Episode 7
Dispelling Myths About Menopause and HRT with Dr Louise Newson (Part 1)
Dr. Louise Newson is a physician, hormone specialist and one of the world's leading voices in transforming menopause care. We discuss the misconceptions about menopause and hormone treatment, the benefits that HRT can provide even for women without overt symptoms, and how it can play a significant role in maintaining long-term health.
Dr Louise highlights that hormonal changes affect every cell in our bodies, leading to surprising symptoms that women may not initially connect to their hormonal shifts. We explore the lesser-known effects of menopause that are frequently overlooked.
Hormone replacement therapy (HRT) is a vital, but often misunderstood topic for women navigating the confusing journey of perimenopause and menopause. Dr Louise answers all my questions.
Takeaways:
- Hormonal changes during menopause can lead to a wide range of symptoms beyond hot flushes.
- It's crucial for women to understand that many common symptoms are often misattributed and could be linked to hormonal changes.
- Hormone Replacement Therapy (HRT) can significantly improve quality of life by alleviating symptoms and reducing long-term health risks.
- Many women remain unaware of the benefits of HRT, even if they don't have obvious symptoms, making education vital.
- Testosterone plays an extremely important role in women's health, affecting mood, energy, and cognitive function.
- Despite the benefits and advancements in understanding HRT, misconceptions and fears still prevent many women from receiving appropriate treatment.
Connect with Dr Louise Newson
www.instagram.com/menopause_doctor
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Transcript
Foreign.
Speaker B:This is Crappy to Happy and I am your host, Cass Dunn.
Speaker B:I'm a clinical and coaching psychologist and mindfulness meditation teacher and of course, author of the Crappy to Happy books.
Speaker B:In this show, I bring you conversations with interesting, inspiring, intelligent people who are experts in their field and who have something of value to share that will help you feel less crappy and more happy.
Speaker A:Foreign.
Speaker B:Welcome back to Crappy to Happy.
Speaker B:Today I am very excited to bring you chapter one of this guest.
Speaker B:This is my first interview with Dr.
Speaker B:Louise Newson, who is a physician and menopause specialist and she's a member of the UK government's Menopause Task Force.
Speaker B:She's a doctor who is really committed to increasing awareness and knowledge of perimenopause and menopause and is really credited with kickstarting the menopause revolution.
Speaker B:She is so committed to empowering women with choice and control over their bodies, their minds and over the treatment options that are available to them.
Speaker B:And she's also doing a lot of work in educating other health professionals as well.
Speaker B:Menopause and hormone health.
Speaker B:And I mean, if we're honest, women's health issues across the board have been under researched and underfunded forever.
Speaker B:So this topic, this area of health has been really under supported.
Speaker B:There has been so little information and treatment available to women and thankfully now we're all becoming a lot more aware and it's largely thanks to people like Louise who have been really vocal and publicly sharing information and educating women.
Speaker B:So I am so excited to bring you today my first interview with Dr.
Speaker B:Louise Newson.
Speaker B:Dr.
Speaker B:Louise Newson, welcome to Crappy to Happy.
Speaker A:Oh, thank you.
Speaker A:Thanks for inviting me.
Speaker A:Yeah.
Speaker B:It's so lovely to have you in the studio, Louise.
Speaker B:You are obviously an expert in the area of menopause and this is a huge topic for my audience.
Speaker B:I've got a lot of listeners who are in that age group.
Speaker B:When we think of menopause, we think of, still to this day, hot flushes, night sweatshirt.
Speaker B:Can you explain what are some of the lesser known effects of menopause that women need to be aware of?
Speaker A:Isn't it frustrating?
Speaker B:Yes.
Speaker A:2025 and we're still talking about flushes and sweats, which are not the most common symptom either.
Speaker B:Right.
Speaker A:So I think the most important thing is to think that our hormones work on every single cell in our body.
Speaker A:Therefore every single cell, every single tissue, every single organ can be affected.
Speaker B:Right.
Speaker A:So it's.
Speaker A:If we think as women about that, then often we'll think, well, that's why we've had pins and needles.
Speaker A:That's why we've had dry mouth, sore mouth, burning mouth, dry eyes, ringing in the ears, you know, indigestion problems.
Speaker A:It's those sort of symptoms that are actually quite common but not commonly attributed to hormonal changes.
Speaker A:You see what I mean?
