Looking back on menopause and hormone health in 2024 – and what does the future hold?

In a departure from our usual format, as we reach the end of 2024, Dr Louise looks back on her highlights of this year, including her recent theatre tour, her education work and the work of the Newson Health research team.

She looks at some of the key developments for menopause in 2024, and busts some myths around hormones and hormone replacement therapy. Plus, she’ll be looking forward to 2025, and sharing details of some exciting work for the year ahead.

For more information on Newson Health, click here.

Transcript

Dr Louise Newson: [00:00:11] Hello. I’m Dr Louise Newson. I’m a GP and menopause specialist, and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon -Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause, symptoms and treatments and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So on this episode of the podcast, I’m going to do something a bit different. I’m not actually going to have a guest. I am going to be the guest of my podcast. It’s towards the end of the year, the end nearly of 2024. So I thought I would just talk a bit about some reflections of the year and where everything is going, where my work is going, where menopause is going and where hormones are going as well. It’s been an interesting year. And really every day is a different day. I always say to my children, every day is a learning day. There’s always new things to learn, and often we learn from experiences. Anything that we experience helps us to grow, to develop, to change, to improve and move forwards, actually. Somebody said to me many years ago that you should glance backwards and look forwards and it’s so easy to not think too much about the future and concentrate on things that have happened in the past. And many of us have had things that have happened that we wouldn’t want to have repeated to us. But actually, every negative and positive experience can shape us in different ways. When I started the work that I do about eight years ago, when I really wanted to dedicate my future career to thinking about hormones and menopause, I didn’t really expect it to be quite as turbulent as it has been. But I also didn’t expect it to be so hard for so many women. One of the things that really drives me to work so hard is the injustice that’s happening. The stories that I hear from women who are really struggling to be believed, to be listened to, to be understood, and also to be able to access evidence based treatment. Now, many of you might know that I have a keen interest in evidence based medicine. I’ve actually written four books about evidence based medicine for GPs many years ago. I wrote a sequence of books and I’ve always read a lot of academic papers. I also have a pathology degree, so I have a first class degree in pathology, which is the study of disease. And it’s made me have a very inquisitive mind. I quite enjoy reading quite difficult scientific text, hard literature, where it’s really explaining the nuances of how our bodies work in a physiological but also pathological way. And I’m very interested in the role of our hormones with respect to inflammation, but also not just at a cellular level within the cells looking at how they affect mitochondria, which is the powerhouse of our cells. They produce the energy that our cells and bodies need for every chemical reaction. So I’m interested in the way our hormones work, and I’m obviously interested in the way that when we don’t those hormones it can affect us in many ways. But what I am always hearing are stories from women who are really struggling. And that is, I think, because menopause has been mislabelled. It’s been misunderstood for a very long time. So the first part of this year, I really spent a lot of my spare time reading, increasing my knowledge, because I knew I was doing this theatre tour, which started in autumn of this year. I wanted to make sure that it gave people information and knowledge that they didn’t have in other ways. I’ve spent a lot of time imparting my knowledge through my podcasts, through the free balance app, through the www.balance-menopause.com website, through my Instagram lives that I’ve started to do every Sunday that are uploaded to my YouTube. Imparting knowledge is a really important part of my work. I like to use the available evidence and try and translate it into easy ways that people can understand. And actually, what I really wanted to spend time on preparing for the tour was finding out information that I hadn’t shared before. So I had read a lot of books, but I read even more about the history of hormones, about how it was when hormones were first discovered, what led to people discovering these hormones and how they applied them to clinical practice. I also read a lot about how women had been portrayed in medicine for many years and also female leaders, how thought leaders have been treated or mistreated over the years as well. And also I reread the papers that I’ve spent many hours reading about the biological effect of hormones, how they work in our body. And so reading and understanding makes you want to learn more, doesn’t it? And so I spent a lot of time reading text, but then actually having to reread and read more detailed information because I couldn’t quite believe what I was reading, because on one hand I’m reading about how important these hormones, oestradiol, progesterone, testosterone