The Dr Louise Newson Podcast - 274 - The great menopause myth

Episode Date: September 17, 2024

Joining Dr Louise on this week’s podcast are US-based Kristin Johnson and Maria Claps, authors of new book The Great Menopause Myth: The Truth on Mastering Midlife Hormonal Mayhem, Beating Uncomfortable Symptoms, and Aging to Thrive. Kristin and Maria share their own menopause stories, why they wanted to write a book to help others and why menopause can be the best time of your life. The pair also share the four things, besides hormones, that can help women during this time: Education Exercise Nourishing your body with the right foods Managing stress For more information on The Great Menopause Myth, which will be released in the UK on 26 September, click here. For more information on Newson Health, click here. Dr Louise Newson’s first-ever live theatre tour, Hormones and Menopause – The Great Debate, takes place 27 September to 12 November. For more information and tickets, click here.

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 Newsome Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. Today on my podcast, I've got two women with me, very excited, people that I haven't met in real life before, who reached out to me because they've written a book together.

And it's a brilliant book, and I thought that I would have them on the podcast to talk about their work. And like many people, they're very frustrated with the suboptimal care, the majority of menopause and women are receiving. So very keen to introduce to you, Kirsten and Maria, who are going to introduce themselves and tell us more about them. So welcome to the podcast, both of you. Thank you.

Thank you. So Kirsten, do you want to go first and explain a bit more about why you've written the book and a bit more about yourself if that's okay? Yeah, sure, no problem. So, you know, this is actually a second career for me. I was a corporate attorney for a long, long time, and took a pause to raise my family and do those things. And then I started struggling with some health issues very palpably in my early 40s. My mom had surgical menopause at 32, so I didn't have kind of a guidebook in terms of what to expect or when this would be naturally, et cetera. Unfortunately, I'd also been given an IUD after the birth of my last son.

So I really had no good eyes on this being anything related to hormones or really understanding sort of that menopausal transition because my mom's was early. So I started sort of diving into some options beyond the conventional model, to be perfectly frank. I was frustrated with my doctors just sort of telling me you're too young to get your hormones tested. This can't possibly be hormones. Maybe you have another illness. I was being looked at for autoimmune diseases, Lyme disease, mold.

I mean, anything you could think of, they were trying to tell me that was it. And nothing really was coming up with any answers. So I started to first work on kind of the nutrition and lifestyle piece. It drove me to go back to school. And then I thought that I was just going to use this information to sort of help my friends and loved ones. And it sort of became a self-fulfilling prophecy in that I was struggling with things. And then women were coming to me similarly struggling with identity. things. And so I figured out, okay, we're all about the same age. Something must be common that we're

all going through. And I started to look deeper into how to understand hormones, how to test hormones, how to support hormones, et cetera. And that's honestly how I found Maria. And then the two of us ended up together. Maria's story slightly different. So I'll let her kind of dig in with hers. Yeah, I think I was just as young as you, Kristen, about 43. And I definitely noticed that something was not right. And so I sought out a doctor in New York City. And he put me on a bunch of supplements and hormone replacement therapy at 43, which I am not necessarily against and think I could have even benefited from it. But because I wasn't really taught what was going on, I gave it up after about six months. But I kind of wish I had stayed on now that I know what I know.

That's interesting, isn't it? Yeah. So we started working together and it was just essentially us deciding there's this huge need for these women. And this was years ago, Dr. Newsom, and this was not kind of at the cusp of where we're all at now. You know, you've been in this space for a long time. We have a lot of international clients. We've referred them to your clinic for a while. But this was something we've been doing for a long, long time kind of in the trenches. We're not selling anything. We don't private label any supplements. You know, it's literally just supporting women, giving them the education that their doctors aren't giving them, and then helping them understand what are all their options, regardless if they want to pursue hormone

therapy or not. So that's sort of how we built our business was just saying, hey ladies, we don't want you to have to go through this transition the way we went through it and sort of building a support network around that. Yeah. And it's such a shame, isn't it, that people don't have more information because it happens to all women and has effects on everybody. Most people have symptoms. Yet most people don't know what's going on, but I think things have changed in that a lot more women are understanding what's going on, but actually still a lot of healthcare professionals aren't recognising it. And that's obviously frustrating for me as a healthcare professional, but it's probably I know I hear in your email some of the frustration that you

have and you're not healthcare professionals. I don't know what you think about that. Yeah, I mean, you just kind of nailed it and said a lot of women have symptoms. And I I think that is unfortunately the construct in the United States, at least, that if you have symptoms, you might get a little bit of attention. But if you don't have the traditional symptoms, right? And Marie and I didn't have hot flashes. We didn't have those typical things. So that's why it was not obvious to us what was going on.

