Reflections on 2022 with Dr Rebecca Lewis
Clinical Director of Newson Health, Dr Rebecca Lewis, returns to the podcast this week for a special end of year episode with Dr Louise Newson. The business partners and friends reflect on some of the positives over the last 12 months and discuss the continued challenges in trying to help more women with their experience of perimenopause and menopause.
Rebecca’s three hopes for 2023:
- Testosterone needs to be licensed for women (and not just for low libido)
- Treatment for significant and severe menopausal symptoms in the workplace to help keep women in work
- Education about the perimenopause and menopause reaching out to other medical specialties so more healthcare professionals understand how it affects the patients they see.
Follow Rebecca on Instagram at @dr.rebecca.lewis
Dr Louise Newson [00:00:09] Hello. I’m Dr Louise Newson and welcome to my podcast. I’m a GP and menopause specialist and I run the Newson Health Menopause and Wellbeing Centre here in Stratford upon Avon. I’m also the founder of The Menopause Charity and the menopause support app called balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence-based information and advice about both the perimenopause and the menopause.
Dr Louise Newson [00:00:46] So today, as it’s in between Christmas and New Year, we thought we’d record a slightly different podcast, really just reflecting on how the year’s been and maybe how the next year is going to be, who knows? So I’ve got with me my trusted – I was going to say partner, but it sounds a bit weird because I am happily married to Paul, as many of you know – but my business partner, my mentor, my friend, clinical director at the clinic, Dr Rebecca Lewis, who’s been on the podcast before and this won’t be her last time. So thanks, Rebecca, for recording this with me.
Dr Rebecca Lewis [00:01:20] No thank you, Louise. It’s lovely being here as always.
Dr Louise Newson [00:01:22] So it’s been a busy old time with the menopause. And it’s interesting, isn’t it, because so many times I come running into your room or you come running into my room and we either are very happy about something or we’re incredibly frustrated about something. And, you know, we’re happy because the word’s getting out, people are talking about the menopause. But I think it’s fair to say we’re also very frustrated with this sort of monetisation of the menopause, the marketing of it, the way that women still aren’t being listened to and valued properly. Would that be fair to say?
Dr Rebecca Lewis [00:01:59] I agree, yes. I mean, we’ve come a long way, haven’t we, really, in the world of menopause, if you go back ten years ago to where menopause is now. So there’s been so much, you know, great achievements. It’s being talked about more and more, which can only be encouraged. And, you know, the media got onto it and women are beginning to understand what’s happening to them a bit more, which is just fantastic. And, you know, as everyone knows, it’s been a constant goal of yours and mine to just improve the knowledge and understanding and get accurate information. That’s the key, is accuracy of the information. We’ve been fed so much misinformation over the last few decades that it’s been very difficult for women to access proper information. But that’s coming right now, thank goodness. So that’s really wonderful to hear. And actually some of the positive things aren’t they Louise, you know, people prescribing more HRT now, are really engaged in asking for your advice and lots of healthcare professionals coming up to you and asking, being curious about the menopause and wanting to help women and seeing actually, that’s an enormous problem really, that, you know, half the population will go through and many will have severe symptoms that are not, haven’t been recognised traditionally, as menopause. So I think they’re waking up to that, which is just incredibly positive. But there’s so much more work to do. But yes, there’s always frustrations because there’s so much more work that we need to do. You know, still we see in the medical community very, very sort of, I don’t know, conservative, really. And we practice in these silos of expertise. So word doesn’t get through to all the medical community how important menopause is, whether you be a neurologist, a urologist, a migraine specialist, a rheumatologist. It affects every single specialty. Psychiatry as well, of course, obviously. And so it’s getting a lot out there and understanding for other healthcare professionals how important menopause is in their field.
Dr Louise Newson [00:03:55] And I think this is part of the problem, isn’t it, that the menopause in the past has been seen as something that affects our periods, which of course it does. The definition is not having a period for at least a year, but also about whether we’re fertile or not. You know, it’s talked about sort of post-reproductive health. Well, for a lot of us, we don’t want to be defined by our fertility. And so I think also it’s always been left to gynaecologists to deal with the menopause. And I’ve always found that a bit unusual just because gynaecologists are dealing with pathology of the gynaecological organs. And this isn’t a pathology for a start, of the organs, it’s actually when our organs stop working. And so, like you say, because the hormones go all around our body, then it shouldn’t really be left to the gynaecologists. It should be, like you say, every single specialty, including gynaecologists, of course. But it shouldn’t be left to just one group of people.
