The Dr Louise Newson Podcast - 38 - Why hormone education matters for every clinician

Episode Date: December 16, 2025

In this episode, Dr Louise Newson and Dr Rebecca Lewis discuss the role of hormone education in modern clinical practice and why so many women are still affected by gaps in training. Drawing on their years of running a large menopause clinic and developing educational resources for healthcare professionals, they reflect on what clinicians are taught, what’s missing and how that affects diagnosis, prescribing and long-term health.They explain how their original training programme, Confidence in Menopause, was created to give clinicians practical, case-based teaching at a time when menopause education was minimal. They’ve now taken time to update the programme, now called Confidence in Hormones, so it’s expanded beyond menopause to include PMS, PMDD, POI and other hormone-related conditions. Want more from the podcast? Sign up to my premium offer: https://www.drlouisenewson.co.uk/premium-podcasts Thank you to Vevobarefoot for sponsoring this episode. To get 20% off your first order, use code NEWSON20: https://www.vivobarefoot.com/uk/ LET'S CONNECT  Subscribe here 👉 https://www.youtube.com/@menopause_doctor Website 👉 https://www.drlouisenewson.co.uk/Instagram 👉   / @drlouisenewsonpodcast  LinkedIn 👉     / https://www.linkedin.com/in/drlouisenewson/ TikTok 👉   / https://www.tiktok.com/@drlouisenewson Spotify 👉 https://open.spotify.com/show/7dCctfyI9bODGDaFnjfKhg LEARN MORE Access the Confidence in Hormones Course here  👉ADD LINKFind our more about Newson Education here  👉ADD WEBSITE LINKFollow Newson Education on Instagram here 👉https://www.instagram.com/newson_education/ Download my balance app 👉 https://www.balance-menopause.com/balance-app/Get tickets for my new theatre tour, Breaking the Cycle 👉 https://www.nlp-ltd.com/dr-louise-newson-breaking-the-cycle/ 

Today on my podcast, I'm talking about education for healthcare professionals. A lot of my work is educating women and men about hormonal changes, but we have to educate healthcare professionals. Because if we don't, we're not going to move forwards. We're not going to help future health of women if we keep ignoring the importance of hormones. So today, Dr Rebecca Lewis, who co-founded the clinic, balance app, our education, our research. She keeps me together. she's on the podcast talking about the importance of our education program,

which we've revamped, we've improved, we've updated. It's just a really exciting time for healthcare professionals to learn about hormones. Rebecca, this is not your first time on the podcast, but it's the first time in these lovely studios with Jack, who is the most amazing person. So I wanted to talk today about education because, well, for those people that don't know, first off, you and me founded the clinic many years ago

and we founded Balance App many years ago Yes 2018 and 2019 that sort of era wasn't it And we also founded News and Education We also founded the research

We also cemented our friendship Yes We weren't really hard Yeah And we were just talking before we started actually lots of people say you must never mix friendship with business. They do say that. And I can see why.

But actually you need people who really you can trust as well. Yes. And we totally trust each other. Well, we know each other's brains pretty well. We're different personalities, aren't we? But I think we complement each other really well. And we know I can sort of second guess what you're going to say and vice versa. We finish each other's sentences.

Which is really lucky. I mean, honestly, I was so. lucky having you and I have said it publicly before but I would I know and I'm not just saying it for attention I would have given up many times if I hadn't had you on the end of the phone because you know what we're doing is really hard really difficult and I didn't think it would be this hard you know no I'm from a very academic background I'm from a medical background lots I've worked with you know really top Taipei cardiologist I've worked with surgeons I've worked with all sorts you've been an anesthetist for many years you know really

hard being a woman in medicine and you've been, you've had all sorts of comments when you were a junior anesthetist by females usually, you know. Yeah. I've had sort of, but you keep going because, but somehow when it's about women and hormones, it's become really toxic

and horrible. Like I've never, since I've been at school when I was bullied, I've never had this, it's hostility really. It's very strange, isn't it? Extraordinary. Yeah. Absolutely extraordinary when we're really trying to help women and improve the lives of women.

