Dr Louise Newson - It's Hormones. Period. | The Imperfects

The Imperfects is not a substitute for professional health advice, treatment or assessment.

This episode contains a discussion about hormones and HRT, and the advice given in this episode is general in nature.

If you're interested in understanding more about your individual needs and any potential risk that may pertain to you, please see a doctor or a trusted healthcare professional.

My name's Hugh. I'm a co -host on The Imperfects.

I'm the son of Sri Lankan and English immigrants, and I call Australia home.

We at The Imperfects acknowledge the Wurundjeri people of the Kulin nation as the traditional owners of the land on which this podcast is recorded and we extend our respects to the elders past and present.

I've spent much of the last decade traveling around this country sharing stories.

In doing so, I acknowledge and pay homage to the Aboriginal and Torres Strait Islander people's rich history of storytelling.

I also acknowledge that whenever I talk about or practice resilience, there is no greater example than the one set by the world's oldest living culture.

For lots of women, it's not just those three days, it's the rest Most of the month, they're dreading those three days coming.

So what happens if I'm in a meeting?

What happens if I'm in an interview?

What happens if I'm at school and I've got an exam going on?

And we've known that since the 60s that girls who have PMS, are you most girls, perform worse in their exams the days before their periods.

The teachers don't teach as well the days before their periods, but it's just being normalized because as women, we just like put up and shut up, don't we?

And that's just got on with it.

Hello and welcome to That Time of the Month again for the Academy of Imperfection, where experts in their field share their wisdom on the subject of imperfection.

Today fellow Brit, Dr Louise Newson returns to chat all about hormones.

So join students Hugh, Ryan and Josh in the Academy of Imperfection.

I'm going to start with a question, Dr. Louise Newsome, do you know who Sir Donald Bradman is?

No. Oh okay, Sir Donald Bradman is statistically - This is not what I expected to start today!

No, no, he's totally fine but he's statistically the greatest cricketer of all time and I was just thinking of him because you are back with us and statistically speaking, last year you were the most shared episode in Australia on Apple Podcast. Oh good I panicked then.

thought you thought this was a different guest. Head coach of the Australian Cricket Team.

And I just feel like we're with the Don Bradman of podcasting here.

So, Donald Bradman has a wonderful story for you, if you would like to look it up.

Say her actual name.

Dr. Louise Newson it is so wonderful to have you back.

Your episode with us last year, anecdotal feedback from hundreds of people.

Not just life changing, but life saving.

So we are so excited to have you back.

Well, I'm super excited to be back in Australia, Melbourne, but here with you guys, in fact, seeing the third member of your team.

For the first time.

Yeah, yeah, definitely.

Josh wasn't here last time.

Yeah, and I signed a bridge, I started listening to last year's ep, and I had forgotten, cause I'd loved that ep so much and the information, the way you delivered it resonated so much with me.

I assumed I was here.

And then I like, listened back and I realized I wasn't in the room.

So it's nice to meet you.

I did a podcast for the first time for you.

Wow. God, there's just so much. There's so much to talk about.

So I mean, last time when you were on your, we obviously covered perimenopause and menopause, which as Hugh said, and you've obviously experienced is like, it's reached so many women and men and it's just educated all of us, but today we're going to focus more on hormones.

Great, yeah. Great.

Now are we gonna do a re -bio?

I'd like to I do bio if that's okay.

But, I've found myself really, when people say menopause I've been saying, like the menopause.

Do you remember that?

Oh no, because you educated me last time, honestly.

Because I said the menopause and you said you don't say the diabetes.

So I've changed my whole team.

Oh my gosh. My whole team are like take out the...

So every time I say the menopause, the perimonopause, we've been deleted yet.

And I think about you every day when I do it.

Oh gosh. That's a lot of pressure.

Yeah, of course it is.

Don't feel like you need to incorporate Donald Bradman stats into everything.

No, I might not. I might not do that if that's OK.

Team there's a new thing that Hugh told me to do.

Donald Bradman. Look him up.

He will be the new metaphor for everything we do now.

I've got a really open mind and I'm always thinking about how to improve, how to change.

A lot of people as you know don't like change, but I quite embrace it.

So when you said, I've never thought about that.

That's really good.

But you would say, sorry to do this, I don't want to do it.

She's already changed all the documentation.

Don't put the V back.

You would say, I have the flu.

No, you'd say, I have man flu.

And I'd barely be able to speak.

I'd be lying. Anyway, Dr. Louise Knudsen is a GP, menopause specialist and bestselling author with over three decades of clinical experience.

She's made it her life's work to increase knowledge and education as well as access to menopause and hormone care for women.

Dr. Louise has degrees in both pathology and medicine and is a member of the Royal College of Physicians.

A fellow of the Royal College of GPs, a visiting fellow at Murray Edwards College, Cambridge at university what does that mean a visiting fellow need to turn up every now and again?

Just turn up every now and again.

Yeah I know it's good.

You'd love to be a visiting fellow somewhere.

The thing is I have access apparently to their wine cellar but I don't drink any alcohol so it's a bit lost to me.

I'm a visiting fellow to my parents house.

Is it dinner now? I haven't got the official title but So excited to welcome visiting fellow, our son.

He's in the cellar.

A member of the UK government's menopause task force and was recently awarded an honor an honorary Doctorate of Health from Bradford University.

Dr. Lewis has founded the Newsom Health Clinic as well as the Balance menopause website and Balance app which has been downloaded in over 200 countries.

As we said before, your previous episode last year was the most shared episode of any episode of any podcasts in Australia.

So at the start there, I said that the two things you look at are menopause and hormones, and we're gonna do the latter today because we didn't really...

I remember we touched on it then last episode and I thought, gosh, that's something we should really all know about because we all talk about it like we know what it is.

Like we'll all say like - It's so interesting actually.

It also makes me think sitting here 18 months later, like the conversation in menopause has really improved.

I remember like when we were talking before, I seem to blow your minds of it and you're going, but now you're just using it, which is great.

But I think in medicine and in life actually it's the most obvious things that are forgotten and then people over complicate things and overthink things and the space in the menopause has become really quite difficult.

Anything to do with women can be hard but thinking about what hormones are is really important.

You know, I think when we often say hormones menopause, people think about HRT and then they're already thinking about breast cancer, whereas actually, let's just think what hormones are.

They're just chemical messengers, we've got hundreds of them in our body, they're not about HRT at all.

You know, we've got insulin, we've got thyroxine, we've got serotonin or adrenaline, all these are hormones, but when it's women and hormones, we forget that they're just chemical messengers that are produced in our tissues, our organs, and they basically go into our blood and go to every cell in our body and tell our cells how to function in different ways.

That's all they are.

They sound like they've got a pretty important job though.

They've got such an important job.

But also what's so interesting with hormones is they don't work in isolation.

So you don't have thyroxin that just does its own little thing or you know insulin that only does its own thing, they work together.

So menopause, perimenopause, but also PMS, premenstrual syndrome, PMDD, premenstrual dysphoric disorder, postnatal depression, we're just talking about three main hormones, estrogen, but really estradiol, which is a good form of estrogen, progesterone, and testosterone, but they don't work in isolation.

So they will affect...

If you have low estradiol, i .e. menopausal, you're going to have a change in your insulin, a change in your glucose, change in your other hormones as well because they they work really closely together and when you understand how the body works and how the hormones work together which we can go through then it's not difficult to work out what's going wrong in perimenopause, menopause, PMS, PMDD.

Okay so there's a lot to get through today like, I think what you just covered is like hormones 101 which I think is like really a really important place to start I also Well I just wanted to talk about the different cycles that will occur and then hormone changes and drop -offs that might happen throughout life, and this is for both men and women.

I think also, we probably need to sort of acknowledge at the top that we are three men who are going to talk about hormones, understanding that, I think it, from what I understand it, is going to be more complex and more challenging for women.

So we're certainly not trying to speak all women here.

I'll give it a go. Okay.

Well, you can do that.

I'm definitely not.

See what happens, eh?

It's worked in the past. But we're just very curious, and also because I think the more that we all understand about this, the more compassionate we can be throughout different stages of a person's life, I guess.

So have we covered in your mind hormones 101 there very briefly, what they are.

Not quite. Can I add a bit more on my language?

Please do. Like 10 .5.

So I've just said the chemical messengers in the bloodstream go to every single cell I don't know if you remember cells from biology?

They've got like a cell membrane, they're just a blob, basically, like you think, in a very simple way.

So they've got a cell membrane, they've got cytoplasm and there's a nucleus and inside the nucleus is where you've got your genetic structures.

You can imagine if our cells are really healthy, our tissues are healthy, our organs are healthy, we're more healthy.

So everything, if you break it down, those little cells are really important, we got trillions of them.

So if you think of the sort of the cytoplasm on the cell membrane, you've got receptors for each hormones.

You have a nice estradiol.

And that's what? Aestradiol?

Aestradiol, the nice form of estrogen or progesterone or insulin, any of these hormones, they have a receptor on the cell.

So it's a bit like a key and lock, if you can visualize this.

So the key is the hormone, the lock is there, then it fits in and unlocks.

and then they've got these lovely biochemical physiological reactions that are occurring in the cytoplasm, but it goes through the cytoplasm into the nucleus and makes all these changes.

And in the cells, we've got lots and lots of reactions going, lots of organelles, like little bits of tissue if you like, or sort of bits of the cell, like there's something called a mitochondria you might have heard of, it's like the powerhouse of the cells, it produces our energy.

And all these chemical reactions need energy, of course they do, and we need energy in a bigger way, don't we?

To just function and get up in the morning and whatever else.

So the mitochondria, we have trillions of them.

They are powerhouses.

But they've also got receptors on them for all the hormones, including estradiol, progesterone, testosterone.

So if you think of all these keys and locks, it's really important, for a bit of a later conversation we'll have, you've got to have the right key, the right hormone, the right lock, the right receptor, so that these reactions can occur.

Do you see what I mean?

And that's the really important thing to understand, because if you don't have any of that hormone going around, then that receptor has nothing to stimulate it.