Speaker A:So when we say surprising symptoms, I think the biggest surprise is they're associated with our hormonal changes.
Speaker A:Do you know what I mean?
Speaker B:So.
Speaker B:So if women are experiencing that, their first thought is not, oh, this is hormonal, this is to do with the perimenopause or menopause.
Speaker B:They're looking for some other reason for this.
Speaker A:Yeah.
Speaker A:And then there's all the symptoms affecting our brain.
Speaker A:So we know the commonest symptoms are the brain fog, the memory problems, the difficulty word finding, the low mood, irritability, anxiety, you know, there's all those symptoms that on their own, people probably wouldn't even bother a doctor with.
Speaker A:But then they cut together and then what's the first thing that happens?
Speaker A:We get misdiagnosed as having anxiety or depression, or it's blamed on us not being able to cope with our jobs or our difficult social circumstances, you know, which is so wrong.
Speaker A:So that's why it's so important that us as individuals try and learn as much as possible.
Speaker B:Yeah, exactly.
Speaker B:Insomnia was one that I experienced, actually, so I.
Speaker B:Which I spent months trying to figure out why I wasn't sleeping.
Speaker B:Is that reasonably common?
Speaker A:It's really, really common.
Speaker A:And I had the same, actually.
Speaker A:I had this overwhelming fatigue, almost like someone had drugged me, you know, it was awful.
Speaker A:And I'd say to my husband about 9 o' clock, I just need to go to bed.
Speaker A:I was trying to.
Speaker A:This is so ironic, trying to develop my website, writing about sleep problems, but didn't really recognise them myself.
Speaker A:Then I'd go to bed, go to sleep maybe, but really patchy.
Speaker A:And then I'd be waking up and it's usually three, four in the morning.
Speaker A:You're ping.
Speaker A:Wide awake.
Speaker A:That's often when you need a wee or you have palpitations or you get these catastrophic thoughts where women often ruminate and worry in a way that they wouldn't worry before.
Speaker A:I mean, I used to worry about, am I going to make the school bus?
Speaker A:Am I going to make the packed lunch?
Speaker A:Am I going to be able to get out the house in time?
Speaker A:Like, am I going to be able to feed the cats?
Speaker A:Like, why was I worrying at three in the morning?
Speaker A:You know, it wasn't Deep thoughts.
Speaker A:But that's when our hormone levels drop at their lowest in the early hours of the morning.
Speaker A:And our hormones are related to melatonin, our sleep hormone.
Speaker A:So if we've got low Estrada, we've got low melatonin.
Speaker A:So it's no surprise we can't sleep.
Speaker A:But it's very common.
Speaker A:And then we feel very unrested.
Speaker A:Of course, yes.
Speaker A:And then this cycle continues.
Speaker A:And it was only when I started my clinic, women started to come back for their review appointments.
Speaker A:And one of the first things they thanked me for, and they still do now, is the sleep.
Speaker A:Because not sleeping is a form of torture.
Speaker B:It is.
Speaker B:That was the first thing that I noticed, actually.
Speaker B:When I eventually got onto estrogen patches, my sleep improved immediately.
Speaker A:Yeah, it's pretty instant.
Speaker A:And, you know, I mean, gosh, we're gaslit all the time as women, and people say, well, it's just placebo.
Speaker A:Okay, maybe flushes and sweats, maybe.
Speaker A:I don't know.
Speaker A:I don't think anything's placebo really, to that extent.
Speaker A:But you don't expect the quality and quantity of your sleep to improve so quickly, I don't think.
Speaker B:Yeah, no immediate for me.
Speaker B:There are many women, even friends of mine, who will say, well, I still have regular periods, or I don't think I have any symptoms to speak of.
Speaker B:What are the benefits?
Speaker B:I want to talk about hrt, and I want to talk about, you know, the misconceptions about that, too.
Speaker B:But even for women who maybe aren't presenting with any of these symptoms, is there still a benefit of going on hrt?
Speaker A:Yeah.
Speaker A:So we need to be thinking.
Speaker A:There's a couple of things, really, in that.
Speaker A:First thing is to be thinking about why we're taking hrt, which I'll come back to.
Speaker A:And the second thing is thinking about the whole period thing.
Speaker B:Yeah.
Speaker A:Like, why are we defined by our periods?
Speaker A:Like, we have so many times with difficult periods that are heavy, painful, irregular, and we're just not given treatment.
