ZOE Science & Nutrition - Menopause: How your body changes and what you can do

Episode Date: March 24, 2022

There's a condition that leads to an increased risk of heart disease, dementia, and early death that's been affecting people for as long as they've existed. The many symptoms can severely impact quality of life - ranging from headaches and memory problems to anxiety and weight gain.  This condition affects more than half of the world's population, but unbelievably its rarely discussed and the scientific research that exists on it is limited.  It's called menopause, and it affects 1.2 billion women worldwide. It's not a disease, but the effects can be just as serious for some women. Jonathan talks to the British doctor who's working to educate us about menopause and bring the discussion on the topic into the mainstream. Dr Louise Newson is a GP, menopause specialist and founder of the Newson Health Menopause & Wellbeing Center. Director of the Balance Menopause App and the non-profit Newson Health Research and Education. Founder of The Menopause Charity. Download our FREE guide — Top 10 Tips to Live Healthier: https://zoe.com/freeguide Timecodes: 00:00 - Intro 00:09 - Jonathan Intro 01:11 - Episode start 01:24 - What is menopause and why is it important for Dr Louise 04:17 - Being hormone-deficient is bleak 07:27 - The overall scale of menopause 12:41 - What is HRT? 17:24 - How little menopause is talked about 19:30 - Dr Louise’s push for menopause understanding & education 23:02 -What’s the accurate test for perimenopause? 28:10 - Understanding hormone deficiency symptoms 31:58 - What else can you do besides HRT: Nutrition considerations 41:09 - Does your body shape change while menopausal? 41:55 - Summary 44:06 - Goodbyes 44:31 - Outro Episode transcripts can be found here. Dr Louise’s non-profit organisation about improving and understanding women’s hormone health: https://www.nhmenopausesociety.org Check Dr Louise’s app on perimenopause and menopause: https://www.balance-menopause.com Follow Louise: https://twitter.com/drlouisenewson Follow ZOE on Instagram: https://www.instagram.com/zoe/ This podcast was produced by Fascinate Productions.

Welcome to ZOE Science and Nutrition, where world-leading scientists explain how their research can improve your health. What if I told you there's a condition leading to increased risk of heart disease, dementia and early death that's affected humans for as long as we have existed? The host of symptoms can be very unpleasant, ranging from headaches and memory problems to anxiety and weight gain. Then, what if I told you over half the world's population will suffer from this at some point? You might assume this condition would be a constant topic of conversation, studied by many of the world's leading scientists and taught in schools. You would be wrong.

The condition I'm talking about is menopause, and it affects 1.2 billion women worldwide. It's not a disease, but its impact can be profound. In today's episode, I'm joined by the British doctor leading a worldwide mission to educate us about menopause and make it a mainstream topic of conversation. Dr. Louise Newsome helps us understand how menopause can affect women and the options available to help. Louise, thank you for joining me today on a topic that is so important and so under-discussed.

And I have a whole bunch of questions from our members today, but I think we should start right at the beginning with like a very simple question. What is menopause? And also, why is this a topic which is so sort of personally important to you? Oh thank you well thanks for inviting me today so the first question first I suppose menopause is just a word and it shouldn't actually be called that it should be called a female hormone deficiency and I'd love to change the terminology but but we are where we are. Menopause

just means, well, meno is the menstrual cycle, pause is stop. So it's a weird one actually in medicine because it's a retrospective look back in time diagnosis for most of us, because it means a year without our periods. That's all it means. And so most women, what happens is we're born with a finite number of eggs in our ovaries. That number or the eggs run out eventually at the average age, not that any woman's average, but the average age is around 51 in the UK. So because the eggs run out, the hormones associated with the eggs, the hormones produced by the ovaries also run out.

And so they decline and hence the term female hormone deficiency. But it doesn't just happen overnight, it happens gradually for most women and so a lot of women become perimenopausal before they become menopausal and peri is just a medical term for around the time of. So often for many years, sometimes even a decade or so, women's hormone levels will be declining at a slowish rate, sometimes a haphazard rate. So they go up and down for many years. And so that means they get symptoms. So menopausal symptoms as well, but they won't know that they are because they're still having periods and the periods can sometimes change in nature or frequency. But also there's a lot of women who never have periods because they might've had a hysterectomy or they might be using some birth control or have a contraceptive device,

coil. So they're not having periods. So then they're just getting symptoms. And so with the menopause and perimenopause, there are lots of symptoms because especially the main hormone oestrogen, we have cells that respond all over our bodies. Every single cell in our body responds to oestrogen. So that means every single system in our body can respond to low oestrogen. So symptoms can really vary and they can range from symptoms such as reduced stamina, brain fog, low mood, dry eyes, dry mouth, painful mouth, tinnitus, hearing problems, palpitations, muscle and joint pains, even stomach problems such as irritable bowel syndrome, digestive problems, urinary symptoms, vaginal dryness. The list goes on and on and on because it affects us, this lack of hormones. But more interestingly, actually,

