The Dr Louise Newson Podcast - 285 - Friendships and menopause: how conversations can be transformational

Episode Date: December 3, 2024

Joining Dr Louise this week is Louise Mulley, who shares her experience of anxiety and menopause. Louise shares the importance of speaking openly about menopause and mental health, and how a conversation with a close friend helped her recognise her symptoms and find the right support and treatment. She also shares her top three tips on helping friends or loved ones who may be struggling with their mental health during perimenopause and menopause: Help your friend unburden: ask them ‘would you like to talk to me about it?’. Make it clear they can talk to you with no judgement and in confidence. Share your own menopause story to encourage your friend to open up about what they may be going through. Keep an open mind: if you’re a woman of menopausal age and experiencing mood changes, consider that it might be your hormones. For more information on Newson Health, 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 the podcast I've got someone with me called Louise, who kindly has agreed to share her story and everything in medicine, or a lot of medicine, I learn through my patients.

I obviously have got good background knowledge. I learn the science, but actually when it's patience that I learn from all the time. And so Louise was recommended to see me a while ago and was not quite as well as she is now, but she's agreed to share her story. So thanks so much Louise for coming on to the podcast. Great. How would you like me to start just from the beginning, how we came across, I came across you? If that's okay, yeah.

Okay. So I'm Australian and I've been on a holiday in Australia. And while I was there, I was on the moraineer coil, had the marina coil fitted, and I'd had that for some years. I've had three children, and I'd finished obviously having children. I had no signs or symptoms of menopause in any way. But while I was down in Australia, I had this incredibly heavy menstrual bleed, quite unusually heavy, which obviously those of you who have a marina coil will know is not common. And that got me thinking, oh gosh, you know, we all have busy lives and I've got a

job and these children. And I thought, God, maybe that thing's expired. I better check it out. So when I got back, I started feeling quite agitated. I got in touch with my male gynecologist and said, listen, I think this moraine at coil may have expired. And he said, well, it hasn't expired for contraceptive purposes, but from a sort of progester and releasing purpose it has, you're probably about the age where you should be considering some kind of HRT. And I said, oh, yes, Yes, yes, of course, yes, I should. I said, well, I don't want any messy creams and potions and I don't have time for that. Or patches.

He said, well, take these tablets. They're very good. And I sort of said, yes, okay then. And off I went. Anyway, I didn't, and this is so ridiculous because I am quite an intelligent person. But I just, I didn't even read the instructions properly, nor did he give me any instructions because he just said, I'll pop one of these a day, you'll be right, kind of thing. So I was merrily popping them away, but I started becoming more and more anxious.

To the point where a very good friend of mine, who is actually one of Dr. Louise Newsom's patients, was due to meet me. And she rang me out to say, now, what time were you meeting? I said, I just can't meet you. And she said, what's wrong? I just, I can't leave the house. I'm just so agitated. I don't know what's wrong with me. And the next thing, she just turned up at my door.

He's a very good friend. And that works. She made me quite teary. Anyway, she said, this isn't like you, what's going on. And I said, I don't know. And then I just started crying and saying, I don't want to feel like this. I think something to do with menopause. I don't know.

I've been given these tablets. She said, go and get those tablets. So she looked at them and she said, well, you're supposed to be taking them sequentially, which you're not doing. Obviously, they have different hormone levels. She said, but did this doctor get you to do any blood tests? Did this doctor even investigate what sort of hormone levels you had? What's going on?

This is ridiculous. She goes, right, that's it. I can't have this anymore. I'm going to call Dr. Newton now, now, and I'm going to get you. you want an emergency appointment, even though she can't see any more patients at the moment. She's full, but you can't leave the house. And this is ridiculous. And I couldn't stop crying.

So anyway, she sat with me for several hours. We had loads of cups of tea. And then very fortunately, I got to speak with you the following week and relayed that story. And you said to me, I can't believe I'm hearing this. I hear this all the time. We've got to get onto this straightaway. I'm going to send you some stuff tomorrow. Then in a couple of months, you're going to go and have blood tests.

