The Dr Louise Newson Podcast - 224 Confidence in the Menopause: introducing our revamped course

Episode Date: October 3, 2023

October marks World Menopause Month, and on this week’s podcast, Dr Louise is joined by Newson Health colleague Dr Penny Ward to talk about the relaunch of our Confidence in the Menopause. Confidence in the Menopause is a CPD-accredited online course from Newson Health which is designed to increase your knowledge of, and confidence in, managing all aspects of the perimenopause and menopause. The course contains free and subscriber-only modules and is designed not only for those working in healthcare: it’s for everyone. We’ve included tailored information for non-healthcare professionals, whether you are a woman looking for information to help you make the right decisions and get the most out of their healthcare consultations, or a partner, friend or colleague who simply wants to know more. Dr Penny’s top three reasons for completing Confidence in the Menopause: It will give you an understanding what is inevitably going to happen to your own body or a loved one's body if you're a partner, friend or colleague. You will be able to appreciate the wide variety of symptoms that women can experience whilst undergoing hormonal changes. It’s an opportunity to listen to the presentations, particularly the one that is dispelling the myths about the menopause and HRT to understand exactly what's gone before us. Find out more about Confidence in the Menopause here This World Menopause Month, help us start the most menopause conversations - ever. Everyone’s menopause is individual and to help others understand and manage their menopause, we must break taboos, educate and start the conversation. How to get involved Have a conversation about the menopause Log your conversation on the balance website Share that you’ve got involved by tagging us on social media, using the hashtag #PauseToTalk

Hello, I'm Dr Louise Newsom. I'm a GP and menopause specialist and I'm also the founder of the Newsom Health Menopause and Wellbeing Centre here in Stratford-Pon-Avon. I'm also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research,

bust myths on menopause symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the News and Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. Today in the podcast I'm going to be talking about something that's really important to me, actually. More important probably than most other things, and we're going to be talking about menopause education,

not just for healthcare professionals, but for anybody, because without education, we're nothing. So I've got with me in the studio, Dr. Penny Ward, who's one of the clinicians that works with me in News and Health Group, but she also leads the education. So we've got lots of exciting things to share in the next half hour. So welcome, Penny. Thanks for coming today.

Hi, Louise. Thank you so much for inviting me and giving me the opportunity. Oh, well, it's, you know, knowledge is power, isn't it really? And I think, well, I know, actually, that education about, the menopause has been so wrong in so many levels, not just for us as healthcare professionals, often not having the right education, but also our patients, but also others who aren't directly associated with the menopause, but indirectly probably affected. And there's so many myths and misconceptions. And certainly I'm really keen to demystify those. And there is more

evidence than people realise about the menopause and safe treatment as well. So the more that we can impart our knowledge and share with others, the better really. But you're a GP like me, have worked for many years. So just talk a bit about what you've done before you came and worked with us. Yeah, so a lot of what you've just said rings true about all the myths and demystifying things for the general public and obviously for us as well. So I suppose I've always been interested in giving the story to patients and actually telling them without jargon, what's happening to their bodies and actually what happens when things go wrong. And I grew up in a family where there were no health professionals, no one was medical. My sister was diagnosed with type 1 diabetes

when she was two. That was at the start of the 1980s. But of course, you had encyclopedias, didn't you? On the bookshelf, you didn't have anything else? And there was so much jargon still given to us in outpatient appointments and clinics. So I'm fairly sure from a young age, I was bumspled by a lot of what was going on. I spent a lot of time on pediatric wards or watching ambulances come to the school to take my sister away. And I imagine, you know, a lot of people talk about how childhood influences what comes next. I imagine that's where some of my interest in not only medicine, but trying to figure out how the message was passed from medical professionals to the public came from. So I got obviously to medical school. I got through medical

training and it was probably 2009 which was the pivotal year for me in terms of making that transition from just surviving as a junior doctor to actually then trying to do something a bit more along the communication lines and what I wanted to do. So my GP training was in Scotland. It was in Glasgow and I went to a GP practice in Mary Hill, which for people listening who know Glasgow, know that it was very much a tale of two cities back then. There were these pockets of very wealthy people. There were lots of pockets of deprivation, and that's where the poverty gap came from in Glasgow.

