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 [00:00:42] On the podcast today I've got Kaye Adams, who’s a well-known presenter of Loose Women and a journalist. We talk a lot about what it’s like being menopausal in your sixties, whether you should be taking hormones or not, what questions you might be asking yourself and your health care provider. Lots to think about, and she’s certainly gone off after the podcast to reflect a bit more.

Dr Louise Newson [00:01:07] So thank you for coming. Last time I spoke to you was on a screen, because I was on your podcast, actually

Kaye Adams [00:01:13] Yes, you were, weren't you? That was a couple of years ago, and you took questions. Which is, which was great, which is interesting, because obviously my podcast is How to be 60, so I wondered, how my demographic would, you know, which direction they would go in. But there were so many women, as you well know, thinking, right, okay, here I am at that age. What am I doing? Or people who whose symptoms have persisted, and were saying, I thought we came through this thing, and they hadn't, you know, so it was really interesting.  

Dr Louise Newson [00:01:40] I think it's really interesting, because a lot of the conversation, well, it's always been, but it seems to be more at the minute that the menopause is a transition. It's a process. It's something we go through. I've recently been in America, and I met a whole group of great women in New York, and they were like, Oh, gee, I'm through my menopause. It's like, ‘are you? Well, you're not dead, so you can't be’ and they're like, What do you mean? And it's like, well, if you actually look at the definition of the menopause in the traditional sense. It's a year since your last period. It's only one day. Do you know what I mean? Or is it? Is it a day? Or is it an hour? Is it a second? Like, no one really defines it. I mean, it's just rubbish actually being defined by your periods. Do you know what I mean? It's so archaic, and it's so, somebody in an ivory tower deciding this will fit into some diagnostic criteria. So we can tick that box as doctors. You know, Mrs. Adams, have you had your period? No, it was 11 months and, you know, two days ago. Well, come back in 28 days, and I'll give you this diagnosis, like it's stupid, isn't it? So, and also, lots of women don't have periods. You know, if you've had a hysterectomy or you've got a Mirena coil in, how then do you know, so, but then the conversation is, well, what is menopause? And we know, obviously our hormone levels decline. They reduce because our ovaries don't work as we age usually. So then once those hormones are low, they are low forever. So it's not just about symptoms, and I think that is a big issue in my mind, because I'm a physician, not a gynaecologist, so I'm not actually thinking about periods all the time. I'm not thinking about the gynaecological organs all the time. I'm thinking about every single cell and organ in the body.

Kaye Adams [00:03:18] That's a very interesting thing to say actually, because, you know, it tends to be defined in terms of symptoms, doesn't it? Do you have hot flushes. Do you have low mood, you know, and are your joints aching? Have you got brain fog, etc? Those are the symptoms of menopause. And I suppose for me, one of the big decisions that I had to take was, I don't feel, though friends contradict me on this all the time, I don't feel that I had particularly marked symptoms, you know, in the sort of terminology that I'm sure you would say is old hat. I didn't have a bad menopause, and yet I did go on HRT, relatively late. I think I was maybe 57? The year to roll back, you know, but well past that point, and I suppose to a certain extent, I've always had an element of not guilt, but should I really be on this stuff? Because I didn't have terrible hot flushes. Okay, I had a wee bit of night sweats. It wasn't too awful. Did have a bit of brain fog, to be honest. But my brain is back. My brain is definitely back. I'm always waking up in the middle of night. I remember that name, and I had very low mood for six months. That was the most marked thing, and that was very much around the time of my period stopping. But, you know, compared to what you hear from some women, it was mild. So why am I on HRT?

