Dr Louise Newson: Today on my podcast, I'm talking about education for healthcare professionals. A lot of my work is educating women and men about hormonal changes, but we have to educate healthcare professionals. Because if we don't, we're not going to move forwards. We're not going to help future health of women if we keep ignoring the importance of hormones. So today, Dr Rebecca Lewis, who co-founded the clinic, Balance app, our education, our research, she keeps me together. She's on the podcast talking about the importance of our education programme, which we've revamped, we've improved, we've updated. It's just a really exciting time for healthcare professionals to learn about hormones. Rebecca, this is not your first time on the podcast, but it's the first time in these lovely studios with Jack, who is the most amazing person. So I wanted to talk today about education because, well, for those people that don't know, first off, you and me founded the clinic. [01:00:59]

Dr Rebecca Lewis: [01:01:00] We did, yes. [01:01:00]

Dr Louise Newson: [01:01:01] Many years ago. And we founded Balance App many years ago. [01:01:06]

Dr Rebecca Lewis: [01:01:06] Yes. 2018 and 2019, that sort of era, wasn't it? [01:01:08]

Dr Louise Newson: [01:01:08] And we also founded News and Education. We also founded The Research. We also cemented our friendship. [01:01:18]

Dr Rebecca Lewis: [01:01:19] Yes. [01:01:19]

Dr Louise Newson: [01:01:20] Like we worked really hard. Yeah. And we were just talking before we started actually. Lots of people say you must never mix friendship with business. [01:01:31]

Dr Rebecca Lewis: [01:01:32] They do say that. [01:01:33]

Dr Louise Newson: [01:01:33] And I can see why. But actually you need people who really you can trust as well. [01:01:39]

Dr Rebecca Lewis: [01:01:39] Yeah. [01:01:39]

Dr Louise Newson: [01:01:40] And we totally trust each other. [01:01:41]

Dr Rebecca Lewis: [01:01:45] Well we know each other's brains pretty well. We're different personalities aren't we? But I think we complement each other really well and we know I can sort of second guess what you're going to say and and vice versa. [01:01:51]

Dr Louise Newson: [01:01:52] And we finish each other's sentences? [01:01:53]

Dr Rebecca Lewis: [01:01:54] Yes. [01:01:54]

Dr Louise Newson: [01:01:54] Which is really lucky. I mean, honestly, I'm so lucky having you. [01:01:58]

Dr Rebecca Lewis: [01:01:58] Oh likewise. [01:01:58]

Dr Louise Newson: [01:01:59] And I have said it publicly before, but I would, I know and I'm not just saying it for attention, I would have given up many times if I hadn't had you on the end of the phone because, you know, what we're doing is really hard. Really difficult. And I didn't think it would be this hard, you know. [01:02:12]

Dr Rebecca Lewis: [01:02:12] No. [01:02:12]

Dr Louise Newson: [01:02:12] I'm from a very academic background, I'm from a medical background, lots I've worked with, you know, really top type A cardiologists. I've worked with surgeons, I've worked with all sorts, you've been an anaesthetist for many years. You know, really hard being a woman in medicine and you've been, you've had all sorts of comments when you were a junior anaesthetist by females usually. I've had...but you keep going because, but somehow when it's about women and hormones, it's become really toxic and horrible. Like I've never, since I've been at school when I was bullied, I've never had this it's hostility really. It's very very strange, isn't it? [01:02:51]

Dr Rebecca Lewis: [01:02:52] Extraordinary. [01:02:52]

Dr Louise Newson: [01:02:53] Yeah. [01:02:53]

Dr Rebecca Lewis: [01:02:54] Absolutely extraordinary when we're really trying to help women and improve the lives of of women. It's really simple. People should be greeting it with oh great. This is really pushing the envelope and and changing things because there's been so much damage over the years. [01:03:09]

Dr Louise Newson: [01:03:09] Well there has. [01:03:09]

Dr Rebecca Lewis: [01:03:10] We have to rectify it. And you know, but people don't want to hear. Perhaps they're wrong. They really find that challenging. And it's always been so actually. If you look in the history of of hormones, I mean, I know you know an enormous amount about that, but you know, people who've had new ideas or actually not new ideas, but just looked at the evidence properly and say, hang on, this is really beneficial treatment for women, hormonal treatment. They've had massive pushback. You know, we can name the names that's, that have happened. Because I don't, I can't understand why. [01:03:43]

Dr Louise Newson: [01:03:44] No. [01:03:44]

