Supporting women’s hormone journey with Dr Samantha Newman
Dr Samantha Newman is a British doctor working in Hawkes Bay, New Zealand. After training in obstetrics and gynaecology, a moving encounter with a patient led her to re-train as a GP and develop an interest in supporting women’s health and wellbeing. Samantha’s clinic, FemaleGP, was established in 2016 to improve access to focused healthcare for women including gynaecological and sexual health and treatments for perimenopause and menopause.
In this episode, the experts discuss shared decision making with their patients, symptom improvements with HRT, and supporting women to ‘listen’ to their hormones. Samantha also shares some of her experiences working with women from the Māori community and culture.
Dr Samantha’s three tips:
- See your hormones as a journey and not as separate, distinct phases of life. Find support along the way – wherever in the journey you find yourself.
- For healthcare providers: see your patients as a whole person and as part of their families and find out their true thoughts and desires.
- Be honest with your patients and encourage them to be honest with you. If they haven’t taken your advice, revisit things and find out what didn’t align with their values rather than viewing it as a negative.
For more information about Samantha’s work, visit www.femalegp.co.nz
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 with me on the podcast, I’ve got someone called Samantha Newman, who I’ve met like a lot of people I meet, online, but I actually met in real life a couple of days ago which was very exciting. And one of the things that’s very exciting about Samantha is that she’s very keen on menopause care, but she works and lives in New Zealand, which some of you might know, I lived in New Zealand just for a year, a long time ago actually, in 1995. So just to hear her talk about New Zealand makes me feel very nostalgic. So welcome, Samantha, to the podcast today.
Dr Samantha Newman [00:01:18] Oh, thank you very much. It is such an honour to be able to talk to you today.
Dr Louise Newson [00:01:22] So tell me a bit about you then because you haven’t always been in New Zealand, have you?
Dr Samantha Newman [00:01:29] No, so I trained at Bristol University having lived my whole life in London and if I didn’t leave London, I thought I never would. And then after university went back to London, met my husband and started obs and gynae specialist training. And like many doctors, decided that actually it’s about the journey and the experience. And so we went to New Zealand and I started work as an obs and gynae registrar, which was great actually in a small rural place called Hawke’s Bay, which has a population of about 180,000. I did look that up for the purpose of being able to explain the size and it was great, really good experience working as an obs and gynae registrar. But I have got a patient that knows she was pretty kind of instrumental in my changing my career direction because it was… it’s a really sad story but with a real positive ending. So on my first week in delivery suite, unfortunately she had a very sad outcome with respect to pregnancy and I was feeling quite out of my depth but supported her through it and her family. And then a few months later, unfortunately, she had a miscarriage and then a few months later she had an ectopic pregnancy. So this whole – it was just really, really sad. And I got to work with her through the surgical side of things. And just after that, my grandma got unwell and one of my friends is like, ‘just go back to England’. So I flew to England and spent a week drinking wine with my grandma in north west London and reflecting on what am I doing in life. And I thought actually, the thing that I’ve enjoyed most is getting to know and working out, developing my communication and working with patients so, and using like ‘wahine’ [woman/wife] with their family. And so then I changed to GP and spent time in obs and gynae working out how I could be a good GP and that was kind of it really.