It's really simple. People should be greeting with, oh, great, this is really pushing the envelope and changing things because there's been so much damage over the years. Well, they have to rectify it. And, you know, but people don't want to hear. Perhaps they're wrong. They really find that challenging. And it's always been so, actually, if you look in the history of hormones, I mean,

I know you know enormous amount about that. But, you know, people who. have had new ideas or actually not new ideas but just looked at the evidence properly and say hang on this is really beneficial treatment for women hormonal treatment they've had massive pushback you know we can name the names that's that have happened because I don't I can't understand why but it's really toxic for women yes and this is the thing so we both went into medicine to help people and when I set up the clinic well initially on my own I was just renting a room and then I said to please can you see some patients yes and you know what we know

now actually and how we practice medicine and hormone medicine is very different to how it was even eight nine years ago because we've learned in two ways but in parallel we've learned more about the scientific evidence yes and basic physiology about hormones but we've also learned from our patients and now we run a very big clinic we see thousands of women yeah but we've come communicating all the time with our clinicians who work with us. And we're constantly changing our pathways in our clinic, changing our knowledge. I often run into your room on a Monday and say, oh, I've just seen this patient. What do you think?

Do you think this is right? And you say, oh, yes. We learn a lot, don't we? Oh, completely. I mean, for me, this distills what medicine is. It's the art of medicine, which I find so much more interesting and rewarding. because and it distills what evidence-based medicine means because evidence-based medicine is not based purely on academic papers

you know it's one of my my topics isn't it it is based on academic papers it is also based on biological plausibility so understanding physiology understanding how hormones work in the body it's also based on clinical experience and particularly in our field when there haven't been enough studies is being neglected and underfunded for years. The evidence we have is limited to a certain extent or they're two smaller studies. But if we keep going back to the evidence, we get the same answers and we don't move forward. What we have to do, and I say this to patients, look, you've come to see me because you've come to see a physician, not a computer. And what we're going to do is

really tailor your HRT, if that's what they're on for you and make it right for you. And that is where the art comes in and transferring that sort of knowledge to other people is it's usually rewarding but actually seeing the benefits and seeing how patients respond the individuality for a start but actually how rewarding it is. It's the most rewarding medicine I've done actually in this field. It's incredible and so this is why education of other healthcare professionals is really important. You know, I'm not protective about my knowledge as hopefully people listening No, I'm very happy to share it, not just to women, but also to healthcare professionals. And, you know, when I started to learn more and more about hormones, I've been in medical education for many years, but I sort of reflected as to how am I going to teach in a best way?

Because when I was doing my MRCP, so remember the Royal College of Physicians, there's a part one and a part two. part one is a multiple choice you have to be like a machine and it's negative marking as you know you get a plus one for right and a minus one for wrong so it's hard it's really tough

and they're very obscure questions things they ask really weird questions you'll never see patients with some of those conditions but you have to know so I spend hours and as you know I can spend hours working but I spent hours going through past papers

I went to lots of courses where you're in a big lecture theatre and you're just learning by rote, learning by rote, and that was wonderful for that exam. Part two is a practical where you have to examine, it's like a theatre show. You have to examine the patient,

but you have to show like all your knowledge. So when you're listening to the heart, you really have to make a big, so it's a big flourish. It's almost like your driving test, isn't it really looking in the mirror? And so I spent a lot of time around the bedside

with really amazing people in Manchester and I always were saying, I was to stay behind another half an hour, just teach me how to do really good cardiovascular examination or really good neurology, all those reflexes. It was a craft. And you see, back then we didn't have the scans that people have now, or it was harder to get a scan. So you had to really, really examine well. Yes. But then with hormones, I spent a lot of time, as you know, I'm picking the literature, writing academically, writing and summarizing guidelines, which is great for the foundation.

but then when I started the clinic and thought when I want to educate more people I thought well how did I learn the most well actually I learnt the most by sitting in other people's clinics you know late Professor John Studs I was really nervous when I went to his clinic I asked my mum to look after the children

they were young it was in the summer holidays it was many many years ago he was quite a formidable person he was very tall physically he had a certain way with patients but he's very clever and I sat there and I just watched what he was doing and after every patient said to but why are you doing that? Why are you giving this dose?

