How do I know if I'm perimenopausal?

A few months ago a member in the Parenting Membership shared a whole bunch of symptoms she'd had, from fatigue to rage to dry eyes. She'd been on a four year journey to figure out what was going on before finding out that she was in perimenopause, and wanted to save other members from the same experience she'd had.

That sparked a huge discussion in the community, with other members wondering whether the symptoms they were experiencing were also related to menopause - and whether this was going to be yet another thing they were going to have to educate their doctors about to get appropriate treatment.

In this episode we answer questions about:

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• What roles do hormones like estrogen, progesterone, and testosterone play in our bodies?
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• What is menopause, and what is perimenopause?
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• What are some of the most common symptoms of perimenopause? (Hint - it isn't hot flashes)
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• What are the benefits of Hormone Replacement Therapy, and who should consider it?
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• Is HRT dangerous?
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• What impacts does culture have on the experience of menopause?
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In our next episode on this topic we'll look at a non-medical, holistic approach to menopause.

Dr. Newson’s books

Preparing for the perimenopause and menopauseMenopause: All you need to know in one concise manualThe Definitive Guide to the Perimenopause and MenopauseJump to Highlights

01:26 Introducing the topic and featured guest for this episode

03:48 Hormones play a crucial role in menstruation.

08:28 Dr. Newson explores the definitions and challenges of menopause and perimenopause, emphasizing the wide-ranging symptoms and long-term health implications associated with hormonal changes.

12:10 Dr. Newson discusses recognizing perimenopause symptoms amid busy lifestyles and the importance of early awareness, regardless of age variability in menopausal onset.

16:05 Dr. Newson explains how hormonal birth control can obscure natural hormone patterns, potentially leading to misunderstood symptoms like mood changes and reduced energy.

18:26 Women face challenges in receiving timely diagnosis and treatment for perimenopause and menopause symptoms, underscoring disparities in healthcare and the importance of seeking medical help despite societal barriers.

22:46 Hot flashes, often associated with menopause, are not the most prevalent or severe symptom. They result from brain disruptions and vary widely among individuals, with many experiencing cognitive and psychological symptoms instead.

27:28 Perimenopause and menopause often bring cognitive symptoms like memory lapses, tied to hormonal shifts that impact brain function, yet frequently disregarded in medical care and treatment.

33:41 Hormone replacement therapy has been found to be effective in managing menopausal symptoms and offering potential long-term health benefits, despite past concerns about risks associated with older synthetic hormone studies.

44:47 Hormone replacement therapy, especially with natural hormones, is often prescribed long-term for health benefits, contrasting with synthetic hormones implicated in higher risks from the WHI study.

47:43 Dr. Newson emphasizes that while non-hormonal treatments like antidepressants and therapies can alleviate symptoms, they don't address the underlying hormonal deficiency that hormone therapy effectively restores for overall health.

49:41 Jen and Dr. Newson discuss cultural views on menopause, emphasizing the need for accurate medical support over stereotypes or inadequate treatments like antidepressants.

57:21 Wrapping up the discussion

References

Attia, P. (2022, August 20). Menstruation, menopause, and hormone replacement therapy for women.

Carson, M.Y., & Thurson, R.C. (2023). Vasomotor symptoms and their links to cardiovascular disease risk. Current Opinion in Endocrine in Metabolic Research, 100448.

Cramer, D.W., Xu, H., & Harlow, B.L. (1995). Family history as a predictor of early menopause. Fertility and Sterility 64(4), 740-745.

Dominus, S. (2023, February 1). Women have been misled about menopause. The New York Times Magazine. Retrieved from: https://www.nytimes.com/2023/02/01/magazine/menopause-hot-flashes-hormone-therapy.html

Gilberg-Lenz, S. (2022). Menopause bootcamp: Optimize your health, empower your self, and flourish as you age. New York: Harper Wave.

Herstasis (2024). Menopause symptoms. Author. Retrieved from: https://www.herstasis.com/symptoms/

Kolata, G., & Petersen, M. (2022, July 10). Hormone replacement study a shock to the medical system. The New York Times. Retrieved from: https://www.nytimes.com/2002/07/10/us/hormone-replacement-study-a-shock-to-the-medical-system.html#:~:text=A%20rigorous%20study%20found%20that,a%20decrease%20in%20colorectal%20cancer.

Lobo, R.A. (2013). Where are we 10 years after the Women’s Health Initiative? The Journal of Clinical Endocrinology & Metabolism 98(5), 1771-1780.

Manson, J., Bassuk, S., Kaunitz, A., & Pinkerton, J. (2020). The Women’s Health Initiative trials of menopausal hormone therapy: Lessons learned. Menopause 27(8), 918-928.

Mosconi, L. (2024). The menopause brain: New science empowers women to navigate the pivotal transition with knowledge and confidence. Knox, ME: Center Point.

National Institute for Health and Care Excellence (2015, November 12). Menopause: Diagnosis and management. Author. Retrieved from: https://www.nice.org.uk/guidance/ng23/chapter/Recommendations

Newson, L., & Lewis, R. (2021). Delayed diagnosis and treatment of menopause is wasting NHS appointments and resources. Newson Health. Retrieved from: https://d2931px9t312xa.cloudfront.net/menopausedoctor/files/information/632/BMS%20poster%20Louise%20Newson%202021.pdf

O’Reilly, K., McDermid, F., McInnes, S., & Peters, K. (2022). An exploration of women’s knowledge and experience of perimenopause and menopause: An integrative literature review. Journal of Clinical Nursing 32: 4528-4540.

Stute, P., Marsden, J., Salih, N., & Cagnacci, A. (2023). Reappraising 21 years of the WHI study: Putting the findings in context for clinical practice. Maturitas 174, 8-13.

