Dr Louise Newson: Today I talk a lot about my free Balance app. And I've got with me Matt Jones, who's managing director of Balance. He has a wealth of experience and knowledge which he's really bringing to shape and change Balance so that it's not just a menopausal app, it's an app for all women. So women can be empowered with information that's relevant to them so that they can get the right treatment, hopefully, from their healthcare provider wherever they live. We talk about how Balance is already shaping the future for a lot of women and how it's really helped them and the plans that we have, some of them quite ambitious, going forwards. So Matt, really great that you're here. I want to talk about Balance app because I haven't really spoken about it on a podcast for a long time. And when people, not always, but when they sort of recognise me or stop me in the streets, it's very humbling because they normally thank me for the work I do. But it's usually either the podcast or Balance. And they're the two things that I'm the most proud of, actually. Like obviously I'm proud of being a doctor, I'm proud of being a mother. But you know, my mission is to give people as much information as possible in ways that they understand so they can be empowered and make choices about their health. So the last bit, making choices about their health, I feel it's up to them, not up to me as a doctor. I'm not a dictator, I'm not patriarchal, it's about people being able to choose. So Balance is a really, really important part of my work. And the last year or so I've sort of been babysitting it because there's been all sorts of things going on. But I set up a few years ago, it's had the most phenomenal feedback and global reach. So you're the managing director of Balance. You've been with us for a few weeks, but it feels like a few years actually, because I'm not here to really big you up. But I do want to say in public, you're very mission driven as well. And you really understand what I'm trying to do with Balance. Is that fair to say?

Matt Jones: Yeah, I think so. I mean I think the overall purpose of the app is to inform women. It's a massive equity issue that women have to suffer some of these symptoms in silence or at least in some kind of state of subjugation almost. And you know, I I've got women in my life that brought me up to care about those things, but also who have suffered from them as well. Not just, you know, menopause and perimenopause, but my daughter and her journey with contraception, you know, wasn't great.
‍

Dr Louise Newson: Yeah.
‍

Matt Jones: And you know, so to me it's important, it's a it's a really big challenge. And the value of, of rising to it and and overcoming it is pretty significant.
‍

Dr Louise Newson: Yeah. Because I I set it up really because I exposed myself, as you know, quite a lot to social media and my reach wasn't nearly as big as it is now. But I was getting a lot and I still am DMs from women, so direct messages from women, telling me that they've gone to their doctor, they've been told they're too young, they're too old, they don't need hormones, that they need antidepressants, but they know that there's more and what other resources can they have? And so I'd spend a long time messaging them, which time I don't really have, and obviously got a lot of resources on my website. But then I just thought look, everyone not everyone, but most people have got access to a phone. And it's such an empowering thing. And also for me, whether there's one person, a hundred, a thousand, a million or millions of women, it's the same effort really, isn't it, when you've got the infrastructure right. And that's where technology is transformational, isn't it?
‍

Matt Jones: Yeah, and you know, the platform as it is already reaching, you know, hundreds of thousands of women on a monthly basis. It's providing really good feedback. It's providing a place for them to talk about what's happening in their lives that's safe and reasonably kind of the, it's a community of interest if you like. And you know, the the main thing is it actually allows them to do something. So they can track their symptoms. They can generate reports that empower them when they go to see their GP. But also just seeing those reports and that data I think will help them understand that there is something going on underneath that you know it needs to be looked at.
‍

Dr Louise Newson: Yeah. I think it helps them validate their symptoms. So we've recently changed the symptom questionnaire on it, haven't we? We had, there was a shorter one and with the research team I work with and within the clinic we've created a much longer symptom questionnaire. And I know when I was initially thinking about putting it on Balance, some people said, Oh, that will take people too long, they might not want it but actually what the feedback that we are getting from lots of women is that wow, I didn't realise those symptoms were connected. So it's actually really helpful, isn't it?

‍
Matt Jones: Yeah, and you know, I think one of the things that Balance gives us the opportunity to do is collect data. And to be able to to look at that data for patterns, for insights, for trends that are relevant to women and and the users of the app, but also relevant to the entire community.