Dr Rebecca Lewis: [01:03:44] But it's really toxic for women. [01:03:46]

Dr Louise Newson: [01:03:46] Yes, so this is the thing. So we both went into medicine to help people. And when I set up the clinic, well, initially on my own, I was just renting a room and then I said to you, please can you see some patients? [01:03:57]

Dr Rebecca Lewis: [01:03:57] Yes. [01:03:57]

Dr Louise Newson: [01:03:58] And you know, what we know now, actually, and how we practise medicine and hormone medicine is very different to how it was even eight, nine years ago. Because we've learned in two ways, but in parallel, we've learned more about the scientific evidence. [01:04:13]

Dr Rebecca Lewis: [01:04:14] Yes. [01:04:14]

Dr Louise Newson: [01:04:15] And basic physiology about hormones, but we've also learnt from our patients Now we run a very big clinic. We see thousands of women but we're communicating all the time with our clinicians who work with us. And we're constantly changing our pathways in our clinic, changing our knowledge. I, I often run in to your room on a Monday and say, I've just oh, I've just seen this patient. What do you think? Do you think this is right? And you say, Oh yes. And we learn a lot, don't we? [01:04:41]

Dr Rebecca Lewis: [01:04:41] Oh, completely. I mean, for me, this distils what medicine is. It's the art of medicine, which I find so much more interesting and rewarding. Because, and it and it distils what evidence-based medicine means. Because evidence-based medicine is not based purely on academic papers, you know, it's one of my, my topics, isn't it? It is based on academic papers. It is also based on biological plausibility. So understanding physiology, understanding how hormones work in the body. It's also based on clinical experience. And particularly in our field, when there haven't been enough studies, it's been neglected and underfunded for years. The, the evidence we have is limited to a certain extent, or they're too small a study. But if we keep going back to the evidence, we get the same answers and we don't move forward. What we have to do, and I tell, say this to patients, look, you've come to see me because you've come to see a physician, not a computer. And what we're going to do is really tailor your HRT, if that's what they're on, for you and make it right for you. And that is where the art comes in. [01:05:50]

Dr Louise Newson: [01:05:51] Yeah. [01:05:51]

Dr Rebecca Lewis: [01:05:51] And transferring that sort of knowledge to other people is is is hugely rewarding. But actually seeing the benefits and seeing how patients respond, the individuality for a start. But actually how rewarding it is. It's the most rewarding medicine I've done actually in this field. [01:06:06]

Dr Louise Newson: [01:06:06] It's incredible. And, and so this is why education of other healthcare professionals is really important. You know, I'm not protective about my knowledge, as hopefully people listening know. I'm very happy to share it, not just to women, but also to healthcare professionals. And, you know, when I started to learn more and more about hormones, I, I've been in medical education for many years, but I sort of reflected as to how am I going to teach in a best way? Because when I was doing my MRCP, so member of the Royal College of Physicians, there's a part one and apart two. Part one is a, is a multiple choice. You have to be like a machine and it's negative marking. As you know, you get a plus one for right and a minus one for wrong. So it's hard. It's really tough. And they're very obscure questions. Things, they ask really weird questions. You'll never see patients with some of those conditions, but you have to know. So I spent hours, and as you know, I can spend hours working, but I spent hours going through past papers. I went to lots of courses where you're in a big lecture theatre and you're just learning by rote, learning by rote. And that was wonderful for that exam. Part two is a practical where you have to examine, it's like a theatre show. You have to examine the patient, but you have to show like all your knowledge. So when you're listening to the heart, you really have to make a big, so it's... [01:07:32]

Dr Rebecca Lewis: [01:07:32] A big flourish. It's almost like your driving test, isn't it? Really looking in the mirror. [01:07:36]

Dr Rebecca Lewis: [01:07:36] And so I spent a lot of time around the bedside with really amazing people in Manchester. And I always was saying, Oh, just stay behind another half an hour, just teach me how to do really good cardiovascular examination or really good neurology, all those reflexes. It was, it's a craft. And and you see, back then we didn't have the scans that people have now, or it was harder to get a scan. So you had to really, really examine well. [01:08:00]

Dr Rebecca Lewis: [01:08:00] Yes. But then with hormones, I spent a lot of time, as you know, unpicking the literature, writing academically, writing and summarising guidelines, which is great for the foundations. But then when I started the clinic and thought, well, I want to educate more people, I thought, Well, how did I learn the most? Well, actually I learnt the most by sitting in other people's clinics. [01:08:24]

