The Dr Louise Newson Podcast - 291 - ‘I’m 76 and thriving on HRT’

Episode Date: January 14, 2025

In this week's episode of the podcast, Dr Louise Newson talks to Paula, a 76-year-old woman who reached out to share her experience of being on HRT for over 30 years. Paula explains how she was prescribed HRT after a hysterectomy when she was 44, following a complicated gynaecological history, which included an ectopic pregnancy, ovarian cysts, fibroids and endometriosis. She had been taking HRT for a decade when the 2002 Women’s Health Initiative study was released. Paula explains how she researched the study, then weighed up her personal risk and benefits in discussion with her doctor and made the decision to carry on taking HRT. Paula was happy to stay on HRT and credits it with helping her to feel better in her 70s than she did in her 30s. 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 Neuson 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 really want to welcome to Yui, Paula,

who is someone that I've connected with remotely. This is the first time I'm seeing her speaking to her. And she's approached me because she wants to share a good news story. Sometimes some of my podcasts are quite harrowing or quite negative. stories. But actually, Paula's is brilliant. And actually, she wants to just talk about how her treatment has really kept her to be so healthy. So, Paula, welcome today. Thank you, Louise. Nice to meet you. So you are, you've agreed that I can show your age, which is very good. And the people that are watching or see a photo, I don't think you look your age at all. You're 76.

And you're fit and well. I am. You certainly look very fit and well. And physically, but mentally fit as well, aren't you? Which is wonderful. I like to think so, yes. And so just, and you do take some medication, of course, and obviously goes without saying that you're menopausal, because you're 76. So the average age of the menopause is 51. Some people, I have met women who are 56, 57 when their periods stop, but at 76, you would be really, you know, creating history if you were still having natural periods at the age of 76. So you're definitely menopausal and you're very well, open that you take HRT, but I'm just really keen to hear about how long you've been on HRT for, how you started it and how you've managed to keep going with so long taking it.

And what you think it's doing for you as a person now? Okay. Well, I've been on it for 32 years since I had a strength to me when I was 44. Right. I had a complicated gynecological history before then, which started it all off when I was 22. had an ectopic pregnancy, discovery of a bichorice. And I was told very clearly, I must not ever get pregnant again. And I was fine after that.

I mean, I got on with my life, but I did have two episodes of ovarian cysts. And the second one was what led me to have the hysterectomy. I think it was a combination of the two ovarian cysts plus my previous history by cornyate uterus, the ectopic pregnancy and probably quite a lot of adhesions as well. So it was agreed by a company doctor who happened to be a gynecologist, which was really handy for us. And the man he referred me to, which is somebody that he knew, who was a brilliant surgeon, who was also a menopause specialist as well, which was really a stroke of luck. And he also agreed that his rectumary was. the only way forward in that situation.

So you had your hysterectomy. I did. And were you given HRT straight after then? I was, much to my surprise. When the specialist came and saw me, he first of all reassured me that I didn't have any cancer because I think that was the biggest worry because the ovarian systems are quite large.

But he said I had had not only a bigger ovarian cysts, but I had fibroids and quite extensive endometriosis. And I didn't know about this at all, except I didn't feel terribly well, I have to say, during my 30s at all. So he said to me, I don't want you to feel unwell going forward. And I think, you know, with the result of sort of a surgical procedure that brings you to an immediate menopause, this will not be good for you without having some hormone replacement. So he said, I have popped in an HRT pellet, which is what I started with, which will last you for six months and help you get better and recover from the operation. If you want to use it going forward, you can.

