When Menopause Meets ADHD with Dr Louise Newson

0:00Why is it that most women who are perimenopausal or menopausal feel really low and flat and tearful? Do you know what I mean? It's not flushes and sweats that are affecting them. Yes. So what's going on in the brain? Eastern-alph progesterone, testosterone are neurotransmitters. Okay, so they're bridges. They are. But I think more crucially, the changing levels can trigger a myriad of reactions in the brain that can affect the way our brains function, especially if we've got ADHD. We should be looking at our hormones in our brain and we should be balancing them because it's safe. What's the most common question people ask you?

0:33It's always about HRT. It's always about will it cause breast cancer. It's been the biggest car crash for women's health ever.

0:43Today's guest is Dr Louise Newson, GP, menopause specialist and well-known advocate for better hormonal health care. She's the founder of the Newson Health Menopause and Wellbeing Centre and the force behind the Balance app, which is helping millions of women better understand their bodies. As a neurodivergent woman and mum to ND daughters, Louise brings both clinical insight and personal experience to the table. This episode blew my mind. It opened up my mind to the impact of hormones on the brain. And I can tell you now, men, you need to hear this too. Let's get into it. Let's see how great minds think differently.

1:31So I'm sat here, Louise, thinking, oh, I'm with someone who knows so much about something that I don't know a lot about, and that is an amazing place for me to be in. Oh, good. Well, obviously I'm here, hopefully our audience, learning and listening, but selfishly I'm like, great, I get to pick your brains and learn lots. Yeah. So I'm going to ask all the stupid questions. Have we always had the menopause? We've always had menopause, yeah, in women, but not in animals, actually. It's interesting, isn't it? But yeah, it's always been there, but it hasn't been such a big problem. And that's partly, if you think back to Victorian times, most women would spend the majority of their fertile life pregnant.

2:20So on average, they would probably have at least 10 pregnancies, probably around seven children this is on average okay but they would be breastfeeding as well so a lot of their life between the age of 20 and 57 was the average age of the menopause then older than now they would have huge amounts of hormones in their body like really high amounts because that's what happens when people are pregnant so they wouldn't be having a period every single month yeah do you see what i mean yes so that's different but also like now the average age in the UK of menopause is 51, so a bit younger. But we live so much longer, don't we?

2:58Yes. Why do you think it's six years earlier? Because you're resting your ovaries. You know, when you're pregnant, well not you, but when I was pregnant for nine months, that's nine months without a period, isn't it? So I'm not releasing an egg. Whereas if, when I only had three pregnancies, but if I'd had 10 pregnancies, you know, those eggs would carry on going for longer. So when you are pregnant, you're producing more hormones? Huge amounts of hormones. So this is a rough guide, but it's about 55 times higher amount of estrogen in the body than when I'm just having a normal period. And then when you give birth, guess what happens?

3:37It shoots right back down. Absolutely, like it crashes. And that's why so many of us feel flat, low, baby blues, feeling tired, feeling joyless. We're just told it's just a bit of blues. But actually, postnatal depression, of course, it's related to hormones, isn't it? So it's your estrogen, progesterone and even testosterone. They fall off a cliff. But we're living longer, aren't we? So the average life expectancy in women is about 82 now in the UK, which is great. But that means we've got a lot longer without our hormones. And that's really important when we think about future diseases as well.

4:12What's the most common question people ask you about hormones and menopause? It's always about HRT Okay It's always about will it cause breast cancer? Is that the most common one? Yeah, it still is now It's the biggest fear and it's the biggest question I think And give me the history on that myth Yeah, so it's such a shame Honestly, it's been the biggest car crash for women's health ever If you think back in time, we knew hormones were good. Hormones are just chemical substances that our body makes from our different organs. We've got loads of hormones. They go into our bloodstream, they go into every single cell and they help our body work.

4:53And we just happened to have hormones that were mislabeled as sex hormones when they were discovered. Why was that? Because all the experiments were done on the womb or the testis because they knew there was something. because they knew that when women had their ovaries removed, they would get all these symptoms and it would be weird. They would be melancholic. They would be low. They would be tearful. So they're saying, oh, there's something in the ovaries. And the same with men. They quickly discovered, actually, that if they, it sounds mad now, but they were using scrotum of monkeys and bull and sort of mixing it up to a tincture so people would drink it.

5:36No. Yeah, yeah, yeah. Honestly, because they didn't know what hormones were, but they knew there was something in these organs. I.e. to replace. Yeah, but they didn't know what they were doing. So there was a really famous, very well-respected doctor called Professor Brown-Saquard. And he took this, he realised there was something in these organs. So he made this sort of mixed junket. And he said, I feel amazing. I've got this joie de vivre. I've got this youth back. And everyone just thought he was mad. And they tried to discredit him. and they said this is awful, terrible. But other doctors were saying, no, but it's the same for us and our patients, we're giving it, we're noticing something.

6:12And sadly, when he died, people really discredited him. But then when they found out, oh, there's testosterone in testes, but because they found testosterone in the male testes and progesterone in the female ovaries, they were labeled as sex hormones. But actually, they're not just made in the ovaries, they're made all over our body and our brains, which we'll talk about in a bit. So men have oestrogen and progesterone and women have testosterone. Do we? Yeah. Okay, so I like, yeah. Yeah, which is so interesting. So they're not sex hormones and they're not about sex. Everyone thinks testosterone is just about libido.

6:49Of course it's not. So they're not gender hormones, they're not sex, they are hormones. And we all have those three. We all have them and we have different amounts. Yes. And that's really important. So that's the sort of first myth really. but I'm really interested in the history. Like, why are we in this mess? Like, what's going on? And sorry, what mess are we in? Well, we're in this mess about this breast cancer risk. So then they started giving people hormones and women started to feel better, their wellbeing was better, their mood was better, their energy was better, they had less flushes and sweats.

7:20This was all sort of post-war in the 50s and 60s. But they made the HRT out of pregnant horses' urine. So that's what they were doing. it was the biggest selling drug in the US worldwide. 40 % of women were taking it who were menopausal and they were better mentally, physically, but also studies were showing that women had stronger bones. They had less risk of dementia. They had less risk of heart disease. They had less cancers. Really important. This was in the 70s. So more and more people were going, God, this is really good. So then they thought, well, let's do a study to see if it's not just women who have just become menopausal.