are throughout our body, affecting every cell in our body, improving biological processes. And on the other side, I’m reading on various social media platforms and websites how our hormones are dangerous, how we have to restrict their use. And there seems to be a big confusion between what natural hormones are and what synthetic hormones are. So I just wanted to spend a little bit of time unpicking the difference. So when we are younger as women, we produce hormones mainly from our ovaries, but also from other tissues and organs in our body. So we have oestradiol, progesterone and testosterone. They’re produced from cholesterol, actually. They’re synthesised from cholesterol. These hormones are made and then they go in our bloodstream and affect every cell in our body. But they’re also made in our brains and they’re also made in other tissues and organs as well. They have really important biological processes. They help ourselves to function and work. They reduce inflammation in our body. And like I say, they help the mitochondria to function. They have effects on our brain, the way our brain works and functions, the way our personality, our memory, our mood, even our sleep. Other metabolic processes like our heart rate, our respiratory rate, our metabolism are all determined by these hormones. So they’re very important ways that they work throughout the body. So when we don’t have them, obviously our body doesn’t work as well. We have more inflammation. Our mitochondria don’t work as well. We have an increased risk of diseases. But when we give people hormones back, certainly in our clinic and many other clinics, what we do is we give the natural hormones back. So these are made, they’re synthesised, but they are actually the same biological structure as our own hormones. So basically, if you look at them literally down a microscope, they look identical to the hormones we produce when we’re younger. So we’re replacing like for like. But over the years since hormones were discovered, they were discovered in the 1930s, people have made synthetic hormones because they wanted to make a chemical that was similar but different to hormones so they could market it out to people and make money from it. And there were two different ways in which hormone replacement therapy has been synthetic. One of them is chemically altering them to different oestrogens and progestogens. So we have a type of oestrogen called ethinylestradiol, which is a chemically altered type of oestradiol. It’s not the same. It doesn’t have the same biological effects and it has risks associated with it. But we also have synthetic progestins. So these are like progesterone, but they’re chemically altered. So we have something called medroxyprogesterone acetate or norethisterone. These two are synthetic progestogens that have been used in different types of hormone replacement therapies. We now prescribe the natural hormone, which is usually referred to as micronised progesterone or Utrogestan is the other name in the UK. So that is exactly the same. But the synthetic ones we know do have risks. They have risks of heart disease, risks of clot, risks of probably breast cancer, only small risk, but actually we need to be thinking about these risks so we mitigate those risks by prescribing the natural hormones, the oestradiol through the skin as a patch or gel and the progesterone as a natural micronised progesterone which can be given orally or off label as a vaginal or rectal pessary to get absorbed through into the bloodstream. And then obviously testosterone, which again causes so much confusion. Testosterone is a biologically active hormone that women and men produce. We produce it from our ovaries, our adrenal glands, and also it’s made in our brains. Now, testosterone is more biologically active than other hormones in our body. We produce more testosterone than oestradiol when we’re younger. And levels decline with age. So actually low testosterone is an age related decline rather than purely menopause. But of course, if women have their ovaries removed and become menopausal at a younger age, their testosterone level would decline quite quickly. So testosterone, when we prescribe it, we prescribe it as a gel or a cream. And it’s the natural testosterone. It’s the same structure as the testosterone we produce from a younger, but we have synthetic testosterones and some of the injectable testosterone are chemically altered. So they’re not going to have the same biological effects that testosterone does. And they are associated with risks. So they are labelled actually as anabolic steroids. They can build up muscle in a very unusual way. They can increase risk of heart attacks, the same way that the unnatural the synthetic progestogens can increase risk for heart attacks. But they’re very different. And I’ve spent a lot of time deciphering the differences. And it’s important that people, women, men, but also healthcare professionals know the difference because it’s lazy medicine to say all oestrogens are the same or all progesterne are the same, or even all testosterone are the same because they’re not. And one of the things that I think is an easy way of thinking about it is what’s the difference between roast chicken and chicken flavoured crisps? The chicken flavored crisps probably don’t have any chicken in them at all, but they’ve been made to taste like chicken, but they’ve been chemically altered, of course, and