Do you get tired of hearing the same old intros to podcast episodes? Me too. Hi, I'm not Jen. I'm Jessica. And I'm in rural East Panama. Jen has just created a new way for listeners to record the introductions to podcast episodes, and I got to test it out. There's no other resource out there quite like Your Parenting Mojo, which doesn't just tell you about the latest scientific research on parenting and child development, but puts it in context for you as well so you can decide whether and how to use this new information. If you'd like to get new episodes in your inbox along with a free infographic on 13 Reasons your child isn't listening to you (And what to do about each one), sign up at YourParentingMojo.com/subscribe, and come over to our free Facebook group to continue the conversation about this episode. You can also thank Jen for this episode by donating to keep the podcast ad free by going to the page for this or any other episode on YourParentingMojo.com. If you'd like to start a conversation with someone about this episode, or know someone who would find it useful, please vote it to them. Over time, you're gonna get sick of hearing me read this intro as well. So come and record in yourself. You can read from a script she's provided or have some real fun with it and write your own. Just go to YourParentingMojo.com and click Read the Intro. I can't wait to hear yours.

Hello and welcome to the Your Parenting Mojo podcast. Today we're kicking off a mini series on the topic of menopause. Because many of our listeners had children on the later side, we may be in the position of approaching menopause at the same time as our own children are approaching puberty, which is a lot of hormones all at once. My own doctor hadn't mentioned anything about menopause to me and I had to ask her about it at my last appointment and she seemed kind of nonchalant about it. And because I have an IUD she said that I might not even notice it happening. But about a year ago a parent in the Parenting Membership had put up a post and said that when she was around 43. She started to feel really angry and stressed and anxious and tried meditating to fix things but there was minimal change. And she said she eventually read an article on brain fog and perimenopause and realized that her slowing periods were a sign of perimenopause. And that also explained a whole host of symptoms like irritability, fatigue, anxiety, extreme dry eyes, and even tinnitus. And so she posted this in the community so that other parents wouldn't have to go through this four year journey that it took her to figure out what was going on with her and it prompted a huge discussion in the community. And it took me quite a while to find our guest today and as an expert to discuss menopause and perimenopause with us and I'm so glad that we have found her.

So Dr. Louise Newson is a physician and menopause specialist and a member of the UK government's Menopause Task Force. She's also an award winning doctor, educator and author committed to increasing awareness and knowledge of perimenopause and menopause. Described as the medic who kick started the menopause revolution she has empowered a generation of women to have greater understanding choice and control over their treatment bodies and mind. She's the founder of the Free Award Winning balance menopause support app, which has more than 1 million downloads to date and the balance menopause website. She also hosts the weekly Dr. Louise Newson podcast, which has been ranked the number one medical podcast in the UK. She's also a Sunday Times bestseller and has authored a number of books including The Definitive Guide to the perimenopause and menopause. Preparing for the perimenopause, and menopause and menopause, all you need to know in one concise manual. So welcome, Dr. Newson. It is so great to have you here.

No thanks for inviting me. It's great. Yeah. So

I wonder, can we start with the basics that I It seems as though we should understand by this point in our lives, and maybe a lot of us don't. Right? What are the roles of the various hormones associated with menstruation on our bodies? Because I think you know, I don't until I started researching this episode didn't understand what all of them did. Yeah.

So I mean, just even before saying that hormones are just chemical messengers. They're just chemicals that we produce naturally, that actually go in our bloodstream and tell our body what to do. So we have cells that respond to the hormones, we have receptors where their hormones bind, and then there's different reactions that occur and they're all beneficial biological reactions. We have hundreds of hormones. The three hormones we're really talking about are: Estradiol, which is the the metabolically nice beneficial type of estrogen, progesterone and testosterone. And these are three hormones that actually are important for our menstrual cycle. So our ovaries produce them, but also other tissues and organs produce them as well, including our brains. We've known for many years, the levels of these hormones change throughout our menstrual cycle. Most of us don't have very regular sort of wonderful cycles where we like a textbook. But if we were, then what happens is our hormone levels will increase and certainly maximize when we ovulate, so usually the middle of our cycle, and then the second half of our cycle, they increase at different different amounts. And then they really go very low just before our periods. And that's important to know, actually, because many people feel that they have a few symptoms might just be feeling a bit more tired, bit lethargic, maybe a bit irritable, just before their periods. And that is related to hormonal changes.

Okay, and so can you just tell us a little bit about what each of those different hormones does? Like what's the what's the role?

Yeah, so they all work together, actually, they're all derived from cholesterol. So they're very, when you look at their structure, they're very similar. So they do have similar effects. But when you think about for reproduction and fertility, they work to the estrogen builds up the lining of the womb, that progesterone will, when there's a drop in progesterone, you get shredding of the lining of the womb, so they work together really to get the body ready for pregnancy. Because after all, that's actually what women are designed for evolutionary, I'm afraid. So So there's been a lot of focus on what they do on the womb, that the ovaries produce. But actually, as you and your listeners know, women are more than just about their womb, what they do also is go into the bloodstream, and have an effect on every single cell, every single organ in our bodies. And they work to improve our metabolism, improve the way that our cells work. And they all work in slightly different ways, but very similarly. So if you think in that, in each cell, they help with the metabolism of ourselves, they're sort of just sugar, glucose metabolism of ourselves, they help with mitochondria, which is the powerhouse of ourselves, that mitochondrial function is depended on by Easter doll, progesterone, testosterone as well. And then if you look at a bigger picture, they help with the way our brain for example, functions, it helps with the way that our nerves talk to each other the synapses between the nerves, it helps building the connections of the nerves with the brain and the other tissues, it helps they help with the way our heart conducts electricity and, and the the rate of which, and the rhythm of our heart helps with eyes, lubrication of our eyes, it helps with the way we smell, the way we taste the way even just the way our teeth are in our gums. All of this every single thing when I could talk for hours going through the whole body thinking about how important they are for our muscles to work our brains to work on things that our digestive system. So when you know how important these hormones are, then that's really crucial, because the next step is, well what happens when we don't have them and obviously, that's when you talk about perimenopause and menopause. But I think it's so important to be aware of basic physiology. So these are just hormones that our body produce and that we are naturally designed to have these hormones. Yeah.

