who Haley's story will have resonated. There might be some of the conversation that are resonating with people today. It's very difficult for them to find

the words. Now, choosing your timing and that, you know, would be very important. But even just linking the podcast, even if you can't find the words to say to someone to reach out, just link the podcast or just send a link and hopefully some of what we're talking about will resonate and they'll know what to ask for and know what to look for. I mean, I feel women are learning really quickly actually and their partners, their work colleagues. So men and women get it actually. But there is still a real resistance from healthcare professionals. There are some doctors and I spoke to four yesterday who are really keen to do menopause as their future career and hormones. And this to me, gosh Louise, it's amazing. I love it. When people come into the clinic, they think they've

got hormonal issues. They might be perimenopausal, PMD, and I just love it. It's great. It's so transformational. But then I have other people saying to me, Louise, because of your work, we now are seeing far too many women in our surgeries. We're so busy with menopause or women that we can't get to see other patients. They think they've got perimenopals or symptoms and how dare they think that they've never had hot flushes. So it's like a parallel universe really. And if as healthcare professionals, we had better education, we could serve our patients better. I was at a conference recently in Spain and they were saying we have to do this blood test in young women. the raised FSAH blood test to make a diagnosis of P.O.I. Premature ovarian insufficiency. So I

asked the panel for the evidence, because I haven't read the evidence that is very clear that 100% of women have this raised test because in my clinical's practice, I see a lot of women with the normal level or the low level. And they've definitely got POI or their perimenopausal of a young age. So then someone on the panel, a professor said to me, but Louise, how else would you diagnose? and I said by taking a really good history. Yeah, medicine's not black and white. I said, but in other things in medicine, we don't always have a test.

A definitive test. So I have migraine. You can take a really clear history and you'll be very clear that it's migraine. You don't need to refer me to for a scan or a blood test or anything. And also often in medicine we give a therapeutic trial. So there's often a pushback saying

these women think that testosterone will improve their mood or estrogen will improve their joint pain. Well, we don't know whether it will or won't, but we try it and see. And we do this with other medicines. Yes, of course. I don't quite know why sometimes people are so scared, but it's also because they haven't been trained. And I wasn't trained before.

I didn't have that knowledge. So it's difficult, isn't it? It is difficult. It comes down to training, and it comes down to our fear. I mean, we went into medicine to help people. That's the bottom line. And we also came into medicine, took the Hippocratic goals, not to do harm.

And sometimes to do nothing, is no defence. It's harmful to do nothing. And we won't all be experts in everything. And it's very reasonable to put your hands up and say, this is not my area of expertise. But it is our job to signpost people to where to get the help and the support. And because menopause is not a linear thing.

And I mean, I'd be very risk averse. You're a pathologist as well. So, I mean, you are, as I say, attention to detail and the science. but to diagnose diabetes is very easy you're either a diabetic or you're not you're either a really bad diabetic and really per-controlled or it's very well controlled

and I think because menopause and perimenopause is not a linear thing it's difficult but it's about the history that's what we're trained to do and it's inevitable that when we raise awareness we've seen the same level of interest with things like prostate cancer when celebrities

or when people who are very well known in the media develop prostate cancer and then we'll see a surge in requests for PSA testing. So it's inevitable that if we're raising awareness of menopausal symptoms and the issues we have with menopause that we're going to see more menopausal women. But we're trained to take the history.

We're trained to understand. We're trained to exclude other things. Yes, we're very mindful of the fact that not everything is hormone-related, but it's few and I'd sometimes explain it to kids. I'd say, like, if your mom didn't, if your mum did have petal in the cart wouldn't go very well, would it? And it's exactly the same with us with, if it's throxin, your thyroid hormones,

if it's your female hormones, even for men if it's testosterone, they're countless examples. Yeah, and it is really difficult. And it's the same in anything in medicine, you know, going back to my migraine, I might have a brain tumour and every so often someone will present with similar symptoms. And as a GP, you cannot test everybody. You can't do a scan on everyone. It's different in hospital. You have more access.

But it's not appropriate, actually, to always be testing for people. And, you know, some people will say to me, well, how do you know what if you're going to miss an arthritis for their joint pain? Well, we can make more than one diagnosis is one thing. We can still send people for tests and give them hormones. Often in medicine, well, it's often not in medicine, just a one thing. There's lots of things. And recently I've been talking to people who have been very socially, economically deprived, saying, well, these women have. trauma Louise so it's not related to their hormones well they have trauma they've had it's difficult

times they might have drug abuse and alcohol abuse effect to their mental health but they've also haven't had periods for you everyone else so some of it is just five or 10 percent but that all adds up in a person's life and i feel as a doctor we really need to be holistic and also we can't just say well your hormones will fix everything for you we have to be thinking about everything else too yeah but it's It's just this willful blindness that sometimes is happening, isn't it? Yeah. Well, certainly as GPs, as I say, we are best placed. We are in the communities.