And in Mary Hill, the life expectancy at the time I was working there was mid-60s, whereas two miles down the road, it was about 81, 80s. to. And there are all these social, economic, lifestyle factors playing in. But what I became more aware of was actually literacy and health literacy was really poor in that population. So on the one side, I'd got this idea that actually people didn't really have any way of getting the information they needed. But I also had this amazing GP trainer called Despents, who had a weekly column in the BMJ, the British Medical Journal, called... Yeah, I used to read it all the time.

Yeah, yeah. A lot of people flicked to it, so thinking that was the one that actually would raise your eyebrows and deliver a bit of controversy. So called Bad Medicine, and he wrote an awful lot about Big Pharma, how hugely influential pharmaceutical companies were, and actually how they were manipulating some of the research and some of the studies that were coming out. and he started to speak up about how antidepressant and painkiller prescriptions had tripled in the decade before. And we saw a lot of dependence and addiction in the surgery I was working in.

And he felt very strongly that was due to Big Pharma and obviously the use of painkillers and antidepressants. And he started then raising questions about over-diagnosis, over-medication, and actually what about patient choice? did patients get a say in any of this? And were long-term medications always the answer to long-term conditions? And I remember him giving me a tutorial on diabetes. And Des never gave your typical tutorial that probably other people would have got. And it was always a bit of a debate about what he was going to write in his next article.

But really, his question to me was, why are we chasing numbers? Is it just about blood glucose? Is it just about HBA-1 C-mon? isn't there more to diabetes with lifestyle advice and diet? And this was 2009. So actually at that time, as doctors, we were always holding on to something quantifiable to measure a patient's success by. And it opened up this broader dialogue between me and him,

which was where I started writing and becoming fascinated in, in the communication sides. And it wasn't long after that that he, made the decision to step down from writing his article, because whilst he had a lot of support and a lot of people really enjoyed and agreed with what he wrote, there were trolls on Twitter, which was the only form of social media at the time. He was getting death threats on almost a weekly basis. Yeah, it was just awful what was happening. And was he getting negative comments from other healthcare professionals or from the public or both, I presume? Actually,

it was healthcare professionals. So the public rarely got to see what. he said, although he did petition Parliament about a few things, but it was largely fellow GPs, a lot of fellow GPs in Glasgow, but it was always health professionals. So if he wrote an article about antidepressant use and are we over-diagnosing depression or the incidence of mental health, there'd be psychiatrists that particular week and then it would move on to something else. So he felt actually despite the fact things were changing. And as we know diabetes, medicine and management is now exactly what he predicted in 2009. He couldn't see the benefit or the good that was coming from what he was writing.

And he felt it wasn't worth it. Or it wasn't worth it to him, the personal. Gosh, I never knew that because I used to really enjoy reading it because it makes you think beyond the box. And I think so much in medicine, we're all. a bit of a hamster wheel, aren't we? Especially when we're busy. So we learn from our peers. We learn from maybe an odd article we might have read, but it might not be the best article on that topic. And then we just keep going and keep going. And every day you're busy. I mean, I've been very lucky because I've

worked part-time as a GP, so I've worked a long time, as you know, as a medical writer, so I've had time to reflect and think and read the best evidence and work it out for myself. But social media is a really horrid place actually and some of you might know there's a lot of abuse for what I do, especially on Twitter. Instagram is less offensive and more supportive, but it's really horrible. We do have the GMC, there's a good medical practice and they have a code of conduct for social media, but I'm not aware that every healthcare professional certainly knows about it because they don't act on it. And even today, actually, this morning, someone put a comment very negative about me. and then someone else said, yes, of course, she's only a GP.

And I thought, well, what do you mean I'm only a GP? I don't understand. Why is there this perceived hierarchy in medicine? And maybe it was the same for him because he wasn't a cardiologist talking about statins or a psychiatrist talking about antidepressants. But he obviously was very holistic in his approach, which is what we should all be, isn't it? Absolutely. And like you, it didn't come from, his writing was delivered through.

anecdotal evidence from the patients that he saw throughout the course of his career and about putting jigsaw pieces together because of the breadth of experience and knowledge he had. So I think it's such a shame that people who perhaps find a link that nobody else has found or begin to question what's at the time considered traditional medicine are treated that way because it's all about groundbreaking research and actually pushing the boundaries. And if you don't have the Des Spencers of the world or Louise Nusons of the world, actually, how are we going to get answers to the questions or would we always be stuck in 2009 looking at diabetes as purely blood glucose control based on medication? Which actually is becoming relevant even in the menopause space,

isn't it? Because we certainly use our patients more than any other numbers with menopause, because there's no diagnosis, even with diabetes, of course, you need a number to make the diagnosis, number of the blood glucose level or the HBA1C. But we don't have that in menopause, do we? We're not a certain level or to make that diagnosis of the perimenopause or menopause. And it's usually about symptoms, looking at the bigger picture. We sometimes measure blood levels to look at estrogen levels to help guide us, but it's not the only thing. And now there's become a bit of a debate all about the levels and the doses and the this.