So then you don't have the same reactions in the cell.

But if you have something that isn't quite the same, as in a synthetic hormone, which we'll talk about in a bit, it can block that receptor.

So it's like having a dud key.

I'm sure you've had keys locked where you think, great.

And then it doesn't unlock.

And you're like, ugh, I've got to go back to the locksmith.

In this metaphor can one K unlock many different locks or is it only one K for one lock?

One for one. One receptor really.

Sometimes like oestradiol can stimulate more than one receptor but it's very specific.

I mean the body is amazing isn't it, the way it's made.

And so if you don't have a certain hormone, other hormones might try and help.

So like a thyroxine hormone insulin might try and help if you don't have oestradiol, progesterone, testosterone.

You might try and pick the lock with it.

Yeah, you might try, but yeah, yeah, yeah, if it doesn't quite have the same reaction.

But it is really important to think of these hormones as biologically active hormones that have important roles in our body.

I mean, how many hormones are there?

There's a hundred. There's loads.

There's absolutely loads and loads that we'd probably don't even know about as well.

So why is like, testosterone and oestrogen, why are they the famous ones?

How did they get so famous?

Isn't it interesting?

So if you look at the history, it was 1941 that they were discovered.

And we didn't, people didn't know what was going on.

But actually, before they were discovered, there was a bit of interesting history, because they realized there was something going on in the ovaries of women, because when they had their ovaries removed, they had menopause, of course they did, they didn't know it, they didn't know what was going on, they could see these women not just with flushes and sweats but men meet with mental health symptoms with skin changes with epilepsy with also I mean the medical books that I've read about have been so well described but they didn't know what was going on.

But then there was a doctor called Professor Siquad Brown who thought actually something's going on with these women there's something in the ovaries there's something and they also thought there was something in the of men, you know, thinking about testosterone.

So, he actually used some of the organs, some ovaries, and testes and actually injected into himself to see whether actually having something, they didn't know about hormones, something, would that help.

And they called it the elixir of youth.

And he was very well respected, really well respected doctor.

So, he injected something from the testes of a, of an other man.

Yeah, actually of an animal.

Of an animal? And then the ovaries of an animal, as well?

Into himself, into the bloodstream.

Yeah, yeah. And he soon noticed that he felt better.

So he was talking at these academic lectures saying, this is incredible but many things in medicine, if you're a bit ahead of your time, you get knocked down.

And they said, this is ridiculous, this is absolutely crazy.

I feel like if he said that now, like if someone came out, like come on mate.

If you put it on Instagram it would be absolute fire.

But then people came to his clinic and went, I'd like some of that, I'd like some of that.

And they had it, they felt better, but not only did they feel better, they looked better, but they had less diseases as well.

Meanwhile, there were people who were trying to work out what to do because they knew that there was something in the urine as well, hormones, but they didn't know it was hormones.

But they knew they had to have a massive volume to have the same effects.

And then because they thought there's a market, it's all about money then, isn't it?

So then groups of people, they were biochemists, they were scientists, they were abattoir owners because they thought there's something in this urine and we needed big volumes, so they thought right let's use horses, they produce a lot of wee, and let's try and work together to commercialize, to do something.

And then they discovered the structure of hormones, but they had to make them synthetic because they needed to be able to make a lot of money.

And natural hormones, if you get them from pregnant women, which is what they did, it wasn't commercially viable.

So they made them synthetic, but they used pregnant horses urine and that's where HRT first was, was made from pregnant horses urine.

But once they commercialized it, everyone's going right, this is good.

So then they paid the gynecologist to work with them.

They said, right, you're a gynecologist. We'll put your name on the paper.

We'll pay for your education.

In fact, we're gonna pay for a journal.

And there was a journal called Hormones, it was a German journal.

And we'll work really closely together.

so this will be really good for your career as a gynecologist. We're going to make lots of money and this is where these synthetic hormones came." And then they suddenly made oestrogen with a synthetic and they made two types, there was a synthetic in a lab that was chemically altered and the pregnant horses' urine.

So everyone's going to bring it on, loads of money.

They tried to make a synthetic progesterone but all of them are very similar chemical structure.

So then they made testosterone by mistake But they realised the men were like, wow, this is what, you know, Brown's acquired was talking about his few years ago.

But it was synthetic.

So people had side effects, people had risks, and then they made a synthetic progestogen as well.

When you say synthetic, do you mean like it's replicating the real thing?

It's trying to and this is this whole thing about, think about this lock and key, it's been chemically altered.

So if you think about a chemical structure, you know, it sometimes looks a bit like a hexagon and it's got lines and it might have oxygen and hydrogen… yeah absolutely, I'm talking about hexagon lines.

Science, science you.

So what they've done is they've chemically altered it.

So that key might have like a tiny extra bit on it, so it's not going to fit in that receptor quite so well.

But it will also work the same way sort of physiologically in the body as well.

So it's impossible to make a synthetic copy of a real hormone?

Well, we can now, yeah.

We do now, and that's the biggest difference between HRT that we prescribed to then, but then it was synthetically, so chemically altered, because they had to do it to commercialize it, but they're very, very different in the body.

They don't work in the same way, because they block the receptors, so the natural hormones can't get looking if you like, but they also don't have the same effects in the cells, and in fact rather than just making it neutral, they can make it worse.

And actually sometimes there's two things I think the listeners and hopefully you will sort of identify with, one of them is if you think about carbon, you know carbon is an atom.

It's the eighth on the periodic table, ninth.

I might think it's the twelfth actually.

It's got 12 and 6 there, so anyway.

hydrogen and helium within brilliant boronite.

Yeah it's up there isn't it?

It's just after that bit.

Anyway, forgetting the periodic table for a minute.

Yeah just like any scientific branch I can grab onto.

But you're right. Helium is up there.

Thanks Louise. So a lead pencil, graphite, is made just of carbon.

A diamond ring is made just of carbon.

One's got three bonds, one's got four.

That's all it's done, they've just added another bond and it's a different chemical structure.

Like if my husband said, I've bought you some carbon, I just hope it's a diamond and not a lead pencil.

But just visualise how different they are.

And then the other analogy, I think, is thinking about fresh strawberries or strawberry Haribo sweets.

Like if I said to you, you know, I've had a great breakfast I had strawberries on my yogurt, you'd hopefully be thinking I was having fresh strawberries.

As opposed to like the gummy...

Yeah, but if I had like gummy sweets...

yeah, they'd taste okay but they wouldn't have the same effect in my body.

And that's... can that help you visualize the difference between the natural and the synthetic hormones?

But since the 40's, you know, this is what's happened.

And the contraceptive pills, the older types of HRT have been all these synthetic hormones.

So they're very different to the natural hormones that we prescribe now.

Do the hormones carry energy or do they tell the cell what to do?

So they tell the cell what to do.

They are exactly the same, so if I, which I do, use HRT but I use natural Estradiol, so I have it in a patch. The glue of the patch has got Estradiol in it so it goes through my skin into my bloodstream.

My body would not be able to tell me that it's from a patch as opposed to 20 years ago when it was from my ovaries because it's exactly the same structure.

Do you see what I mean?

So it's having the same effect on my cells as when I was having periods and producing my own estradiol.

Whereas when I was taking a contraception many years ago when I was in my 20s, I took it because I didn't want to get pregnant as a medical student, but I felt a bit flat.

I put on a bit of weight.

I was like, maybe this is just because I'm a medical student didn't really think that, oh, it's blocking the serotonin in my brain, it's not having the same anti -inflammatory effects, it's not affecting my mitochondria in the same way.

Changing the locks.

Yeah, indeed. This is probably too basic for most people, but I'm going to ask it.

So the pill is hormones.

The pill, yeah, so every type of pill, contraception, the implant, the injections, they are all synthetic.

And they're hormone -based.

They're all hormone -based.

They are based on the hormones that they made years ago.

So when they made them, because obviously women, I know it's all about periods.

That's all we, it's just fertility and periods, isn't it?

That's it. That's all we're here for.

So all the experiments for the contraceptive pills and the synthetic hormones was on our womb, what they wanted to do is make sure that we weren't bleeding because obviously that's all that matters for these scientists, these male scientists in the 40s.

So when they realized that women using the synthetic contraception, these synthetic hormones weren't bleeding, they were like, okay we can give them to women with heavy periods because don't get me wrong, having heavy periods is awful.

So, they started giving them to women.

They experimented actually on women who were trying to get pregnant, because they thought, well, if they don't have periods, maybe they'll get pregnant more.

You can see why they did it.

But then these women really didn't get pregnant.

So, they thought, OK, this is interesting.

They didn't really have to do any tests.

Like now, if I had a new drug coming out, you can imagine all the, you know, these scientific experiments that need to be done.

They didn't have to do much. Ten of them in the labs, like, took it themselves to make sure that they were OK, including the male scientists and then they were like okay let's try a different group of people so they went over to Puerto Rico they gave these doses which are far higher than the synthetic hormones we give now and many women actually if you read the notes that were never published women died they had clots they had strokes they felt awful they felt very sick and they're like oh this is a different population these are poor people in Puerto Rico they're not the same as the people over

in the UK and America so they ignored that data, started to give it to women and initially it was licensed just for periods, for heavy periods, the women took it, they've realized that they weren't having periods but they also realized that they weren't getting pregnant so a year later the drug companies said right let's mark it as contraception because we can double our sales, which indeed they did, because it was in the 60s then and people were like wanting some, you know, sexual liberation, they didn't want to get pregnant, so people thought this is great but they hadn't done any studies to

see whether it was a good contraception or not, because it's all about the womb.

They hadn't done any studies to see how does it affect, you know, clot risk or heart disease risk or brain function or things that aren't just about our womb as women.

So then it went out, but people had lots of side effects.

I've spoken to people who in the 60s and 70s took the contraception and felt awful.

So they have reduced the dose more and more.

So there are lower doses, but they still have risks.

I mean there are small risks.

I don't want everyone listening to think, oh my goodness.

But the risks are there, but they're just small.