Okay, super well, I even in doing the background research, I didn't come across some of those links. So thank you for calling that out. And so I wonder then now we're kind of segwaying into right what is menopause? What is perimenopause? Yeah,

so menopause has been defined? Weirdly, I think as a year since a woman's last period. And again, this is about the definition of women and periods and their womb. Like I don't really understand who decided after a year that we can be officially menopausal. Like it just feels weird to me because nothing biologically or pathologically happens in our body after a year like what's the difference between 364 days? And 366? Or what if it's a leap year? What do we do that and it doesn't make sense does it? And then also, women don't have periods because they might use contraception. They might have had a hysterectomy, for example. And so what it really means is that the hormone levels are low because our ovaries don't work because the eggs run out or they number reduces to the hormone levels reduce.

Perimenopause is the time before when hormone levels start to fluctuate and decline but woman is genuinely still having her periods. And that can last for 10 years. Also, hormone levels are very chaotic, they gradually decline but they're up down up down quite a lot as well. And so the perimenopause again is difficult to diagnose. There's other diagnostic tests that we can do. It's more based on what are the symptoms you're experiencing. But like I said before, the hormones are not just in our ovaries determining our periods, they're affecting all the cells in our body, especially our brain. So a lot of people have symptoms because these hormones are very important and biologically active. So people have many symptoms and the symptoms of perimenopause and menopause are essentially the same. But not everyone gets every symptom.

Some people might get a few symptoms that change with time, but the commonest symptoms are symptoms affecting our brain. So brain fog, memory problems, low mood anxiety, irritability, poor sleep fatigue, and you can quickly see like lots of us have those symptoms, or is it related to our or hormones? How do we know that it's our hormones or not. And that's why it can be very difficult. But there are other symptoms, like everyone knows about flushes and sweats, which can occur in quite a few. The majority of menopausal women will have some of them at some time. But people can have heartburn, they have indigestion, they might have urinary symptoms, they might be going to the toilet more frequently might be having cystitis, pain, passing urine, or urinary tract infections might have skin changes, so the skin can become dry and itchy and irritated. They might have palpitations, so lots and lots of symptoms as dozens of symptoms that people can experience. And they can come and go. But the other thing about having low hormones during panic, perimenopause and menopause, is that they're low hormones, because they're biologically active when they're low. The longer they are low, the more strain if you like there is on the body. So we know, the more risk of diseases like heart disease, osteoporosis, diabetes, dementia, and that's really important, actually, for people to know. It's not just about symptoms that may or may not happen, or may or may not last for years, or months or decades, depending on the person. It's more about the future health as well. Right.

Okay. Well, I use that a lot there. And so I mean, I guess the biggest thing that I heard in that is in firstly, the the massive variety of potential symptoms, and as soon as when you're when you said in the beginning that some of these hormones are linked to, you know, the way your eyes operate. And I thought back to my member who's like, I get a dry eyes, I'm like dry eyes. We've never thought of that as a symptom. So if you know I am a busy person, and I have a lot going on in my life, maybe I have multiple kids. And you know, I'm with them all the time, or I have multiple kids, and I'm working outside the home. And I'm tired all the time. And I have some brain fog. How can I know that this isn't just you know what life is? What might cause me to suspect that this could be perimenopause?

It's really difficult. And I didn't realize even when I was perimenopause, and it took me quite a few months to work it out because I've got three children, I had my third child when I was 40. I just thought I was struggling. And I couldn't cope with everything. But what one of the reasons I developed balance app, which is a free app that people can download is there's a symptom questionnaire on there. And people can then start to monitor symptoms when they feel well. And then if you start to get symptoms, that's where you need to start questioning and thinking, Is there a reason for me to be doing this? You know, am I tired? Because my kids were up in the night? Am I tired? Because my husband's been snoring all night? Am I tired? Because I'm stressed at work? And if it's not related to those, well, could it be related to my hormones, and we have to have a lower threshold than we've done before thinking could any of my symptoms or the way I feel we related to my changing hormones. And the other thing is if you start monitoring when you're younger, then you'll be more in tune with your body. So like I said, at the beginning, a lot of symptoms are very similar to symptoms people get just before their periods. So if they used to feeling tired, irritable, maybe have some flashes or sweats, maybe have some palpitations, maybe have sugar cravings, maybe have bloating before their periods. And then they're getting this at other times and they feel similar symptoms. That should be a bit of a red flag thinking, I wonder whether it's related to my hormones, and sometimes even as a hormone specialist, I don't know. But I do know there's a pattern of symptoms and the woman's saying, you know, I feel similar to this when I'm just before my period, then we often do try hormones and see if it helps.

Okay, okay. And I know there's a massive range in variation of age at which this happens. What I mean, you said you were 40 when you started to do some of these changes. I know that the average age of menopause is considerably older than that. So when should we be starting to look out for this?

No one's too young. So, yeah, in the UK, the average age of menopause is about 51. But perimenopause can last 10 years or so before. So that means most women in their 40s will be Peri menopausal or even menopausal. Because young people can become menopausal or postmenopausal. Around one in 30, women under the age of 40, will have an menopause at a young age. And I've seen women who have been teenagers and their ovaries have declined in function, and they've started to experience symptoms. So we need to be looking out for it more than perhaps we do. Because, you know, if you Google menopause, it's always white haired woman with a fan with their head in their hands looking very distraught. Our head if we ever had gray hair, and yeah, I've never had a hot flash. So it's, that's why it's important to not think, oh, it's something that's going to happen when I'm older, because it might not. And there's no way of knowing what age you're going to be when it happens either.

Right. And for those of us who are on hormonal birth control, right, and you may not have as much visibility into our cycles, like, I mean, my daughter turned 10, yesterday, and I haven't had a period since before she was, you know, before I was pregnant. So like, I don't even know what I'm looking for.

Yeah, and that is hard when people say, especially if they're on hormonal contraception, because hormonal contraception will block natural hormones as well. And although they will still have some beneficial effects, then people find that they do start to get symptoms, and it's put down to side effects of the contraception, but it might be because of hormonal changes in their own bodies as well. Combination or contraceptives will block or reduce the way that testosterone works in our body, for example. So it will increase something called sex hormone binding globulin, which binds to testosterone. And then we have less freely available testosterone. And testosterone can work well to improve mood, energy, concentration, stamina. And so if you're on the contraception, and you're getting those symptoms affecting mood, energy, and so forth, then it's thinking about well, do I need to change my contraception and see what I'm like with my own hormones? If you see what I mean?

