Dr Louise Newson [00:00:00] 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 [00:00:42] On my podcast today, I've got Christine D’Ercole who is a master world champion in track cycling. She's also a Peloton instructor. We cover so much in such a short time. We talk about eating disorders, we talk about pelvic floor, urinary incontinence. We talk about being put down as a woman and who you listen to and who you shouldn't listen to. We also talk about hormones and about testosterone, especially with sport loads to get into, and I just hope you really enjoy it as much as I did. 

Dr Louise Newson [00:01:18] So Christine, I am really super excited about doing this podcast. I've been waiting, it feels like months for you to come. And obviously you're not here in the studio, but you're herein real life. And my husband has a - he got his Peloton bike in lockdown, and he uses it, I don't know, three, four or five times a week. He's really and he's very competitive. So he knows that he's a lot better than all his friends. But I said to him, Oh, do you know this lady? And he's like, What? Yes, so, like, that's really great. And, and I actually do Peloton nearly every morning, actually, but I do yoga, and I get into a lot of trouble if I log on as him, as you can imagine. 

Christine D’Ercole [00:02:00] Of course, that's very don't do that, 

Dr Louise Newson [00:02:05] But you know, exercise is so important, we know that, that's just obvious, like, that's nothing about hormones, but it's still a man's world out there, and men are expected to do certain exercises, and women maybe shouldn't, or can't, or whatever. So, you've really changed the narrative and what you're doing, which is wonderful, but just talk me through a bit about, like, how you came to be such an amazing cyclist, but also how you've come to work with Peloton and, you know, just get out there and share everything with people. 

Christine D’Ercole [00:02:35] All right. Well, I could not have imagined this career growing up. I wanted to be a ballerina. And I was told, as many young girls are told, your body's not right for the part. Specifically, I was told your thighs are too big.  

Dr Louise Newson [00:02:53] And how old were you?  

Christine D’Ercole [00:02:55] Oh gosh. I mean, this is going back as far back as like 9, 10,11, being told that I didn't fit the part, um, trying, you know, approaching puberty and the body's changing, and my dance instructor coming up and poking her finger in my stomach and saying, suck in those marshmallows. And I look back at pictures of myself as a kid, and it doesn't matter whether I was big or tiny, but the fact that we believe what we're told creates such dysmorphic realities in our minds and creates ingrained belief systems that some people never shake. Some people never shake. And it becomes what we tell ourselves which is the most powerful thing anyone can say to us is what we're saying to ourselves, because we internalise what other people say. So, I took that and believed I am too big to be obviously, be a dancer. I am too big to be lifted. I'm too big to be loved, to be successful. It translated into I'm too big for this world in a negative way. And I tried acting. I moved to theatre on recommendation from a therapist when I was 15/16.The therapist came because I was doing everything I could to make myself smaller as a dancer, the eating disorder, the self-harm, everything I possibly could. Stealing liquor from my parents basement. I mean, it was self-medicating, self-harming as a very, very young girl. And the therapist suggested theatre, that that might be a good outlet for me, since dance was notworking out and I got myself into Carnegie Mellon University for the theatre program, which I thought, you know, I am definitely on the right track. Now, this is a sign I can, can act at any age, any size, any type. This is perfect. But one summer, I caught a glimpse of a feedback form from an audition I did, and it said, loved her Shakespeare, loved her comedy, but she's a little heavy in the thigh.

 Dr Louise Newson [00:05:21] Oh no  

Christine D’Ercole [00:05:23] And I, I remember seeing that and just like felt like I got slammed to the floor. How could it be that I have all of these aspirations and dreams of – I want to be on stage because I want to tell stories that inspire people. What the hell does that have to do with the size of my thighs and like it's a cruel joke to have all of this aspiration and desire to do something important and to be told that your body is the problem. 

Dr Louise Newson [00:05:58] So, when, can, I just ask when you had your eating disorder, what was happening with your periods around that time? Can you remember? 