Speaker A:Suddenly we've become perimenopausal and menopausal, and every doctor seems to want to know about our periods because menopause is defined as a year since our last period.
Speaker A:Like, what the hell?
Speaker A:Why is it about periods?
Speaker A:So if we take a step back and think about our hormones affecting every single cell in our body, but they're not just produced by our ovaries.
Speaker B:They're.
Speaker A:They're made in our adrenal glands, they're made in our brains, they're made in our muscles.
Speaker A:Even our heart makes estradiol so then, like, how does our heart know about our periods?
Speaker A:Of course it's ridiculous, isn't it?
Speaker A:So that means there's lots of women who still have regular periods, so they're still producing enough estradiol and progesterone for their regular cycle, but they've got less amounts of those hormones.
Speaker A:Or they might be testosterone deficient.
Speaker A:Because we know testosterone starts to decline in the late 20s, early 30s.
Speaker A:So many of us will be testosterone deficient before we're deficient in estradiol.
Speaker A:Progesterone affecting our menstrual cycle.
Speaker B:Interesting.
Speaker B:That's one.
Speaker B:Yeah, that's one that isn't really talked about very often, the testosterone.
Speaker A:No, exactly.
Speaker A:And we need to be thinking about the hormones separately.
Speaker A:I mean, why?
Speaker A:It's just called menopause, like stopping periods.
Speaker A:Why?
Speaker A:We don't think about it as a progesterone deficiency, an estradiol deficiency, a testosterone deficiency, almost have three different deficiencies.
Speaker A:And then we can have the hormones at the right dose and type and time for each of us.
Speaker A:But then your question about hrt.
Speaker A:I think as a clinician, there are two reasons that I prescribe hrt, and as a menopausal woman, there's two reasons why I take hrt.
Speaker A:One is to improve symptoms, because it's.
Speaker A:If the symptoms are related to hormonal changes or a deficiency.
Speaker A:Having the right dose and type of hormones, of course, will improve those symptoms.
Speaker A:Now, I went into medicine to help people feel better.
Speaker A:Isn't it nice that people come back feeling better?
Speaker A:And as a woman, isn't it great that my brain can work, I can function, I can be happily married, I can look after my children and get to work.
Speaker A:But the other thing is about helping keep us healthy for as long as possible.
Speaker A:So as a doctor, I, yes, okay, I can treat diseases, but I want to prevent diseases.
Speaker A:And we know that these hormones are biologically active.
Speaker A:They have really important roles in our bodies, in our organs, to keep us healthy, like lots of our hormones do.
Speaker A:And we've known for many years that the longer women take hormones, the lower the risk of heart disease, osteoporosis, type 2 diabetes, clinical depression, dementia.
Speaker A:And actually, we're likely to live longer as well.
Speaker A:So that's really important.
Speaker A:So even if people say, I don't have any symptoms, then that's fine.
Speaker A:It's a choice taking hormones.
Speaker A:But we have to know that women who take HRT have a lower risk of these diseases.
Speaker A:A bit like women who exercise will have stronger bones.
Speaker A:Like, people can choose whether they Exercise people can choose whether they take hrt, but it's the knowledge.
Speaker A:And so many times, even now I still read that menopause is a transition.
Speaker A:It's a natural process that we go through.
Speaker A:Well, firstly, it's not really a transition.
Speaker A:We don't metamorphosise into something.
Speaker A:But also, you know, whether we have symptoms or not, we've still got this bone loss, we've still got this inflammation in our body.
Speaker A:And that needs to be addressed in various ways.
Speaker A:But the most obvious thing, if it's related to low hormones, is give those hormones back.
Speaker B:Exactly.
Speaker B:So having said that, given that there are all of these other benefits, quite apart from what you might consider to be the typical menopausal night sweats or what insomnia, whatever it is, for me also the word losing words, I would constantly given all of those other benefits.
Speaker B:When should women start thinking about taking hrt?
Speaker A:So taking ht, like I say, is an individual choice, but women should be starting thinking about it sooner rather than later.
Speaker B:Right.
Speaker A:Like, there are so many women who say, I wish I'd started this earlier.
Speaker A:And I know myself, I wish I'd started Testosterone probably about 10 years before I did.
Speaker A:But you don't know, you know, you don't know what you don't know.
Speaker A:The other thing to remember is, like, not every symptom obviously is due to hormonal changes.