Yeah, okay. Okay. And also, you mentioned the balance app. And I just want to put a little plug in for that. I downloaded it, I want to say, it's been a couple of months ago now, as I was preparing for this episode. And it's a super easy interface, it's totally free for anyone to download. If you want to pay you can I love this model, if you want to pay you can and that supports you in doing this work with more people and spreading it out to the world. I haven't received a single notification from it. I haven't received any any sales messaging from it at all. So I just wanted to make sure that folks know that that is available. And I definitely recommend it as a way for people to keep track of the kinds of symptoms that that you're describing so that we can be more aware of what's happening in our bodies. So thanks for creating that.

Oh, thank you, when I did it out of frustration, I wish I'd had it when I was suffering. But also, you know, I've worked as a medical writer for 25 years. So there's a lot of articles and resources on there as well for people. So it's an information source as well as just monitoring some gems.

Yeah, I did some digging through that and in preparation I found some of the information on kind of how a lot of people figure out that they're in perimenopause, and you actually did a survey I from what I could tell it wasn't sort of a statistically, you know, the, the sample was just sort of a convenient sample right drawn from, from people who responded to an online survey. And my hypothesis would be that people who have had more trouble with their doctors are going to be more likely to, to respond to a survey like that. But still the the numbers that you turned up in that were kind of staggering to me that 75% of people had experienced symptoms for more than a year 7% of people went to the doctor more than 10 times before they got adequate help or advice. And I mean that the thought occurred to me that if this was something that affected the you know, the other half of the population who deals with penises mostly and erectile dysfunction, that there would be a lot more support than there is and we wouldn't have to work as hard to be believed. What are your thoughts on that?

Yeah, it's really shocking. This is a survey that I did in preparation of my book, The Definitive Guide to Perimenopause and Menopause. So it had nearly 6000 responses. And it was just a social media survey. So, of course, it's not representative of everyone, but it does show some harrowing things about as you say, women not being listened to which I find really frustrating because one of the things certainly I went into medicine for was to help people and listen to people and you know, I can share uncertainty. If someone, I don't know what's wrong with them, I could still listen to them and say, I'm not sure it sounds like it could be A but it could be B, or maybe it's C. I'll get some tests, or I'll ask a colleague. But so many women are just going back and forth and being told no, it can't be your hormones, because you're too young, you're too old or too, whatever, which is completely wrong. And I did a similar survey, smaller numbers now about eight years ago, and it was about 12% of people were, were struggling to receive two minutes, and it took multiple GP appointments. So it things have improved, but there's still a lot of suffering going on. And we know that the sooner women receive treatment, the better they will feel, of course, but also for their long term health, it's best to as well. So there's no advantage for delaying treatment, if that's what a woman wants. Yeah.

Okay. And then the another thing that stuck out to me from from the background research I did was that a lot of women experience symptoms, and then just don't go to a doctor, right? It was something like 30% of women just just don't see anyone. And the researchers were saying that this may suggest a pervasive feeling that women believe they should not seek support. And also there's sort of socio economic disparities there as well. So it's the message, we haven't even started talking about treatments yet. But the message that I'm hearing from you is like, if something doesn't feel right, we should be going to our doctors.

Yeah, for sure. Because, you know, we all want to be the best version of ourselves. And obviously, some things we cut are out of our control. But certainly, if people are experiencing symptoms that they think are due to their hormones, they really should try and seek help because there'll be less suffering. And it's really difficult sometimes to be validated, because so many clinicians haven't had good quality education when it comes to menopause. You know, I didn't get any formal training. And most of it even when you look up, it's talking about flashes, sweats, vaginal dryness, maybe low mood, and that's about it. As I said, already, there's dozens of symptoms that can occur. And every day, I hear about new symptoms, and I know they're related to hormones, because when I review people three months later, their symptoms have improved. And it's not just, you know, a placebo, we have to start believing people more and understanding and when you understand the role of these hormones in our body, you can quickly understand well, actually, without them, there will be symptoms that maybe be a bit unusual, but we still have to remember that women are there not for any other advantage, other than to try and be listened to and get directly to the right treatment.

Okay. And you mentioned hot flashes a number of times, right. And so it's I think that's sort of the defining symptom that many people in Eurocentric countries think of when they think of menopause. And so I was really curious to read the, the hot flash, isn't actually associated with the rise in core body temperature. Like what's going on in a hot flash? Yeah,

So a hot flash and sweats effect about 65-70% of women. It's not actually the most common symptom, or the most severe symptom yet we're always thought of is it's just about menopause is just about flashes and sweats. We've got an area in our brain in the hypothalamus, which is a so called our thermoregulatory area of our brain. So it determines the temperature control. It's like the thermostat, if you like, and our brains like everything stable, they like homeostasis. So we've all got that sort of times where we feel very hangry that hunger angry. And that's because our brain likes to be you know, well, you have good nutrition we well hydrated, have regular sleep, all those things. And you can imagine, especially with perimenopause, when our hormone levels are really fluctuating, that fluctuation can really trigger the hypothalamus to not work properly and cause a bit of chaos. And so it's sending out weird signals to the body and one of those will develop this flash and sweat. And it really varies. Some people find they have cold flash rather than a hot flash. Some people find it's from the head down, some people find it starts in the chest and moves it upwards.

Some people find that they get a lot of palpitations or they might get anxiety or catastrophic thoughts with it. They really, really vary but some people just have sweats at night. They don't have any hot flashes. It so everyone's experience can be quite different. And you know not everyone that has a night sweats is menopausal. There are medical reasons why people are going to have night sweats to what's been a shame is that lack of estrogen has been defined or associated rather with flashing and sweats. And so then a lot of people are just thinking menopause is about flashes and sweats. And that's where the difficulty is to really listen to, especially if you don't have flashes and sweats. And also a lot of people when they're looking at treatments, it's always about, well, where are different clothing or change the temperature in the room. But actually, I've already said the most common symptoms affect our cognition and our brain and our memory and our personalities. And so if we're sort of doing women a disservice if we're just thinking it's all about flashes and sweats.