7:58or let's see if older women will benefit as well, which is a good idea, isn't it? For some reason, and they wouldn't do it now, they've spent a billion dollars on this study. So it was a big study, American study. But they used pregnant horse's urine tablet, and then they also used a progesterone as well, because women who have a womb, we give progesterone to. But it wasn't the natural progesterone. It was a chemically altered one, which means that it's not the same as the natural hormone. It won't work the same way. It's been altered. to commercialise it. So they gave these hormones, followed these women up, and then they saw, oh, maybe there's a slight increased incidence of breast cancer.

8:37Let's halt the study. Now, when you do a study, you can imagine there's lots of complicated stats, like big data sets, lots of women in the study. But they didn't analyse it properly. What they did is they just went to the media and said, HRT causes breast cancer. And they went to the medical press and said, guess what goes? HRT causes breast cancer. So there was a big PR campaign. I mean, I've watched the videos of the day after people are like standing on their podiums and saying, big study, HRT causes breast cancer. Everyone needs to come off their HRT. This was in 2002. And of course, if you're a woman or a doctor, you'll be going, oh gosh, this is scary.

9:15This is scary. They also said there's an increased risk of heart disease as well. This is a number 1K or heart attacks, we've really got to stop. Then they analysed it properly and they found some really interesting facts. They found that women who only had oestrogen, they didn't have progesterone, so they just had the pregnant horse's urine, with time they had a 22 % lower incidence of breast cancer. But that didn't make the front news. It wasn't like, hey guys, we've got a treatment that reduces incidence. The opposite. The opposite. But then they also found this increased risk when they added in this synthetic progestogen wasn't statistically significant.

9:53So it was a chance thing rather than a cause thing. But they also found that the women who took hormones of whatever type had a lower incidence of osteoporosis, thinning of the bones, really important. They had about a 40 % lower incidence of bowel cancer. Now that's really important because bowel cancer, as you know, is on the increase. They also had better well-being, better mental health. Then the risk of heart attack and clot, we know that because it's synthetic. Do you know what I mean? So they're not telling us anything we don't know. But the irony is, don't prescribe those hormones. So it's like comparing apples and bananas and saying all fruit is yellow.

10:35So do you think those same hormones or those same drugs that were used in that study are now not available? Well, I'd like to say no, but they are. So in America, a lot of women are still using Premarin, the pregnant horse's urine, as estrogen. They're still using pregnant horse's urine to make estrogen pills. Yeah, it's just estrogen for some types of HRT, yeah. But the worst thing I think is that the progesterone part was called or is called myoxyprogesterone acetate and that is used in a lot of contraception and it's still used in some HRT. Okay. So we know there are risks of clot and heart attacks.

11:17We know that it's not a natural type of hormone, but it's still used a lot. So where are we at then in terms of repairing that damage that was done in 2002? I think we're doing a really bad job actually. Okay, you sort of started smiling as I was waiting for the good news. No, I don't think so. So if you think, like I said, 40 % of women in the US who are menopausal were taking hormones around that time. About 30 % of women in the UK were taking it. And it was on the increase because people could see these health benefits. How many people do you think are taking HRT in the UK now? I wouldn't even like to hazard a guess.

11:55It's about 14%. And then globally, it's about 5%. 14 % of menopausal women in the UK are taking HRT. Why is it so low? Because everyone's scared because of this one study that was misreported. 23 years ago. Yeah. It's good, isn't it? It's quite shocking. And I don't, like I say, we don't even prescribe those hormones anyway. I prescribe the exact replica. So I prescribe the oestradiol, the natural oestrogen that's derived from soy plants. And it's the same. The body recognises it as oestradiol. The progesterone, again, is the progesterone and testosterone. Whereas the older types, they've been chemically altered.

12:41So the body doesn't recognise them and that's why there's risks with them. Do you see what I mean? Yeah, because it's a more foreign, quite an object. Absolutely. And that's the same with all contraceptives have been chemically altered. whereas the HRT that's available on the NHS, it's as cheap as chips, is the same as the hormones we produce. So we're just replacing light with light which is what the body needs. Where does neurodiversity then come into hormones and your work? It's so important. So I'm very interested in the role of hormones in the brain and I'm very interested in the brain because I don't think you'll argue with me when I say it's the most important organ we have.

13:23Yes. And it's the most amazing organ. It's the most incredible thing. It is the most incredible organ. And the more we learn about it, the more we realise we don't know much about it. Yeah, yeah. You know, this sounds a bit weird, but I will share it with you. My dad had a brain tumour many years ago. He died when I was nine. And the first time he had it was when I was about three. And he had radiotherapy, had it removed. And then before he died, he had a lot of his brain taken out. And I remember being sort of nine and him coming home. One side of his head was just collapsed because he didn't have a brain.

13:55And we had to do these jigsaw puzzles with him and try and get him to, you know, I was like, how do you breathe? How do you live when you're, you know, you've had a big amount of your brain taken out? And the brain is incredible. And I've always been very interested in how, what does it do? How does it work? Because I think we all think it's just about thinking. It's about memory. But when I say to people, you know what? The metabolism of your body is dictated by your brain. Your heart rate, your respiratory rate. Like even when you move your little finger, it's your brain that's telling you, you haven't got a little brain in your finger.

14:25And it's like, it's incredible, isn't it? It's amazing. And every single one's unique. So with hormones that we've always been taught are from the ovary. Why is it that most women who are perimenopausal or menopausal feel really low and flat and tearful? Do you know what I mean? It's not flushes and sweats that are affecting them. Yes. So what's going on in the brain? So the more I've read, the more I've learned. but actually our brain produces Estradar, Progesterone, Testosterone. Our brain produces them. Our brain produces them and that's what's really fundamentally wrong in our education because most people don't realise that.

15:01Yeah. So your brain, I don't know if it does now, but it certainly did produce Estradar, Progesterone, Testosterone. Okay. And I'm sure you've heard and I'm sure your listeners have heard about neurotransmitters. Yes. You know, these chemicals that allow the signals. but estradiol, progesterone, testosterone are neurotransmitters. Okay, so they're bridges. They are. And they affect the levels of the other neurotransmitters. Okay. And that's really important if you understand that because then you can quite quickly think, right, so if my levels of estradiol are low, then that's going to affect my carotid, my dopamine, my serotonin, my acetylcholine, my neurodegenerative, you know, all of those important neurotransmitters.

