The Dr Louise Newson Podcast - Bonus: When hormones are missed in mental health

Episode Date: March 26, 2026

In this episode, Dr Louise Newson is joined by mental health nurses Jayne and Diane to discuss the often overlooked role of hormones in women’s mental health.Drawing on their experience working in mental health services, they share how hormonal changes are rarely considered when women present with symptoms such as anxiety, depression or mood changes. As a result, many women are given psychiatric diagnoses and medications without anyone exploring whether hormones may be contributing.Together they discuss the impact this can have on women’s lives, the need for better education for healthcare professionals and why simple questions about hormones should become routine in mental health 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 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/

So today on my podcast, I've got two lovely ladies. They're both work in mental health, and they've personally had a experience, but they've also witnessed a lot. And once you see hormonal changes, you can't unsee them. And once you have knowledge, you want to share it because you want other people to learn from other people's experiences. And actually, that's what we do as women, isn't it? We just share and then we make decisions ourselves. So Jane and Diane, I just welcome you to the podcast studio and thanks for both of you giving up your time to come today.

Thank you, Louise. Thanks so much for having us. I'm a mental health nurse and I'm also 49 and experiencing this wonderful time of life and have had my own struggles with that. But more importantly, I think it's made me recognize how the hormonal impact on mental health for women when women come into our service

and yeah and it's something that I'm struggling with it's something that I struggle to advocate for because there just isn't enough knowledge and it's just not spoken about. Yeah, what about you, Diane? Yep, so I'm also a mental health nurse. I'm a CBT therapist and I've just recently finished my master's degree in mental health specialising in the menopause and the efficacy of CBT for base of motor symptoms. And like yourself and Jane, you know, I've experienced so many women coming into mental health services being, you know, with diagnostic overshadowing, being misdiagnosed, being put on antipsychotics, anti-anxiety medications. And so, yeah, we've, we see it all the time.

So my kind of hope is that I can bring a standard menopause questionnaire into, made sales services at the point of referral for any women over 45. I think it's really... I think it should be any woman though, actually, because, you know, one in 30 women under age of 40 have an early menopause, and a lot of women who are young have PNDD premenstrual disorder. So I often think there are sort of three questions that I think every woman, but especially at mental health services, should be asked.

and one of them is do you think any of your symptoms could be due to your hormones? Because actually once you ask the question, people start to think. But also, do you have changes in your mental health throughout your menstrual cycle when you were having periods? And then the other thing is, have you ever had postnatal depression? Because that would unmask a lot that's going on in mental health at the minute. Because I see a lot of women who have been under-psychitis. They've been under mental health teams. I do see quite extreme cases.

But I think back to my psychiatry training. And a lot of the inpatients were women. A lot of them were, you know, 40, 50s, 60s. But I wasn't taught to ask those questions. And then, like you say, if you have a symptom questionnaire that you give to people and you don't have to give it to them when they're in crisis the first day they come in. But giving it just focuses people to think more about the role of

Humane's in the brain, doesn't it? Absolutely. Yeah. And I think it, Diane and I have worked together, so we both worked on the same service. So I know, well, I don't think anything has changed. But the questions are just never asked. It's never, there's never been any consideration. We used to suggest it and we'd down in the MDT. If somebody came in and they were kind of mid to late 30s, early 40s, and they'd never presented before, we'd then start asking the questions around their menstrual cycles. And I don't think it was ever really taken seriously. Most of the women were diagnosed with bipolar type 2,

which I have to say I'd never heard of until I worked in Scotland. And then when you actually worked with these women, because that was our role as the nurse, as the kind of community mental health nurse, and ask the questions and dug a little bit deeper into their life, you started to see the pattern. So why do you think people are like, asking the questions because it doesn't cost any money it doesn't take much time to ask those

questions there's a lot of reasons but I think fundamentally um a lot of the uh psychiatry traits are misogynistic in nature um that and and unfortunately um it gets poohed um at that level unless you have people who feel really strongly. There's no education on hormones, even from childhood up. As children, we don't get taught about hormones. Women don't know what's happening to their bodies.

