Navigating menopause with Dr. Louise Newson | Doctors on Life podcast

welcome to the podcast Le or doctors on life as it's called in English my name is Anette Dragon I'm a medical doctor and my intention with this podcast is to make useful fun and important knowledge about body health and mind easily accessible to us all today I'm so happy to welcome Dr Luis n to the podcast Dr N is a GP and menopause specialist whose passion is deeply rooted in advocating for improved menopause care and education address The crucial need for Access accessible evidence-based treatment options for women navigating param menopause and menopause in 2018 she founded a new Health Group which was established to be the center of excellence providing evidence-based information support and treatments to par menopausal and menopausal women Beyond her clinical achievements Dr new has developed acclaimed balance menopause Support app and website providing indispensable resources for women worldwide her influence extends into the digital sphere with Dr Lis new podcast celebrated as the UK's top medical podcast as an author her contribution includes the notable preparing for the per manopause and menopause a Sunday Times number one bestseller and her latest publication the definite Guide to the per menopause and menopause which further her commitment to providing valuable insights into menopause care welcome Dr Lis n thank you for inviting me I'm so happy to have you here in Norway how your say oh you know it's really exciting I've never been to Oslo before we came to Norway the first time last year with my family because my husband's great uncle was Ola bull actually so we have some connection and my grandmother um was Norwegian she grew up in liliam and came over when she was 18 and met my grandfather so we've both got Norwegian blood in us but I've only been to Norway once before so it's great to be here wow so then you have to come more frequently to Norway and you have to spread your knowledge yeah because you are one of the best in the world uh on this subject it's so important what you are speaking about and we will go into it quickly but uh today we're talking about per menopause and menopause but could you please explain the difference between those two yeah absolutely because we use the words a lot and there's still a misunderstanding actually last night as you know I was talking to over 500 lovely Norwegian women and some men and I asked the room whether they were confident in explaining what the menopause was and only about five people put their hands up yet they'd come to a presentation knowing it was about the menopause and actually when you look at it medically we're told it's menop pause so meno being the menstrual cycle the women's periods and pauses a stop so it actually the definition is a year since the last menstrual period but I have a real issue actually with that definition because as you know as a doctor we don't make a diagnosis in retrospect we don't say to a woman oh come back in a year's time and then I'll give you a diagnosis if someone's in front of you struggling with symptoms what are you going to do wait of course you're not and how does that definition occur like what's different a year after your period stop to a year and a day or 11 months I think it was just made by probably men around a boardroom who never speak to women I don't know it doesn't make sense so then actually a lot of people say well it's associated with loss of fertility so they call the menopause our post-reproductive life but actually I don't want to be defined by my fertility either and for many cultures it's not actually a it's quite a taboo to talk about whether you're fertile or not and also as you know many people are young and have an early menopur and those women if they have treatment um with hormones can improve their fertility so I think it's really wrong to talk about fertility with menopause so then we should think well what is it what happens and what happens is that our ovaries have a finite number of eggs when the number declines the hormones that our ovaries produce Decline and we're only talking about three hormones estrogen progesterone testosterone they're sometimes referred to as our sex hormones but they're not actually all about sex they're not even all about gender because men produce these hormones as well but there are three hormones that cause a lot of confusion and angst between all sorts of people but our ovaries produce them but other areas in our body produce them as well so our brain produces the hormones our adrenal glands our muscles even our heart produces estrogen but when we don't have uh ovaries working as well those levels of hormones Decline and so when the hormones decline that's when people become menopausal and so the hormones are low forever but they usually don't stop straight away unless