for me as a physician, of course, I worry about people suffering, but it's looking at future disease. And we know that women who have low hormones, such as menopausal women, have an increased risk of diabetes, osteoporosis, various cancers. So it's quite doom and gloom being a menopausal woman. I have to say, I'm listening to this and it's not very cheerful, is it? Absolutely not. So not only are women suffering emotionally, physically, with their partners, with their jobs, everything else, they know that they've got this increased risk of diseases. So it is doom and gloom. It's a natural process for most people. So a lot of people think, well, there's no treatment for natural processes, but actually it's not natural because evolutionary, we're designed

to reproduce and then fade away actually. And so the most important treatment for hormone deficiency is having hormones back. And we'll talk about this in a bit, I'm sure, but a lot of people have been very scared about our own hormones. But I've said the average age is 51. We also know that around one in a hundred, probably more women under the age of 40 have an early menopause. And sometimes that is again, natural. It's just, they've got less eggs and they run out of it earlier. Or some women have their ovaries removed from surgery or they have it damaged, their ovaries damaged by drugs such as chemotherapy or radiotherapy. So there's a lot of women out there who will be young. My

youngest patient was 14 when she became menopausal. And so these women often become perimenopausal before. So there's teenagers who are perimenopausal, there's women in their 20s and 30s. And in their 40s, they'll usually either be perimenopausal or menopausal. So I'm very interested in health. I'm very interested in disease prevention. I'm not a gynecologist. I have a background of hospital medicine. So I actually wanted to do cancer medicine many years ago. And then I got married and thought, how can I be a full-time physician and be a mother of children and be married to a surgeon? So I went part-time and became a GP. And then I've

done a lot of medical writing, a lot of academia, a lot of evidence-based medicine. I've got a degree also in immunology and pathology. So I'm very interested in geeky science as well. We like that on this podcast, so that's good. Yeah, good. It's good. As Zoe's chief scientist, I wanted to talk about something that's not talked about menopause symptoms over half of people on the planet experience perimenopause and menopause yet symptoms are often misunderstood or dismissed zoe's new meno scale calculator lets you score your menopause symptoms your menoale score may help you make sense of what you're experiencing. Personally, as a woman experiencing perimenopause, it's a key talking

point with my friends. And now we have a score that we can share with each other. To me, this calculator is a game changer. At Zoe, we're moving menopause research forward. We recently conducted the largest research analysis of menopause and nutrition in the world. In our research, participants reported an overwhelming number of symptoms. 66% of perimenopausal women reported experiencing over 12 symptoms, like weight gain, memory problems, and fatigue. The good news is our research shows that changing our food habits may reduce the chance of having a particular menopause symptom by up to 37 for some women the menoscale calculator puts our science in your hands go to zoe.com forward slash menoscale to get your score the calculator is

free and only takes a couple of minutes as we scientists, if you can't measure it, you can't change it. All right, back to the show. So I sort of carved this niche really that I've managed to have time to think, which is quite unusual in medicine. And I've also had time to explore my interests. And I've also had time as a GP to listen to patients, which, you know, number one in my career, even now, are my patients. They are the most important. Well, actually, my family are the most important thing. But second to that are my patients, actually, because they have come to ask for professional advice, but they don't want me to be dictatorial. They want to share their decision making.

I want to explore their concerns, their worries, their beliefs, their expectations in a two-way process. And GP gives you great training for that. Or I was very, very blessed. I had an amazing trainer called John Sanders who really helped me learn about the consultation process. And so menopause ticks all these boxes of all my areas of interest actually. So I actually have the best job in the world it's frustrating because I listen to stories all the time of women suffering and that's what I'm determined to change. And can you talk a bit about the scale of the problem because I think you already touched a bit on maybe some of the controversies around hormone but obviously we'll have a lot of

listeners who are going through this many who feel that this is coming up for them, and many who, like me, are not going to experience this. But of course, their mothers have, their partners will, their daughters will. Talk a bit about this across the US and the UK. Yeah, the scale is phenomenal. There's no other condition that is guaranteed to affect us. And when I say condition, people might say, well, it's a natural process. It's not a disease. Well, we can argue about that because there are health risks that I've already said. The same way, is obesity a disease or not? And again, we can argue about that. And I think a lot of people will say there are health risks associated with obesity. Is raised blood pressure a disease? Not really because it doesn't cause

symptoms, but we treat it because it's a marker of future disease. And menopause is the same, but for many years, we think about menopause as a transition. It's just going to last a few years. We also think about it just causing a few hot flushes. And a lot of people think, well, my mother's got through it. I'm going to get through it and when we talk about getting through it that's about getting through symptoms and for some women they might not have any symptoms we don't know the proportion it's probably about 20 percent might not have many symptoms or any symptoms we know 25 percent so one in four women have severe symptoms

that means it's affecting them at work and at home. But also, whether a woman has symptoms or not, she has this hormone deficiency. So she has this increased risk of disease. So you only need to look at figures for osteoporosis. One in two women over the age of 50 who don't take HRT will develop osteoporosis. One in three will have an osteoporotic hip fracture. Our risk of a heart attack increases by a factor of five after the menopause. Who's more likely to get dementia? It's women, it's not men. You know, so it's all there. We know it's there and no one's really looking at it because everyone's scared of hormones. But, you know, these health risks are there forever.