And so if women were perhaps educated in mental health services about it, I mean, any kind of education on this has been self-education for myself and I think for Jane as well because in the NHS you're not taught about the impact of hormones in your body. But it seems so wrong because we've known for decades about the role of hormones in our brain. We've got evidence showing that all three hormones, progesterine, testosterone, testosterone, eustodial have effects on mental health. Even in men, we know that testosterone can have an effect on mental health and low testosterone can cause depression. But it's just being ignored.

I don't know if it's easier to just prescribe the medications that they're used to prescribing. If it's easier, like an easier box to tick to say that somebody has depression as an example. I mean, I'm recently working with a woman that's seen in services for a hell of a long time. And there are lots of factors that contribute to her mental health status. But I recently recognised that she came into service with postnatal depression. And she's now on like heavy antipsychotic. She's on plosopine. And I just wonder what that journey actually looked like for her.

I can imagine nobody asked any questions around her, you know, her hormonal health, around her menstrual cycle, you know, recognise that she had post-natal depression, what that then meant. And as a result of that, she's now been in services for 30 years and I doubt very much that she'll ever get out. So I find that incredibly distressing that we are literally diagnosing these people incorrectly and ruining their lives. Yeah. So you might have heard my podcast with Jay and Haley, who Haley wasn't in and out of psychiatric hospitals for 30 years. And when you talk to her, which is quite nice, isn't it, talk to the patient and ask those questions, do you think it could be related to a hormone? She said, maybe. And then I said, do you have, did you ever have changing mood symptoms with your menstrual cycle? She said, oh yeah, the days before my period were awful. That was when I was argumentative. I was irritable. I just literally was terrible. And then my period would come and I would feel so different. It was like night and day. And then she's had three children. So again, I asked the question, did you have posenatal depression? Well, she did. She had

postnatal psychosis and was sectioned. And that was when she had her first ECT round. But I said to her, how did you feel when you were pregnant? And that was the first time I met her. and she grinned from ear to ear. She said, I just felt amazing, the best I've ever felt. Now, I think if you just asked all your impatience who had been pregnant before, how did you feel when you were pregnant? And it's not because they were pregnant. It's not because, you know, whatever,

usually it's because they've got hormones in their body, often for the first time, and it's often more related to progesterone as well. And I feel just, I feel, just, I feel, cheated as a doctor that no one taught me for so long. But I feel sad because the psychiatrist still pushed back. I spoke to someone the other day. They said, I can't even talk to the, she was a mental health, no, she said, I can't

even talk to the psychiatrist. They won't even entertain. And my pushback's always, you know, I think, I'm sure you agree, mental health issues are multifactorial. It's not just one thing. So I was taught quite early on as a doctor, the way you can't change people's homes and their circumstances, as much as you'd like to, that you can't do it,

but you can change the way that they think about it and the way maybe their future life's going to be. And it's the same with mental health. There's things we can help, and a lot of things are associated together. But often until you balance hormones, they can't think better, and then they can't then address their alcohol and their drugs.

and whatever else is going on. And I feel like we're just letting these pull women down more and more. Yeah. I think women are kind of double disadvantaged because if they go to the GP, often the GP is not educated on hormones and treatments that are available for them. So then they come to us. if they go straight to an outpatient psychiatrist,

they often get, as Jane said, diagnosed with, you know, late onset bipolar, fibromyalgia, chronic fatigue syndrome, they get given a whack of medication. There's still no further forward. They're still having all these symptoms. They think they're actually losing their mind. And in fact, I had a lady last week

who I had a really good session with and she just said at the end of it, you've made me feel that I'm normal again because I just normalised all her symptoms. And, you know, we've done a really good piece of work. But unfortunately, I had to kind of educate her on what to go and say to the GP to try and get what she needs to get. But not every woman gets that opportunity.

