The Dr Louise Newson Podcast - 56 – Why confusion around contraception and hormones is failing women

Episode Date: April 9, 2026

In this episode, Dr Louise Newson is joined by US-based OB-GYN Dr Jordan Emont to explore why so many women are still being denied hormones, despite clear evidence of their benefits.They discuss the ongoing fear and misinformation surrounding body identical hormones, the confusion with synthetic hormones used in contraception and why this is leaving many women unsupported.Louise and Jordan also highlight the inequalities in menopause care and the wider health consequences of untreated hormone deficiency, including heart disease, osteoporosis and mental health.A powerful conversation about informed choice, access to care and why women deserve better.  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 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/ Pre order my new book 👉 https://bio.to/ThePowerofHormones

So Jordan, I'm very excited. I love having US doctors on the podcast because I think you're just a bit more outspoken and you just see it as it is and say it as it is and that's what we need. Like we need to cut through this like mountain of confusion actually. And I reached out to you on social media because I loved one of your posts that you did.

You were in your car with your sunglasses on and you were talking that you just prescribed someone's some estradiol, quite, you know, standard treatment, and the pharmacist had sat down your patient to talk through new medication, that's fine, but sat down and told your patient inappropriate risks of a safe hormone. And you had a little rant, and I was like, I want you on my podcast. So here you are. Well, I think that maybe in continuing with Americans being outspoken,

I, you know, heard that message back from my patient, and I was quite literally in the car when it happened and I just had to post something about it. So yeah, well, thank you so much for having me here and I was just so honored to be invited and I'm excited to be here. Well, I, you know, I think you're the same as me. You'll soon tell me if you went,

but I went into medicine to help people and to help people feel better, actually. It sounds really naive, but, you know, I was like really young when I wanted to do medicine. No one in my family has done medicine and I was about five or six and I just said I want to help people get better and feel better.

And doing the work that I do is transformational. Like the majority, not all of them, but the vast majority of women do feel better when they take hormones. And that's even that has forgotten somehow with all this like confusion and noise that we can talk about.

But I don't think it's a bad thing, is it? Or have I got it wrong if we're just making people feel better? I mean, I couldn't agree more. And honestly, It's quite a frustration for me, even just from a medical training standpoint, because I'm, I'm relatively recently out of residency. You know, I would say I'm relatively new to this field. And in my OBGYN training, there was almost no discussion about hormone therapy.

And when it did come up, it was essentially told to me as this should only be used in absolutely the most severe of situations because the risks are so high. And then, so that was my understanding coming out of training. And then I become an. attending physician. I have my own practice, my own clinic, and every single one of my patients is coming to me with symptoms of menopause or perimenopause or sexual dysfunction. And I had no tools to offer them. And I think that this is a very similar story to a lot of people who get into this field. And I couldn't agree more. It was, I felt so helpless that I got into this field to help women, to advocate for women and to bring that passion to my work every day. And people were

coming to me and I had no training in being able to offer that. And so I really invested myself into learning that for myself. And I couldn't agree more. It's remarkable the transformation that people have when they start hormones, even within a relatively short amount of time. And so I just think that we need to be spreading the word on that. And we need to be calling out the misinformation that exists because, you know, my patient with the pharmacist, it's unacceptable.

You know, and she was terrified when she came back to me. Yeah. And it's definitely harming women. And I was looking at some adverts for Premarin, so the older type of HRT that, as you know, is made for pregnant horses urine. We don't prescribe that now. We just prescribe the natural Easterdial and we prescribe estrogen. But even then, there were pictures of women in the 60s and they were happy. And it just talks about well-being, improving well-being.

And there's some of the adverts I don't quite like because they've got men next to them and saying it helps his marriage. It helps him. And, you know, your wife's happier to live with. So, but you know what? Fair play. My husband will tell you it's a lot easier at home now I take hormones because you know I didn't have symptoms for very long but I was really miserable and I was very irritable and I was very cross and very

angry but I also felt very socially isolated and withdrawn I was crying at work like I've never cried at work over something you know there was a partner a doctor that didn't agree with something I did and I knew I was right and normally I would have just gone back and given them some more evidence and I just withdrew and started crying at my desk and one of the receptionist said What's going on? Are you okay?

She didn't realize it was my hormones. I didn't realize it was my hormones. And so it's difficult. It's hard. And it's one of the things that upsets me a bit is that because this happens at a time in our lives, which often is, you know, in our 40s, on average, but obviously some women can be a lot younger. It's blamed for, oh, it's that sandwich generation.