15:45But I think more crucially, the changing levels can trigger a myriad of reactions in the brain that can affect the way our brains function, especially if we've got ADHD. So therefore, for perimenopausal and menopausal women who are neurodivergent, their hormone levels are at the root in terms of understanding what those levels are. that can cause lots of trade symptoms. Yeah, and it's very interesting because the way our brains work, they like what's called homeostasis. You like everything the same, don't you? Our brain likes routine. Even if we don't like routine, our brain likes routine. Now, in the menopause, when people have low hormone levels and they stay low forever, it's not such an issue, actually.

16:29The brain can accommodate. It might not work quite as well. But in perimenopause, you've got these great changes of hormones. They fluctuate all the time. And they can change seconds, minutes, days, you know. And people know that because they suddenly feel really angry and then they're fine again. Or they suddenly feel very tearful or they've got palpitations that just last for a few minutes. So we know the hormones are really fluctuating. So you can imagine in the brain, you've got high, low, high, low levels. Well, what's that doing to all your other neurotransmitters? It's like, oh my God, guys, I can't keep up.

17:00Yes. And that's really relevant when we think not just about perimenopause, but PMS, premenstrual syndrome, PMDD, premenstrual dysphoric disorder, and postnatal depression. The poor brain is like, whoa, what's going on? What correlation have you seen between something like PMDD and ADHD? Let's get all the acronyms in there. Yeah, so PMDD, premenstrual dysphoric disorder, is a more severe form of PMS, premenstrual syndrome. now about 95 % of us will have PMS where you just feel a bit rubbish before your period but it says only 5 % that's 1 in 20 women a lot have PMDD and if you think about our hormones what happens the second half of the cycle we have a rise of estradiol and progesterone and then they crash just before our periods some women with PMDD it's this crash of progesterone and estradiol actually that really can trigger a myriad of symptoms and can really affect the way the brain functions and it's that changing hormone levels can trigger and worsen ADHD and the way people think.

18:03Often with quite intrusive negative thoughts as well, we know suicide rate increases with women with PMDD. And the brain is very complicated. It's not just one or two symptoms. There's a myriad of symptoms and one can trigger one. If you're not sleeping, you're going to feel more tired. You're going to feel more irritable. So it's the whole cascade approach, really, that happens with PMDD. But a lot of people still don't believe in PMDD. A professor of general practice told me recently that it was a self-fulfilling prophecy and it wasn't a real condition. Wow. And I'm like, hang on, have you not spoken to women who fall off a cliff?

18:40You know, I speak to women who can't go out for those three days before their periods. And are we basically, I say basically, are we terming PMS and PMDD as the same thing with different levels of severity? Well, it's great you're asking because it's actually, there are quite strict criteria for it if you really look it up in the textbooks and it's, you know, you have to have this amount and you have to have them for this amount of time and they have to have so many symptoms and the severity. Do you know what? It's all bullshit really because if you're feeling bad, does it matter if it's PMS or PMDD?

19:15If you look at some of the guidelines, they say women should try a vitamin and exercise and eating better. And then if they still have problems, go and see a doctor. Well, hang on. It's related to changing hormones. You know, obviously, your mood can improve if you eat a bit better. But if it's a hormonal change, but let's think about what it is. Is it the progesterone that's affecting the woman? Is it the estrogen or is it testosterone or is it all three? Let's get on and help them because these women are giving up their jobs. They're not achieving what they want to. And it's not just those three days.

19:47Like my daughter has PMDD and she's fine, by the way, because she's treated. But she said to me, mummy, the rest of the month, you're dreading those three days to come. Because what if they come and I'm playing in a concert or I've got an exam? I just want to be the best version of myself. And that's what's really harrowing. And that's really happening out there. So it doesn't matter the percentage. It doesn't matter the label. What matters is the suffering to women, really. Yes, and being able to make that better. Yeah, absolutely. So then what happens if you throw ADHD medication in the mix?

20:21Well, it's interesting, isn't it? I think ADHD medication, depending on what it is, obviously can help some of those neurotransmitters and calm it down, but it's not going to treat the underlying cause. So in medicine, I've always been taught, and it's the right thing to do, is try and treat the underlying cause. So if you had vitamin D deficiency, and I gave you that diagnosis, you'd probably hopefully say to me, well, what vitamin D do I need? I wouldn't say to you, do you know what, I'll give you some iron as well, because that helps some people who are tired. Do you know what I mean? And that's the same here.

20:53I see a lot of people who have ADHD that's become really hard to manage. Life's really difficult for them. But I know that some of it's related to their hormones. So I will rebalance their hormones and then see if they need anything else. rather than say, let's give you a drug. But there's three hormones. And this is where I think the labeling of menopause, perimenopause is wrong. And like I said before we came on air, that I don't think giving people labels is always helpful because I saw someone, for example, on Monday in my clinic. She's in her late 20s. She said, I think I've got PCOS, polycystic ovarian syndrome, but I might have PMDD and I'm not really sure what else is going on.

21:33And it's like, well, you've got hormonal changes because you're telling me four days before your period, you don't want to go out the house, your mood's really low and tearful, you're arguing with your boyfriend, your skin flares up, you get acne. Then your period comes and you feel fine again. So you've got hormonal changes. It doesn't matter what label I give you. All I'm going to do is give you some hormones to top up in those few days. Before your period. Yeah, so your brain doesn't have to have this, oh my God, what's going on? Okay. But is it progesterone? Is it estradiol or is it testosterone?

22:04And everyone's different. But we can test. You can test to an extent, but again, our hormone levels are changing all the time. So it's like if I do someone's blood test and it's normal, well, it might be normal then, but 10 minutes later it might be really low. So it's often in conjunction with good clinical history as well. Testosterone is a bit easier to measure, but there might be some people, and I see a lot of women who are young who are testosterone deficient, but they're still having regular periods. They feel fine because they've got enough Easterdial and progesterone in their body. And that's where I think we should be really specific about our labelling.

22:42I am deficient of all three hormones and I take all three hormones but I'm sure for about 10 years in retrospect I was low in testosterone and didn't realise it. How would they know if they were low in testosterone? Yeah, it's a great question. Often knowing what the symptoms are really and the problem is knowledge is really good but if you don't have it, you don't know. A lot of symptoms of low testosterone are low mood, poor motivation, stamina being low, muscle and joint pains, headaches, worsening migraines, urinary symptoms, skin changes, but also just the inability to process in the same way.