Chrstine D’Ercole [00:06:06] I always had, pretty much always had. I think there was a brief period of time where it disappeared, because I was, I was never good at starving myself, and I still ate., I mean, even at five foot six, I got down to 112 pounds, which is thin. 

Dr Louise Newson [00:06:25] But it was still on yourmind. I mean, the reason I'm asking is I see a lot of women and whose periodshave stopped when they were younger, but we see it a lot when people thenbecome perimenopausal or menopausal, because the same hormonal changes occurringin the brain and so and body shape can change. Of course, when we, our hormonesalter. And you're really right. I think what you said really resonated. Ifsomebody says something, it's really hard to erase, especially when it'ssomething negative. Positive things can come and go, but it's negative, but,but these things this come back, and a lot of things come back when ourhormones change. But there are lots of people who have eating disorders, theirperiod stop, or they might be extreme athletes, but then no one's thinkingabout their hormones, or they're giving them contraception, which is not thesame as the natural hormones, and it's blocking testosterone as well, which canbe a real problem. So, it's like a double whammy, really, isn't it? You've gotthings going on, and then it can affect your hormones, but then it can comeback and haunt us when we're perimenopausal, menopausal. 

Christine D’Ercole [00:07:29] Yeah, the, we're nottaught enough about it as young women, and we're, I suppose, with birthcontrol, as you said, it sort of messes up the process, a process that has anunfortunate state as we get older. 

Dr Louise Newson [00:07:45] So then tell me aboutyour cycling. 

Christine D’Ercole [00:07:46] Okay, so I had beenvery attached to my bicycle growing up, all through dancing and all throughacting, and I took my bike to college. I was very impatient. I did not want towait for the bus. I could not stand that, and I would smoke a cigarette while Iwas riding my bicycle to class. 

And then I took a year off from college, and I went to NewYork City and trying to learn the city. I got very, very terrified of thesubway. I was sure someone was going to mug me. I mean, New York City in the1990s was very different. So, I used my bicycle to get around. I learned thecity on the top instead of underneath, and I got fired from a bartending job,and I was looking through the, I was giving away way too much liquor. I waslooking through the wanted ads in the newspaper, and I saw couriers needed. Allyou need is a bicycle and a chain, and a bag. No experience necessary. I'mlike, this is perfect. I had no idea the world I was about to enter. It was, islike a underground sort of Mad Max bicycles New York City situation. And I waswelcomed in and shown the ropes, and I, it changed my chemistry to be riding abike for eight hours a day, to be constantly active - pulled me out of adepression. There was one funny detail, though, we had these walkie talkies,and they gave us all handles. There was like, somebody called zippo, somebodycalled basura and they called me legs. And I remember telling them, can youplease just not call, I really don’t like that. Just please give me anothername, they're like, but why your legs are so fast, you're so strong, in fact,you should race.  

Dr Louise Newson [00:09:56] Wow.  

Christine D’Ercole [00:09:57] And I connected withsome of the guys who raced, and they showed me the track, and that was it. Istarted winning races, and suddenly this body that I have always been told waswrong. 

Dr Louise Newson [00:10:11] Wow, it was yoursuperpower  

Christine D’Ercole [00:10:13] Was capable of beingsuccessful. I could be successful because of my body, not because of somebodyelse's opinion of my body. I could own that. You can't own someone else'swavering opinion. You can't own that kind of success. So that was a majorrevelation for me, to in self-acceptance and in changing the narrative of who Iam and who I am capable of being. And I kept racing. I did go back to school,and then when I came back to New York City again after graduating, I wasauditioning. I was trying to get cast in a show I would, also I wasmessengering again so I would be ready to go to an audition. In betweendelivering packages, I would sometimes fold up a skirt under my jacket, andthen I'd have packages in my bag. I'd lock up my bike, go up, do a Shakespeareaudition and come back down and tell dispatch that I had a flat and sorry I'mlate. I was trying to make it all happen. And then finally it became veryclear that if I don't dig into racing now and we're going back to96/97/98. I was like, I've got a limited time to do this. That's what Ithought at the time. I only have my 20s and 30s to race my bike. And so, I toldmy acting agent, I’m gonna, I'm gonna pursue this now. And I did for a coupleof years. And then I got pregnant with my daughter, and I gained a lot ofweight, and I was finally was the big girl. Everybody was telling me that Iwas, right. And I thought, well, 