You've got children. You're working full time. You've got a busy life. Like who says that? that to men. Like, I don't understand. Like, women are copers and they go on and do things and they don't use your whinge. But when you've got a hormonal imbalance, whether it's perimenopause, menopause, or PMS, PMD, postnatal depression, doesn't matter that it's all hormonal changes. It can cause havoc in our brain and body. So why are we just suddenly, like, if you just do a bit

of self-care, if you sort out your stress, everything will be fine. Like, it doesn't make sense. Well, I mean, I completely agree. And I think that there's really kind of two forces that go into that, which is one that there is the societal expectation that women are just supposed to put away their pain, are supposed to push forward, ignore their own needs, ignore, you know, how they're feeling because there are these responsibilities that are overwhelmingly put on women's roles in society. And that in and of itself is a problem. But I think there's also this just ongoing paternalism to women's health that really needs to stop. You know, even just the idea of what we were starting with about, you know, shouldn't it be enough just to help women feel better? You know, if that was the only thing that hormones improved, shouldn't that be enough? And I feel like it goes along with the same thing of saying, well, a woman isn't responsible enough to make a decision for herself about risks and benefits.

Right. We've just decided that, oh, there was this study that was misinterpreted and misrepresented, and therefore women aren't responsible enough to understand that information or make decisions for themselves. And that's something that I really try to counter, you know, both in my public profile, but also on an individual basis with all my patients. It's so important. I could go and buy a car tomorrow, and no one would give me a randomized control study showing whether the car is safe or not. I wouldn't be able to work out whether it was safe mechanically. I could look at the color and see if it was cover.

comfortable. And if I had enough money in my bank account, I could buy it. And I could drive it as recklessly as I like. And it's up to me as a person. And I think this is where, as a doctor, I feel very strongly that our patients should be able to advocate for themselves. And sometimes I don't agree with what my patients do, like if they're smoking or doing drugs or alcohol or having a chaotic lifestyle. But I'm not there to preach them. I'm there to advise them and tell them perhaps they should reduce their smoking or drinking. But also I want to learn from them. You know, why are they smoking so much more?

Why are they drinking so much more? What else is going on? And I think so often I've been to lectures at different Menopause Society meetings, UK and globally, where they've just been presenting the data. They haven't been talking about a person, a patient, a woman, the impact on the life. And we do that often in medicine, Mrs. blogs has her heart attack. Let's look at the heart attack protocol. But let's not see what else is going on. And I think this happens a lot with menopause. And then people are scared about hormones

for the wrong reasons, like this pharmacist, but they're worried, what if she gets breast cancer? What if she has bleeding? What if she, well, she might get that anyway. But also, you know, we're just prescribing natural hormones. So the risks are actually incredibly low, if at all, because it's just a natural hormone replacement, isn't it? Yes, exactly. And in fact, even, you know, with that specific patient, it was remarkable that the exact concern that the pharmacist had brought up was that she was going to get a heart attack from it and completely ignoring the data that the physiologic estradiol replacement is actually cardioprotive. And so it's, yes, I mean, I completely agree

with everything you just said. And I think that, you know, we are slowly making that change by, you know, people like you and I being loud about this and bringing that forward. And I was, I'm always encouraged to see just the numbers of people that are showing up to meetings and, you know, becoming interested in this topic. But at the end of the day, there's, you know, billions of women who are going through menopause and we only have a handful of providers who are actually really knowledgeable about that. It's absolutely crazy how few women are able to access care. And so this brings me on to something else because one of the things, really that I love being a doctor is that I see all sorts of people from all sorts of backgrounds

and I've worked in areas of real deprivation especially when I was working up in Manchester which is in the northwest of England and I've seen things that most of my friends will never have seen I visited homes that most people just couldn't believe I've heard stories which makes me feel very privileged that people trust me have invited me in to be able to be part of something But women often from lower socio-economic classes, if they don't have English as their first language, if they're having a very difficult social or home life, it can be very difficult to advocate for yourself. You haven't got any or enough financial freedom to choose your provider. You don't understand, maybe you can't read, you can't listen, you don't know what's going on. You don't have friends or your partner is probably someone that you're finding very difficult to live with, let alone talk to if you have a partner.

So I worry about women from deprived areas a lot, actually. And one of the reasons I set up balance was so it's a free app to help people to have a bit of me in their pocket, if you like. But I know you work in quite deprived areas as well, don't you, with your work? So just tell me a bit about the women that you see. Yeah, absolutely. So the majority of my time is spent at a community health center here in the Bay Area where I live. And the vast majority of my patients are Spanish-speaking only, very recently immigrated, many of whom are undocumented, which of course is an added stressor in the current state of American government.