Dr Rebecca Lewis [00:04:56] Completely, it’s a systemic problem, isn’t it? It affects every single organ. I don’t know of any other situation in medicine that applies to such a thing, apart from our hormonal problems like thyroid deficiency or diabetes. Is multi-system affecting, isn’t it? But it is no different. This is a hormone problem, lack of hormones and it will affect every single organ.
Dr Louise Newson [00:05:20] Yes. So we’ve tried to do a lot. I mean, I think if we think over the year, one of the things we’ve been really trying to do is obviously educate women, but also anybody actually because anybody, whether they’re man or woman, identify themselves, whatever. It doesn’t really matter because everybody and including children actually will come across somebody who’s menopausal. The information, like you say, has been wrong actually, or just inadequate. So we’ve been working really hard through balance app and also the website. We’ve got a lot of translations now into other languages, haven’t we?
Dr Rebecca Lewis [00:05:58] That’s been an amazing achievement, I think. It’s free for women, the balance app, and just full of evidence-based information. I just love it. Hearing when Gaele, our COO, tells us and now we’re reaching I think it’s over 200 countries now. We’ve had translations in so many languages because actually we think it’s bad in the UK, we’re one of the best countries in looking after menopause, despite the fact we’ve got a heck of a lot to do. So one can only imagine the horrors in other countries and how difficult that would be for women there.
Dr Louise Newson [00:06:31] Yeah, so we’ve been app of the day, haven’t we? I think twice this year, which is quite an achievement for a small app really, or it started off small a couple of years ago and so that’s been really exciting through balance we’ve educated lots of people. I know you’ve spoken at various events for corporates, haven’t you? And I have too, which is very rewarding. But also, I always find it very depressing because it’s just full of women who are really struggling actually, and also often women who might not be struggling themselves but looking after women who are struggling or line manager for, or men as well. I don’t know about you, but I’ve had a lot of men who’ve come to these presentations.
Dr Rebecca Lewis [00:07:12] Yes, definitely. And the questions are always the same aren’t they Louise, really. And it’s sad. And it is like a revelation for many of them still, what menopause means for the men and women in the audience listening and the preconceptions about treatments are just still very hard-wired in brains. It’s a sort of a moment sometimes where the penny drops for many people in the audience, and listeners can think, Oh my goodness, this has been me for the last three or four years, in and out of GP surgeries with multiple problems and complaints related all over my body: muscles, joints, urinary problems, psychiatric problems. And actually, this could all possibly be due to one thing, i.e. my hormones. And when you see the penny drop, it’s good in a way. But it’s also incredibly sad that some people are severely affected. They feel they’ve wasted three or four years of their lives getting wrong diagnoses and often on multiple medications, severe sort of side effects from some of these quite heavy-duty medications, which potentially, you know, if there’s more knowledge around, they could have been spared. You know, we see the casualties as well. We see casualties from not reaching a timely and efficient diagnosis. You know, not only in terms of the workplace and leaving the workplace and failing to sort of take promotion and really crash through that glass ceiling that we’re all talking about and easing up the gender pay gap and the pension pay gap, this is all, can’t be done unless women’s hormones are sort of considered in the whole round, you know, and relationships, you know, can be really severely affected as well with neither party really understanding why perhaps that relationship is going through a very, very difficult time due to women’s menopause.
Dr Louise Newson [00:08:57] Yes, we did that survey, didn’t we, with Farhana, the lawyer, looking at divorce and relationship problems, which really highlighted that. So we’ve had some very good responses with various healthcare professionals. I was talking at the Royal College of Psychiatrists annual conference in Edinburgh, and then there’s various regional centres for the Royal College of Psychiatrists. So you went down to Bristol, didn’t you, and spoke to the faculty down there. I’ve spoken at various ones, including I think it was last week, West Midlands, and I loved talking to the psychiatrists actually. We have spent probably three years trying to find the right psychiatrist to talk to, but now there seems to be a bit of a snowball effect actually, because, you know, the feedback we get from the presentations is very positive. Lots of psychologists actually say, ‘you have changed my practice’ and they’ve starting to be a lot more aware, aren’t they?
