Dr Louise Newson [00:00:02] Hello. I'm Dr Louise Newson, and welcome to my podcast. I'm a GP, menopause specialist and founder of the free balance app. My mission: to break the taboos around women's health and hormones, shining a light on the issues we've been too afraid to talk about, from contraception, sex and testosterone to menopause related addictions and beyond. We're covering it all. I'll also be joined by experts and inspiring guests, sharing insights and real stories, as well as answering your questions and tackling the topics that matter to you the most.

Dr Louise Newson [00:00:43] On the podcast today I'm with my mother, and we're talking about taking HRT as an older person. Of course, I don't mention her age, but lots of times she's tried to have her HRT taken off her by various GPS. So we're just talking about choice. It's a good episode, and I hope you enjoy it.

Dr Louise Newson [00:01:08] So you're here in the studio! Last time we did a podcast was a while ago, and we did it actually on my sofa at home, didn't we?

Anne Newson [00:01:16] That's right, yes, and I wasn't expecting to do it, and then suddenly I came downstairs, and we're doing it. Oh!  

Dr Louise Newson [00:01:24] And now we've asked, because by popular demand, we have had a lot of questions from people that listen to the podcast, asking about, no disrespect (to) older people. What happens?  

Anne Newson [00:01:34] Oh excuse me – I’m going to interrupt – I like the word maturer, not older, because things like cheese and wine improve with age. So I'm hoping, hoping I am.

Dr Louise Newson [00:01:48] Yeah, of course, you are mother. So lots of people have actually asked, I'm over the age of 60. Is it too old to take HRT? And I know I'm not allowed to mention your age, and I'm not going to, but someone said to me yesterday, Louise, you are nearly 55 so your mother is going to have to be over 60.  

Anne Newson [00:02:07] Well, I was a child bride.

Dr Louise Newson [00:02:08] Yeah, but even so, it's pretty hard. So I'm just really keen to, like unpick it, because I see lots of women, and I speak to lots of women who have missed out, if you like on HRT, because lots of the listeners know about this, WHI, the Women's Health Initiative study that came out in 2002, and HRT prescribing was really high and it was increasing, but it fell off a cliff because of the misreporting of this awful study.  

Ann Newson [00:02:37] You mean the breast cancer one?  

Dr Louise Newson [00:02:38] Yeah, so lots of women, then were stopped. So you've carried on, which is great, and we'll talk about that in a bit. But actually, you were really lucky to have been prescribed HRT, like almost from the beginning.

Anne Newson [00:02:54] Well, when I initially went to the doctor, my doctor,  in my day, of course, as you know, it was called the change.  

Dr Louise Newson 2 [00:03:01] Yes.

Ann Newson [00:03:01] The doctor said, oh, don't worry, you're just on the change. And I was teaching drama to students in London, and I just felt so exhausted, and on reflection, probably depressed as well, and having to juggle all sorts of things in my life. So I went to another doctor, and this doctor, she was she. The first one was a he. I shouldn't say that, but it's true. She said, well, try HRT. So I tried it, and I just came back to life and I could cope. You must remember that?

Dr Louise Newson [00:03:33] I think I was about 15/16.

Ann Newson [00:03:36] Yeah, something like that because sort of the exam time and everything.  

Dr Louise Newson [00:03:39] Yeah because, I mean, some people listening know but you know, daddy died when I was nine. You, single mum, three children. John was, my brother was only two. You were working as a teacher. There's lots of reasons why you could be low in your mood and struggling.  

Ann Newson [00:03:55] Oh, absolutely

Dr Louise Newson [00:03:57] So when he said the change, did you know what that meant?

