What does the future hold for menopause and HRT? With menopause activist Kate Muir

Making a welcome return to the podcast this week is menopause activist, author and documentary maker Kate Muir.

Kate is the author of Everything You Need to Know About the Menopause (but were too afraid to ask) and the producer behind Davina McCall’s two award-winning menopause documentaries; her third documentary, investigating the contraceptive pill, is currently in production.

This week, after more than 200 episodes of the Dr Louise Newson podcast, Kate is the one asking the questions. She asks Dr Louise about her hopes for HRT and menopause care over the next decade, and about the importance of hormones for healthy ageing and prevention of future disease.

They also talk about barriers to accessing HRT, the so-called natural approach to the menopause and tackle claims the menopause is being over-medicalised.

And in place of the usual top three tips, Dr Louise shares the four things in her handbag that she can’t live without.

For more about Kate visit her website

Follow Kate on Twitter @muirkate and Instagram @muirka

Episode transcript:

Dr 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 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.

So today on the podcast, I’ve got with me somebody who has been on the podcast before and hopefully a name that you’ll all know, Kate Muir, who is the most amazing, now producer, didn’t used to be, and she’s produced the two Davina documentaries about HRT and the menopause, and now she’s working on a contraceptive pill one which I’m going to get her to come back actually, and talk about once it’s out later this year.

But Kate and I met, some of you might realise, a little while ago and she actually became a patient. And I’m not breaking confidentiality because she’s shared the story before and she’s a very straightforward patient, it wasn’t straightforward her story, but I knew that she needed the right dose and type of hormones. So once I did her consultation, we started talking about the injustice to women and the sheer horror of what’s happened over the last 20 years or so with women not being allowed to have the right information, to make the right decision. And she’s now become a very vehement campaigner for the right education, the right treatment for women, and has written an incredible book as well as read probably nearly as many references and articles and papers and scientific journals that I have, which is no mean feat. So, Kate, I asked to do the podcast today and she decided to spin it on its head a bit so she can explain more what we’re going to do over the next half an hour or so. So go for it, Kate.

Kate Muir: [00:02:18] Well, I decided, Louise, that you’ve done over 200 podcasts and you’re always asking the questions. And I actually have a lot of questions to ask you. And often you’re sitting there agreeing with some expert, and I know you often know more than they do about some things.

And I just want to get a feel for the really big picture in menopause, because we’re always looking at the kind of little niggles and the problems. And I want you to come with me today and imagine the future. And almost the first thing I want to ask you is how do you imagine menopause will be in the UK in ten years time? What do you think will have changed?

Dr Louise Newson: [00:03:08] Well, you know what? I have so many mind games and I think a lot about what the future could look like and what the future would look like and how much is reality and how much is in my dreams. And those two things, as you know, are very different when you’re talking about helping women, because there’s so much that’s stopping and there’s so much potential, but it’s how we unlock it, because I think once it’s unlocked, it could go very quickly. And I feel it’s that whole we take two steps forward and one back. And I think actually when it’s about women, it’s probably one and a half back. And what is moving this whole conversation forward is women actually more than health care professionals, more than thought leaders, more than politicians. It’s actually that grassroots of women, and they’re the ones that are affected. So I, I really think a lot about how the world and the UK obviously would look like if all women who wanted hormones were able to get them and not only get them but get them in the right dose and type, because as you know, about a third of women who come to my clinic are already on HRT. So 20 years ago as a GP, I’d give someone awful, you know, horses urine HRT, because that’s all I had available and they’d come back with some symptoms and I would say, well, it can’t be a menopause because you are on HRT. Because I didn’t know anything else. I didn’t know I could change the dose. I didn’t know about testosterone, but now I do. And so if women have the right dose of estrogen, the right type of progesterone, if they need progesterone, and they offered testosterone to the majority of women, not the minority of women, then how would it look? And I really dream that it could happen. And I think with more patient choice, with more availability of HRT, with more access to the right information and knowledge backed by science, of course, then ten years actually is quite a long time. And I, I think that’s quite ambitious. But actually I know what I’ve achieved over the last seven years with very little money, with very little resources. I’ve never had external funding even for the app. So I feel that this momentum, if it carries on, we could achieve so much more. Where women are not fobbed off, women are able to have what they want, and then the bigger picture of women’s health being better, women being able to stay working, women being able to be promoted at work, women being able to lead households in a way that they’ve not be able to, women who can lead communities as well. And having the conversation not just for British women, but for women in all cultures as well. The world would be so different and the UK would be so different. I see all these nursing homes or residential homes being knocked up all the time. They’re full of menopausal women. We wouldn’t have all those. We could have, you know, different things. You know, the whole generation below could be completely different. And I would be so proud if it could happen, because I think you, me, others have really played a big role in history making, actually.