Dr Louise Newson [00:03:39] Yeah. And it is very interesting. I think having come into general practice like you from a different specialty, I came from hospital medicine. It gives you a different perspective on things, but it also I think it makes you realise how important holistic care is. And I think for everything that we do we can put on other specialties, but also we can make sure the patient is core and central to everything that we do. And I think it’s very easy in medicine to get just distracted by a diagnosis or a treatment. And sometimes we sort of, we’ve all done it, been on a sort of conveyor belt, really, and just ‘it’s another patient’. And even when you do ward rounds, it used to be somebody in ‘bed nine’. So hang on a minute. That’s a real person with a real – and in New Zealand it was quite interesting because we used to refer to the patients as Mr. or Mrs. and often the doctors were called by their first name. So lots of doctors would call me Louise, but I would call the patients, Mrs. Smith or Mr. Bloggs or whatever. So it was a very respectful way actually of addressing patients and having come from England, where it was bed nine or bed six, it was just really enriching actually to make the patients centre to everything we do. And I think in general practice we have a lot of training about shared decision making and I found it very uncomfortable the first time I tried it, to say to a patient, ‘What do you think you can get out of this consultation?’ or ‘Why have you come?’ Or ‘What’s worrying you about this?’ And I just remember saying to my trainer, ‘Oh, John, that sounds so mad. Like we just take a history and we ask them about their symptoms and where their pain is’. He said, ‘No, no, Louise, once you start trying it, you can play with your consultation and you can get the most out even in 10 minutes’. And that is the beauty, I think, of general practice is that ability to talk and enrich your consultations, actually.
Dr Samantha Newman [00:05:29] Oh, absolutely. And I think that’s, you know, at medical school, you learn about the art of medicine. And I kind of was always like, it was a bit of a tick box. But I think it’s actually only now having been able to, you know, be in medicine for kind of 10 to 15 years where you have the knowledge and then you can apply it. And when looking at like, what is our skill set as a GP, it’s to listen, to manage risk, to develop a relationship, to work with allied health professionals, to work with a patient, but also to be aware of ourselves and our own limitations. And actually, I realised communicating that in that consultation along the lines of shared decision making can actually be really empowering for the patient. But also I think for me as a doctor I feel much better knowing that that is the right decision for them as well.
Dr Louise Newson [00:06:21] And I think it’s also really important because we never I never, my consultations are very different for different people and also just treatment options and plans can be quite different as well. And certainly, running a menopause clinic when I opened it, I thought I might get a bit – not bored is the wrong word, I’m never bored – but I might just get a bit tired I suppose of them all being perimenopausal, menopausal women and you know, a lot of people push back and I get a lot of bullying which is escalating at the minute thinking all I do is prescribe HRT and yes, I prescribe a lot of HRT. But actually, I really change my consultations depending on what the patients want. And I know you were sitting in my consultations a couple of days ago, and it’s I find it really enriching, learning so much for my patients and their story and the reasons that they’re coming and what they’re wanting to get out of the consultation and then also talking about other things. So, you know, diet and exercise are really important whether we prescribe HRT or not. And I’m really shocked actually how few women have had any information, just about some basic nutritional advice or, you know, just some really basic exercise as well, because a lot of them have just stopped because they’ve just been feeling so awful. And they’ve also put themselves right at the bottom of the pile. So sometimes just to have a consultation and we’re very fortunate in the clinic where we have, you know, more like half an hour rather than 10 minutes in general practice. But to be able to give them time to think about what they’re doing and how healthy or not healthy their lifestyle is is really important, isn’t it?
Dr Samantha Newman [00:08:03] Oh, it’s amazing. And I think that’s one of the reasons why I love actually kind of menopause and almost midlife consult so much. But I’ve kind of also taken a step back and looked at wider people like it makes sense. If you feel awful, if you’re not sleeping, then why would you want to get up off the sofa when it makes you feel more tired. And I think sometimes, you know, stepping back from that and agreeing and just validating, but then, you know, as a GP working out, okay, so that’s not working for you right now. What can we do to support you and what is the most important thing for you? And that’s when I really like looking at the kind of the nutrition and kind of movement balance, because I think for some women it’s actually all about movement and that’s what they need to thrive and to be them. Whereas for others it is food or weight. So then having that dialogue of, okay, what can we do to support you, to set you up to succeed? Rather than them saying, ‘Well, I need to start walking every day for 30 minutes or an hour’ because then actually it’s not going to work and then you’ll feel really demoralised.
