The Dr Louise Newson Podcast - 247 - Addiction and menopause

Episode Date: March 12, 2024

Joining Dr Louise on this week’s podcast is Alex Newman, a substance misuse therapist with a special interest in the menopause. Alex’s passion is supporting women who are self-medicating menopausal symptoms with alcohol and drugs – a recent survey by Newson Health of nearly 1,200 women found some were spending nearly £3,000 a year on alcohol and over-the-counter medication in a bid to cope with menopause-related symptoms. The pair discuss the relationship between substance misuse and menopause, and crucially, strategies on how to get help for yourself or a loved one. Follow Alex on Instagram @alexnewmantherapy or email [e-mail]. Click here to find out more about Newson Health

Hello, I'm Dr Louise Newsome. I'm a GP and menopause specialist and I'm also the founder of the Newsome 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 and always inspirational personal stories. This podcast is brought to you by the Newsome Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. Today on the podcast I'm going to introduce to you Alex Newman,

who's a substance misuse therapist. And the more I do in the menopause, perimenopause, PMS, PMDD, space, the more I speak to women who actually are addicted to, to all sorts of things, not just drugs, but alcohol, food, various things that they know aren't right, but it's to get comfort, actually, for sometimes symptoms that are really affecting them. And they don't always join the dots and realise that the hormones can cause the symptoms that are leading to their addictions. And I've spoken to a lot of people whose addictions have come back, actually, when they've become perimenopausal. So Alex reached out to me for a while

ago, so I'm super excited about listening to her today. So welcome to the podcast, Alex. Thank you very much. So tell me a bit more about you, if you don't mind, and how you developed your skills to become a substance misuse therapist. Well, I started my counselling training over 25 years ago. My first placement was in a drug and alcohol setting. So yeah, and I became really interested in the whole subject of addiction. My first job actually was as an alcohol crime and education group worker. So that was quite interesting. And yeah, so throughout my career then, I went from being a counsellor, support person, to a team leader, manager, and then got involved in service development and training consultancy. So I did all of that for a really long time up until three years ago

when my own perimenopause hit, and I fell off what I called the hormonal cliff, really, and realized that the corporate job that I was doing, I just couldn't really cope with anymore. And I wanted to go back to doing what I really enjoyed, which was working on a one-to-one basis and especially working with women around not only their alcohol use, but their anxiety and all of the symptoms and issues that come with women dealing with midlife. And yeah, that's become my passion really now. And so did your perimenopause affect you in ways that you were expecting, or was it different to what you were thinking, or had you no expectations?

Well, I'll be totally honest with you. I had no idea what was happening to me. I left my job and moved to New Zealand, strangely, because my husband got a job there, and I just wanted to leave a very, very stressful management job behind. And when I got there, my doctor advised me to come off the pill. She told me I was too old to be on the pill at 46, and I came off the pill and all I can say is all hell broke loose, really, of every aspect of my physical. mental health and I really, really had no idea what was going on. It's the point of where I begged my new GP to give me benzodiazepines because they were the only thing that were helping me relax and sleep and get rid of the anxiety. And I am not normally an anxious person. I'm a fairly confident person. But I had no idea what was happening to me and doctors gave me hundreds it felt like of blood tests.

They thought it had diabetes. they had thought I had all kinds of things. And in the whole three years that I was going backwards and forwards to the doctors with all of these issues, not one person ever mentioned that it was to do with my hormones. And it was only through my own research did I actually figure out what it was and then ended up going to see an endocrine doctor who in the end helped me get onto some HRT and to sort out my hormones. So I have a very big passion for helping women because I was so.

in the dark myself and I was using alcohol and over the countermedication, pain killers, anything I could really to be able to get through anything at the time. It's very frightening, isn't it? And it can be very isolating as well, especially when you're not expecting the symptoms to come on. And I hear this a lot from people who have developed some mental health symptoms because of their changing or reducing hormone levels. And they say, I know I'm not depressed. I know I'm not anxious.