Ann Newson [00:04:01] Well, yes, because, you know, one didn't talk about health issues when I was young. We didn't, you know, talk about periods. It was a sort of secret word, the curse. She's got the curse. But then, you know, some of my mother's friends, especially one in particular, I can remember her sitting in her living room pouring with sweat and really low and depressed. And my mother said, well, she's on the change. So that's what I knew about it. But I knew, you know, after Daddy, died I had to pick up life and carry on and was teaching, so I knew I could do it. But suddenly, it hit me, this energy loss, this, as I say, on reflection, depression and I didn't have the hot sweats or anything. I can't remember whether my periods had stopped, but that's to me, it is irrelevant. Having to cope with life, and it was so incredibly hard. I can remember, you know, having to catch the train up to London and it was just one foot in front of the other. It was just so much.  And then, you know, being given HRT as it was my choice. I could try it, and I did, and as I say, it was a great thing. And on reflection, they say, you know, you react to the menopause, as your parent, your mother has sometimes. And on reflection, again, my mother was probably very depressed, but she didn’t get the hot sweats. As I say, we just didn't talk about things like that.  

Dr Louise Newson [00:05:38] No. It's funny. I don't know if you know this, but I was reading one of my diaries recently because I was showing my children how argumentative I was and how irritable I was as a 15-year-old

Ann Newson [00:05:52] What can I say, I’ll zip up, shall I? (laughs)

Dr Louise Newson [00:05:53] And I was writing, there were things I was saying, like, no one understands me. I'm just on my own. I try and explain to them about work I'm doing or interested, and Mummy's not interested, and she slammed the door, or something. Honestly, I was reading it to the girls, it was a while ago, because I was saying, look, it's not just you that feels like this. It's part of, and I would have been having a hormonal changes, of course, but I also, then, at the time, didn't know anything about the change menopause or anything, but I wonder how much of you and me not getting on so well was because your hormones were fluctuating as well. Because we wouldn't have thought about it, would we?  

Ann Newson [00:06:33] No, I wouldn't be aware. I'm sure that thinking about it, yeah that probably was part of it. I mean, I think we have similar personalities, and similar personalities clash don’t they (laughs)

Dr Louise Newson [00:06:46] Yeah, so I'm not blaming everything on my hormones. (laughs) but it does make me think, because…

Ann Newson [00:06:51] Yes!

Dr Louise Newson [00:06:53] And it is actually, like you say, when people still have periods. So, perimenopause often is the more turbulent time. And you know, households can really break down. It's not just relationships, but actually with children as well. And that really worries me, because it can be very difficult bringing up children, as we both know, but even harder, if you've got anything else that's going on and not being recognised. So, I just think it was very forward thinking of that female doctor to actually prescribe you, but she prescribed you a tablet, didn't she of HRT?

Ann Newson [00:07:23] Yes, yes and only watching your theatre tour, I realised that they were made from horses urine or something that made me feel quite ill.  

Dr Louise Newson [00:07:31] You didn't know. Did you know?  

Ann Newson [00:07:32] Well, no, no I didn't. I didn't know the word menopause I don't think you started specialising in menopause, and certainly I had never heard of perimenopause, what an earth’s that.

Dr Louise Newson [00:07:42] No, yeah.

Ann Newson [00:07:43] I know all about it now.  

Dr Louise Newson [00:07:43] Good.

Ann Newson [00:07:44] You know I just feel sorry that we're talking about how many years ago, a long time, 40 years ago, but things haven't moved on. I’ve got friends who've actually gone to their doctors now, and because I've persuaded them, you know they  might be a little bit older, and I've got some young friends as well, and they're not getting the help the doctors that they deserve. And I think it's not just the help they deserve; it's also given the choice. And you mentioned early on about this scare of breast cancer, and I can remember then I think you were just sort of, you’d qualified. But anyway, we were talking about it, and I said, oh, should I come off? And you said, Mum, you know, if you think about you being on HRT for several (years) if you get breast cancer, tomorrow, you've had a good quality of life for those last few years, and I agreed with you totally, and I just think, it's just fate,if you get it or not, because I have four friends I can name who had breast cancer. They all survived, Thank God, but none of them have been on HRT. So I think things like that are the luck of the draw, and life is for today.