Dr Rebecca Lewis: [01:08:25] Yeah. You know, late Professor John Studd, I was really nervous when I went to his clinic. I got, I asked my mum to look after the children they were young, it was in the summer holidays, it was many, many years ago. He was quite a formidable person, he was very tall physically, he had a certain way with patients, but he was very clever. And I sat there and I just watched what he was doing. And after every patient said to him, But why are you doing that? Why are you giving this dose? Why are you doing that? Why are you starting this? And he was so lovely because he did answer all my questions. And I sat in other people's clinics and then I've become very inquisitive. But then we had people sitting in our clinic initially, but you can't teach thousands of people in that way, can you? It's impossible. [01:09:06]

Dr Rebecca Lewis: [01:09:06] No, but it is the best way to learn, isn't it? Because you see it in front of you. [01:09:10]

Dr Louise Newson: [01:09:10] Yeah, and then also, you know, we're we're busy as doctors, you have a limited time and limited finances to study. [01:09:16]

Dr Rebecca Lewis: [01:09:17] Yeah. [01:09:17]

Dr Louise Newson: [01:09:18] So then I thought, well actually people need to know the basics. Great. That can belecture given, but people have to know this art, like you're saying. And so we decided to do two things, didn't we? We ran this Confidence in Menopause day that we divided into four big lectures, lots of lots of answers, where we talked about the basics of hormones, how they work. We talked about the health risks of not having hormones, so with menopause. We talked about HRT, the different hormones, including testosterone and vaginal hormones, how they work. And we talked about cases to talk through. And that went really well, but it still didn't feel enough. So then we decided to film consultations, didn't we? [01:09:59]

Dr Rebecca Lewis: [01:10:00] Yeah, I think that was the changing point really. We weren't really down that down well that lecture. But actually seeing a patient in front of you is like trying to replicate your experience with with Professor Studd. It is. And you can hear their own, their own words and you can just imagine yourself there. [01:10:17]

Dr Louise Newson: [01:10:18] We had some actors who came in and we gave them little scripts and scenarios and we did some role playing. And I was actually quite nervous because we used to video our consultations as part of our Royal College of GPs. [01:10:29]

Dr Rebecca Lewis: [01:10:29] Yes. [01:10:29]

Dr Louise Newson: [01:10:30] Exam. But then they were really critical on our, on our consultation technique. [01:10:34]

Dr Rebecca Lewis: [01:10:35] Yeah. [01:10:35]

Dr Louise Newson: [01:10:35] You know, do I introduce myself, am I kind? Am I asking you the right questions? Am I, you know, all that. [01:10:40]

Dr Rebecca Lewis: [01:10:40] Absolutely. [01:10:40]

Dr Louise Newson: [01:10:41] But actually the consultations we filmed was more about this art of bringing the patient in, making sure that they had time to talk about their symptoms, to clarify any questions, but also to show other clinicians how to prescribe, how to talk, how to talk about uncertainty, how to talk about benefits versus risk. [01:11:02]

Dr Rebecca Lewis: [01:11:03] Yeah. [01:11:03]

Dr Louise Newson: [01:11:03] Long term health benefits of hormones. All of that. [01:11:06]

Dr Rebecca Lewis: [01:11:06] Yeah. And I think actually being a GP has really helped me in that skill, hasn't it? Because we're used to so many different conditions. We deal with uncertainty all the time, it's part of our job. And actually our communication skills really should be very good as a, as a GP. And I think menopause, therefore, is so well suited for the general practitioner. [01:11:28]

Dr Louise Newson: [01:11:29] But I think people also get very scared because there's no diagnostic test. [01:11:32]

Dr Rebecca Lewis: [01:11:33] Yes. [01:11:33]

Dr Louise Newson: [01:11:33] You know, it's talking about doing the MRCP. You do all these tendons and you do a heart. If you listen you've got a murmur. Well you know that they need an echo, you know they might need an operation or whatever. Somehow it's a bit oh, they've got headaches. Could it be migraines? Could it be a brain tumour? Could it be hormones? But we're used to asking and asking and asking and and most of the diagnosis is always in the history, isn't it? [01:11:57]

Dr Rebecca Lewis: [01:11:58] Always. I mean we were taught that weren't we when we're training. Yeah, I think it's like 90% is from the history. [01:12:03]

Dr Louise Newson: [01:12:03] Yes, but only if you ask the right questions. [01:12:05]

Dr Rebecca Lewis: [01:12:05] Yes, of course. [01:12:06]