It's very, very difficult. And a lot of people can't advocate for themselves. and they have no one else to help them. And I also think once you've been labelled with a mental health condition, that label stays with you forever, and it judges how people think of you. So it's, you know, this 55-year-old lady with schizophrenia affective disorder, this 46-year-old lady with clinical depression,

and that's it. They're locked into the system. But the other thing is, so I, as I've said, it's multifactorial. Some women absolutely need these drugs, they need CBT, they need hormones. There's lots of, lots of treatments that is really important. The same that we do in anything in medicine. You know, we have to look at nutrition and exercise and well-being and mental health. It all works together. That's just going to that same really. But one of the things about the drugs, you've mentioned about antipsychotic medication, is that we've known for many years that people who take antipsychotics have an increased incidence,

of raised blood pressure, metabolic syndrome, type two diabetes, Alzheimer's, the way that the drugs work in the brain and body and affect the metabolism. But we've also known for many years that they affect our hormones. So they give people often a chemical manopause. So we know they reduce progesterone, estrogen, and testosterone levels. I recently contacted the Royal College of psychiatrists to ask them how they screen for this, because I know people have their cholesterol tested and I know they have their blood pressure measured. So I said, I can't find any guidelines, but I'm not a psychiatrist, so I'm probably missing them. But where are the guidelines or can you point me to some practical tips that you give to people about when people are on

anti-psychotic screening for low hormones? And I haven't had anything back. She said there isn't anything. I recently have been challenging. We, have a young woman. I said young woman. She's 36, which is obviously a young woman, but she could also be going through periomenopause. Yeah, of course. She's around that age. And

I've recently learned that lower levels of estrogen increase the metabolism of the medication that she takes. So therefore, the medication is no longer effective. So we have been concerned. And again,

the concerns are sporadic. It isn't, isn't like an ongoing psychosis. It just felt really odd to me. I didn't feel that she was necessarily deteriorating. It felt that something was kind of changing in her that we needed to address. And when I raised it, I was basically ignored. And there's a consideration that, you know, perhaps we need to, you know, consider hospitalisation and all kinds of things.

So I've had to respond and say, you know, I've done my I've done some like I've got to say research it's just it was just Google you just googled it and and the there are some studies that just show up immediately you know and I felt really sad that we didn't know that that that isn't common knowledge that and the medication is clausapine and and there are lots of studies because lots of women when they enter between the ages of 40 and 60 they noticed that the effects of clausapine changed but didn't in men and then that's where they draw the, do the link to kind of, and it's lowered estrogen. But why is that not common knowledge?

Well, this is what surprises me, because sometimes in medicine, if I don't understand what's going on, I try and work it out in my head and I go back to first principles. And so we've known for a while that some of these drugs can increase prolactin, which is another hormone, and often people have their prolactin levels measured. And we know that prolactin will affect the f-sh follicular stimulating hormone. which will then reduce, which will then switch off the ovaries producing testosterone, eustodal and testosterone. And a lot of these women will have lower levels anyway, probably, because that can trigger their mental health symptoms. And testosterone is just a blood test to measure.

Even eustradal, you can measure a blood test. These women are often having blood tests anyway. And even the men, actually. Like, why aren't we measuring testosterone levels in men in these people? because we know that when hormones are replaced, we know mental health can improve, but also those metabolic changes can improve. So the type of diabetes, the raised blood pressure, the Alzheimer's risk, and so forth. So it just doesn't really seem very joined up, does it?

No, and I think on a personal level, Diane has a very similar story. So as we were just talking about, you know, our patient, it's often don't have anyone to advocate for them. You know, as nurses, I think we're a little bit more able to advocate for ourselves. And we're happy to challenge doctors, which people generally are. Great. People generally take the word of their doctor as gospel, which I disagree with. But when I was, I was 45 and I'd fallen, I'd gone for a run, and I'd fallen over and I broke

both my elbows. And that was the first time I thought, oh, oh, you know, I'm 45, maybe I should consider and I spoke to three different doctors, all women, and they all told me that I was far too young and they wouldn't consider with one doctor basically suggesting I may well have ovarian cancer due to having kind of heavy periods. And you were held, 45, he said. Yeah, yeah.