It’s really awesome that I've discovered the unknown athletein me. I know that I I've done this thing and but in order to raise my daughtera strong, confident female, I have really got to accept that I, I am the biggirl. I really am the big girl now, and I need to celebrate that. I need tocelebrate what my body can do. So, I decided I'll become a plus size model.That's what I'll do for work. So, I go to QVC and I audition. And verymuch like that audition form from acting where they said she's great, but herthighs are big, plus size modelling, they said, we love your walk, we love yourenergy, we love your look, but you're not big enough. And what's happening?They told me, though, that if I wore this set of pads, I could do the fall andwinter line, but not the spring and summer line, because for spring and summer,I'd have short sleeves on, and my arms would look too small next to my body.So, I did it. I did it for a while, and every time you had to go on set, youhad to stop and check in the mirror make sure everything you know, your lapelswere flat, your hat was at the right angle. And as you're walking into thismirror, about to go on live TV, you're - you're posturing proud and likepsychological gesture, where, if you stand up proud, eventually you're going tocreate that sort of chemical sensation in your body. If you walk around hunchedover, you can also exacerbate sadness. Your posture not only reflects howyou feel, but you can change how you feel by changing your posture. And I feellike I, I strengthened my proud muscles, if that is right. And it, one day Iwas going up to that mirror to go on set, and I caught my eye, I did a doubletake, because something in me, I was talking to myself, and suddenly I listenedto myself, and I told myself, you've been missing the mark. There is no too bigor too small. There's no too much of anything at all. It's all about you andbeing your strongest. What makes you feel strong? I was like, I need to getback on my bicycle. I need to get back on my bike. It was a revelation. Ifinished the day. I did not go back, and that's when I started teachingcycling, and I, years later, got back into racing, and that, being racing as aMasters athlete, realizing that there is a whole world for people. Mastersstarts at 35 and up, and to recognise, to see how many fields of women in their40s and 50s and 60s. We even have a few 70s and 80s. The fields get smaller aswe get older. But there's, there's a place for us. 

Dr Louise Newson [00:15:48] Absolutely.  

Christine D’Ercole [00:15:49] And it changes whatlike. When I think of my mother's – she’s 53, and my 53, these are completelydifferent universes. And, so, I want to keep racing, right? This is the mostempowering thing I do. I use bicycles at Peloton as a vehicle to help inspire peopleto think more deeply about what they're capable of and and by continuing torace, I hope I'm setting an example that we might be able to be more activethan we thought and make ourselves proud in more ways that we knew werepossible. I've gotten quite a few women, grown adult women, to try trackcycling, and even if they don't get into racing. It's like, at least they triedit, you know, tried something wildly different. 

Dr Louise Newson [00:16:45] It's great, isn't it? Iused to cycle a lot when I was student, just because it was cheaper thanobviously going on the bus. And when I used to cycle for miles. Love it, youknow. But I've got a lot of patients who are in their 40s, 50s and started up racing.And I've got a couple of patients who are doing so well, but then theirpersonal best times have dropped. They've been getting muscle and joint pains.They've reduced stamina. They've realised themselves that they're having hormonalchanges. They go on HRT. They feel a bit better, but their testosterone is intheir boots, really low, and if they're professional, a few of them areprofessional athletes. They're not allowed testosterone, because it'snot… 