Dr Louise Newson: [01:12:06] And this is where I realised as a GP my questions were quite closed because I didn't have the symptom questionnaire. [01:12:12]

Dr Rebecca Lewis: [01:12:13] Yes. [01:12:13]

Dr Louise Newson: [01:12:13] So if someone came in with itchy skin I would only focus on the skin. [01:12:14]

Dr Rebecca Lewis: [01:12:18] Well we also only have ten minutes, don't we? So yes, immediately they're sort of we're into dermatological sort of scenarios in our brains. [01:12:25]

Dr Louise Newson: [01:12:25] So why would you ask about palpitations or headaches or flushes or sweats or whatever? Because you wouldn't be thinking about hormones. [01:12:31]

Dr Rebecca Lewis: [01:12:32] Yes. [01:12:32][0.0]

Dr Louise Newson: [01:12:32] And so all our consultations we filmed started with the symptom questionnaire. And started with the patient almost working it out, which made it a lot easier. So when we did this it was great, but I didn't have like a platform to put it on and I needed somewhere that we would get a good reach of doctors and also it would be technically quite easy for them to access and and watch and everything. I ended up partnering with Fourteen Fish. [01:12:57]

Dr Rebecca Lewis: [01:12:58] Yes. [01:12:58]

Dr Louise Newson: [01:12:58] Which was an appraisal company actually. So doctors did their annual appraisal through Fourteen Fish. Really amazing company. So they had lots and lots of differentvideos, lots of different education. And Mark Coombe, who was the education director, who used to work with the Royal College of GPs as well, said this is brilliant. So we put it on and we charged a small amount, didn't we? And we gotreally good feedback. [01:13:23]

Dr Rebecca Lewis: [01:13:23] Absolutely. And to start with we didn't charge actually. [01:13:25]

Dr Louise Newson: [01:13:26] Well no we we did and then we changed because the Davina documentary, do you remember, it came out? So, so we were charging a small amount because we had to cover our costs. Because we don't do anything that's funded by pharmaceutical companies. So we needed to cover our costs. So we did it. And then as you know I was very heavily involved with the Davina documentary with Kate Muir. [01:13:46]

Dr Rebecca Lewis: [01:13:47] Yes. [01:13:47]

Dr Louise Newson: [01:13:47] And I knew that one of the statements from the Royal College of GPs, because they were approached by Kate Muir's team to ask about education for GPs. And the Royal College of GPs said, improving education for GPs is unworkable. [01:14:01]

Dr Rebecca Lewis: [01:14:02] Gosh. [01:14:02]

Dr Louise Newson: [01:14:03] And they were the quotes and they used that, you know, if any of you watched the programme who's listening, you you might remember it and it was that. So I knew it was that was coming out. So do you remember me saying Do you know what people really need to know because this programme is going to really show the enormity of poor menopause care in the UK. So we said let's make it free to every GP practice. We'll do one free for every GP practice and let's see the response because I feel really embarrassed that we spent the money. Let's just get it out to people. And after the programme it was huge, wasn't it? [01:14:36]

Dr Rebecca Lewis: [01:14:37] Yes, it was. I mean the response was amazing. [01:14:38]

Dr Louise Newson: [01:14:38] We had so many people. And this was before COVID when we first launched the programme. [01:14:44]

Dr Rebecca Lewis: [01:14:44] Yes. [01:14:44]

Dr Louise Newson: [01:14:45] The education programme. So it was very unusual to do remote learning actually, because itwas all face to face, wasn't it, before? [01:14:51]

Dr Rebecca Lewis: [01:14:52] That's right. [01:14:52]

Dr Louise Newson: [01:14:52] And I know people were thinking, Oh, but actually they liked being able to just watch a ten-minute consultation at home. [01:14:58]

Dr Rebecca Lewis: [01:14:58] I know it wasn't [01:14:58]

Dr Rebecca Lewis: [01:14:58] I know. It wasn't some dry lecture for eight hours. You could just take snippets and modules and if you have family life at home, you know, you could just do a little half hour here and there and add it up. [01:15:08]

Dr Louise Newson: [01:15:09] And, and I think what happens also because we had, you know, Mrs smith with migraine, Mrs Bloggs who was young with POI premature ovarian insufficiency. In fact, my mum was one of the actors. [01:15:20]

Dr Rebecca Lewis: [01:15:21] She was. [01:15:21]

Dr Louise Newson: [01:15:22] She was so funny.[01:15:22]