There's no other reason. And I spoke to someone yesterday, actually, and she said to me, my doctor said, it must be because you're not getting on with your husband, or it must be because of your job, you're feeling like this. And she said, no, I know it's not. I know it's absolutely not. And she was only 38. And she said it took three years. I think women need to listen to their own intuition. We know ourselves better than anybody else. I knew that there was something wrong. I knew it wasn't all of the things that the doctors were telling me it was. I knew something bigger than that, but I really couldn't put my finger on what it was. And the only reason that I figured out what it was, I went back to my GP and I said, this all started when you took me off the pill.

Yes. And as soon as I realized that being on the pill was probably what was just actually keeping me going, really, with those hormones in my body that as soon as I stopped taking that and I had literally every symptom on the list. I mean, I had a really, really horrendous time and yeah, it took me a long time to educate myself and get the help

and get back onto a level playing field really with everything. And I don't want any other women to have to go through what I went through. I really don't. Oh, no. And so for many years I've heard women say they've drink more alcohol, often to numb their symptoms and think wrongly often that it will help them sleep or it will help lift them and we know that alcohol can be quite a depressant actually and it can affect sleep patterns.

So it's not always the best thing to do. But they've sort of got into this slippery slope and I completely understand it that they think they'll feel better. But it's not just alcohol actually and we did an addiction survey actually in October last year asking people questions and we had a huge response and people. wrote quotes as well and one has really stuck with me about a lady who was 51, she still is 51, and she said that she started to experience symptoms. She was in this very dark hole. She didn't know how to get out. So she started using Class A drugs. She'd never used Class A drugs before,

but she said it was the best thing to lift me from this deep, dark abyss that I thought I could never get out of. And then after a few months, I realized this was not the best way to help. And I knew I had to get other help and I'm so ashamed that I did this but actually it was wonderful when I was doing it. And I thought, isn't this really sad that we've got evidence-based treatment that's recommended in the guidelines as first line treatment for the majority of women as in replacing the missing hormones that are causing a lot of these symptoms? Yet women can't get help and this woman had been offered antidepressants by her GP and knew she wasn't depressed but she had taken to abusing drugs. and there were lots of other stories of people, not just class A drugs, but smoking a lot more cannabis, trying to, and it was all about their mental health.

They were doing it to try and relax and calm themselves, reduce their anxiety and get out of this hellhole that they're in. And I'm not saying that everybody who's perimenopausal will feel this bad, but there are a significant number of women out there who are turning to recreational drugs or over-the-counter drugs or even prescription medication. and they are addictive as well. And I really worry that we're giving someone something that's addictive, that's actually not beneficial as well in the long term. Absolutely. I mean, most of the women that come to me initially come to me because they've worried about their substance misuse.

I have a lady who I met fairly recently. She came to me because she was suffering huge anxiety with intrusive thoughts of past trauma. Within five minutes of me talking to her, I could tell that she was actually perimenopausal. So we had the session, and at the end of the session, I said, look, I just would like to offer you something. And I actually gave her a copy of your book.

And I said, will you just go away and read this book and let me know if anything in this book resonates with you? And I'll see you next week. Within two hours, she had screenshotsed lots of paragraphs from your book saying, oh, my God, this is me. Oh, my God, this is me. Oh, my God, this is me. You know, and I said, I think that this is really where we need to start.

I'm not saying that all of these other things are not going on for you. But one of the reasons why she'd come because she was really worried about her drinking. Her drinking had increased and she was worried that she was drinking so much that was she sober enough to even drive her child to school in the morning. She was fearful of driving. Lots and lots of issues from her past have come up. And this is another thing that I'm recognising with women is that if there is any unresolved issues, trauma, relationship problems, it all seems to really rise up to the forefront

where drinking alcohol and taking drugs, again, is the only thing that they think that they've got as a crutch to help them through all of these difficult situations. And it really is becoming a huge problem and has become worse since COVID. And this is another thing, is to recognise how many people, their substance misuse has increased so much more since COVID. And a lot of people haven't actually stopped or been able to stop because they've actually become addicts. Yes, absolutely. And it is a real issue and it's also people see it as a real shame that they can't talk about it. And it's socially, obviously, a lot more acceptable to drink wine than it is to abuse drugs. But actually the addictive properties vary between people.