And so, but we're really operating from already a population of patients who can't access care because English is a barrier, can't access good nutrition because there aren't grocery stores with healthy vegetables at an affordable rate in their neighborhood. And also just at baseline have a significantly lower health literacy. And so it's been remarkable, I think, to practice menopause medicine in this population because I think that we, you know, we almost take for granted that a lot of people know, you know, what the gynecologic organs are or how the menstrual cycle works or how these hormones, you know, even just the basics of what is estrogen, what is progesterone. And yet most of my consultations related to menopause with my patients in the

community health center, we, none of that is a given. We are starting from the absolute basics. We are starting from where is the uterus? What is the cervix? What are the ovaries? you know, how do these things interact? And I think that also particularly, I would say, among the Latina population that I see, there's, I think, a lot of miscommunication and there's a lot of kind of a bias against talking about menopause. And so even among peers,

there's very little sharing of what that experience is like. And so it's, I think, particularly fascinating just having my social media profile where, you know, thankfully, a lot of the people who are reaching out are asking very informed questions, you know, clearly are operating on a very different level of health literacy. And I'm able to have a very sophisticated conversation surrounding those topics. But I think we need to remember that at the end of the day, the people who really are actually most likely to face the health consequences

of untreated menopause are the patients in the community health center that, you know, like where I work. And so we know that Hispanic populations and black populations go through menopause earlier and have perimenopause symptoms that last for longer than a white population. And also at baseline, the health status is lower. And so we're already talking about a population that has a higher risk for diabetes, a higher risk for heart disease, a higher risk for high blood pressure, cholesterol, all of these various factors that are going to ultimately lead to a shorter life expectancy. So I would argue that there's even more of a need to educate and to be making menopause care and hormone management in particular accessible for this population because they are the ones who are ultimately going to face the most health consequences if that's unaddressed.

Absolutely. And there's so many diseases that are related to menopause. And when we say menopause, we mean this hormone deficiency that lasts forever. There's so much talk about it being a transition, but it's not a transition because whether people have symptoms or not, the low hormones increases inflammation in the body. That's just fact because that's the way our hormones work. But all the inflammatory diseases are the diseases that are increasing as we age, and they're killing women. And a lot of them prematurely, but they're also diseases associated with poverty and deprivation. So cardiovascular disease, dementia, osteoporosis. but also mental health. And one of the things that keeps me going a lot

is thinking about the mental health association of hormones. So there are two things really that I think is worth discussing. One is we've, and I've spoken about it many times, the role of our hormones in our brain, when these levels fluctuate and reduce, we can get lots of mental health symptoms. But the other thing that I worry perhaps more about is a lot of women from low socioeconomic classes

have mental health issues. for various reasons, and they're prescribed medication. So they're prescribed antidepressants. Some of them are prescribed antipsychotics. Some of them have a lot of pain as well, so they're given opioids. Now, all of those drugs can reduce hormones, so they can make the Easterdial progesterone and testosterone lower. So it's well known that morphine can cause night sweats.

Well, of course, because it's blocking eustodium. And this is in men and women, of course, but I worry. more about women than men. But so when someone of one of your patients, if you prescribed an antidepressant, I can't imagine, Jordan, that the pharmacist sits them down and says, do you know there's a risk of osteoporosis? Do you know there's a risk of not being able to have an orgasm? Do you know there's a risk of dementia? Do you know these hormones might block your own hormones? You know, it's a devil's standard, isn't it? A hundred percent. And I would even say, you know, even just moving beyond antidepressants, you know, oral contraceptive pills are prescribed so much more confidently by so

many providers. And of course, they play a very important role. You know, I prescribed them myself. But there isn't that same level of conversation about, you know, some of those similar health risks, particularly in regards to sexual health and mood. And so, yeah, I think that there's this unnecessary fear that exists surrounding these body identical physiological hormones. that really in every way are safer than the alternative medications that we would use to manage those conditions. Yeah, which a lot of people don't realize. And, you know, I didn't realize actually because I didn't think about it for many years as a GP. And I would prescribe these medications.

And I would prescribe contraception but also long-acting contraceptions. So implant or depropera, which I look back with horror, actually, because a lot of these women were, I was sort of taught, actually, that women won't remember to take contraception because they've got eight children, they've got an abusive partner, they're alcohol, whatever, so just give them a depa, give them a long-acting contraception. So they almost had it without a choice.