someone obviously has their ovaries removed usually what happens is as we age our hormones decline but in a very chaotic way so they might be up one day down another day um so there's this chaos happening in our brains before the hormones plummet and that time is called the Perry menopause and as you know Perry just means around the time of when medically when you translate it so it means around the time of the menopause but that can occur for sever years sometimes a decade before periods stop so women are still having periods they might be lighter they might be further apart but they might be heavier and closer together or they might be regular but they're getting all these symptoms because our hormones as you know are just chemical Messengers they go into our bloodstream they go all around our body they go to every single cell in our body and these hormones estrogen progesterone and testosterone affect every cell function in our body so when the levels are changing and low we can get a myriad of symptoms but we can also have health consequences as well so it's not something that is we should just think oh well it's just something we have to have as a women of course every single woman will become menopausal and it will affect us in different ways but once we understand what it is and how our bodies are changing that's when we can think about what can we do about it and what treatment options are so um the per menopause many women don't understand what they're going through and when you say it's chaos in the body the hormones go up and they go down it's not easy to understand what's happening and I get that a lot in my office as well that my patients say that they've went maybe five to seven years before they understood that it was param menopause or their menopause that was happening to their body could you please explain to us what are the symptoms because it's quite a lot so many symptoms actually there's hundreds of different symptoms because you know if you just think about estrogen it's involved in over a thousand cell processes in our body and it can affect every organ in our body so we a lot of people think that the menopause is about hot fleshes and sweats and can occur in many women but they're not the symptoms that are really affecting women the most so when we've got this free balance app as you know and when we've looked at people who have monitored symptoms across the world the commonest symptoms are the symptoms affecting our brain so there's low mood anxiety poor sleep memory problems this brain fog this inability to think clearly is a really common symptom um reduced libido is very common muscle and joint pains palpitations headaches um vaginal dryness urinary symptoms itchy skin dry skin hair changes it can go on and on but not everybody gets every symptom yeah and so on the balance um app and on our website we've got a common symptom questionnaire that we use in all our patients as well and that's useful for people to do every few months just to see if they're getting any of those symptoms but I've seen some people with just literally One symptom I've see saw a lady a couple of weeks ago who had a lot of tinitus this ringing in the ears she'd seen ear specialist she'd been told it was normal it was keeping her awake at night she'd stop working because it was so distracting but she was also 52 so I knew she was menopausal as well her periods stopped so giving her back hormones I'm sure will improve her tenius because we see it a lot in the clinic so people think you have to have a certain number of symptoms or a certain duration of symptoms to have that diagnosis um and you don't and it's very difficult because there isn't an easy blood test or a urine test or a saliva test that's going to diagnose it but actually there are Clues because as you know when women are having their normal regular periods our hormone levels are changing all the time and we have a peak of our hormone levels when we ovulate in the middle of our cycle and then the second half of our cycle our hormone levels Decline and just before our periods our hormone levels especially estrogen and progesterone are very low and a lots of people get a flavor of what the menopause is like on those days yeah so when you really ask patients and women how do you feel just before your period when you were younger and they'll often say yes I felt really irritable I felt really flat I had sugar Cravings all I wanted to do was sit down and eat chocolate and now I'm feeling like that but it's not just a day or two it's happening more frequently and so often women do know but they don't always put it together and there are a lot of women who think that they've just stressed because of work or they've got busy at home or they've been misdiagnosed with depression um so it's really important I think as women that we take control ourselves and get the education and start to monitor symptoms because then we can try and work out

could some of this be related to our hormones but just uh hearing you talk about all these symptoms I it's profound how much these hormones affect us and how important they are to us and when you say even tunus you say brain fog do we know how we can get brain fog from low estrogen yeah actually we've known for many years so I've got a pathology degree as well so I'm quite interested in science and the role of our immune system is key as you know to everything so if you look at our immune cells our cells that fight infection we've got receptors to estrogen on them and our other two hormones progesterone and testosterone and if we've got good levels of estrogen then our immune cells work well the estrogen can genetically reprogram these cells it can increase the number of the cells it can change the chemicals the cyto kindes that are produced by those cells if we have low levels it the our inflammatory system changes so the immune cells become pro-inflammatory so they change the number they change the action the way that they work if we've got low grade inflammation in our body that obviously can cause diseases and there's obviously increased risk of diseases in the menopause but also there are receptors in other areas so if you think of tinitus for example our nerves um change when we don't have