Dr Louise Newson: [01:00:00] So I wanted to use this time to reflect on the year. It's the end of 2025. And I'm always reflecting, thinking about, are we making progress or are we going back in time? What's happening for women? And obviously I'm very close to a lot of women. I see a huge amount of women in my clinic, on the street, through my social media, just listening to stories. And sometimes I feel really encouraged. I think, how wonderful. Women are being listened to, they're being believed, they're been prescribed hormones when they want them. Their future health has improved, their symptoms are improving. There's so much positivity going on. And then other days, I don't feel quite as happy, I feel very frustrated, I feel angry, and I often feel very sad for the injustice of those women who are unable to be listened to. Who are not being believed. Who are being dismissed by the medical community. And are unable to access hormones. So I thought I would just think a bit about what's been going on over the last year and whether anything is really helping.

Now I'm going to talk positively first because I'm quite a negative person and I think that's not very good to just focus on negative aspects of life. So let's think in a positive way. I feel that a lot of my work is about empowering people. Giving people information in ways that they understand so they can make choices that are right for them about their health and their future health.

So I've been working very hard with a huge team of people to try and help improve this knowledge sharing. So some of you hopefully will have noticed I've rebranded the podcast, the Dr louise Newson Podcast. I've got these wonderful studios that I rent. And it's just so comforting coming here. And every single guest who's come into these studios has really enjoyed the atmosphere. Jack, who runs the studios, is fantastic. He helps us, he reassures us, he encourages us, we have a few tears, but we also have some laughs as well. And that's been really actually great for me.

But also I've got a new website which the branding links in with the podcast rather conveniently. My website really is a springboard for you to find out more about the work I do. So you can read articles, you can find out about the Hormones Unlocked which is a course that we've developed for anybody, especially people who are having symptoms or people that want to know more about hormonal changes. Also for people in corporates, in companies, to understand as well. So this is a course where people can listen to different classes, if you like, about different topics related to hormonal changes. And I've got experts that I interview and also people sharing their own experiences. So you can find out more about Hormones Unlocked on my website.

You can also find out about the large amount of education that I do for healthcare professionals. And we've now got a new website directing people to education, which you can go to from my website. So our education is really important because I feel very strongly that for the health of women to improve, two things have got to happen. We've got to be more empowered as women. I'm a menopausal woman and I want as much information as possible that's right for me. But the other thing is we have to educate more healthcare professionals. I'm the healthcare professional and every day I learn more about hormones, I learn more about diseases, I learn more how I can help my patients and we need to move this conversation forward for other healthcare professionals.

So I've been working very hard with some amazing doctors, nurses and pharmacists to improve our education. Some of you might know that I launched the Confidence in Menopause course several years ago now and it's had over 33,000 downloads with really positive feedback from people from not just the UK, but globally as well. But we're rebranding, we're relaunching that education programme and it's called Confidence in Hormones because my work is far more than perimenopause and menopause. It's thinking about hormones in women of all ages. So women who have hormonal changes, as you know, can develop symptoms due to PMS premenstrual syndrome. Or PMDD, premenstrual dysphoric disorder, or postnatal depression, or women with PCOS, women with endometriosis, that can be related to hormonal changes. So we're doing a lot of that. We've been refilming, we've been using some new content, and this is really exciting, so we can reach more healthcare professionals so they can be more confident into what causes hormonal change, what the symptoms are, what the health risks are. And really importantly for me, what the treatment is and how to safely prescribe hormones in a very individualised way. So we're doing a lot of work with healthcare professional education.