I didn't know that, you know, my desire to not really engage with my husband might be hormonal. And maybe I just thought our marriage was on the rocks. So there was sort of that phase. of life where it wasn't obvious what was happening. And I, you know, we didn't have osteoporosis. We didn't have hot flashes. We weren't seeing these other typical changes. And that's the thing that frustrates us with current, the medical paradigm, is that we have these large medical societies, particularly in the U.S., creating a narrative around who should be given attention under what situations and then what they should be given. And pretty much if you don't fit into that

construct, you're not going to be served. And that's the part that has us so frustrated. And that's actually the same globally. And looking historically at what menopause has meant, and obviously it was called the change in the 19th century. In the 1920s, that's when they discovered hormones. But unfortunately, when they looked at estrogen, it was associated with hot flushes. Somebody decided that was the big thing. Yeah. And then, and I'm trying to work out who, but there was some pivotal shift between 1900 and 1950, where a lot of the symptoms people knew were due to the change, some change that was happening in our bodies, there were some doctors that decided they could strip a lot of those symptoms and take it right back to the flushes and sweats.

And any symptoms that were related to the flushes and sweats, so if people were feeling dizzy or have palpitations or were feeling anxious at the time of the flushes and sweats, it was related to menopause and everything else was just either a psychiatric diagnosis or some sort of cardiology diagnosis or rheumatological diagnosis and that still carried on yet we know our hormones affect every cell and every system and every organ in our body and we know that lots of us don't have hot flushes so why are we still talking about this and I can't quite understand why doctors should be deciding which symptoms are relevant or not. I don't know if I'm missing something, but it just doesn't make sense. Well, I'll give a cynical explanation. I think it is.

I mean, you know, in the early 1900s, what we found interesting in writing the book is that the loss of hormones through the menopausal transition was recognized as predisposing women to a higher risk of disease. And hormone replacement therapy in the form that it was used at the time, which was frequently extracts and different things, was seen and accepted by every major medical society around the globe as being disease prevention. And yet we suddenly then shifted to where we are today. And I think part of the problem is there was a lot of money left on the table,

to be perfectly frank, if we just gave women hormones to address their rising blood pressure and their changes in lipids, and maybe their ventricular issues that they were having, or we just gave women hormones to protect their bones and these things, we suddenly didn't have room for a lot of pharmaceuticals. And there was a huge change post-war where we did have a lot of pharmaceutical interests, developing drugs to essentially address every single ailment across men and women.

And women, as we were growing older, it was blamed on aging. It wasn't attributed to hormones. And so there was a drug for that. And I think that's why HRT, it was kind of a threat. to that development of sort of a medical industrial complex. And unfortunately, I think that foothold still remains, you know, that there is a very strong resistance against seen hormones as the potential solution to all these different female ailments.

And now we've got this huge demographic boom of this age group across the globe where we're kind of loud, right? And we're not wanting to take these drugs any longer. And we're frustrated with the unintentional consequences and something. effects of them. And so people are starting to ask questions more. And finally, we're starting to hear the narrative again of gosh gee, what's the one thing all these ladies are suffering from? It's this loss of hormones. But we're kind of in this position of entrenchment, right? Is that hormones would essentially displace these other solutions and these other solutions

are much more lucrative for physicians. That's my cynical day. No, I think it's very interesting. I mean, it's different in the UK because clinicians, don't get paid, you know, or incentivised by pharma, but medical societies do for sure. Right. And a lot of research is paid for by pharma. So there are needs for pharma and obviously there's a lot of tax that gets paid from pharmaceutical companies. So there is that.