I quoted nice guidelines. I was told that I had to be, you know, I have all of these different referrals to, like, for the things that I knew I didn't have, for them to then come back to me two years later and say, oh, yeah, you were, yeah, yeah, yeah, yeah, you're very menopausal, yeah. It's such a waste of time and money, isn't it? Yeah. I think, you know, similar to Jane, you know, I've done my homework and approached to GP myself and I had a really good experience.

And through doing the kind of research that I've been doing with us, I've kind of had a bit of a specialist role. at my own private practice but in my NHS post and I've actually been met with quite a lot of resistance from some GPs when all we're trying to do is empower women to live a better life

and it can be disheartening at times because you know you're trying to work collaboratively with GP practices to help you know the shared care of our patients, but often we're met with resistance. Or what do they know? You know, they're just a nurse.

Just a nurse. That can be a smart one. You see, I find this really sad. So for two, well, lots of reasons, but two main reasons. Firstly, as a doctor, I love challenge. I love people say, why are you doing this? What's this? Why is the evidence?

I think it's great. I love working with nurses. I love, like, other healthcare professionals to have a, debate because you see different things. You're trained in a different way. And I find it really disrespectful. It really triggers me when I hear that you're only a nurse, how dare you talk to a doctor,

because that is just wrong in so many levels. And then the other thing is, like, it feels that it's, like even if hormones only made you feel a little bit happier, and we know they do a lot more than that, why are people so worried about people feeling happier? Someone was interviewed me this morning about testosterone and it was a journalist and he said something about when I hear you prescribe a lot of testosterone and I hear

that you'll say it can help people feel better. And I said, well, yes, but I also do a symptom questionnaire. We ask about libido. They have reduced libido so we prescribe it for that. But hang on, I said to him. Does it matter if women are feeling a bit better on testosterone? Because actually, lots of people have prescribed antidepressants to feel a bit better. And there's far more risks of antidepressants than there is with testosterone.

So again, it goes back to my thing that it's just allowing people a choice. You know, if you both had low testosterone and you had symptoms of testosterone deficiency and low mood, reduce motivation, poor energy, muscle joint pains, reduce libido. Sure, you could be depressed with all those symptoms, but most women say, I know I'm not depressed. And then if you said, but I really want to try satelopram, and I really don't want testosterone, despite my testosterone level being zero point nothing or whatever, I would say, well, let's talk it through. But somehow if you came and said, all my, you know, everything's low, My testosterone is lemon.

I've got all these symptoms I'd like to try testosterone. You're treated like an imposter as a woman. It's really weird. And that is another, that's another side to it is that because not every avenue is being explored, because women are not being taken seriously when they're discussing their whole range or their menstrual cycle. Young girls especially, young girls have it really tough when they're, you know, just starting on their cycle and growing into young women and dealing. with life and going through schooling and, you know, wondering what the future holds.

And then they're just labelled with a personality disorder if they decide to act, you know, in a way that doesn't fit, you know, the normal criteria of young girls. But having a conversation with someone who is listening to what you're saying, who's trying to look at what might be impacting your presentation, then you get to choose. It's informed consent. It's exactly that. Do I want to try the hormone?

Do I want to try the antidepressants? Do I want to change my diet? Do I want to reduce my stress? Do I want to do them all? It's informed consent, which is what we should be working on. Absolutely. And as a healthcare professionals, I feel our job is to help advocate for our patients in the way that they want. You know, I'm never going to judge someone because they smoke.

I still treat them exactly the same way if they smokes or didn't smoke. I might add into the conversation. It's probably not the healthiest habit. but I'm not going to judge them. And it's the same if they didn't want hormones. I'm not judging them. If they didn't, you know, it's a choice thing. But that choice has been taken away.

And, you know, somebody reached out to me last week on social media. And their daughter has gone to a psychiatric hospital. She's in her 40s and they're convinced it's related to her hormones, the family are. And she's got psychosis. She's having heavy-duty drugs and she's going to have some e-cate. And I said, could I speak to the psychiatrist? They said, no, I can't talk to them about hormones. They're not interested at all.