hormones there so if we have hormones our myelin the myelin sheep that conducts all the nerve Pathways can regenerate with hormones also it can help improve the way that the neurons grow and function and they work as neurotransmitters so the chemicals that tell one nerve to another how to work these hormones all work and they also balance other neurotransmitters in the brain so it's all very basic physiology that we should all be learning at medical school because you know we've got books and papers from decades ago telling us that and this is about our natural hormones that we produce and when you look even the way they're produced in the brain is really interesting and so if someone had like a stroke or a bleed to the brain one of the first thing that the brain does is produce progesterone because it's very anti-inflammatory it repairs cells it repairs um damage cells in the brain because our bodies are so clever aren't they so we know all this and so therefore if you think well what would it be like without those hormones of course it's going to affect brain function we know that estrogen helps improve the sugar the glucose metabolism in the brain it helps the way our mitochondria work which is as you know the PowerHouse of our cells it helps reduce oxidative stress so there's really important cellular mechanisms that are going on but also there are genetic changes that can occur as well so that's with the benefits of having estrogen so it doesn't take much to understand that without estrogen the it's just not working as well it's like trying to run your car without oil you know it's just spluttering it's just not going to work as efficiently but what I don't understand is why do women have to go through this phas then well EV if you think evolutionary we shouldn't so we are designed to reproduce so we're designed to be pregnant a lot of our reproductive life and actually when we are pregnant our levels of estrogen are very high they're about 65,000 where is there about well between 250 and a th000 when people are menstruating so we have very high levels of estrogen when we're pregnant many of us feel great when we're pregnant as well by the way um but then actually then at the end of our reproductive life is usually when we should expire and if you think in the Victorian times the average age of the menopause was about 57 so older than it is now and the average age of death was 57 59 I mean so just two years later we're living longer because of advances in Medicine of course so there aren't many other animals that go through this menopause um so it's one of those things that we don't know but there's lots of people that have other conditions as we age so raised blood pressure occurs as we get older people are more likely to have hypertension um it's not so much a disease but it's a marker for future health and it's no different with the menopause really we have these health risks but what's happened is that people have seen it as just a marker of symptoms so when they discovered um estrogen many years ago it was associated with hot flushes but when they discovered thyroxin it was associated with hypothyroidism a condition and when they discovered insulin it was associated with diabetes or disease and so it's the perceptions of what the hormones are and it's been ignored for so long also because it's a women's problem so why should we bother about women surely it's all in our head and I think it's very interesting if you look at the history of medicine and I'm sure you know as well but if you even think about the word hist which is

actually the Greek word for womb and his hysterctomy obviously is removal of the womb but then we have the word hysteria yeah and so there are a lot of women even now who are um section they're in mental asylums because of this hysteria but actually a lot of women when you tease it back it started when their periods were changing or stopped or they had their ovaries removed and something happened in their body and I hear it all the time in the clinic yet people say oh no it's in your head it can't be related to your hormones why can it not be related to our hormones of course because our hormones are so powerful in our brains and we know that in at least in Norway the suicide rates for women is highest during this phase yeah and it's the same in the UK as well and I had no idea to Lo for my clinic because I see so many women who have been under psychiatrist and mental health teams and crisis teams and they're on anti-depressants they're on antis psychotics they're on I they've had ECT recently I've seen some people have been given ketamine infusions there women in their 40s who have had PMS pmdd postnatal depression the periods have started changing but no one has talked to them about hormones it just doesn't make sense to me yeah that's why your work is so important and when we know that it can have such profound negative ramifications and we have to talk about this more openly because there is Solutions and we can have a good life in our late 40s 50s 60s 7s yeah for sure and it's so important because it has been this taboo people still don't talk and I think as women we're used to suffering we're used to struggling with things and we just get on with it and obviously I don't want people to think that everyone's going to get these awful symptoms because a lot of people don't but actually even if we forget about symptoms and we forget about the stuff suffering I've already said there are Health consequences of not having hormones so menopause or women whether they have