Dr Rebecca Lewis: [01:15:22] Yes, and I was interviewing her. [01:15:23]

Dr Louise Newson: [01:15:23] With her Welsh accent. [01:15:24]

Dr Rebecca Lewis: [01:15:24] And she had a Welsh accent, and I dipped into a Welsh accent, embarrassingly, as well. [01:15:29]

Dr Louise Newson: [01:15:29] And she, she was different scenarios. So she was someone who had urinary tract infections. She was someone that wanted to start hormones at an older age. You know, she was and, and actually it was it was great. It was a lot of fun doing it. But it meant that if I was a doctor, well, I am a doctor, but if I was a GP, didn't know so much about hormones, I'd seen a lady with urinary tract infections that day and I was thinking, Well, I'm not sure about vaginal hormones, I could watch that little consultation. And we'd linked it to patient resources, we'd linked it to all the evidence. [01:15:58]

Dr Rebecca Lewis: [01:15:59] Yes. [01:15:59]

Dr Louise Newson: [01:16:00] And then people were just, the feedback was phenomenal actually. [01:16:02]

Dr Rebecca Lewis: [01:16:03] Well it's in your memory then, isn't it? Because you're memorising the, the two people there, you remember the consultation, you remember it much easier to remember than a dry old lecture. I think and you know, we're talking the same language, both GPs. We we wrote this for other GPs or healthcare professionals and so...[01:16:20]

Dr Louise Newson: [01:16:20] So it was great and I remember going to the, I've tried to go to the Royal College of GP's annual conference and usually we present some of our research there and I remember going and like people stopping me. Do you remember we were both together and people stopping us and saying, I'd just like to say thank you. [01:16:34]

Dr Rebecca Lewis: [01:16:35] I know. [01:16:35]

Dr Louise Newson: [01:16:35] And we were like what? [01:16:36]

[01:16:36] I know. Especially the younger generation actually were really interested. Thank you so much. And they were they were great fans. [01:16:43]

Dr Louise Newson: [01:16:44] And saying you've transformed the way we practise, I used to be scared of hormones and now I'm prescribing. But they also said but when women come back, they're so happy, they're so grateful, they're so much healthier. [01:16:54]

Dr Rebecca Lewis: [01:16:55] Well it's the reason they went into medicine. I mean this this will make women much better. So they they all enjoy learning. [01:17:01]

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Dr Louise Newson: [01:18:32] So it went very well and we had like tens of thousands of people who downloaded it with phenomenal response, not just from GPs but from nurses and pharmacists and some other specialties. [01:18:44]

Dr Rebecca Lewis: [01:18:45] Yeah. [01:18:45]

Dr Louise Newson: [01:18:45] But then sadly, really, and it I think it is sad and quite tragic, that Fourteen Fish was taken over by another company, EMIS, which is a very big company that do a lot of the computer systems, the software for GPs. And somebody, and I'm not pointing any fingers, but there was a body of healthcare professionals who went to EMIS and said, We're concerned about this course because it doesn't, it doesn't work out of the guidelines. And so I remember because I was doing a webinar that evening, and literally just before I logged on, like ten minutes early for the webinar, I got, I looked on Twitter, well, it was Twitter then, it's now X. People saying, Where's where's the where's the Fourteen Fish menopause course? Where's it gone? Where's it gone? And I was like, What? And I got a text from Duncan, who was the CEO of Fourteen Fish, and said, Louise, didn't you know your programme's been taken down? And I phoned him very quickly I said I've only got five minutes Duncan, can I just about to do a webinar, but what's happened? He said, Oh, you need to speak to EMIS, but they've taken it down. So the next day I spoke to them and said, Well, what's happened? They said, Oh, we, some medical society phoned us and said that it doesn't it's not in line with the guidance, so we've taken it down. It's absolute rubbish. And I said, Wellwhere, which guidelines? Whereabouts? I don't understand. We work out of evidence and guidelines and I said, If you watched it, they said no. But if you want another conversation with us, you go to lawyers. What? Honestly, do your remember and I phoned you and I was... [01:20:17][91.5]

Dr Rebecca Lewis: [01:20:17] Based on absolute rubbish. [01:20:18]

Dr Louise Newson: [01:20:20] Nothing. And and they're a big organisation, so you can you, you know we... So I was like, what on earth do we do? Like it was really the, I can't even begin to explain the hours that we put into it and... [01:20:30]

Dr Rebecca Lewis: [01:20:31] So long. [01:20:31]