Kate Muir: [00:06:20] Yeah. And I think understanding about longevity and one of the things you mentioned to me the other day, which was inflammageing. And of course we love ageing and we love being wise, but we do not want creaky joints, We do not want our bones turning to crunchy bars and we do not want to be the one in two women who get osteoporosis. And I just wanted you to tell me a little bit about what the better kind of hormones, the transdermal estrogen and the body identical hormones are going to do to me. Think of me. I’m 59 this weekend actually, but normally between 60 and 70, that’s when things get creaky in a woman. And I want you to tell me what’s not going to happen to me. How is taking testosterone, estrogen and progesterone going to protect me for what is about to land?

Dr Louise Newson: [00:07:15] Yeah, and this is really interesting because when you think about ageing, if we start with this first, I read a really great paper recently written in an ethical standpoint about is ageing a disease or not? And for years we’ve been told you can’t have a disease if it affects the majority of our population because then it’s thought of as being normal. But how do you define ageing? Is it a number? Sadly, you’re going to be older at the weekend than you are now. We’re ageing all the time, aren’t we? But when ageing is associated with disease, this is when it’s a problem. And as you say, this whole inflammageing, this low-grade inflammation that occurs if our immune systems aren’t primed and really healthy, of course we can get infections, but also we can get other diseases. These inflammatory diseases that occur are actually the diseases that are very common. So cardiovascular disease, diabetes, dementia, osteoporosis is even an inflammatory disease. We know a lot of mental health conditions. So clinical depression, schizophrenia, even Parkinson’s disease are inflammatory diseases. Obviously inflammatory bowel disease is, and autoimmune diseases can be as well. And we know they’re more common as people age. But we also know from some very interesting studies, once women are menopausal, they have this accelerated ageing and this accelerated risk of these inflammatory conditions. So none of us really want to age, but we are, that’s fine. We can’t stop that. I’m not bothered about a few wrinkles, but what I am bothered about this accelerated ageing, this inflammageing that can occur. And we know that there’s all sorts of reasons why we get inflammageing. One of the reasons is eating a rubbish diet. So if I fill my body with ultra processed foods then I’m going to have more inflammation in my body. If I smoke…

Kate Muir: [00:09:04] That’s really interesting because if you look at those brain scans of people in the worst Western diet, basically the brain scan on McDonald’s and the brain scan on vegetables and fish, you actually see there are these huge holes in the brains of people who are living on a rubbish diet. And it’s really frightening.

Dr Louise Newson: [00:09:24] It’s very scary. So we know diet has a massive role to play. We know that obviously smoking, alcohol, of course, has a role to play. Not doing exercise has a role to play, as well. So all these things are choices. Of course, we could all decide if we want to eat processed foods and takeaways every day or we could, you know, cook from scratch or whatever. That’s our choice. The problem is with women, we don’t have a choice as to when we don’t have hormones in our body. For a lot of women, it’s just part of ageing that our ovaries stop working. As you know, for some women, that choice actually is a bit different because they have their ovaries removed. And we know from Walter Rocca’s work for the Mayo Clinic that women who are under the age of 40 have their ovaries removed, i.e. become menopausal overnight, have this accelerated ageing. They have a lot of methylation of their receptors, they have a lot more ageing. And we know all these diseases I’ve mentioned and more, including kidney disease, lung disease, even psychosis and drug addiction can increase because of having this early menopause. So with ageing we all want to be healthy. It’s about how we live, it’s living healthily for longer. So it’s not the number that we die or the age that we are. It’s that journey and it’s about preventing disease and keeping as healthy as possible. So this is where hormones do have a role. Like all these other lifestyle interventions. But we know that there are receptors on our cells of inflammation in every single cell for estrogen and testosterone, actually. And we know from well-established studies that if our immune system isn’t primed properly, it doesn’t work as well. If we have low estrogen levels, it doesn’t work as well. So once we have estrogen, we know that we can change the way the immune cells work, we can increase the number, we’ve got more of a good thing, obviously that’s going to be good for our bodies. It can genetically reprogramme these cells, so actually our immune cells can be more efficient. They can produce more cytokines, chemicals that kill things in the body, and they can just work in a lot better way. And so if you’ve got your hormones, which you have, you’re quite open that you take HRT, unless you’ve changed your mind over the last few days since I last saw you. So taking adequate estrogen will help reduce that inflammation. Testosterone hasn’t been researched in the same way on our immune cells, but we do know it’s anti-inflammatory. And anybody that’s had muscle and joint pains that have improved on testosterone will tell you how inflammation improves. We know that men are a lot less likely to have autoimmune diseases and less likely to have diseases such as multiple sclerosis (MS). We know that testosterone can build the myelin sheath that can help the way that our nerve system works. And so it is very likely that testosterone has a role in protecting from diseases such as MS, and some of the other autoimmune diseases. And I think probably has a really important role in protecting from dementia as well. So the body identical hormones that you’re having, so the estrogen through the skin, is just the same hormone as what you were producing 20 or so years ago. It’s just that natural estrogen, the progesterone is a natural progesterone and the testosterone is natural testosterone. Testosterone is the most annoying name I think you could ever think about because it’s not derived from the testes. We don’t have testes. So testosterone is always thought of as a male hormone because it’s produced from the testes, testosterone. We sometimes refer to them as androgens, but that again, is a male connotation.