symptoms or not have an increased risk of all the inflammatory conditions so they have an increased risk of heart disease osteoporosis diabetes clinical depression dementia these are all really common conditions when you look at Global Health the most common cause of death in women is cardiovascular disease and dementia so we know that menopausal women especially when they're younger and have a longer time without their hormones have a greater risk of these diseases yet replacing those hormones will reduce the risk of those diseases and it's a bit like comparing like I said to raise blood pressure we treat it to reduce the risk of heart disease so with the menopause there's a greater risk of developing heart disease than there is if you've got raised blood pressure yet we don't see it like that we just see it as a oh it's a natural process women go through and so I think we need to be really waking up to that fact because it is fact I'm not just making this up this is just fact from and when you understand how biologically active our hormones are and how they act in our brain but also our cardiovascular system as well then it's no surprise it just makes sense but how many PE how many women actually get do we know the statistics of how many people's how many women struggle during this phase it's really difficult because a lot of the studies are quite old um but even when you look at some of the studies about 75% of women receive um sorry have symtoms and about 25% have severe symptoms there was a recent study that said oh it's not as high as that it's only about 18% of women have symptoms I don't care whether it's 90% or 2% women should not be receiving or they should not be having symptoms if there's an evidence-based treatment that they should receive exactly and a lot of women will misreport their symptoms or underreport their symptoms or not associate their symptoms related to their hormones something like flushes and sweats is very easy because there's very few things as you know in medicine there are some conditions but very few that cause flushes and sweats but there's lots that can cause fatigue so we do a lot of work with um an organization helping people with lupus and one of the commonest symptoms of Lupus is fatigue well how many of those women will be menopausal as well you know we just don't know because it's very you won't know how many of your symptoms are related until you have treatment yeah and that's the problem because so few women are receiving treatment so um just to go through uh you mentioned uh estrogen progesterone and testosterone do all of these three decline during menopause so it's very interesting actually um yes to estrogen and progesterone testosterone is actually the most biologically active hormone that we have as women and we produce more testosterone than estrogen

when we're young but the levels of testosterone usually decline with age so it's not a menopause related hormone really it's just an age related hormone because about half of our testosterone is produced in our ovaries if people have um a failure in their ovarian function or they have their ovaries removed then their testosterone will then plummet more quickly yeah okay so but so you see that H testosterone also testosterone decline also can affect us women yes definitely and that's something that's been really under reported and under recognized because even if you think of the word testosterone related to testes well we don't have testes do we but actually it's is produced from our ovary a lot of people think that estrogen and progesterone is female hormones and testosterone is the male hormone but as you know they all come from cholesterol and then they the sort of pathway is ch oerol then there's progesterone then there's estrogen then there's testosterone but actually um men produce progesterone and men produce estrogen as well which can really play with people's minds when you think about it you know a menopausal woman has less estrogen than her husband probably in their bodies but we always just focus on estrogen for women progesterone is often thought of just if we've got a womb we need to take progesterone and it's a very important hormone and then test testosterone as well is always just thought of oh it's just for men or more recently it's been thought of it can just help libido in women but again we have testosterone receptors all around our body we have the in our heart in our lungs in our um GI tract especially in our brain testosterone works as a neurotransmitter as well so we can't ignore the biological effects of testosterone in our body so going through this it it's it sounds um it sounds like a difficult phase for very many women and we know here in Norway in England you're better at uh getting help in Norway I don't remember the numbers but there's very few percent uh in Norway that get treatment for their menopause because of all the scary side effects we've heard about could you please tell us is a hormone replacement therapy safe and what is actually the side effects because I think a lot of women worry about this absolutely and it's not just in Norway worldwide um even in the UK everyone thinks that we're doing really well HRT prescribing is still really low so in the UK about 14 not 40 14% of menopausal women receive HRT globally it's about 5% of women yet the guidelines the evidence will are very clear that it is the m it is treatment that has more benefits than risks and it's firstline evidence-based treatment for the majority of women so the majority is not 5% or 14% but if