Speaker A:You know, I might see someone in the clinic, they've got palpitations, they're otherwise fit and well.
Speaker A:And I'm thinking, is that a heart condition?
Speaker A:Is it hormonal changes, like, I don't actually know sometimes.
Speaker A:So often I'll refer people to a cardiologist to have some heart tests, but I'll also start them on hormones.
Speaker A:Now, if within days or weeks, their palpitations improve, they feel fine.
Speaker A:Well, that's answered the question, hasn't it?
Speaker B:Yeah.
Speaker A:If it doesn't, then we need to be thinking about what else is going on.
Speaker A:Or if people don't feel better, then they can stop taking hormones.
Speaker A:You know, the hormones that we use only work in the body the day that we use them.
Speaker B:Right.
Speaker A:I think some people think that once you're on it, that's it, you're on it for life.
Speaker A:And it's, you know, I mean, I don't prescribe implants which do last a lot longer in the body.
Speaker A:But, you know, if I don't change my patch, I know, like the day after, or if I've forgotten to put a new one on, the day after I start to get joint pain and feel worse.
Speaker A:So they work very quickly, but they wear off very quickly as well.
Speaker A:Which again is quite reassuring I think, for people to know.
Speaker B:Yes, you just raised a good point.
Speaker B:So what are the different types of application?
Speaker B:I guess you mentioned patches and implants.
Speaker B:I know there's a gel as well.
Speaker A:Yeah.
Speaker A:So usually.
Speaker A:So with hrt, the problem is it's just three letters or mht.
Speaker A:Some people call it menopause hormonal treatment, but it's different hormones and all those risks that people have worried about in the past are related to older types of hormones.
Speaker A:So as many people listening might know that the oestrogen part used to be made from pregnant horses urine.
Speaker A:So that was, I mean it's natural, isn't it?
Speaker A:But I wouldn't want to have pregnant horses urine.
Speaker A:And you can imagine pregnant horse's urine contains all sorts of hormones, not just the estradiol that we need for our bodies to work or function.
Speaker A:So of course putting something into your body that isn't natural for humans and contain and goodness only knows the processing how they made it into a tablet, you know, it's all sorts of things in the tablet as well.
Speaker A:So I mean if you start reading about the history, it's quite mind blowing.
Speaker A:So there's that.
Speaker A:But also the progesterone was a, in the big study, the WHI Women's Health Initiative study that scared everyone away from hrt, that contained medoxyprogesterone acetate.
Speaker A:So that's a synthetic, like an artificial type of progesterone.
Speaker A:So it is gonna have risk cause it's not made for the body, it's not the identical structure of our natural progesterone.
Speaker A:So fast forward now we prescribe the natural estradiol, which is a good type of estrogen, usually through the skin as a patch or gel.
Speaker A:So then it goes through the skin into the bloodstream and stays as the molecule of estradiol.
Speaker A:Progesterone isn't quite so well absorbed through the skin.
Speaker A:So we tend to give it orally or it can be given as a pessary.
Speaker A:And then testosterone's the same, we give it naturally.
Speaker A:So there's a big confusion when we talk about hormones because people always think about, oh, but the risk of clot, the risk of this.
Speaker A:Yes, there is a risk with the synthetic artificially made hormones.
Speaker A:And the same with testosterone.
Speaker A:People think if we use testosterone we're gonna have this weird body shape.
Speaker A:We're gonna be like bodybuilders in gyms using anabolic steroids people who inject with testosterone or take testosterone supplements, they're chemically altered.
Speaker A:They're not the same molecular structure.
Speaker A:So we have to be really careful in the words that we use, right?
Speaker A:And a lot of women say to me, oh, I tried hrt.
Speaker A:I got side effects that didn't suit me.
Speaker A:Well, they tried it 20 years ago and it was a different type.
Speaker B:Interesting.
Speaker A:Do you see what I mean?
Speaker A:And that's, I think, crucially important, because for some reason, I don't know why the whole world is scared of HRT to the extent only 5% of menopausal women are prescribed it, really.
Speaker A:Whereas globally, look at contraception.
Speaker A:Look how many millions of women are prescribed birth control.
Speaker A:It's all synthetic.
Speaker A:It's all been chemically altered.
Speaker A:It's all got risks with it.
Speaker A:But somehow that seems okay.