manufactured in a synthetic way. The other analogy that I used a lot in the tour was thinking about diamond compared to graphite pencil led, and I had a slide showing these two and people probably thought I was mad. But actually many of you might know and if you’ve done any chemistry that diamond is made from carbon and graphite is made from carbon and there’s just one bond difference. So there are four bonds between the carbons in diamond and only three in graphite. So just adding one extra bonds can really alter the structure of a substance. So when oestradiol or progesterone or testosterone is chemically altered, just changing one bond or adding one different maybe oxygen or hydrogen atom is going to absolutely change its structure and the way it chemically works in the body. And I think for too long people haven’t understood this. I didn’t spend much time thinking about it when I was a junior doctor, happily prescribing synthetic hormones as contraceptives or synthetic hormones as HRT, because no one taught me and I didn’t have the time or the energy or the knowledge to learn all this. But actually, when you unpick it it’s really important. So a lot of the debate about risks, about hormones when given as a prescription, are hormones that have been synthetically made. They’ve been chemically altered. And this is really important. And I will talk more and more about it next year because it’s so important when we think about reasons for taking hormones. So as a menopausal woman myself, I’m very open that of course I take HRT because I was experiencing a myriad of symptoms, especially affecting my mental health, but also my physical health as well. So my mood was low, my memory was very poor, my concentration was terrible, my sleep was awful, and I was very irritable, very short tempered, felt very low and flat, just wasn’t enjoying things, became quite socially withdrawn and very lonely. I didn’t really know what was going on. I thought I was just working too hard. And that’s just my lot, really. But also I was getting physical symptoms. My migraines were a lot worse. They were more frequent, they were more severe, I had a lot of muscle and joint pain. I had multiple times where I had awful palpitations, bit of indigestion and reflux as well. And all these symptoms really I didn’t understand because I didn’t put them together. And I also had recurrent urinary tract infections. I had some vaginal dryness, I had reduced libido, my hair had changed, became thinner, drier. My skin was quite itchy. So lots of things going on. And then obviously, once I realised what was going on and I was perimenopausal, then I decided to take hormones. But I take HRT for two reasons, of course, to feel better and it’s taken quite a long time to have the right dose and type with hormones. It didn’t work straight away. I had to increase my dose of oestradiol because I didn’t absorb very well through the skin and I had to, well, I didn’t have to, but I chose to take testosterone to improve my libido. But it’s also helped with my mood, energy, motivation, concentration and sleep and actually my migraines as well. But it can take a while for these hormones to work. But the other reason that I take HRT is to improve my future health, and that’s something that is really important and we’ve known it for decades, thinking about how these hormones can reduce inflammation in our body. And when we think about inflammation, inflammation is important because when we have inflammation, it can damage tissues and organs and increase our risk of diseases and the inflammatory diseases, other diseases that really affect our future health as women, but also as men. So if I list them, they’re diseases that you will have heard of before. And these are heart disease, including cardiovascular disease. So that’s not just our heart, but our blood system as well. So cardiovascular disease, dementia, type two diabetes, clinical depression is even thought of as an inflammatory disease. Osteoporosis, other neurodegenerative diseases such as Parkinson’s disease and autoimmune diseases as well. Those can all be associated with altered inflammation in the body. Cancers can be associated with inflammation too. And so we know that I’ve already said that hormones reduce inflammation, so we know they reduce the risk of diseases, these inflammatory diseases. And we’ve got many studies for many years showing that women who take hormones have a lower risk of these inflammatory diseases. And that is important when we think about population health. I’m very interested in keeping people healthy for as long as possible. It’s not just helping them feel better, although as a doctor, it’s lovely to help people feel better, but it’s about investing in their future health. So we know that women who take natural hormones have a lower risk of all these diseases and actually are less likely to die at an earlier age. But it’s not the age we die. It’s a journey to that age. It’s thinking about healthspan rather than lifespan. And for too long we don’t think enough as health care professionals about healthspan keeping people really healthy. And that is so important because we know that the NHS is really on its knees. We know that there are lots of people being admitted to hospital all the time with these chronic diseases and many of these people are not taking hormones to reduce their risk. So it’s is very important when we think about the role of these hormones