Yeah, for sure. And I do would before we leave that topic of flash in sweats just want to point out some research I found that shows that Black women are experienced the most hot flashes and experienced them as more bothersome. And also low socioeconomic status and childhood abuse were associated with the experience and duration of hot flashes. Do you have any idea what they like? What's driving that?

Yeah, it's very difficult. The research is not brilliant either. And it's really difficult when you compare with other people too. And this is one of the problems a lot of the research has just been focusing on flashes and sweats. If you look at, for example, domestic abuse, we know women are more likely to have more severe menopausal symptoms in general. But a lot of people won't be recognizing them as menopausal. So those people that have reduced self-esteem, low self-worth, feeling that they're not sleeping, they're worrying, they've got anxiety, and they are subject to domestic abuse. They will not be blaming their hormones, instead, we're thinking about the situation that they're in. And that's why it's very difficult to get the proper data. We know women who are subjected to domestic abuse are more likely to have a younger, be menopause at a younger age, more likely to have severe symptoms, and sadly less likely to receive treatment. Everyone's different, and certainly some some ethnicities that probably are more vasomotor symptoms. Some are more psychological symptoms. And some people have spoken about, for example, women in Singapore are less likely to have vasomotor symptoms, maybe because they are so in their diet. But actually look at the rates of osteoporosis in Singapore is really high, because women are living longer as well. And that's where we need to just take it away from thinking of it just as symptoms when it comes to menopause.

Yeah, okay. Okay. So you've mentioned a number of times that the, the most common symptoms are actually cognitive based, which I had no idea about. And I've actually been struggling with myself. And I, for me, it's more like I can have these kinds of conversations with no problem, because we're not talking about nouns, for me is the name of a thing, like, what is the thing that I put down over there, and I want you to go and pick it up for me and bring it over. I can't remember the name of it. And so it shows up for me more in family life when we're you know, we're talking about the things that are surrounding us in our lives rather than the concepts, right, the the ideas that we talk about here on the podcast. And yeah, I had been starting to get worried worried about that. And, and then I was sort of reassured to read that for many people, the symptoms are relatively short lived. They don't last forever. So I wonder if you can speak to that a little bit. And then I'd love to sort of look at their connections with dementia and Alzheimer's and some of the other things that come up later in life as well.

Yeah, I mean, it really varies for duration. You know, some people say symptoms only last 7 to 10 years, that's a heck of a long time to experiencing symptoms, which are due to a hormonal deficiency that will go if the hormones are replaced. Sometimes I've seen people who have had a hysterectomy, aged 40, and it's 78, they're still experiencing symptoms. So there's no way of knowing how long symptoms will last for and even which symptoms are related only to hormones. The only way of knowing of course is by replacing the missing hormones.

Yeah, okay. And we'll come to that in just a second. And so I guess one thing that I was kind of reassured by as I was doing this research was the sort of, you know, forgetting where your keys are, forgetting the name of things is not necessarily a sign of like super severe brain troubles like dementia like Alzheimer's, right that I mean, that's where my mind is going. And I read somewhere there the reassuring idea that the dementia is not the kind of forgetting where your keys aren't dementia is forgetting what keys are for that kind of deep breath and okay, everything everything's probably, you know, not as bad as I think it is. So can you talk about kind of the links between sort of the hormones and some of these other dementia these other brain changes and you know, what, why don't they why don't we recognize them as being associated with the hormonal changes? Is it just because we think of you know, I saw this idea of Bikini medicine right. If it if it If it's been in the areas covered by a bikini, then it's a women's issue. And if it's not, then it's not.

Yeah. Unfortunately, people haven't joined the dots for many years. Because you say this the whole bikini medicine thinking about women as ovaries and wombs, which has happened for centuries, actually. People have forgotten the role of hormones in our brain. But we've known it for many decades, not basic physiology, but how our brain works with hormones, and the hormones help our brain in many ways. So they help the circulations. They have the blood flow to the brain, they help the metabolism of the brain, the sugar, metabolism, if you like of the brain, I've already said they help the way the nerves work, they help with neuroplasticity, so it's just the way that the cells work and function and develop. They also help rebuild what's called the myelin sheath, which is the outside part of the nerve, which improves slightly electric current, that the the way that they work, but it also helps every cell work. And we've got a lot of cells that respond to Estradiol, progesterone, testosterone, in crucial areas of our brain.

So areas of our brain that affect our personality, affect our memory, affect our cognition, affect our sleep. And so our tray, our brain sort of light up like a Christmas tree, if you like when we've got all these hormones. And of course, our brain will adapt without them, but it won't work in the same way. And there's quite a few pictures you might see from someone at least in Moscone is working neuroscientist in New York, and you'll see the before and after. It's a bit like a heat map showing the activity of the brain. And it's no surprise really. And we do need to be recognizing this because we know dementia is more common in women than men. We've known for many years that if women have menopause at a younger age, then they have a higher incidence of dementia. There's a study another study recently showing that young women have their ovaries removed, they did brain scans and their brains shrink actually quite quickly after. Again, it's no surprise, this is this. These are physiological hormones that are really important for brain function. But the problem is dementia scientists don't know much about hormones, and lots of hormone specialist for gynecologist who don't really know much about the brain.

And so the people that are missing out on all of these are the poor women that are suffering. And many of us have had cognition problems because of our low hormones. Of course, we know it's not dementia, but it doesn't matter what the label is. Like, eight years ago, before I started taking hormones, I would have had to have given up my job because I couldn't remember drug names, like how would you want to go and see a doctor who can't remember drug names and doses it's dangerous. So whether I had dementia or cognitive decline, or memory problems is just a label, actually, it's really affecting my ability to work. And even at home, I kept forgetting which day of the week my daughter had a swimming lesson. So I'd forget to pack a swimming costume, or I'd forget to take her swimming or take her to quiet and just that's awful, actually, because it has an impact on her. You know, it's those little things that just haven't been thought about before. And that's where a lot of my work is really frustrating because it's so obvious. I'm not trying to talk to people about this new science that I've just discovered, or this new drug that has just come out and we don't know the long term effects, just talking about our basic hormones.

