The Dr Louise Newson Podcast - 32 - Tackling myths and misinformation in menopause

Episode Date: November 4, 2025

Despite increased awareness, misinformation around menopause is still everywhere with outdated fears about hormone therapy, confusion over types of hormones and mixed messages about risks leaving many women unsure where to turn. In this episode, Dr Louise Newson sits down with Amy Alkon, an American author and science writer, for a clear-eyed look at what the evidence really shows. Amy’s book, Going Menopostal, unpacks the research behind menopause and exposes how gaps in medical education still affect women’s care.Their conversation covers the differences between hormone types, the importance of scientific literacy in medicine and the value of personalised, evidence-based treatment. It’s an honest, informative discussion that helps separate fact from assumption in menopause care.LET'S CONNECT  Subscribe here 👉 https://www.youtube.com/@menopause_doctor Website 👉 https://www.drlouisenewson.co.uk/Instagram 👉   / @drlouisenewsonpodcast  Download balance app 👉 / https://www.balance-menopause.com/balance-app/ LinkedIn 👉     / https://www.linkedin.com/in/drlouisenewson/ TikTok 👉   / https://www.tiktok.com/@drlouisenewson Spotify 👉 https://open.spotify.com/show/7dCctfyI9bODGDaFnjfKhg LEARN MORE Buy Amy’s book, Going Menopostal 👉https://www.amazon.co.uk/Going-Menopostal-Science-Menopause-Perimenopause/dp/1637742452 Take my online education course, Hormones Unlocked 👉 https://www.learningwithexperts.com/products/hormones-unlocked-dr-louise-newson Sign up for my Confidence in Menopause Course 👉 https://www.drlouisenewson.co.uk/education---confidence-in-menopause  

Amy Alcon is the guest on my podcast today. She's an author and a scientific writer specialising in applied science. Her most recent book is Going Menopostal. And she's really unpicked a lot of the evidence. She's dispelling a lot of myths about the confusion between natural and synthetic hormones. And she really talks with a very personal experience as well. It's a really great book and it's a brilliant conversation for you to listen to. So, Amy, I'm really excited to have you, even though you're over in US, but I've been reading

your book the last few days. And I just love it. I love the way you think. I love the way you write. I love your inquisitive nature. So just before we talk too much about the book, just tell me a bit about you and why you even wrote this book. Well, I have had the luck. I've been an applied behavioral science writer. So my writing, I give advice, but it's informed by science. And in 2007, I met Sandra Greenland, who's one of the top epidemiologists and biostatisticians in the world. And I was just desperate. I'm always desperate to be better at assessing research. And this guy is so generous. He coached me since 2007 in how to read and critically evaluate research. And he goes after methodological error and fraud and abuse in medicine. And so he sent me all these articles

and papers about the horrible, horrible effects of care that is not based in good evidence. And because of that, when I have an issue at the doctor, I don't go to the doctor and say, like with my hot flashes, I'm uncomfortable, what should I do? I go to the research base. I learn what the research says, and then I go to the doctor. And that is very protective. And this is why I wrote the book for other women because most women can't do that. They're not these huge nerds. I read science day and night.

And so we all deserve the evidence-based care that you, you know, that you're a source of. You're my hero. And, you know, they're one of the few people in this area that I actually just fully respect. Oh, thank you. And it's interesting because I'm like you. I'm very scientific. I love reading papers, you know, quite meaty scientific papers, but I also really like evidence-based medicine.

And medicine is an art and a science. You know, I feel very strongly that the art form is individualising care, but it has to be based on evidence. And many years ago, like 22 years ago, I wrote a book on evidence-based medicine. Four GPs, actually, it was called Hot Topics for the MRCGP. And the MRCGP is the membership of the Royal College of Physicians. So it's an exam that we take as GPs over here.

