Dr Louise Newson: Anxiety! Joint pain! The perimenopause symptoms you’re ignoring

0:00Fearne Cotton: Hello and massive welcome to Happy Place with me, Fearne Cotton. This is the show that empowers you with knowledge so you can make the decisions that are right for you. Today I'm chatting to Louise Newson. If we're getting any symptoms, the first thing as women we should do is think, right, could it be my hormones and could topping up my hormones in a very natural way help? They affect every cell in our body, so that means every organ. So you could literally list going from your head down, literally, obviously, so many functions in the brain. Palpitations, very common. Muscle and joint pains, really, really common.

0:37A lot of people in their 40s get diagnosed with irritable bowel syndrome, weak bladder. All of that can be related to hormones as well. Restless legs. You know, so many women are having these symptoms and just putting up with them.

0:49Fearne Cotton: Hey, how are you all? I hope you are well. Look, this is a chat that I've needed to have for a very long time. Hands up any women that are listening right now that are of a certain age that have got their heads buried firmly in the sand when it comes to perimenopause and menopause. Because that is me. I am in complete denial. Whenever anyone mentions the menopause or perimenopause, I just think, oh, my God, stop talking about it. I can't think about it. I don't think about it. And mainly that's because I've been so confused as to what the solutions are. and it shouldn't even be a solution it should be like how do I cope with this what can I marry with everything else I'm doing in my life to feel okay so I needed to face up to this whole subject head on and get stuck into it and what better person to do that with than the brilliant Louise so Louise is a GP author campaigner and the menopause specialist in the UK she's the founder of the Newson Health Menopause Clinics and Balance Menopause app.

1:57Fearne Cotton: And her latest book, The Power of Hormones, is an absolutely vital read because there's so much in there that gives women the understanding of our own bodies that's been withheld for far too long. This chat could have gone on for weeks, but we managed to really crack on and condense it into a listenable amount of time. And we cover subjects like the power of believing in women's experiences of their bodies. So basically going to the GP and properly being listened to. We also look at understanding the history of the pill. Maybe if you were again similar age to me back in the day, like in the 90s, the early noughties, you popped that contraceptive pill without giving it a thought as to what was in it, what the side effects might be.

2:43Fearne Cotton: We talk about what hormones do in the body and the brain, the perimenopause symptoms to look out for and debunking the fear around taking hormone replacement therapy. That for me is the big part of this conversation because that's been the bit that has been keeping my head buried in the sand. So I really needed to ask all the questions like just to give you a bit of behind the scenes. I do a lot of research for these conversations. I read books. I read news articles. I watch YouTube clips. I listen to podcast episodes. I did all of that with this one. But when I got to sit in front of Louise, I basically freestyled and just asked her all the questions that I have previously felt.

3:26Fearne Cotton: I mean, too embarrassed to ask anybody. Like what happens when you go to the doctor to talk about menopause symptoms? Like that basic. So if you're with me on that, this is the chat for you.

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5:14Right,

5:21Fearne Cotton: here we go. This is the show.

5:44Fearne Cotton: Louise, I'm so thrilled to have you on the podcast. I'm very excited to be here in this lovely, lovely. I'm going to sit here all day and straight your chairs. I wanted tactile chairs. I like to fiddle with textures and a pen and miss fidgets. So I thought, yeah, these chairs are quite nice and comforting. I feel very calm. We have got so much to talk about today. It is unbelievable. Now, of course, you are the doctor known for kickstarting the menopause revolution. But my God, did we need it? And do we still need it? And it seems like many women out there are really on board with having this conversation now and learning and being open minded.

6:26Fearne Cotton: But is the medical world ready for this? no it's not and I'm really proud of being a doctor really proud no one in my family has been a medical doctor and I wanted to be a doctor since I was four so you know it's something I feel very very privileged to be a doctor and I went into medicine to help everybody I've worked in some really deprived areas including in prisons and I never judge my patients because they all have problems but what I learned really young as a doctor is to listen and believe your patients and put them in the centre of your consultations, which is what I do every day. And the biggest agenda with all of this, and I've written a chapter about it in my book actually, is women not being listened to and not being believed.

7:09And that is something that I'm really, really sad about. So we can talk about whether doctors are educated about hormones or not, which is a problem. But for me, the biggest problem is the stories that I hear every day for women not being listened to, not being believed, not being taken seriously. And in my clinic, you know, when I see new patients, before I finish the consultation, they thank me. That's before they've used any hormones, before they've had any treatment, because I've believed them and listened to them. And the stories that I hear, the way other doctors have spoken to them, just fills me with horror.

7:45Because as a doctor, I don't know everything. But I could say to you, Fern, I'm not really sure what's going on. Let me just have a little think or let's do some tests or I'm going to talk to a colleague. And you probably feel quite reassured. But if I cross my arms and say, I think you're just, it's all in your head, you will feel awful. And, you know, I've got a small family and my middle daughter had sepsis a few years ago and Martha's Law wasn't a thing then, but I had to demand for her to stay into hospital. And I'm sure I saved her life that night. But I've got a lot of balls and I've got medical knowledge but I realize how vulnerable patients are and this is the bigger conversation really about hormonal care health of women all of that it's just that side of it

8:27Fearne Cotton: really irates me well I bet because you know we all know and I'm we've touched on this in other episodes before to a degree that we know that women's health is not taken seriously when it comes to you know and we if you think women young girls start their period could be as young as 11 and then have to deal with you know fluctuating hormone levels and everything that comes with having a period a menstrual cycle pregnancy perimenopause menopause until we're you know 40s 50s that's a big section of our lives that isn't really being taken seriously so I'm sure that plays into a large part of it also I'm imagining doctors being time poor that you get these like five minute segments with people I don't think that's it doesn't take long to be kind to people you know I've been a GP for many years 10 minute consultations and actually on a Monday morning we used to do five minute I can't believe we did it just to try and get through some of the emergencies for the day but you can really learn a lot in a short space of time if you listen but also if you educate people so as you hopefully know I've worked really hard the last 10 years to try and educate women so they can make choices themselves so what I feel almost guilty for now is that women are educated like you say so they might have you know downloaded balance got the symptom questionnaire printed it off and say to their doctor because it's always one problem one consultation I think it's my hormones because I've got this this this this symptom they're really empowered so as a doctor who's educated it's really easy because you go right I'm thinking hormones now I'm not thinking palpitations heart problem or joint pains rheumatological problem it's easy the patient's giving you the diagnosis really but then it's still people aren't joining the dots and that's what's really difficult so it doesn't take long you know if you came to me saying oh I'm a bit tired and I'm crying a lot and I've got joint pain that's going to take me 10 minutes to listen to your symptoms but if you've prepared you've got everything on a tick box and you're saying Dr.