23:18So that's where a lot of people have sort of not misdiagnosed because they might have ADHD, but they're thinking about that first without thinking about the testosterone. And testosterone makes a big difference to men and women, actually. Have you come across people who have either mistook ADHD for menopause, perimenopause, menopausal, or the vice versa? Yeah, definitely. Why does that happen? Partly, it's poor information and education, not just for the patients or the people, but from healthcare professionals as well. You know, if I go and see a psychiatrist, they'll diagnose me differently than if I go and see a general physician or a gynecologist.

24:03You know, medicine is very siloed, isn't it? It's very compartmentalized. And I did some training a while ago with some psychiatrists, actually, about ADHD and hormones in the brain. And at the end of it, a lot of them had great questions, but they were saying, gosh, this is all the people I see. I see women in their 40s who suddenly they think they're ADHD, go through, they've got diagnosis. And I said, would you ever give them hormones? No, no, our contract's only for amphetamine-based treatments. That's all we give. But then you're missing a trick then, aren't you? But then they're also not referring anybody on.

24:35No, they're not. They're not. And that's what really scares me. And I do think in medicine, if you give a diagnosis, you want to provide a solution. Because otherwise you're just hanging there, aren't you? Do you think hormones can help neurodivergent people? Yeah, absolutely. And what I've learned, I mean, I've got a huge amount of clinical experience. I've learned so much from my patients the last 10 years. And I see all sorts of people from all sorts of backgrounds, all sorts of ages. And, you know, hormones make a huge difference to their brains. And I really think that menopause, perimenopause is a brain condition.

25:13It's not an ovary condition. The problem is we define it as periods. You know, to be menopausal, you have to be a year since your last period. Like, why? Clinically. Yeah. But why? Who decided that? And that means it's all about our ovaries. Yes, our ovaries don't work as well when we're menopausal, but how much sooner or later do the hormones in our brain change? But you can become pregnant during menopause. Yeah, some people can, especially younger women. So it's not just about fertility. and there are lots of people you know I've had a hysterectomy I'm never going to have a period like does that mean I'm not menopausal of course that's stupid isn't it yes so but we've forgotten about our brain you know and I a lot of gynecologists like so into the bikini area they forget that there's a there's a pathway do you know what I mean but it's the same like cardiologists if you say to cardiologists do you see many middle-aged women with palpitations they I go, oh, yeah, all the time.

26:10Would you give them hormones? Oh, no, that's not my area. That's a gynecologist's area. Really? Because the palpitations are due to their low hormones. What do you think, therefore? I love this question. I give you a magic wand. What do you do? Oh, do you know what? I would make sure that every single healthcare professional had education in hormones and was confident in prescribing. Okay. Because the hormones we prescribe now are the safest thing I've ever prescribed. in my medical career and I have prescribed all sorts of drugs to all sorts of people including methadone including you know heroin equivalent diamorphine I've all sorts of drugs but nothing has been as effective and as safe as natural hormones and it's transformational because it's not just people come back and say you can mean my life back literally sometimes save their lives but I know that I'm improving their future health because we know as I said for decades that it helps the bone strength it helps the heart it helps the brain so it's win-win like yeah it's maddening and really sad actually because women are losing out in this you know women deserve to have the best treatment for them and it's not like out there women are saying you know what i don't want hormones actually i'm really scared because i'm mobbed by people by questions by dms saying but i can't i'm told i'm too young i'm too old i'm too fat i'm too thin i can't have hormones that they're too dangerous my gp's just said no but they can get antidepressants quite easily yeah so so therefore on the flip side of that's what you would like to happen yeah what is happening when people are going to their gp or their well the average person yeah we'll go to the GP and they'll say I'm really low in my mood I feel very joyless I feel flat my brain's all over the place I can't sleep I've got some palpitations and they say oh it sounds like you're a bit depressed would you like some antidepressants or oh you've got three children you must be really busy and that must be really hard for you well it's just suddenly become hard you know so that's a problem or they're given some hormones maybe but they're like at the wrong dose or they might just be estrogen and progesterone and they're saying well I'm really low still I'm really tired I can't concentrate I've got no libido I've got muscle and joint pain I've stopped exercising and they'll go oh that's it you've stopped exercising you better go to the gym but they're not testing their testosterone levels because they think testosterone is a male hormone and it's really dangerous yeah so even women who are on hormones aren't always on the right dose and type you know what i mean if i gave you a really low dose of vitamin d and you needed a higher amount you still have those symptoms and so is it the case that and i'm being deliberately simplistic here you can go to the nhs and get the one size fits all and you can go privately and get something that is not always actually so what i do in my clinic my clinic is private but i do exactly the same as i've always done as an nhs gp the only difference is i've got longer so i have longer appointments so that's like a real luxury but the end product is the same and there are some brilliant doctors that can tailor because it's really easy it's really easy medicine that's what's frustrating so it's not that and actually we also see a lot of people who come from other private clinics where you're like oh dear what have you done here okay somebody got in touch with me a while ago who'd gone to another private clinic she'd had her ovaries removed at age 32 because she had a family history of cancer of the ovaries so they removed them so she wouldn't get cancer.

29:46Fair play, that's fine. Then they gave her some HRT, which is good because a lot of people don't. They just say, see how you get on. So she was given a very low dose of estrogen. Three months later, she went back to the clinic and she said, I feel awful. Like I can't get up in the morning. I'm really tired. I'm very tearful. I can't carry on like this. I'm very joyless. And the doctor said, well, you're on HRT. So it's not that. I think you're grieving the loss of your ovaries go and see a psychotherapist and she reached out to me and I went sounds like you're not on the right dose maybe you need a higher dose of estrogen you might need some progesterone and what about some testosterone six months later she's on the right dose she's on testosterone she's like wow this is brilliant I feel back to normal thank you for saving my life so you don't always get you know she spent a lot of money seeing somebody who was a professor and she thought would be great.