Right. Okay. Okay, so, so leading us neatly into hormone replacement therapy, which I know is often now called menopausal hormone therapy. And so for some folks may remember that it's got a little bit of bad publicity, and due to a certain study that was conducted in the 90s and early 2000s, and it was very widely reported and all kinds of inflated links to breast cancer. So I wonder, can you give us the rundown on where did that study come from? And what did it find? And why might we maybe take its results with a dose of caution as we're thinking about whether...

It's really important when we think about hormone replacement therapy or menopause hormone treatment, I just prefer it's thinking of it as a hormone treatment. There are different types, and that's what's really important. So what we normally prescribe our body identical. So biochemically, the structure is exactly the same as the hormones I've been talking about so far. The WHI study, the Women's Health Initiative study, which you've alluded to, was actually using synthetic hormones so they were chemically altered. The estrogen was from pregnant horses urine, so you could argue it's natural. Of course, urine is natural, but no one wants pregnant horses urine, but that's how estrogen used to be made. So it's this conjugated equine estrogens. With a synthetic progesterone in this study, they use something called medroxyprogesterone acetate MPa.

Now, that is actually a lot of contraceptions contain MPa. But it's chemically altered, so it will work. But it doesn't have the same biological effects as a proper progesterone because it doesn't link into the receptor properly. So they gave that type of HRT to older women, and the average age of the study was 64. So they gave it to older women who didn't have symptoms to see if there are any health benefits for those women. But most of those have symptoms. Yeah, and that's that was why it was so difficult. They decided to do it get asymptomatic women and most women do have symptoms. And the reason being is because HRT is so effective at reducing symptoms, because it's treating the underlying cause. If they use women with symptoms, they would soon know who was on placebo and who was on the hormones.

So they get started, the average age was 64, a lot of these women had had heart disease and heart attacks in the past, a lot of them were overweight. So it was actually the wrong type of hormone in the wrong type of women. And in the in the wrong sort of clinical situation as well. Anyway, they gave this they were following it through it was a billion dollar study a lot of money to spend even then, but you know, even now, actually, as well, on a women's study, they weren't getting amazing results. A very small group of the researchers looked at the study and said, Oh, I think there's an increased incidence of breast cancer. Let's stop it. But what they did, which was the biggest problem is that they didn't analyze the data properly. They decided to feed it to the medical press and the lay press literally overnight. Other investigators said: Hang on, guys, please stop. We haven't looked at this properly. Is it actually statistically statistically significant. Let's look at what this means. They went we're sorry, it's too late. It's gone to the press.

And overnight, people were going HRT is awful. It causes breast cancer, no one should be on it. And the rest is history. And it's the biggest travesty to women's health. Because overnight, we're all being told our hormones are dangerous. What they did do then is obviously look at the study properly. And there's some really important take homes from that, in that those women who were in the study who had had a hysterectomy were only taking estrogen. Actually, we're starting to have a lower incidence of breast cancer, which is really important. So estrogen is the goodie if you like which we know because it's very anti-inflammatory. Those of people that took estrogen and progestogen, this synthetic progestogen was showing that there was possibly an increased incidence of breast cancer, but it wasn't statistically significant. And they also showed that women who took any type of HRT had a lower risk of dying from breast cancer, because women will get breast cancer, regardless if they've got breast regardless of whether they take HRT or not.

But they also showed there was a lower incidence of osteoporosis, which we knew already. And for women who started taking HRT when they were younger, within 10 years of their menopause, they had a lower incidence of heart disease as well. So it's actually a good news study. But again, it was a type of HRT, we don't prescribe, there was some, there was some results showing about clot risk as well, for example, but we don't give estrogen in that way. When we have give it through the skin as a patch or gel. We give the natural progesterone, there isn't a clot risk, there isn't a heart disease risk. All we're doing is replacing like for like, so of course, it's got different benefits. But everyone just hears these letters, HRT, or MHT, or whatever, and they just get scared about breast cancer. And that's been awful, because, you know, in the US 40% of menopausal women were taking HRT, it's now only about 4%. So that's 36% of women who have far greater risk of heart disease, osteoporosis, diabetes, dementia, and we're catching up with that, because people are living longer. So therefore, because they're living longer, they're more likely to have these diseases. And I've already said, the longer you live without hormones, the greater the risk of diseases. So it's a real problem, actually, and other studies have shown all the benefits of HRT as well. So there are more risks of not having hormones than there are of having hormones.

Yeah, okay. Okay. And so I just want to I'm going to share the stats on the the breast cancer risk increased 27%. That's the number that made the headlines. And the absolutely that's the relative list, the absolute risk increases the difference between four cases per 1000, and 5 cases per 1000. And that is 25% increase, but the context is completely inappropriate. Because things like smoking increased cancer risk by 26,000%. And so sorry, 2600%. And so, you know, the, the context is super important there. And yeah, the the number of prescriptions being written as has absolutely cratered. And so, so I guess now I'm thinking, Well, you know, to whom do you recommend hormone therapy? And why do you recommend it? What symptoms does it treat? You know, you're talking a lot about the benefits in terms of long term health, you know, I don't have any symptoms at the moment other than this potential, you know, forgetting words thing that I'm aware of right now. Should I be taking hormones for the potential future health benefit? Even if I don't have any symptoms? Right. Well, what's your thoughts on all of that?

It's a great question. I think we need to be sort of filling your head a bit. And like I say, think about what are the risks of not taking hormones, and thinking well, the evidence shows that the earlier a woman takes HRT, the better because you're replacing these missing hormones, as soon as you don't have hormones in the body, there's increased inflammation. With increased inflammation, there's, like I say, increased risk of diseases. So whether a woman has symptoms or not, she's still got inflammation in her body. Of course, we can reduce inflammation by looking at our nutrition, looking at exercise, looking at our sleep, looking at everything else that is important. But we can't eat or exercise our way out of perimenopause or menopause. It's because there's no diagnostic tests. Sometimes it's hard to know. And like I said before, sometimes we give people hormones just to see if they help. We're very fortunate, we've got these natural hormones. So it's just replacing like for like, or not even replacing in the perimenopause with just topping up. And sometimes, for example, if someone's got PMS, or PMDD, and they're just getting symptoms for a few days of their cycle, we might just give them hormones for a few days just to balance out the hormones. And that can work very well as well.