We'll reassess, re-evaluate. and I cannot tell you within a matter of weeks, I was back to my normal self. It was that fast. It was that fast the descent into despair, and it was that fast the track out of it. And honestly, I know it was because of those hormones. It's quite scary, and I do remember seeing you, and you're right, you weren't as well as you are now. But you actually said to me, you feel like you're on a snakes and ladders game and you're the snake and you've landed on the tail and you've gone down. Do you remember saying that to me? It was honestly, it was that fast. In fact, my friend and I were talking about it. She was saying she'd experienced something similar, which is why she was so helpful and supportive.

And she said she equates it to being just standing on a trap door that opened suddenly and down you go. And I said, honestly, and I felt like I was in a game of snakes and letters that I had literally stood on the biggest snake and went right down to the bottom. And I didn't even know how I was going to climb my way out. I couldn't find a ladder. That makes sense. It absolutely makes sense. And it's really scary. And obviously there are many symptoms that can occur with our hormones.

And as many people who are listening, know that our hormones, our three hormones, eustodial, progesterone, testosterone, affect the way our brains work. They work as neurotransmitters, chemicals that have. messages for one part of the brain to another, and they affect other neurotransmitters as well. So when the balance is off kilter, it can really affect people. Sometimes it's very insidious. It's very slow onset. People just feel a bit more nervous, a bit more anxious. They might not want to go out with their friends as much. They might not want to drive as much. They might want to go on the tube as much. And it can be over a few months. And then they just adapt and think, oh, it's just because I'm getting older. But for some people, and we don't know why, but for some people, but for some

people, it can be a real, like you say, fall off a cliff moment, you know, you're fine. And then, and there's nothing else that's happened in your life, you know, to account for this. Well, this was the strange thing, Louise, just for other people to understand. I suppose there's two things I wanted to say on that. The first is, so I am a really happy, positive, cheerful person by nature. I've got a fantastic husband, great kids who are all doing really well. I live in a lovely home. I've got gorgeous friends. I've got a great job. I've got a great job. There wasn't something in my life that could have been causing this. Obviously, you have your little ups and downs of things that go on, but nothing serious. And the second thing is, when I was a

very young woman in my very late teens, I did suffer an episode of extreme anxiety. And I was quite a late developer, too, just to put this in context. And then I sort of got back on track. And I almost have the feeling that this whole sort of hormonal thing that happened brought me right back to an episode of when I was in my late teens and so, so very quickly, and I couldn't see the way out. I just could not see the way out. And there was no reason in my life that I should be feeling like this. And in fact, I couldn't even see the hormone thing for myself because I thought I'd done what I needed to do from a menopause point of view, because this doctor had prescribed these pills to me. But it was when my friend came around who understood and had been there

before herself and she could see, she said she'd seen it all before and she knew it wasn't normal, that action had to be taken. But also the recovery out of it was just so swift. That was the other strange thing. Yeah. And I just want people to know, the reason I was really keen to come on the podcast actually when we talked about it is I wanted people to know how powerful the change and how quick the change can be, but that a lot of doctors themselves aren't giving women the sort of help and support that they really need. Yeah, and often that's due to lack of education, not realising the power of hormones in our brains. And I've recently emailed quite a few psychiatrists, I know, and I do know a lot, asking what's the evidence for

antidepressants for clinical depression and anxiety? And of course, there is some evidence, but it's actually not brilliant evidence. They do help, but not a huge number necessarily. And there are risks of antidepressants. If people are on the long term, we all know about the addictive properties, but we also, they can increase incidence of osteoporosis, for example, which lots of people don't realise. But actually, when you look, even in our clinic data of people who have anxiety