And I do really feel having treated thousands of women in our clinic, I know and most of us know that people who take hormones are less likely to be on other drugs. so they're less likely to be on antidepressants, antipsychotics, blood pressure treatment, cholesterol lowering treatment, sleeping tablets, painkillers, antibiotics for their urinary tract infections, arrhythmia drugs for their heart. It goes on and on migraine drugs, reduce, all this. Which is great for the individual, actually, and it's great for me as a doctor. I don't get paid, you know, depending on how many drugs someone's on.

But actually, you're right. those people that do have vested interest, it's not a great position. What do you think, Maria? Well, I think Kristen's spot on. And I also think it's going to be the women that we're going to have to rise up and demand what we've been taught about by a physician such as yourselves and, you know, the book that we've written and other good books that have been put out there that talk about HRT for whole body health because I don't think we're going to get medical societies to come

around probably not an hour lifetime saying that, hey, this is great if you want to age healthfully. So I think that, you know, it's women. We're going to have to be educated and we're going to have to demand better. Yeah. I heard someone say the best menopause experience isn't a woman who's empowered. And a woman who's empowered is a woman who's informed. And so that, you know, that's kind of what we're saying because I think there's this fear around menopause, right? women, you know, whatever social constructs they've bought into about it. Oh, we're not relevant

any longer because we're not fertile or we're aging and therefore we're not attractive or whatever women buy into. Marie and I kind of reject all that. We think it's a great time of life. We think it's the best time of life that we've had so far. But when you look at the younger generations, they're scared about this because it's been now painted as this awful thing. And, you know, we're like, but you all have an opportunity here. You know, you all have. You all have an opportunity to get some things on board and do the right things and not maybe even have to experience hitting the wall during the perimenopausal transition. But it's going to have to come, like Maria said, from the grassroots movement of women. I just don't love kind of there's this tribal

attitude, you know, you need to be politically aligned one way or you need to buy into a certain type of feminism or whatever. You know, there's just not enough time for that. We're all women. We all have ovaries, they're all going to sleep, and we're all going to experience some form of something. Can we just found together and demand better from, you know, the physicians? Yeah, it's so interesting. And certainly when I went to my first menopause conference several years ago now, I remember sitting in the auditorium thinking, what can I do that's different? Because education is not getting out to people, to the right people, the people that really need information. So I thought, well, I want to just educate people that are suffering,

but I can't do it through a clinic because I'll only see a small number of people, but I can do it with technology through, you know, a website, through the app, through other means. And obviously that's why I created my podcast as well. So people could be in a comfort and the privacy of their own home. They're not spending any of their money, but they're getting information that's right for them. And the most important thing is being able to make a choice. And what upsets me is the choice has been taken away from them. And I'm still hearing every day on my social media,

I get messages from women who have been empowered with choice. They decided they want to take hormones. Yet they're being told, no, you can't. You're too young. You're too old. You're too, whatever. And actually, as a clinician, things aren't always my choice.

It's about shared decision making. and allowing women to choose something on the information that they've had available to them and people are allowed to have different opinions to their clinicians that's part of consent. But that seems to have forgotten. So there's this power going on, which I don't think there is in other specialties in the same way.

There's one thing not knowing, but the next level, like you say, is women being empowered and knowing, but yet they're being refurb. And that is a really awful place to be in 2024 that women are not having a voice when they deserve to be heard. In the UK, how is it with the NHS? Because I'm assuming, I don't know, is your clinic, you know, can women come with NHS coverage and get care from you or is it a cash pay situation? No, so it's a private clinic because when I set it up, I went to various

NHS practices and hospitals and they said there's no funding for menopause care. We're not doing it's not a priority. So the only way I could start seeing patients was to do it privately, but I only wanted like three doctors to work with me. I wanted it to be very small. I had no idea how many women were suffering. I had no idea that people would come from all over the country telling me stories. And a lot of them are young women who have really not been listened to,

have had their ovaries removed and just being told, see how you get on. And then their life's fallen apart in front of them. They've still not been able to get hormones. So we see people who are generally underserved by the NHS. But the NHS still say that it's a natural process. They just say it's a condition, it's not a disease. And there's a big debate, isn't there, whether it's a disease or not. But actually, it doesn't really matter what you call it.