But I realize that a lot of people are not quite so geeky as me. They have a better social life and they read other things. And so as busy doctors, you often read like the top line of other sort of highlights of guidelines and you never read the papers. Whereas when I read the papers, I'm not just reading the science. I'm learning about the authors, what conflicts they might have, what other agenda they might have, who's paid them, is farmer behind them? like what sort of paper is it

and what are the numbers in the studies and all sorts of things which really builds up this picture so I wrote the first book and then I did three more books after which were just like first edition second edition so that when people were like treating someone with diabetes

I would be unpicking all the papers and just summarising what they were and I've always worked like that and I really enjoy it but I realise a lot of people don't And it's not just the doctors. It's like you say, patients don't either. And then they go to a doctor. They don't know how much science they've read.

They don't know how many papers they've read. They know they've got a medical qualification. But it's very difficult to know, isn't it? And so to have access to information as a patient is really crucially important. In our training here, medical education in the U.S., it sounds like there's training in how to read and critically evaluate studies there. And I write about the three big men. miss in our medical care. And one is that doctors base your treatment according to evidence. And

that's not true because here in medical schools, it's more a moral failing. They do not teach doctors how to read and evaluate papers. So doctors don't read papers because they don't know how. And then to be fair, at an HMO like mine, they see patients every 20 minutes. And so I might read a night. You're a nerd too. But people want to go home at night and I can accept and understand that as much as I think it is a moral failing for doctors to not educate themselves in the ways medical schools have failed them. Yeah, and it's interesting. So I've worked 25 years ago when I trained as a GP, I was in hospital medicine before and I worked full-time and I didn't have time to read many papers then. But then I worked part-time as a GP so I could be

flexible around my children. But when I wasn't working as a GP, I was doing medical writing. So I was writing articles that was based on evidence for healthcare professions, but also for people as well to learn more. So I've had a lot of blue sky thinking time. I've been really privileged with that. And then I, when I had my third child, I was only working one day a week as a GP and it was really hard. Like, I'd come home after seeing maybe 60 patients and I would literally, my children would know not to go near me on a Monday night. You know, I was broken. But then the rest of the days, I would be reading articles, guidelines and papers, and then I would be summarising them. And if you're writing about it, you have to know the evidence. You have to know it inside out, back to front.

You can't write something unless you can support it by knowledge. And then I'd go back to the practice the following Monday and I'd say, oh, hi guys, what have you been doing all week? And they'd been just seeing patients. They would be having my Monday every single day. So of course they're not going to read. But medicine does advance and change and things that I learned at medical school very different. The drugs that are available are very different now. You know, I qualified 30 years ago. So things have changed. And some doctors just haven't advanced in the same way with their knowledge. I have to tell you, you'll know how horrible this is better than anyone. The head of gynecology at the big, massive West L.A. facility had an appointment with me about two months ago because my gynecologist, who's great, is off.

She told me the circa 2002 advice from the discredited women's health initiative study that I should taper off estrogen at 60 because it causes, and I'm 61, it causes breast cancer and Alzheimer's and all this. And I was so shocked. You know, here's this woman. She told me she read the science. Yeah. No, you haven't. Not only that, you haven't even read the practice bulletins from the menopause society from 2017, 2020, that say, we don't have a stopping rule. we have what you said individualized care so important you know we look at a woman's health and then

monitor her and that's why you can if you initiate estrogen right at menopause or within six years you know for cardiology for cardiovascular health you know you can take it throughout your lifetime if you remain healthy and so you have it in your body protecting your bones at 79 when you're likely to fracture and then you're not left for years from 60 to 80 without this while your bones, you know, become more and more fragile. I think what I'm going to ask you is really important based on your book as well. So I've got teenage children who are girls and I've got an elderly mother. And my younger children can get hormones very easily.

They can go and ask for contraception. Whether they need it or not, they might just want it for their skin or their mood or whatever. They can go and ask it. And I can pretty much guarantee if they wanted it, they'd come out the same day with a prescription of hormones. My elderly mother has been on H.R.T. for about 30-odd years now, maybe a bit longer. She has been phoned up by her GP last week to tell her she needs to stop it. Now, they're on different hormones. So the hormones of contraception are not the same as the hormones my mother's on. So just tell me, with your knowledge and research, which hormones are safer? Oh, okay. So transdermal estradiol, that's basically an estrogen sticker. That is the safest form of estrogen to take. And again, if you need to initiate it as close to menopause as possible.