Dr Louise Newson [00:09:12] Yeah, I think that’s it is really important because sometimes it’s even the little things. I’m really surprised actually. Sometimes patients will come back to me and say, ‘just because you asked me whether I do any exercise or not shamed me into starting to do something’. And I think I didn’t lecture them because I’m not judgmental. But I always say, ‘What exercises do you do?’ And I’m really surprised how many people say, ‘Well, I used to run regularly, I used to go swimming, I used to do yoga’. And it’s like, ‘Well, what’s happened?’ ‘Well, my joints have been stiff. I’ve got no motivation, I’m too tired’. And I think it’s really important that women don’t feel more of a failure than they do already sometimes. And I think there’s a lot of perimenopausal, menopausal women who are really desperate to get out of this cycle, but they don’t know where to start. And, you know, just for them talking about it and realising they’re not alone is a start of a really important journey, isn’t it?
Dr Samantha Newman [00:10:09] Oh, yeah, absolutely. And I think there’s so much I could say with that. Like, I think, you know, working in a small community and seeing people that have moved in and that are lonely and isolated and need that accountability, I’ve started doing these weekly walks, which has been really cool, like with patients we meet at – or other, like they don’t have to be my patients, but other people – meet at 7pm and we go for a walk together. But one of the most amazing things I think for me is HRT and the improvement in joint pain. And that was quite early on in my journey when I’d be prescribing HRT for, like it was a joint decision. And then women would come back and be like, ‘Oh, my ankle fracture from ten years ago that was preventing me walking, the pain is now gone’. And I still like every time someone says that to me, I’m just like, this is amazing and I feel really lucky to be able to be in that role, to be able to just be like, that’s so cool that we can support you to be able to move.
Dr Louise Newson [00:11:09] It’s quite something, isn’t it? I think it’s not until you see the volume of people and listen to their different symptoms. And I’ve recently went to the International Menopause Society meeting a couple of weeks ago now, and there was so much talk about vasomotor symptoms, so hot flushes and night sweats, vaginal dryness, being the key symptoms of the menopause. And I just feel like a lot has been missed and, you know, estrogen and testosterone, actually are really good anti-inflammatories in the muscles and joints. And, you know, we know physiologically that estradiol helps improve muscle strength and ability to build muscle and the muscles to function and more blood flow through the muscles. And even the joints helps with the ligaments and the synovial fluid and all this very basic stuff that we should learn at medical school. But often people don’t because they don’t think about sex hormones beyond the ovaries. But that’s really important. And there’s so many women who tell me that they can’t get out of bed in the morning because they feel like an old woman. They can’t put their feet down because everything is painful, and it often improves with the day. And then you give them HRT for other reasons, and then they say, I’m jumping out of bed. I think, gosh, I hadn’t realised quite – and I wish when I had done a rheumatology job many years ago in Manchester, I wish I’d thought about that as well because it’s often women and I was just talking this morning actually to a patient, who’s got autoimmune disease and she’s been given some heavy duty biological agents. And it all started when she was in her late forties and she’s now 57 and she’s struggled for many years now. And she said, ‘Oh, I tried HRT once, but I took it for a few weeks and I’ve given up with it and I’ve just realised I’m going to be a grumpy, miserable woman riddled in pain for the rest of my life’. And it’s like, no actually you can try again. And you know, it’s really difficult, I think, for women because they feel like they’re always giving in or giving up if they’re taking HRT. It feels like it’s such a battle that they need to try and fight. And there is a big anti-HRT brigade. And I’m not saying everyone has to have HRT, but I think everyone should know the benefits and they should also be thinking of what are the harms of not taking HRT as well. And that’s something that we’ve not really thought about for 20 years. So it’s hard. But I think looking at how estrogen can work in the body is really important for a lot of people.