But it's also looking at the reasons behind. And it's so multifactorial with addiction. I don't need to tell you that as a therapist. But it's sometimes one small thing that can tip that balance as well. And we know, and I've mentioned it many times before, that all three hormones, actually, estrogen, progesterone and testosterone work on our brain. But they also affect the dopamine levels, which are reward levels. And we all know that, don't we, if we do some exercise or we have a good laugh with some friends or we eat some chocolate, you get this hit where you feel great. And that's often with addictions, isn't it?

People want to get that sort of endorphine, that sort of hit. And if we're not getting enough dopamine naturally because our hormones, estrogen, progesterine, testosterone have lowered or are fluctuating and causing chaos in our brains, you're not going to get the same hit with just having a belly laugh or watching a good film. You're going to want something a bit more and a bit more. And it's that slippery slope. And then if you're not recognising, which often a lot of people don't, because we've all been told the menopause and perimenopause is some hot flashes and sweats

that may or may not last for a few years, some vaginal dryness, and that's all related, then women aren't going to be thinking, oh, it's my hormones. And then I don't think I'm different to many other women, but I internalise a lot and blame myself for the way I feel. So I then think, oh gosh, that's because I'm no good. I'm a failure. I'm really anxious. And then you get this downward spiral.

And often in the perimenopause and menopause, people do ruminate as a lot and they catastrophes. So what would have been a trivial worry when their hormones were balanced becomes out of proportion. So they're worrying, you know, not just can I take my child to school, but what if I have a car crash and what if this happens? Like things that you wouldn't naturally normally worry about. And we see that a lot. And if you've got that sort of addictive personality or you just don't know how to get help, you're spiraling down and down. So you need these crutches sometimes. but they're not right, are they?

Exactly, and a lot of people hide it as well, you know, I mean, you know, I know lots of people who, their substance misuse is incredibly problematic, but they're hiding it from their partners, from their children, from their families, from their work. You know, I mean, I know people come and tell me that they're taking vodka into work with them to have at lunchtime or they're smoking cannabis before they go to work, lunchtime after work, just to be able to be able to relax, you know, know, I mean, people are doing things that they wouldn't ordinarily do, and because of the shame of

that, I think. And I'm talking about people with quite high-brow jobs sometimes as well. Oh, absolutely. No, from all socio-economic backgrounds. And, you know, when I was a medical student, obviously people, so in the 80s, 90s, people used to prescribe a lot of benzodiazepines. We didn't know the addictive nature of them. We'd prescribe a lot more coding-based preparations as well. And then, obviously, we realized addictive properties. And then this WHOI study came out scaring people away from HRT. Around the same time when I was a GP, there was a real move to stop benzodiazepine prescribing, which was the right thing, obviously.

And looking back, I had so many women, female patients who were in their 50s, 60s, some in their 70s, who'd been given benzodiazepines, often started when they were in their 40s. And then my job was to try and get them off. but I had nothing else to give them. So I would lower and lower it and talk to them until I was blue in the face, but it was impossible often because of their crippling anxiety. And I'm so embarrassed and shame because never once did I think, oh, what about their hormones?

What if I replace their hormones, their anxiety might reduce? Because no one taught me then that anxiety, low mood, depression, rumination, low self-esteem, reduced self-worth, could be symptoms related to the perimenopoles, Menopause. I feel the same, Louise, because I used to run women's groups for addicts. And there were lots and lots of middle-aged women in those groups who were either addicted to alcohol, addicted to benzodiazepines, heroin addicts, crack addicts, you know, and I had no idea. And I had no idea. And I had no idea. And I had no idea. And we only need to look back in history, don't we, and see, like, you know, in the sort of 50, 60, 70, women were given mother's little helpers, so they were given amphetamine-based medication. They were given benzodiazepines, anything to karma, so we weren't a nuisance, so we could stay at home and clean for our husband and warm his slippers by the fire and make sure everything. Because if you look back in history, that's just fact what happened.