Why are you doing that? Why are you starting this? And he was so lovely because he did answer all my questions and I sat in other people's clinics and then I've become very inquisitive but then we have people sitting in our clinic initially but you can't teach thousands of people in that way, can you? No, but it's the best way to learn, isn't it?

It's the best way. It's the best way. So you sit in front of you. Yeah. And then also, you know, we're busy as doctors you have a limited time and limited finances to study yeah so then i thought well actually people need to know the basics great that can be lecture given but people have to know this art like you're saying and so we decided to do two things didn't we we ran this confidence in menopause day that we divided into four big lectures lots of lots of answers where we talked about the basics

of hormones how they work we talked about the health risks of not having hormones so with menopause we talked about HRT the different hormones including testosterone and vaginal hormones how they work and we talked about cases to talk through and that went really well but it still didn't feel enough so then we decided to film consultations didn't me yeah I think that was a changing point yeah we weren't really down that down well that that lecture but actually seeing a patient in front of you is like trying to replicate your experience with Professor Studd. It is. And you can hear

their own words and you could just imagine yourself there. We had some actors who came in and we gave them little scripts and scenarios and we did some role playing. And I was actually quite nervous because we used to video our consultations as part of our Royal College of GPs. Yes, that's right.

But then they were really critical on our consultation technique. Yeah. Do I introduce myself? Am I asking you the right questions? Am I, you know, all that? But actually, the consultations we filmed was more about this art of bringing the patient in, making sure that they had time to talk about their symptoms, to clarify any questions, but also to show other clinicians how to prescribe how to talk, how to talk about uncertainty, how to talk about benefits versus risks, long-term health benefits of hormones, all of that. Yeah. And I think actually being a GP has really helped me. me in that skill, hasn't it? Because we're used to so many different conditions.

Yes. We deal with uncertainty all the time. It's part of our job. And actually our communication skills really should be very good as a GP. And I think menopause, therefore, is so well suited for the general practitioner. But I think people also get very scared because there's no diagnostic test. You know, it's talking about doing the MRCP, you do all these tendons and you do all heart. If you listen, you've got a murmur. Yeah. Well, you know they need an echo. You know they might need an operation or whatever. Somehow it's a bit, oh, they've got headaches.

Could it be migraines? Could it be a brain tumour? Could it be hormones? But we're used to asking and asking and asking and most of the diagnosis is always in the history, isn't it? In medicine. Always. I mean, we were taught that when we were training. Yeah. I think it's like 90% is from the history. Yes. But only if you ask the right questions.

Yes, of course. And this is where I realise as a GP, my questions were quite closed because I didn't have the symptom questionnaire. So if someone came in with itchy skin, I would only focus on the skin. Well, we also only have 10 minutes, don't we? So yes, immediately they're sort of, we're into dermatological sort of scenarios in our brains. So why would you ask about palpitations or headaches or flushes or sweats or whatever because you wouldn't be thinking about hormones?

Yes. And so all our consultations we filmed started with the symptom. questionnaire. Yeah. And started with a patient, almost working it out, which made it a lot easier. So when we did this, it was great, but I didn't have like a platform to put it on and I needed somewhere that we would get good reach of doctors. And also it would be technically quite easy for them to access and watch and everything. I ended up partnering with 14 fish, which was an appraisal company actually. So doctors did their annual appraisal 314 fish really amazing company so they had lots and lots of different videos lots of different

education and mark coom who was the education director who used to work with the Royal College of GPs as well said this is brilliant so we put it on yeah and we charged a small amount didn't we and we got really good feedback absolutely and to start with we didn't charge actually well no we did and then we changed because the divina documentary do you remember came out so so we were charging a small amount because we had to start with a small amount because we had had to cover our course because we don't do anything that's funded by pharmaceutical companies. So we needed to cover our course. So we did it. And then, as you know, I was very heavily involved with the Davina documentary with Cape Muir. And I knew that one of the statements from

the Royal College of GPs, because they were approached by Kate Muir's team, to ask about education for GPs. And the Royal College of GPs said, improving education for GPs is unworkable. gosh. And they were the quotes and they used that. You know, if any of you've watched the program who's listening, you might remember it. And it was that. So I knew that was coming out.