and low mood, and it's in the 80s and 90s, it reduces by about 60% within three months. at the follow up consultation. Now if I said to you, Louise, I found this new drug that will reduce anxiety by 60%. It will improve sleep by 60%. It will improve memory and also joint pain, skin dryingness. You know, palpitations, it will also improve by about 40, 50%. You'd go bring it on. Can I have some, please? But we've got this, but people are avoiding it because they're so worried about the potential risks, which we know for most types aren't there. But the other thing that you're clearly highlighting is that you weren't on the right dose and

type of HRT. And that's really crucial. About 37% of women who come to our clinic are already taking some sort of HRT. And often they've been told, it can't be your hormones because you're on HRT. But that's like saying you can't still have a headache because you've taken paracetamil and that's a pain killer. Well, actually, I might need to take. Brufin as well. It's not, you know, and there are so many different doses. And if you take a tablet,

as you know, estrogen then gets metabolized differently. The progesterone is usually a synthetic progesterogen, which can have detrimental effects because it can block the natural progesterone working in the body. And then, obviously, testosterone is another hormone. And some people respond better to testosterone than estrogen. You know, we're all different. And that's where you said having the blood test afterwards is in my mind quite useful. It's still only a guide. But actually, if someone has got low hormone levels, being on HRT, it suggests they're not absorbing it properly through the skin and the dose might need changing. So it's really crucial that we review people regularly and make sure they're on what's right for them at that time. So what you're on now,

even in a year's time, could change if your body changes in some way. You know, you might still be producing hormones now that will reduce with time. And that's fine. And we need to know that giving hormones is a dynamic process. It's not like a one pill. There you go, Louise. On your go. You've had this, which is what you were really told before, isn't it? That's right. Well, they're not even told how to take them properly, quite frankly. I mean, and I don't want to say that he was sort of mansplating me or anything like this. But it was, I mean, it was more like, oh, just take one of these and off you go. And I was just so naive. I just thought, oh, yes, he's a doctor, he knows what he's talking about. And that was my mistake. Well, to be fair,

you might have got better in which case, absolutely, that's fine. And certainly a loss of my work as an educator, medical writer, is to just empower people with knowledge and then know that we're all different, know about the different hormones, know that there are other reasons why people can feel like this. But certainly, when somebody has a mental health issue, without any triggers at a certain age, we've got to be thinking, rather than could it be the hormones, we should be asking ourselves as practitioners, is there any reason why it's not her hormones?

We should be thinking hormones at top of the list. And it's a pivot to the way we've been taught and the way we're thinking and the way that I wish I'd thought for 30 years as being a doctor. Because now in my mind so much is related to hormones, and I'm usually right. But I didn't think about it before, because no one told me to think about hormones in women of any age because hormones can change. And it's really interesting because someone ages ago was pushing back in a lecture that I gave and said,

well, you're just medicalising women. We don't medicalise adolescents or people that have hormonal changes when they're younger. And it's really interesting because I'm increasingly doing work for women who have PMS and PMDD, which you could say is just a normal part of their cycle. they're feeling rubbish a few days before their periods when their hormone levels drop. But actually, those women, just having hormones on those few days to lift their hormone levels, it can be transformational for the way that they work. So that's fine as well.

We're allowed to do those things too. Yeah. It's interesting, isn't it? Because obviously teenagers are going through a lot of hormonal changes. And I actually, all through my reproductive life, suffered from terrible PMS, terrible pain, but more significantly horrific a couple of days of deep, deep dark depression, really. And then, I mean, I'm such a moron. I literally would feel this way.