We also have the ability. We know our patients really well. Yeah. And we have the ability to say, come back to me. Yes. You know, and we know our patients. So we can safely net. It was one of the things we were taught from day one,

safety net. If you're not any better, please come back. If you're any worse, please come back. Yeah. And we certainly do that a lot with patients all the time. Because we're also, even if it is, related to hormones we sometimes change the dose, the type, we sometimes

add in testosterone, sometimes progesterone, even if they've had a hysterectomy and everybody's different but I'll always say to patients if this doesn't work or if you know leave it this length or you know like you say if you have any symptoms that concern you come back but usually women know

actually when you ask enough whether it's hormonal or not because they've had similar symptoms just before their periods haven't they? And women are very tuned in and we're great talkers I mean, we'll have these conversations in the tea room and the workplace on football sidelines. And we're very open. We're very open about our symptoms and chatting.

And it's great to just create this really safe environment that women can continue to do that. Which is great, as I say, even in the workplace, I would often say to patients, you know, don't be afraid. Don't be afraid to mention hormones. Don't be afraid, as I said earlier, it's sometimes some of the stories patients tell me. are, some of them are very distressing and some of them are absolutely hilarious, you know. So it's just trying to tie all of those symptoms in and nobody is on their own. That's really important and that there is help and support there. And I think training for GPs and all healthcare professionals has got to improve globally.

Because it's a global problem. All the guidelines are very clear that. HIT's first line treatment for the majority of women. Gloverly, 5% of women take hormones. In the UK, it's about 14% and it's plateaued. It's not going up. That is not majority. So like you say, there are harms of doing nothing.

And we need to think about what are the risks to their bone health, the heart health, brain health, and day-to-day symptoms by denying an evidence-based treatment because of unfounded fears. And this is where we really have a response. I think to be training the medical students, junior doctors, senior doctors, different specialties. I mean, everybody should know something, shouldn't they? Even if they don't treat, they should be signposting. I suppose there's two aspects to that and I think medicine has changed.

So we would have had a very doctor-centered approach to care for years. And now we're moving into this very patient-centered approach where we're asking patients to become involved in their decision-making. And then there's also a piece of work around supporting colleagues. We're all in the same team. And I think that's really important. We're all in the same team. No one, no doctor ever wants to cause harm to patients. And if we are supporting each other with the evidence, with the anecdotal evidence,

looking after patients, that's just better for patient care across the board. Yeah, absolutely. And it is multidisciplinary. And we need to be involving all specialties. and working together. And it's a whole history of medicine in women that there's always been this sort of antagonism and people are sort of scared or we do it this way,

we're not going to change. And I do think social media is good and bad, but patients learn a lot from social media. There's a lot of noise there, isn't there, yeah. Some of it is brilliant. But if they're not getting help from their doctor, it can be very difficult. It's really tricky, yeah.

I mean, I have a lot of women that contact me through my social media from Southern Ireland, especially, who can't go and see someone else because they're very rural and they only have one doctor who's telling them. He keeps telling those lovely ladies to me. I know. It's good to get chatting to them. Yeah. Yeah, but it's hard, isn't it? It is really difficult. And, I mean, the communities are difficult. We have a great, we're on a, we're on a crest of a wave in Ireland at the minute. We have had, we've had a very poor relationship with women's health that just, I suppose, again, it's a,

global problem. Women's health has never had its place in the sun and it has never been given the funding or the time. We're coming off the back of the revelations of these terrible atrocities in mother and baby homes and I think we've lots of great women in politics, both north and south, and that makes a massive difference. Women get stuff done and we are on the crest of a wave, as I say, where women are now using the momentum from that movement and all of their emotions associated what it was gone before. And now we had a big win in June this year across the country that HRT is free to everyone in Ireland.

And that includes testosterone, doesn't it? Yeah, but certainly in the South testosterone is there. And it's a great win. Testosterone is difficult to get as we chatted about earlier on. But that's a great win. I mean, that's certainly something for us to boast about at home and we're hoping to just continue on that trajectory. Which is amazing.

Over here we have this prepayment so people can get HRT cheaper, but it doesn't include testosterone. So in the north, we're in NHS in the north, but we have free prescriptions. So HRT is free to patients. And in the south it's a slightly different system, but now there's a new exemption card where HRT is free to everyone. Which is great.

So is HLT prescribing increasing in Ireland? There is an increased prescribing of HRT for sure. Women are more aware and women are coming forward. So in our clinic, we've two kind of physical clinics and an online clinic. And what I would do with patients is because they're able to get their prescriptions free, I'll ask their GP. So it'll be a prescribing recommendation. And my GP colleagues are amazing.