And farmer then decided to do that. And even now, there's still a huge amount of antidepressant prescribing. And that's another conversation. but these drugs can be addictive, but they can also have long-term harms as well. We know long-term antidepressant uses related to osteoporosis. We know menopause increases risk of osteoporosis. So even if you just look at that one problem, then that's something we need to consider. But it's such a shame.

We haven't done a study and I'd love to know how many women who take the right dose and type of HRT are abusing drugs, alcohol, compared to those that are not taking HR. and certainly the women that I see are the women who haven't been taking it that are the ones that are having problems and often when they're on the right dose and type, especially often with testosterone as well, it can be very calming on the brain. They can still function, but they get enjoyment, they get pleasure from things that they didn't use to, you know, just looking at the sun shining, they're happy. Whereas without hormones, the sun, so what? Well, everything's just flat. Everything just gives you no joy. I certainly felt like that

for a long time when I was in that space. And even with drinking or taking drugs, you know, you have to take more and more and more to get the same effect, you know. And that's where the problems then arise, because before you know it, you're having not just a glass of wine every night, you're having half a bottle and then a bottle and then maybe even two bottles of wine a night. And it just creeps up for people because their tolerance levels just increase and increase and increase without them even realizing it.

Yes. And then where do they go to try to stop? and we all know that the NHS is crippled at the moment with mental health issues and addiction issues and there's less and less funding to go around. And so the average person that just needs probably some education and some counselling, for instance, that doesn't need full-on treatment, but just really does need some help and support guidance, maybe a group or something like that. There just isn't enough help to go around really. So women, I think, are struggling and don't really know where to go to be able to get the real general advice, really, how to sort of reduce their substance misuse

gradually and easily over time and try to replace it with other things. Obviously, if they go onto HRT, then that's fantastic, you know, because you can try to kind of reduce one and increase the other, if you like, and that's definitely something I try to do with my clients. And it works. It really does work. I mean, the women come back to me and say, oh, you know, I feel like a new woman really. And they don't want to drink anymore, they don't want to smoke cannabis. They don't even want to go out that much anymore because they're so much happier and relaxed, you know, either at home or doing the things they love. Absolutely. And it is really important. And I remember giving a talk to some healthcare professionals about eight years ago now.

And it was just a 10 tips about HRT because this was many years ago now and people were a lot more scared about prescribing it. So it was things about there isn't a clot risk with estrogen through the skin, that it can reduce risk of cardiovascular disease, it can reduce risk of osteoporosis. And then my number 10 tip was women can take it forever, just be reviewed every year as long as the benefits outweigh any risks. And for the body-identible hormones, they usually do. And a gynecologist then stood up at the end of the lecture and said, I really disagree with your number 10. She said, I get everybody age 70 to come off. They don't like it. They're all addicted to hormones because they are steroids after all, so they just get addicted to them. So I just say they should all

off. They don't like it, but actually I'm not going to prescribe to any woman over this age of 70. And I was really quite surprised with this very black and white, because nothing in medicine, in my mind, it is an art as well as a science. And for me, the patient is central to everything I do. And actually, physiologically, what's the difference between a 70-year-old and a 71-year-old? I don't quite understand that either. But actually, for most women, there aren't any increased risk because the longer people take. This has come from unfounded fears from the the older types of hormones and the breast cancer risk, but that risk was never statistically significant.

But then we have to choose, don't we? But this whole thing about something being addictive, I really reflected on afterwards because I thought, in my mind, the problem with addictions is it's when you're addicted to something that is not good for you in the long term. Whereas for most people, HRT, just giving hormones back, is good in the long term.