Dr Louise Newson [00:04:44] See, this is a great question. I'm so pleased that you've brought it up, actually, because lots of people say this, and because, you know, a percentage of women do have a dreadful time, and I mean, really dreadful. And we often hear about those women, because improving their symptoms is literally life changing or lifesaving sometimes. Then people that have mild symptoms almost feel guilty. But you see, the other thing about menopause is it's not just symptoms. It's about low hormones, and those low hormones are biologically active in our body. So, with those hormones, it helps reduce inflammation in our body, it helps keep our organs really healthy. So the other reason for taking hormones is reducing our risk of inflammatory diseases, of which there are loads, and the commonest is osteoporosis affects one in two women, but also heart disease increases by around a factor of five when we're menopausal, so we're five times more likely to have a heart attack. The commonest cause of death in women globally is heart disease and dementia. If we don't have our hormones, we have an increased risk of dementia as well, but we also have an increased risk of type two diabetes, clinical depression, schizophrenia, autoimmune diseases, Parkinson's, cancers, like the list goes on and on.

Kaye Adams [00:05:56] And I'm not trying to take a dig here, but is there a medical consensus on that?

Dr Louise Newson [00:05:59] Yeah, and we’ve known it for decades. So this is what's really interesting, actually, because I'm talking about hormones here. I'm not talking about HRT. I'm talking about how our hormones work in our body. So I've got a pathology degree as well as medical degree. Pathology is the study of disease. So I spent my whole time doing the degree learning about inflammation and the way that our cells work to protect us and keep us healthy, I learnt a lot about how, when our cells don't work well, we have this increased inflammation. We have increased risk of cancers, increased risk of cardiovascular disease, dementia, like how it works in a cellular level, like really geeky, like, right down to the cells. And we have these cells called macrophages, which really are like our gatekeepers for inflammation. So, if we're fit and well, everything's going fine, then it's stopping inflammation. Anything that might eventually turn to cancer, it's gobbling those cells up and like giving us new ones all the time, whereas if our environment changes, so if you smoke 20 a day, those cells are going to be exposed to chemicals that they don't want, then they might mutate. They won't work as well. The macrophages become quite angry and inflamed, and then they turn against us and damage tissue. So we know it's No, it's not rocket science, isn't it? Smoking, too much alcohol, not exercising, inflammatory diet, sometimes genetics, like if you've got poor genes, then you're going to have this increased risk. But guess what? Those hormones will change that microenvironment. So if you have low oestradiol, you've got increased inflammation in your body. And we've known that since the 80s. We've known that for many, many years, that's the way the hormones work. We also know that progesterone and testosterone are the same, but also in our brains. For example, I'm very interested in neurophysiology, the way our hormones work in our brains. The hormones are made in our ovaries, for sure, but they're also made in our brains, and that will reduce with age, and our hormones will help the nerve pathways to work. They'll help the neurotransmitters, the sort of transmission of chemical messengers from one part of the brain to the other that help reduce inflammation in the brain. They help the blood flow in the brain. So that in itself, is really important. And then when you think, Well, hang on, dementia is far more common in women than men. Why is that? Is it related to their hormones? And we know that men with low testosterone are far more likely to have dementia as well. So like, what is going on here? So this is where it's like basic science is forgotten, because everybody's thinking, Oh, HRT, should I take it? Should I not take it? I'm really confused. Are my symptoms bad? What type of HRT Am I on? But if you go back and think, what do those hormones do in our body? And the problem is, in some ways, is that we're living so much longer as women. In the Victorian times, we didn't really live very much longer past our last menstrual period, so we didn't have this like, Oh, I'm sitting here in my 60s, thinking, do I take hormones or not. But I sometimes say, when I'm teaching like other doctors, when they say, Oh, well, it's just about symptoms, I often compare it with raised blood pressure. So if someone had hypertension, raised blood pressure, they often don't have symptoms. They might have a bit of a headache, but usually they have no symptoms. And as you know, every doctor always checks your blood pressure. So, if your blood pressure is high, we give blood pressure lowering treatment to reduce the risk of heart disease and stroke. So, if you had raised blood pressure, you probably would feel quite happy taking a blood pressure treatment. And I would say to you, well, as long as your blood pressure is high, we'll continue the treatment, and you'll go, Yeah, okay. It's not causing any side effects, I'll crack on. So lowering blood pressure will reduce the risk of a heart attack by about - depends on the drug - between 20 to 40 percent. You taking HRT lowers your heart disease risk by about 50% so it's more effective than taking a blood pressure learning treatment.