Dr Rebecca Lewis [00:09:54] Yeah, I agree completely. And they’re very sort of open to listening to, you know, the role of hormones in their population that they see. And they are very interested. I think they see a lot of patients, you see. So I think they they also can see and understand that this can be a big factor. So yeah, really receptive and that’s brilliant news isn’t it actually, that we are talking to other specialists and they’re listening and that will be a good conclusion from that, you know which is hugely exciting.
Dr Louise Newson [00:10:22] Absolutely. And with Claire Crockett, one of our senior clinicians who’s a medical specialist who works in the clinic, we set up a group of like-minded people who have an interest in mental health. And so we’ve got a psychiatrist, Louisa, who’s hopefully going to start doing a clinic with us next year and do some group work for women as well, which I think is going to be really important. And there aren’t many places where you have a psychiatrist with a menopause specialist helping women. So that’s going to be good, isn’t it?
Dr Rebecca Lewis [00:10:51] Yeah, really exciting, actually. And we’ve come a long way, as you said, Louise. What things have been achieved in the menopause arena is phenomenal. We’ve seen the documentaries come out, and I think that’s really helped women. It’s really spoken to women in their living room as they’re watching it, perhaps with their partner. I think that is so helpful to discuss it as a couple.
Dr Louise Newson [00:11:11] Yeah, I mean, Kate Muir’s a genius, really. She’s a person who wrote and produced it and she’s really done it in such an amazing way. And obviously Davina’s been fantastic at being the vehicle in allowing people to be educated in a very straightforward way. But it has had a knock-on effect, hasn’t it, because now people talk about the ‘Davina effect’ and there is this resistance still for people to prescribe HRT, but also to want to believe women. And you know, there’s a lot of – abuse is probably a strong word – but there’s a lot of negativity on Twitter and social media. And even, I read quite a lot and I speak to women who is told, ‘oh, well, your joint pains won’t be related’ or ‘your poor sleep won’t be related to your hormones’. And ‘come on, you’re only 32. Why do you think it’s going to relate to hormones? That’s ridiculous’. And ‘you just want to look like Davina. That’s why you’re coming to us for HRT’. And I still feel that’s quite sad because it does reflect that women are still not believed and listened to in a way that they should be.
Dr Rebecca Lewis [00:12:18] Yeah, I agree. I mean, I think it’s years of indoctrination from society. If I think about myself as a GP, let’s go back 15 years ago when I always thought I was treating people properly with menopause until I really had the luxury of meeting you and being educated by you. Some years ago, I realised I wasn’t touching the sides really, and I shudder to think how many people I have seen probably and in genuine honesty probably thought that they had other illnesses. So I can totally understand why some healthcare professionals are still thinking like this because they’ve never been taught from when they were a medical student.
Dr Louise Newson [00:12:56] That’s right. And even now, there’s still you know, I just, I mean, I receive, as you do, different menopause journals, and it’s always about vasomotor symptoms and often about vaginal dryness. And, you know, people don’t focus on the other symptoms. And if you’re not taught about it, then it’s very difficult. And to not have a diagnostic test for the perimenopause and menopause is also quite difficult as well. And I was talking to some pharmacists last week from NHS England and there’s a lot of move – which is going to be fantastic actually – helping women by them being able to go to a pharmacist rather than their GP, which is going to be great. But they were saying they’re still going to have to refer to a GP for the diagnosis of the perimenopause or menopause. And I said, ‘Well, I think you might be wasting your time because a lot of women can diagnose it themselves’. But I know some people feel uncomfortable about that. But also, if a woman’s, say for example, had both her ovaries removed, well, the diagnosis has been made on it.
Dr Rebecca Lewis [00:13:57] Yeah, exactly. I think, you know, similarly, perhaps this was the situation with antenatal care. I don’t know, 30, 40 years ago, you always had a doctor, didn’t you, to be told you’re pregnant. So many women know anyway, and they can help by going to Boots and buying a tester kit, etc.. And so basically what’s happened there is that the ownership and the empowerment has come back to the woman about diagnosing her pregnancy and then, you know, she can then make choices and to attend antenatal care, which most people do and have a very safe and successful pregnancy, one hopes. And you know, I’m hoping that in time that that’s what will happen with the menopause.