So to be addicted to something that's beneficial, surely that's different to being addicted to something that isn't good for you in the long term. Exactly. And I think just that word addiction, you know, it conjures up real negative connotations, really. You know, we all joke about being addicted to things we like sometimes like exercise or chocolate or whatever. And, you know, people laugh at that. But it's just like, I don't know. I think it's, if you mention the word addiction, it's almost like it's something that has to be controlled. Yes. And how do we do that?

It's all down to the individual, you know, and obviously, as you know, it's all about being holistic and everything needs to be balanced. So, I mean, yeah, I would hope that I'm going to be on HRT until, you know, I pass over to the other side. I think of the thought of coming off it actually terrifies me now because I'm like a new woman, you know. Yeah, but it did make me really reflect about the word addiction because it is associated with negative things, which is absolutely right when we're thinking about, you know, drugs and alcohol and things and other substances. But to be addicted to being happy or being addicted to being with friends or being addicted to good food actually isn't a crime.

It's not a bad thing. And that's the same with when we talk about some medication. But this isn't really medication. It's just natural hormones. And, you know, you could say people are addicted to thyroxin because without it, they feel slow and sluggish and they've got an underactive thyroid gland. that's not really the same as a proper addiction. So I think we have to be really careful on the words that we use

and the connotations that they have. And certainly as a doctor, I've learned very early on never to judge my patients. You know, I've seen and spoken to and managed a lot of people who have taken all sorts of medication. But actually, when you get under the layers of complexity, there's usually a very sad person in the middle who really wants help. I've never met someone who doesn't do it. with any other trouble in their mind. And for us, or for me as a healthcare professional,

you as a therapist, it's finding out all those layers is really important because actually if you don't address the more, you're just doing that person a disservice really. It's not going to help. Yeah, I mean, I always say that I work with the person and not the problem, not the issue. You know, you need to look at the person as a whole, look at every aspect of their life, what's actually going on for them, but also a lot of people use substances because they have unresolved trauma of something that's happened in their life, whether they've dealt with it or not, you know, and quite often, as I said previously, women, once they start to experience the perimenopause, I think that those things come back, you know, and especially if there's anything from childhood

or things might get triggered, if you like, with their own children or with relationship breakdowns or, you know, anything could happen like that. And it can trigger off a series of events then, which women just don't seem to be able to handle in the same way when they are in perimenopals unless they are stable on the hormones. And they make some very strange and weird sort of decisions sometimes about leaving marriages or, you know, leaving jobs that they really don't want to or shouldn't because they just literally cannot cope with how much they have to deal with. Yeah. And I think the other thing to just highlight, actually, is that addiction of certain drugs, can actually lead to an earlier menopause.

So I spoke to a lady recently who's 30, and she's a heroin addict, and she's now on methadone. And she said, oh my goodness, I've got all these symptoms. I thought they were due to me being on methadone rather than heroin. And actually, I haven't had a period for two years. And I said, yes, but actually our bodies protect ourselves. They don't want to get pregnant when you're abusing your body. So actually, it's great that the body does that.

But actually it means that you're not having your natural hormones in your body. So you abusing drugs, but also there's a lot of people I've spoken to who don't eat properly, they very chaotic lifestyles, but also domestic abuse, whether it's physical or sexual or both or psychological, it doesn't really matter. Any abuse can lead to an early menopause as well. And actually there's some work that it can lead to more severe symptoms. But again, if someone's been abused, people will be thinking of the effect. effects of the abuse, but not the effects of hormones on that person as well. And so it's really

important we're not waiting for people to be in their 40s and 50s and thinking about hormones then. And the other thing is there's a lot of women who have PMS or PMDD. So it might just be a few days before each period that they're using or abusing drugs, alcohol, whatever, more than other times. And that's really important people who are listening to to think, is there a variation? at all. Could any of this be related to hormones? And of course, I'm not saying all addictions due to hormones, but actually it's another layer that we, I don't think it's been really spoken about much before. And once you see it like you have, Alex, you can't really unsee it. And that's what's so important for all of us to be aware of, isn't it?