Kaye Adams [00:09:54] I mean, it's really interesting to listen to you rhyme off all those various ways that hormones impact on your body, and, you know, the beneficial effects it can have because, you know, aside from the girl and should I be, whatever I mean, and I think a lot of women will be my position, the single, single reason that I am nervous of it is breast cancer, and not even just cancer, because, of course, you know your cells, you know can any cells could sort of turn and particularly, specifically breast cancer. That is my single...  

Dr Louise Newson [00:10:30] I think you're absolutely right. It's the biggest reason why people don't want to take hormones. So this again, I'm really happy to explain. And I sometimes like play mind games. And I think if I was a Martian, if I was like, from outer space and I came and I didn't know the evidence, I didn't know any science, I didn't know any medicine, I would then be asking a few simple questions. So here it goes, in 2000, the year 2000, about one in 12, one in 11 women had breast cancer. HRT prescribing was about 30 percent of menopausal women in the UK, about 40 percent in the US. So then this study happened, 2002 HRT prescribing stopped because people were scared about breast cancer. So now, 23 years later, about 14% of menopausal women take HRT. So half here, in the US, it's about 5% so it's really fallen off a cliff. So do you think breast cancer incidence has increased or reduced?  

Kaye Adams [00:11:31] Well, they should have reduced?

Dr Louise Newson [00:11:33] Precisely, but it's not. It's now about one in seven women. So firstly, that tells you that not all breast cancer can be related to HRT, because a lot of women take it without. The other thing is, the commonest group of women who get breast cancer, as a generalisation, are postmenopausal women, so women who are menopause or not taking hormones. If the hormones were a problem, younger people who have higher levels of hormones, natural hormones in their body, especially pregnant women, would certainly have this increased risk, which we don't see. So the other thing is, which is the saddest thing in my mind, is the misreporting of this study. So the WHI, the Women's Health Initiative study, you know, the media reports breast cancer, breast cancer, and then they put this black box warning in the US, and over here, we've got this warning, you know, you only open up your patches, and it says, risk of breast cancer. And it was the, it's just been the biggest car crash to women's health because they didn't analyse the data initially, properly, before it went out to the media. Like I have never known a media press release of any other study that's been done.  

Kaye Adams [00:12:41] And was it a single study?  

Dr Louise Newson [00:12:42] So it was a big study, it was a big study, it was a billion-dollar study. But what they did was they were trying. Everyone knew how beneficial HRT was. They knew in the 1940s that it was beneficial for bones. In the 1970s they had this great conference showing guys it reduces risk of heart disease, diabetes, obesity, dementia, like I've read all the minutes from the meeting. It's like people would just bring it on. Bring it on. It was so people were taking it was the it was the number one selling drug in the US. It was just incredible. And then they thought, well, actually, if menopausal women are doing so well, let's try it in older women. So then they decided, in their wisdom, to give it to older women to see if it had the disease preventative effects. But the average age of the study was 64 starting HRT, so, but also, a lot of these women were overweight. A lot of them had had heart disease, and they were given, this is the big thing. They were given the wrong type of hormones. So they were given the conjugated equine oestrogens, so pregnant horses urine oestrogen, which contains far more than the oestradiol that's in patches and gels. But the biggest mistake was they were given a synthetic progesterone called Medroxyprogesterone acetate, which is a man-made, artificial progesterone, which, by the way, is in loads of contraception. And that is the hormone that increases clot risk, increases stroke risk, and probably because it wasn't statistically significant, increases breast cancer risk. When they followed the women who'd had a hysterectomy and only had oestrogen, even though it was a pregnant horse's urine oestrogen, they had a 22% lower risk of breast cancer. But that didn't make a press release. It wasn't on the front page of the papers, but that's, you know, good quality studies.  