‍
Dr Louise Newson: And it's really important to me because I'm very scientific as well. But it's also really astounding that menopause affects half the population. Hormones that change affect half the population. Yet there's vanishingly little research. When you look at some of the research about symptoms, it's still focused on the vasomotor symptoms, the flushes and the sweats. And a lot of people, and I've been at quite senior meetings where doctors who are very senior have been saying, Oh gosh, people have joint pains and they think that's hormonal, that's ridiculous, or their migraines, or their urinary symptoms. And of course I know it's related. But if I say, Oh yes, I've seen two patients this week who have had urinary symptoms and eight patients this week have migraines, that's really small numbers. But when you talk about hundreds of thousands of women who have those symptoms it's hard to ignore those numbers, isn't it?

‍
Matt Jones: Well, I mean and the data that you've produced recently, with the symptoms, the top ten, you know, it is, the hot flashes aren't even in it, I don't think.

‍
Dr Louise Newson: No, they're not.
‍

Matt Jones: Yeah. No. I think they were like number 14 or something, weren't they? It feels to me like it's just easy answers with simple solutions when in fact it's a much more complicated, very individual problem that needs to be solved for everybody.
‍

Dr Louise Newson: Yeah, absolutely. And you know, when we collect the data, just to reassure people it's completely anonymised, people consent, don't they, when they sign up to the app. We don't work with any pharmaceutical companies, we're not sharing the data. We, all we're doing is using it to help more women. And that's really important. And I know when I was presenting some data at a conference a couple of years ago and it was not nearly as big numbers as we have now, and people going, Wow, Louise, gosh, this is amazing. I've got a study of, you know, eight women who've tried a treatment or whatever. And, but it's also looking globally because it's quite hard to access information globally in different regions, different areas and and also knowing what people want because the app was very much designed, obviously I'm a woman, but we had a female team who were asking women what do they want out of an app? What would help them? And we want to get it right, don't we, what we're doing with it?
‍

Matt Jones: We do and and we want to expand and to provide this information globally and you know, to be able to reach as many women as we possibly can to give them that opportunity to, to learn and to understand. But to do it again in their own language and in line with their own kind of cultural norms as much as we can.
‍

Dr Louise Newson: Yeah.
‍

Matt Jones: But the the thing about the app is it's in their pocket. Most women will have a phone. You know, they can carry it around, it's pretty discreet and they're able to, you know, really drill in because there's so much information in the app.
‍

Dr Louise Newson: Yeah.
‍

Matt Jones: So they can really, you know, almost follow their symptoms and their own kind of circumstances through that, that data. And then there's the community where they can go and see what other people are talking about and find agency, which I think is one of the most important things.
‍

Dr Louise Newson: Yeah, and it's a, it's a good community. People are really helping each other and supporting each other on the community section, aren't they?
‍

Matt Jones: Yeah, yeah. It's it's phenomenal how how active it is considering as you said, it's been babysat for a little while.
‍

Dr Louise Newson: Yeah, yeah, yeah.
‍

Matt Jones: It's just powering along.
‍

Dr Louise Newson: But what we have been doing is adding content all the time. And that's something as a medical writer I feel very strongly that it's a skill I have that I want to help and share. And we've constantly added more information. And recently we've added a search function to it. So it's a lot easier to access information, isn't it?
‍

Matt Jones: Yeah, the search really helps drill into into the details. You can go find what you want and save it and build a collection of information that that you're actually looking for. Because there's so much in it. It potentially could be a bit overwhelming.
‍

Dr Louise Newson: Yeah.
‍

Matt Jones: I think when women find the information they're looking for, that overwhelm tends to sort of dissipate a bit because they, they find some answers, they find some leads that they can follow.
‍

Dr Louise Newson: Yeah.
‍

Matt Jones: And talk to their their GP about.
‍

Dr Louise Newson: Yeah, yeah. So when you knew that we were looking for somebody to work with us...
‍