30:38So that's why individualised medicine is so important. But it's not always you pay for it, unfortunately. Or fortunately. A lot of patients come to us, patients go on the right dose and type of hormones, and then the GPs go, great, I now know what to prescribe, I can help them, and it's lifelong treatment. And then it's great, because then women aren't paying in the way that they would privately. I'm really struck by the amount of women who've been missed or misdiagnosed let's say the lack of I guess knowledge and understanding and fear mongering on breast cancer scares and stuff around perimenopause and menopause how many people have been missed it's really sad you know I'm just I've just made making a word cloud actually of different diagnoses that have come in or different conditions since I trained as a medical student and the thing you know the personality disorders the conversion syndrome the fibromyalgia all these new labels and actually yes some of them might just have them but let's think about hormones first and and that's really important for your listeners i'm not here by the way saying that no one's got adhd it's all hormones i'm absolutely not but what i am saying is that we should be looking at our hormones in our brain and we should be balancing them because it's safe and then waiting because it can take three to six months to get you know sorted properly and then also thinking about you know are there any other supplements that might help our brain what about magnesium what about fish oil i'm sure you've talked about this before all these other are food you know most of us when we don't have hormones we feel a bit crap and we just eat like just rubbish because we can't fit we can't be bothered to cook do you know what i mean we just reach for i mean i don't drink alcohol but people do drink alcohol they go to drugs they go i mean as we did a survey lots of people go to class a drugs because they can't get hormones they want to get out of this cage of doom what's that doing to their adhd you know so let's let's do basic medicine first yeah look at lifestyle yeah you know i do yoga every morning and i do a headstand every morning that's going to help my adhd as well as putting on a patch you know i can't put on a patch and think it's going to do everything i've got to but you've got to unpick it and as doctors you know i'm very holistic i've been trained in all sorts of areas of medicine and everyone's different.

32:53You know, if I said to someone who's got six children trying to get to school in the morning, oh, darling, just do some yoga every morning. I mean, that's stupid. That's not going to happen, is it? But she can do a bit of meditation before she goes to sleep just to empty her mind. Yes. Do you know what I mean? And it's those little tools that are so important. But why do we have this, like, one size fits all? I think because people try to make medicine very simplistic and very tick box. Yeah. And I think there's still a lot of power games in medicine. I am the doctor, you are the patient. I'm going to give you a prescription and you go away and take it.

33:28And that's how medicine was in the 80s and 90s when I was a medical student. You know, we never involved our patients. And then this thing called shared decision making came in. And I was like, what? And I remember when I was training to be a GP, my trainer was lovely, John Sanders. And he said to me, Louise, you're going to be a really bad GP. And I was like, what? He said, look, you've trained in hospital medicine. you've got distinction in all your exams, you're very clever, but you will treat the patient as a disease. Because I tell you what, in medicine, in the hospital, I bet you were saying bed number six, asthma, bed number seven, heart attack.

34:00And I was like, oh, yes, that's what we did. And I think back and I was like, gosh, I was like that in an asthma clinic I used to run and I'd be not even saying to the patient, do you have any pets, dogs? Who looks after you? You know, like it was just, this is the asthma. I want to give them the best inhaler. rather than thinking, oh, actually, they've got rheumatoid arthritis. They can't actually pick up an inhaler. I didn't, like I was very, that was the way I was trained. So he really spun things for me and said, involved the patient, asked them what they want out of the consultation. I was like, John, I can't do that.

34:32I think I'm really stupid, you know. But when I say to patients, you know, why did you come today? What is it that's worrying you? And sometimes, you know, you hear some amazing things. And they might say, well, I listened to this podcast about ADHD and now I'm thinking, could it be, you know, and it's like, great, you know where they're coming from then. And that's really important because then patients feel happier with their consultation. Do you know what I mean? Whereas if I treat you and your best friend and your mate all the same, it's like, hmm, that's just like... But it's a more human experience.

35:02It is, it is. But people forget there's an art in medicine, you see. It's a science and an art. You have to know the knowledge. You have to have the evidence. You have to know the science. But the art is individualising. And we've lost that art somehow. And I think there's a lot of guidelines and they're a guide. They're not a tram line. They're not, you know, we have to be working out what's right for the person. And we don't do that. And I worry even with ADHD, it's like tick, tick, tick, tick. Yes, you've got it. Okay, tick, tick. This is the drug. Right, that's it. Off they go. Not thinking about their lifestyle, the impact.

35:39What does that label mean to them at work or at home or, you know, all of that? Who's picking up the pieces? because I know what ADHD is. You certainly do. Lots of people don't. So then it's like, gosh, what does this mean? Yeah, yeah. Yeah, and there's no safe landing or there's no support system or structure. No, no. Do we know anything about hormones and autism? Yeah, again, it's very interesting, isn't it? So the whole autism, neurodivergent, I do see people who a lot of women, when their hormones aren't right or they're fluctuating, become very obsessive with their thoughts. They become very ritualistic.

36:18So a lot of people who have OCD worsens and then they ruminate a lot, they worry a lot, they obsess a lot. Then they can't sleep very well and these thoughts really occur like early hours of the morning and then that spills out to the day. And so then you can see those sort of traits become worse and worse. But is this hormones or out-of-balance hormones? It's accentuating traits. Yeah, often it is. Yeah, often is. And I can say that with confidence because often I see people, but they've also got other symptoms. And I'll say, do you know what? I don't have a crystal ball. I can't tell you whether this symptom and that is related to your hormones, but I do know that you've got some hormonal changes.

37:03So what I want to do is replace your hormones in a physiological way, weight a bit, and then see what's left. And then it might be that they've still got some anxiety or they've still got palpitations that need seeing to or whatever. But often you'll find that symptoms that really affected them with autism just really improve and become manageable. Do you see what I mean? But are you hearing someone go, well, I was sort of managing some of the challenges. Yeah, and then they fall off a cliff, yeah. Then it all has gone nuts. Yeah, yeah. Is that a typical... Yeah, and then you'll often, you know, a lot of diagnoses in the history is talking and listening.

37:41listening isn't really important as a doctor but you'll say to them what were you like when you were pregnant and they're like oh do you know what it was so easy my brain was clear I could think I was happy everything and then right after you had the baby oh no I fell off you know cliff it was terrible but then you say what about your periods oh yeah just before sometimes when they ovulate as well because you can get a rise and trough quite quickly of hormones and they can feel that some people's brains are really sensitive to those changing hormones so then you know if they say well i i felt like this for two or three days before my periods but now it's like longer but it's the same feeling then women are quite intuitive you know what i mean but you've just got to allow them because like on paper or when they say it you just think you could think oh that's that's a bit crazy when they say you know i i can't think straight and i'm really sad and i'm arguing and i'm this and i'm that and some people have very very dark thoughts But then they said, but then I'm fine again.