Dr Samantha Newman [00:13:38] Oh, yeah, absolutely. And I think, you know, looking through it, one of the things that I love to see is any diagnosis of fibromyalgia. So when it’s in forties, actually, you have to have a – it’s very paternalistic –but you have to have a trial of hormone treatment because the amount of women that I think is just misdiagnosed and the same as pelvic pain, and I’d be really interested to kind of talk a bit about that later in the same context, because actually what’s the risks of a trial of it in principle for most women and if it can make a difference? So when I’m doing my… so I do some community education sessions, I kind of talk about like two roads, kind of parallel roads going along together. And for me, hormones impact everything and they impact different things at different stages of life. And as a doctor, I want to rule out the worrying things. So if someone comes to me in mid-life with palpitations, I’m going to rule out the heart attack. But at the same time, I’m going to be thinking, ‘Oh, is it palpitations related to hormone changes?’ And so I try to do that with everything. And I know you’ve talked about before that once you see menopause or perimenopause, you kind of see it all the time. And I’ve even had some doctor say to me like, ‘Why do people come and see you? Why do you have a waiting list? Why did you set up a clinic?’ So it’s really validating that I’m not the only one that can attribute a lot of things to hormonal changes. And I think, you know, you don’t have to have HRT as part of that management. But what I also completely believe is that we shouldn’t have to enable people to justify to themselves that it’s the right thing for them. And also, I know, I find a lot of my consults, I end up giving women the confidence to be able to tell their family and friends why HRT is not risky for them and why it’s beneficial.
Dr Louise Newson [00:15:33] Yeah, and it is really important. There was somebody, again, who was abusive about me on Twitter recently, and she’s a medical doctor. I won’t mention her name, but she had written an article which she retweeted talking about symptoms that don’t fit into a diagnostic box and looking at how women are always fabricating some of their symptoms. So there were lots of menopausal symptoms on this list and just saying about we’re over diagnosing certain conditions. So a lot of people are overdiagnosed with the menopause when they’ve got joint pains or headaches or vague symptoms, you know, all these vague symptoms where in medical school don’t really fit into a diagnostic box. So she was suggesting that a lot of women are being labelled as menopausal when they’re not really that, but they’ve just got nothing else that they can say. And I always say to women, ‘I have no idea how many of your symptoms are related to hormones, but let’s balance your hormones and see what’s left’. And I think that’s where having a therapeutic trial, if you like, is very safe and easy. I would never really want to give someone a therapeutic trial of other medication, you know, if I thought someone was depressed and I wasn’t sure whether it was clinical depression or not, I wouldn’t want to just give them antidepressants to try and work out whether they really needed that treatment. But giving hormones is the safest thing I’ve ever done as a doctor, and certainly for three months, you know, you haven’t got any risks with that, especially if you do transdermal. There’s no risk of clot. So three months can be a real turning point in someone actually to know whether they’re on the start of something that is hormonal or not. And three months is often not long enough to get the absolute right dose and type of HRT. But people then often have a feeling, don’t they, whether it’s related to the hormones or not.
Dr Samantha Newman [00:17:26] Yeah, definitely. And I, I think also looking at that kind of, you know, symptom pattern, and particularly if I find if women are having periods, trying to break down what is happening at the different stages of the menstrual cycle, and are symptoms worse or they feel less premenstrual as a kind of indicator to also help, okay, are we on the right track? Do we need to be thinking of other things? And I think always and yeah, I would give it like, you know, being in that specialist clinic, people often come to you at the end. They’ve seen everyone else. And I’m like a lot of people that come to see me with pelvic pain or bladder symptoms. They’ve seen the gynaecologist, they’ve seen a couple of GPs, they’ve seen the urologist, they’ve seen gastro so I don’t want to miss anything because I literally feel I’m like the last person. But actually trying hormonal options alongside reassessing the other things, I’ve just seen such incredible, incredible results. And one of the things that I would love to do, and I know my patients would want to tell their stories as well because it’s really sad, I think, when it’s they’ve been so troubled by multiple symptoms for such a long period of time and it could have been identified earlier. I do wonder that actually, if we start with a lot of the work that you’ve done, people are more aware of menopause, which is great. But one of my concerns is that a lot of women and men don’t know what perimenopause is, and therefore we still could end up with women getting symptoms in their mid-thirties and early forties for a long duration and getting to that all mid-to-late forties and then getting hormonal treatment. I don’t know how to kind of approach that.