Earlier this year in March, I had a conference at the Royal College of Surgeons in London. And this was really exciting because it was a Newson Education conference and people came from all over the world. We had people from 16 different countries who came for this day, mainly doctors, but we also had some nurses, some pharmacists and some other allied professionals as well. And it was a really wonderful day. We had a lot of lectures from people that I know very well, including people from the US and Singapore came over to educate. We talked a lot about hormones and about how important they are to get right. We talked also about lifestyle, about longevity, about reducing inflammation, about cardiovascular disease, and really importantly, about mental health and hormones. We presented some of our research there as well, which was really great to be able to share it with other people. The night before the conference, we had a dinner, which was great because the energy in the room was so positive. And what I learned from it is that so many healthcare professionals across the world are working as hard, if not harder, than me to really help educate others and also to help our patients. Because all of us as healthcare professionals have gone into medicine to help our patients. And so talking to others really gives us all more confidence. There's some negativity that goes on in our work. But actually if we know what we're doing is right, if we share our clinical experiences and knowledge and work together, it makes a big difference. So having this conference was really important for me. The feedback we had was absolutely brilliant.

So in 2026, we're going another one on the 13th of March, again at the Royal College of Surgeons in London, a great venue and you can learn more on the education website. But people already are coming. I've got two colleagues who have already booked their flights from Australia. So they're coming over. We've got people from other countries coming over, healthcare professionals, and we're just preparing the programme for that. So that's a very positive thing that has happened.

I just want to remind you that I'm the founder of the free Balance app which you should all be downloading so you can learn so much more about your hormones from and also monitor symptoms if you're having them. So just head to the App Store or Google Play and download Balance app.

We've also been working very hard in the clinic to help our patients in lots of ways. We've been improving some of the clinical pathways that we have developed, we've been updating them, we've being listening to feedback from patients and really improving and optimised what we're doing.

But as many of you know, my work is far more than the clinic. One of the things that's been really important for me is research, because I feel very strongly that the only way we can really improve things to have published research because so often people say oh Louise there's not enough research into hormones we can't prescribe them. Well that's absolute rubbish in some ways because our hormones are physiological. We've got basic physiological knowledge about how hormones work in our body and we can use that knowledge to help when we prescribe body identical hormones but I fund a very small research team and we've published quite prolifically.

So we've had quite a few publications in peer review journals this year. One of our publications was about dosing because some people have been concerned about some of the higher dose prescribing that we sometimes do for women, especially of estradiol. So the estrogen through the skin as a patch or a gel. So this paper was looking at how some women, about a quarter of people we see in the clinic, do need a higher dose on a review consultation. When their levels of estradiol in their body are low, they're still having symptoms and increasing the dose improves their symptoms and also results in their estradiol levels being normal. So this is really important because it shows that some women don't absorb adequately through the skin. And the skin, of course, is a barrier. We don't have many drugs or medications that we apply onto the skin but estradiol is one that can penetrate through the in. But we've known for decades that the thickness of the skin, the temperature of the skin, and the type of skin really varies between women and all of these factors can affect the absorption of estradiol through the skin. So this paper confirms something we've known for many years but it's very reassuring.

We also, which was sort of part two if you like, we looked at people who have had bleeding because there are some doctors who get very concerned about bleeding, which is a very common side effect of HRT. So we looked at people who had been referred for a scan and had a scan of the lining of the womb to see whether the dose of hormones we prescribed correlated with the increased thickness of the womb. And we showed that there is no correlation, which is what we see in our clinical practise. So we have some women who have low levels of estradiol and low doses and their thickness of their lining of their womb, their endometrial thickness, is greater than other women who are prescribed a higher dose. And that's again because of the absorption, but also the way that the lining of the womb responds to different concentrations of estradiol. So there was no correlation between dose of estradiol and the thickness of the lining the womb. But also the dose of progesterone that was didn't correlate with the thickness of the womb also. And some guidelines over this year have changed to say that if women are on a higher dose of estradiol, they automatically need a higher dosage of progesterone. There's no evidence for this. And in fact, our paper showed that not everyone needs a higher does of progesterone. Some people will need a higher dose if they're on a lower dose of estradiol or vice versa. So the upshot of those articles really is that dose of hormones is individualised, which we've known for many years. It just seems to spark a debate sometimes in medical communities. So those papers are really reassuring.