Christine D’Ercole [00:17:23] This is exactly whereI'm at 

Dr Louise Newson [00:17:26] And I have a real issuewith this. And we've just done a paper that's just come out in a peer reviewedjournal, actually showing that women are really struggling, and I and peopleare now trying to decide between their career or having testosterone, and itfeels so wrong, and we've been sort of contacting various authorities about it,and they're like, oh, it's on our committee meeting. It's not really ourproblem, but men can have a medical exemption certificate if they need testosterone.Women are allowed oestradiol, they're allowed progesterone, but they're notallowed testosterone because they're worried that it's an anabolic steroid andit might like really affect people, but the synthetic testosterone that'sinjected is an anabolic steroid, but the natural testosterone we're justreplacing. 

Christine D’Ercole [00:18:15] Right 

Dr Louise Newson [00:18:16] And I feel really sad,because even if you just look at the data in women about testosterone, we knowit improves libido. You know that's that no one's really arguing that. We alsoknow it improves muscle and joint pain, it improves sleep, it improves mood, itimproves stamina and so forth. But does that mean that women aren't allowed alibido if they're a professional cyclist with low testosterone? 

Christine D’Ercole [00:18:41] I am so very much withyou on this, and I, I have been deep in the question of my knees, my back hurt,and, you know, I'm on HRT and there are - it's better sometimes, but I'mtraining, and if I make one false move, I'm going to tweak that knee. I'm goingto tweak my lower back. It's a whole, you know, how the body works. 

Dr Louise Newson [00:19:08] Absolutely. Are you? Areyou… 

Christine D’Ercole [00:19:10] Goes up thechain. 

Dr Louise Newson [00:19:11] Yeah. And are you takingtestosterone? 

Christine D’Ercole [00:19:13] No, because of racingthis and I'm at the I'm at the crux of a decision, like, do I, if takingtestosterone, the tiny amount to replace what my body naturally had when I didnot have all these aches and pains? If that's going to improve my quality of lifeand help facilitate keeping my bones strong and avoiding osteopenia,osteoporosis, and help me maintain some muscle. Then yes, that's going toimprove my quality of life. And if, if I don't have those aches and pains thatwill potentially improve my performance. Yeah, but is that consideredperformance enhancing? 

Dr Louise Newson [00:19:56] Well, it shouldn'tbe. It should be, it should be just performance resuming, really, to what youare, and it's a difference, right? You know, when we give testosterone, we'rejust giving it in a physiological way. So, when I had low testosterone, I foundmy yoga practice very difficult. I had a lot of stiffness, a lot of muscle andjoint pain. I had low stamina. I just, I couldn't be bothered really, you know,my I felt quite flat and joyless, but musculoskeletal really common. I hadfrozen shoulder a couple of times. Had steroid injection. I just didn't feel,and it's not just me. I see it with 1000s of women that I see through theclinic and it improves. And it's no, surprise, because testosterone worksin our muscles. It works in our joints. It works in our in our brains. Reallyimportant. And I, and I can't really understand, you know, even if you were 20,and you had your ovaries removed, and your testosterone would then decline veryquickly. With that operation, you’re still not allowed testosterone if you werea professional athlete, which is just madness. I don't, I don't really getit. 

Christine D’Ercole [00:20:59] The three all. There'sso many hormones in our body, and they all work together. Like, how do youlike? Pick and choose. You can have these ones, yeah, and have those onesbecause we said… 

Dr Louise Newson [00:21:08] Precisely. I mean, ifyou're if you're low in iron, you can have iron. If you're low in thyroxine,you can have thyroid hormone, like they're not going to stop you having insulinas an athlete. But there's something about testosterone, because there's misunderstandingof what it is and what it does. But it feels really, really wrong, but so thatwe've got to do work on that, and I'm committed to trying to help, because Ifeel very sad when I speak to women who are really struggling. But the otherthing is…. 

Christine D’Ercole [00:21:33] Because if I gave upcycling, that's I'm all then I'm compromising my quality of life, because I'mnot doing the thing that brings me joy anymore. 