And that's how I got to continue because I felt so much better after the hysterectomy. I can't tell you. I hadn't realized how bad I'd felt until I felt so much better. Yeah, and that's that interesting because a lot of people, if they've had an ovary removed or they might have had endometriosis or just their ovaries while working as well, and then they get replacement hormones. They feel so much better often. But it's really great that you were offered, the HRT. And actually, many years ago, they did give a lot more implants. So the implants are pellets, they go under the skin.

slow release. And that was really because we didn't have the patches and gels that we do now. So it was either a tablet. And actually it was genius. And so sometimes people gave just estrogen or sometimes they gave testosterone as well. I don't know which did you have. Can you remember? I think I just had estrogen. Yeah. I think it was just estrogen at the time. Yeah. Which is great. And actually the recommendations now are that if people have had a surgical menopause, so they have their ovaries and womb removed, then they should be offered HRT unless there's a real reason why not, especially when they're young. But we've recently, one of our research team, did an audit in one of the hospitals in London, I won't say which one, looking to see how many

women after having their ovaries removed who were young were offered HRT. And the number was vanishingly small. And it's really quite shocking, actually. You're removing their ovaries which are still functioning. So you're meaning that the ovaries won't be there, weren't be having any hormones, or there will be some hormones, but not anything that was produced from the ovaries, of course. So that can lead to symptoms, but more importantly, it can lead to health risks as well. And the more I understand what menopause really is and what it means, we shouldn't be thinking about just symptoms, actually. And I'm very interested in, you know, being well as long as possible. And it's this whole sort of health span rather than lifespan is so a

important. It's not the age we die. It's the journey to that age. And it's very hard when you're in your 40s because you do feel better than you do when you're in your 50s and 60s because you know, you're younger. But actually, like you say, even in your 40s, you were struggling but didn't realize because you didn't know you could feel any better. That's absolutely right. And in fact, even now I'm certainly in my 70s, I still feel better than I felt in my 30s. And that's probably because you were hormone deficient. Probably, yes. I was dragging myself around.

I was very tired. I was in quite a demanding role. I worked in the city at a senior level. I didn't mind it. I was quite enjoying it. But it was full on 100%. And there was no time to breathe. You know, it really was.

And I assume that the tiredness was to do with the long hours. And although I did sleep quite well, but, you know, it was very long hours. And the thing is insidious. It sort of builds up. You don't realize, I didn't know I had endometeusis. I had bloating. I had been kind of a bit of discomfort during periods. But again, I'd been brought up in an era where women were told, or young girls were told,

look, you're going to have periods, you're going to feel maybe a bit ropy for a couple of days, take a couple of aspirin, you'll be fine, get on with it, which is what we all did. And I don't know that because that was how things were handled then. But it still happens now. And there's very much this attitude that you have to put up and shut up and just get on with it. And that's your lot. And for some things, of course we have to just put up with things. You know, certain disasters that happen or things that have happened in our life that are out of our control.

I do constantly feel having that mindset we can cope with things is really important. Otherwise, you dwell. Someone said to me a while ago, you can't change the past, Louise, so don't reflect too long on it. And I think actually that was a really good piece of advice because I, like many people, can catastrophize anything. I wish I hadn't said that. I wish I hadn't done that. If I hadn't done this, that might not have happened. But you can't change the past.

But you can change the present and the future. And certainly when it's symptoms or we know there's a medical reason for something. And what's happened so much and it still happens now is menopause is, normalized. So it's like, well, you will have symptoms. You will feel tired. You will have flushes. You will have low mood. But that's just your lot. But that's not right, is it? No, no. And I think it's far better now. People can speak out and say if they're feeling unwell. Although, to be fair, it wasn't bothering me sufficiently until I had a particular episode that frightened me. When I went to see the company doctor about, you know, having this

pain again before my hysterectomy because I felt very lightheaded too and this is something I'd felt when I had an internal hemorrhage when I was 22 with the ectopic and that worried me. I thought something's not right here. Unfortunately he acted immediately, sent me immediately for a scan and I was referred to. I went to saw him on the Monday and I was in hospital having surgery on Friday, which was fantastic. And, you know, both those doctors really, I think, really did a great job for me, really did. And I'm very grateful for that. And that's a really good story. Of course it is. So you've been on HRT. You felt great. And then over the years, I'm sure it hasn't always been easy to keep HRT being prescribed for you.

Because obviously in 2002, the Women's Health Initiative Study came out, the WHOHI study, which, I've been looking at some of the news reports recently, actually, some of the videos were saying HRT causes breast cancer, everyone needs to stop it overnight. Like, it was just awful, actually. It's the biggest travesty to women's house. But you would have been caught up in some of that, I'm sure. So can you remember what happened? Yes, I do. Well, when I read it, I thought, hmm, okay.