And we've got good data to show about disease prevention. So if a woman does want it to reduce disease, that it's something to talk about with their healthcare practitioner. I think it's a bit like treating blood pressure, raise blood pressure doesn't actually usually cause symptoms, but we treat it to reduce risk of heart disease and stroke. And HRT is more effective, actually, that reducing risk of heart disease than reducing blood pressure. But it comes down to an individual choice. And what's been such a shame is that women have been scared away from hormones, for no reason, actually. And even you're not saying even in a derogatory way, but your 10 year old would understand this. And my 13 year old would that when WHI when it was came out in 2002, the incidence of breast cancer was about one in 11 women. Now it's about one in seven women. So it's become a lot more common. And I've already said HRT prescribing has fallen off a cliff. So even if you knew no science, you'd never read a study you didn't know about stats, you didn't know about absolute relative risk, our children could work out that there must be something else that's increasing incidence of breast cancer, and it won't be hormones. And maybe is it associated to the lack of hormones. We've already said that estrogen is predictive.

But we also know that obesity is commonest risk factor for most cancers now. And we know that women are more likely to put on weight when they're menopausal. And that's where as an individual, we can decide, you know, do you want to start taking HRT when you are younger, and you're getting since some symptoms, you don't have to wait for a certain number of symptoms for a certain duration. Because no one's gonna give you a medal for suffering. Sometimes we do do blood tests, though, saying all this we often in our clinic, we will do blood tests, looking making sure that people aren't iron deficient or they're not hypothyroid. Or there's something else going on. Doing a testosterone level can be useful because some women become testosterone deficient before being estrogen deficient. So their level of estrogen doesn't decline as quickly as testosterone. So that's why having individualized support and advice is really important.

Okay. And how long would we expect to spend on hormone therapy? Is this like, I'm going to be taking this to the rest of my life kind of thing?

Yeah, usually in the same way that if you had an underactive thyroid gland, you'd take thyroxin forever off your head. Type one diabetes, you take insulin forever. We take hormones often to improve our future health. So it's not just about symptom control. I've been on HRT for eight years, if I took my patches off, I might or might not have symptoms, it depends on how my body adjusts to not having the hormones. But as soon as I don't have hormones, I have an increased bone turnover, increased risk of osteoporosis, I've already said the effects on my brain, you know, are going to happen. All my other, you know, biological processes in all my cells are going to be affected without hormones. So that's where it comes down to personal choice. The guidelines say as long as the benefits outweigh any risks. But if you think about the risks of the natural hormones are very low, actually, because they're not associated with cancer risk. There's no clock risk when it's the natural hormones, there's no stroke risk. So there aren't really risks. Actually, one of the risks is not having the right dose and type because you're still having symptoms, maybe, but there aren't any risks with just having natural hormones.

Okay, okay. And so I that's comforting to hear. I did read that there were some risk of people have already had a heart attack, breast cancer stroke, blood clot cluster significantly.

That's if they have tablet estrogen and synthetic hormones, because that's derived from the WHI data, which I've already said, a lot of those women had established heart disease and were older. So I would never give synthetic hormones to those women. Tablet estrogen gets metabolized through the liver to estrone, which is again an inflammatory type of estrogen. Estrogen is very anti-inflammatory, so it reduces inflammation. It's a vasodilator, which means it opens up blood vessels. It also reduces cholesterol and triglycerides, reduces any atheroma. So even if someone's got established heart disease, it will still be beneficial. There's been this worry that over the age of 60, HRT might worsen heart disease, or someone's got established heart disease. But how does a hormone that's biologically very anti-inflammatory suddenly turn against us because we've got some raised blood pressure or atheroma are very hard to tap before, it doesn't actually make sense. And in the 80s, one of the treatments if someone came in to the emergency room with a heart attack would be to give sublingual, so under the tongue estrogen, to help the blood vessels open up and reduce that inflammation, we need to be thinking more about basic physiology rather than about the WHI study.

Yes, leave it safely behind. And I'm also curious about how hormone therapy fits with other potential treatments. So I know that a lot of women, when they first go to the doctor reporting these kinds of symptoms, the doctor will say, Okay, here's some antidepressants, which may or may not be helpful. And then there's sort of non hormonal treatments, cognitive behavioral therapy, herbs, massage, its service, aromatherapy, all of all of the potential suite of stuff, how do you fit that in with the hormone therapy?

But then we need to just remind ourselves that we're treating a hormonal deficiency or insufficiency, when hormone levels start fluctuating. There are lots of treatments. And I say that with inverted commas, because they none of them are good marketing, they're not going to replace the missing hormones. But obviously, having acupuncture having a room of therapy, going for a walk in the park with your friends, having a nice drink of herbal tea is going to help whether you're menopausal or not, what's happening is is that women are almost been sort of shoehorned into this belief that we'll do all this stuff, and it will help our hormones. Of course, it won't, it might help our mental health, it might help our physical health but that's because it's a good thing to have, rather than or do, rather than it's due to hormones, if you see what I mean. And it's been a big void because people have been scared away from hormones. So these companies have evolved and done. So mean, sometimes people find taking some supplements might help blush or a sweat. But is it going to reduce all that inflammation and help future health? Probably not. So we just need to be honest with ourselves. What are we doing? Why are we taking something? You know, if I take a supplement, and I do take some supplements, they're the same ones that I give my children and my husband because we're taking them for our future health, not for my menopause, if that makes sense.