I'd start crying. And two days later, I'd get my period and I'd feel happy again. And I'd think, oh, that's what it was. You know, it constantly seemed to surprise me every month. But it's weird. I think that's where having such a good friend has been amazing for you because you want someone to recognize it because I think so. often as women, we normalise the way we feel. And actually, when you're feeling low, it's also

your brain often doesn't process in the same way. So you do think, oh, that's just a life, that's just it. Yes. And many of us felt like that. And actually even now with my youngest daughter, who's 13, she's, sometimes she's really level-headed, but every so often she gets very tearful. I'm like, gosh. And then she's has this really heavy period. It's like, okay, that's why she was like that. And we can laugh about it. But, yeah. I was very lucky to have such an understanding friend. And that is why I was quite keen to talk openly because I still think there's such a stigma around mental health issues, anxiety, particularly with women. So many women I speak to who are in sort of my age bracket, I'm now 54, are suffering from tremendous anxiety and other things

and having personality changes and all sorts of things going on. And it needs to be spoken about, at least menopause now is in the conversation. When I was young, My mother and her friends, I didn't know anything about menopause because they didn't talk about it. Now people talk about it, but the mental health side of it is still not talked about very often. No, you're absolutely right. And I do a lot of training with psychiatrists, actually. And it's really interesting because they are waking up to it, which is great. But they haven't been talked about it before. And I do a lot of training for psychiatrists. Because we need to recognise it. There's so many conditions that are now around that they weren't even 30 years ago,

I qualified as a doctor. And a lot of these personality disorders, you know, it's not a personality disorder. It's the disorder of our hormones that hasn't been identified. And I suppose, you know, the important thing for people to understand is, of course, there are other issues for mental health and other issues around mental health. And it might be that there are other factors coming into things and at play. And, you know, hormones aren't the panacea and the be all and the end all. But in my particular case and why I felt quite strong,

strongly about talking about it, is that, you know, I was at a certain age. So it's obvious that something was happening hormonally. I was too blind to see it because I got myself into such a state so quickly. And, you know, it really, really did work in my case. And obviously it's not going to work in everyone's case, but it couldn't do any harm. Well, this is the thing. I totally agree. And you can have more than one diagnosis in medicine. So you're, you know, there are some people that do have a psychiatric illness. They do have clinical depression or schizophrenia or bipolar, but they'll also be menopausal and perimenopausal. So there's no way that I'm saying it's all related to hormones and when we find if everyone just has their hormones, but we need to co-prescribe, we need to work together

the same way that if someone had an abdominal operation and also a migraine, you would give treatment for the migraine and you would do their surgery as well. That's fine. But I think what's happened for many years, decades, centuries, is that our hormones have been forgotten. And then you can never completely help that person to be completely well because you're not treating the underlying cause. Yeah. I think the other thing too, I wanted to say, I suppose, is that you talk to so many different people about their experiences with menopause.

Some people have 10 or 12 different things happening to them. Some people say they've had nothing happened to them. In my case, it was one, well, I will also say I've been a bit of weight gain, but I don't think that's because of menopause. I just think that's my age, sadly. But in my case, I really just had one big thing happen to me. I have no brain fog. I don't forget things.

I sleep extremely well. You know, this thing just went, it was like I've got one big thing happen to me. And so, again, I think, you know, women need to know that menopause isn't one of these things that necessarily causes brain fog or heart palpitations or lack of sleep. It could be just one other thing. And if you are suffering from anxiety or you are feeling stressed and anxious, maybe go and do something about it from a hormonal point of view. Yeah, and that is really important because actually some of the menopause guidelines will still talk about hot flushes, sweats, low mood and vaginaldiness. They don't talk about any of the other symptoms at all.

And lots of people think you have to have a certain number of symptoms or a certain duration for those symptoms or a certain sequence of events and some menopoles conference. I've been to, they say all women have flushes and sweats and then they have some low mood and then they'll get vaginaldriness. And it's like, hang on, no, I've seen women that have only had tinnitus or they've only had dry skin or they've only had vaginal, dryness and cystitis when they're young and no other symptoms. So we can't put people in a box and say, no, you've not had X, Y, Z symptom, therefore you can't be perimenopausal or menopausal. And that's a danger, I think, medicine because we don't have a diagnostic test. You know, I can't send you for a blood test and go, yes, actually, you are definitely menopausal. But even if you had a blood test, of course,