Like you say, it's associated with diseases. And this is something that really worries me, actually, because sometimes I'll put out on my social media is something about association with osteoporosis or heart disease. And then people are saying, well, all the menopause societies are saying that it isn't associated and we listen to the menopause societies. And you can listen to who you like, but you can just look at the evidence and you can actually just read very basic science, sharing how important our hormones are for every cell

in our body and how anti-inflammatory they are. And I wouldn't ignore someone with raised blood pressure. I wouldn't ignore someone with a raising glucose and had diabetes. So why would I ignore someone who had low hormones with an increased risk of diseases? And, you know, we've known for many years, decades about the protective effects with osteoporosis. That was the first condition that it was documented that people realized could reduce osteoporosis. And that's when osteoporosis sort of slid into the guidelines. But even if you only look at osteoporosis, it affects one in two menopausal women who are not on HRT.

There's a big mortality from hip fractures, but also there's a morbidity as well. So people who fracture their wrists or their pelvis or their hip from a fragility fracture, a low-impact fracture, they're less independent, they're more dependent on others. They're more likely to have mobility issues. they're more likely to have cognitive decline. And osteoporitis is an inflammatory condition. So it makes sense that all the other inflammatory conditions increase. And especially in younger women.

So obviously we've mentioned midlife, but one in 30 women under the age of 40 have an earlier menopause. And NHS are not prioritising these women because they're saying it's not common enough. But actually it is common, the diseases that are associated. with having longer without hormones. And it's more relevant, as you say, because we're living so much longer. So I don't think it's good enough to say because someone says this, I'm not doing it.

And we should be looking at the evidence, we should be listening to patients. And I do think women are understanding more that they want to protect their bodies. They want to reduce their risk of osteoporosis, heart disease and so forth. And it's not a bad thing that we know this. because again it's giving us choice and it shouldn't be just about symptoms because then, as you say, some women don't have symptoms or even when I see people in the clinic. I saw someone today who's had multiple sclerosis for several years. She has pins and needles.

She has coordination problems. She has fatigue. I have no idea how many of her symptoms are due to her MS or how many are due to her menopause. But I do know that the hormones. are very important in the way our brains and nerves work, and it's likely to improve some of her MS symptoms as well. And she made the decision she would like to try HRT for six months, and I can optimize her hormones,

and then we can review whether she wants to continue or not. But for me, as a doctor, to say, no, you haven't got enough symptoms. Just isn't right, is it? No, and you have to ask sometimes, where's the chicken and the egg with respect to her development of MS, because we know so many women are developing, developing autoimmune diseases in their early 40s, mid 40s and beyond.

And that's not a coincidence. If you look at the immune regulation in the body and our T cells and B cells, you know, all the technical piece of it, estrogen is significantly providing the balance in that system. And as we lose our hormones, we lose that balance and we get these self-attacks. And that's the saddest thing is, you know, do we have to have all these statistics of diseases, of aging, if we were to just recognize that the moment the hormones start to decline, that's the time to act, right?

And, you know, I think that piece of it is probably fairly far off, sadly. But I think the other side of it then is even women who do start to have hormonal irregularities in their 40s that their doctors recognize, they're not also given great HRT. I mean, you know, they still consider birth control pills for women in their 50s as a form of hormone replacement therapy. And that's another kind of angle to the problem that we've got on our hands right now with how this system is working or not working. And I wonder, again, you know, what the reason is for that. You know, in medicine, I always want to give the safest option, the option with the least side effects, with the most evidence.

And so why most people don't need contraception at a certain age or it's not something on their radar, why just give them a contraception? contraceptive if they don't need it and it's got synthetic hormones in them which are different obviously to the natural hormones. You know, years ago, all I could prescribe was premarine and prempaxy, which was the pregnant horses during derived estrogen with a synthetic podestogen. But that's all I had. And it was like a one-size-fits-all you have it and you either helps or it doesn't. But that was 25 years ago. Things have changed. So we have the capacity and the ability to prescribe those three hormones, estrogen, progesterone, testosterone, separately so people can have the right dose, the right type,

the right combination for them. But it's still really difficult. And about a third of women who come to our clinic are already on HRT. And they're being told, well, none of your symptoms could be due to your hormones because you're on HRT. And then we see what they're on and they're on a really low dose of estrogen, no testosterone, or they're on synthetic combinations. preparation, and of course it's not going to have the same effect.