We also looked at women who've had breast cancer to see what it's like for them if they've become menopausal. Are they listened to? Do they have people they can speak to? Do they understand about the symptoms of menopause? And a lot of women who have breast cancer are given treatments to block hormones, so they become menopausal, sometimes at a younger age than they would do otherwise. And so we asked women, it's always good, isn't it, to involve women in research, so we asked women, what was their experience like when they've had breast cancer, learning about menopause, talking about menopause, getting help, advice, support and treatment for their menopaual symptoms. And so, we published two papers, one was quantitative and one was qualitative. The results were actually really harrowing and sad to read because what they showed was that many, many women who've had breast cancer are not being listened to, they are not being explained, they're not being told about the myriad of symptoms and also rather concerningly they're not being told the health risks of having low hormones as a consequence of their menopause. They're not prepared for it. They're being often dismissed and being told they're lucky that they've got through their breast cancer. But breast cancer generally has a really good prognosis. So we should be thinking beyond the initial diagnosis for many women, and we should be thinking about ways of making their menopause as happy and healthy as possible. Many doctors didn't even want to talk about treatment options, especially when thinking about hormones. And many doctors are saying to patients they absolutely could never have hormones, despite there being no good quality evidence that hormones are dangerous for women and there's always choices, of course. So it's very sad reading this.

We also had another publication where it's taken us three years actually to get it published, where it was a consensus document. So we've involved other doctors. So people who are breast oncologists, people who are breast surgeons, people who are menopause hormone specialists as well, to ask their opinions on different statements about hormones and breast cancer. And it was very interesting because this hasn't really been done before. And it's very hard, isn't it, for people to agree, especially when we don't have good solid evidence. What we all agreed was, is that people should be listened to, people should have a choice. And we agreed that vaginal hormones are safe for women who've had breast cancer, but also we don't have the evidence. We don't know whether HRT is safe or harmful in people with breast cancer, but we know there are different types of breast cancer. There are different grades, different stages, different receptor status as well. And all of this needs to be taken into account. Often when I see people who've had breast cancer we have very open conversations led by the patient, of course, and some women decide to take hormones because they want to feel better. They want to improve their future health. For example, their bone, their heart, their brain health, and increasingly I might prescribe testosterone first line without having to think about the estrogen side of hormones. We all agreed at the end of the consensus document that choice is really important. And actually what this paper has done has almost allowed clinicians to think beyond the box. And quite a few clinicians I've spoken to have thanked me for the paper because they say, We've been prescribing hormones to women who've had breast cancer, but we've been too scared to talk about it. And now you're talking about it, it means that we can all talk a lot more and understand for some women, hormones are really important and we can't just dismiss them because of unfounded fears.

The other side of research that I've been working very hard on is looking at mental health and hormones. We've had quite a few publications in peer-reviewed journals about this and I've been funding a PhD student in suicide prevention with Liverpool John Moores University. And this has been really great research. It's just come to the end, so Olivia has just passed her PhD, which is wonderful. And she's learned so much. So we've been looking at women who have had suicidal thoughts as a consequence of their hormonal changes. Some of these stories have very harrowing. A lot of these women haven't been receiving help, support and treatment, but what we've also learned is that when women are given hormones, especially with testosterone, their mental health improves. Their intrusive negative thoughts improve as well. So really important because we've known for many years the association of mental health and hormones, but this has often been dismissed. So actually having research in this area is really crucial. And Professor Pooja Saini who was the lead for this research, she was on Woman's Hour talking about this research which is so crucial and we're doing a lot more in this area.

We've got loads more projects lined up looking, especially at mental health, but not just in perimenopause and menopause, also in women with PMS, PMDD and postnatal depression. So we've got a lot going on. We've done a lot of collaborative research actually with other people, especially Professor Mo Khera in the US, and we've been presenting some of our data at different conferences. We've also been looking at our de-prescribing data, so looking at how women who are balanced on the right dose and type of hormones can reduce their antidepressants, their anti-anxiety medication, their sleeping tablets, their antipsychotic medication as well. And this is really powerful data because we know how addictive these drugs are. And they also are associated with risks and side effects. So reducing those medications when women are given the right dose of hormones is really important.