Exactly. And also, I think that the symptoms of drug and alcohol abuse exacerbate the symptoms of perimenopause and this is the problem even though in the short term they might help for a short while you know with the relaxation with the feelings of well-being you know the next day unless you've got your drinking or using that drug again you know you're going to feel worse you're going to have all the and if you look at the list of symptoms of a hangover and the list of the symptoms of the peri menopause quite a lot of them are very similar you know the dehydration and the headaches and you know that type of thing anxiety for instance i mean the amount of women that i know still drink, even though they experience massive anxiety the next day.

And it's like, the body's trying to tell you that it just cannot tolerate alcohol anymore. You know, are you going to, when are you going to start listening? And eventually they just say, oh, actually, I had three nights now without having a drink. And I feel so much better. And I'm like, okay, you know, when we get to the age where perimen and reports are starting to happen, our body physiologically cannot tolerate, especially alcohol and other drugs in the same way as when we were younger. It's just how it is. Yeah, it's just fact. It's just fact, isn't it? But it is difficult. And just finally, the other thing that many people are addicted to actually

is processed foods. It's a different conversation. I've done podcasts about this before, but we need to be thinking what we're putting into our bodies as well. And, you know, this isn't a lecture, but it is really difficult to, once you start, to sort of stop. But making small changes is really important. And for those, of you that are listening, there are things that can be done and you're not alone. That's the other thing, as you've already said, Alex. There are lots of people that aren't talking or aren't admitting that there is a problem. So working out within yourself is really important. So I'm really grateful for you being so open also about your own personal experience as well. Before we finish,

I always ask for three tips. And I feel like we're opening a bit of a sort of can of worms, really. I think people will be thinking, yes, maybe that is me or I know someone that might be struggling. And it might just be there, just getting home after the school run and having that glass of wine a bit earlier than they would have done before. Or like you say, waking and having a pick-me-up or taking something to work, or it could be something that's more addictive or drugs or whatever. But if people are thinking, oh gosh, who do I admit to, who do I talk to,

what's the best way of getting help? What are the three tips that you would give, either to that person personally or for them to give to someone who they think might be struggling? Well, the first thing is a very practical thing. I'll just ask anyone that thinks that they might have an issue is just to do a drinks diary. I think it's very important just to be able to write down exactly what you're using on a daily basis and try to correlate it with your symptoms as well. If you're kind of looking at what you're drinking and what your symptoms are, if you could see a correlation with how you feel the next day as to whether you've been drinking,

a lot or not or taking drugs, whichever you do. And then you can just really see in black and white what you're dealing with. Because I think when you see it, when it's actually written down, it's much easier to be able to see which of the days are the problems or, you know, what situations might arise that make you want to drink more. Is it on a Friday night or is it on a Monday morning, for instance? You know, those types of things. And also try to record your drinks in units. If people can learn about units, which is very simple to learn, you can find it anywhere because people think, oh, a glass of wine. Some people's glass of wine is one unit. Some people are two. Some people will pull themselves a three unit glass of wine. I think,

I would have only had one drink. But that's actually three units in a glass. If you have three of those, then you've already almost hit your healthy units for the week. And also, again, it makes it a lot clearer to yourself about how much you're actually drinking. And the third thing I'll just say is get help, talk to people, talk to your friends, get some support, do your own research. There's so much out there now on the internet. I mean, there's no way that you can't find what you need where you are, you know, and it might be difficult to actually find a counsellor or that type of thing, but, you know, there will be other areas that you can discuss your alcohol use with, even if you just start with your GP, you know, or just go online to find a local

support group or AA or any of those things, really. I just say to everyone, talk and try to do things that don't involve drinking with your friends, like go for a walk instead of the glass of wine or the wine o'clock on a Friday, you know, just try to do different things and try to cut your drinking down that way. Really great advice. So important thing to acknowledge if there's a problem and do something proactively. And so I'm really grateful for your time. It's been really interesting and revealing. And thank you very much. Pleasure. Thank you very much. You can find out more about Newsome Health Group by visiting www. news and health.co.uk.

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