you say to women HRT or healthc Care Professionals HRT the first thing that they'll come up with is breast cancer yes so I'm happy to demystify that and it stems from this study which it was just so sad it ever happened really it was the called The Women's Health Initiative study the w hi study and it was um brought out in 2002 so in the '90s um when I started I qualified in 1994 and we were prescribed HRT a lot it was given out to people because we knew it helped people feel better actually in medicine that's a good thing to help people feel better but more importantly we knew that it was helping strengthen bones we knew there was a reduced risk of heart disease people were really wake up to the fact how important our hormones are so we used to prescribe it as a lot and then they decided to do a study looking at wow I wonder if it's going to be as helpful starting it in women who are older and it was a billion dollar study and that in it in itself is quite remarkable because since that time there hasn't been a billion dollars spent on women's health research as you know or hormonal research which is so awful so anyway they did this study they were looking at um the effects of HRT in older women now there's a couple of things that's really important about this study and one is the time type of HRT so HRT just stands for hormone replacement therapy which actually it's not really because it's only about these sex hormones it's not all hormones but there are different types so in this Whi study they use very synthetic hormones so the estrogen was a tablet and it was derived from pregnant H's urine which you could argue is natural but it's not something we really want to take and we know that tablet estrogen does have some effects because it gets metabolized in the liver so there's a risk of

clot and there's a risk of stroke with it as well and then they also W those women that had a womb they gave a synthetic progesteron called mojoy progesterone acetate we know it doesn't work in the same way as our natural progesterone because it's chemically altered so it has a small clot risk heart disease risk we know that so they gave women and the average age of women in this study was 64 and these were women that hadn't been on HRT so they gave women um this type of HRT and followed them up they started to notice that some women seem to have an increase inance of breast cancer and as you know in a big study what you do is you analyze results really carefully and you reanalyze them and you get the best statisticians and go through the results but they'd seen this result and they hadn't analyzed them properly but they told the newspapers and they told the New England medical journal and one of the investigators Rob Lango I've had him on my podcast before said a group of them said please don't publish this data because we haven't looked at it properly they said it's too late it's gone to the press and if you look at footage from that time there's people sitting on sofas being interviewed in the Press saying HRT causes breast cancer and of course I understand completely people stop prescribing it overnight it was a massive car crash but actually it's been the biggest travesty to Women's Health ever because since HRT prescribing has reduced the incidence of heart disease especially in women especially in America has really escalated Women's Health has just deteriorated and suffering for women has actually escalated as well but we've they've reanalyzed the data they've looked at it properly we've now got over 20 years data obviously because it came out in 2002 and there's some really reassuring parts of it so firstly when they look at the women who were only taking estrogen who'd had a hysterctomy those women were shown to have a 23% lower incidence of breast cancer so the estrogen which is no surprise because it's so anti-inflammatory isn't associated with this increased risk of breast cancer the breast cancer risk was associated with women taking the estrogen with the synthetic progestogen but actually it wasn't statistically significant anyway and the study wasn't set up to have breast cancer as a primary Endo it was looking at cardiovascular disease as a primary end point so if you look at the way the study was designed it wasn't designed to pick this up anyway so there's lots of flaws in the study and the is but actually also the other reassuring thing about it was that any type of HRT if someone did develop breast cancer their prognosis that Outlook was actually better than compared to someone that had never taken HRT but and this is a big but we don't prescribe those types of HRT we now prescribe the very natural body identical hormones that are derived from yam plants so it's like comparing apples and pears they are very different so we now just use the natural hormones so if I look down the microscope they are exactly the same as the hormones that we produce when we're younger so they have the same biologically active processes and benefits that I explained earlier whereas the synthetic hormones don't have the same ACT results and they're more pro-inflammatory so they're not going to have the health benefits anyway so that's what you call the bio identical well we call them sort of body identical there can be confusion with the term because some people um prescribe these bioidentical hormones that are compounded so they're not regulated products and as you know if something's not regulated it's not consistent with the way that it's produced so we always prescribe the regulated products they're not always