Kaye Adams [00:14:29] But also, the other point that you make about contraceptives, I mean, I went on the pill when I was 17, and I think I was on the pill until my mid 30s, never gave it a thought, you know, never gave it a thought. And clearly, it's a hormone treatment, isn't it, but at no point did I concern myself. I think younger women think about it differently, and I don't know what's happened, because that boat has sailed for me, clearly, because my daughters talk about it differently from the way that I did. But when I was going to university, you went on you went on the pill. Boom.  

Dr Louise Newson [00:15:03] I mean, I was the same. I went on it, and I look back, and I was like, Why? Why was I? Because I didn't know. But even as a doctor,  I didn't even realise there was a difference between natural and synthetic hormones, because no one taught me. You see, because it's called progesterone only pill, but it's not progesterone. It's a synthetic progestogen. We talk about combined pill oestrogen and progesterone. It's not, it's, well, there's one type that contains oestradiol, but most people don't use it, so most of it is synthetic. So it's even worse, because it blocks the receptor, so your natural hormone doesn't work, and it doesn't help the inflammation in the body. So it's actually greater risk.  

Kaye Adams [00:15:43] that's incredible.

Dr Louise Newson [00:15:44]  So, the but the other thing about the study, what they didn't say, and they did have the data from the start, was like this, breast cancer risk was so not it wasn't statistically significant anyway, but there was a 30% reduction in bowel cancer in this study. Like, that's really important. No one talked about that, but they also showed that there was a reduction in osteoporosis that affects one in two women. And you know, osteoporosis is really important. We that we need to protect our bones, because if you have an osteoporotic hip fracture, or you were diagnosed with breast cancer, which do you think has got the worst outcome?

Kaye Adams [00:16:20] Well, I think it's the hip fracture, yeah.  

Dr Louise Newson [00:16:23] Yeah, you then one in five women after an osteoporotic hip fracture die in that first year. That's far greater mortality than any type of breast cancer. Yet, you know it because we're not thinking about it the same way.

Kaye Adams [00:16:36] So was that a great conspiracy or what?

Dr Louise Newson [00:16:39] Yeah well, wouldn’t ..  

Kaye Adams [00:16:40] We couldn't talk about that yeah  

Dr Louise Newson [00:16:39] but it's, it's, but also, now we don't even prescribe those types of hormones. But the problem is, when you look at some of the guidelines, you look at some of the evidence, they'll lump it all together, and they'll say there's a risk of stroke and clot and breast cancer in HRT, and then me being really geeky is like, hang on, which type of hormone replacement are you talking about? The synthetic or the natural? And it's completely different. The other thing that they found in the study, which again, wasn't really reported externally very much, this, if women did develop breast cancer, taking HRT, their outlook was better, their prognosis was better...  

Kaye Adams [00:17:20] wow

Dr Louise Newson [00:17:21] which again, is really important. You know, if one in one in seven of us are going to get breast cancer, like it's one thing having the diagnosis, but there's another thing actually, dying from it.

Kaye Adams [00:17:30] I think the other thing that contributes, though, to the fear factor is that generally, you hear if a woman is taking HRT and then is diagnosed with breast cancer, the immediate advice is to come off the HRT. So I mean, that signals to people that that is the problem.  