Kate Muir: [00:13:15] But it’s from our ovaries, isn’t it?

Dr Louise Newson: [00:13:19] Yeah, absolutely, so it’s coming from our ovaries and our adrenal glands and probably elsewhere, but actually it’s just another biologically active hormone, but it’s the most biologically active hormone that we have in our bodies, testosterone. And we produce a lot more testosterone than we do estrogen. And actually we produce more progesterone than estrogen when we were younger as well. So estrogen is probably the least significant hormone. So, you know, you having all these hormones, hopefully it’s going to help improve your longevity and the whole journey to older age is going to be a lot better for you. You know symptomatically you’re so much better. When I first met you, you were, well you still do describe how awful it was, that you couldn’t remember words and your temper was quite vile at times and you didn’t have the energy that you had.

And, you know, I was looking at somebody today, I won’t tell you her name, but she’s quite well known. But she’s one of my patients and visually, she’s changed so much over the last six months. And I know it’s because she’s got hormones on board. And yes, that’s great. Her skin looks different, she looks younger, she looks more vibrant, she looks happier. But her skin has this glow. But actually, that’s me thinking what’s happening to her heart, what’s happening to her lungs, what’s happening internally to her liver, everything else. I know she looks like she’s lost a lot of weight as well. And that’s great. I know she’s been exercising and eating better, but actually, we know that the visceral fat, the fat around our internal organs reduces with hormones. So this skin appearance is just a window to all our other organs. And that’s what’s happening, obviously, to you, to me, to people that take HRT. And that’s really, really important when we think about disease prevention. Now, we also know that none of the societies, the menopause societies guidance, recommend HRT for disease prevention. And in the UK…

Kate Muir: [00:15:20] Why is that? Why? Because we are looking into the future and they are looking into the past. What’s happening?

Dr Louise Newson: [00:15:26] Yeah, so I think there’s a few things. So when I go to quite high level meetings, there’s always this talk, there isn’t enough evidence and that’s a kneejerk reaction because that’s what the guidelines say.

Kate Muir: [00:15:36] Can I say I’ve read so many papers and they may not be vast randomised controlled trials, but there are tons and tons of trials, say talking about cardiovascular disease and the effects of having your estrogen back or keeping your estrogen.

Dr Louise Newson: [00:15:52] Absolutely.

Kate Muir: [00:15:53] There is a mass of evidence. And again, I was talking the other night about what would a 12-year-old think if you presented them with the evidence and a 12 year old would think. It looks to me like estrogen is really helping with stopping people having heart attacks. Why is this incredible negativity to hormones?

Dr Louise Newson: [00:16:14] Well, I think I’ve sort of been thinking about this a lot, actually, because, as you know, I’ve got a pathology degree and I do enjoy science and basic science as well, because in medicine, if you don’t understand something, one of the things I do and a lot of other clinicians do, is go back to basics. Just have a look at the basics. So if you knew nothing about HRT, you look at the diseases associated with no hormones and we’ve talked about that at length before. So it does make sense, common sense, that actually if you’ve got an increased risk of dementia, the longer you are without hormones, then isn’t the most obvious thing to put the hormones back to reduce your risk of dementia? The same with cardiovascular disease, osteoporosis, everything else as well. But if you look in the USA, they’ve grouped lots of societies together and they’ve all stated there isn’t enough evidence. In the journal JAMA recently they actually did this big paper, why there wasn’t enough evidence for HRT as a disease preventative agent, and a group of us actually wrote a letter to say there is enough research actually to support this. And we weren’t the only group that wrote a letter. So there are other people who are more learned academics than me who agree with this. So when I look about why is this happening, I can tell you I think this is me being a bit cynical, but I’m sure you’d agree. Kate. One of the reasons is that HRT is really cheap, so pharma are not interested in it. But also there’s a lot of us, there’s 1.2 billion menopausal women, 14 million in the UK. It’s dirt cheap, but something dirt cheap times by 14 million, it’s still quite a lot of money that they’ve got to shell out to us. So there’s this don’t really want to do that because it’s short term pain for a longer term gain. But then also, if you think about America, who are dictating a lot more that we shouldn’t be using HRT for disease prevention, pharma is massive in America, a lot bigger than in the UK. So if women take HRT, we already know, we know it from our patients, we’ve got thousands of them, that women on HRT are less likely to take statins, they’re less likely to take blood pressure lowering medication, they’re less likely to take antidepressants, they’re less likely to take painkillers, they’re less likely to take sleeping tablets. And oh, my goodness, they’re less likely to take some of these expensive osteoporosis medication and dementia medication because they won’t get these diseases. So what will happen with pharma if every woman who needed her hormones had them back? And actually, let’s think about men. If every man had testosterone replacement when they needed it, about a third of men at least, we wouldn’t need all these other medications. So pharma will be a lot reduced. And I can’t think of any other explanation because the science is there to support it. We’ve got more evidence that HRT is beneficial at reducing cardiovascular disease and statins. Yet as GPs, when I was working as a GP, I was encouraged to prescribe statins because it helps with the QOF, it helps with a quality framework to help the way GPs should be paid.