Dr Louise Newson [00:21:39] Absolutely. But whyshould you you're young, you're in your 50s you're not in your 90s. Like, eventhen, like, it shouldn't be determined by your hormones. You know you shouldn'tbe. It's wrong. But the other thing that you've been very vocal on, when I'mvery grateful, and I'm sure lots of women, is it's just talking about yoururinary tracts, talking about incontinence because, you know, lots of peopledon't want to talk about their symptoms that they don't want to talk about, youknow, their libido or their vaginal dryness or soreness, but urinary symptomsare really common, but they're so common, they're normalised. You know, so manyof my friends will say, well, I won't jump or sneeze because I'm going to havea leak, but I'm like, why? Why aren't you using vaginal hormones? Why aren'tyou thinking about it, oh, when I do my pelvic floors, but that's not enough.If you haven't got those hormones in your pelvic floor, your urinary tracts andso forth, but, but you've been very out there, haven't you about yoursymptoms?  

Christine D’Ercole [00:22:34] You know, I did thosebox jumps at the gym a couple weeks ago, and I, you know, I, I think thatI have gotten so accustomed to not doing things that put me at risk for leakingthat I - that day, I just thought, I'm gonna, I'm gonna see if I can do these,see if I can do the box jumps. And wasn't really thinking about it. And then Ihop up there, and I'm like, whoa, yeah, that's why I don't do these. And Iremember, I did all three sets. I was like, Well, I'm in it now. Like, what amI gonna do? And I kept turning to the mirror to the back to see you could see.And I finished the set because I was angry. It was angry. It was really angry.And I - but I had other exercises that I had to do which would have required meto sit on a machine to do my cable rows. And I said, I can't I won't do that.I'm not going to sit on the machine. I'm damp. That's not okay. And my husbandwas still working out, and I, I felt like I was on fire emotionally. I was soupset, I mean, felt humiliated, I felt ashamed, I felt embarrassed, and so Iwent out and sat in the car and I wanted to journal. I wanted to write aboutit, and I opened my phone to write about it, and it occurred to me. Christine,you should share this story. You know you're not the only one going throughthis. And I said to myself, I, oh, this is too much. This is too much. 

And then my other inside voice said, no, this is exactly whyyou should share this. Oh, but you're going to come off like you're performinglike, no, this is really happening. And so, I said, forget, I'm doing it. Ishared my authentic thoughts and feelings in that video, and I'm so glad that Idid, because the responses were profound. I knew I wasn't alone, but sharingthat vulnerability made me realise, in like you know, by the stats, you're notalone by the metrics out there. But this, was this, I knew I was not alonebecause of their stories, because they shared their stories with me. And Isaid, my God, I had no idea that this was the response I was going to get. Butit seems like it's contagious.  

Dr Louise Newson [00:25:25] Well, it's so common, andwe've just written a paper, actually, with some American doctors and nurses andclinicians trying to change the terminology, because we call it GSM. You'veprobably heard genitourinary syndrome of menopause, but it's not of menopause,because perimenopausal women have urinary symptoms, but also women who've had ababy, women who are on the contraceptive pill, women in general, you know, youdon't have to have a certain - but a lot of it is due to hormonal changes, butit's not being picked up. So, if you're on the contraceptive pill, that willblock your natural hormones. It will block your testosterone. If you've had ababy, your hormone levels fall off a cliff. If you’re perimenopausal, yourhormone levels are changing. If you're menopausal, you have no hormones. Andthese hormones, all three, oestradiol, progesterone, testosterone, have reallyimportant roles and functions in the pelvic floor, the bladder, the ureter, theurethra that we wee out of. All of this is really crucially important so youcan be as fit as you like, and obviously you're super fit, but that's not ifyou haven't got those hormones, the tissues will change and they won't supportthe bladder in the same way, the muscles won't be as strong, the collagen won'tbe there, the blood supply won't be there. And that's a real problem, and weknow that although the majority of women with age will have urinary symptomsaround you know, 5% or less will receive vaginal hormones. So, this isn't HRT.This is different. This is just - they go in the vagina, but then they leakout, obviously, through to the surrounding tissues with the bladder, andthey're very safe. And we actually, I first line use something calledprasterone which converts to oestrogen and testosterone just locally in thebladder, and it reduces urinary tract infections, but it can help withincontinence. So it's like, I always, well, I spend a lot of my life reallyfrustrated because it's so sad, the suffering, but even sadder for me as aclinician, knowing that there's a treatment that's really readily available,that you know, your followers, my followers, people out there, will not be evenoffered, let alone be prescribed. 