Speaker A:But as soon as we become hormonal and menopausal, suddenly we can't have our own hormones back.
Speaker A:It's madness, isn't it?
Speaker B:That doesn't make any sense.
Speaker B:But now that you've mentioned that.
Speaker B:So you.
Speaker B:The.
Speaker B:The point that you just made was even the hormones that are in.
Speaker B:Because I know some people also will say, oh, I couldn't take the pill either.
Speaker B:Like anything hormonal, it doesn't agree with me very well.
Speaker B:But what you're saying is this.
Speaker A:Very different.
Speaker B:Very different.
Speaker A:Yeah.
Speaker A:So sometimes when I'm sort of trying to explain to people, I'll say, if you think about strawberries, we can have the fresh strawberries grown in the fields, or we can have strawberry flavored candies or sweets.
Speaker A:So if my daughter comes home from school and says, oh, mummy, I've had some strawberries today, I really hope that it's nice, fresh strawberries.
Speaker A:But she might have just had sweets.
Speaker A:And for her they've tasted pretty good.
Speaker A:But we know quite readily in the body they'll have different effects.
Speaker A:Or if I'm having chicken roast chicken dinner, or I'm having a packet of chicken crisps, of course they're gonna be very different in our body.
Speaker A:Cause one's the real deal and one's synthetic.
Speaker A:It's been made to look like.
Speaker A:So these hormones in contraception and older types of HRT are made to look like.
Speaker A:But our body knows the difference.
Speaker A:So we have receptors on all our cells made for the pure hormones.
Speaker A:We suddenly chemically alter it, the structure changes.
Speaker A:So it won't fit in that receptor.
Speaker A:It won't have the same biological effects.
Speaker A:And what's worse is it blocks the receptor.
Speaker A:So if there is Any of the nice hormone around in the body, it won't be able to get in and help the cell to work properly.
Speaker B:Right.
Speaker B:So given that all we're doing is putting back into our body something that it would normally naturally produce and then it just stops producing and therefore it has all of these flow on effects, do we need to stop taking it or can we continue to take it?
Speaker A:So it's a great question.
Speaker A:Yeah, of course we can continue taking it if we want to.
Speaker A:So that's the importance.
Speaker A:The crux of all of this is about choice.
Speaker A:We know from the guidelines, the evidence that women can be reviewed every year if the benefits outweigh any risks and usually it is, you can continue taking it.
Speaker A:Like why would you stop something that was good for you?
Speaker A:It's like saying, right, you've reached a certain age, don't eat any more fruit, don't drink water.
Speaker A:And you know, we don't do that with people with type 1 diabetes, with insulin or with any other, you know, hormonal supplement.
Speaker A:We just need to be thinking about it differently.
Speaker A:And it's all stems from the concern about breast cancer.
Speaker B:Yeah, it does.
Speaker A:That's the biggest, that's the problem.
Speaker A:You know, in the 70s and 80s, women were actively encouraged to be taking HRT for their bones.
Speaker A:You know, one in two women over the age of 50 who don't take HRT will have osteoporosis.
Speaker A:So in the 40s it was discovered about the bone density increasing with hormones.
Speaker A:So there was a big move, there were no other treatments.
Speaker A:So it's like, come on, let's keep your brain strong, replace with hormones.
Speaker A:And people were encouraged to take hrt.
Speaker A:And then it all went wrong, didn't.
Speaker B:It, with that one.
Speaker B:Was it that one study that.
Speaker A:Yeah, well there were a couple of studies.
Speaker A:So there was one in the 70s when, because they used to just give estrogen on its own because they knew estrogen was really good.
Speaker A:And then there was some reports of some increase of cancer of the lining of the womb was a really, really small number, like one in a thousand women.
Speaker A:Of course we don't want to increase the risk of anything.
Speaker A:So then they quite quickly realized if people had progesterone as well, then they wouldn't get bleeding, they wouldn't get buildup the lining of the womb, their risk of cancer reduced.
Speaker A:So which is great.
Speaker A:Makes sense, of course.
Speaker A:So then they gave it, but it was the synthetic progesterone, don't forget.
Speaker A: nd then the study came out in: Speaker A:So it was sort of made to fail almost.
Speaker A:And then they thought there was an increased risk of breast cancer, but they hadn't studied the data properly, they hadn't gone through it all, but they'd already pushed it out to the media, the medical press and the lay press to say, everyone should stop taking hrt.