10:24Newsom these are my symptoms I would now like to talk to you about whether I can take hormones I've got nine and a half minutes to talk

10:31Fearne Cotton: to you about hormones yeah long time so it's really for the patient taking back control to say I've got a feeling as to what's up rather than oh my god I don't know what's going on with me but I'm really struggling. I think the ripple effects of women not being informed previously, but also, as you say, the medical world not catching up with this conversation, is many women, like me, have got their head buried in the sand. So in many ways, I'm the perfect person to interview you today. Not only about your new book, which I fucking raced through because I was just like, I need this book right now.

11:03Fearne Cotton: The Power of Hormones. We'll put all the details in the podcast copy. But I am that typical mid-40s woman who is totally and utterly in denial. Why? My head's buried in the sand. I don't know. I think because I have found the conversation around perimenopause and menopause overwhelming at times. And you're fed so many different pieces of advice. And also people like to regurgitate their own narrative to you. Yeah, which is worth. which then you could start thinking, oh, maybe I should go and talk to someone about this or should I start hormones? Then someone else says, definitely don't because of this or the fear mongering comes in.

11:42Fearne Cotton: I am that person right now who is still slightly head in the sand. And I know I've got certain symptoms. My periods are certainly getting closer together. So the cycle is shorter. The periods can be shorter, but I can get a bad headache on day one and a heavy period on day one. And then it's kind of very light after that. So I know that there's changes. I know there's stuff going on, but I'm doing nothing about it. And I reckon there's a large portion of my listeners of my age who feel exactly the same. They're confused. I hate my Instagram. I mean, I love it and I hate it. Whenever I go on it, there's all this stuff like, oh, my God, what do I believe?

12:21Who do I trust? It's just awful. But can I ask you a question? If you had like low iron, would you take an iron tablet? Yeah. and if you had an underactive thyroid gland making you really tired would you take thyroxine yeah yeah so it's it's interesting isn't it because you know that's why in the book I've written that I hate the word menopause perimenopause you know PMS PMDD they're just labels for women but if I said to you I've done a blood test and you've got low I mean I haven't by the way just for your listeners but you know but you've got low testosterone and that's why you're feeling more tired you're having headaches whatever would you like to try testosterone just for a short time see if it's going to help your symptoms yes it makes the conversation then really easy exactly

13:05Fearne Cotton: I guess what we need to do first is debunk some of the myths perhaps all the fears that women have so yeah you you say in your book only 15 percent of women in England are all the UK sorry are currently getting hormone therapy the lowest in in years isn't it more likely because of these these fears one of the big ones being a story that we've seen in the news circulating it goes it comes back around the link between taking hormones and breast cancer this is a big subject to dive into straight off the bat but i think it's the one that we need to tackle it's really important so i think before i answer that we need to just remember what hormones are because so many people think hormones are something we prescribe they're not something we produce ourselves yes so we produce dozens of hormones they're just chemical messengers that go into our bloodstream made in different organs in our body they all have defined actions but they're really important for our cells our organs to work properly so the hormones we're talking about are only progesterone estrogen but I really talk about estradiol because that's the best form of estrogen and testosterone to keep it really simple but when I prescribe hormones or HRT there's loads of different types so there's the ones that I prescribe day in day out which are the same structure as estradiol, progesterone, testosterone, because they've all got their own chemical structure.

14:25So they are the body identical natural hormones. You're replacing light with like. But when HRT was first made, and that's where you've got that whole history of HRT in the book, it was made synthetically because one of the problems, which isn't really a problem, but when they made it more naturally, you could buy it over the counter. But the pharmaceutical companies wanted to clearly make money. They worked with gynecologists and scientists, and they made a synthetic version. So they changed the chemical structure. Now, even if you don't know much about chemistry, most people know that water is H2O, two hydrogens with one oxygen atom.

15:02If you add one more oxygen and make H2O2, it's hydrogen peroxide, it's bleach. So just to highlight to you, a small change in a chemical structure can make a huge difference of properties. So they changed the chemical structure. So it's like estrogen, like progesterone, and even they've made lots of synthetic testosterone. It's like testosterone, but it's not. It doesn't work the same in the body. So you know quite simply that putting something that's a chemical in your body is not going to have the same biological effects. No. It's not going to bind to that receptor and unlock those lovely, beautiful cascades.

15:35You know, even Lizelle talking about mitochondrial function. I love mitochondria. They're the powerhouse of all our cells. But we've got receptors for estradiol, progesterone, testosterone on our mitochondria. not for synthetic estrogen, not for synthetic progesterone, not for synthetic testosterone. So once you know that, that's really important because all the risks with HRT, including that big, terrible study that came out in 2002, was using synthetic hormones. So you can almost discard it other than the hormones they used are still similar to hormones and contraception. So it brings a whole new complexity.