38:40And if you didn't understand hormones, you think, oh, she's just a bit loopy, isn't she? Everyone's people did. They were locked up in asylums, weren't they? So, you know, if you've got the understanding, that's why taking it back and thinking, hang on, these hormones are made in our brain for a reason. They're made because they work in our brain. They have a really important function. So these poor women who are trying to cope without their hormones, you know, my car doesn't work very well if it doesn't have petrol and oil in it. Yeah, yeah. We've got to think of it in very simplistic ways, really.

39:13Can we have too much hormones? It's very hard. Think about being pregnant. Those levels are really high in the body. We measure levels as a guide and we keep them within the normal physiological range. So normally up to about 1 ,000 for Estrada. And it's about 55 ,000 when you're pregnant. So you can see the scale is quite different. But that's not dangerous. No. So we don't know what is best because what I need and what someone else needs might be different. And also I measure it in my blood. What's in my blood is not what's in my brain. There have been some studies, very interesting studies from the 70s and 80s, looking at people who were sectioned in psychiatric hospitals with very bad depression.

39:54And those people needed a lot higher doses actually of tablets. Okay, so they were deficient. Yeah, yeah. They were menopausal. No other psychiatric drug helped them. So they said, okay, let's give them higher doses. And those women did really well. But the problem is everyone's scared of hormones and they're dirt cheap. So no one funds really good studies. And they don't even really differentiate between the different hormones. So wouldn't it be great if we did some studies of progesterone in men's brains, for example? I mean, I didn't even know I had progesterone in my brain. No, so the first thing yours and my brain would do, if we had a stroke or a head injury would be to produce more progesterone because progesterone repairs the brain cells, reduces inflammation, helps reduce damage.

40:45So should I as a man be having my hormone levels checked? The thing is it's hard to measure like progesterone because it changes all the time and your blood level isn't your brain level. But it would be very interesting to know. Progesterone is a very calming hormone. It helps people sleep. It helps reduce anxiety. It's got all sorts of benefits. And there are some men that have taken it to help them sleep, whatever. Really? Yeah, and it's very interesting. But why are we not looking at that more? It's not like with thyroxine, we give it to men and women. Testosterone, we give to women as well as men.

41:24Most men will have far more estrogen in their body than any menopausal woman, but they won't realize it. That's wild. It's madness, isn't it? Yeah, it really is. But why aren't we doing more studies on hormones in the brain? Yes. It's so important. Could we measure hormone levels in the brain? It's hard because to get into the brain, you know, you've got your spinal fluid that comes as you could do a lumbar puncture. I don't know if you've ever had one, but I used to do a neurology job and I did them a lot. And it's like, oh, I wouldn't want one of those. But you could do brain scans. You can look at the activity of the brain.

42:00It gives you a sense of, like if you did a brain scan of an ADHD lady who's menopausal. Yeah. You see, it would be very interesting. There are some brain scans of people who are on hormones and seeing the activity in the brain before and after estrogen, for example. And conversely, which we haven't talked about, is women who take contraception, because it's synthetic, you know, that chemical structure is altered, it can block the receptors. So we know that the brain doesn't work as well when they're on contraception. contraception and there have been some studies showing the activity in the brain reduces when people are on contraception wow and what does being on contraception do to hormones it stops them it gives people like a chemical menopause because it's stopping them ovulate i know it's double whammy wow yeah yeah so you see a lot of women girls who are given contraception do people not taking taking no and i didn't as a doctor because i didn't join the dots because i was just like conveyor belt medicine, women coming in with heavy periods, give her the pill.

43:01Women who maybe has migraine and can't have the combined contraception, give her the Depper, give her the implant, you know, on she goes in her conveyor belt. And then they come back and go, oh, I'm really tired. Oh, I've put on weight. Oh, I've got, I've had urine infections and I treat each of those things. And now I'm thinking, no, hang on. I've given them something like the injection or the implant stops ovulation. so it blocks your hormones but also it's blocking those receptors so it's chemically altered having that you know study WHI study the clot risk the heart attack risk that's why people have their blood pressure checked when they're on contraception because the blood pressure can go up we know that there's a small risk of breast cancer in women who take contraception and even meningiomas benign brain tumours have been shown with some types of contraception because they're synthetic chemicals our body isn't made to have some vegetables.

43:53It's like having, you know, dare I say, McDonald's or processed food compared to real food. It's different. You know, it doesn't mean it's terrible, but it's not the same. Yeah, and your body reacts differently to it. I spoke to someone yesterday who works as a mental health nurse and she's got somebody who's in with psychosis and they've just changed their contraception and it's come on since then. And the psychiatrist said, no, there's no association. We're going to give her lithium. And if that doesn't work, we'll go to ECT, electroconvulsive therapy. And this nurse is like, excuse me, excuse me.

44:24And they're like, no, no, no, it's nothing to do with hormones. But she said the history is so obvious. It just literally changed. And it might or might not be, but again, in medicine, let's try and unpick it and see. And I see a lot of women who they change their contraception, they come off it and they're like, wow, I'm back. Or they top up. So people might have an implant, but we might give them some estrogen through the skin, testosterone through the skin if it's low. and they're like, wow, gosh, all these symptoms are better. This all sounds like so prehistoric. It is, isn't it? I mean, yeah, that's why I spend so much of my life frustrated.

44:59Yeah, I was going to say, like, I'm getting... Because it's so obvious, do you know what I mean? Yeah, but that's why I'm sat here thinking and I'm only getting a five-minute window into your world. No, but I do. I have a lot of insight and I'm constantly thinking, is there a study I haven't read? Is there like... It must be like, you know, when they thought the earth was flat? Yeah. And I feel a bit like that. Do I live in a parallel world? Are you going to suddenly produce some papers saying, Louise, you're all wrong? Yeah. But I can't find them. And the more I find, especially papers from the 80s and 90s, before this WHI study, about how hormones work.

45:33So not HRT, just hormones work. You're like, wow, it's so obvious. It's all there. But it's been ignored. And then it's been commercialized. And also don't forget the antidepressants that are available. Think of all the antipsychotics. Think of all the statins and blood pressure drugs. It's like we've got a hole. No, we've had a boom. We've got loads, haven't we? Yeah, yeah. So why would you prescribe something that's, you know, it's been forgotten, natural hormones. And even contraception. There's so many. I don't even know all the names of them now because there's so many. But they're all synthetic.