Dr Louise Newson [00:09:12] Yes, and I remember at the time writing articles, because, you know, I was writing that weekly column for GPs, and I actually found them recently, because you very kindly have kept everything that I've written, unlike me. So in 2000 I'd written about HRT, saying that it's good for mood, it's good for mental health, it's good for bone protection, it's good for heart disease, probably good for dementia, type two diabetes, with the evidence associated with it. Then in 2002 the Women's Health Initiative study. So again, I found another article that I'd written saying there's a study that's come out, but actually it doesn't tell us anything we didn't know already. There might be this small increased risk, but it's associated with synthetic hormones, and there are still benefits to the heart, the brain, the bones, and so forth. So in my own little world as a GP and also helping advise you a little bit, I just thought business as usual. I didn't realise the rest of the world were going into a mega panic because the data had been misinterpreted, and that's been the hardest thing. Because going forward, you say those three letters, HRT, and everyone says breast cancer.

Ann Newson [00:10:20] People still remember  

Dr Louise Newson [00:10:22] Of course they do  

Ann Newson [00:10:23] They're still scared of it. But you know, life is a risk. You know, crossing the road is a risk.

Dr Louise Newson [00:10:30] But the irony is...  

Ann Newson [00:10:31] We have a choice don’t we, whether we want to cross that road or not and wait for the little green man. So, we should all as women, have a choice whether we want to take HRT or not, but we're not. Women generally are not given that choice.

Dr Louise Newson [00:10:49] No, but the also, the irony is, is that all those studies and all that misinterpretation was based on older types of hormone, the one that you were taking,  

Ann Newson [00:11:03] Yeah, yeah.

Dr Louise Newson [00:11:03] The one that you're now taking, the one that I'm taking, is what we call body identical. So, it's exactly the same hormones, no horse’s urine has been used to make this type of HRT. So, it's sort of like comparing apples and bananas, saying all fruit is yellow, like you just can't do it. So the conversation, the studies, the research, has moved on, but this people being scared still hasn't, but we also were from this study, there was a big misunderstanding, because it's…what they did, as you probably know, is that they were giving the wrong type of HRT to women, and they the average age of women in this study was 64 so a lot older than we usually start women on HRT. And they found that some of those women had an increased risk of heart disease when they started HRT over the age of 60. So now lots of doctors think we can't start HRT and women over the age of 60, because there's this increased risk of heart disease. Actually, that's with the older types of hormones. So, the natural type of hormones, we know, reduce inflammation on the lining of the blood vessels. They help reduce blood pressure. They help the whole cardiovascular system to work well. So, in the clinic, we often do start women over the age of 60 with a lower dose of the natural body identical hormones. But also, a lot of doctors now think anybody over the age of 60, red flag, you must stop your HRT. Now, do you know roughly how many doctors have tried to stop your HRT?  

Anne Newson [00:12:33] I could count on more than one hand, and I can remember I wanted a repeat prescription. This is several years ago. My doctor, oh, menopause. Well, it's not really part of our remit. And me being a bit arrogant, I suppose one as I left, I said, Well, I want them, so please can I have them, and also promise me to make it part of your remit in the future? And she said, Oh yes, we will have a meeting about it. And she was a woman. But I think you know people who've perhaps, because you have brought it all to the fore, you have made people aware that they can get help out there. We as women can get help out there. I think people from the age of, say, 50 odd, where they probably have become menopausal, then they've suffered all that time, and something you've helped make aware, there's help for us. But why are the doctors so stubborn or so old-fashioned or set in their ways that they won't give it, you know. And I went to one recently, and again, she gave me, oh, why? Why are you on HRT? I said, because I want to be, but it shouldn't be like that, should it.

Dr Louise Newson [00:13:53] No, I know. because

Ann Newson [00:13:55] Because it should be my choice. And if you said to me, yes, okay, it might cause this, it might cause that, but then it will help you that way. It has to be my choice, surely, whether I want to take that risk or not or take that benefit, but we're not given that choice are we?