Kate Muir: [00:19:18] Shall we talks about the QOFs because people don’t know what QOFs are, but when you tell them, they’re really shocked. So the quality outcomes framework. So basically and you can explain it in more detail, but basically your GP surgery gets paid an extra 50 or 80 quid if they diagnose someone with depression, if they diagnose someone with diabetes, if they diagnose someone with using tobacco and they get all this extra money for ticking these boxes and for a while they got money for just mentioning the coil at one point,and just mentioning it at all. They were given an extra and then lots and lots more people took up the coil because the doctor had mentioned it. Now, if we had a QOF, which really wouldn’t cost very much or we could swap one of the other QOFs over that was just saying please mention menopause and hormone replacement therapy and what the possibilities are to the appropriate women and that would make this extraordinary change in the course of the NHS. But why aren’t we going to do that?

Dr Louise Newson: [00:20:31] Well, I mean, I was always a salaried GP, so my salary was the same whether I saw one patient or a hundred patients a day or whether I contributed to QOF or not, my salary was the same. But you’re absolutely right for GP partners, for practices. They have this way of being paid and the QOFs do change quite a lot. But there are certain targets. So if I saw you, for example, you were my patient in general practice and you had a raised cholesterol. If I gave you a statin and reduced your cholesterol, then the practice would get paid. If there were a percentage of people and I can’t remember the percentages and they change all the time, but it doesn’t really matter, you get paid more for a higher percentage of people whose cholesterol had reduced. Now, you, as a very educated woman, would probably say to me, Louise, I’m not diabetic. I haven’t had a heart attack. I’m really fit and well. I exercise regularly. I’m not overweight, I don’t smoke and I don’t drink. So actually, my cholesterol isn’t going to be the thing that’s going to cause my heart disease. And I don’t want to take a statin because there are risks. And actually when I’ve read the evidence, there isn’t good evidence that statins for primary prevention of heart disease in women is really that good. So I’m going to refuse. So I could then mark you as an exemption so you wouldn’t be in part of these figures. That’s absolutely fine. But if you came to me and said, I don’t want a statin for all these reasons, but actually I would like to take HRT because I know it reduces my risk of a heart disease, but it also reduces my risk of osteoporosis, diabetes, clinical depression, and probably dementia as well. I could give you that, but I wouldn’t get or not me personally, but the practice wouldn’t get paid. It wouldn’t be part of the QOF. Now, one of the problems is introducing something, introducing anything in the NHS means a lot of work, a lot of effort, and they will do it if pharma are behind it, or if there’s a real reason that it’s going to reduce disease and make a big sort of impact for a public health reason. Now, they won’t do that for the menopause until they understand what the menopause is, because every time I say the menopause should be categorised as a disease, I get shot down on social media. But let’s think about disease and causing harm. And we’ve already said all these diseases that are associated now, obesity for many years has not been thought of as a disease, but actually now it is thought of as a disease because it has so many risk factors associated with it. And as you know, it’s overtaken smoking as the commonest, contributing cause for cancer, risk factor for cancer. So if it’s thought of as a disease you automatically get more funding, you get more attention to it. So the problem is, if you ask people what menopause is, they’ll say it’s an inconvenience, it’s a few symptoms, it’s something that women just have to endure. And it can’t be a disease because it affects 51% of the population. But actually, I can’t think of anything else that has such negative effects on future health and such risks of other diseases.