But they are very different to the natural hormones.

Yeah. And obviously contraception is extremely important to get right.

And so we'll put a link in the show notes to other options if people want to explore those.

Right. So the contraception that women are taking now is the same as then, but a lower dose?

Yeah. There's difference.

I mean, they've sort of fine tuned them, and sometimes they say every so often there's a new one that comes out.

There is a one that came out when I was sort of newly qualified to the doctor.

So 25 years or so ago.

And they said it's got less clot risk.

So we're like, Oh, bring it on, bring it on.

Great. Started to prescribe it.

But then actually I was reading, I'm not going to tell you the name of it, but I was reading the company's reports recently and uh, they actually earmarked $2 billion a year for law, um, sort of legal claims when people have died from clot from, you know, and that's just an accepted risk that they have. And so they know that there is, I mean, it's a small risk, like I say, but there's millions of people that take it.

So you know, a small risk, you know, but if it's your daughter or your, you know, friend that has that problem.

But do you think, I mean like, it's maybe fair that I don't know the risk because I haven't done the research into it, which I probably should have. But is, do you think most women or a percentage of women would know that risk before taking No, I certainly didn't even as a medical student.

Um, because people say, well, look, the risk of a clot is a lot higher if you're pregnant, which it is, and people take it to not be pregnant.

But actually I've just recorded a podcast with my 20 year old daughter who said, I actually remember most people take the birth control because they want to regulate their hormones.

Most of us aren't that bothered about contraception, in that we can sort it out ourselves.

It's not just about the pill for contraception.

But she said, my friends go on the pill, then they become quite low in depressed, then they're on antidepressants, there must be some connection.

And of course, if you look at the few studies, not many studies have been done.

Serotonin, a happy hormone can be blocked by these synthetic hormones, because like I said at the beginning, our hormones work together.

So in our brain, the hormones are really important, they're produced, estradiol, progesterone, testosterone are made in our brain, but they affect other levels of hormones, neurotransmitters in our brain as well.

So if we've got low estradiol, we have low serotonin, which is our happy hormone.

We have low dopamine, which is our reward hormone, you know that sort of, I don't know, you open like this morning, it's sunny in Melbourne, everyone's going, oh, bring it on, this is going to be a good day.

If you haven't got dopamine, you're like, I don't care.

So these hormones can block that in your brain.

And testosterone, you know, often they have very low testosterone levels and we can talk about testosterone but it's an important female hormone as well.

And that interests me.

Before you go on to that, do you mind me if I just get into it?

Because I think it relates to something we said, then we can do testosterone.

Before you said, take it to regulate their hormones, but then I felt like what was said… maybe I'm just not following, but then it felt like what was said afterwards was saying that it actually dysregulates the hormones.

Yeah absolutely right, so they think...

this is where the conversation at the beginning...

Everyone thinks a hormone is the same, whether it's a natural hormone or a synthetic hormone and they're different, but actually a lot of people take it because they've got heavy periods and they don't want them, or because they have mood changes, like you said at the beginning, let's talk about how our cycles change and our hormones change with our cycle so they want to feel good most of the time.

PMS premenstrual syndrome, which we can talk about, it's so common but it's normalized by others.

But that person really suffers.

So they think well, I'll take the pill, then I have the same hormones every day.

But they're not, because they're blocking other hormones in our body.

So am I to understand then that it might stop the sort of large swing, but it might result in a lower.

What it's basically doing is giving people a chemical menopause.

Because it's switching off their natural hormones.

Well, okay, yeah. I know, it's a bit of a mind spin, isn't it?

To think like that, but this is just basic science.

This is what I said at the beginning, people don't think about basic things, whereas I think because I've got pathology degree as well, I'm quite geeky.

I, you know, I like looking at, like, how does it work?

Like if something's broken in medicine, i .e. someone's suffering or they've got disease, rather than just need to treat the disease, I'm always thinking, well, how's it happened?

and what's going on in their body in a cellular process?

Because then you can understand more.

Do you see what I mean?

But that makes complete sense to do it that way, which is maybe the harder way and takes more time.

It takes a lot of time.

And I've, you know, I've written four books on evidence -based medicine, I spend a lot of time thinking, as you can probably appreciate, but I wasn't taught any of this 25 years ago or 35 years ago when I qualified, like no one sat me down and said, these are different, look at the chemical structure, think about the mitochondria, think about the way your cells work.

It's all very fragmented in medicine and you don't really join the dots.

Yeah, okay. So... Testosterone, you wanted to talk about.

Well, I do, but maybe, I do, but let's...

Desperately. Let's, before we get to that, so I wouldn't mind talking about the hormonal changes that occur throughout different stages.

We know that hormones will change and drop off.

We've talked about menopause, perimenopause.

What are the other times that women specifically will have a change of economy?

Really important. And just as an aside, really, one of the reasons women haven't been used in clinical studies, and they didn't have to be until 1994 the year I qualified, was that our hormones interfere too much. What do you mean?

So up until 1994, all the experiments on medication was done on men.

70 kg men because that's apparently the average size of the man, which clearly isn't really now.

But they didn't use women because of our hormones, it was too complicated and it would mess up some of the experiments.

So they knew then that hormones aren't just like our ovaries having an effect on our periods, but rather than thinking, wow this is interesting, how do they have an effect?

So then a lot of studies it's been very difficult to interpret for our female patients.

So our hormones change all the time.

Many people, I'm sure, will have teenage children, girls and boys and you'll be, you know, first -hand experience of how hormones can change.

But again, some people would have learned in biology we have those three hormones, oestrogen, progesterone, testosterone.

Especially the first two, the oestrogen and progesterone, they will change throughout the cycle.

So an average, no woman is average of course, the average length of a cycle is 28 days.

So the first half of the cycle, the hormones are sort of fairly lowish, they're sort of increasing and then there's a massive spike when people reduce an egg because you need all three hormones actually, testosterone as well.

I have this surge. They release an egg because our function obviously is to conceive and become pregnant, so we release an egg, hormones dip again and then the second half of the cycle, which is called the luteal phase, so roughly between days 14 and 28, have a massive rise in progesterone, like off the scale progesterone, a rise in estradiol and then they fall very quickly, and if there isn't a fertilized egg, i .e. the person isn't going to become pregnant, then that massive drop in hormones shreds the lining of the womb and people have a period.

But this massive drop in hormones, hopefully already visualizing is very similar to the drop of hormones we have in perimenopause.

So that's why it that can trigger symptoms, so 95 % of women will have premenstrual syndrome, PMS, where they have, guess what, low mood, anxiety, poor concentration, reduced memory, feeling very low, sad but they might have palpitations.

They might have dry skin, they might have acne, they might have joint pain, they might have every single menopausal or perimenopausal symptom because it's a hormonal change that's triggering those symptoms because those cells are going, I haven't got those hormones.

It feels appropriate to me that men should stand and applaud when a female colleague works into the office.

Totally. And if we know they've just been through a massive hormonal drop, you'll just go, I'm illegal.

You've done it again.

You're incredible. You're absolutely right.

And you know, I've got three daughters so I'm very close to their hormonal changes.

But in fact, I was talking about it in my podcast with my 20 year old daughter Sophie when she started her periods, I don't know, around 13, 14, I remember, she came down to the kitchen in floods of tears and she's quite dramatic.

She said, Mommy, I can never ever go to work if I have periods.

I can never, like how do women do it?

She said, this is, she was just so shocked.

I felt it was interesting that my older daughter has PMDD, which is Premenstrual Dysphoric Disorder, which is a more severe form.

And three days a month, and I realized in COVID actually, because we're together aren't we living and breathing doing everything together she'd have three days a month where she just didn't function she she's a trombonist she didn't pick up her trombone she does amazing art she couldn't be bothered she said there's no point i'm just exist under this like what what's wrong i know we're all pretty pranked off in covid but you you suddenly were really happy now and then suddenly she'd be walking down from her bedroom with her sheets and she'd come on a period and flooded the sheet i said and then

suddenly she as bright as anything.

And if you think of that graph, those three days her hormone levels are down, period comes and her hormones come back up and she's a different person.

And I just thought, gosh, this is really awful.

And then like reading about hormones, joining the dots.

I said, well just cause you just need some hormones, natural hormones for those few days.

Let's just top them up.

And obviously she's fine now.

But then when she talks about it, and this is what I think is really important for people who normalize.

Oh, you will feel a Oh, I'm due on, I'm gonna feel a bit bad." For lots of women, it's not just those three days, it's the rest of the month they're dreading those three days coming, what happens if I'm in a meeting?

What happens if I'm in an interview?

What happens if I'm at school and I've got an exam going on?

And we've known that since the 60s that girls who have PMS, i .e. most girls, perform worse in their exams the days before their periods.

The teachers don't teach as well the days before their periods, but it's just being normalised because as women we just like put up and shut up, don't we, and it's just got on with it.

And not only that, I guess I've almost been self -medicating.

With a bit of a... I don't know if the term is right, but just like a broad blunt instrument that's not appropriate for the job.

Yeah, totally. You're absolutely right, and I'm as guilty as any other doctor because when people used to come, I'd say one of two things.

Either let's just give you the contraception to smooth out the hormones, which probably wasn't the best thing.

Or we could just give you antidepressants for those two weeks where you feel bad and the other two weeks when you're feeling great, you don't have to take them.

That's not treating the underlying cause at all, but I didn't, I didn't know.

So I'm sorry for all these women that I haven't treated well.

It is, I mean, I'm constantly, it's like, it's so ignorant and naïve as a guy, but like, I feel like every month I'm like, again, like my partner, it's like if she lets me know that a period's coming, I'm just like, wow, I feel like we just did this.

And it feels relentless.

But it is relentless.

And my daughter's, older daughter, she's a musician and she's still at music college, but she also plays in all sorts of orchestras and plays with the homeless choir and all sorts and she's constantly saying, Mummy, this person, this person, this person has hormonal changes.

She said one of her friends, who's a French horn player, She said for three days of the month that she actually can't play because whenever she plays, you can imagine the pressure playing the french horn, she wet's herself.