And then you look at some of the other symptoms. So vaginal dryness, I'm sorry to talk about vaginas so early in a podcast, but vaginal dryness is very common. It affects about 80% of women who are menopausal, yet studies show about 8% of women receive treatment. Now, because all the tissues everywhere in our body responds to oestrogen, the tissues lining the vagina, the vulva, even the urinary system respond to oestrogen. So without it, these tissues can become very thin, very friable, not stretchy. You can imagine it causes pain and discomfort, but not just with penetrative sex, actually. A lot of women I see can't sit down for long periods of time. Some of them stop wearing underclothes because that friction is

really painful. A lot of women experience recurrent urinary tract infections, some urinary incontinence. And this really is affecting the quality of life. But the minority of women are getting treatment, which is just a replacement estrogen in those tissues. And so the scale is huge. You only need to think about how this is affecting women in different cultures. If women are incontinent in Africa, they're ostracized from their community. They can't work. Well, that's awful in 2022. And then we've done some studies. We recently did a study of nearly 4,000 women. And we found that 50% of women answering had either given up their jobs or not taken a promotion at work as a direct consequence of their menopausal symptoms,

mainly fatigue, memory problems, and anxiety. So this is awful awful actually. So this is where the scale is mind-blowing actually. And the work I'm doing, there's so much because I'm on a real mission to improve the future health of women, not just in the UK, but worldwide. So we have to do it in a grown-up way and we have to empower women, but we also have to give healthcare professionals the tools and knowledge and evidence to support them helping these poor women. And can we talk a little bit about that so Louise I know you were telling me just before we started I think that you're seeing something amazing like 4,000 women a month I think you said just in the clinics that you've set up and that's obviously here in the UK can we talk a bit more broadly I think you've already touched

a little bit on this topic about hormones and hormone replacement what is the here in the UK. Can we talk a bit more broadly? I think you've already touched a little bit on this topic about hormones and hormone replacement. What is the situation in the UK and the US today? What's the latest scientific evidence and what's actually going on and what do you think should be going on? Yeah, so it's a huge problem because women aren't able to access the treatment. And so I set up a clinic three years ago, really to get some of my friends off antidepressants because antidepressants is not a treatment for the low mood associated with the perimenopause or menopause. And, you know, the demand has increased exponentially, but people shouldn't be coming to my clinic. They should be getting it from their local healthcare provider. In the UK, around 14% of menopausal women receive HRT. In the USA, some figures are about 4%. And Louise, just to explain for a bit, what exactly is HRT?

So HRT is hormone replacement therapy, which is what we call it in the UK. In other countries, it's MHT, so menopausal hormonal treatment. It is just hormones and I'll talk about what it is in a few minutes. But we have really good guidelines. So in the UK, we've got NICE, the National Institute of Health and Care Excellence Guidelines came out in 2015. Internationally, we've got the International Menopause Society Guidelines that came out in 2016. They're very similar. And actually what they do show is the huge benefits of taking HRT, not just to women's symptoms, but to their future health, especially for osteoporosis prevention. So we have these great guidelines that as clinicians, we should be working out of whichever country we're in,

but we're not, are we? Because the minority of women are able to access it. And this isn't because the minority of women want their hormones back, it's because they're struggling to get them. And so we need to think about why, why are people so scared about their own hormones? And that's because if we look back in time, in 2002, there was a massive billion dollar study. So 20 years ago, I mean, it's now a lot of money, isn't it, to spend on research a billion dollars, but then- I think even today,'s now a lot of money, isn't it, to spend on research, a billion dollars. I think even today that's a lot of money, yes. Massive amounts of money. And it was looking at how the future health benefits of HR or hormonal therapy will help women. But it was actually not a great study in the way it was set up.

And this is really important to understand. What they were doing was giving hormones to women, but the average age of women where they were starting MHT or HRT, depending on which country you're in, women who were 64 was their average age. A lot of these women were obese and they had heart disease already. And so if you give them HRT or hormones the way that they gave it? They gave tablet oestrogen, which we know has a risk of clot, and they gave a synthetic progestogen. So it's a modified progesterone, and that has effects negatively on the heart system, on clots as well. Gave them, these women,

quite high doses. So women in their 60s who had become menopausal maybe 14 years ago, gave it to them. And then they found that there was a small increased risk of heart attack in these women, not surprisingly, because we know about how these hormones worked. But also they weren't really getting very good results and they were spending a lot of money. So what they did find that there was a little bit of an increase in breast cancer with women who took combination HRT. They hadn't analysed the data properly. And what happened was some of the investigators just went

to the New England Medical Journal. They went to the lay press and said, HRT causes breast cancer. You can imagine it went wild. And some of the investigators, such as Robert Langer, who's very outspoken about this said, I went to the chief scientific officer and said, you cannot do this. This is going to be the biggest travesty to women's health for decades. And they said, it's too late, it's gone to press. And isn't that awful? And now we've got 20 years data from this study. We have seen from this study very eloquently that women who have had a hysterectomy only needed oestrogen actually have about a 25% lower risk of developing breast cancer.

