The Truth About Menopause and Hormones for Women Over 40 with Dr. Louise Newson

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1:21To get first access in August, go to hayleyhappensfitness.com forward slash fat loss happens education or grab the link in the show notes. Now back to the show.

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2:17Hi, everyone. My name is Haley. And this is Laura. And welcome to The Body Pod.

2:31Welcome back to The Body Pod, everyone. Today, I have the honor and privilege of speaking with Dr. Louise Newson, who is a general practitioner and hormone specialist and a leading voice in transforming menopause care worldwide. As the founder of the Newson Clinic and the not-for-profit Newson Education, she is dedicated to improving awareness, education, and access to evidence-based care. Through in-person events, a comprehensive library of freely available articles, and an education program for healthcare professionals, she empowers both women and clinicians with the knowledge that they need.

3:13A Sunday Times bestselling author and host of the UK's number one medical podcast, Dr. Newsom is passionate about driving positive change for women's future health. Dr. Newsom has been described as the medic who kick-started the menopause revolution. She is an award-winning educator, podcast, and author committed to increasing awareness of hormone health, including perimenopause and menopause. Her mission is to provide inclusive, accessible, and evidence-based information in formats that suit all women, helping them make informed choices about their health. Through her work, she has empowered a generation to take control of their treatment, bodies and minds, ensuring menopause care is recognized as a vital part of women's health care.

4:04Today, we dive deep into what each hormone does and the benefits, pros and cons, as well as common myths that are surrounding hormone therapy. So enjoy this episode with Dr. Newsom.

4:29Welcome back to The Body Part, everyone. We have Dr. Newsom here with us, who we've already introduced. And Louise, thank you so much for joining us. We are thrilled to have you. Oh, thanks for inviting me. It's great. Well, we have probably five pages of questions. And then, of course, I put out on my Instagram story. I was thinking I probably wouldn't, but I love how in your YouTubes, in your lives, that you always ask questions at the end. And so I was like, I'm going to keep some of these on there if we have time to answer any in the last five minutes. But this is going to be a hefty conversation in all things hormone therapy.

5:12So we are going to dig right in. so first of all when you're called the medic who kick-started the menopause revolution first of all that's a hefty title yeah what sparked your passion for transforming this menopausal care yeah it's interesting because I didn't always have this passion like if I'd met you 15 years ago I would have gone what no I'm interested in everything in medicine and I still am but I suppose it was hearing stories when I'm in my when I was in my GP practice I would only see the patients that came to me and you're limited in how many you can see you know 30 40 patients a day probably ended up about 80 percent of them are menopausal by the time I left but I'd hear those stories women would be suffering for a little bit and then I'd help them and then they would start to feel better and then when I started to do my clinic I thought it would just be an extension of what it was like in general practice, but it wasn't.

6:14Women would travel for hundreds of miles sometimes. And they would tell me how they'd been suffering for years because their doctor had given them antidepressants, told it was all in their head, that they'd needed other drugs and all their symptoms had started since their ovaries were removed in an operation age 30 or since their period stopped or whatever. And I was like, what? Like how? What's going on out there? And then I started, wrongly or rightly, to sort of play with social media and people would message me with these stories. And then over the years, obviously, the clinic's busy, my social media's really busy, people stop me in the street and tell me about how they're not being listened to and believed.

6:55So what drives me now is just the injustice, actually, of what's happening and how the medical system is letting down so many women without any good reason. So it's gone from just being interesting to like something that's making me really sad and cross actually yes and what do you think do you think that one country has has it a little bit harder than others i mean we're in america actually laura's in europe right now so yeah i'm in norway nice but just i mean if we look at the UK and take America. Are there huge difference? I mean, I know there's a lot going on in America right now. Yeah, for sure.

7:42For lots of reasons. But you know what? Every country is bad. So lots of people say, Louise, what you're doing is amazing. UK is really increasing. HRT prescribing had been increasing, but the last few months it's plateaued again because there's various people who were trying to scare people away again from hormones. But let's think about it. 100 % of women will become menopausal. About 5 % of menopausal women globally are prescribed hormone replacement therapy. And in the UK, it's about 14%. But every menopause guideline, whatever, you know, you think about the guidelines, they all say first line treatment for symptomatic menopause for the majority of women is HRT.