Matt Jones: Yeah.
‍

Dr Louise Newson: What sort of made you really interested or excited about it?
‍

Matt Jones: When I left my last full time job, I I wanted something different. I've done the same kind of tech business growth challenges for most of my career. I wanted something that was more purpose led, less wealth creation, more purpose, more sort of social value if you like. I wanted to work for a female boss. That was another one of my criteria.
‍

Dr Louise Newson: Why is that?
‍

Matt Jones: Just because I've mostly worked for men.
‍

Dr Louise Newson: Okay. No pressure then.
‍

Matt Jones: Well yeah, no, I think I don't want to stereotype gender roles and and leadership capabilities, but it's just a change that I wanted. And I wanted something that was to do with with healthcare and and with generally, generally with health because I just think it's it's very meaningful. You know, I've had my own health challenges in the past and you know, the thing that you find when you have something like that happen is you need data. You need to understand what's going on. So irrespective of conditions or or or gender, you know, data when you have a health challenge is extremely important. And I think that's where Balance just really intersects the market. And going from my old kind of tech world, the kind of product market fit that Balance has, the kind of engagement it has, most investors would die for that kind of leading indicator.
‍

Dr Louise Newson: Yeah, well I've been really protective of Balance. I sort of see it as another child really. I've I've turned away a lot of investment opportunities because I think they haven't been done with the right, right motives. And there are a few things, just to be really clear to people listening, that are not going to happen with the app. So I'm not going ever offer consultations through the app. I'm not going sell supplements. I'm not going work with pharma. And those things are really, really important that people know because there are, or there have been lots of femtech apps, lots of, lots of big money as well that's been invested. And then people have struggled and they've either like sold coaching or they've sold supplements because that's easy. But I don't think we need to do that, do we?

‍
Matt Jones: No, there is a a pretty stable, pretty solid user base. You know, we've got over a hundred thousand active users each month without really trying. We're gonna try much harder.
‍

Dr Louise Newson: Yeah.
‍

Matt Jones: And we're going to you know, add new features. We're gonna I've got hundreds of user requests to process for the kind of feature enhancements that we're looking for that I need to work through. And, you know, as I said, we're gonna go global and we're gonna try and drive as much insight for our users as we can from the data that they provide. You know, whether you're a paid user or not, you know, the data you give us is valuable and we wanna treat it that way. So we will protect it. We will make sure that it doesn't go anywhere it shouldn't. You know, in the future if we were to do some kind of research tie up, it would be opt in. So the users would be given the opportunity to get involved in something that might be off but you know, with the goal that it's again, you know, we're getting a multiplying effect by being able to provide that user base to that kind of situation. We talked at my interview about the the overall purpose of Balance and you know, I did have some walk away criteria but they didn't come up, so I was I was delighted.
‍

Dr Louise Newson: That's good. And and having worked with Balance really, you've got really into the detail very quickly and seeing what what it what it's doing now but what it's capable of. Is there anything that has either surprised you or enlightened you about it?
‍

Matt Jones: Yes, it it's not new information for you, but the way women use it, the trust they put in it. Is pretty humbling when you when you look at it. And I think for me the the biggest moment really was just realising how massive a problem this is. And we're talking a tiny sliver of the global market of women that will suffer some kind of problem as a result of of perimenopause and menopause and and even all of the other hormonal things that happen. It, it's almost as if, you know, you I can't unsee it now. And and that, it kind of amplified the overall size of the goal, the size of the challenge and to try and turn global thinking around. And I you know, you've had problems trying to get traction, you've had resistance to try and push these things ahead. What we really need is for women to almost rise up and demand it. And they need the data to do that.

‍
Dr Louise Newson: Yeah, and I think it's changing. I mean you can probably maybe understand why I spend so much of my time cross.

‍
Matt Jones: Yeah.