age 54, you know, your hormone levels will be low because that's what happens as we age. But having low hormone levels doesn't mean it's the cause of your anxiety. You know, you could have had something else going on. And so that's why in medicine, it's really important that we keep our minds open to all sorts of reasons for a problem. possible diagnosis and also think about a differential diagnosis as well because sometimes what happens is and I've seen it a lot people maybe give an example for someone with tinnitus the ringing in the ears I saw a lady recently and she had been seen by the max fax team she'd been by ENT so she'd had brain scans she'd had inner ear balanced tests everything was normal so they said well you're it's fine you're

normal she's like no I am waking up with tinnitus it's driving me to distraction I really can't hope I can't work, I can't function, it is awful. And she was 54. So I said, well, your menopausal because of your age, I know there are more benefits and risks for you for HRT. I have no idea if it's going to help your tinnitus, but we know tinnitus is a symptom. Let's see how you get on. And then when she came back, three months later, she's like, you've cured me. This is incredible. So the proof is in the pudding sometimes, as long as we're giving safe treatment to see if it helps. And if it doesn't help, then I can think of something else, you know. And that's what we often do in medicine. But you, you know, your story was very clear that you had this

catastrophic. It really was catastrophic anxiety. That was awful. Yeah. And just so fast. But fix so quickly too. That's the unusual thing. And the other thing I also wanted to say is I have told a lot of people my friends about it because I just, you know, I think it's important for people to not be afraid to talk about these things. But there are a few women that I knew who've sort of said to me, oh, I haven't needed any HRT. I've been fine. I have no menopausal symptoms, almost sort of showing off, if that makes sense. And well, good luck to them. But the problem is that makes other women feel bad. And I don't want other women to feel bad about taking HRT. It's not a secret. I think that why wouldn't you? And I want anybody out there who might possibly feel even the tiniest bit anxious

or low, to go and get their hormones checked and to continually check their hormones and realize that maybe it's not them, it's their hormones. Yeah, and that's where doing even a symptom checker, like on balance app, is really useful because you can see if you have any change in symptoms. Now, having hormone levels checks can sometimes be confusing, but thinking about hormones is the most important thing, but also allowing others to know the importance of hormones. So they can maybe witness it in you and, you know, maybe ask, could this be related to your hormones? Because I've read that anxiety could be a symptom when your hormone levels change because that's really useful as well like your friend did for you. But you're right. And I've seen quite a few

patients over the years who've felt so much better on hormones, but they say, well, I am not telling my friends. It's like it's just a badge of shame for taking hormones. And that's hanging over from the WHOHI study from people thinking hormones are bad. And actually, I keep saying to people, you don't get a medal for suffering. No one says, well done, Louisa. You've had menopausal symptoms for three years and you've done nothing about it. But also, I think we need to turn away a bit from thinking even about symptoms because we need to be thinking about the health risks of not having hormones. So we know that there are health risks the longer we are without our hormones, so are you being menopausal? And these risks include heart disease, dementia,

osteoarthritis, osteoporosis, clinical depression, type 2 diabetes, neurodegenerative disorders. I mean that's just, we know that, that's a fact. It doesn't mean everyone's going to get these conditions. It's like saying to you, if you never exercise again, you will have an increased risk of all the same conditions, actually, or if you eat fast food every day, or if you smoke or drink. It's your choice, but you need to know that. So these people that are saying, I don't have symptoms, fine. But actually, they've still got these health risks.