8:29So I'm not a mathematician, but 5 % and 15 % are not the majority. So even if you just look top line, do you know what I mean? Then it's bad. So I feel sometimes guilty with my work because awareness has improved, knowledge has improved, But access to evidence-based treatment generally hasn't really improved. So let's go to that, evidence-based treatment. What does that mean to you? Because I'm obviously, I am in the strength and conditioning world. But I have partnered with a lot of influential experts. And I feel like there's that while menopause has gotten widely more popularized, there are two camps.

9:22Yeah. And the camps are, you know, and sometimes it's loud. But when you, I feel like everyone's throwing around evidence-based care. What does that mean to you? And what do you provide in a clinic that's different? No, it's a great question. And I think women's health in general becomes very polarized. Something about hormone health becomes really quite toxic in some way. You only need to look at some social media comments and you're like, hang on, what's going on here? So obviously I'm a physician and all my work, whether it's hormonal or not, is based on evidence. And when I say evidence, that's scientific evidence, but clinical evidence as well.

10:05so we have to remember that medicine is a science and an art so the science is knowing you know the biology the physiology the biochemistry the pharmacology studies the trials the evidence but it's also the art is individualizing care and that's sometimes lost in people who don't have a huge amount of clinical experience so then well if we think about what menopause perimenopause is it's related to hormonal changes menopause is when the hormones are low because our ovaries don't work for various reasons so then if we unpick what the hormones are they're chemical messengers that work in every single cell so then when I talk about hormone deficiency there's already people going no it's not a hormone deficiency well what is it then do you know also mean it's low hormones therefore it's a low deficiency so then you have to think well how do well does our body work with hormones well the cells work better the tissues work better the organs work better the organelles in the cells like our mitochondria work better that's just fact that's not me telling you something I've made up this is just you know basic physiology but then when you think about treatment and individualized treatment it's about choice and I often will compare it with things like exercise I don't need to tell you that exercising is really good but there are different types of exercise and there's choices some people don't exercise at all and that is their choice they're not all going to get heart disease because they don't exercise but we know that risk of heart disease for example increases if you don't exercise and it's the same with hormones if you don't take hormones there are risks to your future health but you might be absolutely fine but you just need to know and accept what's going on in your body and knowledge is really important and I see some people on social media are going look at me I'm amazing and I've never taken a hormone this is all done like naturally well it's not natural to not have hormones for a start but do these people want a medal you know I see women who are suicidal and falling apart do I say to them oh do you know what if you exercise then you might be fine like I don't say that if someone's got other deficiency if they've got low iron I wouldn't be saying well exercise and you'll be fine I mean exercise of course you'll improve with other ways you won't replace that iron so I think it's misunderstanding actually about what basic hormones do in our body and then the HRT conversation is really fragmented because people don't seem to often understand there are different types of hormones like if I wanted if I was 10 years younger and wanted contraception I'd get it really easily and if as a 54 year old menopausal woman if I want HRT everyone's like what you can't have that that's terrible but if I wanted antidepressants it'd be very easy for me to get them so this there's this inequality of care that's going on and my work is really about empowering people with knowledge so then they make choices you know it's not saying you have to take this hormone or you have to exercise in a certain way.

13:32Just have this knowledge. But the knowledge has been hidden or it's been wrong. And I, just to be really clear to your audience, I don't work with pharmaceutical companies. I don't work with supplements or brands or, you know, my knowledge comes from reading academic papers and, you know, knowing a lot about basic science and then putting that into context for individual patients. Do you think that it's, so we will get to what, what hormones, pros and cons and what each one of them do, because I think those are still with all of this information out there. I just know from, from what I'm getting in my DMS and my groups, because I always hire a menopausal, like a menopause physician to come into my courses to educate because not my lane, but it's amazing how much of the same questions come up all of the time.

14:26So what would you say are the three, the top three, if you could pick two or three misconceptions about HRT that we're still getting wrong today, or most people don't understand? I think the biggest reason why people don't take hormones and don't prescribe them if they're doctors is the risk of breast cancer. That's the biggest thing people are scared about. Now, one of the things to think about is the study that scared everyone away from 2002 was using synthetic hormones. So even though it showed the risk wasn't statistically significant, and even though it showed estrogen only, HRT was associated with a lower risk of breast cancer, you can't compare it with the natural hormones the body identical hormones we prescribe now there has never been a study to show that our own hormones cause breast cancer like it wouldn't make sense really even if you think about it as a basic scientist how would our own hormones cause cancer just feels a bit weird doesn't it yes so that is the biggest myth that scares people away.

