Your questions answered | Dr Louise Newson

so I'm going to try and answer as many questions as possible in the short time that we have I've done this before and it's actually worked really well um there's always so many questions that people have and it's really sad actually because so many of them they should be able to answer very easily but as many of you know there's a huge amount of information on various websites on social media and not all of it's accurate and it's really important that anything we can we do is as evidence as possible often in menopause and hormone

care and also in anything related to women the evidence is really limited and that's because the studies haven't all been done but actually a lot of this is common sense I've spent a lot of time in the past um talking about the role of hormones in our bodies and so we have to remember a lot of what we're talking about is just natural physiology it's not the same as talking about drugs that are made and manufactured and are not natural substances so I've downloaded as many questions as I could there were loads um onto my

laptop so I'm going to read through them and see how much we can do so they're all quite chaotic I haven't ordered them so they're on different themes so the first question is um I'm have I was on HRT for four years and then I um developed breast cancer and I've also got adenomiosis so breast cancer will occur with a women take HRT or not actually around one in seven women now um do develop breast cancer the commonest type is an estrogen receptor positive breast cancer which means it's got estrogen receptors on it doesn't mean

it's been caused by estrogen though um I have done a whole um YouTube about U menopause after having breast cancer and treatment choices and a lot of this is very uncertain because we don't have evidence um so it is worth also listening to some podcasts that done on this topic especially one with Dr Sarah Glenn um can I take progesterone and estrogen every day or should there be a day off usually people take it um continually I have heard of some people where they have a pause especially of their progesterone progesterone is actually licensed for

25 out of 28 days even when it's taken continuously but most people actually just take it the the same time every evening some times people um talk about resetting the receptors and having a few days off and that's fine as well and OB obviously the progesterone we sometimes give cyclically so two out of four weeks so then people have their periods um so it's a very individual decision but normally with the estrogen we and and testosterone we don't have a break my GP says I can't have testosterone as it's not approved for women on the

formulary why so I've also done a um a YouTube about testosterone but testosterone isn't licensed for women the only country it's actually licensed for women in it in Australia but I speak to a lot of Australian women who can't access it over there either testosterone is a natural hormone we have license preparation that's available for men in the UK and we are allowed to prescribe things off label or off license if um we know that they that it could be there isn't licensed alternative also in the NHS many people do prescribe testosterone um off license

but some GPS it's still not on their formulary and I've spoken to quite a GPS whove told me they're not allowed to prescribe testosterone which doesn't actually make sense um sometimes people uh feel that they haven't got enough confidence or had enough training to start testosterone so quite a few people come to our Clinic to be started on testosterone stabilized on the right dose for them and then their GP takes over the prescribing afterwards so there's always options test toin can be very good to improve libido but actually more importantly it can improve mood energy

con con ation stamina can help with sleep it can help reduce muscle and joint pains so it is important to consider for many people um surgical menopause no notable symptoms um when can I expect them after surgery really impossible to answer actually it depends on your age as well um and it actually menopause isn't just about symptoms if you're young and had a surgical menopur so under the age of 51 the recommendations are the majority of those women should be considered for for HRT um and even older women you can still continue as long as

benefits out weigh any risks can the contraception pill Be an Effective form of HRT so um HRT is the best way of taking it is the natural hormones so estrad progesterone testosterone and usually we prescribe them separately so you can have the right dose and type for you if you um have contraception it might help with some symptoms but it's synthetic it's been chemically altered so you're not going to have the same biological benefits we know that people taking the pill for example aren't likely to have the same heart bone and brain benefits and people

taking natural hormones and there are risks with the synthetic hormones a small risk of clotch for example a small risk of heart disease and the and the risk of clot and heart disease increases as we age anyway so always in medicine if there's a safer alternative we usually recommend that so it would be worth talking about having an alternative um I I take everl 100 patches is it worth trying the gel to see if I absorb that better so absorption is a real thing isn't it because a lot of people are worried about the dosing

of hormones but actually it's all about penitence and absorption through the skin of the gel or the patches which are the two main ways that we give estrogen through the skin people's skin type is different our skin is a barrier so many people find it hard to absorb the adequate amount through the skin if you find that you're on for example 100 microgram everall like this lady your eile level is low and you're still getting symptoms then one of the things would be to consider changing to the gel and you might find the gel absorbs