licensed because for example testosterone isn't licensed for women in the UK or in many other countries as well but it's still the regulated product and that is important but they are exactly the same as the the actual hormones that we produce when we younger yeah okay so can you go through uh if a woman now um wants to try treatment for her menopause symptoms what would she get then yeah so we know from the evidence that the earlier a woman takes hormones the better so that's really important that they can be started in the per menopause when symptoms start we don't have to wait until we're menopausal um and like I say the per menopause can last many years so you don't want many years of suffering we also know that the sooner a woman takes HRT the better for her future health so we know that women who take HRT have a lower risk of heart disease by about 50% and a lower risk of osteoporosis and also a lower risk of dementia as well when it's the body identical hormones that are taken so we it's not just about waiting for symptoms for a certain length of time for example so usually in the clinic what we do is we start estrogen and progesterone if people need progesterone and then review

them and then the guidelines say that if women have reduced sexual desire despite being on HRT we can consider testosterone okay and so we then if women want to try testosterone then we try testosterone um and then review them and do their blood test to see make sure it's in the female range but we do find and many other clinics notice the same that women find that their mood energy concentration stamina um their sleep of often their headaches muscle and joint pains really improve with testosterone as well okay so all three often yes yeah and then there's also vaginal hormones as well um which are different to HRT because they only work in the vagina and the surrounding tissues so whether a woman takes HRT or not they can be really useful for people with localized symptoms so vaginal pain discomfort and urinary symptoms as well so people find that they go into the toilet more frequently they might have some urge incontinence and also unary tra infections and cystitis so they can be really beneficial for those women too people who are against this they often say but every woman goes through menopause is a natural phase or why should we medicate something that's natural what do you have to say to that isn't it interesting so I don't really see it as medication because it's just natural hormones there's a lot of people that have underactive thyroid gland and of course they can survive without their thyroid gland they'll feel more tired they'll probably put on weight but they can continue without thyroxin but a lot of people take thyroxin because it helps the body to function better and then you think of other sort of natural things so being in pain and child birth is natural but we give painkillers for it you know so we need to sort of think about what it what is what do we mean by natural then a lot of people say well I'm going to take a natural supplement for my menopause um and there are some supplements obviously they're not regulated um there was an article in the paper recently of a lady who had liver failure because she'd taken a black cush a supplement to try and help her flushes and it affected the liver there's lots of plants in my garden that are natural but I wouldn't want to eat them yeah so we just have to be careful and I think the other thing to sort of let us think about is what are the risks of not taking hormone replacement I'm not here saying everyone has to take it I'm saying everyone should know about it so if I as a menopausal woman which indeed I am wasn't taking HRT I know that the symptoms I had would have stopped me working because my brain had gone my memory had gone I was also getting a lot of migraines I was Finding working as a doctor really difficult so if I wasn't taking HRT I probably would still have some symptoms I don't know whether I would have them all but that was something that concerns me but actually one of the things that concerns me even more is osteoporosis I've seen a lot of women with osteoporosis of their spine who have had a lot of pain from these micr fractures they get it's very difficult to digest food very difficult to be mobile I don't want osteoporosis so one of the reasons I take HRT it's a personal decision is to reduce my risk of osteoporosis as well as other conditions as well if I didn't take HRT I know I've got an increased risk so of course I can look at my nutrition which I do exercise mental health and well-being which I do but I can't replace those missing hormones there's nothing else I can do to have those hormones back so you can't eat yourself out of no but are there any lifestyle factors that can influence it and make it easier for us yeah it's really interesting because yes of course and actually as a GP I'm really holistic in my care not just my care for myself but my care for patients but I see and speak to so many women who have been told come on you need to exercise more you need to eat better you need to sleep better and these poor women have been trying so hard but when they're menopausal it is a cardiometabolic problem so it changes our metabolism that's why there's an increased incidence of heart disease and Diabetes Type 2 diabetes as well people tend to put on weight when they're menopausal sometimes it's because they're Comfort eating they're not eating the same food or they're just sitting around they can't exercise because of the way they feel but also our body does need estrogen so one of the ways it can produce estrogen is by increasing our number of fat cells now our fat cells our ad deposites are very active when I was at Medical School in the 80s we were just told it was just a like an inert substance that didn't do anything but of course we know they're very active the osit they do produce estrogen but they produce estrone not estad and that's important because the commonest estrogen we produce when we're younger is estradi