‍
Dr Louise Newson: Because the injustice is palpable. The the failure of the medical establishment for a lot of women it really is you can feel it, you can sense it and I sense it because I hear it in the clinic but I also feel it from social media. But you only need to go in the community section and I find it really, really upsetting as a healthcare professional who I know I can help all these women on the app, but of course I can't because there's only one of me. Yeah. But what I want to really do is to change it for future generations as well. And when I started with Balance it was very much it was a menopause app and we obviously included perimenopause. But my whole way of thinking about hormones has really changed. The labelling of patients and women has really changed as well because I feel as a doctor it's irrelevant what diagnosis it is. It's about the treatments. So if I say to a woman, Oh, you've got PMDD, you've got polycystic ovarian syndrome, you've got endometriosis, what does that mean to them? It just means suffering. But what they need to know is about what causes it and what treatments are available. So we're going to be working really hard to open up the app for all women really with any hormonal issue. Which is so important, isn't it?

‍
Matt Jones: It is and I think there's, there will be equal amounts of demand in that in that track. I mean, when I first started working for you I showed your podcast to my daughter and the app and she said, Oh, it's such a shame it's just for perimenopause and menopause And I said, Not for long. You know, because she she had her own issues with the Pill and you know, she came off it eventually because she just wasn't feeling great as a consequence. She, she feels much better. And you know, she she, I think would would be a very apposite target kind of audience, if you like. That, that kind of emerging from puberty and into adult life, I think is such a tempestuous moment for moment for women.

‍
Dr Louise Newson: It's really hard for women. It's really hard and and like, we often, we're very open as a family and we have our meals together as a family when we're together and my all three of my daughters actually say, Gosh, how do people cope when they don't have medical parents? Because so many symptoms that we know are are really very trivial or other symptoms that we know are associated with the hormones or with a side effect from contraception. We can pick it up when I say we, my husband and I, like very quickly because we've got that knowledge, but actually people don't have the knowledge and they might have one doctor in their local village who may or may not be able to help them. And this is where I think Balance really does come into its own because you can really search and understand and what's relevant for you and hear about other people's experiences as well.

‍
Matt Jones: Yeah, and as I said before, I think it's so key when you when you struggle with how you feel and the kind of foundations of your normal existence get rattled that that need for data, that need for meaning and understanding is is quite intense. And and it's evident, clearly evident, that women have not been having that level of or the right level of information.

‍
Dr Louise Newson: No.
‍

Matt Jones: Until recently.
‍

Dr Louise Newson: And I was really frustrated this morning. There was something on the radio and someone was saying, Well, of course, menopause occurs at a time when women are struggling because they've got elderly relatives, they've got young children, and it's always this like excuse. But actually what no-one's thinking about is what about their hormonal change and why aren't we giving hormones back? And there is, people are still scared of HRT, they're scared of testosterone for women, yet, as your daughter knows, it's very easy to get contraception. So it's really incongruous. It doesn't make sense, but women are understanding it. But you know, we've got this global problem that all women will have hormonal changes and with time they'll all be menopausal, which we know is associated with health risks. We know all the guidelines, all the evidence is very clear that hormones, especially the natural body identical hormones, are first line treatment for women yet globally it's only 5% of women on average that are treated.
‍

Matt Jones: I don't it's crazy, isn't it? It doesn't make any sense.
‍

Dr Louise Newson: Did it shock you? Or like just did you realise it was that bad?
‍

Matt Jones: I I do. I like I said, I can't unsee it. You know, and I look back now, at my my life, my family, my wife, my ex wife, and I think there are so many things there that are potentially could have been helped and could have been different if there was a kind of a a keen awareness of what natural hormones can do for people. And that you get to an age where they start to naturally dissipate. And everyone thinks it's a natural process. And it may well be, because evolution doesn't care about people beyond a certain age. But fundamentally, I don't think it was you, but someone said if this was happening to a man it would have been fixed a long time ago.
‍

Dr Louise Newson: Yeah, of course it would.

‍
Matt Jones: And that I think is is the equity issue. That's that's the real thing that it kind of attracts me to this challenge and trying to make as big a difference as possible. You know, and I'm just about building an app, you know. I'm not I'm not I'm not going to change the world medically. But, you know, it it's for for me it's a it's a viable, worthy cause.