And you obviously can reduce risk by nutrition exercise, but you're not going to replace those missing hormones that are biologically active. And it's really important because we're living so much longer. In the Victorian times, the average age of the menopoles was around 57. And the average age of death for women was around 59. And evolutionary, we're designed to reproduce, aren't we? We're designed to be pregnant most of our lives. With very high levels of hormones, actually, when we're pregnant.

we're not really designed to have 30, 40 years without our hormones. Funnily enough, my mum, who is 76, had a late-onset epilepsy condition, mainly because she had a brain tumour when she was 50 and went into menopause as a result of that surgery. And everything was fine, but then the scarring, it was a bit more rudimentary in those days, the scarring on the brain caused to have late-onset epilepsy. She's got this lovely old doctor who's about 90. And he said, get back on HRT. Now obviously she's on anti-epilepsy medication, but she said the HRT has made an enormous difference and she said, I will be on it till I die.

And that's really interesting actually when you look at the effects on the brain. I'm very interested in neurophysiology, so how our brain actually works and how it responds to hormones. And our brains produce hormones. And one of the first things our brain does if we have a head injury or a stroke, the same with your mother with a scarring on the brain, is that your brain cells will produce some progesterone, which is very, very, anti-inflammatory, very healing, if you like, on tissues. But if you are older and you're not producing the same amount of hormones, of course you won't have that there. And so it can not just stabilise conditions, it can improve conditions. And over the years, people have said, oh, we can't start HRT and older people because there are risks. No, there are risks with older types of hormones,

but not the natural ones. And I've got a patient who's got dementia and it's quite mild, but It's come on over the last couple of years and she started HRT and it's absolutely stabilised her dementia and she had a fall recently, quite a nasty fall, but she didn't break her hip. That's interesting. And when she went to hospital, they were shocked that she hadn't break her. And so she's still independent. She has carers, but she's at home. And it definitely has made a difference to her muscle strength, obviously her bone strength,

but cognitively she was declining quite a fair amount. And if she carried on, she's only 76, if she's a life. for another 10 years or so, she'd definitely be heading towards a nursing home and it's been stabilised and who knows whether it's hormones or not, but certainly her son really doesn't want them stopping because he's noticed a really big difference. That's very interesting. Well, all I can say is, do you know what, I'm very grateful to you. I'm extremely grateful to my friend. I mean, she's a very good friend indeed. And I think all of us are very lucky with the friends we have in our lives and we need to share with them because if I

I hadn't shared with her, I don't know where I'd be now. Yeah, and that's such an important way to end, actually, is, you know, look out for each other, sharing information, sharing how you feel, because so many times people feel embarrassed, especially when it's mental health, it's so much easier if I had a rash on my arm to show you and you would give me sympathy. But when we're feeling vulnerable, when we're feeling low or anxious, it's a really crucially important time that we share with people because those people might help us get the right. help support and treatment. So I'm very grateful for you being so open about your story. Before we end, I always ask for three take-home tips, so you're not going to run away without me asking those. So three tips, I'm going to spin it a bit. Three things that if you were a friend and acquaintance, a loved one, a work colleague, and you saw that person slipping mentally, what are the three things that you think would be really useful for them to do? Well, if

I saw it, I would firstly approach them and say, would you like to talk to me about it? And if not me, somebody else, would you like to talk about it? With no judgment, and of course, I'm not going to talk to anyone else about it in a very confidential way so that they felt they could sort of unburden themselves. And then I guess if I hadn't told them already, I would share my story. That would be my second thing because often if people realize it's not just them, they feel more comfortable in sharing what's going on. And the third thing, I suppose, is I would always tell anybody to just keep an open mind.

Because obviously, if you are feeling very low, you should certainly not turn away from antidepressants or other sort of psychological aids or talking therapies or any other sorts of therapies or medications because your experience might be individual to you. But if you do the maths and you're a woman between 45 and 60, there's a very high chance your hormones are playing an integral role in this scenario. So keep an open mind and perhaps consider that it might, as I said, not be you. It might be your hormones. Absolutely.

Really important and great advice. And I'm very grateful. ever so much for your time today, Louisa. It's been great. Thank you for your time. Because you helped me a lot. Thank you. You can find out more about Newsome Health Group by visiting www.newdenhealth.com.uk. And you can download the free balance app on the App Store or Google Play.