So menopause being 12 months without a period. And this is healthier than the oral estradial, and you need less of it. So oral estradial can do all sorts of bad things like raising clotting factors because it goes straight to your liver. It's called first past hepatic effect. that's fancy, fancy talk for, you know, you take it orally, goes to your liver, your liver is very good at getting rid of stuff from your body, so you need a huge amount. And then transdermal estradiol, because it goes to your bloodstream, there's a negligible amount, trace amount that gets to your liver. And so it can't elevate those clotting factors. This is very important. And doctors don't know this. I know because one of the other substitute gynecologist just told me, transdermal could cause me to have a heart attack or a stroke. And it, Okay, that's physiologically implausible to impossible. Yeah.

You know, and, you know, and the stroke thing, my blood pressure is 99 over 62. You know, I'm not going to have a stroke. Okay, let's look at our whole health. And this is something I appreciate that you do where doctors don't. Looking at the patient as a system and being the creativity, the art of medicine you're talking about, you need to have the deep transdisciplinary knowledge to be able to look at what is the actual underlying effect. And, of course, one of the other myths of medicine I bring out. is that doctors are not trained in diagnostic reasoning.

So this is a big problem because what they do is that you come in with the symptom. Now, we're empathetic as humans. We evolve that way. And so the doctor wants to ease your suffering. Doctors are not terrible people. There's a sociopath in every profession, but they want to help you. They just don't know how. And so if you treat a patient the way doctors do with their fear,

their unwarranted fear of hormones, give a patient antidepressants, You know, and there are patients who need that, you know, who can't take hormones. If you give the patient antidepressants, what you're doing is leaving their breasts and uterus unprotected, their endometrium, their uterine lining, they're being, they're not being protected against cancer, breast cancer, uterine cancer, they're not having their, you know, their bones helped. So you're treating the symptom of hot flashes, and these do, the antidepressants do, but you're not, you're leaving so much of them not protected, not help. And it's just terrible. And it comes out of the

lack of science, you know, in our medical care and the fact that our practice standards, they're not science-based and doctors don't know. And I want to bring out one thing because since you, you're the antithesis of this, in America, almost none of the gynecologists have any training whatsoever in menopause and perimenopause. They treat patients anyway. which is a violation of medical ethics. And then there are some experts, and they've been trained by the menopause society, and the training is a joke. 45 hours required of continuing medical ed in women's health in general,

15 of which must be in menopause and purring menopause. And then they take an online test, and then they're experts. They're absolutely not. And I know this because I'm like a medical lie detector for science. They say things to me in these appointments. I had 10, 10 gynaecologists deny me. the increased dose of estrogen I needed. And they just say all these things that are not scientific.

And I have to not come off like the irritating know-it-all because that doesn't help you get the drug you need. But it's very difficult. But also, like what I was trying to also tease out with my children, if they did, they don't. But if they did want contraceptive, then that's synthetic hormones. It's not even the same as my mother who takes body identical.

Easter dial, progesterone, testosterone, are the same structure as the hormones we produce, whereas in the book you're very clear, especially talking about the synthetic progestins, but also ethanol, estradiol, the conjugated equine estrogens, so the estrogens that have been used in older types of hormones, but they're still used in contraception. So I find it's like double standards. It's fine to have a contraceptive that's synthetic with risks, but people don't talk about those risks, they're younger people, Whereas any type of natural hormone, everyone always presumes has got risks associated with, even though they haven't. As many of you know, I'm passionate about helping women make positive changes for their long-term health and well-being.