15:33The other thing is that people think that they're too old to be considered on hormone. And let's face it, we've got 20 years of lost women who have been misguided and denied hormones. So now a lot of these women who were 40s, 50s when the study came out are maybe in their 70s. No one is too old to be considered for hormones. And then the other myth is all about testosterone what it is who can have it what does it mean because a lot of people think testosterone is the hormone that people inject to be bodybuilders and have like massive muscles and what those people are doing are giving themselves something that's like testosterone but it's not the same so it's like you know eating strawberry flavored sweets rather than having strawberries there's a big difference in the body so those are myths um and not every hormone is the same you know i contraceptives are very different to hormones that we prescribe and most even doctors don't seem to realize that okay so if i were to come in so laura and i are the same age we're both turning 48 this year so it's a good assumption that we're in perimenopause And I feel like this is almost the, I mean, I would love your advice, but it feels like perimenopause, where everything is really erratic, is the harder section.

17:04Yes, it is. That at least postmenopause. But here we have perimenopausal women, the majority, as you said, from the statistics at the first of the call that are either postmenopausal or in this peri phase, that aren't taking hormones. And if this is the most dramatic, you know, few years leading up to it, if I were to come in your office and this is generalized, I know it's super individual, but do you normally more than not prescribe? What do you start with? Do you go in and just say, oh, progesterone is like the easiest one, although I heard you say it was the most forgotten or maybe the most misunderstood.

17:45And I was thinking that that was the testosterone. I feel like testosterone now is getting a lot of love. It's kind of like the darling of the hour, but they each are so individual. Where would you just start someone generally? So it's a great question. The most important thing actually for me as a clinician is really taking a good history and understanding because, you know, things have changed. When I started my clinic 10 years ago, people would come in and say, I think I'm perimenopausal, but I tell you what, I don't want hormones because they've been so scared away. Whereas now people will come, they've got more information, great.

18:25And they'll say, I'm perimenopausal. I've used your balance app. I've listened to your podcast. I would like a gel. I would like progesterone. I'd like testosterone. And they basically running the consultation. So the important thing to me as a doctor, firstly, is, is it definitely perimenopausal? And that's hard because there's no quick test. But also, is there anything else that's causing their symptoms? So not everyone who's tired, I can blame low testosterone, they might have low iron, they might have low vitamin D, there might be something else going on, they might have another condition.

18:58But you know, I've had a lot of good training, very, I've done a lot of medicine. And so I can ask those screening questions and do blood tests to try and exclude. So that's really important. And then it's working out. I think perimenopause and menopause is just labels for women. What is going on? Are they progesterone deficient? Are they estradiol deficient? Are they testosterone deficient? Do they have endometriosis, which is a lot worse when their levels of estradiol are fluctuating? Do they have a history where they find that they're more intolerant of progesterone? Are their periods regular?

19:40Are they heavy? Do they need contraception? So all of these things is working out in my mind, which hormones, what dose to start. Sometimes if someone has really bad PMDD, premenstrual dysphoric disorder, and they're just feeling terrible for those few days before their periods and the rest of the time they're fine, well then I might just give them some progesterone for those few days. And then I might consider doing their estradiol and testosterone blood test and reviewing them. But other women, I might give all three hormones together. It really, really depends. And that's where it's very individual.

20:15And then we just review people. And it's a review consultation that actually can be more revealing because then we can see, are they responding? What are the symptoms do they have? What are their blood levels doing? And then that will help us guide whether we need to change the dose or the type or add in another hormone for example or think about vaginal hormones as well and then in a review usually when the hormones are balanced we spend a lot of time thinking really carefully about nutrition and exercise and whether they need supplements or what else is going on in their lives too so it's not just a like transaction that we just do it's and it's a journey and often in perimenopause you think you've got it patients Patients feel really well and then suddenly their own hormones drop and they might need their dose changing.