16:14And this is what I do tease out in my book as well, the whole history of contraception because they're not hormones they're synthetic and i took that

16:21Fearne Cotton: without even thinking back yeah i was like i'll take whatever pill you've got give it to me i did no research so it's weird that there's so much more focus on well this is this is what i find like i wish i'd written this book 10 years ago really because 20 years ago i was the same as you i took the pill i didn't actually know no one taught me at medical school that it wasn't a hormone it was only because I'm very scientific evidence-based I've had a lot of blue sky thinking as a doctor because I've written I've worked as a medical writer for so long and an educator that I sort of sat down and just thought what is the difference that they're all called different they can't be the same and then once you understand them and you understand how they work differently in the body it's suddenly this big wake-up call and think hang on they're not hormones we need to be really clear with our language and women are being misguided but so are doctors because the doctors that are scared of HRT are merely prescribing synthetic contraception for 12 year olds with acne and I'm like hang on we don't know we know that all synthetic hormones have a small risk of clots and heart attacks and stroke and cancers we know that they probably get into the DNA so whatever goes on might be transmitted to other generations and we've known that with some other types of synthetic hormones but no one's really looking at that they're still trying to like stop women from having natural hormones which improve symptoms but also improve our future health is there such a thing as a contraceptive pill that isn't yeah wouldn't that be nice there isn't so there is and there isn't so there's one called zoli z-o-e-l-y which contains estradiol not ethanol estradiol now we've known since 1979 the world health organization put out a report to show that ethanol estradiol is carcinogenic, so it causes cancer.

18:09But every combined oral contraceptive bar one contains ethanol estradiol. All of them contain a synthetic progesterone. Right. But what's ironic is that when contraception came to market, it was just for periods. They didn't even test it properly as a contraception. Then they changed the marketing after a year because it was going so well and women weren't having periods. They thought, oh, it's probably fine for contraception. So sales doubled. but they never did testing of the contraception on the bones, the brain, the heart, on our other organs. All the testing was done on the womb. A lot of it was done in the war actually as well in concentration camps.

18:43It's mind-blowing when you read the history.

18:45Fearne Cotton: My God. Yeah. I think because we were fed at a young age, the fear of getting pregnant as a teenager was so huge. You're like, I'll do anything to avoid that. Precisely, yeah. And we were taught at medical school, you know, you have to worry about the risks of unwanted pregnancies and backstreet abortions and all of that and and I'm not coming on to here to say that we can't use contraception it's like I sort of explain to people sometimes who don't understand like the difference between having roast chicken and chicken flavor crisps like chicken flavor crisps do not contain chicken they might taste like chicken it doesn't mean you can't eat crisps but you just need to know they're probably not the healthiest thing to have yeah do you see what I mean and it's the same with if if it's the only option for you then absolutely but you've just got to know there are small risks associated with all these synthetic hormones I mean Zoli like I say the Easter dial contains which is which is better some people top up with other hormones as well so someone might have a Mirena coiling which is a synthetic hormone and it can block the ovaries working so it can lower Easter dial progesterone testosterone so then some people take those hormones as well right which will improve their symptoms and future health too.

19:57Fearne Cotton: The thing that grates the most, I guess, is that all of this is on women and young girls. So not only do we have no choice, if we're looking first and foremost at the contraceptive pill, okay, we've got no choice, we're like, I guess I'll take the synthetic one, but there's A, not much research seemingly into let's look at a natural alternative, but equally nothing on the boy slash man to be part of that conversation. Which men has never really taken off. Because if you say to a man, right, I'm going to give you a synthetic hormone that's like testosterone but not, it will reduce your fertility but it will probably block your hormone receptors in your brain.

20:36It might make you feel low and flat. It will increase your risk of clot and cancer and heart attacks. Quite rightly, they'll say no. And actually, to get a drug to market now is a lot harder. Perfect because we've got more stringent rules. We have to do more studies. In the 60s, there was no ethical consent. They had no proper studies. And in fact, when you do read some of the studies, a lot of them, they disregarded some of the risks and the problems because they said that we can't prove it's a direct cause. So they had no real idea what they were doing. But these drugs were pushed by the pharmaceutical companies.

21:11Once it's got licensed, you don't have to do the same stringent studies. so I do wonder if the pill was being or the contraception were brought to market now in 2026 would it get over the line and I can't answer that question but you know it's just

21:29Fearne Cotton: crazy I mean it's a minefield that I'm happy to dig into and like yeah let's really dissect it and get into it's so so important for women I think because so many women and young girls even I wasn't cognizant of it as a young person, but we feel so out of control in terms of what our options are. I think that's why my head's been in the sand. So let's move on now to looking at, you know, women of my age, which will be a large portion of my audience will be women who will be perhaps thinking about this or women slightly younger thinking, I should start to prepare for what that looks like down the line.

22:02Fearne Cotton: when you go to your GP thinking yeah I probably have got some symptoms here that are alluding to you know hormonal changes in my body are you automatically offered the synthetic HRT initially is that how it works it really varies right really basically there's a there's a big move to changing to the body identical hormones 10 years ago it was very much one size fits all and it was usually the synthetic hormones so there there is a choice and often people say the patches the gel if the patches are just the pure oestradiol and it will stay on them it's a bit like food if you look at the ingredients it'll say if it says oestradiol that's fine the tablets um micronized progesterone usually utergestone in the uk um and then sometimes we give it as pessaries or suppositories pure progesterone testosterone the cream or gel is testosterone it's not one of the synthetic hormones.

22:54But it's important to know because it's not just perimenopause or menopause. So many women have PMS. 95 % probably of us have PMS. PMDD, premenstrual dysphoric disorder, is a more severe form. Postnatal depression affects 85 ,000 women a year in the UK. And it's all due to hormonal changes. And some women are more sensitive than others to these hormonal changes. And these hormones, as you know, are made in our brain. And I'm more concerned about the effect on our brains than anything else. Because mental health, we know, is in a crisis. And we know that more women and children, actually, are prescribed antidepressants than they are hormones.

23:35But they're misdiagnosed as having.

23:37Fearne Cotton: We had Callie Beaton on here, a comedian, who's written a brilliant book about the changes in midlife. And one of the big fuck-ups for her was she went to the doctor and they said, you've got bipolar. And she was prescribed a tonne of medication. And then she realized she was going through the menopause and it hadn't even been on the doctor's radar to quiz her about that. I mean, you know, I'm doing my theatre tour at the moment and I've called it breaking the cycle, the power of hormones, because people are locked in this cycle of mental health. Once you get diagnosed, usually with a mental health condition, that's it.