But then the period comes and she's fine.

She goes, mummy that's definitely hormonal, I said, yeah of course it is.

She's got other friends that don't come into university for three days a month because they're feeling really low, really joyless, and then they're fine again.

And it just and then she's she texted me when I've been in Australia said, mommy I've just found out, bloody blah, friend, she's on lithium, she's 23.

that's got to be related to hormones why has no one picked it up so she's there thinking and then she's seeing some of the older people she's playing with with their dry hair and their low mood and they're sort of you know it's just like mommy it's so sad like it's so sad it's everywhere what's so like I mean I went to a co -ed school in high school and and I maybe I just wasn't privy to it but I don't know of any like what's the level of like empathy that schools have for female students.

I mean, my 14 year old obviously is still at school and I managed to phone her the other day which is lovely because I really miss her being away and she she said, oh gosh, two days ago I've got detention because I was late and I felt really dizzy and I said, Lucy you've got to sort yourself she goes, well, she said the first day of my period she said, honestly, I've just been like, I can't use enough, sorry, tampons but I'm just flooding and I feel so dizzy and I'm just And so I thought, you know that's not what we shouldn't be.

shouldn't be that it's just like, okay, just get on with it and, you know, she's got a male teacher.

How can she talk to the male teacher?

It just seems like something, it seems like literally half the students at the school or, you know, a lot of workplaces, it's like a dealing with 95 % of them are dealing with this or more.

And it just seems really, I mean, it's obvious, but it's like, it's, it's really strange that there, there's so many things in place for, you know, more and more now for like neurodivergence in school, you know, if like, you know, students need particular care or attention, like, that's incredible.

But it feels like this is like all women are dealing with this.

There is. But what frustrates me more as a doctor is that I know I can treat most of those people.

So I see a lot of my daughter's friends as patients, I give them just some natural hormones for three or four days while they're feeling bad, so that graft they don't drop quite as much and they're like, wow, I didn't even know this was legal to feel this good, like this is incredible, you transformed my life.

I'm like, gosh, this is really cheap effective medicine and we've known it for years.

There was someone called Katrina Dalton who qualified in 1958, the year the NHS was launched, very incredible person and she gave a lot of progesterone, the natural progesterone, she's written books about how to be the natural progesterone, not the synthetic progestogen, to these women with PMS, PMDD, and she was reported to the GMC.

They tried to strip her from being a doctor, they said, you're using high doses of progesterone, this is terrible.

But I've spoken to some of her patients and she transformed and actually saved their lives as well because of the mental health component and she did some work in prisons as well because that anger that irritative state that people can get into people have killed and committed crimes and then their periods come and they felt better she got there's articles about it in academic journals and last year I was doing some work in some prisons just volunteering and you know Rebecca who's here today came with me and we spoken to women I split to one lady who had really bad PMDD in fact her mother used

to come and live with her for the few Sorry, can you tell us what PMD is?

Premensal dysphoric disorder, so really bad PMS basically.

So just before her period every month, she would feel really bad, really angry.

She had a young child, her mother came to live with her to look after the child because they were worried about how she could function after the child.

And then one day something happened and she killed somebody.

And then she said, the next day her period came and she felt fine.

And every day she's regretted it.

17 years, she's been in prison already for life.

she's been in prison with these hormonal changes and no one's even spoken to her about it and now she's perimenopausal.

Things are worse. So she has to write on the calendar beginning of the month, be kind, don't talk, you know, because if you're rude to the people who look after you in prison, you know, your sentence could be increased.

Wow. So that's the extreme.

It is extreme but still affecting people and it's still being normalised.

And that's, I I've personally experienced being a woman but you know it's really hard when your hormones aren't there because you can't eat them, you can't get them in any other way.

I know different women in my life who have very different cycles and very different experiences, how do you know if what you're experiencing is PMS or if it's PMDD?

It's a great question and in medicine we just give lots and lots of diagnosis is to make us feel really important and clever.

But actually, the most important thing is thinking what's causing it.

So PMS is premenstrual syndrome.

So premenstrual before the period syndrome, like a cholesterol symptoms, I suppose.

PMDD is premenstrual again before the period dysphoric disorder.

Like it really means it's fucking with your brain like it's having… sorry.

So the abbreviations too long.

Yeah but then when you look at the criteria, because in medicine there's lots of people in ivory towers like salivating over the criteria and what to put in and what to not put in and how long someone should have symptoms for and all this stuff.

So every so often they update the criteria.

But basically PMDD is a more severe form.

If you look at some of the criteria they have to so many symptoms on so many days, on so many cycles but in medicine, I was taught for people not to suffer, I went into medicine to help people.

So I don't really feel like if someone comes to me and says to me those few days before my period are just overwhelming, I feel very sad, I really worry about my mental health, I'm no fun to be with.

The last thing I think I should do as a doctor is give them a diary to say go and monitor your symptoms for six months, So I've got it all there in a nice graph like it's common sense often and we know like when people are perimenopausal and their hormones are really fluctuating.

If they have had PMS or PMDD or postnatal depression before, those symptoms often get a lot worse and they say I don't know whether it's my PMDD worsening or I'm perimenopausal.

I'm sitting in the consulting chair thinking well this is related to your fluctuating hormones, this is due to your low hormones.

It doesn't matter what label I give you, I'm not going to give you a badge to say, by the way, I've got XYZ.

All I want to do is treat the underlying cause.

You're telling me those few days before your periods, your mood is changing or you might be having physical symptoms. All I'm going to do is top you up with those natural hormones and let's come back in three months and you probably had three cycles.

Let me know how you are.

The other thing is is that people sometimes respond to changing hormone levels.

So you remember that graph I spoke about.

You have a peak of oetadiol and testosterone and progesterone mid -cycle when you produce an egg.

Some people find they feel worse when they ovulate as well because they're not responding to the absolute level, it's the change.

Like our brain likes everything the same, if you suddenly got changes of levels.

And so some people say they feel worse when they ovulate as well.

So again, if you give the same dose of hormones throughout the cycle, you can stop these hormonal fluctuations.

But one of the things is that a lot of women will have their ovaries removed because the gynaecologists will say, let's just remove your ovaries we'll remove your hormones and you'll be fine.

Some women it makes a difference but they'll have...

a lot of their own hormones will go in the bucket with their ovaries, so sometimes they need replacement but our brain produces the hormones.

And the first time I saw a lady who was in her 70s, this was many years ago, and she told me she gets this cyclical change.

But she'd had a hysterectomy and her ovaries removed many years ago.

And I started thinking, well this is ridiculous.

You must be making this up.

And then I thought, no believe the patient.

Let's think about it.

Then reading about all the neurophysiology and how these hormones are made in our brain.

They have a cycle in the brain, it's not all about the ovaries.

Of course it makes sense.

It seems like the, So, then, therefore, with the PMS vs. PMDD thing to paraphrase you, it doesn't really matter if you don't feel great, you deserve to feel better?

Totally do, and when you read some of the guidelines, they'll say, start with exercise, start with healthy eating, think about your vitamin Bs.

Like most people have done that already, and they can't still get out of bed those few days before.

You know, I saw someone recently, she's only early 20s.

She's had symptoms since her periods started, and was too scared to tell her psychiatrist it was associated with her periods because he was a man and she was a teenager when it started.

She says just two days before her periods, she really feels like life's not worth living.

And she said, I just go out to the supermarket because I can see people walking around and I know that I shouldn't do anything awful to me.

And that shouldn't be happening.

You shouldn't be like that in your 20s.

So, it shouldn't be happening that women are feeling so isolated because of their hormonal changes yet it's being normalized in conversations.

When I went to school where if you're in the best football team, the best cricket team, you got to wear a different colored shirt on a Friday so everyone could acknowledge you and you just walk around going, I feel so cool.

and like you could see people looking up to you going wow i feel like at that stage of the cycle women should be able to walk around wearing a different colored shirt and we should look at them and go oh my gosh it's unbelievable look at him before i agree with you i'm gonna see what louise says yeah i think women should have a bright colored shirt every day we need more respect as women because i go with you you know i go with louise yeah thank you because you know It's very good for society isn't it, that women are invisible, that we just fade and that's what's happened for decades and that is a real

problem when women aren't invisible, when they're trying to just stand up for their rights, especially something about hormonal rights and you know it's happened for many years even in, I think it was 1939, Elizabeth Sanger set up the first contraception clinic and they didn't have hormones then cos they didn't know about hormones.

I think it was 1929 actually, it was just barrier, so it was just you know barrier contraceptives In America, she set up the first contraception clinic.

Do you know what happened to her?

She was arrested and went to prison.

I know. It sounds madness now, doesn't it?

But it happened. So people, there's barriers for women having choice, and that's what my work is about.

I'm not coming on this podcast and saying everybody has to have natural hormones.

I just think everyone has to have knowledge and they can make choices.

There's a research group in America that are doing a lot of great work on PMDD, and I changed I changed my name, sorry, went in on Zoom just to have a listen to what was going on.

And they said suicide risk is really high in some of these women with PMDD.

And someone else said, well, how do you manage when you're doing research or hearing these stories?

Or we just encourage a relative to go and sit with that person until their period comes for a few days.

So then I'm putting as a question, you've already said it's related to hormones, how about giving hormones?

Oh, no, we're worried because of the risk of breast cancer.

Well I'm worried about the risk of death actually in suicidal women, who are young.

Like it's just not good enough.

You know there's loads of doctors that are really getting this.

Like I go to the Royal College of GP's conference every year to present some of our data and don't get me wrong, there are some doctors that would just spit in my face but there are others that literally come up and have selfies and say, you have transformed the way I work and I was doing an education event in Sydney for 300 doctors.

And you know these people coming up, trembling as much as the women to say, you have transformed the way I practice your education program.

It's amazing and they're having selfies with me, like I'm sorry.

And I'm just like this is unheard of in an academic conference, you know what I mean?

Because people are really learning, it is the most transformational medicine you can imagine.