21:03So it can be a moving target sometimes as well. A moving target. Exactly. Do you think blood tests are useful for perimenopause? So they have to be done, this is what I think, in conjunction with a really good consultation because it's so easy now to get blood tests, isn't it? And people come in with these like reams and reams. A lady came in yesterday and it was almost like a book of blood tests, but she hadn't even had her testosterone level done. And I'm like, oh, you've had all these other blood tests. So you have to be really careful. And our hormone levels do fluctuate and change. So I've seen ladies with really high estradiol levels, and they're not on any hormones, but their own body squirting it out.

21:52But then other times of the day when they weren't having their blood tests, they have got loads of symptoms of low estrogen, but they've been told you're estrogen dominant. Well, they might be at the time that the blood test was taken, but all the other times of the day they're having low estrogen. So we have to be really careful how we interpret blood tests as well. I think they're useful. I mean, when we start testosterone, we usually do a testosterone level just to see. but then there are some women who um have polycystic ovarian syndrome who might just be you know always run with a slightly higher testosterone than others so we have to this is where you're taking a context but we often do do blood tests to exclude other causes like i say like looking at their iron level their vitamin d get their kidneys their liver and all that as well so you know but you can the thing in medicine you only do a test if it's going to change your management.

22:51It's very easy now. Like, I mean, I've been qualified for many years. It wasn't so easy to access all the scans and things that you can now. But I always ask myself, is it going to change my management? And if it isn't, then I'm not going to just do a blood test for the sake of it. Is estrogen dominance real? It's a great question. Yeah, I don't think really. I think, I mean, there's lots of labels we give women, what does it mean that you're Eastern dominant? Like basically it means that you've got low progesterone and probably low testosterone. The balance of hormones is really important. And Professor Mo Kira, who's a urologist I know well in the US, he talks about the triangle of the hormones.

23:34And I love that because you've got to get those three hormones balanced. Sometimes I talk about a three-legged stool. You can have the right height of one leg, but if the other two aren't there, you're going to be lopsided. So often it's because people don't have the other hormones balanced. So also sometimes when people are perimenopausal and their hormones really fluctuate, sometimes we do give a higher dose of estrogen, which seems a bit paradoxical, but then it stops the ovaries doing this yo-yo stuff, you know, and that can be very useful for some women, you know, so this is where it's all very individualized.

24:16So if we were to take estrogen, let's start with estrogen. Yeah. Because I feel like that's the one that gets the most love. Most women are very familiar with estrogen. So if we're taking that, we have vaginal estrogen, and then we have systemic estrogen. So what are the different types? Because I was just, I was fascinated, Laura and I were talking about this before you jumped on about the um transmission of of of through a patch or through a gel um i didn't even think about like the the skin texture and if the skin is thicker and now i'm questioning is mine getting absorbed on the gel am i putting it in the right place what are the options it's really interesting actually because it's very crude medicine so we usually use it through the skin so it stays as oestradiol because there are different types of oestrogen and the oestradiol is the anti-inflammatory the good oestrogen if you like and once we put something in our mouth things get metabolized through our liver that's just how anything works that we eat or drink so if we have oestrogen through our mouth it can get metabolized to different types of oestrogen If we put it on our skin, it goes through the skin into the bloodstream and then it stays as estradiol.

25:36But the ways of getting it through the skin are usually a patch or a gel. But you're absolutely right. The absorption can really vary between women. It can vary because of their skin texture, their thickness of their skin, their temperature of their skin. And you can imagine if I put it on my bottom, which has more subcutaneous fat than the small of my back, of course the absorption is going to change. And then we've got the way we prescribe drugs. They're always within sort of license to certain range. But some women, even with the highest license dose, they're just not getting it through their skin.

26:16And so we sometimes change to a different manufacturer patch or the gel. but even then you might have seen on my Instagram every so often I flap mine in the camera and just say like they really don't stick very well so I use more than one but some people use a very small dose and they get loads more through their skin than I do using more than one because we're all different and we've known that for many years but we have to have the right amount into our body so that it works to not only improve our symptoms but also to improve our future health. Well, I'm second guessing everything now. So if you have it, where's the best place?