24:11You're on this trajectory with antidepressants, antipsychotics, lithium. I've seen people that have had ketamine infusions,£8 ,000 ketamine infusions. 45 year old woman no one asked about her hormones no one thought about her hormones and this is really scary because we know and we've known for decades the importance of hormones in our brain to improve our mental health and actually 60 years ago doctors were giving natural hormones for postnatal depression postnatal psychosis pmdd natural progesterone it's not rocket science no and women improved but you know we've got all these other chemicals that people have been given whether it's synthetic hormones or whether it's antidepressants antipsychotics and very few people are thinking about hormones and it doesn't make sense hi it's page from giggly squad and this episode is sponsored by experian boost summer glow up check credit glow up even better boost your credit scores instantly by getting credit for bills you're already paying your phone utilities rent and insurance i wish dating kind have worked like that.

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26:40Fearne Cotton: So if we, like me, know very little about hormones, what are are hormones impacting physically mentally what are they doing so they affect every cell in our body so that means every organ so you could literally list you know going from your head down literally obviously so many functions in the brain so that's why memory problems anxiety low mood poor concentration sleep problems related to hormones changing in the brain eyes dry eyes mouth, burning mouth, sore mouth, teeth changes, even smell changes, you know, just going down the body. Palpitations, very common. Breathing changes can occur. Asthma increases without hormones, for example.

27:23Coughing, obstructive sleep apnea where people have difficulty breathing at night. Muscle and joint pains, really, really common. Also, gastrointestinal symptoms. A lot of people in their 40s get diagnosed with irritable bowel syndrome. A lot of that's related to our hormones. Our hormones affect our gut microbiome in a positive way. So if we don't have them, bloating, heartburn, indigestion, very common symptoms, constipation, all of that can occur. It's basically everything. It's everything. Urinary symptoms, really common, UTIs, incontinence, you know, weak bladder, all of that can be related to hormones as well, restless legs.

28:03I mean we've got a symptom questionnaire that we use for all our patients but it's also in balance the the app and it's got over 80 symptoms because I extended it well you did use one that had 21 symptoms but I extended it a year or so ago because I find it really useful as a doctor so I can eyeball all those symptoms but also patients do and women because they look and go I didn't realize I didn't realize my hair changes my skin changes all of this could be related and that's really important because often, you know, when you ask women, they're quite intuitive. And if the symptoms are similar to maybe how they've had those days before their periods, they're more likely to be tuned in and go, you know what, I think there's some hormonal change.

28:43And it's just the suffering, you know, so many women are having these symptoms and just putting up with them. Even PMS, for example, you know, my daughter has, my oldest daughter has PMDD, and she's had a really difficult time and thankfully she's so much better because she takes natural hormones but she's had some very very dark times and she said to me but I mean it's just not those three days that I feel awful the rest of the month I'm dreading those days coming yes she's a trombonist so she said what happens if I'm doing an audition or I'm you know I'm playing in a concert like I can't function she said but the rest of the days when I'm feeling great I just think surely I can't feel this bad It must be, you know, it can't because it's so black and white.

29:26And then it comes and I'm just like in this hole. And I see that so much of my patients. And I see a lot of her friends as patients now. And a lot of them are great, really clever musicians, are quite neurodivergent, a lot going on. A lot of them have had from very difficult upbringings. So they've always been blamed for their trauma, their past or whatever. But I give them often just some natural progesterone for a few days when their mood dips of the cycle. and one of them said to me the other day Louise I'd just like to thank you because you've transformed my life and are you sure it's legal to feel this good every day of the month and it really made me think though Fern because yes we should feel good every day of the month like can you imagine saying to a man like once a month you're going to have a duvet day you'll probably feel a bit shit you won't want to go to work not only that you're going to be paranoid

30:10Fearne Cotton: that you're going to be I'm constantly like can I wear that outfit at that time of the month because I'm going to be checking the whole time the paranoia the worry can I get to a loo quickly if I'm out in public. And then there's all this about where you should change your exercise. So there's a few days before a month when your hormones are low, you could just like not do so much cardio and you should rest. And it's like, hang on, stop it. If we're getting any symptoms, the first thing as women we should do is think, right, could it be my hormones? And could topping up my hormones in a very natural way help?

30:42Because evolutionary, we have to remember, we are designed to have hormones in our body. And, you know, in the Victorian times, we were pregnant more than we weren't you know lots of pregnancies really high levels of hormones actually in our body but the average age of menopause was about 57 the average age of death was 59 but we have to be thinking actually these hormones are really beneficial for our day-to-day functioning but our future health so women who don't take hormones have a higher risk of inflammatory diseases heart disease osteoporosis diabetes dementia autoimmune diseases multiple sclerosis all those diseases of the increases we age but increase without hormones and studies have even shown women with pmdd because they have half of their cycle or a weaker cycle so you know good chunk of their time without hormones they have an increased risk of future diseases so we have to sort of spin it on its head a bit and think what are the risks of me not having hormones rather than what are the risks because taking natural body identical hormones how do they have

31:43Fearne Cotton: risks when they're our own hormones so is there any risk of say the big one that we keep getting fed in the press breast cancer is there any risk of that with the body so when we look at the study that scary study yeah there were two groups of people there were people that they only gave estrogen to and that was the pregnant horse's urine so it was a bit different to what we prescribe now but it had estrogen in it yeah but there was also the people that had estrogen with a synthetic progesterone called mejoxyprogesterone acetate which is still used in contraception now But the risk of breast cancer was small, wasn't statistically significant, was only in the arm of the study that had the synthetic progestogen.

32:21The ones who had oestrogen had about a 44 % lower incidence of breast cancer. So there's no evidence anywhere in the studies that oestrogen causes breast cancer, which is really important for people to know.