The ones who were taking this combination oestrogen-progestogen, there might have been a small increased risk, but it was never found to be statistically significant. And what's very interesting actually is that when they looked at women who have this supposed increased risk, what they were doing was increasing their risk back to baseline in women who had taken HRT before. And women who had taken HRT before were found to have a lower risk of breast cancer. So actually the data is already teasing out that hormones are safe, but the way it was misreported, it doesn't matter what the data shows because that's all everyone knows. And we know this is always the danger of taking very complex science and the press wants

to jump away with a very simple... Because they want to sell bad news stories, don't they? And so we've now got 18-year follow-up studies that came out recently and they found that women taking any type of HRT have a lower risk of heart disease, osteoporosis, diabetes, dementia, death, and also colon cancer, but also other cancers as well. And women taking any type of HRT are less likely to die from breast cancer. So there might be some women who have a higher diagnosis but they're still less likely to die from it. One of the things that I'm struck again every time you or anyone else talks about this is how little is talked about this. You're talking about really severe symptoms. I can tell you right now that

if men were going through half of those, like we'd all be talking about it all the time. So not only are you saying that many of them are faced with quite a difficult choice around whether to take these hormones because of what people have been talking about in the past and potentially some trade-offs, how are they supported? How well is this being understood across the West? I think we talk a little bit more about it than we did, but my mother got through this. I can tell you that generation definitely didn't say anything

about it. So is it changing? I think it is changing actually. So when I went to my first International Menopause Society meeting, it was in 2016. So the guidelines had just come out for the International Menopause Society. And I was sitting there in the lecture theatre with some amazing academics who I've now got the privilege of connecting and knowing. And they were all talking about HRT and saying how safe it is and how great the guidelines are and how amazing all their patients are. And I sat there thinking, what can I do? Actually, I'm really struck by these stories. And I had just started doing my own clinic.

I was just working one day a week, like I say, seeing some of my friends, some people, and I'd started a website to help give people some evidence-based information. And I was quickly seeing stories of women who had given up their jobs, their partners had left them. They were, some of them suicidal and really struggling with no help. So I sat there in this lecture theatre thinking, well, what can I do? I can't run a massive research project. I'm just a woman on her own who has just started taking HRT and it's given me my life back. But I couldn't get HRT or menopause or hormonal therapy from my own GP, my own primary care physician. They said, no, it's too risky. You can't have it. So I had to go and seek it elsewhere. I just want to stop there for a second, because that's an amazing thing for you to say. You said, here are these new guidelines,

you know, global guidelines saying this is safe. Could you explain how it was that your own physician is then basically just saying no, because I'm hearing that and it sounds extraordinary. I know, I know. It's shocking, isn't it? And I'd like to say things have improved, but they haven't. And because they, when they were being trained, but they haven't. Because when they were being trained, and most of us don't have formal menopause training, but all they read was that hormones are bad and they're going to cause breast cancer. And we still see that from MHRA, our Medicines Health Regulatory Authority are telling us that estrogen is dangerous and it's not. So I sat there in this actually thinking, what can I do? I can't just

have a really big clinic because I'm not business minded. And you've already said, I do now have a big clinic, but it's not enough. It's not enough. And I don't want to be having a clinic empire. So what I've worked really hard the last few years doing is empowering women with knowledge and education, because as much as people think women are stupid, we're not, but we have to be given the right tools. And so I started off developing this website, Menopause Doctor, it was called dot co dot UK. It's now been taken over and it's balance hyphen menopause dot com. So I could reach people through a website, but not everyone has the luxury of a computer and internet access. So then I've

developed the free Balance app, which has a lot of information on it. I've also played a lot with social media, mainly just to stalk my children. So a few years ago, I set up Instagram and I've now got, I don't know, 270 something thousand followers. It's just grown organically. And every day when I get up at six in the morning, I just post something. And that's been an amazing platform for people to share knowledge and to learn evidence because so many women and men have been given misinformation about the menopause and especially hormonal treatment. And then that's great. But then what I have found is that more women are understanding that they don't need antidepressants, that their fibromyalgia might be due to their low hormones or their headaches or their palpitations or

their urinary symptoms, but then they're going to their clinicians who are saying, no, like mine did. And so what I set up three or four years ago was a not-for-profit company called Newsome Health Research and Education, and it does what it says so we launched an education program which is a online program actually I did it online not because of Covid I set it up before Covid but I was very just worn out really with going to lectures where I had to find child care pay for it take time out of So, and I also found that I learned the most by sitting in clinics, by being with a very esteemed clinicians, asking them questions, seeing how they consult with patients. So we did some videos with some actresses who pretended to