Dr Louise Newson [00:14:39] Which would be wonderful, wouldn’t it? I mean, I do remember as a newly qualified GP, having probably one or two women most days coming to see me and they’d say I’m pregnant, I’ve done a pregnancy test and I went, “What can I tell you?” And many years ago, it was harder to get information. So I would spend a lot of time making sure they were on a folic acid supplement, trying to advise them about smoking and alcohol and diets and everything else. But over the years actually, the need for me really reduced, like you say, because they were getting the information themselves, they’d often quite rightly start folic acid before they even conceived. So I was quite redundant actually as a GP, unless of course they had medical problems and it should be like that in the menopause. You know, even in our clinic we should be seeing specialist problems or complicated problems or we do see a lot of women who’ve had breast cancer and they do need a specialist input then. But a lot of women we see are women who’re just desperate to get their lives back and they shouldn’t be well, they certainly shouldn’t be paying to come to a private clinic, but they shouldn’t really be seeing a specialist either should they?
Dr Rebecca Lewis [00:15:46] No, standard care really is what they need and they will respond very well to that and absolutely sure that this is a tragedy, isn’t it? It’s not universal care all over the country for the menopause and then even if they go to an NHS menopause clinic is on the waiting list of 18 months and if you see an NHS menopause specialist because they’re so busy, you might have a follow up in a year’s time, which really isn’t going to be very helpful for women. We need to be seen quite regularly to start with just to get the dose stable and then followed up, you know, once a year, of course, once everything’s stable. But this is a problem, a difficult time for the NHS obviously.
Dr Louise Newson [00:16:25] So we’ve obviously keep going with our education. We’ve added more cases to our Confidence in the Menopause course and we’ve had over 30,000 downloads, which is great. Still a long way to go. It’s good, though, isn’t it?
Dr Rebecca Lewis [00:16:37] A great success. You know, that’s great that people are listening and wanting to engage and really nice feedback about it as well. So I’m very proud of that.
Dr Louise Newson [00:16:47] It’s really good. And then one of the big things we’ve also been doing is really increasing our research, haven’t we? We’ve managing to build a research team within our organisation but also work collaboratively with others as well. So we’ve got Dan Reisel who’s our clinical research lead, he’s very experienced but he’s been reaching out, as have others from our organisation with other universities. But we’ve been doing a lot of clinical audits as well, haven’t we? We’ve been looking at our own records and we’ve been focusing on a few really important areas, including the dosing of estrogen we prescribe, estrogen levels in the blood, the effect with testosterone for women who are already on HRT. And we’ve been also looking at women who are bleeding and having scans as well, and we’ll hopefully publish the results next year, as in in 2023, for those of you who are listening. But we’ve got some very reassuring results actually, haven’t we, which is great.
Dr Rebecca Lewis [00:17:48] Yes, exactly. And it’s just wonderful to see because we see so many patients, we can say this will help, testosterone will help. Yes, libido. But it also we know that it helps the mood, the concentration, the memory too, fatigue, many things, even muscle, joint pains. We know that from a clinical experience and that actually is a really valid and valued assessment of the drug is the clinician’s experience. Certainly, a clinician who sees many, many patients every week with the same condition, we often pick up things much more quickly than waiting for research. However, you know, evidence-based medicine is not just about research, but that is really important. It’s about biological plausibility, it’s about clinical experience. Does it fit in with the clinician’s experience? And then research is there to back that up and to guide as well. But of course, research is difficult to find in women anyway, and that’s an absolute scandal in all specialties, and particularly in the menopause. Very limited research has been done and quite often not a very good quality with very small numbers. So it’s been very difficult to base things on. So once again, the menopause is a very clinical sort of specialty in terms of diagnosis and dose adjustments because there’s really isn’t enough evidence from the research data about what the ideal level is or the ideal dose to achieve that level would be, you know, problems with bleeding, etc., etc.. But we’re finding some really interesting results which corroborate with our own clinical experience. For example, testosterone, the addition of testosterone to our patients. Yes, it’s helped libido quite a lot, but the main thing it has helped was mood, which is really interesting but no shock to me. Lovely to see that parallel our own experience. But when we release that, I think that would be very interesting for the whole medical community to read about and see, don’t you?