So again, you want to be able to make sure women are treated properly rather than a third treating them or half treating them. And women are understanding this. I've heard, I've been to meetings where they say, well, no, we wouldn't recommend people to have hormones separately because women won't remember to take their progesterone and then there might be risk. And I find that really quite discrediting to women

because allow women the choice. And most of us will remember. We're also great multitaskers. Indeed. Indeed. So when there's conversations like this, it really makes me frustrated. And actually, you know, a lot of younger women, I've got three daughters, and my older two daughters, don't really want synthetic hormones.

They just would prefer if they're going to have hormones to have more natural hormones. And so, again, they have to choose. They have to be part of the conversation. And I think that's going to change more and more over the next couple of decades or so as younger women become even more empowered and share information with each other's, which I think is really important, isn't it? Yeah, we say we don't have daughters. We have seven sons between us, but, you know, we're chomping at the bit for the girls in their lives to listen to us.

But yeah, I mean, I think we didn't have awareness of, let's say, xenobestrogens. We didn't have awareness of, you know, poofas and different chemicals and GMO issues and whatnot generally across all health aspects, you know, our food, our body products, or all of these things. And these younger generations are pretty clued into that. And I think they need to sort of take it the next step as it applies to their hormones and start saying no to the synthetic birth control, saying no to the synthetic progestins and that IUD and, you know, find different ways to sort of regulate their body in a much cleaner fashion. But Ray and I go all the way back even to let's start teaching girls about their menstrual cycle in grade school.

You know, let's change the narrative around even the menstrual cycle and let girls understand what it's doing for them beyond just fertility and a monthly bleed. And that piece of it, I think, could really blow everything wide open because women would start to then evaluate the choices they're given in the context of understanding their cycle and their hormone health and everything else. that it would be a much different outcome, but all we can do is kind of help the women right now who are paying attention. Yeah, for sure. And I certainly think with time we should be getting rid of the word menopause and talk about hormonal insufficiencies because then we can quite quickly recognize those people with PMS and PMDD who might be a long way away from their period stopping, but they might have 20, 30 years of terrible periods and it might just be that they are progesterone deficient, and they don't need HRT, they don't need birth control,

they might just need a small amount of progesterone in which we're seeing more and more in the clinic can be transformational. So looking at it across all ages, I think is really important. So lots to do. But before we finish, I'm just keen to ask just about the book that you've written, the great men and Paul's myth. So what's so good about it?

Why do people need to read it, do you think? You know, I think what's different is we're trying to open up the conversation, starting all the way back to when hormones were recognized as very powerful instruments in women's health. And it actually goes back to, you know, 600 AD in traditional Chinese medicine. And I think when women maybe understand the context of their hormones, how they were seen as being so instructive on women's health, how they were used historically, and then sort of this gray area of about 70 years that we had a big interruption in that across the globe

and kind of how we got here, they're going to start to learn, you know, maybe their body wasn't revolting against them. Maybe it's not just simply aging. Maybe it's not that they don't need to fast more or they shouldn't be working out more, that this is actually something they can't overcome necessarily on their own. They need someone to partner with them and help them restore those hormones. So we try and give women that context because I think there's still a lot of fear around HRT and we want to disband that fear. But also, you know, there's plenty of what we call low-hanging fruit for women to pursue in terms of nutrition, in terms of lifestyle, stress management, movement, all of those things. So we try to cover all of that. But then we do come back around to

even in the best pursuits of all those things, most women still will benefit from some rest of of their hormones. But HRT is not one size fits all. It's not a bottle of Advil on the shelf, right? We need to personalize that care and we need to make sure that women have true informed consent. So we try to give a really deep dive on all forms of HRT globally because we wanted to recognize that what's available in the U.S. isn't always available everywhere. So we tried to cover everything and just give women this sort of survey and then let them decide. You know, don't just make it the insurance companies dictating the physicians or the medical societies dictating the physicians to determine what a woman gets. Women should be able to say this is what I want and find a