So do you remember me saying, do you know what? People really need to know because this program is going to really show the enormity of poor menopause care in the UK. So we said, let's make it free to every GP practice. We'll do one free for every GP practice. And let's see the response because I feel really embarrassed that we spent the money.

Let's just get it out to people. Yes. Yeah. And after the program, it was huge, wasn't it? Yes, it was. I mean, the response was amazing. And this was before COVID when we first launched the program. Yes. The education program.

So it was very unusual to do remote learning, actually, because it was all face-to-face, wasn't it, before? That's right. And I know people were thinking, oh, but actually they liked being able to just watch a 10-minute consultation at home. I know. It wasn't some dry lecture for eight hours. You could just take snippets and modules and if you have family life at home

you know you could just do a little half hour here and there and add it up and I think what happens also because we had you know Mrs Smith with migraine Mrs. blogs who was young with POI premature of own insufficiency In fact my mum was one of the actors She was yes and I was interviewing her

with her Welsh accent and she had a Welsh accent and I dipped into a Welsh accent embarrassingly as well She was different snowing so she was someone who had urinary tract infections, she was someone that wanted to start hormones at an older age, you know, she was, and actually it was great, it was a lot of fun doing it, but it meant that if I was a doctor, well, I am a doctor, but if I was a GP, didn't know so much

about hormones, I'd seen a lady with urinary tract infections that day and I was thinking, oh, I'm not sure about vaginal hormones, I could watch that little consultation. And we'd linked it to patient resources, we'd linked it to all the evidence. Yes. And then people were just, The feedback was phenomenal, actually. Well, it's in your memory then, isn't it? Because you were memorising the two people there. You remember the consultation. You remember much easier to remember than a dry old lecture.

Totally. And, you know, we're talking the same language. Both GPs, we wrote this for other GPs or healthcare professionals. So it was great. And I remember going to the, I've tried to go to the Royal College of GPs annual conference. And usually we present some of our research there. And I remember going and people stopping me. me. Do you remember we were both together and people stopping us and say, I'd just like to say thank you.

I know. And what? I know. Especially the younger generation actually. We're really interested and thank you so much and they were great fans. And saying you've transformed the way we practice. I used to be scared of hormones and now I'm prescribing. But they also said, but when women come back, they're so happy, they're so grateful, they're so much healthier. Well, it's the reason they went into medicine. Yeah. I mean, this will make women much better. So they always, they always. enjoy learning about that. As our hormones change throughout our lives, especially during perimenopause and menopause,

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So information is down in their show notes. So have a look and subscribe. and enjoy. So it went very well and we had like tens of thousands of people who downloaded it with phenomenal response not just from GPs

but from nurses and pharmacists and some other specialties. But then sadly really and I think it is sad and quite tragic that 14 fish was taken over by another company, Emis, which is a very big company that do a lot of the computer systems,

the software for GPs. And somebody and I'm not pointing any fingers but there was a body of healthcare professionals who went to EMIS and said we're concerned about this course because it doesn't work out of the guidelines and so I remember

because I was doing a webinar that evening and literally just before I logged on like 10 minutes early for the webinar I looked on Twitter well it was Twitter then it's now X people saying where's the 14 fish menopause course where's it gone where's it gone and I was like what?

And I got a text from Duncan who was the CEO of Pauline Fish and said Louise, didn't you know, your programme's been taken down? And I phoned a very quick. I said, I've only got five minutes, Duncan, I'm just about to do a webinar, but what's happened? He said, oh, you need to speak to Eamis

but they've taken it down. So the next day I spoke to them and said, well, what's happened? They said, oh, we, some medical society phoned us and said that it's not in line with the guidance. so we've taken it down.

It's absolute rubbish. And I said, well, which guidelines? Whereabouts? I don't understand. We work out of evidence and guidelines. And I said, if you watched it, they said no. But if you want another conversation with us, you go to lawyers. I said, what?

Honestly, it was awful. It was so awful. And I was how, based on absolute rubbish. No, nothing. And they're a big organisation. So how can you, you know, we, so I was like, what on earth do we do? Like it was really, I can't even begin to explain the hours that we put into it. So long.

It was so awful. So we worked really hard to try and get it back. We put it on another platform. But almost then the damage started to be done for women because people then thought something was wrong with the way that I was teaching. They thought something wrong with, yes, with all of us really, didn't they? That we don't follow guidelines. I mean, it's rubbish. Nice guidance.