which is very anti-inflammatory estrone is the pro-inflammatory estrogen so when people have estrogen as a tablet it gets converted to estrone which is pro-inflammatory hence the problems with the Whi study but also in our body so when people are putting on weight they're giving themselves more estrogen without realizing but actually it's not the great the best estrogen and we know weight gain is not ideal so women often are then made to feel more of a failure because they come and they say I've tried everything and I can't lose weight I can't sleep I've been doing all this self-help I've been meditating I've been trying but they're trying to do it without hormones and often the hormones is the missing piece yeah so often when people have hormones it's so much easier to have a better lifestyle but if you only have hormones and smoke 20 a day drink alcohol don't look at your diet then the hormones are good but they're not going to help everything so that's why it's looking at really you know 360 Dee care with a menopause because the menopause lasts for decades you know if the average age of the menopause is 51 death is 83 in the UK that's 30 years but one in 30 women under the age of 40 will have an early menopause my youngest patient was 14 when she was diagnosed with menopause um so she's got the majority of her life being menopausal so we can't just think oh it's Nature's Way let's just eny it let's just go see what happens because it's not fair on our bodies so if you're on the HRT and you want to do um you want to change some lifestyle factors what would you recommend then it's really important to not do everything at once I think because otherwise it's really hard nutrition is so important and it's something that we should be looking at more and it's probably easier in Norm way than it is in England to eat healthy healthily but certainly there's so much processed foods it's so easy to snack on rubbish eat the wrong Foods so looking at processed foods is crucial looking at our sugar content even looking at what we drink it's so easy a lot of women say to me they drink more alcohol because it helps them numb their symptoms it helps them forget about things helps them sleep they think it helps them sleep but obviously it doesn't um so and then a lot of people will have fizzy drinks they'll have fruit juices know all of that is actually not good so looking at what we're drinking looking at our gut microb is really crucial because then it all works together you know um and obviously looking at smoking looking at exercise many people find their type of exercise has to change know you doing high intensity like adrenaline inducing exercise increases cortisol and we know that adrenaline and cortisol ol those levels can change when our hormone levels are low and so actually a lot of people find that they have more cortisol then they find that they're not um able to um exercise as well but also they tend to put on weight despite exercising so sometimes people find doing different types of exercise like yoga or Pilates can actually be more mindful but actually it can be more calming on the body as well um so because our body is adapting as we're aging as well it's not always related to hormones but we need to be sort of working out what's best for us both physically and mentally H so women experience that they get higher cortisol during their menopause many women do often yes yeah many women gain weight during this phase I don't know will they as well if they are on hormone replacement therapy will they increase in weight most women no actually a lot of women lose weight on HRT and it's being quite muddled because when people have looked at studies they've looked at older types of HRT as well as the more natural body identical hormones but actually if you'll replace the missing estrogen our body doesn't have to make fat cells in the same way of course um and so people often find especially the midline that they often put weight on that can reduce but also estrogen test and testosterone can help build muscle as well because um it strength and tone so a lot of people find that able to change the shape of their body more easily when they exercise they say that they can feel that their muscles coming back they feel that their postures changing and that's really important so it might not be their actual physical weight that changes but actually their the makeup of their body and we know that um this sort of visceral fat the central fat which is a marker of heart disease as you know and inflammation that often can reduce as well and it's getting the combination is right and that's really important with HRT is that there are different Doses and there are different types yeah about a third of women who come to our