Kate Muir : [00:23:36] It’s a little shopping bag of diseases, it’s a little collection, and you are likely to get one of them. And you know, in terms of women, one in two is going to get osteoporosis. So you really don’t want that in your shopping bag if you don’t have to have it. That’s what I find sort of extraordinary and sort of so irritating. But another thing I want to ask you about, Louise, is the digital menopause world. And you’ve made this huge leap into it, I think almost as much to your own surprise in a way. But you are, you know, doing the Steve Jobs of menopause. You’ve got this app, the balance app. It’s great. It’s really easy to use and I recommend it to everybody as the best source because it’s really up to date and you’ve got almost a million downloads and you’re up there on the app charts with it. I mean, there’s a huge demand for good information, isn’t there?

Dr Newson: [00:24:32] Yeah, absolutely. I mean, as you know, I developed the balance app with a great team of people to try and improve awareness and diagnosis, thinking I wish I’d had it when I was perimenopausal instead of, you know, thinking of the things I did without thinking about hormones. So what it does highlight more than anything else is this huge thirst and appetite for more information and knowledge from the users, from women. It’s only allowed to be used by women, and it shows how important women are at being involved in this conversation. And it’s highlighted not that it’s the most amazing app in the world, not that people go because they like the colours and the logo. They’re going out of sheer desperation and that’s, you know, really sad. We’ve had over three million comments on the community section of the app and I can’t bear to look at them because I know I could help every single woman on there, but I don’t sleep enough anyway. But I can’t, I wouldn’t ever get any rest if I was trying to help three million people on my own. But actually there’s a lot more that we can do with technology. And this is one way. I mean, I also developed it because I knew that I would never be able to help all the women I want to help. Even in the UK, I would be so naive if I thought I could really help through my clinic 14 million women. But actually I don’t want to. I’m very uncomfortable charging a lot of money for people to come and see. But the good thing is that some of the profits we use can fund balance and funds a lot of the other work I do. So there is some benefit, but actually we’re working really hard behind the scenes to even look how we can use technology in different ways. And hopefully I can explain more over the next even few months, I think, because what we’re doing is going to really challenge the way that we undertake consultations, the way that we can be more patient-led with what we do and use technology, because technology is the only way we can reach people at scale. You know, I can download a new article on Balance, press a button and that’s it, it’s gone to a million homes. I can’t do that with anything else, you know. So we’ve got some really exciting things. Firstly, that I think when they’re switched on, we can really make a difference to as many people as possible and as many different types of populations as possible.

Kate Muir: [00:26:59] I was thinking about that because the problem is that as we realise, you know, smart women and smart 12 year olds, are realising that if they can take hormones, it’s a brilliant plan. You know, once you get your HRT levels sorted out, you are not going to suffer and you’re not going to risk getting these diseases and you’re less likely to get obese and you’re less likely to forget everything and you’re less likely to lose your job. And that’s exactly what an elite of women have worked out. And I was very interested looking at LinkedIn the other day, all the people on LinkedIn who had responded, a thousand women to a menopause survey and 63% of them were on HRT. And it was like, yeah. So those people are on HRT. The people in boardrooms are quietly on HRT. But what happens, you know, in Glasgow, where I come from? What about economically deprived communities? What about the people struggling on drugs or just got off drugs? What about the racial weathering on women who have suffered from racism all their lives and have earlier menopause? All those things, you know, by ignoring the future here, you know, the NHS and the government and whoever, are making this divide. And we’ve already got an economic divide and we’ve already got a health divide but it’s growing and growing and growing.

Dr Louise Newson: [00:28:19] Absolutely. And it horrifies me. And I spend, as you know, a lot of time thinking about how do I reach women who I’ll never see, who will never come to the clinic. And actually, we’ve just given a free book, one of my books to every prison, we’re working with women who’ve had FGM, female genital mutilation, because you can’t imagine what their perineum must be like when they’ve been cut, when they’re menopausal. Obviously, the tissues become very thin. They get urinary symptoms, they get a lot of pain, discomfort. So it’s how do we educate them, me as a white English middle class woman? It’s going to be very hard going into those communities and try and explain in my very posh English voice what it all means. But we can educate and work with some charities and we can educate the leaders of those charities who can then use their own language and terms and in a safe environment. But technology obviously has a role with that, with the different languages and everything else as well. And learning about different cultures is so important. And I think this is where trying to get into lower generations before they suffer. So they can not only educate themselves, but they can educate their elders is going to make such a difference too.

Kate Muir: [00:29:30] Now, here I want to ask you, ten years time will there still be a shortage of the only body identical progesterone that seems to be around for most of us, Utrogestan. Why is it just with one manufacturer? What can we do?

Dr Louise Newson: [00:29:45] Well, this is crazy. I mean, you don’t put all your eggs in one basket, do you? And this is what’s happened with Utrogestan and Besins.