Dr Louise Newson [00:19:14] Yeah, it’s really interesting because until a few years ago I think people, even medics as well as women, didn’t really know that perimenopause existed because we’ve always talked about menopause. And for those of you who are listening, who don’t perhaps know the perimenopause, peri just means ‘around the time of’ so it’s around the time of the menopause. But women are still having periods, menopausal symptoms start and the hormone levels start to drop, but it can last ten years or so before the menopause. So the average age in the UK of the menopause is 51. So that means a lot of women in their forties will be perimenopausal, but one in a hundred women under the age of 40 have an early menopause. So that means one in 100 women under the age of 40 will also be perimenopausal. And so there’s a lot of women actually in their thirties and forties who are perimenopausal. And recently I’ve read a lot of pushback from some gynaecologists saying it’s outrageous because now women in their thirties and forties are asking for HRT and thinking their symptoms are due to their hormones because they’ve watched the Davina documentary and I’m thinking, ‘well, isn’t that good that they’re thinking it might be related to the hormones?’ And certainly, as you say, when women are still having periods, often their symptoms are worse before their periods and it’s more than just a day or two. Often it can be a few days. And if a woman is thinking, could these symptoms be related to my hormones? And they’re usually right, actually, because most of us have had hormones in our body since we’ve been teenagers. And we know how our mood changes, how our bodies change. I was reading something in the newspaper today about cravings for food, and they were saying, ‘Oh, it’s related to serotonin, which changes just before the periods’. And it’s like, yeah, but what’s driving that? It’s not the serotonin it’s low estrogen.
Dr Louise Newson [00:21:01] But we’ve all had these, when I think as women and a lot of us have had these really bad sugar cravings. And I think if you’re a man or if you’ve not been sensitive to female hormones, you wouldn’t understand it. But if you’ve been the woman in those few days before the periods, you just want to eat rubbish and you’re feeling awful and you’re feeling a bit bloated and you’re fed up and you’re irritable and then your period comes and you think ‘Oh that’s it, great, I’m going to be okay for a month’ and that’s what a lot of people are noticing and realising. And so why we can’t be listened to as women when we go to a healthcare professional and say, ‘I think it could be related to my hormones’. I think it’s a great tragedy. And we hear it a lot with women with PMS and PMDD, as well as perimenopausal women. And I find the whole narrative of not being listened to really sad actually.
Dr Samantha Newman [00:21:52] And I think one of the reasons is fear, as a doctor, because I think when women used to come and say to me, ‘I think it’s my hormones’, I’d kind of almost panic because I was like, but how can it be? Because that’s not a diagnosis. So what am I missing? And I think actually, if we step back and think, okay, well, on my agenda, what do I need to rule out? I need to rule out the worrying things, but I can still do that and you can still tell me about your hormones. But I also know that I’ve had to go away independently and read books and journal articles about what’s happening to the hormones at different stages of life, at different stages of the menstrual cycle. And for me, that’s what’s given me a lot of clarity and understanding when talking about things, because it just makes sense. And then I think, you know, working in – I don’t know what it’s like in England – but in New Zealand, I think there is a real a kind of push to actually understanding our bodies and listening to our bodies and being kind of more regulated. So I often kind of, you know, talk to patients about how actually in society right now there’s kind of, you know, there’s things everywhere. It’s really busy. We’re expected to be busy the whole time. But actually if we go back to kind of the indigenous cultures and what the values were, well actually periods were celebrated and women were encouraged to stop and feed and rest because that was what was needed, you know, for maximal reproductivity. And so actually using the periods and our hormones to kind of support us in a beneficial way I think can be really valuable rather than just go, go, go all the time and having the hormonal changes as little clues can be really validating.