You know, I saw someone the other day in my clinic who 27 years has been in and out of psychiatric hospitals.

First time she went in was a week after her first baby.

A 27 -year -old son reached out to me and said, I've listened to your podcast. I think my mother might have some mental health condition due to her hormones.

So she was in hospital about to have her next round of electroconvulsive therapy.

And I spoke to the psychiatrist, she said, oh, we recognize your name.

You've done a course, yeah, okay.

Tell us what to prescribe.

They prescribed. He sends me a photo at Christmas with her Christmas cracker.

It's the first time they've had Christmas with her.

And then a few weeks ago, she comes to my clinic in Stratford -Farnavon with him.

like the first time they've really been out and I said to her, I mean she's quite slow in thinking because she's on lithium, she's on alanzapine and she's on hormones and they've started to have an effect and I said, what were you like?

Can you remember when you had your periods?

and she said, oh, I loved having my periods because I started to feel better those few days before.

She's had three sons and I said, what were you like when you were pregnant?

And she smiled from ear to ear and she said, I felt amazing.

Well you could probably guess that some of her symptoms are due to her hormones.

Yet she's had 27 years of being paralysed, her sons don't know her.

She was an alcoholic, she's now not drinking, she's trying to rebuild her life.

Amazing. It says amazing but it's sad isn't it?

I had a meeting a few weeks ago with a friend and the podcast came up And she mentioned the episode you did last time and she said that her mother died of heart complications in her 50s and wanted to take HRT in the 80s and 90s, but was too scared to.

And she said that I think often I wonder if my mom would still be here.

We hear that so much there's a lost generation of people that have missed out.

Yeah. I also feel like the reason that it's not talked about at schools or there's not the support there and the way you've been talking and then PMDD, that surely has a causal link to the history of hysteria.

Yeah. Should we talk about that now?

So hysteria, if you break down the word hyst is the Greek word for womb.

So hysterectomy is removal of the womb.

Okay. So hysteria related to the womb.

So many years ago, um, in, um, in the Greek times, they realised that women who had their ovaries removed and often if you have taken the ovaries, you might as well take the womb out sort of thing.

They changed. So they did that thousands of years ago.

Yeah. Cause they, well they are trying to help women, aren't they.

But, um, so, but realized there was something in the womb, they thought, they didn't know about the ovaries really, they knew there was something.

And you know they knew that women changed throughout the months as well.

So they thought that the womb was wandering around the body to try and find sperm.

And once it found sperm then it would settle in the body and the women would be better.

So their observations were actually very good, because we've already said lots of women have PMS, if you speak to most women who've had PMS, PMDD, and you say what were you like when you were pregnant?

They'll say amazing.

I felt the best ever.

They've got really high levels of oestradiol, progesterone and testosterone in their body.

Like most of us would love to feel like how we did when we were pregnant, but especially those women with PMS and PMDD, because they have lower progesterone, which really increases and oestradiol as well.

So as an observer, you know nothing about ovaries, you know nothing about hormones, you're seeing these women that you're living with, like you say coming around every month thinking, oh here it goes, suddenly she's pregnant with this womb that's becoming bigger.

So their observation was right, but it's not right that our womb by the way wanders around our body, that doesn't happen.

Just to confirm. Between the person who decided that and told everyone.

Yeah, but then, this is where it becomes funny and awful, so they thought well actually if we can give treatments to keep that womb in the pelvis women would be better.

So they hung us upside down, they shot water and there's photos and I did it my theater tour to show women of like big jets of water aimed on these naked women on their womb to keep it there.

So this went on with the practice for thousands of years.

But even in the Victorian times, not that long ago, 100 years or so ago, the male gynaecologist used to do uterine massage.

I'll just let you think about what they do with their fingers to massage the womb to keep it in its place.

Yeah, it was very expensive.

So it was only the wealthy people that could get it done.

They would love it because it's probably the first time they had an orgasm in their life.

So I don't know if I'm allowed to talk about orgasms. Oh, we're here now!

No going back. I was going to say let's dig deeper.

So the worst thing was honestly, and I've read a lot and it's definitely happened, there's adverts of people with their long dresses and the gynecologist is putting his fingers in the woman's vagina and advertising for it, and then the gynecologist obviously made a lot of money.

They recruited other gynecologists.

And then this is where I think it's quite funny, but awful.

They started to get repetitive strain injury in their hands and they would describe the pain and the discomfort in their hands And they couldn't keep up with a workload It's awful, isn't it?

I mean I really do feel sorry for them.

You know, I tell you what they did It's the best thing they created the vibrator Yeah, so I found the first one in the Wellcome Collection it's in this like black box it looks really weird It looks like I don't know But yes… But the purpose was not a pleasurable purpose.

No, of course not. It was supposed to help the women's mental state and help the men so that the women would feel better.

As a side effect, these women would come to climax, wouldn't they?

It sounds like the main reason was to give those poor men a brag.

I know. But then, these were the wealthy women… It's so hard being a man, just so you know.

Yeah, I'm sure it is, I'm sure it is.

In fact, let's talk about that now.

No. But these were the wealthy women.

So what about the women that didn't have money?

And they're the women that I still worry about most today.

Think about the asylums. Think about the people that were locked up in asylums, with their straight jackets, they had, Lobotomies came into play.

You know, a lot of these will be hormonal women that will not be recognised.

And you can think, gosh, that's awful.

But Louise, that was 100 years ago.

Actually, The suicide rate in Australia is greatest in women in their early 50s.

In the UK, it's women in their late 40s.

It's the highest category.

Yeah and we see women day in day out in our clinic have come from psychiatric hospitals who have been given quetirapine, lithium, olanzapine, catarina infusions, electroconvulsive therapy and no one's thought about their PMS, PMDD.

Even now? Even now in 2025.

Oh my god. That is shocking.

Yeah, and I speak to quite a few gynaecologists who are quite high up and they say no Louise, there's no mental health component of menopause.

It's like, well, come and set my clinic, come and talk to the women, come and read the history books, it's all there.

Wow. So this is where it's a real problem and that's what you said at the beginning, actually, the podcast before literally saved lives and it did.

I mean, I've heard it so much first hand, people stop him in the street in Australia but saying actually if I hadn't read that you know I've now stopped my Alanzapine, lithium, whatever I was empowered with information so I could get the hormonal treatment so because if doctors don't know then women have got to find out for themselves because we deserve as women to have the best chance in life really, we only have one of them might as well get our hormones balanced if we can.

With the like teenagers for example or younger women and this is like not perimenopausal, this is like women girls with PMS, PMDD, they can up their hormones.

Yeah, so this is where we can give the natural hormones.

So that dreaded three letters HRT or sometimes in Australia you call it MHT, menopause hormone treatment.

It's not all about menopause, as you know, we just give the natural hormones back.

So if you think of that graph your progesterone, well it's not yours, but someone's progesteroneous as ours dropping it makes a lot more sense to give the natural hormone back there's something then synthetic that is lock and keys you want to just keep all the fun you know body functioning properly as well and this is something that's available now like it is it's off license because these drugs haven't been licensed because no one's done this proper studies and when you license or when somebody licensed a drug they license it for one indication but then we use lots of medication for lots of different

indications in medicine you for migraine for example.

So but like I say we've done it for decades you know Katrina Dalton, John Studd, others have done it for many many years but they've always people have said oh that's a bit maverick that's a bit weird but don't forget natural hormones are really cheap they're often cheaper than contraception so but in medicine you know one of the first things I...well there's two things I was taught that are really important, one is listen to the patient, believe the patient, and time and time again women are not believed we're told it's all in heads.

But the second thing is cheat the underlying cause.

Don't put a sticking plaster on it, you know?

And that's very important you know.

That sounds like exactly what you've made your life's work, really.

So since, I hope you don't mind me asking this, but since you're on the podcast with us there has been a bit of controversy around HRT?

Yeah. And what is the safe prescribing levels?

Can you talk about why has that happened, first of all?

But then also can you talk about why it's so important that women are advocating for themselves?

For sure. It's really important and it's a real shame what's been happening actually.

And you know, just to put things into context, 22 years ago there was a study, the Women's Health Initiative Study that many of your listeners will have heard of, which went to the press and the lay press, medical press as well, saying that HRT caused breast cancer and you can imagine HRT prescribing fell off a cliff.

They hadn't analyzed the data properly.

When they had, it showed that this risk of breast cancer wasn't statistically significant and it was only with people that took the synthetic progesterone, not the oestrogen, which then was the pregnant horse's oestrogen as well.

So fast forward, we know that even the synthetic hormones are safer than this study was first reported at.

But HRT prescribing in the UK went from 30 % of menopausal women to 10 % or less.

So it really dropped off a cliff.

I've been doing a lot of work, wrongly or rightly, advocating for women through podcasts, social media, media, various things.

I hope so rightly. Yeah, I hope so, thank you.

But also, and this is where some of the problem is, is that I am only a GP.

So the gynecologist, and there are a few, yes.

And it's happened. It's been going on for the last eight, nine years since I started becoming more more sort of prolific in what I do.

In the UK, HRT prescribing has gone from 10 % to 14%.

Like the guidelines will say the majority of women HRT has more benefits than risks, even the synthetic.

Like I'm not a statistician or mathematician, but 14 % is not the majority.

But every day I see women, I hear from women who say, I'm a given antidepressants, I've been told it's all in my head, I've been told I'm too young, I'm too old, I'm too fat, I'm too thin, I'm too whatever, I can't get hormones and I want them because I worry about my risk of heart disease and osteoporosis and my health.

You know, it's fine, you can choose as a patient, can't you?

So I've been campaigning really on behalf of women and I've been, you know, lots of people have said no, hang on, the pendulums gone the other way.

We're over prescribing HRT too many women having it we need to reduce and I'm like well, hang on it's 14 % isn't too many.

I don't care the percentage but in my mind every woman who wants it should have it and it's the same in your country it's the same in other countries women are scrambling to try and be listened to and get evidence -based treatments and then the way that I was taught to prescribe and the guidelines also say you have the dose, you individualize the dose.