Dr Louise Newson [00:17:45] Course it does. But again, that's fear mongering, because everyone thinks that oestrogen causes cancer, because we talk about oestrogen receptor positive breast cancer, but we have oestrogen receptors all over our body. So if you have an oestrogen receptor negative breast cancer, it's actually a worse prognosis, usually because the cancer has mutated the cells, so the receptor status is lost. So we've got oestrogen receptors everywhere on our body. And then some of the treatments for breast cancer do block oestrogen, but there are different types of oestrogen, and that's where it gets more complicated. So, the type of oestrogen that's in pregnant horses' urine but also type of oestrogen that we produce if we don't have our natural oestradiol, is estrone, which is very inflammatory. So some studies have shown that it's the estrone, not the oestradiol. So, if you're not having hormones, a lot of people put on weight. The fat cells produce oestrone, which increases inflammation, more likely to have breast cancer as well. So, you know, it's, it's really interesting, isn't it? And it's such a shame that our natural oestrogen has been labelled as a carcinogen. Like, how does it cause cancer? Like, do you know what I mean this outer space sort of, you know Marshall that keep thinking about, like, it doesn't. Like, why would any other hormone cause cancer? And that's been the real problem. And your right people, people are scared. But, as a menopausal woman, I'm really scared about osteoporosis. That's my big fear, actually, especially of my spine, because if I fall over and pressure my hip, hopefully I'll get over it. I'll be the four out of five that will keep going. But on my spine, like, what do you do then, when you've got these micro fractures. And I also used to, every week, go and visit women in nurses, always women in nursing homes, and they'd be sitting and they'd be rocking a bit and the smell of incontinence, and I just thought, I just want to do everything I can to reduce that risk.

Kaye Adams [00:19:43] Yeah avoid that, and they might have dementia as well.  

Dr Louise Newson [00:19:46] Yeah, precisely. And I've just done a presentation for some healthcare professionals about the risks of not having hormones. And I think this is a conversation that needs to be had more actually, it's like not controlling your blood pressure. You know you don't have to take treatment, but you know your risk of heart disease will increase, but especially the risk to our brains as well is that the biggest you know, the brain is the most important organ in our body. And you know, the diseases of ageing, are the same as the diseases of inflammation are the same as the diseases related to low hormones. And I think this is the thing when people almost like you're saying you feel a bit guilty taking hormones or do I stop? Sure, you can stop. But the studies do show that in the first year after stopping HRT, there's an increased risk of clots and heart attacks. It's almost like the body's used to this reduced inflammatory state, and then without hormones, it increases inflammation.

Kaye Adams [00:20:40] Wow.

Dr Louise Newson [00:20:40] Which a lot of people don't realise.  

Kaye Adams [00:20:42] No.

Dr Louise Newson [00:20:43] but also, you'll have that accelerated bone loss. So you know, you'll lose a lot of bone this increased risk of osteoporosis will occur.

Kaye Adams [00:20:50] So would you take it for life?

Dr Louise Newson [00:20:51] Yeah, yeah. I mean, the guidelines are, you review people every year, if benefits outweigh risk, then you carry on. And for most women, the benefits do. And it's the same way, like if you had an underactive thyroid gland, we would give it for life. If you were type one diabetes, we would give you insulin for life. Actually, if you had raised blood pressure, we wouldn't necessarily do it for life, because your blood pressure might come down. But again, that's why thinking about as our hormones are biologically active throughout our body, and I think because it's always been associated with periods, associated with flushes and sweats, people don't realise the other symptoms. And we see a lot of women in their sort of 60s, 70s, they say, Oh, I'm through the menopause. I'm fine. And then I say, Well, what's your sleep like? And do you get off at nighttime to have a wee? ‘Oh, yes. Oh, I'm bit stiff in the morning, and I have slowed down a bit. And, yeah, I've had six urine infections this year’. And, you know, and then you give them hormones, because they, you know, to try, and then six months later, they're like, wow, you know, this is, I never thought I could feel like this.

Kaye Adams [00:21:53] Oh, my God. You're giving me food for thought here, I can tell you, yeah, yeah.

Dr Louise Newson [00:21:57] But it's important to think, though, isn't it? I mean, I'm, I'm very much like, it's about choice I have. I'm not going to lose sleep. I hate to tell you whether you take hormones or not, but it's I would lose sleep if you stopped it because you felt bad, because you're in your 60s, that you're taking it. Do you see what I mean?

Kaye Adams [00:22:10] Yeah, no, it has to be an informed decision, doesn't it?