They are so understanding and they are doing great work. And very often they lift the phone because I'd like to think, I was approachable. I left the phone and they said, what were you thinking there or what was the rationale? And I am very risk-averse person anyway. But it's great just to be able to have that conversation

and be able to get women, certainly their estrogen and their progesterone on the NHS or the HSC in the South. And just kind of, I suppose we're educating as we go. Yeah. And I've learnt that a lot over the years in the clinic because a lot of our patients start with us

and then they get their HRT. Sometimes their testosterone. or sometimes they just come back to us every year. But we write really detailed clinic letters. And then so many doctors I meet say, gosh, I've learned so much. We save your letters. We got them and we file them through great reference. But it's great though, isn't it?

Because that's the whole thing you learn by osmosis actually. And the more clinically experienced you are, the more confident you are. But also, I'm very happy to share uncertainties with other colleagues. you know, oh I don't know about this lady I'm not sure, do you mind seeing her and we do that a lot, we're lucky in our clinic we've got lots of doctors but we're constantly asking each other and I think

that's important because it can be quite isolating as a GP sometimes can't it? Yeah, absolutely. I mean I came to England and Scotland for my menopause training there wasn't the level of training or there wasn't the availability of credited trainers or training programmes so I mean I can get forward and back

in the same day and And that's where I did a lot of my training. Yeah. But sitting in in clinics. Yes. I think just quizzing people who see a lot of patients is really important because every clinic I'm learning something and trying something different. And then if it works great, if it doesn't work, then you might think, well, maybe not.

But it's evolving. And there's so much in menopause, hormonal care that we haven't got the research. Yeah. But you can't wait for the research if you've got someone sitting in front of you. Well, that's it. I mean, we're building research. research we're learning as we go. And I think that community, again back to that Royal College of Surgeons day that we had with you and your team, it's building that network of experts. And that's a really secure place, certainly for me to find myself and be able to pass it on to patients. Yeah. So how do you see things going in the next 10 years? If you were coming back here in 10 years time, how do you think landscape would be changing for women? I think we'll both be a bit older and grayer. There's no doubt about that. I'd like to think that. I'd like to think that, women's health is going to be put on the front burner going forward.

I'd like to think that women will have that opportunity. There won't be the same barriers to accessing healthcare. How the NHS will lick in 10 years, it's very difficult. At home at the moment, we are general practices on its knees. We just, as I said, before 90% of all of the work on the NHSS is done in primary care, about less than 10% of the budget. So it's very difficult. but I'd like to think that women's health

will be further up the agenda. We will have more women able to access treatment for whatever it is they need, whether it's contraception, whether it's HRT, whether it's menopause care. We're all living longer as well

and it's very important that we have quality of life. So many of my patients will say I want quality. I don't want to live to him 120. I want to be able to live and enjoy my grandchildren or enjoy my kids

or, you know, have not. Yeah, and I think changing it to thinking about a way of preventing disease is really important. I was talking to an orthopedic surgeon in America and she said all her colleagues don't even know that HRT is licensed to prevent osteoporosis. So if we can see it as something to help symptoms and prevent disease, that's going to have a massively positive impact going forward. You know, there'll be less fractures, there'll be less heart attacks, there'll be less recurrent

admissions to hospital, less urinary tract infections. So it would be great to see that landscape changing. Yeah, absolutely. But we've still got a lot of work to do. I know there are a lot of healthcare professionals that listen to this podcast, GPs, pharmacists, nurses. What would you say the three things that we should do as educators or people that wanting education about hormones? What are the three things that we should be doing, do you think? I think the first thing is remembering that we're all in the same team.

We all have the same goals. We want to protect patients. We want to help patients. we do not want to do harm. That is the most important thing. We have a very safe space for sharing information and sharing guidelines

and sharing anecdotes and conferences like yours in London a few months ago attending very safe places and spaces like that can only improve the quality of care that we deliver. So I think that's certainly the most important thing from a healthcare point of view. I am also as I say an educator

so I think that learning and getting more knowledge and being very open-minded to change and being mindful of the fact that we probably don't have a lot of the evidence that we really need to be able to make the changes that we want to do but certainly continuing to bang that drama and making plenty of noise which is really important and then I suppose the final tip is for patients

and for them to have an awareness and for them to recognise symptoms of perimenopause and menopause of symptoms in themselves, in their loved ones and in loved ones that have gone before us as well. So it's lovely to be in that position where we can shed some light on the history and the very difficult history

and the very difficult times that patients have had before. But going forward, if they can't find the words, if they've had a catastrophic row with a sister or a loved one and they just can't find a way of healing those bridges or if they've had a complete breakdown in work and they can't find the words to go back, link the podcast

and maybe something will resonate and they might be able to reconnect those relationships which is so important. Oh, thank you. Well, thank you so much for coming. Thank you. Thanks so much for having me. It's lovely to be here.