let's look at the patient, let's hear, let's see what's happening, how is this estrogen being absorbed through the skin, but also there's this debate is, well, it's just HRT or nothing, and you have to choose which you want. But actually, whether you take HRT or not, you still need education and information exactly the same, but it's for diabetes, isn't it, about your lifestyle and so forth? It's very weird when people don't think outside the box, and I think for some healthcare professionals, thankfully not many, there's this lack of professional curiosity. I don't know about you, but I'm sure you're the same as me, Penny, is that if someone asks you or tells you something that you didn't know, you might push back initially, but then you might actually tell me a bit more

about that. I didn't realise. Let's read this paper together and let's discuss and debate. Healthy debate is a good thing in medicine, isn't it? It's a way that you advance, really. But if you don't listen, you're never going to advance, are you, or change? No, no, not at all. And for me, healthy debates during my training and even now are actually the best part because not only do you learn but you get to debate both sides and you tease out essential bits of knowledge that either you didn't know or you need to just go back and read over again and coming back to your comments about measuring blood estradiol or testosterone levels or even making the diagnosis of menopause in the first place, so many people, when you have your initial consultation with them,

will often appear surprised that they're not going to get a blood test done. And of course, it's all about shared decision-making now and informed consent. And part of that is education and talking to them, but actually explaining why, of course, they can have a blood test if they want one. But actually, in the perimenopause, the blood levels will fluctuate hugely and they've just left their job, they're crying, they can't sleep, they've stopped accepting the social invitation. So whilst a number on a piece of paper might make them feel that you're helping with a diagnosis, regardless of what that number is, you're still going to offer them treatment, whether it's hormonal, non-hormonal, a combination of the two. And I think

without having that conversation, people aren't necessarily going to pick that information up somewhere else. It's really critically important because when I was starting to really specialise the manifolds, I went to sit in someone's clinic and I won't mention names, but it was in London. And you learn so much more when you sit in and listen and understand how the consultation goes. And it was the first consultation I sat in with was a lady who was 48, she was a barrister, had very high-powered job and she said, it's awful because I'm at court and I can feel myself getting very hot. I know I'm going bright red. but the worst thing is I can't remember things.

I just have this blank. It's like the shutters have come down. I can't remember and it's really petrifying. And my periods are now scanty. I have about three or four a year. They can be quite heavy and that's a real problem at work, everything else. So she was otherwise very fit and well. Never had any problems.

And so the doctor I was with said, right, Mrs. Bloggs, all we're going to do is do a whole panel of blood tests and then I'll see you again in three months time. And he did very complicated blood tests, things that we wouldn't normally do, like cortisol levels and other different hormone levels that we don't always monitor and the usual hormone levels and blood count and thyroid and kidney and liver tests. And when she left, I said to him, oh, if I saw someone like that in my general practice, I would have just talked about treatment choices because in my mind, the

sooner she's on treatment, the sooner she'll start to feel better and be able to function and her future health would improve. And he said, well, Louise, we're sitting in a heart and Street. And I said, yes, he said, well, these blood tests really are important because, you know, and then I looked at the price of the blood tests and it was, this was seven years ago and it was about £800 for the blood tests. And I thought, do you know what, if ever I have a private clinic, I am not going to do that because I absolutely, and we all do in the clinic, treat people the same as if they weren't paying. Occasionally we get people, not complaining, but they do phone up to say, I'm really surprised I didn't have a blood test.