and how they work. And if some of you had come to the tour, you would have seen I had a massive slide with a picture of a macrophage, which is the cell that reduces inflammation in the body. It’s really important because macrophages work better when we have oestradiol, progesterone, testosterone on them, stimulating them. We know in the presence of oestradiol that macrophages work better, they can genetically be reprogrammed, they can increase in number, they can improve the efficiency of how they work. And I also had a slide of mitochondria because we have trillions of them in our body and we know that these hormones will improve the way that they function as well. So I spoke to thousands of women on the tour and many men came too and it was such an incredible experience that I hope I can repeat again. I was incredibly nervous. The thought of having 34 tour dates all around the UK. I went up to Scotland, I went to Wales, went down to the south coast, all around meeting people. And I had sessions before with small groups of women. Obviously the theatres were very full or some of them were full. And then I saw people afterwards because I did book signing as well. And it was amazing. I was very fortunate in that I had a lot of support. I worked with Anne Gildea, who’s a comedian who lightened it a little bit for me, which was great. The team that came with me were very, very professional, very supportive, and I never thought I would be on a stage. My mother’s an actress and going on the stage would have filled me with horror, but I knew that it felt the right thing to do, to be able to have a different platform, literally, to share some of my knowledge, but in different ways. So I had lots of slides. I had lots of information in the second half about, like I say, the history of hormones, the history of what happened to women. I even had some adverts from the 50s and 60s about how women were portrayed as well, and there were a lot of laughs in the audience and there were quite a few tears as well, especially talking about mental health impact of hormones. But what I wanted to do was allow people time to really reflect and think differently about my work and what hormones do throughout the body and about ways that women have been almost stopped from having hormones throughout history of medicine. And there are lots of examples where people have been taken down by other healthcare professionals when they’ve tried to help women with hormones. So that’s been really interesting for people to listen to and to watch. And just feeling the energy from the room, it’s really been incredible. And I really want to thank those of you who are listening who did come to the tour. But I also came away very sad because every single place I went to, I heard stories from women who were often very tearful telling me that they are unable to receive hormones from their doctors. Even some of them in Scotland said to me, there’s no point even being referred to the menopause clinic because we know they won’t prescribe testosterone, but we know we really need it. We have zero libido. We feel absolutely dreadful. We take HRT and we still have symptoms. One lady told me that she was on testosterone and she was feeling wonderful, her testosterone level was normal within normal limits for women. And her doctor said, no, you must come off it and then don’t come back for another six months. You don’t need to be on this anymore. And she was really scared because she didn’t want to go back to how she was feeling. I also met a lot of women who tell me that my work had transformed their lives and actually saved their lives. I had partners of women telling me that information that I said had given them the confidence and the impetus to go and receive help, which had transformed and often saved their lives. And they wanted to just thank me. And it’s very humbling, actually, when people thank me because I’m not really doing anything special and all I’m doing is giving them common sense information based on the evidence. But it’s almost as if these people haven’t been allowed to have evidence before, haven’t been allowed to have this knowledge. And it makes me realise how closed actually a lot of medical healthcare professionals are and how they don’t empower their patients in the way that they should. And it’s really sad because it doesn’t seem to be improving for everybody. I went to the Royal College of General Practitioners annual conference in October in Liverpool and presented some of our data and there was a lot of people there who were really encouraged, they’re doing a lot more training. They’re learning a lot more about the role of hormones and health and prescribing more HRT, which is great. We have the new NICE guidance that came out in November this year. They’re updated from the ones from 2015, but they don’t depict all the evidence. They’re quite skewed in what they present. But even then, then take home tagline, if you like, is that HRT is first line treatment for the majority of women. But the problem is, is that it’s not first line treatment for the majority of menopausal women because only the minority are receiving hormones. Less than 20%, around 14 or 15% of women who are menopausal in the UK are prescribed HRT. And it’s in areas of deprivation. In ethnic minority groups, it’s a lot lower than this. We looked at some of the data of people that have had fragility fractures, so low impact fractures, people who have