I'm not, I don't tend to panic. You know, I tend to think, what am I going to do next? What's my next course of action? What can I do if it's something I can do? I thought, well, the first thing I'm going to do is talk to the company doctor because he was the one that was prescribing this for me. There was no chance of me getting it, you know, locally at all. And I was quite happy to pay for it because it worked.

So it's fine. So we spoke about it. I didn't think immediately, oh, I've got to come off this. In fact, quite the opposite. It was my main concern was I hope he'll be able to continue. to prescribe this for me. Because I've been on it by this time, probably about 11 years. And I thought, you know, I feel fine.

If anything awful was going to happen, it probably happened by now. A large part of what might go wrong has been removed in any event. And yes, breast cancer, okay? It wasn't in my family. It didn't run in my family. It doesn't mean to say it was soapia, but it didn't. And I thought, no, I don't. Well, then would have panicked about this.

And I very quickly learned as well that this was a flawed study. And it hadn't been properly peer-reviewed. And I thought, no, I don't want to come off it. I'm going to take, yeah, I weighed up the balance. I feel so much better. I don't want to feel like I felt 10 years ago. I want to continue to feel well as I do now. So I stayed on it.

Didn't come off it at all. And with the support of the doctor, he said, well, obviously it has to be your decision. But if this is what you want to do, that's fine. And he continued to prescribe it until he got to the stage. And I carried all of this until I sort of retired myself. And I knew that he would, because I could see him privately after that, if I wishes, that wasn't a problem. But I thought, you know, there's going to come a time when it will be so much easier to have it prescribed locally. So I asked him if he would write to my GP, which he kindly did, and set all the up-to-date information as well.

wealth, which was available at the time, as told him I'd been on it for a long time, not of them, and that in his view, I needed to continue or wanted to continue. And they did let me have it, but it was quite clear that there wasn't the standard of knowledge about it within the surgery, although they were kind and they helped and they listened, which was a good thing. Which is wonderful, of course, isn't it? Yeah, that's it's very interesting because there are a lot of doctors now have grown up in the era of the WHA study and some doctors and some practices were actually paid to

stop people on HART and it was that people were actually called in to be stopped because of this study which is awful when you think back about it and and then then after that menopause wasn't a priority because people thought well there wasn't a treatment or the treatment's too dangerous so people weren't being educated so there's a lot of people with misinformation and as you might know I've worked as a medical writer for many years And I started doing my medical writing in 2000 when I was qualified as a GP. And I wrote a weekly column and it was for a GP magazine actually called GP. And it was just a hot topic.

So I would choose a topic and I would give them some tips really. So about raised blood pressure or diabetes and I would scour the evidence. I would summarize it and add a few references so they could see the sources. And so I wrote first about menopause and HRT in 2000. It was one of the first topics that I wrote about said, There's more benefits and risks. It's very safe. It's well tolerated.

Lower risk of heart disease and osteophrosis with some references. And then it was interesting because then I wrote again in 2002. And the study had come out. But because I wasn't, I was just in my GP practice, I wasn't aware of all the take people off HRT. This is awful. I wasn't aware of all this really because the end of anything in medicine. I've always just looked at the evidence.

So I was looking at the articles that I wrote recently. And this article basically just said this study has come out, the WHI study. It shows that there might be an increased risk of breast cancer, but it's only with synthetic progestogens. The risk is still lower than if someone drinks wine regularly or smokes or is overweight. So actually, this study is really reassuring. And the study did show that it reduces risk of heart disease and some women and reduces osteoporosis.

And I thought, isn't that interesting? I've just used what I read from this. I didn't see all this sensational reporting. And so it was quite interesting that I've sort of just carried on regardless. But actually what's happened is there's been this big media effect. There's been this big worry and anxiety in medical professionals, especially by gynaecologists, but some GPs and other healthcare professionals. And when the MHRA took it on board, so they keep putting all these risks and there still are with HRT.