Dr Louise Newson: [01:20:32] And it was just it was so awful. So we worked really hard to try and get it back. We put it on another platform. But it almost then the damage started to be done for women because people then thought something was wrong with the way that I was teaching. [01:20:45]

Dr Rebecca Lewis: [01:20:46] They thought something wrong with, yes with all of us really, didn't they? That we don't follow guidelines. I mean it's it's rubbish. NICE guidance is you know, we happen to follow that completely. [01:20:55]

Dr Louise Newson: [01:20:56] Well NICE guidance... [01:20:56]

Dr Rebecca Lewis: [01:20:57] Don't mention doses in there. [01:20:58]

Dr Louise Newson: [01:20:58] There's two really, yeah, precisely. So you've got NICE menopause guidance which have recently been updated since this happened, but they're very clear about individualisation of care. [01:21:06]

Dr Rebecca Lewis: [01:21:07] Correct. [01:21:07]

Dr Louise Newson: [01:21:07] They don't talk about the numbers of you know the doses at all. [01:21:10]

Dr Rebecca Lewis: [01:21:11] No, no. [01:21:11]

Dr Louise Newson: [01:21:12] They talk about we're treating for symptoms. But also the other guidelines which I think are crucially important with this conversation are the shared decision making guidelines. [01:21:21]

Dr Rebecca Lewis: [01:21:21] Yes. [01:21:21]

Dr Louise Newson: [01:21:22] Because even as a doctor, if a patient wants a treatment that might have more risks than you believe, then they can still choose that treatment. So if I said to you, Rebecca you know, I don't think you should have antidepressants because I don't think you're clinically depressed and there's risks with them and you say, Well, do you know what... [01:21:40]

Dr Rebecca Lewis: [01:21:40] I'm convinced I am, I really want to try them please. [01:21:41]

Dr Louise Newson: [01:21:41] Because I really want them and I want to try them. We would have a very considered consultation. We might agree to disagree, but you are allowed to be, you know, involved in the decision making. [01:21:50]

Dr Rebecca Lewis: [01:21:50] Yes. Absolutely. [01:21:51]

Dr Louise Newson: [01:21:51] So so anyway, I was really, really shocked. So we we've moved it and and since then we're moving it to a another platform, but we're also updating it as well because I feel very strongly that we can't be stopped by others that don't agree with what we're doing. [01:22:06]

Dr Rebecca Lewis: [01:22:07] Absolutely. And it's so destructive for women because the the GPs were really delighted to learn on there. And they were communicating with us and we were guiding them a little bit. There was a question and answer session they could have and they love that. It's just a quick question, can you just give me advice on this? And one of our doctors, you know, they rotated it. To help an answer things. [01:22:28]

Dr Louise Newson: [01:22:28] And we did this for free. So it was like an advice and guidance. People would contact us and say I've just seen a lady who's 23. Could she have hormonal changes? I've just seen a lady who's 63, she wants to start HRT. What would you suggest? And it really people loved that. Because it meant they didn't have to come to the clinic. It really empowered them. And now we feel like there's this void really. I mean, there is some menopause education, but the people that do this are different people, different organisations that do it, but they're got, they're all are all funded by pharma, although pharma supposedly don't have any editorial role with their programmes, it it still some pharma influence. [01:23:09]

Dr Rebecca Lewis: [01:23:10] You know, every GP has missed out on education because of the WHI report in 2000. And so they weren't educated in medical school. So actually we need something that's really accessible, not horrendously expensive to educate GPs. And that was always our mission at the beginning. I mean you were you're brilliant at educating women. And in fact, so much so that I've just had a really busy clinic. And four, four out of you know, five women constantly say, Do you know what? I feel I know more than my own clinician. My own GP. They have huge respect for their GP because they're brilliant, say going to see them about their diabetes, their heart disease. They're really well respected, clever doctors. But, but they don't know about menopause. Like actually, I didn't really know about the the impact of hormones on women until we got together and we learnt and we studied and saw the transformational effects when they're treated properly. So this was part of our, you know, educate women to understand. I think you've done that brilliantly. But then we wanted to close the loop so that they that they could go to their GP and have a good conversation so that we hope that there would be two people in that room who would understand about hormones and why they're symptoms are due to hormonal change. [01:24:32]