32:34Fearne Cotton: So if you were to go to the doctor and they took the symptoms seriously and they said, right, we're going to prescribe you HRT, but it was the synthetic version. Do you have the autonomy at your local GP to say, I want body identical? Firstly, body identical actually depends on the region, but it's similar price or slightly cheaper than the synthetic. So they can't use cost as a thing. The guidelines that I think are the most important are shared decision making guidelines, which is for any condition. so if I'm your doctor and you come to me and say I really don't want to take iron and I've got low iron and I'll say to you well Fern you've got the risk that you're going to be more tired and you know you've got this low iron and unless you eat differently or take an iron supplement it's going to carry on you might say well that's fine I want to carry on like that you are allowed to be involved in that consultation and share the decision even if your decision isn't what I would recommend as a doctor so this is what's really important that people know and it's really that's why it's so sad that people do go to their doctors and say I would really like to try hormones I would like to try testosterone and they're met with this no I met somebody at the theatre tour a couple of days ago she said to me she felt so prepared for her consultation she printed off some information from balance app she had the questionnaire she went to her doctor and her doctor said this information is wrong and Dr Louise Newsome you don't trust stood up and marched her out of the consultation room so she was crying and said I've just given up now I'm 62 there's no point me even trying to go back to another doctor she's got she might have 20 30 years of her life without hormones putting her life at risk and she wanted to try them you know this is where I just in my head I get so sad because these stories are all the time and you you know not only are you trying to get this information out there and debunk you know myths that are putting women off, getting the help that they need.

34:27Fearne Cotton: You genuinely want to help women, want to stop the suffering of women in general. You personally have had a lot of backlash. And I can't even imagine how that's felt. When you're passionate about something and you've spent your life's work is studying this, to be constantly pushing against that must be personally exhausting. It's horrible. You know, you've got children. It's not just me. It has had a big impact on my whole family. You know, they as a mom, you're the strong person. You get all the everything together. For them to see me broken last year is really hard, like really difficult. But, you know, I've got three daughters and they won't let me stop working.

35:06They're like, you get back out there because every day you're having these women, these women who have suicidal thoughts. You know, one in six of our patients have suicidal thoughts. you know if I've funded a PhD student in suicide prevention and we've got some amazing results and you know a lot of people they can't they've got nowhere else to go to but last year I was close to having to close my clinic because of the financial impact that Panorama did to me and it's like if that goes Balance App goes my podcast goes everything goes but also you know I went into medicine to do the best and I've not done anything wrong there are loads of doctors out there that have done things wrong and you know they should be sanctioned but often they get off so I feel like so strongly because I'm very fortunate I'm on hormones and I know who to go to you'll be pleased to know to get good advice but you know when I was doing some voluntary work in prisons these women have no voice and no one's prescribing them hormones you know I said to the prison doctor do you ever prescribe testosterone in the prison like no why would we do that women don't need a libido in prison I said but they might be in a same-sex relationship but you don't always need a man and a penis to have a libido I mean the color just drained from her face and then obviously they reported me for even going into the prisons and educating women and this is where I feel like sad because I'm not here saying you have to take hormones but you have to know you have to know the benefits you have to know the risks of not having them and it's about choice and my role is really as an educator really you know people come to my clinic because they've decided they want hormones and they want the right dose and type for them but my work is so much bigger than the clinic it is just allowing people to have this knowledge that has sort of been hidden from us for so long and I've spent a lot of time you know thinking and reflecting and I'm very evidence based you know I think it's about 30 pages of references in my book because I'm very clear that I am telling a story.

37:06People keep calling me controversial. I'm like, well, I'm not inventing a new drug or a new treatment. Why do you think that is just because you're wanting to bust the

37:12Fearne Cotton: myths? Yeah, I think so. I think sometimes the truth hurts and it's uncomfortable. And I'm very, well, I didn't say I'm happy because I'm not happy, but I wouldn't say, like, I don't mind admitting to you, Fern, that I was that doctor that used to give contraception for heavy periods. I was the doctor that used to give 45-year-old women antidepressants because I didn't know about the effect of hormones. I was that doctor who, you know, gave biologic agents to people with rheumatological problems because I didn't know there was an option. I didn't ask the right questions. And I've done a lot of hospital medicine and I look back and I think, all those women I saw, all those women that we were admitting with all these different conditions, and I never thought about it.

37:55But you know, it's like anything in life, you learn and then you say, okay I'm going to change my practice but it's this resistance for others to learn that is harming women and that's really sad.

38:07Fearne Cotton: Is that what is that why you've been occasionally called controversial or you've had shit thrown your way is because you want to do things differently and the medical world is a bit stuck in time? I think there's this and I've written about it in the book I mean medicine is very patriarchal. My husband's a surgeon and obviously you know I courtesy to him every morning I don't but you know um there is mutual respect yeah but there is this thing that in in medicine there's the surgeons and there's the physicians and then there's the gps really at the bottom which I really challenge because you know I was doing hospital medicine I only went into general practice so I could see my children and go part-time and and help you know bring them up really um but I've I've always worked as a medical writer I've written books on evidence-based medicine I've I've got pathology degrees science degrees so you know I am clever but I'm very inquisitive I like to know like but why but why you know I'm one of those people but in medicine you often learn from your peers so you learn from your senior doctor and if they tell you something and it's in a guideline then you do it and we're quite robotic but because I've written and summarized guidelines for the Royal College of GPs I worked for them for 20 years I'm used to like looking at the guidelines looking at all the references that have been used the studies, looking at who's written them, what conflicts they might have, which pharma involvement they've had, for example, and then summarising them properly for people.

39:30Lots of people don't have the luxury of that time. And I think what's happened is in the past, menopause hormones has sort of been owned by gynecologists, if you like. I'm not a gynecologist. So some gynecologists have got quite rattled. And I know that because I've had a subject access request. I've got 350 pages of emails that they've written about me, really frustrated that I'm doing work in unconventional ways as well. Because women in the past, like Katrina Dalton, who prescribed a lot of progesterone for women with PMDD and postnatal depression, was really slated as well because she was only a GP.