Speaker A:There's this risk of heart attacks, there's a risk of breast cancer.
Speaker A:So the whole world, literally, and doctors were encouraged to stop HRT prescribing.
Speaker A:It was awful.
Speaker A:And so since then, everybody goes back to that, but it's still.
Speaker A:Even if there was a risk now, when they studied the data properly, it wasn't statistically significant.
Speaker A:Women who only had oestrogen, so not a progesterone.
Speaker A:Women who had had a hysterectomy had a 22% lower risk of breast cancer.
Speaker B:Right.
Speaker A:And that's really significant.
Speaker A:That never made the front pages, of course, did it?
Speaker A:But even then, it's like you're comparing apples and bananas and saying, well, they're all fruit, therefore they're all yellow.
Speaker A:Like, you know, even.
Speaker A:Even, like the worst type of HRT still has got bone protection, still helps people feel better.
Speaker A:So it's still not as bad as half the things that I have prescribed as a doctor over the years.
Speaker B:Yeah.
Speaker A:You know, we need to be looking at what are the harms of prescribing antidepressants?
Speaker A:Because it's easier to get antidepressants than hrt.
Speaker B:Yeah.
Speaker B:Right.
Speaker A:Do you know what I mean?
Speaker A:So it's like, you know, what are the harms of getting in your car?
Speaker A:What are the harms of, you know, I've just got a taxi here and he was driving quite fast because I was late.
Speaker A:And, you know, there are risks, but, you know, I'm an adult, I can decide if I want him to drive a bit faster or not, you know.
Speaker B:Yes.
Speaker A:Whereas somehow that decision has been taken from us and women across the world.
Speaker A:I've been told no, sorry, talk to the hand.
Speaker A:You can't have hormones.
Speaker A:What's this about?
Speaker B:That's true.
Speaker B:Are there any women who shouldn't who would be at an increased risk of a type of cancer, for example?
Speaker A:Yeah.
Speaker A:So the only group of women that we're still uncertain are women who've had an estrogen receptor positive breast cancer.
Speaker A:But one of the things really to add for that is that just because they've got estrogen receptors on their breast cancer doesn't mean it's been caused by oestrogen, because we've got estrogen receptors on every cell in our body.
Speaker A:But the oncologists, the cancer doctors have known for years that if we block oestrogen, then the prognosis is better for some women who've had an estrogen receptor positive breast cancer.
Speaker A:But that doesn't mean oestrogen is bad.
Speaker A:There are different types of oestrogen.
Speaker A:So what we don't know is it blocking one type of oestrogen, not the estradiol.
Speaker A:Oestrogen actually used to be a treatment for breast cancer.
Speaker A:So we don't know.
Speaker A:But also ICD women might clinic who have testosterone, not estrogen, after breast cancer, because some studies have shown that's beneficial for breast cancer, but it can also help symptoms.
Speaker A:And, you know, in medicine, we often don't know the answer because the studies haven't been done.
Speaker B:No.
Speaker A:Wouldn't it be great if someone did a study for women who'd had breast cancer?
Speaker A:I think a lot of women would want to be recruited into those studies.
Speaker A:But we see women in our clinic who have had breast cancer, you know, 20 years ago, they're on their knees and they say, I just want to use my brain even if I have breast cancer again, even if I have to go through treatment again.
Speaker A:Like, I've tried all these alternatives, I just want, or I'm worried about osteoporosis or whatever.
Speaker A:They make a choice and then they can, that's fine.
Speaker A:And so many times they've just been told, no, there's nothing in medicine that's an absolute no.
Speaker A:Everything is individualized.
Speaker B:Yeah.
Speaker B:You made the point that there has been this real gender gap in science and in medical research.
Speaker B:Is it catching up now?
Speaker A:No, no, I don't think it is, actually.
Speaker A:I think we're more aware of it, which is good.
Speaker A: I mean, it was only in: Speaker A: started at Medical School in: Speaker A:So all my medical training was about studies based on men.
Speaker A:Like, it's just madness.
Speaker A:So I'm happily prescribing blood pressure lowering treatment statins, antidepressants tested on men.
Speaker B:Right.
Speaker A:Whereas we've got all this great data about testosterone in men.
Speaker A:Somehow we're not allowed to use that.
Speaker A:Everyone says there's not enough data.
Speaker A:So it's like people, people cherry pick evidence for their own agendas often.