Dr Louise Newson [00:23:34] Absolutely. And it is really interesting I think, you know, looking at me in England and you in New Zealand helping women, but also how different cultures, different societies view the menopause and view treatment. And I know you’ve been doing some great work with the Māori population, haven’t you? And I remember years ago when I was in New Zealand, my husband worked in a hospital in South Auckland where there was a larger proportion of Māori patients and they have an increased risk of cardiac disease and type two diabetes and obesity. So in my mind I’m thinking, goodness me, when they’re menopausal, then this risk of diseases is going to increase more. But I’d be really interested to hear from you. Do many of these women, take HRT? What are their views of taking HRT?
Dr Samantha Newman [00:24:23] It’s really challenging, and I feel every patient I’m learning more from, I definitely in my private work I don’t have high numbers of Māori women, but I also work in a practice which is 85% Māori. So I am getting incredible exposure and learning loads from my patients. I had a couple of patients who shared their stories with me and I learnt a lot from. And so Utrogestan previously in New Zealand wasn’t funded but they said to me because there’s a huge inequity between Māori and Pākehā [New Zealanders of European descent], so they were like, look our family, our whānau [extended family] and our communities can’t afford Utrogestan, which exactly like you said, with a population that are at higher risk of these things, then giving us synthetic progestogen just seems ridiculous is just… Anyway, so we wrote a petition to Pharmac which is our funding body, and Utrogestan is becoming funded from the 1st of December, which is amazing. And I think that, you know, for me that means so much because on a personal thing, I’m really bad at writing. I can ramble, but I can’t write. So having had that read by really important people, supporting the kind of, you know, the endocrinologists and the gynaecologists that have been working tirelessly for years to improve access for Utrogestan. But also what really shocked me is that because it’s not funded, patients weren’t even offered it. And I went round pharmacies and looked at how I could get it more cost effectively. But still, women weren’t offered it, and it’s the best treatment and the gold standard and I find it has much more symptom improvement compared to the progestogens as well, regardless of the health risks. So I’m really hoping that now we can start to actually really kind of proudly say that we have really safe treatment options that are well tolerated if women are bothered by menopausal symptoms. And I think that from what I am learning in New Zealand, is that it’s about giving women the knowledge and the understanding and letting women come to you rather than saying ‘you need to have this’ or ‘I think this’ and I need to… I’m still on my journey of how we can work together and how this can be communicated in that safe way because of what has happened in the past, and individual’s fears. So it’s an incredible space to be in. But one I’m kind of treading slowly to make sure that, you know, everything is sustainable and long lasting as well.
Dr Louise Newson [00:27:08] So exciting times, I think, you know, it’s very exciting doing a job where you know that you’re going to improve the future health of women is very, very privileged and there’s so much more that we need to do and it’s great, so thanks so much for sharing your experience and what you’re doing and I look forward to seeing and hearing how women’s health in New Zealand can be transformed and improved over the next few years. So before we finish, I’m really keen for three take home tips and I’ll be really keen to hear from you because we’ve talked a lot about empowerment and shared decision making. So what three things do you think are the most important things for women to do to be able to make the right decision for them?
Dr Samantha Newman [00:27:55] So I think for me, one of the things that I want to see is that women see reproductive hormones as a journey, so we don’t have to have these compartmentalised puberty, reproductive years, perimenopause, so we can get support along the way. I think what’s transformed my practice is looking at patients and families as a whole and understanding what their physical symptoms are in relation to the psychological and actually just where the heart is, what they feel is right for them. And then I think lastly, is be honest with patients. And in the past when a patient would come back and say to me, ‘Oh, I didn’t do what you said’, I would have been upset or offended. But now actually, I kind of think of it as a positive in that they felt that they could trust me to say why what I’d recommended hadn’t aligned with their values, and then we can move forward with it rather than thinking of it as a negative.
Dr Louise Newson [00:28:58] Excellent. Very good and lovely way to end. So I’m hoping that lots of people listening will really feel more positive too. Being in control and knowing that they’re allowed to make their mind up but change their mind at any time and always try and seek the right help at the right time is crucial. So thank you so much Samantha, and I’m really pleased that you’re enjoying your time in England as well.
Dr Samantha Newman [00:29:23] Thank you very much.
Dr Louise Newson [00:29:27] 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.