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Your body will thank you. The irony of this, and this is where the art of medicine comes in, so you have the deep transdisciplinary knowledge, and you see that this is ludicrous. You know, I always tell women that, you know, that, you know, I had the copper IUD, which is just copper blocking the little sperm from reaching the egg, you know, and so, and this is so important because, you know, okay, there can be res, perforation, everything,

but those risks, to me, if you look at the end, actual trade-offs, those risks are preferable to the risk of taking these synthetics. You know, we talk about the Mirena Mustache or women who have the Morena IUD. There are all these virulizing, you know, male side effects that can happen to you. And, you know, why would you take something that has health risks when you can use the copper IUD that has no chemicals in it, that just has a reaction that kills the sperm? Yeah, I think because people don't know, and often it's the patients don't know, but also the doctors haven't been educated the difference.

And I didn't know for many years because no one sat down and spoke to me. And if you don't really know, you're not really understanding the difference in the chemistry. So I think this is where your book is so good and interesting because it talks about the science, but we've through it. You've got your own personal journey as well. And we all change when we experience something. That's definitely for sure, whether we're doctors or patients, we become more knowledgeable. and we also know how hard it is sometimes to access the medical system.

So your book does a lot, but it must have taken you a long time to write the book and research, didn't it? Eight year deep dive. I did this thing I'm not supposed to do as an author. I'm still living off my savings. I'm running out because this was such a mission. What had happened was I went to my health care provider to my gynecologist, you know, and I wanted to get oral micronized progesterone for the wonderful work of Geraldine, prior MD, the endocrinologist and clinician. And they, on the formulary, only had medroxy

progesterone acetate, the synthetic knockoff that raised your risk of breast cancer. It is harmful to the brain. It's harmful to the cardiovascular system. And so I fought three battles with a woman who's now the associate director of the hospital, former head of gynecology. They treated me with respect instead of blowing me off. They listened. And they allowed the progesterone, the dose I want to, which they don't give in the U.S. for no scientific reason, because we don't know how we metabolize steroid hormones. And so you need to make sure you have enough to protect your uterus and breasts against cancer. And it's also a very helpful, healthy drug that promotes GABA and sleep and mental wellness. And so this is not a drug where you're in danger. It goes up

10 times the amount in a menstrual cycle in pregnancy. Women are not dropping dead from progester on quite the contrary. And so when I did this, because I'm naive, I'm from the Midwest, and we're kind of like polyanus and I said okay so now I've showed you the science and now will you put this on the formulary and give this to all women I think there's almost a laugh no they wouldn't and to me this was like the equivalent of you know I got the care and it would be like watching a stream of women an endless stream walk into an open manhole and saying nothing and so I did this book I call it the stupidest most horrible and most important thing I've ever done because my joke is that I I forgot to take endocrinology.

When I forgot to go to med school, I had to learn all this. But I did this book as a mission because I thought, how dare you leave women unprotected? When you know this, you've been trained by Sandra Greenland. You have the capacity to write this book in a way others don't. And I include all this stuff on dietary science and everything, the most efficient and powerful ways to eat and exercise doable by mere mortals. And so I put this all together, but it was really, really horrible because you have to do what you're saying, you verify the science. What I love about you is that, you know, you look at the,

the, are people, are the, who are the scientists? And I look at that. And what I see basically is that every scientist, the ones I respect, there, there's some way in which they're selling their point of view a little too unscientifically. And it is, it depresses me. But I understand that we're human and people do this. But I look for it always and everybody. And I look for also big famous researchers. This woman J. Julie Kim, not to call her up particularly, but she's famous. She has a paper on how progesterone causes breast cancer. What? Okay, wait a second. This doesn't make physiological sense. So I go and I read her paper and I look, I always look at the citations in the back. So the citations for this, they all say medroxy progesterone acetate, and that's what those

papers are about. And so this gets spread. It's like a game of toxic telephone. So when you get a prescription here for progesterone. You'll get this, this scary sheet with it. This is going to kill you. Here's how, because it's formidroxy progesterone acetate, not progesterone. That's how big the confusion is and how terrible it is. Yeah, and it is confusing because if you use the word estrogen, it can include ethanol-eustodial. It can include equinextradin's and eustodal and eastrone. So there's lots of different types of estrogen under the word estrogen. But the word progesterone is only progesterone. That's where we're really careful using the word in the US, it's more progestins. We say progestidens, but it's not progesterone. And there is this