This was sort of 20 years ago, so things I know have changed. But I didn't really think and sit down and think, what am I doing to these women? I'm stopping their own natural hormones working. I'm increasing inflammation in our body. I'm going to probably make them a lot of, mental health feel worse. Firstly, I'm not telling them about it because I didn't know to tell them. But secondly, they're never going to ask. And then if they feel lower in their mood,

they'll never, or they'll often not think about the association with hormones. They'll think, well, it's because of my life, what's going on at home or what have you. So it's a spiral of doom that often happens, doesn't it? No, absolutely. You know, it is interesting. I do find that in my patient population, I think there is, to some extent, a baseline suspicion of, of synthetic hormones. And so I think that a lot of people, you know, whether based on their own experiences in the past or from talking with friends, you know, they have this understanding that contraception might affect their mood or their weight or, you know, various other factors in their body. And that these, I think for this reason, I almost sometimes struggle to talk to somebody about contraception because I think that, you know, sometimes there's a little bit of a resistance. to even thinking about it.

But I completely agree. And I would say, again, you know, thinking about how training differs across time, you know, in my OBGYN residency, I would say that there wasn't a very strong discussion about a lot of these long-term health consequences that can happen with contraception. And, you know, I don't like to hate on contraception because I think it's so valuable. And, you know, we need to use that appropriately. But I think that in terms of actually thorough counseling, there is a huge deficiency in in that education element as well.

Yeah, and I think often with contraception choice is taken away because people think hormonal contraception is the only contraception. Yes, that's exactly right. That is a real shame, I think, for women. And I mean, I've got three daughters. I've, they all have different contraceptive needs and choices. But I've thought very differently about them than I would have done if they were 10 years older, actually.

And, you know, I think, and they've been very involved. the conversations as well and they do use natural hormones as well as well as their contraception. So they're a bit atypical but they're not because a lot of people are learning from social media. A lot of people are joining the dots. And so I don't want anyone to think that we're saying anything that's like controversial or we're trying to promote some sort of conspiracy theory. We're just saying these hormones are different. Like it's, you know, they are not hormones.

They are chemicals that are similar to hormones for different. and they have benefits for some people, but they have risks as well. And I think it goes back to what we were saying before, which is just at the end of the day, I think that we have to really trust women to make informed decisions for themselves. But what that requires is adequate counseling and adequate experience. And so you're exactly right. It's not necessarily our job to make a choice for somebody,

but it is our job to make sure that we are informed enough to be able to tell them, these are going to be the pros and cons in choosing various pathways here. And I think ultimately, you know, people make fantastic decisions for themselves when they're given the right information. And in our, you know, in the patient population that I see, the burden is even more intense because we have to start from a baseline level of health literacy that is so much lower. But I don't think that that means that we should be ignoring that population, which is unfortunately what happens. I think it just puts even more emphasis on the fact that we need to be getting basic information out there, whether that's through our individual. efforts or through broader societal efforts, like, for example, through the balance app or really, you know, through even sex education when you're in, when you're a 10 years old.

And so I think that, you know, these, these, I think we need to have a complete shift in how we think about women's health and women's role in society to really be able to have these informed conversations. And again, just trust women, you know, to be smart about themselves because it's really a travesty that we don't do that. Absolutely. And I often talk about health of women rather than women's health. And even just that play on words makes people think differently about the overall health, just guiney health because it's so important.

So when I worked as a GP, I worked in the same practice for many years. I worked there for about 18 years. And it was in quite a deprived area. And a lot of women, especially towards the end, And I knew more about hormones and the benefits. I was prescribing hormones to the natural body identical hormones, often all three, often vaginal hormones as well. And I loved it.

You know, I was on a role. My patients really enjoyed. And then I left general practice to dedicate all the other, do all the other work that I did. And one by one, the doctors that I work with have taken every single patient off their hormones. And it's, I know, it's like the saddest thing that's happened because some of them have reached out to me, like through social media. year or they've just some of them have come to the clinic but not many because it's expensive and they haven't got money and i saw one of my old patients um last week in my clinic who's has an alcohol problem as soon as makes a lot of um cigarettes she's had a really difficult time since i