So if you had diabetes and you had diabetes, you might need a certain amount of insulin and you might need a different amount of insulin.

Like it is, or if you've got raised blood pressure and you have, you might give different drugs, you might give different doses.

We do it all the time and medicine, we individualize care.

So when I was taught, I was learning a lot about menopause from gynecologists of course, but they're really nice guys.

And the irony is, and I mentioned it last time, so I won't go through it again.

Is that I was then peri -manipulism on myself without realizing.

Eight months of feeling like shit.

Which we could go into the episode we did with you last time.

My GP wouldn't prescribe for me so I saw one of the gynaecologists whose clinic I'd sat in a few months before.

And so he prescribed for me and I thought, this is gonna transform my life.

I didn't feel any different like three months later.

I just, I was getting night sweats slightly better but nothing else.

My brain was still mush.

So I went back to her and I said, oh Nick, I don't really feel much better.

And he said, well, let's do your blood test let's see what's going on and I had zero libido as well so he did my blood test. My oestradiol, my oestrogen level was really low and my testosterone was hardly anything so he said well let's just double the dose of your oestrogen and we'll start you with some testosterone.

So I said okay but that's a really high dose, like it's like the hundred patches like the licensed what that's going over.

He said yeah but you're not absorbing.

I said yeah the patches don't stick on very well but the other patches I tried just floated off my genes, so I'm keen to try something else.

So he said well two patches not sticking on very well, your skin is a barrier, it's the same as somebody who's using half that amount getting through the skin, it's just basic pharmacology.

I was like, oh yeah that makes sense, I hadn't really thought like that.

So I used twice the amount, my level came up to within a normal and I felt amazing.

So I've always just thought, well this is basic medicine, you know we don't have many drugs if you like, we put through you can get nicotine patches, as you know, fentanyl, a painkiller.

But most drugs we either have through our mouth or through a vein or whatever.

So over the years we've got a huge amount of clinical experience.

My clinic's really big, we share knowledge, we look at our audit data and we're constantly saying, well actually these people aren't improving.

You look at older studies, even from the 80s showing the same hormone in different women is going to have different metabolic effects, different absorption, especially when it's through the skin.

And we know there's a big variation of how things are absorbed through the skin.

So your skin temperature, your skin thickness, whether it's dry or wet, whether it's your bottom or your back with subcutaneous fat, it just differs because all you're trying to do is get it through into the bloodstream.

So some women, like me, need a higher dose to get adequate amounts to penetrate through the skin.

So we're not giving higher doses because I want them to have really high levels of oestradol, it's just to get enough through the skin.

and the guidelines say give the lowest effective dose.

So for me my lowest effective dose is higher than Mrs. Smith, so it's not difficult, but there are certain groups of gynecologists who don't like this what I'm doing.

So they made a documentary about me.

They've been very nasty professionally about me, but they also have produced a statement to say some women do need higher doses than others And the literature is very clear that some women need.

Yes of course. But meanwhile what's the saddest, I mean I'm obviously very sad in a professional way that somebody has been so nasty or bodies, but the saddest thing in my mind is that women are really struggling and last night we went out with four amazing doctors from Melbourne who we met for the first time in real life, which is cool and they're saying we're too scared to prescribe high doses because we're getting told off we can't do it.

Same in Perth. And I'm just thinking, this is dreadful actually.

We've got studies from many years ago showing some women need higher doses and even in psychiatric hospitals some people need higher doses to get into their brain because these hormones are not just made in our ovaries, they are made in our brains as well.

So PMS, PMDD is probably a brain disorder, not an ovarian disorder.

So, why aren't we doing more research looking at that?

Why aren't we doing more research looking at why in the world only 5 % of women are taking any type of hormones.

Why are 95 % of women not only often suffering with symptoms, but they've all got an increased risk of heart disease, osteoporosis, diabetes, dementia without their hormones.

And because we're living longer as women, we have to be thinking about preventing disease, being healthy for as long as possible.

it's not the age we die, it's the journey to that age, keeping healthy, preventing diseases.

And we know that hormones, whether they're synthetic but especially the natural hormones have a lower risk of all these diseases.

It must be so frustrating for you cause it's so apparent and clear that you care so much about women and about their health and about helping them.

And you obviously know so much and have done so much research and are so professional and then it's infuriating.

Yeah I can't tell you and I'm not going to get upset because you've got no tissues on your table but...

You can get them. It's really sad.

And it's really sad for women because we're, it's like two steps forward, three steps back.

And, you know, sometimes I feel really guilty for my work because I've, you know, shared all this knowledge and information.

The women get it, and don't be wrong, there are a lot of healthcare professionals that get it.

But there are others who have got power because they've got a voice with high up people who have made this, like, decision that they don't like.

Like these people I've not, most of them met, so it's not like we've had fisticuffs and it's gone pear -shaped.

But they can damage me as much as they like, because it's just me.

But they're damaging all these women.

And, you know, these women are really struggling, because I hear them.

And if you look at the evidence for antidepressants, we haven't got good evidence, because most of the studies have been done in men, like I say, because of the way the studies have been set up.

We know that antidepressants increase the risk of osteoporosis.

We know a lot of people it reduces libido so they have risks with them.

Most of my patients on antidepressants no one's spoken about their risks, they've just been given them.

We know antidepressants don't help with a low mood associated with menopause.

We know that they're not an effective treatment but we know that more women in Australia and UK who are menopause will take antidepressants than they do taking hormones.

But I know I'm not wrong.

But this is really basic science.

And I think this is the other thing in medicine.

Like I have had a lot of training as to how to put my patient central, how to really find out what they want.

Why have they come today?

What's on their mind?

What's worrying them?

What treatment do they want?

What have they read?

What did they learn?

What are the risks?

What are the benefits?

And that's part of being a GP.

Whereas, dare I say, before I was a GP, it was like, you're Mr Smith, you've got a disease.

Why is your treatment?

here you go, off you go, I know nothing about you.

So it's a very different way of training and some doctors don't like patients being central to their consultation because it messes up the way that they practice.

And so what I have done and this is why I still feel guilty but I don't but I've empowered a whole well generations of women to stand up for themselves and doctors are feeling quite threatened by that I think.

I just, yeah. I have so many things to say on the back of that but I feel like it's not, you've said it all so well.

I think it's just so great that you continue to do this, like you put yourself in the firing line to save lives I think.

And empower women too.

So should we talk about testosterone?

Absolutely. Lately, mate.

No, not yet, not yet.

Can I ask you one more question about women?

Yes, go on then. He's always banging on about women.

So, we have three kids.

And the first, so the first time we're having a baby, we were warned, just look out for day three, Day three, please.

And I remember going, oh yeah, it must be a hormone thing, not understanding, but yeah, it must be a hormone thing and we're so aware of we're told that on day three, Penny would basically have collapsed in a heap and would just be so low mood and so shattered and Is this where the baby's three days old?

Yes, three days into Benji's life.

And we knew it was coming, we were both like, if anyone was coming we can surely...

and sure enough, my goodness, I've never seen anything like it.

And Penny won't mind me saying this, but it was she was very, very flat and for some reason, her dad and I thought we'd take her to a cafe just to get out of the house and we thought maybe that might be good and...

Avocado will help this.

I don't think it was avocado, I was thinking that, and we got into this cafe and it was very crowded and we got a seat very close to the door and Penny was sitting in the chair that when people open the door, it kept going into the chair.

She nearly threw a fully grown man through the window when he opened the door into her chair.

Incredible strength.

Anyway, we laugh about it now, but then it happened for our second child as well and then it's certainly for the third child happened to me, not to Penny, but that's a completely different story.

But, I'm so interested to know, so so that's a window what she's going to be like when she's perimenopausal.

No, what you're gonna do instead is educate about hormones, so she doesn't suffer.

And honestly, I've got three children and each pregnancy you get loads of input when you're pregnant for that nine months.

You get warned about day three and milk comes in you might get night sweats, when you have sex with your partner it might be uncomfortable..

Of course not God, but they still do this and your mood will be low and you're and like honestly it only took me and like it's only been a few years I thought ah that hormone you know that graph it's come from like thousands down to nothing overnight of course it's hormonal but I didn't think everyone told me that you get night sweats because your milk comes in you get night sweats because you haven't got any oestrogen in your body like I feel cheated and I had urinary tract infections, I had joint pains after having my children.

I had my third daughter when I was 40 and my hormones never recovered, I'm sure, because it was I started HRT when I was 45 and I looking back I went to see a cardiologist when I was 38 for palpitations, that would have been my hormones, I didn't know, but this postpartum period and postnatal depression, again like the risk of suicide is high, it's one of the and causes death in young women, yet if you ask psychologists, how are you treating these women?

Oh, we're giving them drugs, we're giving them antipsychotics, we're giving them antidepressants.

I've seen women have had ECT in the postpartum period.

Well, why don't you replace the missing...

You can still give all these drugs, but why don't you give hormones as well?

And it's awful because it's really hard having a baby and it's really hard when you don't have your hormones as well.

I'm just thinking about one of my friends, who is pregnant right now, who's probably listening to this going, hang on what's about to happen to me, are my hormones gonna be gone forever, will they come back, what can she expect or anyone who's expecting to have a baby?

Not everyone feels bad after they have a baby, I don't want to think that they're going to but for everybody their hormones will really drop because that's just what happens physiologically, so it depends on how our bodies are sensitive to those hormones.

They will drop as you say Day Three, they're probably at their lowest and then they will recover of course they do But we all know that we're different in when our periods come back after having babies.

Some people it can come back really quickly.

I've seen people like one, two months that back having periods.

Other people, especially if they're breastfeeding, it can take even longer.

So as a general rule, if they're not having periods, then their hormones are going to be lower.

But you can still have periods with low hormones as well.

So it really does vary.

and it's very hard because even when I see people in the clinic for whatever reason, I don't have a crystal ball.

I can't tell you definitely this is related to your hormones, but I can say, well, it might be.

We can try some hormones and see.

Are we talking purely about that sort of 3 -day dip or is there a link between hormones and postnatal depression?