Speaker A:And that, I think is a real shame.
Speaker A:But often, like some of this doesn't actually need great big studies because we're just talking about our hormones.
Speaker A:So what we need to understand more as women, as and as clinicians, is just how our natural hormones work in our body.
Speaker A:And then we can join the dots a lot better, I think.
Speaker B:Yeah.
Speaker B:But speaking of gaps in research, so many women in their 40s and 50s are being diagnosed with ADHD, including myself.
Speaker B:I was diagnosed only at the end of last year.
Speaker B:How do the.
Speaker B:Does the hormonal changes of menopause exacerbate symptoms of adhd?
Speaker B:I mean, quite apart from the fact that we didn't really know what ADHD looked like with.
Speaker B:In women, there is this.
Speaker B:There does seem to be an increase in the presenting symptoms.
Speaker A:Yeah, absolutely.
Speaker B:Yeah, yeah.
Speaker A:Especially in the perimenopause as well.
Speaker B:Right.
Speaker A:So we need to remember that the hormones, estradiol, progesterone, testosterone, are neurosteroids, meaning that they are made in our brain and they have important function as it's in our brain, but they work as neurotransmitters.
Speaker A:So chemicals that send a signal from one part of the brain to another.
Speaker A:And we have other neurotransmitters.
Speaker A:So serotonin, dopamine, glutamate, they all have really important functions in our brain.
Speaker A:People with ADHD often have altering levels of these neurotransmitters, but our hormones can change the levels of these neurotransmitters.
Speaker A:So you can imagine if you've got up and down yo yoing of estradiol, for example, and then you have an up and down yo yoing of all these other neurotransmitters.
Speaker A:Your brain's like, oh, my gosh, what's going on?
Speaker A:And so that's often why we see people have worsening symptoms or new diagnosis of ADHD during perimenopause with this time of hormonal havoc.
Speaker A:But also women that have pmdd, you know, this big crash of hormones before their periods that can trigger symptoms.
Speaker A:Sometimes adhd, like symptoms or ocd, obsessive compulsive disorder, everything that affects our brain.
Speaker A:So it's often people don't join the dots and medicine's very siloed.
Speaker B:Yes.
Speaker A:So you think you've got adhd, you go and see a psychiatrist who specializes in adhd.
Speaker A:They probably have never prescribed hormones in their lives or thought about hormones.
Speaker B:No.
Speaker A:You think you might be menopause, you see a gynecologist.
Speaker A:Well, they've never done Any psychiatry they don't know.
Speaker A:So.
Speaker A:And that's the problem then.
Speaker A:People are having individual treatments.
Speaker A:And we see a lot of women with ADHD who just tell us that they, the symptoms improve, they feel calmer, they feel easier to think and easier to sort of compartmentalize their thoughts, often when they're taking testosterone and progesterone as well.
Speaker A:So, you know, hormones work differently in different people, but testosterone can have a big effect in men and women, actually when they've got adhd.
Speaker B:Yeah, that's interesting to know.
Speaker B:So testosterone is not approved for.
Speaker B:I'm from Australia and most listeners are in Australia, but testosterone is approved for use in women in Australia.
Speaker B:Right.
Speaker A:So it's licensed in Australia.
Speaker A:You're the only country in the world that has a female testosterone licensed for you.
Speaker A:But having been to Australia a couple of times, women can hardly get it.
Speaker B:They can't get it either.
Speaker A:It's madness.
Speaker B:Right.
Speaker B:Whereas over here, for example, in the uk, it's more of like an off, what do you call it, like self license.
Speaker A:But you know what, it's really funny, isn't it?
Speaker A:Loads of things we do as doctors are off license.
Speaker A:So most drugs for when women are pregnant have never been tested on pregnant women.
Speaker A:It's all off license, prescribing children, you know, but we do it all the time.
Speaker A:Suddenly it's a hormone and everyone just seems to be really scared.
Speaker B:So for example, I went to the doctor and he prescribed like estrogen or who actually went to a couple of different ones.
Speaker B:But anyway, so estrogen patches and then suggested the marina to get the progesterone part of it.
Speaker B:And then it was, ah, you might want to think about testosterone.
Speaker B:But what is it that the testosterone does then?
Speaker B:And particularly because you just mentioned the adhd, like, what is the role that testosterone plays?
Speaker A:So testosterone is like the other two hormones.