40:06And she could reach her patients. But you know what it's like with the podcast, with social media, you can reach people that you're never going to make money from, you're never going to know, but you're empowering them and that's what I think a lot of them haven't liked the way that I've gone about things but also and they have told me because inverted commas I'm only a GP and I find that really really frustrating and it's sad because it's other colleagues like we've all got plenty of work to do and patients can choose we can agree to disagree but not do it to the extent that you make a panorama documentary about me and try and ruin me professionally and personally

40:46Fearne Cotton: Yeah, I mean, horrific for you, horrific. But also, like you say, for all the women that you desperately want to help, and you say in the book you don't want menopause, perimenopause, to just be seen as a gynecological issue. Because as you stated a moment ago, it's affecting literally every part of us physically and mentally. And maybe we're being reductive in terms of this conversation. It's just the reproductive part of women's bodies and that's it. Whereas we know it's not that. But it's just stupid, isn't it, really, to think that women are just periods of fertility. It doesn't make any sense to me.

41:23And even the testosterone conversation, you know, some people, you just look in the media and all these experts are saying, we're so scared there's overprescribing of testosterone. It's getting out of control. Somebody, a doctor, even wrote that it was abusive, the amounts of women who are being prescribed testosterone in private clinics. She didn't kindly mention my name, but I'm sure that's where she was pointing her finger at. Now, if you work out the stats, it's about 0.82%. So less than 1 % of women are being prescribed testosterone. That isn't out of control. What is out of control are all the drugs that people are being prescribed instead of testosterone.

41:59And we've published some data that women who are on testosterone, as well as progesterone and estradiol, we can reduce their antidepressants, their antipsychotics, their painkillers, their gabapentin, their progabalin. You know, those drugs I would lose sleep about prescribing for my patients. I don't lose sleep about prescribing natural hormones to patients who feel better. You say that testosterone is the most misunderstood hormone. Why is that? Well, look at the name, test it. It comes from the testicles. We don't have testicles. So that's really confusing. And then what happened is, as you know, the history of it, once they discovered testosterone, they made synthetic testosterone, went to market, and then athletes got hold of it.

42:40So then they were pumping themselves with synthetic testosterone. So then they have this weird body shape. They know it's associated with heart disease, other problems. And so that's why it's a banned substance. Even in sport, women are not allowed any form of testosterone, which is crazy. But we prescribe the same chemical structure as our own testosterone. And testosterone is made in our ovaries, our adrenal glands, but also in our brains as well. And so it's the most biologically active hormone we have. testosterone starts to decline in our late 20s early 30s so it's not a menopause related it's it's probably later so usually in the 40s and 50s yeah but it's a problem for men too and men struggle to get testosterone but women especially and then when you look at the guidelines they say it's if women have reduced sexual desire and then some menopause societies say women have to have this ridiculous disorder called hypoactive sexual desire disorder which is hsdd for short if you look at one of the criteria it says that women have to be severely psychologically distressed with their reduced libido for at least six months wow so like can you imagine

43:50Fearne Cotton: suffering yeah of course so if you've been suffering for five and a half months i'd have to say no sorry if i can come back in two weeks like it's just sorry it's just bullshit it's just ridiculous but also why does someone think that libido is just like an the testosterone is just a tiny bit of our libido part of our brain when it affects every cell in our body and we've known since the 1940s that testosterone helps with well-being it helps with mood they used to give it to people with period problems as a menopause treatment in the 40s that's like 80 years ago so we've gone backwards we've completely gone backwards yeah going back to something you said a moment ago something just sparked in my head if you are a woman who has an inkling that you know your hormones are changing but you are on anti-anxiety medication antidepressants etc can you take hormones in the same way yeah there's there's nothing that will interfere with natural hormones because that's what they are if you see what I mean lots of people have told someone contacted the clinic the other day and said oh I've had a meningioma I've been told I can never have hormones so meningioma is a benign brain tumor it's like well of course you can you know there's very few conditions that you absolutely can't have natural hormones because that's what they are the synthetic hormones very different okay so that's a really good thing to clear up because i think again some people are completely put off because someone has once said it to them yeah absolutely lots of people are told if they've got family history of any cancer they can't take hormones someone last night because i do a live q a in the show as well um said that one of their If family members had a clot, they're worried about the clot risk.

45:22There's no clot risk in progesterone, estradiol or testosterone. So just because you've been told something, the chances are it's not right.

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47:43Fearne Cotton: There's also a terrifying fact in your book. You say that the suicide rates for women are the highest since 1994 in the age bracket 40 to 59, which as we know, it's quite clearly the hormonal change, perimenopause, menopause era of a woman's life. But there is little, if any, correlation to hormones when we look at how the medical world are viewing those really scary very real suicide rates yeah how what do you how do you feel about that oh it's terrible it's one of the reasons that I work as hard as I do because I worry I really worry about suicides mental health we know that about 84 % of women with PMDD have suicidal thoughts I mean that's huge but like you say suicide rate is is increased in this these women and of course there's lots of reasons why people might want to harm and end their lives, but we can't keep ignoring the role of hormones because we've known for many, many years that hormones can improve mental health, reduce suicidal thoughts.

48:43You know, we've just published data to show that 92 % of women with suicidal thoughts reduce their suicidal thoughts when they're prescribed progesterone, estradale, and testosterone. 92 % reduction. I've already said one in six of our patients come to our clinic with suicidal thoughts. Like why wasn't that in the front page of the papers? I don't know, and I might be wrong, but I'm sure your listeners will tell me, I don't know of any psychiatric drug that will reduce suicidality by 92 % that doesn't have long-term effects. And, you know, I wrote a training module for the Royal College of GPs a few years ago, and it took me a few years to get it over the line because they kept pushing back on the data and saying, we don't have enough evidence.