DR Louise Newson [00:14:15] No and I….. yes, I mean, there are so many doctors I know because you've told me have tried to stop your HRT or questioned you or said you should reduce the dose. What are you doing? And you know, that's even before talking about testosterone. You know, it's, it's just quite incredible. And I don't know there's a lack of professional curiosity. I think if someone comes to me as a patient and they're asking me for treatment that maybe I've not heard of, or maybe I don't understand, I might not prescribe it in the first consultation, but I would always say, let me find out about it. Let me go to the guidelines, let me read the evidence, and then we'll have a discussion. And if I don't feel confident prescribing it. I can, you know, arrange for you to see somebody else, and I've always done that as a doctor. No patient expects you to know everything.  

Ann Newson [00:15:00] I think it's not just, I don't want to run the medical profession down, because I think you all do a fantastic job knowing what you've been through to just get your qualifications is amazing. But I think in any profession, a lot of people are set in their ways, and they've got their routine job and they do it, and they go home and that, and it's a way of life, and they don't want to explore other avenues, but you always have had that inquisitive curiosity, and you wanted to help people so they haven't. And also, for a lot of people, still, it used to be my day that you had to put on your Sunday best to go and see the doctor. And it's Yes, sir, no, sir, three bags full, sir. You know the doctor was on a pedestal, but it shouldn't be like that. The doctor should be the friend you can reach out and help and but with this, HRT, I remember when I had my first hip replacement, then for operations, you had come off HRT. And you know, I was off for a while, but I was so glad to get back on it again, because again, it was….

Dr Louise Newson [00:16:07] Yeah, and that just to let people know you were not on the type of HRT you're on now, now the type of HRT you're on, body identical. There's no increased risk of clots. And just, actually, I do remember you were feeling quite warm and sweaty then after your first replacement, and it probably made the recovery harder, because you were not feeling so well with not being on hormones.

Ann Newson [00:16:28] No, no I can remember the difference. Yeah, yeah.

Dr Louise Newson [00:16:30] Yeah. And some people, like I was at a conference recently, and they were talking about how to stop HRT in our patients, and how to reduce the dose..

Ann Newson [00:16:38] But why?

Dr Louise Newson [00:16:39] Well, precisely, I've got no idea, but if some people do want to stop, there's lots of the doctors are saying, well, symptoms will only last however many years. But as people know, it's not just about symptoms, it's about improving our future health. And so even if you had no symptoms stopping, as soon as you stopped, you have increased bone turnover, increased risk of osteoporosis, increased risk of heart disease. And I hope you don't mind me saying but when you had a problem and went to hospital last year, the nurse was really shocked that you're not on other medication. Wasn’t she, do you remember?

Ann Newson [00:17:13] Yeah, yeah.

Dr Louise Newson [00:17:14] She sort of was quite surprised with your date of birth, which I won't say, because you do look younger than you are

Ann Newson [00:17:19] I’m glad you keep saying that you know!  

Dr Louise Newson [00:17:20] But when you said, Oh, I'm on HRT and I'm on just a heart tablet, and she said, What else? And you know, people usually are on about a dozen medications when they're your age. They're on a blood pressure treatment, a statin, a painkiller, you know, lots of and you're not...  

Ann Newson [00:17:39] I know and I feel very fortunate. I'm sure it’s well, thanks to my family, but a big thank you to HRT, because, as you know, I only retired last year from work and, stop it’s not funny!  

Dr Louise Newson [00:17:53] No, I think it's incredible!

Ann Newson [00:17:54] No! But I know if I hadn’t been on HRT, I wouldn't have been able to keep going, because I see friends who are my same age. I've got two particular close friends who were students with me, one I first met when I started teaching, and they both sadly got dementia and It's really sad, and if there's any chance of stopping that or helping us and you know if, as I said to my doctor recently and she said you know well, come off and I said, why,  why do I have to?  And again, it's probably because it's expensive for them to prescribe it to me, is it? I don’t know.

Dr Louise Newson [00:18:32] No, it's not. That’s the irony of it. It is actually really cheap, and even if you look at the risks of the worst type of HRT, it's still less than most other medications. But it's also about keeping people well for as long as possible.  

Ann Newson [00:18:46] And then well, long term, that’s cheaper for the NHS.

Dr Louise Newson [00:18:48] Course, it is absolutely is.