And it's not just in the UK, it's been globally. So globally, H.RT prescribing was really on the increase. There was more than 30% of menopoles of women in the UK, around 40% of menopals of women in the US were taking HART because people understood the disease prevention effects, especially for the heart and bones. And then suddenly, that's it. The rugs pulled over under a lot of these women.

HART prescribing went down to 4% in the US and around probably 5, 6% in the US. and around probably 5, 6% in the UK. So you were very lucky that you were one of the minority that managed to keep going. I really was lucky. And I can't be more grateful for this because I really think it's made a huge difference.

And I know I have a number of friends who have had terrible problems trying to get onto HRT. And they shouldn't have to fight. Women shouldn't have to fight to do what they think is best for their own body. We're constantly being told you must take control of your own health and you eat properly, do this, do that, do the other. But when you want to do something that helps you, then you're being told no.

I mean, what I find difficult to swallow is if you had diabetes or thyroid problem, which are hormone-related issues, they will be routinely treated. And this is a deficit, a hormone deficit. I can't understand why this is done. It would keep so many women, I think, out of the doctors generally, not just for gynecological issues, but for all sorts of other issues. You know, because they would feel well. And feeling well and quality of life is so important.

I totally agree. And I think there's been so much sort of debate about it that we've lost what we're trying to do sometimes. And that happens in medicine when we've got lots of different opinions. People might have their own agendas as well. But I went into medicine to help people feel better and to be healthier. That was why I went in into medicine. And most people do, actually.

But also, I'm quite scientific. So I wanted to give people the best treatment based on the available evidence that we have. But the other thing being a GP taught me far more than a hospital doctor. So as a hospital doctor I was for a few years before I went into general practice, that was very much about evidence and regurgitating papers. and giving the right drug to the right person at the right time. Really important, of course. But my general practice taught me about sharing decision-making with the patients

and seeing what was the most important thing for them. And even in the clinic now, we ask all our patients when they come back for three, what are the three things you want to get out of this consultation? And it's been the best thing ever to ask because sometimes it's not what I want to get out of the consultation. But I focus on what the patient wants. And that's really important. And like you're saying, you're really into your health in general. You've made an informed choice.

And so I don't feel as a doctor, I can say no to something when someone has made a considered choice about something. And this is where I can't think of any other medicine that is refused so frequently as HART. And that's what's really sad when we know that there are more benefits and risks for the majority. Most types of HART actually don't have a risk. But actually, lots of other medicines have far more risks and less benefits. I agree.

I absolutely agree with that. It seems that women have had a fight for things for a very long time and it goes on. We're not there yet. It's improving, but we still have a way to go. We do, don't we? Yeah. And I think also it's convenient for society for us to be not performing quite. quite on par. I do think it's become more apparent what a problem it is when you think about

the workplace. Like you're saying, you had a very high power job in the city. And I wonder age 44, 45, if you had had a hysterectomy and not had replacement estrogen, whether you would have been able to continue to work at the same place. I don't think so. I don't think so. Because I got busier after I'd had the hysterectomy, things got even busier. So it was a really, really busy period for me. And, you know, I mean, I was surrounded by working moms and what have, how they managed to do it. I don't know, except they weren't running the show, but they were still working extremely hard. But I had elderly parents at that time who had to keep an eye as well. So it was all consuming.

And there's no way I feel I could have continued in that role. I had gone downhill after, you know, even further after having the hysterectomy. and I feel I would have done so. For me, energy levels are there. When I talk to some of my friends, I see some of my friends, or people that are not necessarily friends, but acquaintances,

they don't have the same energy level. And I think that is really important, and I believe that's helped a lot. Oh, for sure. And I think people underestimate because I was talking to someone the other day who's doing some research and to exercise, which obviously is really important in menopause

And she said, well, if we can just get people to exercise more, then they'll feel better. And their bone strength and their heart disease risk will reduce and they'll be so much healthier. And I said, have you ever spoken to menopoles or women who are really tired and really struggling? Because actually it's quite cruel for a lot of them because they don't have the energy in the stamina if they don't have their hormones. But actually, when they have hormones, they often feel more energetic and then it's easy to exercise. And then you feel healthier and you are healthier. and it all works together. It's really important.