Dr Louise Newson [00:22:13] Yeah, absolutely. But I think I often say to people, look, one in seven of us will get breast cancer, and if you get it, actually firstly, like I say, your prognosis is going to be better, and there's always treatment options. But it doesn't mean that your HRT has caused it, because if you're on body identical hormones, there's no evidence to support that.  

Kaye Adams [00:22:33] Hmmm, Yeah, it's funny. Actually, sadly, a friend of mine has been diagnosed recently who was on HRT, and it was the first question she asked. And again, I mean, that's the thing, HRT is always in the frame, you know, if they're looking at a list of suspects, if you think of it that way, then it's always going to be, you know, there in the identification line. So that was her first question. And I think the response she got was no it probably didn't cause it, but given that it is now there, it will feed it, that was the line.

Dr Louise Newson [00:23:03] Yeah, yeah. And again, there aren't any good studies. There's studies, for a while, actually, that when people have oestradiol in their system, the cancer doesn't grow quite as quickly, and it sort of calms it down, because it reduces inflammation. And before they had tamoxifen, high dose tablet, oestrogen was a treatment for breast cancer, and I've seen these amazing pictures of like, really quite disfiguring breast cancer that's coming out through the skin and resistant to any other treatment. They didn't have the drugs that we have now. This was in the 60s and 70s, and people given really high doses where they felt quite ill because the doses were so high and this cancer shrunk. You know, you can see it. It's amazing. And that's when tamoxifen started, because tamoxifen actually increases oestradiol, as well as blocking some of the oestrogen receptors. But a lot of people don't realise that either.

Kaye Adams [00:23:53] I mean, you know, obviously you understand it from a medical perspective, but I mean, even in the explanation you've given for lay people, it is immensely complex...  

Dr Louise Newson [00:24:02] Yes.

Kaye Adams [00:24:03] And at the end of the day, as lay people, we rely on the medical profession...  

Dr Louise Newson [00:24:07] course you do.

Kaye Adams [00:24:07] to take all the information, to read all the studies, and, you know, to understand that and then present it to us in a way that we can understand and make sense. And you know, well, my job, so I'm a journalist, so I mean, my job is to communicate. And I do find it enormously frustrating, like from my personal point of view and professional point of view, that I think most women out there will say something's not quite right here, and they're not entirely sure what's not quite there's just, it just doesn't smell right, it doesn't sound right. You know, there's just something off...

Dr Louise Newson [00:24:44] yes, yes.

Kaye Adams [00:24:44] about this conversation around HRT, but they're not quite sure what. And I think, from that point of view, I think all women have been let down, because at the very basic level, you know, I think we're very fortunate in this country, aren't we in a western world, but we're at least entitled to reliable information, professionally appraised and, you know, communicated in a way we can understand it and believe it, and I don't think we're getting that.

Dr Louise Newson [00:25:14] I absolutely agree with you. It's a really noisy space, actually. And then, you know, we haven't even talked about testosterone, which causes even more confusion. And you know, I'm like, a really annoying, inquisitive two year old, like, if something doesn't fit with me, and I've done it in all walks of medicine, is I go back and look at the evidence, but I also go back and think, how does it work in the body? What's going on? Like, what are the mechanisms? And then it's really easy to unpick. But I've worked as a medical writer for 28 years, and I've written books on evidence-based medicine, so I'm like, annoyingly fast at reading data and understanding it and looking at like which is the good studies and which are the bad studies, and who's got bias and who's written this, and what are their conflicts? Because all of this builds up a picture, but most doctors haven't got time for that.

Kaye Adams [00:26:01] You're, I mean you're not a lone voice. I mean, there's lots of people who agree with you, but having said that, you're probably slightly outside the mainstream. Does it frustrate you? Or how do you feel about the fact that there is still a large body of the medical profession that is sceptical despite, you know, a new understanding?

Dr Louise Newson [00:26:24] I'm sure you know the story of Semmelweis. Do you know the story of (Ignaz) Semmelweis? He was an obstetrician from the late 1800s and so, yeah. So he was very interesting, because they quickly realised that the women who were having babies from midwives, the women and the babies had a lower mortality than the male obstetricians that were delivering them, and they couldn't work out why.