So she's been transferred to another hospital in London. She must be quite severe. I'm not sure. And they said, we're really hoping that the new psychiatrist might entertain a conversation. And it's really harrowing in my mind. Like, it's not the Victorian times. We don't have to give people chemical strait jackets for every. of course I'm not saying that these drugs aren't important but I am saying why are we so resistant

to thinking about hormones as well yeah I think from my experience that whole you know talking about it is the only place to start because like Jane said when we're on the NDTs or when we have been it's been kind of dismissed but we won't stop challenging we'll continue to challenge and the more we speak about it and the more we put it out there the more

women will feel empowered I think it's about that it's about sharing and building and continuing to challenge that's so wonderful that you said that because it's so true and it's it's sharing so that actually relatives and partners like with Jay and Haney it was Jay's

25 who's a 25 year old son of Haley. He's her biggest advocate and he reached out to me. But that's what we need to do. We need to recognise it and not be ashamed that we've missed it in the past. Because I wonder, you know, I think when I see the behaviours of some people and I think it's because they feel embarrassed.

And then when you, you know, I know that when my children were younger, if they did something wrong, they get cross because they're cross with themselves that they've been found out. But that's just, life. Like we change and we should be saying as mental health nurses, doctors, psychiatrists, you know, we should be saying, look guys, we've not thought about this before. Let's embrace it.

Let's think about it. We're not saying it's replacing all these other drugs, but we just need to think in the same way, you know, we used to think that the world was fat and it's not. Yeah. And I really feel for, because I've worked on. I worked on a team before, and this was many years before, before I really started to think about hormones. And we had a woman and she was 60. And, you know, I do admit to thinking that she was kind of older and maybe it wasn't necessary to consider it. But then as I started working with her, she had a really good job, really happy family life. and then it was kind of around the time she retired,

she kind of went in sunk into some deep depression and she just wouldn't get out of her bed. And that was her life. And so she was tried on all different sorts of medications that didn't work. And when I mentioned that, you know, could we consider it it might be hormonal, again, it was ignored.

And the saddest thing for me was that people were willing to just let this woman lay in her bed every single bed at 60 years old. I did actually, again, do some of my own research and spoke to her husband and said, you know, I've tried to get this through our team, but it's not working. And I referred into kind of a menopause specialist, which he said that he went and spoke with them and they did start on HRT. And I don't know what happened because I left that role. But I was just so so angry, really, that somebody was happy to say, well, there's nothing more we can do and that's that. Rather than, you know, I'd give another other areas that we could explore. and it just didn't want to happen. I always find as a clinician that I'm always giving choices to my patients. So, you know, I don't give up very easily. So if this doesn't work, we can try this.

If this works, we might carry on with it. If it doesn't, then there's this or this, or I can ask someone else. I can, you know, because there's a reason why something happens. And just because I don't know the reason, other people might. And I'm always keen to learn and explore. You know, it's just we've got so much more to go. But I think the momentum is changing. I think people are learning in different ways.

And I think us just doing this podcast is going to help a lot of people. So I'm very grateful that you both came and reached out to me. And so before I end this, I always ask for three take home tips, but I can't divide. So I'm going to have to ask for two each. So two things each that you think we should do to make these changes as in thinking about mental health

and hormones more what three things or four things sorry do you think should happen quickly to reduce the suffering for some of these women so I'll go with you first Diane

for me standardised questionnaires as part of the referral process. We do a generic screening for people, have the questionnaire. It doesn't take any more time and you're going to get so much more information. Education for GPs, that's my two things.

Very good. Very good. Thank you. What about you, Jane? I think education for nurses to be able to challenge doctors. And I think, I think, That's it, just to continue to challenge if you are a nurse or a patient and you don't feel that what is being said or the treatment that's being given isn't correct. Just challenge. Just continue.

Don't accept if you're not happy with the response. Yeah. I think it's so important. It's a difficult thing to challenge healthcare professionals. But sometimes we have to or get a second opinion. It's not always easy, especially if you're in a psychiatric, hospital you can't just go to another place but just ask keep asking and feel listened to and valued so thank you again so much for your time this has been a really interesting podcast