test. This doctor obviously didn't know what they were doing and I'll often speak to these people and explain. And I saw a 45-year-old lady this morning who was, or is, still perimenopausal, really struggling to hold things together. Both her parents have dementia and I always offer people, so I can do your blood test, but it will be low, I'm sure. Your testosterone will probably be low, but your estrogen, if it's low, normal or high, I will still say to you, I think you need some estrogen because you're getting these symptoms, you tell me they're worse before your period, and everything fits in. But actually in medicine, you only do a test if it's going to change what you do, and it might confuse. And we see lots of women, don't we, in the clinic who have been told,

my hormone levels are normal, my estrogen's normal, therefore I'm not menopausal, or perimenopausal, and they've got a myriad of symptoms. So we have to be really careful, don't we, how we investigate people. Yeah, absolutely. And I think it's really common, isn't it, to hear women come to the clinic and say, I've got all these symptoms. My GP has done some blood tests. They're within the normal range, whether it's the normal range for them at the age of 40 or the postmenopausal woman at 51. And I think the boundaries start to get muddied. And that's where education, patient choice, advocacy, and all of that has to come in. Because if we're not empowering women to understand what's happening to their bodies and actually whether

they need bloods or no bloods and what the treatment options are and we're not helping to then educate some health professionals because we have this wealth of information from the thousands of women come to our clinic then actually we're not pushing boundaries we're not letting women make decisions for themselves and for me that's the whole purpose of medicine that actually We're all in this together and it's not divided by whether you're a health professional or not, whether you've got a medical degree or not. It's our bodies and we have to be able to advocate for ourselves and to do that. We need to be educated in a way that we can understand with no jargon, back to basics and just stripping it all back down again. Absolutely. I think that's so important.

And I've been to lots of educational events where you sit there and you're looking at these really complicated slides. and even as a doctor who can, I've got some basic statistic knowledge, you think, oh my goodness, actually I just want to know how to treat the patient. What I want to know is, is it safe and is it effective and is it going to help that person? And medicine is very individualised and it is a science and an art, isn't it? We have to know the science, but the art is making it individual and allowing the patient to be part of whatever we do. And certainly with my menopause training, which was very scanty,

and wasn't always exactly what I wanted and actually sitting in the clinic even with a very expensive blood test. I learned a huge amount sitting in the consultations and so some of you know when I decided to develop the confidence in menopause course a few years ago, I wanted to use that clinical experience because a lot of doctors and nurses

and pharmacists were sitting in my clinic, but you can only have one at a time and it's quite intrusive, isn't it, for the patient who may be telling you some very personal information, or you might have built up a relationship. And it's not always practical because then that doctor, nurse or pharmacist has to take the day off to come and sit in. So we decided to start filming some actresses pretending that they had different scenarios. And the feedback was really, really positive.

And so we've now had over 30,000 healthcare professionals from all over the world have downloaded the course with phenomenally good or excellent feedback. And most of them said it's increased their confidence, not just to diagnose, but to manage the menopause. which is wonderful, but it's become very big, and it's a big responsibility training thousands of people. So you've come on board barely recently, really, and with your interest in education, you've sort of, I feel like I've given you my fourth child almost of education. You've been working with Kat Kiyov, who's our editorial lead and education need, really. She's very instrumental and she's not a medic, but she's pulled everything together. So the two of you have worked more hours

and I can imagine, with a team of people, to update the confidence in the menopause course, haven't you? Yes, and it feels like one of my babies now as well that I will take good care of, and I'm very excited about it, actually, and everything that it means, because it's the case studies, as you've described, that although we've helped with an actress with the script,

actually, it's telling stories behind not just the perimenopause and menopause, but nuances that individuals face. And we're relaunching the confidence in the menopause course with a lot of these updated case studies and modules talking about women who experienced migraines that have suddenly got worse during the perimenopause, trying to demystify it, but using the voice of everyday people, alongside doctor talking through actually what the treatment options are.

And each of these cases are centered around one particular part of the perimenopause and menopause with questions attached to them that are checking knowledge, which a lot of health professionals will like to do because they can get CPD points. It's an accredited course. But actually there's really long explanations to the questions along with supporting evidence, whether it's research papers, podcasts that you've previously done, linking back to balance with all of the articles in there. So there's lots of supporting evidence and documentation around every story that we're telling. And for me, I think that's absolutely amazing because you're giving the same information to health professionals, whether it be an HCA, a nurse, a doctor, a pharmacist, as Joe Blogs, the person on the streets.

And I say Joe Bloggs, because it's for men as well as for women. Yes. The men are pores affects everybody. and actually going through the course, looking at the case modules alongside the presentations, which debunk a lot of those myths. We've talked about Big Pharma and how actually they have had influence on research studies before. And I think it's an amazing course and absolutely fascinating to be part of, but it also delivers such an important story that is part of everybody's makeup and lives.