But I think looking at workplace, again, we know around 10% of women give up their jobs because of menopause symptoms, usually anxiety, memory problems and fatigue. So it's not about having a fan on your desk or a different uniform, which still is being told so much. I know.

It's crazy. But we also know, we did a survey from NHS, people working in the NHS. But we found just from surveying, there's about 1,300 people we surveyed, 37% said that they would like to reduce their hours, but they couldn't afford to do so. So those women will be going to work and not doing the job that they really want to do or they won't be going for promotion.

And I feel that's really sad because most of us do our job and we want to do the best we can do. You know, you turn us and you, you know, when you've got a job, that's right for you. You're excited to get to work. You get to work a bit early. You're thinking about it on the way to work. You're going home. And it's a wonderful feeling to have a job that you really enjoy, isn't it? It certainly is, yes. I enjoyed my job. I'd never thought of that going part-time because it wouldn't have been a possibility in that role. Well, I understood that. But as you said, the exercise issue, when I was in my 30s, if somebody had said to me,

you need to go and exercise. I'm so too busy, first thing. And secondly, I just don't have the energy. And that was the thing I really noticed in my 40s. It felt like I was dragging myself around the whole time. And now I don't have that. I don't wake up tired. I wake up fine, refreshed.

I get out of bed. I do Zolver twice a week. I took up singing during lockdown. And I took my exams last year. my grade eight last year. So I'm really pleased about that. And it's been great fun. And I think that's really what's important. So now I'm trying to concentrate. I'm doing some of the things I never got a chance to do when I was younger because the world wasn't like that. But like it is now. And you know, so I did some voluntary work for 20 years. I did 16 years as a trustee at the hospice,

at local hospice. And if anything opens your eyes about quality of life, it's doing that. It's so important. And I also worked as an independent specialist for the association listed, too. Very interesting work. And I really enjoyed doing that. All that was post-retirement. And now I'm just having fun, which is great.

But it's wonderful to have choices as well. And certainly the more I talk and think about, menopause, I think about it as a brain disorder, not a disorder of our ovaries, because these hormones go into our brains, but also they're produced by our brains as well. And without our brains, obviously, we're nothing, but we know dementia increases as we age. It's more common in women. It's certainly related to hormones. The longer we are, menopausal, without replacing hormones, the greater the risk of dementia. And obviously, dementia can be multifactorial, so having low hormones, eating the wrong foods, not sleeping well, not exercising, not being stimulated.

They all go hand in hand, of course, and will increase risk. But isn't it important that we can light up our brains? We can be taking on new hobbies. We can be keeping our brain active because that's so important, especially, you know, as you age, you want to keep healthy, don't you? Yes, and I think you want to keep interested in life as well. You know, you're quite right. So you do want to keep healthy.

I mean, that for me is the most important aspect. Because you can't enjoy your life if you're not well. Like, you know, nobody can much. No, absolutely. You're so right. And then I wanted to ask you something which, putting you on the spot here, so you may or may not want to ask, answer me. But you're taking HRT.

What other medications do you take? I don't take any other medication at all. None at all. So just to summarize this, You are 76-year-old lady who takes hormones but no other medication. That's absolutely right. And I'm laboring the point here to be just a highlight, actually, because there are very few 76-year-old women, probably less men,

but most people aged 76 will be taking medication, usually for blood pressure, often for cholesterol. They might take some painkillers for some muscle and d. joint pains, at the very least, and then other medications, maybe for bladder problems, maybe for a heart arrhythmia, maybe skin condition. There's so many things that can happen as we age. And we know that people who take HRT have less biological aging. I can't change the number.

No one can change the number of your, you know, your age of breath. But how healthy you are is really important. And when I think about a lot of the work I'm doing is to try and help people keep healthier, as I said, at the beginning. And that's really important when we think about training health services as well. We've got a really difficult time with our NHS, but globally health systems are straining as well, because we're living so much longer with more diseases, more illnesses, more medications as well. We often talk about polypharmacy, lots of drugs people are taking. And my mother was in hospital recently, and I'm not allowed to publicly tell you her age,

but she is older than you. She takes HRT and she's only, she's on one heart medication, that's it. And when she was being admitted, the nurse said, what other medication? She said, I'm not. Well, you must be. No, no, I'm not. And this nurse was really shocked because she's not used to seeing people. And it's not a coincidence.