better um there are two different types of gel in the UK there's one called easr gel and one called Sandrina the one called Sandrina is slightly thicker and more viscous so some people find that's that's better absorbed so it's definitely worth speaking to someone about having the optimal type of hormone for you um I'm on HRT plus testosterone but for the last six weeks suffering from intolerable insomnia now poor sleep is a very very common symptom of menopause and per menopause um I always say patients let's optimize your hormones and then see what else is

left and so it might be related to your hormones it's important to make sure you're on the right dose of estral and uh testosterone you haven't said whether you're on progesterone as well cuz progesterone can help with sleep too often we'll do Easter and testosterone levels which are a guide to see how the amounts absorbed and whether the dose needs changing many people take a supplement like magnesium um which can help with sleep um and obviously there's lots of other reasons why people don't sleep as well um can I use vaginal estrogen um I'm also

using HRT yeah I've done it Instagram live about genitor urinary syndrome of the menopause so symptoms of vaginal dryness soreness urinary tra they can really improve with um um they can really improve with using vaginal sorry vaginal estrogen or vaginal DHEA prasterone is the other name can be very effective and about 20% of people who use systemic HRT still need to use vaginal hormones as well and it's absolutely fine um does the marina coil help with per menopause or does it make it worse so the marina coil is a synthe IC type of progestogen and

it just works um on the womb it helps the womb to be thin so it means that the womb doesn't build up if people take estrogen as part of their HRT um it doesn't work really systemically in the body and I say really because some people find that it does and they get side effects with it um but it's not the same as natural progesterone so increasingly we are giving people natural progesterone with um the marina coil because a lot of women benefit from having progesterone as well what could you do about itchy arms would

you need to do increase the HRT patch so dry itchy skin very common symptom of per menopause and menopause and that's because we have receptors for eile progesterone testosterone on the skin as well so um if you are on HRT and you're getting skin changes then obviously there's lots of reasons why you might get dry or itchy skin but it's worth just making sure that your hormones are optimized um because it often does improve um I'm using Easter gel but sometimes forget to put it on can I use patches instead of course it's a personal

choice in the clinic we offer people a choice and sometimes people find that they think they want the patch and then they find that it doesn't stick on very well or they can't remember to change it twice a week and they prefer the gel or vice versa so of course you're allowed to change your mind our hormonal migraines inevitable in per manopause they're not inevitable but if someone has a hormonal migraine often the migraines are worse before periods when hormone levels really fluctuate and reduce in the per menopause our hormones are going up and down

so this yoyo um level of hormones can trigger migraines in a lot of people and sometimes what we do is give a higher dose of estrogen to suppress that up and down um sort of fluctuation of hormones which can be very effective for people with migraine if they're not on the right dose migraines can still be triggered and anecdotally some people find that using testosterone and also progesterone can be beneficial for migraines as well can I take utest stand daily I get awful anxiety when're not taking it yes people can so some people find when

they take the progesterone for two out of four weeks they have two weeks where they're not feeling as well as the two weeks when they are taking the progesterone so what we um do in those circumstances is people can then take the progesterone every evening the reason that we start off giving pesterin for two out of four weeks is so that people if they still have their periods they're less likely to get irregular or breakthrough bleeding but often it will settle with time and if if you find it beneficial to take progesterone every day then

usually you can I started on vagifem three months ago and I'm still getting urinary tract infections so vagifem is a very very low dose of estrogen used as a peasie it's usually given One A Day for two weeks then twice a week after that but some people need more so some people use it every other day some people even use it every day it's only 10 micrograms they used to do a 25 microgram but for some reason stopped it so increasing it is still a very low dose but increasingly I prescribe inosa which is this

DHEA which converts to estrogen and testosterone we've got testosterone receptors in our bladder and our urinary tract so a lot of people find that their um symptoms of urinary tract infections actually um reduce when they're using Prestone as opposed to estrogen and obviously people taking systemic HRT it can help as well do you have to come off HRT before an operation no if you're on the body identical hormones so estrogen through the skin is a patal gel the natural progesterone the natural testosterone do not increase the risk of clot so therefore people can continue taking

it when they having an operation lots of hospitals haven't updated their policies so they say come off if you're taking any hormones if you're taking older types of HRT which are synthetic or if you're taking contraception then you usual advice is to come off a um those hormones before surgery because they're associated with the risk of clot but the Natural Body identical hormones are not so it's quite safe to continue and also just be mindful that especially Easter Dal can help wound healing as well and also help you feel well so you're more likely to