be different patients. We also filmed some lectures and we've linked it to evidence and also linked it to patient resources. So we've worked with 14 Fish, an appraisal company, and we've got this platform and we've had over 21,000 downloads of this education program over the last six to nine months. But we've made it free because my mission really would be for women to empower themselves wherever they are in the globe, for healthcare professionals to have the right knowledge that is evidence-based and then the dots can be joined and then I can just go and line a dark room. It'd be lovely, wouldn't it? Your job will be done. I feel you'll be campaigning on this topic for a long time, Louise. So just before we move off this way,

one of the questions we asked a lot of our members on social media this week, and there were loads of questions on this topic, but one of them was, I think, directly into this. You're talking about hormones replacing the natural hormones you have. But one of the questions was, what's the accurate test that can tell me if I'm in perimenopause? Because you described menopause as, hey, it's a year after this stopped. So that's quite a funny sort of diagnosis, isn't it? It's like, wait for a year, it's already happened. Generally in medicine, we like, and I think this is something we believe a lot in Zoe, right? Preventative health, how do you understand early? So how do our listeners test for themselves and understand where they are in what you described as quite a long, slow transition?

Do you know what? Wouldn't it be lovely if I could say there was a test and there isn't, and it's really important to say that there isn't because even in the UK, figures from about four years ago show that 9.2 million pounds is wasted on inappropriate hormone testing. Now, my clinic is private because I can't get a job in the NHS because there aren't enough NHS menopause clinics. If someone gave me 9.2 million pounds, I'd tell you I could do some really good clinical medicine with that. So we know that the hormone blood tests aren't reliable for a simple fact is that I've already explained when you're perimenopausal, hormone levels really

fluctuate. So if I was perimenopausal and I went to my doctor or nurse and had a blood test at three in the afternoon, I probably would feel not so bad and my hormones levels would probably be okay. If at two in the morning, I wake up drenched with sweat, having a night sweat, palpitations, intrusive thoughts, crippling anxiety, I can pretty much tell you my blood tests will be low. No one's going to take a blood test at two in the morning. And so that's why they're very unreliable. So there's lots of women who are told it can't be your hormones because your hormone blood test is normal. Well, at that time, it's like looking out the window when it's raining and then 23 hours out of the day, it's sunny. And you say to me, what was the weather like?

And I say, it's rainy. I say, don't be ridiculous. It was sunny. Hi, I love that you're listening to this. It means a lot to me and the whole team who put such a lot of hours into this podcast each week. We release this show for free without ads to help millions of people improve their health with cutting edge science. In return, all I ask is that you help us on this mission. If you know someone who'd benefit from listening to this episode, please send them a link to this show. And if you haven't already, hit follow wherever you're listening right now. Thank you, and on with the show. Interesting, because we see exactly the same thing with a lot of metabolic tests that we do. So,

you know, people historically measure all the things like blood sugar and blood fat fasted. Well, it's exactly the same, isn't it? And so, you know, when I was a medical student, I did a lot of diabetes work. You know, you were diagnosed diabetes, wouldn't you, by fasting. Well, sometimes you do random blood sugar. That's completely useless. If someone's just had McDonald's, of course, they're going to have. And so then we did fasting. That was a bit more out there. And then we did the glucose tolerance test. We had to bring people in as an inpatient. Oh, it's just ridiculous. And then HbA1c came out. So this is your average, as you know, average sugar level. Oh, that was brilliant. That was pivotal actually.

And so what we want to do, what I would love to do is can we have a test to show everyone's so focused on is oestrogen being bad and let's delay the menopause, let's delay treatment till people are really bad because oestrogen and hormones are so dangerous. Well, actually they're not. We know from studies that the earlier women take hormone replacement therapy or menopause or hormonal treatment, the better. So let's start it in the perimenopause. Let's not wait till these women have given up their jobs and they're really struggling. Let's do it early. But how do we find these women?

So actually let's look back into common sense medicine. Let's see what's happening in the body. So rather than relying on symptoms, and I've already said a lot of women don't get symptoms or symptoms that they recognize as being related to the low hormones. Let's see what's going on. So we know these inflammatory processes start quite early because oestrogen works very well on every cell, but especially our cells that work for inflammation. So if we think of all those cells, our monocytes, our macrophages, all our white cells, they're very good at fighting infection. That's what we need,

aren't they? If you have a virus, it will eat them up and sometimes develop antibodies. But actually we know, especially macrophages, if they're switched on wrong, they become pro-inflammatory. And if there's pro-inflammation in the body, then it increases risk of disease. We know that for diabetes and heart disease and dementia and osteoporosis. Oh, isn't that a coincidence? All the diseases I've mentioned related to low oestrogen. And we've got some really good work, some of it's from the 80s, so before the WHI came out, looking how oestrogen is an anti-inflammatory, it's an immune modulator. So it genetically reprograms the white cells, it changes the number, it changes the function, it changes the way the cytokines work. It's really powerful actually. And so when in the perimenopause