‍
Dr Louise Newson: It is mad. I mean, I play a lot of mind games with myself and I've, I read Matt Haig The Humans years ago and it's one of my favourite books. But I sometimes think about if I was a if I was an outer space person coming and just visiting the world for the first time and he talks about the madness of us getting dressed and doing sort of the routines that we do and even walking rather than crouching over and various things. It's a really great book. But I think, gosh, if someone had said to me there is a condition that might be a natural condition, but it affects half the population. We know that the majority of women will have symptoms affecting their mental health, their mood, their memory, their energy, their sleep. We know it's associated with an increased risk of diseases. We know most people will have vaginal dryness, soreness, so sex will be really painful. But we have a really cheap, available treatment that is safe, but the minority of women are given it. Like it it's just nonsense, isn't it?
‍

Matt Jones: It it it beggars belief. I can't square that one. If I was an alien I'd be saying, What the hell's going on?
‍

Dr Louise Newson: But that's where I think, I'm very interested in the history of medicine and I can see why things have happened for the wrong reasons and menopause has gone into the the wrong hands. You know, often people think about it as a gynaecological issue, it's about periods and it's not. But there have been other doctors that have really tried hard to do similar things to I've done and been really knocked down, and obviously I've been knocked down a lot. But I think what's different now is that we can access and educate people in ways that's right for them. So the way that technology is, the way that AI is, it's a double edged sword sometimes because you know, I can Google what are the risks of HRT and it will tell me incorrectly that all HRT has a risk of clot and heart disease and stroke, which I know it doesn't if it's body identical. So that's where the human touch with technology has got to almost always stay together.

‍
Matt Jones: Yeah, I I agree. And you know, we're we're talking about AI and how we might utilise that safely. It could massively help find patterns, insights, things that we might not necessarily see. But it can also help Balance, which is, you know, a free app ostensibly to limit its costs by automating some of the tasks that we don't need people to do. And you know, so there's there's a great utility in technology and you know, this challenge and the internet, you know, everybody knows the internet has created a knowledge explosion you know, and and consequently we're able to access people anywhere in the world providing they have access to a mobile or a laptop or an iPad. And they can get hold of this information and and educate themselves. You know, it doesn't matter really where they are, the problems that the medical issues will be the same. Now obviously the country might have different laws around hormones and therapies, but you know, I think over time when people start to rise up, the the equity issue and the productivity drain of women leaving the workforce, it just seems to again be overlooked. It's like, well surely that's a massive issue for all of our economies.

‍
Dr Louise Newson: Of course it is.
‍

Matt Jones: And you know, just I I think my wife said, it it's crazy. You know, I spent years getting to be an expert in my field and she also works in the NHS. She says I'm at the pinnacle of it and that the menopause came along and felt like it just robbed me of it. She's getting treatment now and that's working for her. So she's, she's not quite as desperate as she was when it first kicked off. But fundamentally, she still struggles. She's still having issues, you know, she's in it. And I think I think my understanding is she's gonna be in it probably for the rest of her life until she...
‍

Dr Louise Newson: Yeah, and that's why optimising hormones is so important. You know, a lot of women who come to our clinic already taking hormones, but they're just not on the right dose and type. And it can take a while, you know, we have to be really patient. And I know myself, you know, a few months ago I wasn't feeling right. And is it, is it what's going on? Is it, is it's the children or is it, is it my hormones? And it's really hard sometimes to know. And then, you know, I had a review, changed a dose of something, and then it's like, Wow, I feel amazing. This is great. And it it's all the time, but our hormones are constantly changing. So it, it's naive to think one dose is gonna help. But that's where, you know, knowing that it's safe, and I often say to patients, if we change your dose, you'll know within a, you know, quite soon. But if you want to stop, then you can do because it will come out of your system very quickly. It doesn't build up in your body. And there's all these myths and fears that are usually unfounded. But it's the confusion and then people don't know where to go. So we've got a lot we need to do and want to do with Balance and we I want to keep it free. We've got this Balance+ because it has to fund itself so that we can shape it in the way that we want to. But we've got lots of ideas for Blance+, haven't we?