Okay, yeah. And I guess, to some extent that I addresses the question I had on sort of cultural issues, and that people in different cultures experience menopause very differently. And you know, Japanese define menopause is this kind of season of regeneration and renewal and only about 25% of Japanese women experience hot flashes, which I think is a lot lower than women in Eurocentric cultures. There's you know, in in Eurocentric cultures, I think menopause tends to sort of represent this sort of loss of sexual attractiveness of youth. And so we we sort of I, a personal perception of it is that we approach it with this sort of sense of dread of, oh, yes, this time of my life when I was attractive and to, you know, whoever is now over and I'm entering this new phase where I'm, you know, I don't know what my role in our culture is because we don't have a well defined role for older women in our culture. And so I guess I was super curious about the different symptoms appearing in different people in different cultures and wondering to what extent symptom wise, at least our experience of menopause is what we expect it to be.

When I think I get really across actually, so with that, because I think it's all about gaslighting women. I've heard so many people say, if people are negative about what's going to happen, they'll be really negative. I have a huge amount of clinical experience. And I have seen people who have been as happy as anything, with no reason to worry about their menopause with no reason to worry about their perimenopause, and suddenly, they fallen off a cliff overnight. That's nothing to do with them having negative expectations that's to do with a brain functioning in a different way when they don't have hormones. And also, I've been heard that people say, Well, if you're not healthy, if you don't exercise, want to look after yourself, you're going to have a worst menopause. Well, I do regular yoga ate really healthy, I don't drink alcohol, I don't do caffeine. I wasn't expecting even at 45, which is stupid in hindsight to have any menopausal symptoms. But I was sitting there as a GP general practitioner thinking, I'm just gonna have to stop working, something's happened to my brain. I don't know what's happening. I couldn't do that. Because my joints were stiff. I was getting lots of migraine. I wasn't expected to be negative.

But actually, when I realized what was going on and got the right treatment for me, menopause should be the best time of our lives. So I think we need to stop thinking for women, what phase of life is it? What's the reason? You know, a lot of people saying, well, it's the grand mother theory, we're here to look after. Yes, of course, we have, we want to be really well actually, we don't want to be made invisible. We want to be really fit and well. But evolutionary, we are here to reproduce. And we used to die quite soon after the end of our reproductive age. We also in the Victorian times used to be pregnant a lot of times because sadly, a lot of people had miscarriages, but they'd have multiple births. So we were sort of designed to have lots of hormones in our, in our in our bodies, really for a shorter length of time. But then we didn't weren't supposed to be living 30, 40 years without our hormones.

So the menopause still should be a really positive time of our lives. But we should be fit and healthy and be allowed to make choices. And the problem is a lot of cultures, it's hard to describe. And people don't have words for menopause, or they've been told that their symptoms are due to something else. You only need to look at the number of people who have urinary tract infections. No one's talking to them about what is their hormonal status? Do they need hormones, vaginal hormones, you know, their libido? Of course, it's not just due to hormones, it can be due to all sorts of things. But we need to be thinking and being realistic. You know, is it related to hormones or not, rather than trying to avoid the issue or try and blame us that, you know, society is making us think that we're going to be really bad or it's negative experience.

And a lot of people are having symptoms because the hormone levels in their brain is low, the brain produces these hormones. So let's forget our wounds. Let's forget our ovaries. And think in a different way, because then people can then understand more what's happening, if you see what I mean. Because the problem is it's women are often labeled as well, they're like that, because they've had a difficult life, or they're going to be tired, because they've got three children, or they're going to be really low because they've had trauma in the past, or it's always excuses. And that's what's happened. I've read a lot of medical history books and women's history book. And it's happened time and time again. Whereas that's why let's just face up to what these hormones are. And I'm not here saying everyone needs all. I'm not here saying everyone has to take hormones. But I think we have to think about what are the risks of not having them. The risk, there are symptoms may or may not carry on. But there's risk to our future health as we're living longer. And none of us want to be cooped up in nursing homes, with dementia, having had osteoporosis, maybe having had a heart attack or a stroke, when there's a treatment that would have reduced the risk of all of those that we could have started years before. And I'm not saying that it's just HRT, they're like, there's no point me taking hormones, and never exercising or never looking after myself. So we've got to have a joined up approach. And the problem is it's like this HRT or not feeling good or not doing this or not. And we've got to support each other to make the right choices for us at the right time for us as well.

But we do need to wake up to the fact that for a lot of people, they do have very low mood, they do have anxiety, we have to remember that suicide rate increases by a factor of seven in the late 40s. You know, it can be a very harrowing experience for some people, not everybody. But if we're not aware it can be we're not going to pick it up in our friends and our colleagues or ourselves. But we need honesty, and we need to know what is going on before it happens. So we can think, what are we going to do? What are the choices and if it happens, or when it happens to me or my friend or my daughter or my mother? What's the best choices for them? And the problem is for 20 years choice has been taken away because we've been told wrongly, like I said about this breast cancer risk. So then women are trying to fill that hole and there are a lot of societies where it's culturally not acceptable to be menopausal because the other definition is loss of fertility. And that is a label that most people don't want and we shouldn't be we shouldn't think about having a barren womb and and this goes back to how we were talking at the beginning. It shouldn't even be thought of as a gynecologic issue.

Yeah, and it seems as though it'd be nice if our doctors believed us when we showed up with these symptoms. And we're willing to help us rather than we have to convince them that something is happening and go to, you know, three different doctors and 10/10 appointments just to convince them that there's something going on.

Yeah, and I think that's the hardest thing. You know, I speak to so many women who have been offered or given antidepressants, for example. And we shouldn't be doing that we shouldn't be medicalizing the menopause with the wrong treatment, because that's worse than not giving any treatment at all. But medical education for menopause urgently needs to change.

Yeah. Well, thank you so much for for being here with us today for creating the balance app. There are also links to your three books as well, that are going to be linked in the episode page at YourParentingMojo.com/menopause. So thanks so much for being hereDr. Newson. I really appreciate it.

Thanks for the invite. It's been great.

Hi, this is Jess from Verlize, Panama. I'm a Your Parenting Mojo fan and I hope you enjoy this show as much as I do. If you found this episode especially enlightening or useful, you can also donate to help Jen produce more content like this and also save us from those interminable mattress ads. Then you can do that and also subscribe in the link that Jen just mentioned. And don't forget to head to YourParentingMojo.com to record your own message for the show.