these hormone levels start reducing, these pro-inflammatory effects start working. So what we need to do, I think, is develop a test where we're looking at this biological aging. So not just aging with a bit of gray hair, actually internal aging of the body, this inflammation that goes on. And this is some of the work that we're starting to do and starting to get some results actually. I know myself, you start to feel a bit rubbish, but you've got like, I've got three children. I was setting up my website. I was opening my clinic my clinic of course I'm going to be tired of course I'm going to be forgetting things so how do you know? Hard to tell whether these symptoms are related to menopause

or whether they're related to the fact this is tending to hit you in your 40s which is we all know even for men right a particularly tough time with aging parents often children work all these things together absolutely and so most women even those women who say they have no symptoms once they start on some HRT or MHT then they come back and go wow god this is the best I felt for ages and I know personally I had my third daughter when I was 40. I started HRT when I was 45. I felt after a couple of years when I got the right dose and type, I felt the best I felt for about 10 years. So I wish I'd started it earlier.

But of course, I didn't know, did I? I just thought it was having the third child that broke in the back of me. So actually, if I had done some biological thing, because I started to notice that I was putting on a bit of weight in the midline and I've always been quite slim, but I couldn't be bothered to do yoga. Everything was an effort. I knew I wasn't sleeping well and poor sleep, we know, increases weight. So I still didn't pick up these subtle signs really. Whereas if I had been doing a test, like looking at inflammation and then,

or my biological age, and it had been the same for the last three or four years, and then suddenly had jumped up, that would be a warning sign. And it might not be diagnosing perimenopause or menopause, but it would be a wake up call. It's a bit like doing your blood pressure, isn't it? Every time you go to the doctor or to a clinic, suddenly it goes up. You think, what can I do? I don't want to take drugs. I want to think about, is it my lifestyle? Is it because I've started smoking or drinking or not exercising? And that's what we do with blood pressure. That's what we do with, even with diabetes, type two diabetes, we'll think about lifestyle. Well, actually with perimenopause, of course we have to think about

lifestyle, but we also have to think about our hormones as well. But we need this biological sort of marker. And that's what I think would be really interesting. And then it helps with my whole thing about thinking of the menopause as a female hormone deficiency with health risks, not about, oh, let's just stop this poor lady having 20 hot flushes and just, you know, make her feel a bit more comfortable giving her a fan. Let's work out what's going on biologically in the body and help prevent disease. Part of the reason that we first got to meet you, Louise, right, we suddenly woke up and Sarah Berry, our chief scientist, sort of realized we've actually got the biggest in-depth study of nutrition and menopause in the world with all of this information about the microbiome and metabolic responses. And actually, this has hardly been studied, shockingly. Already,

that first study with 1,000 people was like 10 times larger than anything that we had done, that anyone had done. And now we are sort of 20 times bigger than that. And I think what's really interesting is that we see in this first paper that you're an author on that will be coming out shortly, these profound changes in biological responses in the period around menopause, some of which we see very much, you know, just within the 12 months around menopause, right? But also we also see these big changes in maybe sort of the five years on either side. And so I think what people have said a lot, right, which is I feel like my body has changed. You can measure this, right? We can see that your blood sugar suddenly is

completely different in terms of your responses to food, that your blood fat is suddenly completely different, that your inflammatory markers are up. And interestingly, that your microbiome, right, these gut bacteria, we're also seeing these big changes. We are early in this journey of understanding how to piece all of that together, but we can already see, and I guess this is a way to talk a bit about nutrition, which is something we always like to talk about here, that if your responses are changing dramatically, then clearly how you should be thinking about what you should eat has also got to change. So maybe on that topic, Louise, you know, we talked a lot about hormones, but I know

the other question for listeners, and I think maybe to talk about food and others, is what else can you do? You have these symptoms, you can take these hormones. What else can you do when you're going symptoms, you can take these hormones. What else can you do when you're going through this really sort of profound physiological changes? Yeah, it's really important. So whether someone takes hormone replacement or not, they still have to think about their food. But there's also a lot of talk out there that you can help your menopause or you can get through the menopause with a certain diet, a certain

supplement, a certain this. Phytoestrogens always come up because they contain some estrogen. Do you know what? You'd have to eat so much to stimulate your estrogen receptors properly. And so any supplements that are labeled menopause, I would just put in the bin or I wouldn't even buy, waste my money on them actually, or any sort of specific foods foods you have to think about what you're doing and I think yes there are some work to show that not eating processed foods not eating spicy foods not drinking alcohol reducing caffeine can improve symptoms but I've already said the menopause is not just about symptoms so we're kidding ourselves as women if we think that our future health is going to really make a big difference if it's just about diet. But absolutely, you know, I've already said I take MHT or HRT,