49:26I said, you do. There's this, there's this, is this anyway got it got it over the line I actually paid my money so it was free access for psychiatrists and it I got a prize because it was the most downloaded course lots of psychiatrists learned for the first time about the role of hormones in the brain some of them started prescribing hormones to see seeing the transformation effects and then a few weeks ago someone from the British Menopause Society contacted them to say that I over exaggerated the effects of hormones and they've taken the course down what and I've given them more evidence now because we've published since you know the course came out and um they they said it's under review at the minute and i told them that i would if you don't tell me what's going on i'll tell people in the theater tour so i i have done because i'm really sad and they said you know i know they've had complaints from psychiatrists about it and it's just it's harming women like i'm not saying that all mental health can be cured by hormones i'm not saying all suicides can be reduced by hormones but i am saying and I've seen it time and time again you know I've saved lives from women who are on hormones and they've tried everything else you know I'm in the Twitter tour I'm going with a guy Jay who's 26 and his mother had 30 years of being in a psychiatric hospital she had her first mood change was after a termination of pregnancy she had postnatal psychosis three times she had PMDD her mood worsened when she tried contraception then she was perimenopausal and he just reached out to me on instagram 18 months ago and i managed to persuade the psychiatrist to prescribe for her now i've prescribed for her the gp won't have anything to do with her doesn't won't prescribe hormones yet they'll prescribe the lithium the crotiapine the antidepressants for she's had electroconvulsive therapy over the years nothing has transformed her life like hormones it's it's there in black you know what i mean it's but i've seen it so often and and like i said i didn't know it when i did psychiatry training i didn't know it as a gp but you learn you know i've learned from scientific evidence which is there when you look for it and basic physiology that's why in the book it was so important to write about the basics of how hormones work so others can work it out for themselves but then i've got a wealth of clinical experience you know we see so many women in our clinic and we're constantly you know writing up our data sharing with other people and we just have to we have to join the dots because the suffering is palpable not just in the UK but globally well of course if um women out there feel like there's something up and they've done

51:59Fearne Cotton: nothing about it me yeah um what would your one bit of advice be I would say download balance get information that's right for you ignore the noise it's like having children everyone will tell you things you've got to do what's right for you and you've got to make sure that the decision is right for you and no decision is irreversible as well so but I would also seek out someone who really understands hormones have a really good conversation about it but also try and have that mind shift about is it right for not just me but my family my friends my colleagues if I keep ignoring it and not having hormones and often I say to people who a bit like you go not really sure I'll often say look I'll rebalance your hormones in a physiological way you've got to wait three to six months for them to have an effect and then decide if you don't want to carry on I'm not coming around to your house and putting them on for you every day like then you stop but then you can decide and it's really hard because also when you don't have hormones your brain doesn't function properly so you often overthink and catastrophize and think about things that really you shouldn't worry about yeah that's me yeah there you go that's me now obviously many people out there will be in a heterosexual partnership and their partner will not have a fucking clue about any of this we'll have checked out this conversation weirdly seems to actually determine completely or they just think oh god time of the month hormones like all the usual stuff that we're fed but if you're in a loving partnership of course you know it's a two-way street you want to support each other if one person's struggling the man or the woman then you want to be there for each other so I believe that men should be fully integrated in this conversation absolutely what one thing do you think all men out there should understand about perimenopause menopause they should probably listen to my podcast with joe warner because that's a man talking about you know from a man's experience they should know that hormones affect women but we can do something about it so I really feel that that men partners whether it's heterosexual or same-sex relationship they should be an advocate for that person because you know when you're with yourself 24 7 it's really hard you can always sort of make excuses for how you're feeling but if you notice that your partner's changing mentally physically it doesn't matter you should rather than just normalizing it say look I'm going to read this book I'm going to listen to a podcast I'm going to work out let's try and work together and let's go to and find a doctor who can you know give you or talk to you about having treatment so you'll feel better and so many partners come to consultations with us and it's really important it's so lovely it's really lovely because you know they they really care it's not just because they want to have sex again if they really care and you know divorce rates increases it's it's quite awful but we need to and I you know I only suffered symptoms about six months and my lovely husband really didn't join the dots at all um and I didn't because I thought I'm just working too hard I'm just like I've got three children I can't cope with my work the people at work weren't very nice to me and I everything was just and it was really it was actually my my daughter who's now 21 she was about 12 and she just said to me one day mama you are so cross and irritable I just wish you'd have your period and your mood might improve and then I suddenly went oh so if you haven't had a period for about six months that's why I've got all these symptoms but it took her and she obviously my children are very well educated about hormones now but then she didn't know she was just using common sense because she knew her friends their mood improved and they got their periods so we can't be normalizing it and that's what I feel really sad so many people are like let me hold your hand and talk to you while you're having these symptoms and people also think it's some transition that we go through and all these people on Instagram saying you know it's a phase of our lives it's not a phase in our lives the low hormones last forever and we have to wake up to the fact as women we're less healthy the last 10 years of our life so at the age of 60 most women are on six, seven medications.

56:05They're on antidepressants, blood pressure treatments, statins, painkillers. You know, like, why? Whereas if they're on natural body identical hormones, they won't be needing all these medications. So we're sort of investing in our future health as well with hormones.

56:21Fearne Cotton: And also all of those other medications you've just mentioned, we hear far less about the side effects of those. I mean, some of those, and I've been on antidepressants. I couldn't tell you what the side effects are. I didn't look into it. I just was desperate and was like, I'll take them. Whereas with this one, you could live under a rock and still have heard the breast cancer. Well, this is the thing. So, you know, antidepressants have a risk of early death, dementia, osteoporosis. Yeah, I didn't know that. So who tells people that? No one, because they're just pushed out like smarties. I read the other day that one in seven children in the US are taking antidepressants.