Kate Muir: [00:29:51] But I waited four months to get mine in my local pharmacy.

Dr Louise Newson: [00:29:55] I think, you know, when I started menopause work seven years ago. I wrote an article about the effects, the beneficial effects, especially with respect to cardiovascular disease for body identical hormones. And I got a letter of complaint. And as you know, I get lots of letters of complaint from all sorts of clinicians and this doctor wrote and complained for two reasons. Firstly, how dare I say that HRT reduces risk of cardiovascular disease because he was taught it increased. And I did say, well, actually if you read the article, there’s a little number above the end of the sentence and that number is related to the reference. And the reference is an article by Boardman et al from the Cochrane database that perhaps he could go back and not shoot the messenger, but read the original reference. So he was quiet then and then he said, I’ve also always respected things you’ve written in the past, Dr Newson, but you’ve mentioned the drug I’ve never heard of, called Utrogestan. Why mention a drug that you’re only prescribing in your private fancy clinic? And I said, no, look in the BNF, it’s been there for years and I thought people aren’t realising about it. So obviously now people are. And actually I phoned the drug company and said, who’s your women’s health specialist? What education are you doing? They said we don’t have one because no one really prescribes Utrogestan, it’s not there. So to be fair to Besins, they’ve gone from hardly any prescriptions to now millions of prescriptions literally overnight. And I did speak to the managing director tonight and they’re building a factory. They’ve got nine acres of land for a factory and they’re really cranking it up. There’s going to be a lull because there always will be. Our CEO went to see them last year to tell them about the plans and the projections are going to increase for prescribing. And he said then think big. And he said, Louise, our motto at the moment is think big because of what you’ve said to us. So we are being bolder. We are. And it’s a big financial commitment for a company, especially when some people are saying we’re prescribing too much HRT and we have to slow this down. And so there is a bit of…

Kate Muir: [00:31:55] That’s not what women are going to do.

Dr Louise Newson: [00:31:57] It’s not at all.

Kate Muir: [00:31:59] Women very clearly and also just like myself and you, when you pass through the door and you put on the menopause glasses, because you are a patient too, and you have changed hormones, have changed our lives overnight or within a couple of days…and I think we’re different in a way from many doctors in that you are a physician who has cured thyself kind of thing. And so many of the great doctors are women of a certain age in the menopause movement. And I think that’s really important that you understand it from the inside. And you understand that you couldn’t remember the name of the prescription years ago before you went on HRT. And I think that changes the way we think.

Dr Louise Newson: [00:32:43] Course it does.

Kate Muir: [00:32:44] It’s incredibly important to understand this from the inside as well as the outside and reading the science. But a lot of it is about emotion in midlife, and we’re all struggling with all sorts of other things. And to understand that additional burden on women who are holding up so much, particularly if they’re working and we’ve got a family, we understand that we are those people that we’re talking to. We’re not coming from above. In fact, we’ve come from right below. And dug our way out. And I think I think people should remember that about you, too, and that you’re not coming in all dressed in white like an angel. You’ve actually struggled from the bottom to do this. And I think that’s really important. Here’s another mad thing I want to talk about before we go is, you know how people are always saying to you we need to go the natural route. Isn’t it marvellous that orcas, killer whales, have the same menopause as women, though the only other species that have it. There’s one other kind of whale as well. But these big whales, big killer whales. Well, I thought. Right. I would be interested in that. I’ll look up, because I’m a geek now too, but I’ll look up the testosterone level in the blubber of orcas, male and female. So I’m wondering how the orca, age 40, has her menopause and can go on to live about 90, lead the pod and lead them to salmon, pods that are led by these grandmother orcas do really well and the young thrive better in their wise pods. So that’s really, really interesting. And of course it’s like this is totally natural. Now I looked at the testosterone levels and obviously they didn’t necessarily know what stage each female whale was at, but basically they have half the testosterone that male whales have. So that’s a huge amount.

Dr Louise Newson: [00:34:36] That is a lot.

Kate Muir: [00:34:37] And I’m thinking, so what is that female orca doing with all that testosterone in later life? And why is she leading the pod? And, you know, there is that thing that you think there are those women in life. Like one of my heroes is Ruth Bader Ginsburg, the great American jurist on the Supreme Court who died a few years ago. And, you know, I always thought she must have a lot of testosterone to be doing that in her eighties. And so everything everybody tells you, you know, this is the natural way. Look at the blubber samples and see what hormones are in them.