Dr Louise Newson: [01:24:32] Absolutely. So then the new updated version of course is even better actually because we've got more consultations, More doctors involved. We've got lectures from other people that people can watch. There's a lot more just talking about our experience clinically as well. Basing on the evidence and since we started the education programme we've actually published quite a lot of data as well, which is really important. But we've also like I said at the beginning, we've learnt a lot from our patients. So we started calling the course Confidence in Menopause. But we want to be thinking about confidence in hormones for women. Because obviously we we talk a lot, menopause, perimenopause often go together. But actually PMS, PMDD, so premenstrual syndrome, premenstrual dysphoric disorder, postnatal depression, even PCOS, polycystic ovarian syndrome, we'rerealising these are all due to hormonal changes. Symptoms are the same, whether it's a hormonal change due to menopause or PMDD. It's associated. [01:25:42]

Dr Rebecca Lewis: [01:25:42] Low hormones really. [01:25:42]

Dr Louise Newson: [01:25:43] Yeah, absolutely. And that's what you were saying about people in the past, like Katharina Dalton. Amazing work about progesterone that we weren't taught about. So we didn't know. [01:25:54]

Dr Rebecca Lewis: [01:25:54] No. [01:25:54]

Dr Louise Newson: [01:25:54] But we've learnt, we've read, we've changed our practice. But now we want to share what we've learnt. That's associated with the basic science and clinical practice toothers. And you know, I think it's, it's just a shame because medicine advances, knowledge changes, guidelines are updated, education improves. Whereas for health of women and hormones, we're just stuck in the mud aren't we? [01:26:21]

Dr Rebecca Lewis: [01:26:22] It's actually gone backwards in the last few years actually. [01:26:24]

Dr Louise Newson: [01:26:25] Yeah. [01:26:25]

Dr Rebecca Lewis: [01:26:25] I think we were seeing a real traction when we first started out and we were really getting some improvements. But actually with recent events it's, it's gone, it's gone backwards. GPs have become more scared. They're feel much more restricted in what they can do. They feel that they will be sued. I don't know what it is, it's ridiculous. [01:26:43]

Dr Louise Newson: [01:26:43] No, I mean they're petrified of hormones, which is crazy actually. We prescribe a lot of off label doses, we prescribe a lot of off licence medication. [01:26:50]

Dr Rebecca Lewis: [01:26:51] We've done that all our lives as GPs. [01:26:52]

Dr Louise Newson: [01:26:53] I mean, as an anaesthetist, most of the things you gave are probably not licensed. But we're used to that. But so, you know, Panorama, the effect of our education being taken down, all of these things have made a negative effect on women. But I want to end talking about some good news because The FDA announcement. So in America the FDA have taken off their black box warning. We don't have the same black box warning. [01:27:19]

Dr Rebecca Lewis: [01:27:20]Can I just say you in particular have been campaigning for this what, ten years? In our own country, to to deaf ears, really. But you have been going you know, and we all agree because I've had patients you know, who won't take their medication because of the warnings written down. [01:27:36]

Dr Louise Newson: [01:27:38]So we don't have the black box, but we still have the warnings. You know, we all see if we open any of our hormones, it will say risk of clot, risk of heart attack, risk of breast cancer. It's just... [01:27:48]

Dr Rebecca Lewis: [01:27:48]Wrong, wrong, wrong. [01:27:49]

[01:27:50]Wrong, wrong, wrong. And so what's been wonderful for us is and and and women is that the FDA have really clearly they've looked at the evidence and they're basically saying estrogen is safe. We don't need to have these warnings. And that's really, really reassuring. [01:28:06]

Dr Rebecca Lewis: [01:28:08]It's a massive thing. It's a real change. You know, America, they were the country that sort of developed the WHI and the disaster from that. I think it's quite nice actually that they are actually making some improvements. It's almost I think they did say I'm sorry, we're sorry. [01:28:23]

Dr Louise Newson: [01:28:24]Well they did. [01:28:24]

Dr Rebecca Lewis: [01:28:25]It's good they've recognised that at last. [01:28:26]

Dr Louise Newson: [01:28:27]Yeah, absolutely. And they talk about, you know, we're sorry for the millions, this is millions of women who have suffered by not having hormones. And so one of the things in the education programme we do talk about is the risk of not having hormone replacement. So not having progesterone, not having estradiol...[01:28:44]

Dr Rebecca Lewis: [01:28:44]Not having the right levels of them. [01:28:47]

Dr Louise Newson: [01:28:47]Not having testosterone, and the right doses. Absolutely, it's really crucial that we wakeup and think about the health risks. [01:28:53]

Dr Rebecca Lewis: [01:28:54]Yes. [01:28:54]