but what would be the point of me eating McDonald's and smoking 20 a day? It would just be stupid, wouldn't it? So we have to take responsibility for what we eat as well. But I say it with a bit of caution because I also know when women have low estradiol levels, they often get sugar cravings. They often comfort eat because they're feeling bad as well. And their metabolic processes, again, we haven't got good studies about this, but slow down. So they're going to put on weight more easily. We also know that fat cells, our adipocytes, produce quite a toxic type of oestrogen actually. It's a pro-inflammatory oestrogen, but that's all the body's got if it needs oestrogen. So people will lay down more fat and increase their weight without changing their lifestyle, especially in

the midline because their body's saying, give me some estrogen. And so these poor women then often feel like failures and they're feeling bad anyway because of the psychological impact of their low hormones. So it's this downward spiral for a lot of people. And a lot of women listening might acknowledge that even if they're getting regular periods, because most women experience some sort of dip in their hormones just before their periods and that's often when they're craving sweets or sugars or whatever but it's only a day or two a month so people often just ignore those signals from their brain or succumb but it's only a short term but that all the time is really having an effect so it's difficult, but certainly most women can take HRT. We're just writing up some work actually for the Cancer Journal, which will be out soon.

And I've written about vaginal oestrogen. You know, I've already said for vaginal dryness, how safe it is for women who've had breast cancer. And Avram Blooming, an oncologist in America, is looking at a review of studies of giving hormones to women who've had breast cancer and 24 out of 25 studies have not shown a detrimental effect. So this is going to be really important. So I would hate people here listening to think, but that's fine, but I can't take HRT or MHT. Most people can, but we need to obviously look at diet as well. And if women are not able to receive the right treatment or they're struggling to see the right clinician, then they should be looking at diet.

And you're absolutely right. Thinking about insulin is really evil, actually, if we get too many peaks. And so looking at this sort of processed food, those fast food, those sugar hits is actually really bad for us in our system metabolically as well. And if we've got a metabolic insult, i.e. the perimenopause or menopause, don't throw more metabolic insults at your body. So looking at foods, looking at the glycemic index of foods, looking at the whole range of foods so that we're really feeding our gut microbes as well and adding things to our diet, even if it's

just adding a handful of seeds to a salad or trying a new vegetable that's hopefully in season, that's going to be really good for your gut health as well. And so the last thing I would want, and I see it a lot, is that women restrict their diets because they're so scared of putting on weight. So they come and say to me, oh, Dr. Newton, I'm putting on weight, but I'm now not having breakfast. I'm just having a cheese sandwich at lunchtime and I'm having a low fat something rubbish. Given up gluten and I've given up lactose and I've given up all these other things. Yeah, precisely. And I don't have any fat in my diet. So their brain fog is even

worse than ever. And so it's he's like no you've got to feed these microbes and we work with Emma Ellis Flint who's an amazing nutritionist and a chef and she's one of our balance gurus and if any of you watch the way she cooks it's so exciting you can smell that food coming from the video you know she and it food we all need to eat don't we we can choose whether we drink alcohol or exercise or smoke but we have to eat but it should be a real pleasure I love my food but I really careful about what I eat and I know that if I just went off now and had a packet of crisps and a muswell firstly I'll get a migraine so I can't do it because I can't function without

a migraine but secondly I might feel fine for 10 minutes when my sugar level changes and my insulin, and then suddenly I will just burn. And that's what's happening all the time. We're giving ourselves these insults. We're having these juices or these low fat sugar drinks or whatever. And it's a car crash, isn't it? For our gut microbes and metabolically. Right. And I think what is interesting, I think what is new with some of the research that we've been working on and that Zoe's been published otherwise is the way in which we see these profound changes in people's responses to food as they age. And so I think what is really interesting, we see these huge personal variations, but we can also talk about, you know, in general differences between men and women, because there are big average differences. And I think one of

the things that's really striking is that on average, women in their 20s and 30s are able to eat much larger quantities of food that's high in fat or high in sugar before having these inflammatory responses on average. And we see these huge variations. And then what we see in this paper that's been coming out shortly that you were involved in, right, is this profound change sort of during your 40s, where at the start of this, you've probably had this food that you've been eating for 20 years and it's been causing no problem. And absolutely, you haven't put on any weight and you feel good. And then suddenly you're 50 and you look at it and you say, well, yeah, I'm not surprised that you're now having problems. Because if you look at the amount of blood sugar impact that's happening, if you look at the amount of blood fat, well, now you're not managing to clear that, right?

It's still there after six hours. You're having these inflammatory responses. And so this idea that your body has changed, you know, it's not just in your mind. It's real. And I think the positive news is that it doesn't mean there's nothing you can do about it, but it does mean that probably in a sense, you've sort of been able to get away potentially with eating these foods, it was fine. And now there are some things that doesn't mean you can never eat them, but you've got to think more about, well, if these are treats, how do I sort of feed myself around it? And how do I support those gut microbes, right?