Ann Newson [00:18:50] But I also feel it does, you mention bones and everything, but I think I also your skin, your hair because again, I have several friends who, you know, really look wizened. And, yeah, well, I might look in the mirror sometimes and think oh my god but you know hopefully….

Dr Louise Newson [00:19:08] Well, we've talked about this too with Dr Sajjad Rajpar, the dermatologist that you know as well. Because I've been told off in meetings before, saying Louise, people just take HRT because they want to have nice skin, and that is terrible. Well, firstly, actually, if people want nice skin, that's not such a bad thing. But also, the skin is an organ. It's living. We have blood vessels going through it and everything else. And the skin is a window to what else is going on in our body, really important, actually. And if people lose collagen from their skin, from their faces, they're going to lose collagen in their bones and their muscles, so they're going to be more at risk of having osteoporosis as well. So we have to be really clear about our skin is important. But the other thing is that a lot of people who are older, especially women, have ulcers on their legs, and that is a real problem. And I know when I was a GP, I had so many patients where the nurses would go in and out do all these pressures, and we know there's a study that Saj and I found from decades ago showing that women who take hormones have, guess what, a lower incidence of ulcers. Now if you can imagine the cost of nurses going back and forth to somebody's home for the dressings...

Ann Newson [00:20:26] But getting back to this sort of, you said people with their skin, if I want to take it because it helps my skin, why shouldn't I? Why shouldn't I be allowed to? But, can I ask you one question, which I find really confusing. A lot, or several of my friends, have been to the doctors now getting HRT health, but they're advised to take antidepressant. So as I took antidepressant after your father died, but it was really hard to come off them. But as far as I, in my naivety, antidepressants sort of dull the brain, and it's supposed to calm you down, but if you take HRT, it stimulates the brain, so it brings you back to life. But if you come off, you don't have withdrawal symptoms or anything like that. So why is our antidepressants more important than HRT? As far as some medics are concerned?

Dr Louise Newson [00:21:22] What a great question. I wish I could answer, because it's easier, actually, for most women to get antidepressants than it is HRT.  

Ann Newson [00:21:30] Yeah, yeah, I know that!  

Dr Louise Newson [00:21:32] And you're absolutely right. A lot of women who take antidepressants when they're not clinically depressed will say, I just feel like I'm numb. I feel like I don't have emotions. I don't have sad emotions, but I don't have happy emotions. I feel like I'm going through processes in life without thinking about, I'm just a robot, and that shouldn't be right? Yes, we don't want people to be sad, but we really want people to be happy as well. So having the right balance of the happy hormones, if you like, the good neurotransmitters, is really, really important. And often, when women are on the right dose and type of hormones, they'll say, my life is in colour again. It's not black and white. That zest for life is come back, that joy. And that's really important. But one of the problems is it's very hard to measure that in studies. And in studies, a lot of it has been looking at flushes and sweats, because if I was analysing you, if you're better on HRT, and I had my little clipboard with my tick box, I could see you having a flash. I could actually monitor that. If you tell me one day, oh, Dr Newson I feel a bit happier. Well, I might not believe that that's due to your HRT, and then it's very hard to quantify in a study, so it's easier to exclude that sort of data and just think objectively about the symptoms that I can see as a scientist.  

Ann Newson [00:22:53] Yeah, but we’re all different aren't we.

Dr Louise Newson [00:22:53] Of course, we are.

Ann Newson [00:22:55] I’m not a flat clipboard, I’m a person, I’m a human being

Dr Louise Newson [00:23:00] Absolutely!

Ann Newson [00:23:01] And I might be different to someone else but we’re all individuals so we should have that choice...  