46:04Just more and more, you know. I'm also kind of struck, I guess, by the fact that what you're saying for women is going to be like, holy shit music to people's ears but what you're saying for a lot of the medical community as you've mentioned briefly with psychiatrists or gynecologists is like shut up Louise yeah quiet how do you deal with that hard it's really hard actually because you know I feel I'm a really privileged person because I'm educated and knowledgeable you know I've got a pathology degree as well so I'm not stupid but I'm also a woman who's really suffered with a perimenopause and I can't get hormones from my NHS GP and I feel like there's a lot of injustice because okay I'm very fortunate I'm white middle class educated I can pay and see somebody who can prescribe for me but you know what to do I know what to do but actually there's women that that can't that don't and I hear them and I see them you know I was doing some work in prisons last year and I used to work in a prison.

47:14I didn't know anything about hormones. And then I read some papers from the 1960s, a long time ago, even before I was born, showing that women were more likely to commit a crime the days before their periods when they're more agitated, more angry. And you can imagine, if I'm agitated and angry, I might just tell my husband where to go. But if I was in a different household and had a knife in my hand and my husband was very abusive, you can see where it's going. So when I knew all this, I thought, I want to go back to prisons and I want to listen to the women. And I just love women in prisons. I feel sad for them because they've been born into the wrong families often and they've had really bad chances in life, but they're great sort of the earth women.

47:55And I was listening to stories time and time again from women. And a couple of them I spoke to very clearly told me that they had committed a crime. Then their period came and they're in for life. One of them had had a baby when she was 16, had really bad PMDD. Her mother used to come and live with her for that, those few days every month because they were worried about how she would look after the child. She said, one day my mum went to the shops and I just did it. And she said, now I'm in my forties. I haven't had a period for years, but I can't get hormones from the prison doctor. I can get antidepressants, antipsychotics, progabalin, gabapentin.

48:27And she said, just with my brain, I don't want these drugs. I've got dry itchy skin. I've got urinary symptoms. I just want some hormones and they won't give them so i'm like what what's going on and you see them all and you know a lot of them if you do drugs you know street drugs your body protects from getting pregnant so often they switch off the ovaries so a lot of women have an early menopause if they've under a lot of trauma a lot interesting if they've you know alcoholics if they do drugs a lot of them are doing drugs aren't they so a lot of them aren't having prioris or a lot of them are on like the depot or they're on different contraceptives.

49:01So you see them all with their dry hair, their dry skin, their, you know, everything else. And the doctors hated me going to prison. In fact, now they've banned me from going because they say it's not related to mental health and hormones, Louise. Don't you realise there's a lot of trauma in these women's lives? And it's like, yeah, of course I do. I've worked in really deprived areas. But they can also have hormones. Yeah, why does that mean they can't have hormones? And also like this person who wrote in the 60s, Katrina Dalton, about people in prison committing crime she wrote a lot about pmdd and she was reported to the general medical council they tried to strip her from her license her medical practice because they said she was maverick and she was and she was right and she was very insistent that women should have natural progesterone not the synthetic okay and she's written books about it this is 60 years ago and i've spoken to some of her patients i spoke to one lady who she had really awful postnatal depression and was had psychosis and was very close to doing awful things to herself and her baby she just had enough and then she read something about katrina dalton and went to see her down in london and she said my dear she said you just need some progesterone you need a high dose as a pessary through the vagina and this will help you and she was like oh anyway she said within days it was it was like light and day the switch and she said she absolutely saved my life and i said what was she like as a person because i know that all these people she said oh she was very formidable or she was tall, she was quite larger than life, and she just knew what was right, and the women knew what was right.

50:28I am insightful, and I know what I'm doing is right. I know each patient's different, and you need to listen, and you take the history, etc., but how quickly can you know when someone comes to see you? So often I know because of the history. So, you know, when people say, and it's the mental health symptoms that worry me the most, because suicide rate's increasing, isn't it? Yes. It's about one in 10 for suicidal thoughts for menopausal women is what I read. It's more than that. Well, it depends on the group of women. In our clinic, it's one in six. Okay. But we do see a cohort of women. But when I speak to women who've been in and out of psychiatric hospitals and their history is very clear that they felt well when they were pregnant, they had postnatal depression, they've had PMDD, and then their mood's gone.

51:14It's not difficult to work out that some of it might be related to hormones. And the power of hormones just can't be forgotten. It's not even about it being forgotten. No. It needs to be forgotten. No. I know. And is, let me also clear up, is the only way to rebalance your hormones to take hormones? Yes. So that's a really good question. You cannot have a menopause-labelled supplement and it's going to do it for you. Okay. And a lot of people, you know, will talk about self-care. like I don't even understand what self-care is you know does that mean I clean my teeth I don't know but exercise nutrition yes you need to eat well yes you need to exercise our muscles do produce some hormones so if you exercise you might have a bit more oestrinal progesterone testosterone in your body but it's not going to replace it properly do you know what I mean and it's the only way to replace it properly is to have the right hormones and and this is where I I feel it's really sad because women are just being gaslit a lot of the time.

52:13Because medicine is letting down so many women, these commercial organisations are coming in and marketing and selling. You know, you can buy a menopause dress, you can buy menopause shampoo, but how's that going to get hormones into my body? Can you really? Yeah, oh yeah. You can buy face creams, all sorts, because women are desperate. But you know what? Yeah, but women are therefore in that state very vulnerable. But I get that. When I had symptoms, you know, my husband's breathing was annoying me. Like everything was just shouting at the children. And it's quite scary. And I couldn't think.