Dr Louise Newson: [00:35:13] And what is fascinating is and I think when you look at nature, what do you mean by natural? You know, I go into my garden, it’s beautiful. It’s spring at the minute. So the flowers are out, the blossoms out, you know, we only need to look around us and nature is wonderful. But I wouldn’t want to go and eat my garden. I wouldn’t want to eat half the stuff that’s growing there or growing wild. So when people say, I want a natural treatment, what does natural mean? And a lot of these supplements are for symptoms, but we’ve already said the menopause is far more than symptoms. And then we think about our conversation earlier about ageing and inflammageing. You know, were we really designed to live for so long and get dementia? You know, dementia is the cruellest condition. I don’t need to tell you because you’ve got first-hand experience, but it’s a horrible, horrible condition. We’re not designed to have dementia, we’re not designed to keep living. And so medicine has advanced so much, you know, cancer treatment is so much better. When I was younger, as a junior doctor, I always saw so many people with strokes, so many people with heart attacks. That’s better because management of hypertension has improved. We’re now going the other way because of obesity. Obviously, there’s far more other conditions, but we’re really not designed to have all this time without hormones. And if people really, really push back, okay, well, that’s fine. If you’re over 50 and you decide you don’t want hormones, that’s fine. As long as you know the risks, that’s absolutely fine. And of course, if you optimise your diet, if you optimise your exercise, you will mitigate some of these increased risks of diseases. But then let’s look at these people who are under the age of 51 or even under the age of 40 who have premature ovarian insufficiency, POI. We’ve always been taught one in 100 women under the age of 40, but a recent study shows that it’s probably more like 3%, and I think it’s probably even more than that who have an early menopause. Well, there’s nothing natural about not having your hormones in your 20s or 30s, so 3% of half of the population is still a lot of people and there’s a lot of disease associated with it. But then if you think, well, if you hundred percent want to treat people when they’re young, what happens to them between their 50th and their 51st birthday? Do they really change? Do their bodies really change? Of course they don’t. So why do we then need to stop something? So we’ve got to think about sort of this meddling with nature or not. And then the other thing to add to that is, well, you know, I get a lot of pushback because people say that now I’m over medicalising the menopause and it’s natural. Well, the average number of medications that women I see in my menopause clinic are on when they’re not on HRT is about three or four, you know, and so they are being medicalised with other drugs, usually anti-depressants, as you know. But there are other drugs that people are giving to try and help with a symptom such as Gabapentin, which is a horrible drug, really horrible drug. Some people are given antidepressants for their vasomotor symptoms, their flushes. People will put all sorts of things in their vaginas, which actually aren’t made for their vaginas to try and help some of the burning, the irritation, the discomfort, the antibiotics that are used for urinary tract infections, which are often associated with low hormones, they’re not very natural. So we’ve just got to take a step back before we get into this boxing match about natural or medicalisation. I think we need to just look, and hormones, like you say, they’re plant based, they’re just not even medication. They are just hormones that we’re using here.

Kate Muir: [00:38:56] What nobody seems to understand. I mean, the idea that one patch suits all women is absolutely hilarious because we know all our hormones are completely different, never mind every day, but from all our friends. And that’s really difficult. But, you know, the very simple thing of saying are you overprescribing estrogen, are you not? I mean, very simply, if I have two pumps of Oestrogel a day and I get mine from the NHS, from my local doctor, I get hot flushes, if I use three pumps, I do not get hot flushes. Now it’s absolutely clear to me that’s exactly the level I should be at because my body has agreed that that is good for me and I’ve done that over time and it just makes complete sense. And I’ve been doing studies for my Pill documentary and we’ve been talking to people sequencing sort of the genome around hormones, and they’re sequencing the levels of estrogen and whether women with certain genes absorb estrogen or progesterone or whatever, more or less, or react badly. And by looking at women who’ve had terrible symptoms on the Pill, they can see that their particular pattern is different. And then they can look at another woman and say, you’re going to be fine taking the Pill because you don’t have this weird selection in your genome. And we know that we can see it, we can sequence it, we can see it just like we can see our ancestry, you know, and the idea that we are one cookie cutter human being and that you can sit the same patch on me because I’m just a woman and I’m old and I’m complaining is so utterly wrong and kind of really misogynist and really uncomprehending. I think. So I’m very interested in doctors being taught that HRT is incredibly complicated, and it is not literally a sticking plaster on your arm.