Dr Louise Newson [00:23:07] But what's I find, as you know, I spend most of my time very frustrated, but I find it frustrating because we have known for many years that wellbeing can improve with hormones and even some of those quite awful adverts in the 60s did have women behind a steering wheel of a car saying, you know her wellbeing - She's happy, she's joyful. Actually, that's not a bad thing, if that's all it did. It's not bad because, certainly in the 60s, there were lots of other drugs being given. There were barbiturates being given, there were benzodiazepines being given. There were lots of amphetamine type drugs to try and boost people. And there was very much a we want women to be happier, because then they'll be better at home. They'll be better housewives and all that. But we've known that hormones can help, because we're replacing what's missing. But I wonder sometimes whether it's just because people don't want women to be the best version of themselves. They don't want them to be strong, independent women.

Ann Newson [00:24:07] Because we're still suppressed human beings, aren’t we, really. And of course, you know my days, not so many women had careers, you didn't, sort of have female lawyers, or not many doctors you, you know, come up against discrimination as far as being a female doctor. And that's still going on. And still, you know, my father was very much my mother's place was at home, with a clean pinny and, you know, cooking his meals and everything. She wasn't allowed to have a career or anything. And you know, when I was first married, I was doing the drama and everything. And I can remember my father saying, your place is at home, looking after your husband. Of course, your father, he was so supportive. You know that's what it should be all about, but I just feel that you, I know you're my daughter, and I'm very proud of you, obviously, but I think you're doing a fantastic job to fly the flag for women. And I don't know anybody who's worked as hard as you and researched as much as you have on HRT, and you know, putting it out and giving us the opportunity to make a decision for ourselves. You're not telling us we have to take HRT. You're giving the pros and cons and giving us a choice. It should be freedom of choice.

Dr Louise Newson [00:25:34] Yeah, I think, thank you, and I think that's so important, because other things in life we can choose, obviously, some things we can't choose, as we know, but we can choose what we eat, we can choose whether we exercise, we can choose whether we drink Sherry at six o'clock.  

Ann Newson [00:25:51] Shhhh!  

Dr Louise Newson [00:25:53] But that's fine. No one judged you. How many doctors have said to you, how much Sherry Do you drink?  

Ann Newson [00:25:59] None, and that’s probably worse – well it is, isn’t it? Could be addictive?

Dr Louise Newson [00:26:05] Well, yeah. It does seem like just wrong that women, I can't think of any other medicine that's so hard for people to obtain as well when we've got the guidelines showing the benefits of in all ages.

Ann Newson [00:26:19] Well, I think the guidelines are a bit strange, aren't they?  

Dr Louise Newson [00:26:22] Well, depends which guidelines, there's many. Yeah. I mean, there's many different guidelines, and it can be very confusing for people, but we know that the benefits outweigh the risks. You know, we've got lots of good evidence about how safe hormones are, how different the body identical hormones are compared to the synthetic hormones. And we don't have evidence showing us that there are risks when we start HRT in older women or continue it. And we have to remember the health benefits too. So again, it goes back to choice. It goes back to allowing people to choose and also knowing that there is some uncertainty. There's uncertainty in lots of things we do.

Ann Newson [00:27:01] Life is uncertain.

Dr Louise Newson [00:27:02] Yeah and women can usually make that decision. But in my mind, like you say, the most important thing is having that patient in the center of the decision making processes and reviewing that decision. We review people every year, so if you change your mind, of course you can change your decision about whether to continue, or if you need the dose changing as well. So I'm very grateful for you being quite so open. Thank you. And just to end on three tips, and this is really, I think, that people would find it useful to know three things that have worked, actually for you when you've seen your doctor and you've wanted to continue your HRT, what are the three things that you feel have worked, that you have been able to continue having HRT on your repeat prescription?  

Ann Newson [00:27:50] I think sadly, we still have to thump the desk. We still have to thump the table. And if we're not given the choice, we have to, you know, stick to our guns, and if our doctors won't give us, then we have to move on and find another doctor. We mustn't take no for an answer, because life is for today, and it's not a rehearsal, and we as women must be given the choice. That's probably three things all in one, isn't it? I know we're going to end now, but I would like to say, please continue your work. I know you've had lots of people anti but please go for it. I will be there flying the flag for you, and I know a lot of women who will be and want to be. Thank you.

Dr Louise Newson [00:28:37] Awwh.Thank you.

ENDS [00:28:49]

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