big confusion. And like you say, Pryor's work is amazing because she has worked so hard for so many years. And I was reading the other day that she applied for so many universities. I think it was nine times to try and get into medical school as a woman. And her determination was huge, but she's still people like raise their eyebrows and don't want to think about progesterone. So the WHO have got a list of essential medicines. And obviously there's antibiotics on there. There's really important drugs. There's insulin. But when you look at hormones, they only list the contraceptives and modoxy progesterone. They don't have progesterone. They don't have eustodial. They certainly don't have testosterone. And, you know, I think

this is a real omission because it shows this sort of. of ignorance between these different hormones. And we've got to understand the difference because some are associated with risks, the synthetic ones. The natural hormones are associated with lots of benefits. And as you say in your book, the benefits to symptom control, but more importantly, the benefits to future health as well. Exactly. And then another thing, in my book, I wrote the book and the longitudinal research was not out on testosterone. I now am taking it. I had to write my own prescription and the pharmacokinetics for somebody very high up in gynecology because they don't know this. They have the male, the androgel on their formulary. And this men have

20 to 25 percent thicker skin, more sebum. And because I know how to take this, I have, I have to take it twice a day, you know, every 12 hours. I have to divide this, get it in a little, get in a little container within 30 seconds because it evaporates. And I put it on with the back of it, like an eye drop of the individual eye drop thing that I use you know and I mean I'm not I'm not getting an exact dose and this is so terrible and this is the how deep the lack of evidence in in our medical care goes where you know they don't even know that you need to have cream you know they should have cream and you're called oral syringes which is they're not oral and you don't inject them but it's a precise dose for women cream is better with women's skin and I know because I've

read your research on, I've read your papers on testosterone. I was looking at one the other day when I was writing the pharmacokinetics up. And I mean, this is, this is egregious. We don't even have approved here in America. And you have to have hypoactive sexual desire disorder. And by the way, before I did the medical stuff, I read the papers on this because I'm an evolutionary psychology expert. And it doesn't really seem to work for that. But you have to make up this story about your sad sex life in order to get it, you know, because you have to get, you have to look at what is it allowed to be prescribed for by the menopause society. And, you know, I'm not a dishonest person, but I'm going to lie for my, for the benefit of

my health if I have to, to get the prescriptions I need. I have a real issue with HSDD, which is hypoactive sexual desire disorder, because it says that women have to be severely psychologically distressed for at least six months before being able to make that, you know, have that diagnosis. Now, as a doctor, I don't let my patients become severely, psychologically distressed with anything. So, and our guidelines and a lot of other guidelines say that if women have reduced sexual desire, we can consider testosterone, which is a lot nicer and it's a lot better.

But it's not all just about having sex with a partner. So many of my patients are told by doctors, well, you haven't got a partner, therefore you don't need a libido, therefore you don't need testosterone. And I also think as a doctor, I shouldn't be judgmental. If people want to improve their libido, I'm not going to ask them, like, what they're doing with their improved sexual desire. It's up to them. And it feels really like going back in time to have these very rigid criteria to say whether someone can or cannot have a hormone that affects every cell in our body. It just seems weird.

It's paternalistic to use that word. And the thing is, the real reason I wanted it, I have attention deficit, disorder, which I hate it. I don't have a deficit of attention. I have too much, you know, all over the place and I need to focus at. Or all helps me with that. But, you know, in menopause, you have a decrease in noraphenaphrin and dopamine. And these are some of the things that are already, you know, not in sufficient quantity in those of us who have this. And so in menopause, I had, you know, really terrible memory problems, other problems. And estradile help. But the testosterone, I've just been taking it for maybe it's been three weeks.