Dr Louise Newson: [00:40:52] Absolutely. And I think a lot of it, again, the common sense has gone out of the menopause. And so even when I was first prescribed my HRT by someone who’s a very eminent menopause specialist who was very high up in the International Menopause Society, I was given a 100 microgram patch with some progesterone and went off to see if I felt any better. And three months later I contacted him and said, I feel a bit better, but I still feel rubbish. I’m still getting back-to-back migraines, I’m still getting night sweats, I’m still getting joint pain and I feel as miserable as sin. So he did my estradiol level and it was low. And he said, well, just use two patches. And I said, oh, no, I can’t do that, because that seems really high. He said, don’t be ridiculous. You’re not absorbing it properly. I said, yeah, you’re right, my patches they do slide a bit, they often end up in my jeans. I don’t think they stick that well at all. So I used two patches and then after a couple of days, my night sweats improved my mood, my energy, my concentration didn’t. But that was testosterone deficiency rather than estrogen. But I did feel better, and that makes complete sense. So what I’m being prescribed is not actually what is going into my body because my patches do not stick very well. But if I use the gel, it just slides and slips and it doesn’t really get absorbed very well in my skin. So there’s all this narrative that we’re prescribing too much, but actually we’re all different. So the amount that’s absorbed through the skin can really vary, but actually the amount of hormone that I need is probably different to what you need it probably very different to my 22-year-old patient who I saw yesterday needs because her body requires a higher dose and we see this in other hormones. I’ve prescribed 25 micrograms levothyroxine for people with hypothyroidism and I’ve also prescribed 225 micrograms to very similar looking women with very similar symptoms. But their requirements have been very different. When I ran a diabetic clinic, I’d see women and men with type 1 diabetes and they’d all need different requirements of insulin. So why is estrogen so different? Why is it we are so worried about our own hormone? I’m not aware of any data showing that there are risks or benefits with high dose anti-depressants or lithium or Quetiapine or the drugs that have no biochemical measurement that we see a lot of menopausal women on. So we’re almost singling out a hormone trying to prove that it’s dangerous for women when we’re not looking at all the other drugs that people are given as sort of ad nauseum almost. So it doesn’t all add up.

Kate Muir: [00:43:20] No, no, none of this adds up. But when things are really difficult and you find sort of, you know, an establishment saying, oh, that can’t possibly do that, and this isn’t good for women. And, you know, I just think that women know what they’re doing and having sort of made these two and this third documentary. And I’m very aware on the Pill that there’s going to be this huge push of women saying we’ve been gaslighted about our side effects for years. If we genuinely do have these, even though you haven’t done a randomised controlled trial of a million people, we happen to know that, you know, we’re coming off the Pill because we’re depressed and we feel much better the months after and that women’s truth is not being heard in both departments of hormones, both down at the Pill-end in your early life. And we happily give women the Pill for 30 years. Oh my God. And we hand it out free and it only costs a £1 month, but yet HRT is some other weird stuff, even though it’s much safer and the formulation is much safer than the Pill. What are we doing there? What is the game? The game is that men are involved in benefiting from the Pill. Men are not necessarily involved in benefiting from HRT, although I have to say that in my life, men do benefit from the HRT in terms of my sex life.

Dr Louise Newson: [00:44:38] They get more sex.

Kate Muir: [00:44:39] And it is absolutely clear that is okay to 70% of women to try the Pill. But HRT is over there and it is a deep, deep seated medical misogyny, which I am very glad you are fighting.

Dr Louise Newson: [00:44:53] Thank you, Kate. So before we end, you have to ask me three take home tips because I always ask. So I don’t know what you’re going to ask me.

Kate Muir: I want to know what is in your handbag? What do you carry round?

Dr Louise Newson: [00:45:06] So the three things that I can’t survive without in my handbag is obviously number one, my mobile phone, because I’m addicted. Obviously, I have so much going on all the time. Number two is my glasses, because without my glasses I can’t read my mobile phone because I’m old and I need glasses. And number three, I’m always, well, I could have maybe three and four. The two things that are really important to me are having herbal teabags because I don’t have caffeine. And the other one is sumatriptan, which is a migraine tablet. I have to have that on me all the time because as you know, I often get migraines and triggered by all sorts of things. So those are the things in my handbag, but I have to have, the other things, my notebook and my pen. Really important because I’m a bit old fashioned with writing down lists. I have lists all the time. The things that I think of, people I need to contact, things I need to do. So yes, I don’t have a big handbag because that’s enough for me.

Kate Muir: [00:46:03] So that was good information.

Dr Louise Newson: [00:46:06] Well, thank you very much. It feels very weird being the other side of my podcast, and I know we’ve gone a bit over time, but I hope you’ve all enjoyed it and I am going to ask Kate to come back to talk about the documentary, because although the contraceptive pill might be thought of as not for menopause, actually a lot of perimenopausal women are on it and a lot of women who have hormonal changes. And my interest is not just about the perimenopause and menopause, it’s about health, longevity and hormonal health for men and women, actually for all ages. So I’m looking forward to our conversation next. So thanks ever so much for your time today. It’s been great.

Kate Muir: [00:46:44] Thank you.

Dr Louise Newson: [00:46:48] 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.


What does the future hold for menopause and HRT? With menopause activist Kate Muir

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