Kaye Adams [00:26:45] My mum was a midwife. I think I might know the end of this story. Yeah.

Dr Louise Newson [00:26:48] So they didn't know about germs then either. But what the male obstetricians, of course, did all the autopsies, they did all the postmortems, but they weren't wearing gloves, and they had very dirty aprons. But then when they would deliver the babies from the mother, they wouldn't wash their hands, and they would keep their aprons on. So, I don't need to tell you that there were germs flying everywhere. So he suddenly realised that the women, obviously the female midwives, were not allowed in the autopsy room. And so they, you know, usually washed their hands and did whatever. So then he just said, well, hand washing is going to make a big difference. And they said he was mad. They said he was ridiculous. They stopped him going for medical conferences. They stopped him working. They stripped him from his license. He ended up beaten to death in an asylum, actually, in a straight jacket. And look what's made the biggest difference, you know. And so with a lot of this, you know, a lot of it's just basic science. I'm not talking about a new drug. I haven't, you know, made pregnant horses' urine. I haven't made an artificial hormone. I'm just talking about how natural hormones work in our body. So I have enough insight to know that I'm not doing anything like, out there. I'm not controversial. I'm just stating facts. But I can see quite sometimes how he went mad, because I do drive myself mad sometimes thinking, well, what am I? What have I like learned that others haven't like? It's almost like there's this wilful blindness where people don't want to, like, look at the evidence. They don't want to look at basic physiology, because they're too busy saying HRT is dangerous without actually understanding why they're saying that.

Kaye Adams [00:28:25] I do think about that with you sometimes, though. I mean, it's interesting that you say...

Dr Louise Newson [00:28:29] What that I'm going mad?

Kaye Adams [00:28:30] No, no, no, you're going mad, but that there is a sense of frustration from you, because you've kind of been on the scene for quite a while. There's been so, you know, different documentaries. And of course, Davina’s documentary was a big one. And, you know, I think there is a much bigger conversation out there than there was certainly 10 years ago. But it still feels as if there is a level of resistance and to be, you know, upfront about it, you know, maybe looking at you there, oh, Louise, whatever. And I just wonder how you respond to that.

Dr Louise Newson [00:29:02] Yeah, yeah, I probably won't answer you honestly, because I'll just get upset. But, you know, I think the other thing is, you know, I don't work with pharma. I don't have any conflicts. I'm I haven't got another agenda for any of this. And I think that's a really big issue. And you know, you can just see the number of menopause supplements and everything else that's going out there. I think the big thing that is changing, though, is that women are making choices for them. And, you know, I do yoga most mornings and do a headstand. I don't expect people to do that, but if they do, they'll feel great, and it will really help them. I take hormones because I want my brain to function, and I'm scared of osteoporosis. I don't I don't mind whether people do it or not. You know what I mean? And I think, and I think this is where medicine is changing, because, you know, as a journalist, you see, like, people have access to information they didn't have before. And for some doctors, they find that very threatening, almost.

Kaye Adams [00:29:53] Yeah, we do have access to a lot of information, but we don't always have the skills or knowledge to interpret that information.

Dr Louise Newson [00:29:58] And that’s the big difference.

Kaye Adams [00:29:59] And that's where we need, you know, the medical profession, to do that job for us, and to do it in a way that we can trust, and I don't think we're getting that, to be honest, and I think that is a great shame, and it just, I'm sure it happens in other spheres of health, but I can't think of one that's quite as wide ranging.

Dr Louise Newson [00:30:19] No it's not. I can't tell you another medical guideline that is mostly ignored, you know, a guide, all the guidelines, national, international. Doesn't matter what you read in menopause, they will say first line treatment for menopause for the majority of women, is HRT. Globally, 5% of menopausal women are taking it. So if you read a, you know, blood pressure guidelines, and say that.