Dr Louise Newson [00:19:43] Absolutely. I think it’s so important. And you know for a lot of people, they still don’t understand how basic some of the work we’re doing just because it’s with hormones. And I think, you know, sometimes I reflect and think, well, ten years ago, for example, I didn’t even know women had testosterone in their bodies. And now we’re talking about research, looking at thousands of women that take it. And I think, you know, we’ve moved at pace very quickly, and I suppose we’re very fortunate having a private clinic for one reason. We can change the pace, we can be very fluid and we can pivot quite quickly and work out what’s needed actually from the patients. And they really have helped to shape and mould what we’ve done, we’ve obviously really expanded with over 100 clinicians, but we’ve also got pharmacists, we’ve got nurses, we’ve got a physician’s associate as well as many GPs working with us. And but we’ve also been able to try and shape some research and the education as well in a very sort of dynamic way and we’re not held back like we probably would be if we were in the NHS.
Dr Rebecca Lewis [00:20:49] Completely, and it’s just the most exciting place for me to be here. Not only seeing things clinically, but to be able to sort of start research projects going on, educate professionals. We’re not just about seeing patients at all. Some people think just we have a private clinic, so we want to do just see patients. We want to see patients. Of course we do. But we want to actually because, thank goodness, we are very successful in our business. We can use that money then to fund research projects, to help fund the free balance app and keep that free. And of course, the Confidence in the Menopause course as well, which is free and the many other projects because we feel that’s really important that we reach to sort of give back and to sort of help women who can’t come. You know, areas of social deprivation, women, you know, and from ethnic minorities and not being able to access the information properly. And we’ve got the translations, as you’ve mentioned, and that’s hugely important or women who get forgotten. What about women in prisons? You know, we’re trying to do some work to help them. You know, no surprise reoffending is much more common in terms of perimenopause and menopause, you know. So I think it’s just that we’ve got so much work to do. We’re beginning to crack heads, you know, in some areas. But there’s a huge amount left. But it’s so important that it’s looking at women in totality, not just women who come to our clinic as they are, but other women as well who can’t. And improving the landscape for women coming up into the menopause is hugely important. I know for you and for me and having that, you know, being able to do something about it, whereas the NHS, we really were paralysed because of course the NHS is so enormous, the bureaucracy, getting the administration for all this, we can actually go off in a charitable way and help people which is absolutely vital to our work as well.
Dr Louise Newson [00:22:41] Yeah, absolutely. And we’re very fortunate now. We’ve managed to recruit a Chief Medical Officer, Dr Magnus Harrison, who’s very experienced. And one of the reasons that he came on board was so that we can really try and expand in clever ways, so we can reduce costs further, make menopause care more accessible, and at the same time making sure that we are collecting the data, being really at the forefront of menopause research and also continuing with our education. And we’ve got some really amazing clinicians working with us, some of them doing research, many of them doing education, not just for healthcare professionals, but through corporates and through other companies as well. And also they’re helping us with reviewing all our information to keep us up to date. We’ve got Kat Keogh who’s leading all our content as well. And that’s really important because some of the content now is a few years old and we’re adding more to it. We’re adding a lot of resources as well. So people know it’s not just our word. And even when I was writing my book that’s coming out in March, you know, I’ve made sure that it’s very, very heavily referenced because the more noise we make, the more people want to sort of chop us down and stop us and silence us, because there are people – gladly a minority of people – who don’t want to believe that there’s any good in us. And as you know, it’s very distressing, isn’t it, when we try our best and people misunderstand and misinterpret what we’re doing.
Dr Rebecca Lewis [00:24:17] It is, it’s very negative and it can bring people down. And I have to try and remember, why are we doing this? We’re really doing this to help women. And I think people, lot of people, know that and understand that, but some don’t. And I think it’s more a reflection of them, really, than a reflection of you and your work, because we will carry on. We will continue. We’ve got so much more work to do. We’re not going to stop. We’re not going to be beaten by this, by these words. We’re going to carry on because women need us to. And you know, Louise, thanks to your work, you’ve made us, oh, gosh, such an enormous impact on the lives and the health of women. I mean, you know, without being sentimental about it, it’s just a fact, quite frankly.