You know, we happen to follow that. Well, nice guidance. They don't mention doses. Two really, yeah, precisely. So you've got nice menopause guidance. Yes. Which has recently been updated since this happened. But they're very clear about individualisation of care.

Correct. They don't talk about the numbers of, you know, the doses at all. No, no. They talk about retreating for symptoms. Yes. But also the other guidelines, which I think are crucially important with this conversation, the shared decision-making guidelines. Yes.

Because even as a doctor, if a patient wants a treatment that might have more risks than you believe, then they can still choose that treatment. So if I said to you, Rebecca, you know, I don't think you should have antidepressants because I don't think you're clinically depressed and there's risks with them and you say, well, do you know what? I'm convinced I am. I really want them and I want to try them, please. We would have a very considered consultation. We might agree to disagree, but you are allowed to be, you know, involve decision-making. Absolutely.

So, so anyway, I was really, really shocked. So we've moved it and since then we're moving it to another platform, but we're also updating us as well because I feel very strongly that we can't be stopped by others that don't agree with what we're doing. Absolutely. And it's so destructive for women because the GPs were really delighted to learn on that. And they were communicating with us and we were guiding them little bit. There was a question, an answer session they could have and they love that.

It was just a quick question. Can you just give me advice on this? And one of our doctors, you know, they rotated it to help and answer things. And we did this for free. So it was like an advice and guidance. People would contact us. I've just seen a lady who's 23, could she have hormonal changes. I've just seen a lady who's 63, she wants to start HRT. What would you suggest? And it really, people love that. Yes. It meant they didn't have to come to the clinic. It really empowered them And now we feel like there's this void really I mean there is some menopause education

But the people that do this are different people Different organisations that do it But they're all got they are all funded by farmer Although farmer supposedly don't have any editorial role With their programmes It's still some pharma influence And how many people do it You know every GP has missed out on education

because of the WHOI report in 2000. And so they weren't educated in medical school. So actually we need something that's really accessible, not horrendously expensive, to educate GPs. And that was always our mission, wasn't at the beginning? I mean, you're brilliant to educating women. And in fact, so much so that I've just had a really busy clinic. And four out of five women constantly say,

do you know what? I feel I know more than my own clinician. My own GP. They have huge respect for their GP because they're brilliant. You say going to see them about the diabetes, their heart disease. They're really well-respected, clever doctors. But they don't know about menopause. Like actually, I didn't really know about the impact of hormones on women until we got together and we learnt and we studied and saw the transformational effects when they're treated properly. So this was part of our, you know, educate women to understand. I think we've done

that brilliantly. But then we wanted to close the loop so that they could go to their GP and have a good conversation so that we hope that there will be two people in that room who would understand about hormones and why their symptoms are due to hormone or change. So the new updated versions, of course, is even better actually. We've got more consultations. Yes. More doctors involved. We've got lectures from other people that people can watch. It's a lot more just talking about our experience clinically as well, basing on the evidence. And since we started the education program, we've actually published quite a lot of data as well, which is really important.

But we've also, like I said at the beginning, we've learned a lot from our patients. So we started calling the course confidence in menopause. We want to be thinking about confidence in. hormones for women because obviously we talk a lot menopause, perimenopause often go together but actually PMS, PMDD, so premencil syndrome, premencil dysphoric disorder, postnatal depression, even PCOS polycystic aberia syndrome, we're realising these are all due to hormonal changes. Symptoms are the same whether it's a hormonal change due to menopause or PMD. It's associated with, yeah, absolutely.

And that's what you were saying about people in the past, like Katrina and Dalton, amazing work about progesterome that we weren't taught about. No. We didn't know. But we've learned, we've read, we've changed our practice. But now we want to share what we've learned that's associated with the basic science and clinical practice to others. Yeah. And, you know, I think it's just a shame because medicine advances. knowledge changes, guidelines are updated, education improves.

Whereas for health of women and hormones, we're just stuck in the mud, don't we? It's actually gone backwards in the last few years, actually. I think we were seeing a real traction when we first started out and we were really getting some improvements. But actually with recent events, it's gone backwards. GPs have become more scared. They feel much more restricted and what they can do. that they will be sued. I don't know what it is.