Dr Louise Newson: [01:28:54] But also the education course is led by GPs like us. Because we're thinking very holistically and we want to bring in other specialties, so cardiologists, neurologists, rheumatologists. [01:29:05]

Dr Rebecca Lewis: [01:29:08] Every doctor, whatever your speciality, you're going to be touching on hormones for every patient. You need to know about it. [01:29:14]

Dr Louise Newson: [01:29:14] And we need to we need to show people our, our knowledge as well because, you know, for many years menopause has been sort of given to gynaecologists and some people listening might know, but when you train as a gynaecologist, generally you just do a year of medicine as a very junior doctor and then you go straight into gynaecology. So a lot of gynaecologists haven't been trained in cardiovascular health, osteoporosis, bone health. [01:29:39]

Dr Rebecca Lewis: [01:29:39] No. [01:29:39]

Dr Louise Newson: [01:29:40] Brain health. You know, they haven't done the different specialties. [01:29:41]

Dr Rebecca Lewis: [01:29:42] No. [01:29:42]

Dr Louise Newson: [01:29:43] And then they literally see hormone changes through the lens of a gynaecologist, which is basically... [01:29:49]

Dr Rebecca Lewis: [01:29:50] The womb. [01:29:51]

Dr Louise Newson: [01:29:51] The gynae, the womb and the bleeding or whatever. [01:29:52]

Dr Rebecca Lewis: [01:29:53] Yes, exactly. [01:29:53]

Dr Louise Newson: [01:29:53] Whereas we see it affecting every organ. [01:29:54]

Dr Rebecca Lewis: [01:29:56] It's a multi-organ problem, isn't it? It's a multisystem problem. [01:29:59]

Dr Louise Newson: [01:29:59] Absolutely. [01:29:59]

Dr Rebecca Lewis: [01:30:00] And I think that's why GPs are so good at that, because they they deal with that day in and day out. [01:30:05]

Dr Louise Newson: [01:30:05] Absolutely. So I'm really looking forward to how the education programme, we can really go for it. [01:30:11]

Dr Rebecca Lewis: [01:30:11] Yes. [01:30:11]

Dr Louise Newson: [01:30:12] And we've got great teams supporting us this time. I feel that we're stronger. [01:30:15]

Dr Rebecca Lewis: [01:30:16] Yes. [01:30:16]

Dr Louise Newson: [01:30:17] I feel like we can't be taken down like we were before and so... [01:30:20]

Dr Rebecca Lewis: [01:30:20] Definitely not. [01:30:21]

Dr Louise Newson: [01:30:21] It's great. It's exciting times. [01:30:22]

Dr Rebecca Lewis: [01:30:22] Oh, it's really exciting, you know. I think I think all these changes and positive changes with the FDA announcement, it's a real sort of a, a global awakening, if you like. About, actually, hang on. These hormones are really important to women. And women deserve the right to understand that and make their own choice. [01:30:40]

Dr Louise Newson: [01:30:40] Of course. [01:30:40]

Dr Rebecca Lewis: [01:30:40] If they don't want the hormones, that's fine, but make it based on correct evidence and choice. [01:30:45]

Dr Louise Newson: [01:30:47] So three things that I want to ask you. So there's quite a few healthcare professionals thatlisten to this podcast. [01:30:52]

Dr Rebecca Lewis: [01:30:52] Yes. [01:30:52]

Dr Louise Newson: [01:30:53] I know a lot of women, men even who are listening. You can all share this episode with your healthcare providers. So three reasons why healthcare professionals should be doing our course. [01:31:05][12.0]

Dr Rebecca Lewis: [01:31:05] Because they'll be dealing with hormones all the time. They may know about the fact that they're dealing with hormones like GPs, or they may not, like rheumatologists and psychiatrists. So if you see women in a medical capacity, you need to do the course because it will touch your specialty. Because so much misinformation, number two is so much misinformation over the years. And people haven't had a chance to be taught because the medical schools didn't even have it really on the curriculum, maybe an hour's lecture. So this is a chance to understand why. Number three, you want your patients to get better. It's the most rewarding medicine I've ever done. It's the safest medication I've ever prescribed. And as I said, the most the most rewarding, not not every single person, but the vast, vast majority get so much better when their hormones are balanced. And I think this is really important as a doctor. It's exactly what you want to see. [01:32:02]

Dr Louise Newson: [01:32:03] Brilliant. Thankyou so much. And thanks for coming again. [01:32:06]

Dr Rebecca Lewis: [01:32:07] Thank you, Louise. [01:32:08]