provider to give it to them. So then we try and give tips on that too and kind of how do you locate providers? You know, many times going to a compounding pharmacy and asking them who's writing your scripts, you know, who are the people that are seen to be approaching menopause care from a whole body health perspective and then, you know, try and seek them out. So that's, we try and to make it, you know, we call it the great menopause myth because exactly what you just said, which is let's get rid of the term menopause. It's nothing to do. There's no magical moment in a woman's life where suddenly this is relevant. It's relevant from the day she's born in those ovaries start. So we just kind of wanted to bust open a lot of those narratives, give women kind of a

to Z in understanding it, how to address it, and then let women, you know, hopefully be the change makers by demanding better. Yeah. Fantastic. And it's so needed because the more people can read and understand every book, people can take things that are pertinent and relevant to them. And it's just brilliant. It's very easily written. It's something for everyone. And I think also it's lovely that it's not been written by a medical person because you just have a different view, a different perception about things, which I think will resonate with a lot of people. So I'm very grateful for you coming on to talk about not just the book, but everything in general. It's been really. really great. So before we finish, I always ask for three take-home tips. So I will ask for two from each of you and go up to four. Two reasons each are really not reasons, actually, two things that you think are going to make the biggest difference to the most women over the next 30, 40 years

with hormones. Besides hormones? Just in general, what things, what actions that are going to make a different. So not what treatment. We know hormones are there and they're safe, but people can't access them. But what are the things that are going to make changes that in 20 years, we can say, look, because of this, this and this, this is what's happened? I would, so the biggest one for me, and I think probably has been my guiding force for maybe for as long as I can remember is, is just seeking, you know, more education, just learning and becoming educated. that to me is just one of the biggest change makers. And then I would say physical exercise is probably going to be one of the biggest change

makers for women whether or not they actually use HRT. I would say in my own life besides HRT, it would be like just the most important thing for health and wellness. Yeah, absolutely. Now I would agree with that. Go on then. What are your two? Yeah.

So for me, I would say similarly to Marian, and these are just things in women's control. I think nourishing your body is wildly underappreciated. I think we as women at this stage in life, we're busy. We're either, you know, running businesses, having careers, being a partner, raising children, helping parents, you know, whatever. We're kind of everything to everybody, and we tend to skip out on ourselves. And we see too many women at this age and stage of life. They are not nourishing their bodies at old. They kind of do enough to get by. And I think women need to start to feed themselves better and feed themselves more. You know, fun fact is these declining hormones are probably contributing more to your belly

in midsection than what you ate last night. So we really want women to focus more on nourishing themselves. And then the other big thing that I think we've seen over the last few years is the management of stress. And, you know, even the best, most individually designed robust hormone restoration therapy will not work in a woman who is stressed. and whether it's getting off devices, whether it's changing careers, whether it's getting more nature, whether it's faith, whether it's meditation, whether it's community. I don't really care. I think we all probably could do a little bit of each of those things, but we need to bring the stress levels down.

And it's not about eliminating it. It's more about mitigating it and blunting the impact of it. Life is stressful. There's a lot of things going on in this world that's kind of coming at us all the time. And I think women need to be more in. about what they allow into their lives and how they kind of allow their bodies to get stressed and bring it down because we just see it too often. You know, great HRT can suddenly not work in a woman who is a super stressful event. So eat and manage your stress. And like Maria said, move and be educated. Those would be art for. Yeah, you couldn't ask for more, really.

I think having this holistic approach, looking at every aspect of our life, being really honest with ourselves and with others is really crucial. So we can make it the best time of our lives, because it should be, actually. So lots we can do, but lots we can do working together and helping each other and amplifying our messages. So it's great to have other people in other countries who are also flying the flag to help women have a positive time going forwards. So thank you so much for your time today.

It's been great. Thank you. Thank you. Health Group by visiting www.newsonhealth.co.uk. And you can download the free Balance app on the App Store or Google Play.