Clinic are already on HRT and some of them say oh it doesn't work for me and then you look at what they're on they're either on a really low dose or they're on the synthetic hormones and then you convert them to the Natural hormones and give them the right dose that's right for them yeah and they're completely different okay so it's important to get their right types of HRT as well um I was just I just thought of a question that I probably will get from a lot of my listeners is how do I know if I'm going through perimenopause or it's just a lot on in work or life that happens a lot and it's impossible to know and so one of the things we often do is just give a therapeutic trial and it's the same with anything in medicine but everyone seems more worried when it comes to hormones so if I thought someone had um I don't know someone had migraine for example and I knew from the history they had a migraine there's no blood test for migraine we don't rush and do a scan for a migraine it's all in the history but if I think someone has migraine they are firstline treatments that I try if they come back after 3 months and say no my head's really bad I've got more frequent migraines I will talk about other treatments it's exactly the same with a per menopause if a woman comes and says I think some of my hormones are related then I can say all I can do is give you back your missing hormones in a physiological way and let's see what symptoms are left so a woman with a headache might also have a brain tumor I don't know or someone with palpitations might have a heart condition I don't know but they can have both they can also be per menopausal and have a heart condition we do it all the time in medicine we're making diagnosis all the time when we talk to patients and sometimes there are two three four different things going on and we can address them all but say for example someone with palpitations I take a good history I examine them and I think well there's nothing a red flag there's no nothing serious that really means they have to go into hospital today for their votations so they'll often have other symptoms as well which I think may be related to their hormones I prescribed them HRT I might also refer them for a test to their heart but usually what happens is their palpitations melt away before their appointment comes through for their heart investigations and then the proof is in the pudding really you can see um but if the palpitations carried on or persisted or changed of course they would need a c cardology the problem is it's all happening the other way around so we see hundreds of women that see cardiologists for their palpitations they see neurologists for their headaches they see rheumatologists for their muscle and joint pains they see urologists for their bladder symptoms they're on a myriad of treatments and no one has talked about hormones so once they're on HRT they often come off their anti-depressants they come off their painkillers they can even reduce statins in their blood pressure treatment so we're deprescribing a lot of the time oh that's so the menopause is being medicated with the wrong things and that's really worrying actually are there any clues though for women who are in their 40s and thinking about it's if it is this oring at symptoms so downloading the free balance app has got I've been a medical writer for many years so there's lots of information lots of Articles we're adding to all the time so people can just read information but also there's the ability to monitor symptoms as well and it's worth people doing even in their 30s or 20s if they think there are hormonal changes doing it every three to six months and then just having a internal check with yourself do you think any of these symptoms could be related to your hormones and that's the biggest question that people need to ask themselves and if women say yes that that's when they need to try and get some health advice and treatment great that you have this app okay is there anything else that you want to uh to share while you're here nor when we're so lucky to have you here a I just want people to have knowledge and make sure it's the right knowledge because just being here for 24 hours people still very scared about hormones women and healthc Care Professionals still seem scared but actually what I love about Norwegians is that you've very thoughtful and you want to learn you've got this appetite for knowledge so it's I think it's a woman's Duty actually to understand what's going on but also people around them should understand as well because sometimes when you're menopausal or per menopausal it's overwhelming and it's very difficult sometimes to learn new information so we all should be having this conversation but we shouldn't just be talking about the symptoms we should be thinking about treatment as well so I feel like there's a lot changing already globally certainly in the UK because women are understanding how important our hormones are so yeah I'm hoping me

coming as a start of a conversation but I really want it to continue as well yeah I know we are behind the UK so I'm very happy that I get to share your knowledge with the more people in Norway thank you so much for joining thank you for inviting me it's been great and if H my listeners want to H find you where can they find you so my website is Dr Louis n. c. and then you can link on to the podcast or to the balance app from that website and I'm very active on my Instagram which is menop undo doctor great I follow you it's a great Instagram account and if you have any questions for me you find me on Dr Anette dragin h on Instagram and uh Facebook and I also get I also recently got a YouTube channel Dr anet you can find me there and please subscribe and if there's anything else just don't hesitate to reach out and that's it for today have a great day bye