There is a link between hormones and postnatal depression but it's often not recognized because in medicine we're very siloed.

You have your baby, you're under gynecologist. You have postnatal depression, you're under psychiatrist. People don't join the dots.

People forget that there is a link between the ovaries in the brain and also that the brain produces hormones as well.

Not every case of postnatal depression will be purely hormonal, like not every case of clinical depression will be purely hormonal.

And I've been to many lectures where you see these eminent psychiatrists who look after women with most atrial depression.

They show you the graphs of hormones falling off a cliff.

and say but the best treatment is antidepressants.

You know, why don't you give some hormones as well?

So the people that do have the right dose absolutely can make a huge difference.

I think the word, I'm gonna use a word I think I know it means.

The dearth of evidence?

Is that it? No, study, not evidence, sorry.

The dearth of evidence?

Yeah, not much. Because it does seem like due to the fact that, as you said, shockingly, drugs weren't tested on women of any format until 1994 and that there's a lot of catching up to do.

Is there is there much money being put aside at the moment for studies on hormones that I feel like would alleviate a lot of the...

Yeah, well, there's two things, there actually is the evidence, there is really good evidence about hormones and also there's really good studies like immunology studies looking at how anti -inflammatory hormones are, how they improve our immune function, we've got good studies showing about hormones having risk of heart disease, reducing risk of dementia, but also osteoporosis.

So, even in 1941 when hormones were discovered, they noticed the association with osteoporosis in the 1970s.

It was a big conference with really good academics talking about the preventative effects of heart disease, dementia, diabetes and so forth with hormones.

but then this WHI study has meant that everyone's forgotten all the good evidence.

There's evidence from 19...

in the 1980s for women who had their ovaries removed at a young age, so half...

you know, a lot of their hormones will drop, showing that when they've been given hormones, their risk of diseases reduces, their mental health improves.

If you add testosterone, that we will come to, to oestrogen with their HRT, their cognition, their mood improves as well.

But yeah, I mean your government has announced like half a billion dollars for women's health, but that sounds a lot, but there's a lot of women and it's got to get in the right hands and I think there's some great research that can be done.

But even if you look at our recent NICE guidance, the word risk is mentioned so much more, like 22 times more than the word benefit.

Breast cancer is mentioned so much more than osteoporosis.

Breast cancer affects around one in seven women, osteoporosis affects around one in two women.

If you have an osteoporotic hip fracture, 20 % of women will die in that first year.

If you're diagnosed with breast cancer then it's like you won't die in that first year, mostly, because people's prognosis is good.

So they're sort of focusing sometimes on the wrong things as well.

Yeah, okay. Just to acknowledge, that's a must be...

You say it makes you sad professionally, but to now be experiencing this, it must be really hard. And it says a lot about you that you keep going.

Yeah, well, I've got three daughters and my middle daughters, you are not giving up.

Get back out there.

She's even brought me...

I don't know if I'm...

I'm not gonna swear cause I told them not to, but she's brought me a mug and now she's brought me a coaster with a C word on it.

And that she said, you just look at that.

Wow! So, it's like ok, thank you Sophie.

New merch idea for us.

Very quickly, Testosterone, the role of Testosterone across men and women.

Yeah, so Testosterone is the most biologically active hormone women have. We produce three to four times more Testosterone than Estradiol.

Yet, for decades, we've been taught testosterone's for men, oestradol's for women.

But also men have oestradol and progesterone as well.

It's a really important hormone.

You all have more oestradol and progesterone in your bodies than menopause or women.

Just to leave you that.

It's interesting, isn't it?

So we should be doing more research in men.

I would love to know about progesterone in male brain.

Like the first thing our body does if we have a stroke or a head injury is produce more progesterone men and women in their brain.

So it's not all about these hormones in women.

Like why aren't we looking at more like heart disease in men?

Do they have low A status?

Like we don't know.

Anyway, testosterone is a really important hormone for men and for women.

It's the hormone, chemical messenger, goes to every cell in the body, helps ourselves to function, helps our mitochondria to function and levels decline with age.

So it's more of an age -related decline rather than falling off a cliff, which happens often to ease down a progesterone.

And about half of our testosterone is made in our ovaries, so that's why if someone has their ovaries removed at a young age, they really miss the testosterone quicker.

But as we get older, our testosterone level often reduces.

That's for men as well?

Yeah, so for men it's about 30 % of men as they age will have low testosterone, for women it's most of us that will decline.

And how do we, what are we looking for to know like, what should we be looking out for to know if it's declining?

So symptoms of low testosterone are very many, and very varied, but they often are low mood, reduced memory, poor sleep, muscle joint pains, headaches, can be palpitations, can be sweats, just that everything's an effort.

Everyone talks about libido and of course for men and for women it can help with libido, help with sexual pleasure, but it's not just about that.

We don't have a tiny little area of our brain that's only marked for libido, like testosterone works throughout our brain, throughout our body, like every cell, so it's not just picking off libido and it's important.

You know, there's good studies, this is what's really ironic, is that there's so many good studies about testosterone in men showing all the symptoms but also the health risks.

So if, as a man, you have low testosterone, you have an increased risk of all the inflammatory diseases.

So heart disease, osteoporosis, diabetes, dementia, testosterone replacement will improve future health, reduce risk of those diseases.

We've got limited studies in women because they haven't been done.

The studies usually are focused only on sexual function and libido, but I've already said most of the work we do in medical practice is based on male studies.

But the male studies on testosterone we're all ignoring and saying, No, we need more evidence for women.

So that's a bit weird in itself.

But again, go back to basic.

See how testosterone works.

So if a woman has low testosterone and they have symptoms of low mood, reduced energy, so forth, it could be something else.

It could be they've got low iron, you know, it doesn't all have to be their low testosterone.

And as a general physician, I'm quite good at working out what else is going on.

But if I think it might be like we do a lot of medicine, we say, well, I just give you therapeutic trial you can have some testosterone.

Let's repeat your blood test in a few months, see if the levels coming up and see how you are.

The same way if you had a headache I'd say well look try this painkiller, come back and see me if it doesn't help and I'll try something else or I might do a test and see what's going on.

We can do that in any other area of medicine, but somehow testosterone, no you're all going to grow beards, you're all going to feel awful.

I've used testosterone for eight years and I didn't shave to come I promise.

Right, yeah. Can you test for if you feel as a man, those symptoms, can you test for low testosterone?

Because I remember last time there was a problem with testing for oestrogen levels, is that right?

Yeah, I know, you're right.

Testing for hormone levels in women is harder because hormones fluctuate, as you know.

So you might get, on a good day, normal levels and then people gaslight you even more and say your levels are normal.

The guidelines are clear with men, actually.

You have to have testosterone levels done before ten in the morning and usually two levels, and then if your level is below a certain amount, then you can try testosterone.

With women, it's harder because the levels are only a guide.

Like the level of a hormone in my blood is not the same as the level in my brain.

Like my brain doesn't function without testosterone, it's just like thinking through treacle, I can't string a sentence together, I can't remember anything and I'm really low and tearful and I can't sleep and I have worse migraines, it's not much fun.

So the level is just a guide really, it's in clinical context, which is really important.

Yeah. Do men have cycles?

No, not really, no. We're just like...

No. But you see men...

I do a lot of work at the British Society of Sexual Medicine and I, you know, read a lot of the articles and publications about male testosterone and it is a car crash for men actually, I hate to tell you, three men around the table, But because your testosterone level reduces with age, there's a lot of men with testosterone deficiency and generally men who are overweight, don't exercise, they're more prone to having low testosterone.

But testosterone, if you Google it, it's going to be somebody with rippling muscles and it's like a lot of people in various gyms will inject testosterone.

Now they won't be using the testosterone that I use, they use the synthetic testosterone which has risks.

It has a risk of heart attack and clot.

but it's synthetic but you know that strawberry, that diamond thing and that's where testosterone has a bad name because people are using it rather than having the natural testosterone.

So is regular exercise a way to maintain testosterone?

So in men it's slightly different.

So if people, if men who are overweight not exercising with low testosterone actually if they start to exercise more they lose their fat, build muscle.

muscle can produce hormones as well.

They often can improve their testosterone, depending on how low it is.

I mean if it's really low, but sometimes the doctors give testosterone to men when they've got low testosterone and then it's two ways.

Metabolically, you're going to feel work better in the body but also you'll have less low motivation, less poor sleep, whatever.

So then you're more likely to go to the gym.

So then it's a two -way thing and then once people then feel better, So they might not need to continue with testosterone.

Whereas for women often once it's low, it stays low.

So although having testosterone enables me to do more exercise and sleep better, I still will need that testosterone just to replace what's missing in my body.

Fascinating. I might be jumping in shadows, but it kind of makes me just want to get my testosterone checked to maybe just rule that out.

Because my sleep's been getting worse and worse and my eczema has been getting worse and worse.

I don't really exercise very much. I've always had pretty low motivation to do so, so I probably fit into that category.

And I've got quite high bad cholesterol, so I feel like I've got quite a few risk factors or at least commonalities in what you said before.

So listen to my podcast with Mo Keira, he's a urologist in America, he's brilliant.

In fact, he was talking about testosterone at this urology conference in Perth and I'm a bit naughty because I use men in various ways.

I love my husband. Don't worry.

I've been with him since I was 18, but he was talking about the importance of testosterone in men and women and I did a little screenshot, put subtitles on, and it's had like over 700 ,000 views with all positive comments on my Instagram.

If I put my words doing that.

Anyway, that aside.

He talks a lot about testosterone in men and women and he says testosterone levels are the single marker of health for anybody.

And I agree with that because if people have adequate testosterone, their blood pressure comes down, the cardiovascular risk comes down, their bad cholesterol comes down, their good cholesterol goes up.

We see it so much. But when you talk about testosterone to people, oh so you're not having erections.

Is it all about sex?

It's not about that.

It's about every single cell in your body.