Kaye Adams [00:30:38] Okay, well, here's the thing from a journalistic point of view then. What stands out to me on that is why? Because, as you say, the pharma business is the most lucrative, isn't it, I think, in the world. So surely if pharma, if it was one entity, felt that it could make zillions and millions and trillions.  

Dr Louise Newson [00:30:58] See, they won't make money out of HRT, though, because the natural hormones, they are just natural. They can't, they can't make a different version of them. They're off patent, so they're dirt cheap, so the only way of making money is a new menopause treatment that won't be hormonal. So then that puts it into another sphere, you see.

Kaye Adams [00:31:13] This is interesting. So the HRT and the form that you would personally recommend is not necessarily a profitable drug.

Dr Louise Newson [00:31:22] No, it doesn't cost much money at all. Because if I was making a drug like Viagra, for example, you have the drug and it's a trade drug, so it's not generic any only that drug company can make it, they've got their secret recipe, and it's usually depending it's usually a couple of years or so, and then it goes generic, and anyone can make it. So the other name for Viagra is Sildenafil. They always have the weird names for the other ones, so no one remembers. So you always go to Viagra, but then it means other drug companies can make it. They'll still make money, but they won't make as much. And it's like any drug treatment is like that, but because it's a natural hormone, you can't call it something else. It's oestradiol, its progesterone, its testosterone, so it's cheap. So why is Pharma? You're going to make far more money out of other drugs.

Kaye Adams [00:32:12] That is really, I've never heard that before. That is interesting, because, as you say, when you look at the menopause supplement market, it is vast and growing by the minute, isn't it?

Dr Louise Newson [00:32:27] Yeah. So absolutely billions and millions, because you can sell anything as a as a supplement, because it's not a drug. So there's a lot to think about, but I'm wondering, at the end of this, three take home tips, I'm just wondering what three things you might have learned on this podcast that you can take home with you?

Kaye Adams [00:32:49] Okay well, that is number one, I have to say, because, you know, I mean, so I'm a journalist, and I'm always trying to make sense of stories, you know, that that's, that's the way that my brain works, and I've never been able to make sense of the story, you know, in terms of the whole HRT story and the information that women are getting and the choices that that we make based on information that we're not entirely sure about, that, you know, I've always felt that that was just unsatisfactory. So that overview from you, I have found really, really interesting. And you know, they say that about so many things in life, don't they, follow the money. If you want the answer, follow the money. And so that's my number one. That's where the money is. Well, I mean that in my 60s, and you know, not conscious of any terrible symptoms of the menopause, that actually, I can still look at it as something, and I don't know what I'm going to do, to be honest. I mean, I will probably go for some kind of I've had blood tests taken recently actually for a different reason. And touch wood, everything seems fine, but, you know, it's good to check in with your health, so, you know, and I don't think you should be casual about these things. So I mean, it is something that I'm going to think about. But you've given me a lot of food for thought in terms of where I am right now in my life. And my feeling was, oh, I should probably think about coming off it just based on that sort of looming shadow. You know what I mean. Enough of this now. So there you go. That is number two. And what is number three? Well, sadly, it comes down to, you know, women maybe not getting the information that they that they need and deserve, you know, and that's, something that we should all be really concerned about. Because flipping to the other, my two daughters, one’s 22 and ones 18, not going to reveal their contraceptive choices. But you know, obviously, you know, I'm interested in their health going forward, and when I think how casually I took the contraceptive pill, really didn't think about it, has it had any negative effect on my long-term health? I have absolutely no idea. You know. I mean, it was just like, convenient, lovely. Thank you. Off I go. And for them, I would hope that they would have more information in terms of the choices that they make, and so they sort of feed into each other, don't they?

Dr Louise Newson [00:35:14] Yeah, absolutely, knowledge is power at the end of the day. But thank you for joining me. It's been great.

Kaye Adams [00:35:19] Yeah, no. Has fascinating. Thank you.  

Dr Louise Newson [00:35:21] Oh, thank you.

Ends