26:56You can put it on the thigh. So it really varies. It's where it sticks really. So I actually put mine on my lower back because I don't have much subcutaneous tissue. I can feel my muscles quite easily through my back and they just stick. They don't wrinkle. If I put them on my bottom, my bottom, I'm sitting, I'm standing, I'm moving. So they just become a bit more crinkly if I put them on my leg they just come off in my jeans like they just once the patch is edge start rolling they flick off so so that's just for me personally but other people find different places so what are the other options like on your head on your stomach so I mean again the way they're licensed they say put them below the waist but you're just using the skin as a vehicle you know I sometimes joke and say to patients you put it on your forehead like it's just using your skin to get it.

27:47You wouldn't put it on your forehead, of course. But it's just about doing that. And then the gel, again, it's licensed for the arms or the legs. But again, it varies on the way that it's absorbed, it can really change. And that's where like the deuce is less important than the penetration and the absorption. okay so the the the gel the patch we have that vaginal estrogen so that's separate um i was shocked because i was just hiking with my sister in europe and she has access to any of my podcasts and i've had a lot of experts on i don't think she's listened to one clearly but she was like oh no you can't take vaginal estrogen if if um you're you're uh if you've had breast cancer.

28:39And I'm like, that's not true. And she was arguing with me. And I was just, it showed me how much misinformation is still out. I mean, it's with my sister. Yeah. So, so vaginal hormones are very, very, firstly, they're very low dose. And they only really penetrate the area. So they'll use, they help the vagina, the vulva, but they'll go into the bladder, the pelvic floor, the urinary tract. So they work for localized symptoms. And we've got vaginal oestrogens, and we've also got something called prasterone, which is a hormone called DHEA, which converts to oestrogen and testosterone, which can be a lot more effective, actually.

29:21And these hormones can be usually very safely used for women who have breast cancer, because they don't get absorbed into the body, they can really make a difference. But women who take HRT often still have urinary symptoms or vaginal symptoms. So then we can use the vaginal hormones as well as having systemic hormones. And you can put it on your face? Oh, yeah. Yeah, sometimes people use the vaginal. That's the trend. Yeah, and put it on their face. But you know what? If you have systemic hormones, so all three hormones, oestrogen, progesterone, testosterone, they work throughout your whole body.

30:02So they work throughout your whole skin. So they will improve collagen deposition. They'll improve the skin, the blood flow to the skin. They'll reduce wrinkles. They'll change the texture of the skin. Now, most of us, yes, it's the face is what we see, but there's no point having a young face and then like really old hands and dry flaky skin elsewhere. So if, you know, I don't know, people do it but then they're not on hrt and i don't really understand why do you know what i mean so i think we have to um of course it's going to probably help it won't penetrate very much but it's the skin is a really it's the biggest organ in our body so we want we want it well perfused because if our skin is healthy our liver our lungs our heart our kidneys are going to be better as well so it's all very well having a nice young face but we need to be thinking about getting these hormones into our bloodstream and our body.

30:58Yes. We've all seen the 80 year old that has the amazing 40 year old face, but then the rest of the body, I don't remember. So if we move on to progesterone and the different ways, so we can have that orally, which I didn't even know. And I have to tell you, I was training a client and she was just super, she'd gotten on progesterone and she was super tired when she would show up in the morning for our training session. And she came back the next day and she said, oh, well, this is like I take it rectally now. I didn't even know that was an option. So you can take it vaginally, you can take it rectally, and then you can take it obviously oral.

31:45What's the differences? How would you decide? So progesterone, and this is really important terminology, progesterone is the same structure as the natural progesterone we produce from a younger when we use the term progestogen or progestin that's a synthetic chemically altered progesterone that's in all of contraception by the way um so progesterone we use as part of hrt and historically i was taught people are taught that you only need it if you have your womb because it protects the lining of the womb from oestrogen. But actually, it's a really important hormone in our organs and our brain as well.

32:28So many women, including those that have had a hysterectomy, still take progesterone with good effects. So we can have it orally. It's quite hard to get absorbed orally. So it's made in a way it's called micronized. So they basically make it very small and suspend it in an oil so it can get absorbed through the body but like I've said before anything that gets absorbed through the mouth gets digested metabolized through the liver so it can get broken up into different types of progesterones and some of those metabolites can cause side effects for some women whereas if we use it as a pessary so as a vaginal or rectal pessary, it gets absorbed through the mucous membranes.