52:44Like I just couldn't think. I couldn't sleep. It was horrid. And if someone said to me, do you know what, buy this Hocus Pocus stuff. Sure. It's cheaper than a divorce, isn't it? Yes. You know, you go, yeah, come on, I'll try it. I'll try it, you know. So for listeners and watchers who are neurodivergent and are listening to you and thinking, oh I wonder I've never really thought about my hormones or I'm having various challenges what can they do? I think you've got to remember that you are the best judge of yourself like even as a doctor and I'd like to think I'm quite a good doctor I don't really know what it's like to be sitting in my patients you know I can see what they're like but I'm not living with them and I feel very strongly if anyone's suffering even if another person isn't suffering as much with the same symptoms if it's affecting you you've got to get help because you know symptoms related to adhd hormonal changes it's not just having a cold that's self-limiting it will continue and it will impact not just your life but others i think and this is me coming from it as a menopausal woman not as a doctor i think the important thing is to work it out yourself if you can might need to involve your partner your friends whatever but so i've created balance which is a free app it's always going to be free for people it's got a symptom questionnaire that we've just recently extended so it's got 72 symptoms on it and it's put you know brain symptoms heart symptoms whatever and a lot of people like doing that because it often validates them they often realize that their itchy skin their their jumpy legs could be related to itchy ears yeah dry eyes burning mouth all those things like oh all right so so just have a bit of time to do the questionnaire and just reflect and think have I always been like this or is this new or or does it change throughout my cycle so this isn't just for menopause but younger people can do this too so that's really important have that knowledge about what what hormones are what they do and then if you think yes it might be then the next step and that's the hardest step is actually going to see someone who understands but we can be advocates for ourselves this this you know shared decision making choice advocacy is so important so then if you can and you're strong enough maybe take someone with you and say to your doctor i'd really like to try hormones because i've read that they're safe they might or might not help me but i also know that they only work the day that i use them they don't build up in the body okay so that's really important to know as well so if they don't work then I'm happy to try something else.

55:20Or you can try something at the same time. You know, there might be someone who's clinically depressed and needs antidepressants and has low mood related to their hormones. Have both. Or try one first and then the other. It's sometimes worth having testosterone levels checked because we always check them before we start, usually. Because if they're low, it's just, again, you've got something to mark through. I wouldn't have blood tests in isolation because blood tests need to be interpreted in clinical context. So I wouldn't say rush off and get a blood test in a local wherever, because also you want the labs that are really good and, you know, used to doing female hormones.

55:54But then talk it through. And if someone says, no, you are depressed. No, you've got ADHD and you need this amphetamine based drug. Just say to them, well, why am I not able to try hormones? And, you know, don't be put off if you're young, if you're older. If it feels like it could be, then it probably is. And also to clear up, you don't have to be perimenopausal or menopausal to take hormones. No, and I think this is really important. It's a great question because so many people think they have to be menopausal. And the best time really to start hormones is certainly perimenopause because you've got this fluctuation.

56:31You want to suppress that. But increasingly I see so many women with PMS and PMDD. So you don't have to have irregular periods. you don't have to have changing periods you have to be thinking and a lot of women now especially women with endometriosis polycystic ovarian syndrome might be more progesterone deficient or they might need testosterone it's not all about estrogen and that is something that I've learnt more and more like I couldn't have had this conversation with you 10 years ago because I would have said oh estrogen, estrogen but now I'm like no we see people with very heavy periods with PMS we just give them a little bit of progesterone and they're like, wow, is it legal to feel like this every day?

57:11Because I feel great. And now I've got my job and I'm promoted and I'm not having any days off sick. God, you're only 22. What would it have been like if I'd left you for 20 years? And I do see those women who have been left. Yes. But I don't want it. You know, I've got three daughters. You've got three daughters. I want them to have that knowledge. And my oldest daughter, who's I'm sure got ADHD and neurodivergent, she's also got PMDD and she uses hormones, but natural hormones. and she was saying to some of her musician friends recently, do you know what, guys? I don't even know when my period is.

57:41I feel the same every day of the month. And they're like, no, no, how? And she's like, mummy, I didn't realise how common it is. And she's got some friends. She told me recently one of her friends is on lithium. She's like, mummy, that's got to be hormones. Like, I can't believe, like, why would you give someone that young? God, I feel with having, you know, my wife who's perimenopausal and who's on natural hormones and HRT and having three daughters. God, I feel so fortunate for this conversation, Louise. I feel so fortunate to be a man that feels able to be interested in this. It's so weird to say that.

58:20No, but do you know what? I think it's wonderful because you're just coming at it with a very open mind. You haven't been brainwashed by these studies, by this noise that's been really suppressing the conversation and damaging women's lives. So men have to be involved because they have to advocate for others because, you know, my brain didn't function without hormones. It was really struggling to string a sentence together. So, you know, you need to lean on others and that's why having others involved is crucially important. Yeah, because there's lots of parents and partners and I would hazard a guess that a lot of the medical community is male.

59:05and yeah this is like I'm still kind of like digesting the fact that I have estrogen in me and progesterone it's crazy isn't it yeah it's really wild yeah how ridiculous that is and do we teach any of this at schools no of course we don't go I could talk to you for a long time but we can't last thing is I'd love to give you another green badge Louise who would you like to give it It's been on the back of my mind all podcast because most women, most people, because the awareness has got to improve, the understanding has got to improve, the stigma has got to improve with ADHD. And the work you're doing, by the way, is phenomenal because if you haven't got understanding, you haven't got a clue, have you?

59:56I think I'd probably like to give it to my older daughter because is it okay that she's not had a formal diagnosis? Of course it is. Is she still allowed? That's okay. Of course it is. Because she's quite kick-ass. In fact, all my children are. And they're really empowering the next generation. There are times when I'm really close to giving up my job and they won't let me. But even if I do, they're not medics, but they'll carry on. So I'd just like her to wear it with pride and start conversations. Yeah. Is that all right? Can I do that? Absolutely. And I think that breaking the cycle, and whether it's about hormones, menopause, ADHD, neurodiversity, there is so much sort of unlearning and relearning that we need to do around the beliefs that we've sort of grown up with that are now being challenged.

1:00:46So yeah, I've loved hearing you. I've got a lot to digest, I think, the impact of not knowing about hormones and a misgeneration and a kind of lost section of society around females and late diagnosis for neurodiver. Like it's all part of this same... Yeah. So we've got some work to do. You have? Thank you very much for having me. Thanks, Louise. Thanks for having me. Thank you. You've been great. You've been listening to The Hidden 20%. If you're still knocking about, then let me introduce you to the band. First up, main man on the mic, host Ben Branson. Our wonderful producer, Bella Neal. And the man who'll probably try and cut this bit, video editor James Scriven.

1:01:37Not forgetting our wondrous theme tune by Jackson Greenberg. Lovers or haters, we want to know. So be sure to leave a review wherever you're listening. For the lovers amongst you, you'll find us on TikTok and Instagram at Hidden20Podcast or over on hidden20.org where you can join our mailing list.