And that's why with men it's important because you have to have two levels, about six weeks apart, but actually often people do have it like a therapeutic trial so I don't know if I'm allowed to tell you this I'm telling you everything about my children's I tell you my husband uses testosterone and his level was borderline if you look at the guidelines it says it may respond to treatment his I know I don't need it you do you're falling asleep on the sofa you're miserable you're not doing much exercise you've drawn a bit you know it's just you're not like yourself said can you just try it so he's tried

it his level is still in the normal male range but he's exercising most days he's He's happy, he's caring, he's loving, he's, you know, and it's only a load, you know, it is just but he uses the gel so it's a natural testosterone.

We will put a link to that episode in our show notes.

Mo Kira. he's a really amazing urologist. Awesome.

I'm just wondering whether or not because there's so much about hormones that we don't know and obviously we don't create for, are there sort of conditions or maybe neurological conditions that are kind of maybe diagnosed, or maybe not even diagnosed but sort of assumed and it's actually not that.

Yeah, there's loads.

Because our hormones reduce inflammation in our body, there's lots of inflammatory diseases that unsurprisingly increase in women in their forties so if you think about everybody's So Parkinson's disease is an inflammatory disease.

We know women are more likely to have Parkinson's when they've had early menopause without their hormones.

Multiple sclerosis, inflammatory bowel disease, cancers are very inflammatory.

But if you think this might blow your mind a bit, but I'll keep blowing your mind.

It's already blowing to us, a billion pieces so.

So our hormones are all made from cholesterol.

So cholesterol forms part of our cell membrane but it's also a chemical in our body, it's really important for us.

I know we've been told that cholesterol is bad but there is good cholesterol.

Our cholesterol forms progesterone, which is that you know, good hormone.

Then there's different enzymes.

You know enzymes are something that break down something, chemical reactions.

Progesterone forms testosterone, and then testosterone forms estradiol.

So they're like in a, that's that's why they're so similar in their structure.

So one becomes the next?

Indeed, yeah, with the different enzymes.

But progesterone also forms cortisol and cortisone, which are inflammatory, they're anti -inflammatory.

You know, if you have a cortisol injection in your shoulder, reduces inflammation.

So if you don't have progesterone, the levels of cortisone are going to be different and you have more inflammation in your body.

Because these hormones have always been called ovary hormones, sex hormones, people forget that these pathways exist. So anyone that needs steroids, needs biologic agents, they should be thinking about their hormones.

So a lot of people who have autoimmune diseases, a lot of people who have even osteoporosis, some mental health conditions can be associated with inflammation.

And so every so often, I read articles saying, we don't know why there's a link between osteoporosis and dementia.

think about the bottom, think about those hormones and then it all fits into place.

My kind of immediate sort of like fear or worry from everything you've spoken about today is that like someone will go on to their GP or doctor and say what you're saying and they'll be like no you're wrong.

Yeah, it's a real worry and I think the other thing really to think about is in medicine you can have more than one diagnosis, so I never want anyone to misinterpret this podcast to say that hormones will get rid of all diseases.

But for example, I've got a lot of patients with multiple sclerosis, they're on biologic agents, they've had lots of difficult times, we know the hormones work in our brain, they rebuild the myelin sheath, which is often disturbed in multiple sclerosis, your myelin is like, helps everything fire a lot quicker.

So if I put my hand on a hot plate in the cooker, it will go off really quickly.

If your myelin isn't working you keep it on a bit longer, it's more painful, you get more burns, so it will help.

But these people, even when I give them the right hormones, the right dose for that person, they've still got MS, they still need treatment, but often they might not need as much treatment, and so in medicine we're allowed more than one condition, you know, you can hurt your foot and still have a headache, and I can treat you with both.

And that's what's really important, like some people who have schizophrenia or bipolar, they'll still have it.

But if they've got hormonal changes as well, we should be thinking about rebalancing their hormones too.

Does that make sense?

It absolutely does.

It's, it's, it's, this is not the same, but like I recently like, you know, hurt my ankle and so I've been going to a physio, but I've also got a problem with my elbow, but I'm thinking, I can't tell her about that as well.

I kind of do things at the same time.

But you can. No, that's really helpful to, of course.

That makes so much sense.

So if, if, uh, women are listening now and they think potentially they've got symptoms or they might be you know feeling like some they might have PMS or PMDD.

What do you go to a GP and what do you say?

So I think the most important treatment for any of these hormonal conditions is knowledge.

Right. We're all individuals we need to be able to decide for ourselves.

So getting more knowledge is crucially important, really understanding what's happening to your body.

So you know download Balance.

Balance app is not just for menopause or women, it has lots of articles about PMS, PMDD, I've done podcasts.

On my website you can search for, you know, I've done Instagram lives that are on my youtube.

So, just have a real think about hormones, all three of them actually.

Estradiol, progesterone, testosterone.

So, when you go to a healthcare professional and it's usually a doctor, go with knowledge because then you'll get the most out of your And I would probably take someone with me because it's always better to have a separate pair of ears, because when you're living with yourself 24 7 you think, oh it's not that bad.

When you feel better you think, oh no surely.

Then it happens again, so go with the partner, your friend, your work colleague.

And then at the beginning of the consultation I would actually say, look I really think I've got PMS, PMDD or a hormonal problem.

And I'd really like to talk to you about having some natural hormones, I just want to try them for three months.

and if you get faced with no then just say who else can I say don't waste your time because I get quite scared going to see a doctor because I always think oh they're really busy, they're really important and this is me as a doctor.

So if you have a hostility it's really hard, like my middle daughter had sepsis a few years ago and I had to force for her to stay in hospital and I'm sure I saved her life but it was really hard standing up to a doctor to say no don't send her home, she's vomiting, she's ill, I need you to look after her and do some more tests.

And it's the same even with a GP you know, oh it's not.

So if you're getting a bit of hostility say I'd like to see someone else.

If you're really struggling then I would actually spin it on its head a bit and say look, I would like to try natural hormones, I know they work differently in my body to synthetic hormones, I would just like to try them for three months.

Could you just let me know the risks of me not having them as well because I can't really want to carry on like this.

And I'm prepared that there might be some risks, they might not help but they are just natural hormones and I just would like to try because that puts the patient in the middle of that consultation fair and square.

I think that's the problem even with you know women who have perimenopause or menopause, you know, I was talking to some healthcare professionals in Perth the other night.

Talking about what are the risks of not having hormones, because we've always like oh hormones, hormones, hormones risk.

We've talked about risk of diseases, risk to our mental health, risk day to day.

So actually we need to be thinking a bit about, are you really confident as a doctor that you are going to not give me my own hormones back when I've already told you I'm having this hormonal drop for three days a month?

That's such a, I've never thought of it like that way in thinking about the risks of not doing the thing.

Yeah and and the other thing just about sorry is like we mentioned last time on the other podcast is one of the reasons that I take hormones obviously I want my brain to work I want to feel better and as a doctor I want to help people feel better but I'm personally really scared of osteoporosis like I've seen so many women with osteoporosis at their spine they can't digest food they can't breathe they're all stumped they're in pain like I'll do anything I can to reduce my risk of osteoporosis so it's not just about symptoms and that's where like so many doctors and say well it's all in your mind,

this symptom is probably due to your stress, your family breakdown, you've got three kids, you must be really tired.

Just forget symptoms for a while and think about preventing disease in the same way we give blood pressure lowering treatment because we want to stop it or reduce the risk of a heart attack.

This is a preventative treatment and we've got enough evidence for that.

So, even if you just look at osteoporosis, HRT is licensed as a treatment to prevent osteoporosis that affects one in two women, but one in two women aren't getting that preventative treatment.

Wow. That's the promo right there, thank you.

Okay. Thank you for persisting with such incredibly important work.

Thank you. Yeah, it's just amazing, it's very inspiring to talk to you.

Yeah, it's amazing.

I mean like, it's such a shame, and it's so frustrating, and frustrating and devastating for you that people are coming for you like they have. You know, the few people.

But to sit here with you today like I'm no medical professional, but you can...

We can see the care and I think that has got to count for a lot and it's amazing you're doing what you're doing.

Aw thank you. So care was the word on the mug, is that the...?

It was! You're right it was a four nutta work.

I thought it was something else.

Watch your mouth you!

Thought it was something else.

Of course not. Dr Louise Newson, thank you so much for joining us.

Oh, thanks for inviting me.

I've really enjoyed it.

Thank you. Enjoyed this week's episode, but want a little more?

Then you might want to know that we have a brand new show called A Little More Imperfects over on Patreon.

For a little bit of money, you'll get access to bonus episodes with the three of us every fortnight.

Early access to live events, plus other things that we haven't thought of yet, but when we do think of them you'll get them.

Visit patreon .com forward slash the Imperfects.

The Imperfects is hosted and produced by Hugh van Kuylenburg, Ryan Shelton and Josh van Kuylenburg.

Our executive producer is Bridget North East, producer Bella North East. This episode is edited by George Martin.

The Imperfects not a licensed mental health service and is not a substitute for professional mental health advice, treatment or assessment.

The advice given in this episode is general in nature but if you're struggling please see a health care professional or call Lifeline on 13 11 14.

[Hormones: The Chemical Messengers and the Importance of Individualized Care]-[Dr Louise Newson - It's Hormones. Period.]

📋 Summary

Understanding Hormones: Beyond the HRT Stigma

The "Lock and Key" Mechanism and Synthetic vs. Natural Hormones

Normalizing the Abnormal: PMS and PMDD

The Role of Testosterone and Preventative Health

Advocacy and Empowerment

🎯Key Sentences

📝Key Phrases

📖 Transcript

[Hormones: The Chemical Messengers and the Importance of Individualized Care]-[Dr Louise Newson - It's Hormones. Period.]

📋 Summary

Understanding Hormones: Beyond the HRT Stigma

The "Lock and Key" Mechanism and Synthetic vs. Natural Hormones

Normalizing the Abnormal: PMS and PMDD

The Role of Testosterone and Preventative Health

Advocacy and Empowerment

Deep Learning with ListenLeap

🎯Key Sentences

📝Key Phrases

📖 Transcript

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