To try and generally reduce this inflammation. I think that's really exciting and one of the things that, you know, we're looking to get much deeper into with you and some of these other experts on menopause. It's very interesting. I mean, I've talked a lot about oestrogen, but also, I don't know if you know this, Jonathan, but women produce three times more testosterone than oestrogen. And so testosterone is a female hormone as well as a male hormone. It's produced by the ovaries. Whether it's a menopause decline or an age decline, there's a bit of a debate,

but it doesn't matter. It gets lower as we get older. And so testosterone, again, we have receptors all over our bodies, in our brains. So have low testosterone, often find they have brain fog, they have memory problems, reduced stamina. It's also very important for muscle. So muscle mass can reduce because of stamina and mass reducing that can be a real problem with exercise. But we do see a lot of women who once they start oestrogen, especially when it's given through the skin as a patched gel or spray, their weight starts to reduce, this midline reduces. And then when they have testosterone, their body shape rather than their actual weight changes as well. Whether that's because they're exercising easier and better and more effectively, I think that is partly to play, but I think also there's metabolic

changes. We don't know enough about testosterone in women. There is research testosterone in men, but obviously they have higher doses. What I'd love to do is more research on that. And we have a DEXA scan here in the clinic looking at bone density, but it also can do body composition. And so I'm really, really interested in looking at visceral fat and how that changes with estrogen and testosterone. Because I think if we got some good studies, we would show that both those hormones probably independently have an effect on our visceral fat, which as you know, is a marker for cardiovascular disease and metabolic disease. We actually had a lot of questions around body shape change. So what you're saying is this is real?

Yes. You know, it's real, but there isn't any evidence. So there's a lot of those people who only believe in randomized control studies say that there's no evidence. Well, actually, you know, I've seen thousands of women. And so I have some real lived in experience actually of this. And you have to learn from patients, you know, it's very good. We have to have evidence as well. We have to have studies. But if we only looked at randomized control studies, we wouldn't have penicillin, would we? And also you have to do the studies, right, Louise? I mean, I think one of the things that's really striking is how little science has been done on women

compared to men. It's one of the things that's, I think, really been shocking for me as I've got into this over the last five years. If I try and play back a little bit of what we've just covered today, I think we started by saying that menopause is actually interestingly defined as something that stopped 12 months earlier. And actually, if we really want to understand what's going on, we have to think about this perimenopause, which is very variable between women, that there is no test that allows you to understand that you're already in this. And so a single hormone test, for example, if it said that your hormones are fine, you're

dubious because it could well be that it's just the point in the day and that we need to develop a better test to understand this. That hormone replacement is now viewed through global guidelines as well as the guidelines you described in the UK as the right solution for many women, that there's been a lot of debate about this impact, particularly to do with breast cancer, and that your strong view is that when you look against the benefits that you get, including things that are affecting health and death rates, as well as just your quality of life, you're a strong campaigner for the ability to take these hormones that, as you say, all women have in their bodies all the time until this point, and that this is sort of transformational, and that there's shockingly low levels of this. You described even between the US and the UK, right? I think you said between 4% and 14%, is that right? So that itself is interesting, right? That you could have two countries with very shared views about the

health system and such big variation. And then I think we talked a bit about nutrition and the way that this does not replace this question around hormone replacement, but is incredibly important in addition, and the way there is these sort of profound changes in the way that women's bodies metabolize food through this period. And so it is true that your body is different from before. Some of these things, people are feeling like body shape changes are real and that therefore understanding what's right to eat now, which is different from before is important. And then I think we just wrapped up by saying, it's sort of amazing

how little this has been studied, how much opportunity there is therefore to understand all of this better. And, you know, I know I speak on the Zoe side, this has become one of the things we're most interested in because it's just such an enormous impact on our members and there's been so little investigation so we hope to have you back again in the future and to talk about some of the further studies and the guidance that comes out of this. I'll be delighted thanks ever so much for inviting me today. It was a real pleasure Louise thank you so much I think that it's really amazing to hear your your sort of personal championing of this and I think for many people listening whether it's affecting themselves or affecting people that they love I think that it's really amazing to hear your sort of personal championing of this. And I think for many people listening, whether it's affecting themselves or affecting people that they love, I think it's a really powerful message. So thank you so much.

Thank you. Thank you to Dr. Louise Newsome for joining me on Zoe's Science and Nutrition. We hope you enjoyed today's episode. If you did, please be sure to leave us a review and subscribe. If you're interested in learning more about Zoe and the best foods for your body and what to do during menopause, you can head to joinzoe.com slash podcast and get 10% off your personalized nutrition program. Finally, if this episode left you with questions, please contact Zoe on Instagram or Facebook, and we will try to answer them in a future episode. As always, I'm your host, Jonathan Wolfe. Zoe's Science and Nutrition is produced by Fascinate Productions with support from Sharon Fedder here at Zoe.

See you next time.