weeks, oh my God, I'm back to being myself again. I saw that and I had to make up the story about how my sad sex life. Along the lines of what you said, I want to point something out to women, you know, I have a whole section on vibrators in my book, you know, that women, you know, to tell women, you know, it is wonderful, give yourself pleasure, you know, that if you have sort of stigma against that in your head, here's why you might rethink that, you know, and to, to, to, to, to, to, to, to, to, to, to, to, get the pleasure throughout your life that you can have, you know, from the marvelous little clitoris, clitoris here. And, you know, this is stopping women from having the full, rich lives they can,

all this sort of prejudice against, you know, the drugs that comes from a lack of scientific evidence and fear defensive medicine, the practice of medicine to defend a doctor's license, avoid getting complaints, you know, and prioritizing that over. with the patients. And the reason you have to do that is if you're ignorant, if you know the medicine that you can confidently prescribe for your patient and let them know what the risks are and you know the risks, if there are risks, that's, that's real, that's doctoring, how it should be. And it's not what we get for the most part. Yeah, for sure. And actually, there's a lot of risks in a lot of other medicines that I prescribe as a doctor compared to hormones, you know, and there's

not nearly as much discussion out in the public about risks of antidepressants or risk as of antibiotics or risk of blood pressure treatment. It's just maddened how it's been shoo-worned into the space of hormones. Absolutely. So show me your book. I know you've got the book there. I should have done that. I forgot. I was so excited to be on. I forgot to sell my book. This is going metapostal. What you and your doctor need to know about the real science of menopause and perimenopause. And it's written in this everyday language because I needed to tell women the science without it being in this medical ease, where it's impenetrable. So what's been happening? This is so, I have joy every time I get these messages. Women are going to their doctors and sometimes screenshoting science in the book

and using it to get the evidence-based medicine where they're getting the hormones and a sufficient amount, the right kind. And that's just so beautiful. It's so beautiful. I think it's giving people more confidence, actually. Because your book is based on evidence as well as opinion, that's really important so people can learn from it. And you write in such an easy way for people to understand. So I always ask for three take-home tips, but what three reasons are there why people should buy your book? What are the three things you hope that people will learn and be able to act on from your book? Well, I tell them, you know, the actual science in contrast to what they prescribe here. I also tell you, beyond hormones, because I'm transdisciplinary. I know the evidence across

many areas from decades since 1995 of reading and dietary science and exercise, the most powerful and efficient ways to exercise. And they are not based on nutrition research, which is the crap fest of research, where they ask you, did you have a donut? What did you eat last month? I can't tell you what I had yesterday. And so these are doable by mere mortals. I exercise, you can see my muscles. I'm a lazy hedonistic pig. And so, you know, I exercise 16 minutes a week with weights to get like this, you know. And, and so you can do that. I've weights on my floor. I'm not going to go to a gym. You know, regular people, you get a gym membership. You don't go. Then you feel bad because you didn't go. Then you eat cookies because you feel bad. So we're not

going to have that cycle. And then the other thing that I do in the book is to talk about aging at the very end and how women are stigmatized as we age and how ludicrous this is. We're powerhouses. I'm so much better as a human being at 61 than I ever was. And note that I talk about my age all the time. I will tell you my age as insistently as somebody who went to Harvard will let you know that before you've licked your martini aleph at a cocktail party because I don't accept the stigma. And if you're healthy, if you take the right hormones, use the right hormones, eat in an exercise this way, protect your bones through eating and exercising this way. You can live, be old and be fabulous, and have a new career and a new you.

Menopause can be a beginning rather than the sad, oh, the change, and we're not going to talk about it. And that's why, by the way, my cover, I designed my cover and the title and everything. This is bold. It's like, we're not going to be all like ladies' bathroom colors here, you know, the pink and the flower. No, no, no, broken fan. This is about the inexplicable rages women feel in perimenopause when they're not getting

progesterone and through cycles where they don't ovulate. And it's also about my outrage, the going menopause. at women being denied the care. And so this is all about bold. See my earrings? These are, they're like $2. But the size of coffee tables. I wear red lipstick.

Here I am. I'm 61. I'm fabulous. You're not going to ignore me. And that's how I'd like to see women go out into the world. You know, because we're old and powerful and fabulous. And if you have your health, you're more able to do that than anybody. Brilliant.

What a great way to end. So thank you so much. It's been really enjoyable. Thank you. Thank you.