osteoporosis, who have fractures. And it was less than 1% of those women are prescribed HRT, whereas HRT is licensed as a treatment for osteoporosis. There’s been a lot of confusion about dosing of hormones, and we’ve been working very hard as a group. I fund a small research team and we’ve been showing that we do see women who need higher doses, myself included. And that’s very simple. It’s just the skin is a barrier. It’s harder to absorb oestradiol through the skin. If the skin is thicker, if it’s colder, there’s more subcutaneous fat. Skin type and texture really varies between people. And I know personally my patches do not stick on very well, so when I remove them, there’s still glue on them. The glue contains oestradiol so it hasn’t all been absorbed through my skin. And so my consultant many years ago gave me a higher dose so I could get adequate absorption and monitored oestradiol. And I have my oestradiol, testosterone levels done every year as part of my review. And my levels are within normal ranges. They’re not too high and they’re not too low and my symptoms are optimised, but I use higher dosing because that is the right dose for me to get adequate amounts through the skin. Many people have been quite scared about these higher doses. Now we know it’s just a natural hormone and we give higher doses to a minority of women who need it because they’re just trying to get adequate absorption through the skin. But I’m very proud of our research team. We’ve had publications accepted. We had a great one about testosterone. So symptoms of mood changes, memory changes as well as libido reduction can improve when testosterone is added to HRT. So this was looking at our patients. We had that accepted in an academic journal and now we’ve got one about our dosing accepted. It’s going to come out any minute now and we’ve been doing a lot of work for women who’ve had breast cancer. So we’ve had two publications accepted, another one that’s been submitted for review process, and these are in peer reviewed journals. We always present our data at different conferences and certainly I can’t think of another menopause clinic that is producing the quality of research and data that we’re producing. We’re working collaboratively with different universities as well, such as Liverpool John Moores University, Bristol University, King’s College, London, Monash University in Melbourne. And working collaboratively with other people’s is just wonderful. There’s a huge amount of support for what we do, not just in the UK but globally as well. This year I’ve been to Norway, which is wonderful. I met some incredible people and I’ve got Norwegian blood. My grandmother was Norwegian and so it was great. My first time visiting Norway and I really, really enjoyed that and I hope to go back at some stage next year. I am going to Australia, I’m going to go to Sydney, Perth and Melbourne. Really, really looking forward to that. Talking to women, but also to healthcare professionals as well. Recording a couple of podcasts over there too. So lots of exciting things that are going to happen. And on my way over to Australia, I’m going to be stopping in Singapore and Singapore. It’s going to be very exciting as well. Talking a lot about longevity. Talking about future health with hormones. So that’s going to be exciting and hopefully going to go to America as well at some stage. So I’m also going to be focusing a lot on my podcast, how to reach wider audiences all across the world. I’m going to be doing a lot more work on balance, enabling people to have balance in many, many countries and improve the quality of the information that we’re giving. I’m doing a lot of work with our education programme as well, so that’s very exciting. We’re going to be updating our education, working collaboratively with all sorts of people. Our research team is going to continue working with other people and of course, our clinic is still going to be seeing people, seeing people who are unable to receive the evidence based care and treatment that they want and deserve from the NHS. But we work very closely with the NHS, so increasingly patients come and see us maybe two times, then they’re optimised on their hormones and then their NHS GP takes over their prescribing, which is really great. So we have a great network of colleagues in the NHS that we work with which will continue and we’re going to be doing monthly webinars for people who are non-healthcare professionals and then also monthly webinars for healthcare professionals as well. So lots of things going on, but I just hope you’ve enjoyed this podcast to learn a bit more about what I’ve been up to and what I want to get up to and what’s been going on in my mind recently. So I hope you’re looking forward to Christmas. I’m looking forward to spending time with my family. I have three daughters who are so inspirational and a lovely husband, and the four of them prop me up and persuade me to keep going and keep doing what I’m doing because it’s making a difference to the right people. So enjoy your time. Keep knowing as much as possible. Improve your knowledge. Try and advocate for other people as well, and let’s keep going with this massive community of people we have who are determined to make changes for the better going forwards. Thank you. You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk. And you can download the free balance app on the App Store or Google Play.

ENDS