Yes, and we can just add and improve, and we've never had external funding. We just need for transparency sake to say that we don't do any paid work with pharmaceutical companies. No one in our organisation does. So we funded it ourselves. We've spent over 300,000 on our education because it was free before. So we then decided to use a different platform that wasn't available actually before called Teachable. So we, you and the team have uploaded onto Teachable. So if we want to change something or we get some feedback where someone says,

oh, could you have had this or could you change this? We can literally do it in a very reactive way, can't we? And it's about having that control will be really important. So we've got lots of cases and lectures, like you say. And we've actually, this time, there are still free resources there. Absolutely. So people can still have an overview. I've done a lecture about menopause and HRT and treatment.

and what it means. I've done a presentation about testosterone, another very important hormone, and just a short presentation about shared decision making and informed consent, because that confuses some people. And it's like you already said, the cornerstone of what we do. And then the rest of it, we're charging for it, aren't we? We are. And there's a number of reasons we're charging for it, which primarily are to reinvest money into our ongoing education and research. So where we are doing a lot of our own research in-house. We've got an amazing research team who are looking at the wealth of information and all of the data that we collect from the women who come through our clinic. Actually, we've already got the basis of hopefully doing some groundbreaking

studies, but of course we're not going to use pharmaceutical companies. We want to do it ourselves, and we need to use our resources and our finances that are available to us. So by putting a small charge onto the course, we've got the money to keep reinvesting in what we do and doing research studies, doing more education, doing more presentations, more events, and just widening our reach and hopefully allowing more people, especially the ones we mentioned earlier who actually don't have that health literacy, just keep trying to help and empower people to make decisions. So it is new that we're putting a fee on it, but incredibly important to support the ongoing work we're doing.

Absolutely. And the fee is exactly the same, regardless of whether you're a consultant neurosurgeon or you're a non-medic, you know, somebody that doesn't have a job, actually. The cost is going to be the same. We've kept it as low as possible. And compared to some other courses that really do run into hundreds, I've known people that have spent over £1,000. Having some education in the menopause, this is actually very cheap. And I also, and I'm sure you've been the same, I've been to many educational events where you have to tick whether you're a doctor, nurse, pharmacist. And there were different pricing brackets. I always used to get quite upset because I only worked one day a week as a GP. And so I would be paid less than a full-time nurse.

And nurses would often get, they'd pay less for a course. So we've just made it easy so that it's fair. And it's also available globally as well. Some of the presentations, we've got subtitles, we're looking at having. some translations and some people volunteered to translate actually. So there's so much that we can do. We're just starting. So it is a baby rather than a toddler or a teenager. There's so much more that we can do. But just to start that conversation so that people can feel even more empowered and what I hope it does is it gives people more knowledge so they can be better advocates for

themselves when they go to a healthcare professional and allow the healthcare professionals to have more confidence to really help those people as well. So it's all very exciting. So I look forward to seeing the feedback that we get. But before we finish, Penny, I'm really keen just to ask you for three tips actually. So three reasons why you think people should do the course. Only three. Okay. I will choose wisely. Number one, to understand what. is inevitably going to happen to your own body or a loved one's body if you're a male doing the course. And I think that's crucial. I think you need to understand what's happening. Number two, to appreciate the wide variety of symptoms that women can experience whilst undergoing hormonal

changes and that's whether you're a friend, a colleague, a partner, a boss, actually understand that whilst one person might have seemingly sailed through it, of course you don't know what's going on in the background, that's not to say the next person's got exactly the same experience, so to be mindful and to be kind whilst listening to the course and understanding the various aspects of it. And three, to listen to the presentations, particularly the one that is dispelling the myths about the menopause and HRT and the Women's Health Initiative and the studies, just to understand exactly what's gone before us. And no doubt the same is going to happen again. There will be more myths to debunk and more problems raised that actually

20 years in the future might not be a thing. So I think to listen to that and actually think about research and studies and who actually is funding the various studies that are being done and be mindful of what's the truth, what's not the truth, and be critical and have your own open mind. Excellent. Thank you ever so much. And thank you again publicly for all the work that you have done and continue to do plenty because it's going to help hopefully thousands of people. across the world. So thank you again for joining me today. No, not at all. It's lovely to chat to you and be so involved. So thank you. You can find out more about Newsome Health Group by visiting www.newsonhealth.com.uk.

And you can download the free balance app on the App Store or Google Play.