56:55Oh, God. Like it's awful. Yet you just mentioned the word HRT and everyone goes. Everyone knows. Cancer, cancer, cancer. Contraception, like, you know, it's that's where I feel like it's a double standard, really. But we no one really talks about the benefits. And in fact, it was amazing, because I'm sure, you know, the FDA in the US did this big announcement last year that they were removing the black box warning of estrogen. So you've got Dr. Martin McCurry, who's the FDA health commissioner, who says that he estimates 50 million women have been harmed by not having hormones. like that's a big thing for the government to state that so that's probably an underestimation and that he was saying they have been harmed they want to change it but it's still every day because you've already said for 15 percent of women and that's 15 percent of on average in areas of deprivation it's as low as two percent of women who have hormonal changes are taking hormones so the harm of not having those hormones is happening every single day i feel like i need

57:58Fearne Cotton: to go on holiday as I process everything that you've just told me in the best possible way because this is a conversation that I've wanted to have for so long. You know, probably since I hit 40 where I was like, well, yeah, things are changing. I'm noticing things. I've just been like head in the sand, head in the sand. So I am so grateful for your time for reading the book. I mean, we've literally skimmed the surface of a very big conversation. So I would urge everybody just to read the book, listen to your podcast, do the research if they want to get more information on this to make the right decisions so we can all feel as empowered as possible to walk down a path that feels right for us rather than be so bombarded that we bury our heads in the sand, pretend it's not happening, or deny ourselves of help that is available.

58:43Fearne Cotton: Before we wrap things up, I want to first of all ask you a bit of a careful question that's not related to menopause at all, but we're making a playlist at Happy Place of songs that make us feel great. And I wonder if there's one song that puts Pep in your step. Well, I've been doing a bit of a warm up song like for the theatre tour, just because I don't want my voice to go. I've got so many tours left to do and shows left to do. So I really like My Life by Billy Joel. Oh, I love that song. Yeah, because it's a bit of a F you to other people. Like, just leave me alone. It's my life. And my children sort of chose it for me last year when I was having some dark times because of the stuff that's going on.

59:22And it makes you just feel good, actually, and a bit stronger, which I think is great. We all need that. I love that.

59:28Fearne Cotton: And where, Louise, is your happy place? Oh, on my yoga mat. Yeah. Yeah. I do yoga most mornings. And I do Ashtanga yoga. And my teacher's now 70, James Critchlow. He's amazing. I've known him for 23 years. And so my yoga mat, if I'm allowed to, with James, because his voice, he's just so calm. And it's just like, I mean, you do yoga, don't you? I do but I've never done Ashtanga I've never tried it even what's the difference? well it's the whole primary series it's just it's a whole every breath is a movement it's a lovely flow it's really lovely it takes about an hour and 15 minutes to do properly but I do it with him every week it's a bit difficult with the tour but that's really powerful and I just love doing headstands I love a headstand I just love it and it's one of I think I also do it because I know like a lot of these people that really hate me can't do them And I'm like, it's just a bit of a power thing as well.

1:00:23But I do like it. I do. And I sort of think I don't keep doing them most mornings. One day I'm not going to be able to. And I want to be like a 70-year-old woman doing headstands. Me too. I want to be able to do the splits forever.

1:00:35Fearne Cotton: I also think turning yourself upside down once a day is a really good thing. I do handstands up against the kitchen cupboards every day. And there's something about it that is just like, I needed to do that. I don't even know why. No, it's great. I love all that blood going to your brain. It's brilliant. It's so good. well Dr Louise what an absolute pleasure to have you on it's been a chat that I really needed to have so thank you so much thanks for inviting me oh god thank you Louise my main emotion coming off the back of that is relief because as I said at the start that is a chat that I've been putting off having for a very long time I am 45 this year in a few months time so this is very much a conversation that I need to be having And these are subjects that I fundamentally want to understand better so that I can make informed decisions about what I want to do next.

1:01:22Fearne Cotton: As Louise said, she's not sat here saying everybody should take hormones. But what we should be doing is looking out for symptoms that are causing us great distress or even just like mild annoyance and do something about it. Louise's new book, The Power of Hormones, is out on the 21st of May. Now, Louise mentioned in the conversation that I'd had a chat with the brilliant Liz Earle last month. If you haven't already listened to that one, that is probably a good one to go and listen to next if you want to get deeper into this kind of sort of healthy aging conversation. A massive thanks again to Louise and to you.

1:01:58Fearne Cotton: Gorgeous lot. You are brilliant.

1:02:21Fearne Cotton: Happy Place is researched by me, Fern Cotton. The producer is Anushka Tate at Happy Place Studios with studio engineering by Basil Oxtoby. Hannah, I just Venmo'd you for dinner. Obsessed. I'm spending it right now on the lip gloss that's been sitting in my cart. What do you mean spending it right now? You can instantly spend your balance with the Venmo debit card or when you pay with Venmo at checkout. Stop. Say more. More exactly. The more you do with Venmo, the more you get, like earning up to 5 % cash back with Venmo Stash. Get the Venmo debit card or checkout online. Venmo Stash bundle terms and exclusions apply.

1:02:59Max$100 per month. See terms at venmo.me slash stash terms. Venmo checkout not available at all merchants. The Venmo MasterCard is issued by the Bancorp Bank N.A. Hi, it's Paige from Giggly Squad, and this episode is sponsored by Experian Boost. Summer glow up, check. Credit glow up, even better. Boost your credit scores instantly by getting credit for bills you're already paying. Your phone, utilities, rent, and insurance. I wish dating kind of worked like that. Connect your bank account, add those on-time payments to your Experian credit file, and your FICO score updates right away. You could instantly raise your FICO score by an average of 14 points with Experian Boost.

1:03:41Download the Experian app for free today. Results will vary. Users who received a boost improved their FICO score 8 from Experian by an average of 14 points. See App Store or Experian.com for details. Results will vary. Not all payments are boost eligible. Users who received a boost improved their FICO score 8 from Experian by an average of 14 points. Some may not see improved scores or approval odds. Not all lenders use Experian credit files, and not all lenders use scores impacted by Experian Boost. See Experian.com for details. Thank you.