Speaker A:It works on every single cell in our body.
Speaker A:It's produced about half of it's made in our ovaries.
Speaker A:It's also made in our adrenal glands and our brain as well.
Speaker A:And levels, just, like I say, tend to decline with age.
Speaker A:But if our ovaries suddenly stop working, we have them removed.
Speaker A:We're gonna have a big, bigger decline of our testosterone.
Speaker A:It's the most biologically active hormone that we have actually as women.
Speaker A:And it's really good for mood, energy, concentration, stamina, for sleep.
Speaker A:It helps reduce inflammation in the body, so it helps reduce muscle and joint pain, it helps with muscle strength, it helps with that sort of clarity of thought as well.
Speaker A:But it can help with dry eyes, it can help with our skin, it can help in a positive way with our hair.
Speaker A:Everyone thinks we lose hair when we're on testosterone.
Speaker A:It affects every cell in our body.
Speaker A:It's really, really important.
Speaker A:The problem is, is that the studies have been done in men, obviously showing lots of benefits, not just for symptoms, but also future health.
Speaker A:So reducing risk of heart disease, osteoporosis, diabetes, dementia.
Speaker A:But most of the studies in women have all been done about libido.
Speaker A:Because there's something that people think it's all about sex with women.
Speaker A:And so we do know that if women are on testosterone and because they've got reduced libido, they're likely to have better libido, they're likely to orgasm better, have increased sexual desire.
Speaker A:But you know what?
Speaker A:Libido in women is not just a hormone.
Speaker A:Like, of course it's not, but that's where the studies have been done.
Speaker A:So a lot of men have a miracle.
Speaker A:I know it's madness, but it's.
Speaker A:There are lots of Menopause Society guidelines now say we can only prescribe it for something called hyposexual Hypoactive Sexual Desire Disorder, which is hsdd.
Speaker A:And I don't even want to share the criteria with you.
Speaker A:Cause they're so, like, barbaric.
Speaker A:I mean, one of the criteria is that women have to be severely psychologically distressed with their reduced libido for at least six months before they fulfill that criteria.
Speaker A:Which, like I've already said, I went into medicine to help people.
Speaker A:If you were my patient and you said for five months, I'm having a horrendous time with my partner, we're not having sex, I've got no libido, he's an alcoholic, he's beating me up, all these awful things are happening and I just want my sex life back because it might help.
Speaker A:Well, firstly in HSDD diagnosis, it says if there's any other reason.
Speaker A:So alcohol abuse, you cannot make that diagnosis.
Speaker A:And then it has to be six months.
Speaker A:So I'll say to you, oh, do you know what?
Speaker A:Come back in a month.
Speaker A:And then I might talk to you about it.
Speaker A:Like, it's just mad as well.
Speaker A:If, you know, if men have reduced libido, they can buy some Viagra over the counter.
Speaker A:Like, it seems very clinical to make the diagnosis.
Speaker A:And I'm not prudish about talking about sex to patients, but I shouldn't be prying into their sex life to such to try and assess how distressed they are, you know, and also I shouldn't be saying to them, do you know what, if I give you testosterone, your partner's suddenly going to love you forever.
Speaker A:Like, actually, it sounds like there are all sorts of other issues going on, if this is going on.
Speaker A:But, you know, we don't do that in any other area of medicine.
Speaker A:And also we know that it has benefits.
Speaker A:We produced a study just before Christmas that was written up showing that women who took testosterone on top of taking hrt, or in addition of hrt, their mood improves, their cognition improves.
Speaker A:A lot of people I see come from very dark places.
Speaker A:They've been under psychiatrists, many have been sectioned in the past.
Speaker A:They've been on olanzapine, lithium, they've had ect, electroconvulsive therapy.
Speaker A:They go on HRT and they feel a bit better.
Speaker A:And then testosterone is what lights their brain, makes them so much better.
Speaker A:And I've seen it so often, it makes such a difference.
Speaker A:So we need to be thinking about it differently as a hormone.
Speaker B:Louise, this has been really interesting.
Speaker B:Thank you so much for your time.
Speaker A:Oh, thanks for inviting me.
Speaker B:Crappy to Happy is created and produced by me, Cass Dunn.
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Speaker B:Thank you so much for being here and I cannot wait to catch you next week for another fabulous episode of Crappy to Happy.
Speaker A:It.