‍
Matt Jones: Yeah, we do. You know, the the core purpose of Balance is to share information, but Balance+ is there for people that want a little bit more and can go a little bit deeper. We're looking at serialising content around themes and issues that we see in our data. Giving early previews to some of that. But also doing kind of content exchanges with with other kind of friendly adjacent creators with a view to giving a bit of added value back into the that, to that user base. And also, you know, any surplus to to help with the research effort that you're you're driving at the back of it all. So, you know, it it's it's it's trying to find value and give a good return on our users' investment in Balance+. And to make sure that there's a downstream kind of benefit for everyone that uses balance as it all kind of begins to become established and and flow outwards over time.

‍
Dr Louise Newson: [01:25:35] And it's really important because someone said to me a few years ago, look, Louise, why don't you just make it a pound a month for everybody? Because then you would have the finances to keep going with it. But I really pushed back. I fell out with a few people over it. But actually that wasn't the point of setting it up. And I really want to make sure because it's so hard, like as you know, the stories, it's so hard for women and I don't feel they need to pay for something that's giving, but it can really help and transform their lives.  [01:26:01][26.8]
‍

Matt Jones: Yeah. And you know, knowledge should be free. Yeah. Because it's power.
‍

Dr Louise Newson: Absolutely and and to make change, but I mean I the app has really good reviews from women, which is great, but we've been app of the day quite a few times, haven't we?
‍

Matt Jones: Yeah, we have indeed, yeah. Well over 150 in the last three years, I think.
‍

Dr Louise Newson: That's amazing, isn't it?
‍

Matt Jones: And it is quite incredible how it becomes app of the day around the world in countries that I don't even think we have users contributing as much as they could. But you know, so part of the reason we want to translate it because I think it deserves to be available in those countries. Yeah, it is it is staggering how it the app performs just without any real kind of underpinnings. It just manages to the right thing.
‍

Dr Louise Newson: Yeah. I mean I've never spent big money marketing it or anything. It's just evolved. And I think that's the power of women as well, because women share, women talk, women communicate and they want to help each other. So I really hope going forwards I can continue to be proud and even prouder of it. And obviously there's a lot of pressure on you, Matt, to do lots of things.
‍

Matt Jones: Yeah, including the user growth.
‍

Dr Louise Newson: Yeah, but it's an exciting journey though, isn't it?
‍

Matt Jones: Absolutely. Yeah. I mean given the size of the market it should be easy to get to meteoric levels of active users. But and given the subject matter and the fact that it's, it's like any lifelong thing. It it's gonna be there. People are gonna going to need it at different stages in their lives, especially as it broadens. So as you say it's not just about perimenopause and menopause, that's just where there's an acute problem. And I think there are others in in younger age groups.
‍

Dr Louise Newson: Absolutely, there's loads. You're going to have your work cut out, that's for sure. So before we finish, three take home tips. Now this is really easy for you because I am just going to ask you three reasons why people listening should all download the app. What, why would they do it?
‍

Matt Jones: So I think if you're perimenopausal and menopausal or think you might be, you'll find some trains of knowledge that will help you understand if you are and you'll be able to go and speak to your GP. If you are looking after or a loved one of somebody in that position, you can do the same. And you can also go there to find help about other menopause, sorry, other hormonal conditions and what to do about them and what the kind of symptoms might be, so you can begin to correlate and work out if it's there. So it's really about hormonal health of women and also propagating the understanding of that, not just amongst females and women, but amongst their partners and their loved ones and their colleagues and their employers.  You know it's really important that this stuff becomes totally destigmatised and absolutely normal to talk about. Because it is absolutely normal and it happens to every woman.
‍

Dr Louise Newson: Yeah. But we, this will help move the dial even more forward so people will not just be normalising the conversation but then thinking about action to really help. And that's when the change is going to happen. So thank you so much for coming. It's been great.
‍

Matt Jones: Thank you for having me.