No, I mean, they're petrified of hormones, which is crazy, actually. We prescribe a lot of off-label doses. We prescribe a lot of off-licence medication. I've done that all our lives. I mean, as an anaesthetist, most of things he gave were probably not licensed. But we're used to that.

But so, you know, panorama, the effect of our education being taken down, all of these things have made a negative effect on women. But I want to end talking about some good news because the FDA announcement, so in America, FDA have taken off their black box warning. We don't have the same black box warning in the UK. Can I just say you and particularly have been campaigning for this, what, 10 years in our own country to deaf ears, really.

Yes. But you have been going, you know, and we all agree because I've had patients, you know, who won't take their medication because of the warnings written down. We don't have the black box, but we still have the warnings. We all see if we open any of our hormones, it will say risk of clot, risk of heart attack, risk of breast cancer. Wrong, wrong, wrong. And so what's been wonderful for us and women is that the FDA have really clearly, they've looked at the evidence and they're basically saying estrogen is safe. We don't need to have these warnings.

And that's really, really reassuring, isn't it? massive thing. It's a real change. You know, America, they were the country that sort of developed the WHOI and the disaster from that. I think it's quite nice actually that they are actually making some improvements. It's almost, I think they did say, I'm sorry, we're sorry. But they did. It's good they've recognised that at last. Yeah, absolutely. And they talk about, you know, we're sorry for the millions. This is millions of women who have suffered by not having hormones. And so one of the things in the education program we do talk about is the risk of not having hormone replacement. So not having progesterone, not having testosterone, not having testosterone. Not having the right levels

of them either. And the right dose is absolutely. It's really crucial that we wake up and think about the health risks. Yes. But also the education course is led by GPs like us because we're thinking very holistically and we want to bring in other specialties. So cardiologists, neurologist, rheumatologist. Every doctor, whatever your speciality, you're going to be touching on hormones for every patient. You need to know about it.

And we need to show people our knowledge as well because, you know, for many years, menopause has been sort of given to gynecologists and some people listening might know but when you train as a gynaecologist generally, you just do a year of medicine as a very junior doctor

and then you go straight into gynaecology. So a lot of gynaecologists haven't been trained in cardiovascular health, osteoporosis, bone health, brain health. You know, they haven't done the different specialties. No. And then they literally see hormone changes through the lens of a gynaecologist, which is basically the guine and the bleeding or whatever. Yes, exactly.

Whereas we see it affecting every organ. It's a multi-organ problem, isn't it? It's a multi-system problem. Absolutely. And I think that's why GPs are so good at that because they deal with that day in and day. Absolutely. So I'm really looking forward to how the education program we can really go for it. Yes. And we've got great team supporting us this time. I feel that we're stronger. Yes.

I feel like we can't be taken down like we were before. And so it's great. It's exciting times. Oh, it's really exciting. You know, I think all these changes and positive changes with the FDA announcement. It's a real sort of a global awakening, if you like, about actually, hang on, these hormones are really. really important to women. And women deserve the right to understand that and make their own choice. If they don't want the hormones, that's fine. But make it based on correct evidence and choice. So three things that I want to ask you. So there's quite a few healthcare professionals that listen to this podcast. I know a lot of women, men even who are listening. You can all share this episode with your healthcare providers. So three reasons why healthcare professionals

should be doing our course. Because they'll be dealing with hormones all the time. They may know about the fact that they're dealing with hormones like GPs or they may not like rheumatologists and psychiatrists. So if you see women in a medical capacity, you need to do the course because it will touch your speciality. Because so much misinformation, number two, is so much misinformation over the years.

And people haven't had a chance to be taught because the medical schools didn't even have it really on the curriculum, and maybe an hour's lecture. So this is a chance to understand why. Number three, you want your patients to get better. It's the most rewarding medicine I've ever done. It's the safest medication I've ever prescribed. And as I said, the most rewarding, not every single person,

but the vast, vast majority gets so much better when their hormones are balanced. And I think this is really important as a doctor. It's exactly what you want to see. Brilliant. Thank you so much. And thanks for coming again. Thank you, Louise. Lovely to be here.