Christine D’Ercole [00:27:35] Exactly. I was justspeaking with a woman yesterday who - all of these symptoms, she's in theperimenopause state, and she says she went to her doctor and explained all thesymptoms, and she's like, that's normal this, yeah, it's just ageing and but wedon't have to. We don't have to age that way. We don't have to. We don't haveto just accept it and, like, lie down and take it. 

Dr Louise Newson [00:28:03] You're so right. Youknow, I'm so grateful for you being so open, but there's so much more we needto do by just empowering women. And a lot of my work is really about empoweringwomen with knowledge, and then they can make choices that is right for them. Sojust before we end really, because, sadly, we've got to wrap it up. But there'slots more I really want to ask you. You know, your work is just so empowering,and I think also, I don't know if I'm allowed to say this or not, but beingAmerican, you do go for things stronger than we do. And once you've made yourmind up, it is brilliant, but you're so forthright, you know you you've got tobe really strong to keep going in what you're doing and what you believe in.But what I always ask for three take home tips at the end of my podcast. Whatthree things do you think women should be really doing to change the narrativegoing forward so that they are not dismissed as just being older. 

Christine D’Ercole [00:28:59] We've got to speak upand keep speaking up until we get to a productive conversation.  

Dr Louise Newson [00:29:05] Yeah 

Christine D’Ercole [00:29:07] Absolutely must. And inorder to do that, we need to have a sense of agency. I think that our culturehas taught us that we need permission to have agency. 

Dr Louise Newson [00:29:21] Yeah  

Christine D’Ercole [00:29:23] Which does not makesense. And I believe that we create a sense of agency, which is the, the sensethat you can take action about something. We create that sense of agency bymanaging how we're talking to ourselves, because that's the voice we listen toin our head, and that's the voice that drives our action. So, in managing ourself-talk, which is another whole world of the work that I do in my wordshopsand my words work retreats, is learning how to manage what we're saying toourselves, recognise when we are defeating ourselves, when we are being our ownoppressor, changing the words. Now, changing your words is not going to changea diagnosis, not going to change what happens. Changing your words is not goingto change your life, but will change how we handle the challenges in life andunderstanding that we can change the narrative and then change what we do,which means to keep speaking up, make the appointment. If your doctor, if yourcaretaker, is not addressing your needs, is dismissing your concerns, then findsomebody else. And I have encouraged 1000s and 1000s of people to start aconversation, make an appointment, start a conversation. And there's so manywomen who are like, oh, I can't do HRT because of breast cancer and theoestrogen and just have a conversation, because we all know what happened withthe study.  

Dr Louise Newson [00:31:12] There's alwaysoptions. 

Christine D’Ercole [00:31:14] Speak up, speak up,speak up, speak up, have a conversation. Keep asking questions, because no oneshould suffer like this.  

Dr Louise Newson [00:31:23] Absolutely, really,really important and great advice. So, thank you so much for your time, and Iwill remotely wave to you next time I'm doing a Peloton when I if I'm allowedto sneak onto my husband's bike. Thank yuo so much it’s been great! 

Christine D’Ercole [00.31:40] Awesome. Thank you somuch. I really appreciate the conversation. 

ENDS [00:31:43]

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