It's not just good genes and good eating and looking after yourself because we know these hormones, estrogen is very biologically active. It helps every cell process. to work better. So that's a basic science we've known for many, many years. So you are just a living proof, really. Well, touch when it continues. Yeah, I have to say, I don't have, I don't take anything else. And, you know, life you're fine. Obviously, we're all going to get old in, as you say, we're all going to have to die of something. But I believe that this, in HRT, taking HRT and continue to take it.

Please have really been part in keeping well for me. Yeah. And so just before we end, just really for those people listening, there is no upper age limit for taking HRT. The guidelines and the evidence are very clear that for as long as the benefits that weigh any risks, we have an annual review if we're taking HRT and then it's an informed decision making. But we know that older people, even taking low doses,

is still has good bone protection, can help keep bones strong. So people can keep taking it, as we've said earlier. Menopoles last until the day we die. And so if you stop taking HRT, then you're going to have this increased risk of diseases, possibly symptoms, but it's not all about symptoms, as I've explained already. And then I know you started HRT in your 40s, but some people haven't been on HRT for decades, and they haven't ever been on HRT, or they might have been taken off in 2002.

or they might never have thought about it until they reach their 60s, 70s, 80s. And we do see people in the clinic who say, well, I feel like I've missed out, but I'm wondering whether it would help. And we're very fortunate we have the body identical, the natural types of hormones that we can give to women who are older because they can often be very beneficial. And we often start at a low dose review people. And people can really feel very different and healthier. And we know all the other effects as well.

So I don't want this podcast to be thinking, only listen to if you've been on HRT and continue because there are choices and that's the most important thing. So before completely finished, Paula, I'd just like your three take-home tips. So for three things really, for women who are listening and go, well, it's all right for her, but I'm really struggling to continue my prescription. What three things do you think we should do as women to enable us to continue? if that's what we want to do? Well, first of all, I said, don't be afraid of trying HRT.

I would say, you know, read up about it, find up as much as you can about it from reputable sources, and know that there are different types that you can take. So have a go. If you want to take it, you know, within a few weeks, you will notice a difference. And you say, if it's not quite right for you or you need the dose adjusted, then go back. Don't give up and say, oh, I've tried it. It's not older. And while we're on this, that subject, there are a lot of older women, I'm sure,

who would be really interested to hear what you said a moment ago about it's not too late if you want to start. Because a number of them have said, I've been told many times, it's too late, can't start it now. So that's a good news. The second one is if you're taking HRT, this is my view, and it works for you, and you've been through the menopause, the change is actually taken place, but you're feeling well, don't stop. Say if you had diabetes, you wouldn't be stopping. If you had a thyroid problem, you wouldn't be stopping.

You'd be carrying on because there's nothing to be gained from stopping in my view at all. And a lot to be gained by carrying on, having the protection against these various diseases, inflammatory-based diseases that can make you old before your time. I would say keep going. That will be. And finally, the third thing will be, I think as you do age, and many of the people that are on HRT are much younger than me, but the more important quality of life becomes,

keeping well, feeling well, and having a good quality of life. It really is so important because you can't enjoy your life without feeling well. And also maintain your independence. Most people my age want to be this to maintain their independence for as long as possible and stay out of the doctor's surgery for as long as possible. And I think that will help them to achieve that. Yes. Unless they are very strong contraindicators to say they can't do that.

But then I think, as you've said, I think the most women, it's safe. And for most women, it will be beneficial. Yes. Well, thank you so much for your time, Paula, today. so transparent and sharing so much information, I know it's going to help a lot of people. So thank you so much. Thank you for having me, Lewis. Thank you very much.

You can find out more about Newsome Health Group by visiting www.org. www.newsonhealth.com.uk. And you can download the free balance app on the App Store or Google Play.