So there's lots of research going on which is really stimulating. It's really exciting to be able to bring everything together. We're doing some research on addictions, we're doing research on ADHD as well. We're do some research on different types of contraception too. And lots more that I'm not going to talk about, but I will share with you next year. So there's lots of really positive things.

The other thing that happened was that I went to Australia earlier this year, which was a real highlight, talking at Sydney Opera House to an audience of 3,000 women. I went with some other doctors from US, it was wonderful to be able to share the stage with them and also to listen to the stories that we all have our heads from our clinical practice. But to share and realise that inadequate and poor menopause care is harming so many people.

I've given lots of lectures over this year to healthcare professionals, to women. I've been to face-to-face events, I've been in the media, in articles, in magazines, in newspapers, on radio interviews. There's been a lot that's been happening, and every time we have these conversations, more and more people learn.

The podcast is doing really well since being in this studio, we've had more and more people subscribing to the podcast, sharing the podcast with their friends and family and colleagues and keep doing this because the more that you subscribe, the more you share, the more we can put out really good content. I've got some really great guests lined up.

I'm not going to talk much about the negative things that have happened this year because I feel very strongly that when something negative happens, it just makes you grow stronger. There's no time in life to focus too much on negative things because it can really draw you down. And I know this from having negative things that have happened to me in the past. If you dwell on them and focus on them, you end up looking backwards rather than going forwards. And I feel there's so much we need to do that I need to keep propelling myself forward. So there are negative things that have happen. In the media, on social media, various platforms, various people, various healthcare professionals. But, you know, I was bullied a lot at school for being clever and I felt quite ostracised at school and quite lonely at times, but I took comfort in learning and moving myself forwards academically. And the same is happening here. I think there are quite a few healthcare professionals that are scared of what's happening. They're scared of all this knowledge that's being shared. They're scared of choices for women, and they're scared of a new generation of healthcare professionals that are happy to share their information in ways that we never did before. So through social media, through each other, just connecting in different ways.

And I realise there's a huge community of healthcare professionals that are working together to educate women, to help women, and we need to move faster. The reason I want to move faster is that I can't bear the suffering. I can bear the stories every day. I'm hearing stories of women who are being turned away from healthcare professionals for the wrong reason. Women who are suffering often by themselves with quite harrowing symptoms that I know would improve with the right dose and type of hormones and having supportive treatment as well.

So we need to be changing conversations. We need to bolder. We need to be thinking differently.

So next year, I've got some really exciting things planned. Hopefully some of you already will have booked your tickets for my tour, which is starting in April. I think it's going to be rather exhausting. I'm going to 45 different theatres throughout the UK, hopefully meeting many of you, but there'll be a lot of time for questions and answers, which I will be answering live to the audience.

Before I end, I just wanted to say the other thing I've been doing a lot on is my Balance app. So this is a free app, there's a small paid for section, but the free app is giving people lots of information and choice and knowledge. And also you can monitor your symptoms if you want to. We've been working with some other people collaboratively to share some content. And through Balance+, I do a weekly event, it's a live event, talking about different topics and people can put in their questions on that as well. So those have been going really well. And we're going to continue that.

But the most important thing I want to share with you is that the only way we can move forward is by you, your listening, you being a community and you shaping the future. So if there are things that you want more of or less of or done differently or new topics or ideas for podcast guests, please get in touch because I can shape and change things very quickly if I know what's needed. I want make the biggest impact to the most people in the shortest time possible. So with your help, we can do this. So get in touch either through my website, through my social media, through my podcast and give us ideas, shape up, let's work together to think about the future, how we're going to share the knowledge, how we are going to help others because it's not just us who are suffering, it's people around us too and we need to be looking out for them.

So I just wanted to thank you also. For all your kindness, all your support, because it means a lot. Having your support will really help to encourage me to keep going, because there's some really exciting things we can do in the future. So thank you very much.

‍