last saw her and i weren't really hard with her 20 years ago to help her to come off her alcohol and she did it because she's got fire in her belly and she's had a very difficult life but her hormones have impacted her now. And like, I know the doctors at work just think it's a bit of a middle class problem having hormones. They don't see the role. Whereas I look at her and think, gosh, her liver is not going to be very healthy because she drinks a lot. Her lungs are not going to be healthy because she smokes a lot. She hardly eats. She's a, you know, a lot of people who drink a lot of calories and she drinks a lot of cider. So she's trying to convince me that the apples in the cider are the fruit that she eats and that's enough. We've always,

all seen patients like this and it's amazing that they keep going. But I'm there thinking if she doesn't have her hormones, her life expectancy will be worse. Her risk of diseases will be far higher. Of course I could spend all my time and energy talking to her about smoking and drinking. But at the back of my mind, I know that she'll be more able to reduce her smoking and alcohol if she has hormones on board. Yes. It's, you know, I know with time she will feel a lot better and it's great to see her again, but I feel really sad for all those women that are just missing out.

Like, I don't know where they go or what happens. But it's a worry, isn't it? Absolutely. And I struggle with the same problem, you know, in my clinic as well. And, you know, we have wonderful GPs who work at our clinic. And I think, you know, people who are very intelligent. but I think that there's still just this baseline fear, and I can't tell you the number of patients

that I will start on some kind of hormone therapy, again, using natural body identical hormones, and then they end up with their GP upstairs, and there is a whole conversation about how that's a very controversial choice, and that they're going to be dangerous to that, and that we didn't have an informed enough conversation. I've just had this conversation way too many times. So I completely agree.

It's a huge frustration. And I think that, again, it goes back to the education, which is that at the end of the day, this isn't just a gynecologic concern. This is a bodywide concern. And every single medical provider, whether you're in OBGYN or whether you're an orthopedic surgeon or whatever it might be, you need to be having these conversations in this education about how hormones are going to impact your patient because it does. And I can guarantee that if you were a provider, hormones are going to impact your patient in some way. Absolutely. And no disrespect to you as an OBGYN, but I don't feel that gynaecologist should be in charge of women's hormones. I think they are a provider that can help. But I see, like, I was trying to persuade a cardiologist to prescribe hormones the other day. And they were like, Louise, we just don't do that.

So what? Sorry, you give all these other drugs. And, you know, psychiatrists keep telling me they don't prescribe hormones. But we recommend them now. We talk about. more in the letters, but I don't, again, I really don't understand and we need to shift this narrative and we need to do it quickly because there's so much suffering of women. And I think what we're doing with a lot of our work is just empowering people, letting them have other conversations and letting them hopefully not just the women who are suffering, but other people who know people who are suffering to actually be part of this with them, but not just sit and hold their hand and watch them suffering, actually grab them by the hand and take them to

a doctor, a nurse, a pharmacist who understands. And it's fine to have a second, third, false opinion as well, whichever country you're in, it's fine to see someone else, isn't it? Yes, 100%. And I think that people do get really locked into that mindset of, I guess this is just what the doctor says, and I got to stick with it, but it's 100% something that is so important. and, you know, just like so many things in the health of women, I think that there's a lot of, there's a lot of women, you know, for a variety of conditions, for endometriosis, PCOS, who end up seeing multiple providers before they get an accurate diagnosis and treatment, and menopause is no different.

And so, yeah, I think we need to just change that conversation completely because at the end of the day, these, just like you said, hormones are just a part of a woman's old. overall health, not specifically a women's health concern. Absolutely. Very well put. So before I end, I always ask for three take-home tips. I'm conscious it's your wedding anniversary, so I don't want to keep you too late. But three, I would like to ask you three risks to women if they are not prescribed hormones.

Yeah, absolutely. It's hard to limit it to just three. Yeah. But when we think about really what are the most likely factors to impact, not just women's lives, but, you know, anybody's life, those would be heart disease, osteoporosis, and falls associated with that and fractures, and then risks to mental health and dementia. And all of those are so infinitely affected by the lack of hormones that happen. after menopause. And so we know that heart disease risks can decrease by 30 to 50% when hormone management is initiated. And similar numbers for osteoporosis prevention, similar numbers for improving mental health. And these things, they really don't just impact somebody's quantity of life,

but more importantly, they impact somebody's quality of life. And to go back to where we started this whole conversation, even if all that happened is that women felt better and were able to live the life they want to live with hormones, that should be enough. But in addition, we now have all of these other benefits for their health overall. Oh, that's so good. And thank you so much for your passion and energy. And I hope I'll be able to meet you in real life maybe next year when I come to US. So thanks so much. I would love that. Thank you. Thank you so much.