Dr Louise Newson [00:25:00] Well it’s a team effort. It’s not me on my own because I haven’t got the confidence to do it on my own. And I think to have you behind me and others as well. And actually, you know, we have monthly meetings that we have with our clinicians. And in November this year, we had a clinicians’ conference, which was the most incredible day, wasn’t it? We had an evening where we all met and a lot of our clinicians hadn’t met each other face to face before. So there was a lot of laughter, a lot of chatting, a lot of sharing of stories, actually, and patients stories. A lot of, we shared a lot of information. We’ve got treatment pathways that we had printed out for everybody and lots of troubleshooting tips. But we spent a lot of time talking about breast cancer as well and with some external experts and oncologists and medical specialists, which was really, really great. And then we had lots of time for questions and answers and there’s a real body of support and they’re very committed, the GPs and nurses and pharmacists and the physicians as well. They really get what we’re all doing and they’re really making a difference themselves, which is wonderful.
Dr Rebecca Lewis [00:26:13] It was a joyous occasion actually to have so many people. I think 110 people were there. Yeah, great speakers outside our organisation, which is really important. The last thing we want to be accused of is propaganda, obviously. You know, these are really erudite, clever clinicians from other places and you know, really it was a meeting of minds of interesting things and stimulating conversations about problems with menopause. And we felt very comfortable to share ideas and approaches, which I think we all found very, very helpful and uplifting. And yes, to your point that clinicians are very loyal and, you know, behind you very much so. I think when you first start working here after about two months, you just see the enormity of menopause and how, because you will have seen several patients, many, many patients by then from all walks of life, that they all have these common themes of perhaps not being listened to in the first place, having multiple severe symptoms affecting many organs, usually not flushes and sweats, although that is a problem but usually other problems. How their work life has been completely demolished quite often by menopause and relationships as well. So it’s you know, we’re all seeing the same thing over and over again. And I think that creates the passion in us all. This can’t go on for women. This needs to change. And you know what a great vehicle here at Newson Health we’re on to sort of help that change.
Dr Louise Newson [00:27:41] Yes. So we’ve got a lot more to do. So before I finish, normally I ask for three take home tips, but I’m going to ask you to put you on the spot, Rebecca, and ask you for three things that you’d really like happening next year that would make a difference globally for women.
Dr Rebecca Lewis [00:27:58] Well, I’d love to have testosterone licensed. I think that’s really important. It’s a real, it’s our own hormone. It can help women enormously. And I think it just should be licensed, you know, like other medications that help. So that’s number one. Number two, I think in the workplace, we need to really look into treating people who have severe or significant menopausal symptoms to help them keep on track. Because, you know, I feel very strongly about, quite a lot of lip service, gets given to women and progressing and crashing through the glass ceiling and increasing hours and things. Well actually we’ve really got to address menopause if we need to improve the situation in the workplace for women. It will help the economy enormously, of course, as well as a nice side effect. And thirdly, I think education continuing with what we’re doing really and the understanding from other healthcare professionals. We’re seeing from our talks with the Royal College of Psychiatrists, you know, that could be to all sort of specialties in the UK, really sort of understanding, the penny dropping sort of moment, if you like, to understand more about how menopause affects their own specialty. I think that those are my three priorities. Difficult to select three that tough, but I think that’s probably my three priorities.
Dr Louise Newson [00:29:15] Yeah, no, they all sound good. I would agree with that. So let’s come back next year, this time next year and let’s see what we’ve achieved but we’re both determined to keep going.
Dr Rebecca Lewis [00:29:25] Yes.
Dr Louise Newson [00:29:27] I really look forward to seeing what’s in store for us. And just publicly, I want to say thank you again, Rebecca, for all your hard work and support and propping me up many times. So thank you very much.
Dr Rebecca Lewis [00:29:40] No, not at all. It’s just wonderful to be involved in such an important thing, really, for women. And it gives me great pleasure. Thank you.
Dr Louise Newson [00:29:47] Thank you. Thanks very much. And Happy New Year to those of you who are listening to it in between Christmas and New Year. So thanks very much. For more information about the perimenopause and menopause, please visit my website balance-menopause.com. Or you can download the free balance app which is available to download from the App Store or from Google Play.