recover better from your operation if you continue taking HRT um HRT and the impacts of on gallbladder so tablet estrogen and the synthetic progesteron get metabolized through the liver and so there's always a risk with with gallbladder that things can worsen if you're having tablet estrogen if you're having it through the skin and um then there isn't a risk and there's so it's not a contraindication it won't increase the risk if you having G gallbladder issues or G stones and actually if you've got goul Stones taking the natural hormones will be absolutely fine um how

to manage POI symptoms whilst taking HRT so POI premature ovarian insufficiency is menopause at a younger age we know from studies that some of these women need higher doses of hormones so if you're still getting symptoms then it's really important to see a specialist who can fully optimize your hormones because it might be that you're not on the right dose or the right type for you um Is testogel bioidentical is it safe so the testogel is the test testosterone gel that's available for men that we can prescribe off license in the UK it is a

body identical so it's exactly the same preparation as testosterone that we produce ourselves so it hasn't been chemically altered like some other testosterones um what do you do if your anxiety increases with oral um utter justtin so it's utter justtin is interesting CU some people feel very relaxed and calm with it and some people get side effects with it it's a real Marise actually we can use it off label vaginally or off license vaginally rather than orally that way it gets absorbed as the pure progesterone through the vaginal mucosa into the bloodstream and so some

people find that they that's better for them and actually some people find using a higher dose which sounds a bit paradoxical of future Gan or we use cyclogest quite a lot which is actually a peasie of progesterone it's made for the vagina or the rectum um so a lot of people find they absorb that really well and the dose can be increased so if you're not having or if you're having symptoms orally then it's worth discussing about having it vaginally or even rectally as well um is it too late to at 60 or 70 to

have HRT recently been diagnosed with osteoporosis absolutely not too late no one is too old to start HRT especially now we've got the Natural Body identical hormones so the um estrogen through the skin is the patch or gel the natural progesterone even the natural testosterone they can all help build bone and so anything that's going to be beneficial for our bones is good and HRT is actually licensed as a treatment for osteoporosis so it is worth talking to a doctor or a healthc care professional about considering HRT when you're older as well um can sudden

weepiness be due to estrogen suddenly plummeting and affecting neurotransmitters yes so our neurotransmitters don't work in isolation they work with our eile progesterone testosterone and so when those levels reduce or fluctuate it can affect um the way that our brain works so people can become very irritable very angry angry but also very tearful and weepy as well um is there anything in the new guidelines that references utilizing progesterone only in early per menopause no if you're talking about the nice guidance then no there's very little but there's very little on the nice guidance about dosing

and formulations actually it's all very general but a lot of people notice that their progesterone declines quicker than their estrogen declines when their per menopausal especially when people have PMS or pmdd sometimes we find just adding in the natural progesterone first is enough to improve symptoms and then with time they need to have estrogen and maybe testosterone as well um I put on my HRT gel in the morning then I go swimming should I reapply it depends how quickly you go swimming usually the gel will absorb within about 20 minutes half an hour so if

your skin is dry then you're usually good to go and it's not going to come off when you're swimming if you're concerned in any way your skin is still damp from the gel then it might be prudent to just um wait until after you're swimming to apply the gel um what physical exercise you recommend for postmenopause anything that's going to help but anything that you enjoy is the most important thing because if you enjoy doing exercise you're more likely to continue with it it's really important that we all have a routine or a regime um

that we continue to and and commit to it's so easy to think I'm going to try and do um whatever exercise and then find that it doesn't fit in with your routine or your schedule um so it doesn't really matter but it is important an to think about something that's going to help strengthen your bones and build muscle as well really important as we get older because of this muscle loss and bone loss that we get um please discuss HRT and fibroids and hyperplasia the lining of the wound so I've talked about fibroids before I've

done a uh YouTube about it and I've also done one about bleeding so it might be worth listenting to those in detail bleeding is one of the commonest side effects of taking HRT but it's usually benign meaning that it's not related to cancer in fact people who take continuous HRT have a lower instance of cancer of the womb compared to people who don't take any HRT at all and often it can be the imbalance of the hormones working together or the being on the wrong dose hyperplasia just means thickening of the lining of the womb

we all have it when we're younger that's what happens every month when we're having a buildup of our lining of the womb which shreds when we have our periods um and so that can happen obviously when we take HRT because again we're using natural hormones hyperplasia isn't the same as cancer in a very very small number of people they might develop something called atipia which then can can lead to cancer but that's going to happen in people if they take HRT or not but it's a very very small amount um so we don't need to

be as concerned as perhaps some people are what we always do if someone's bleeding and it hasn't settled is a anger scan we look at the thickness um of this of the womb and then we look at the dose we look at the absorption we look at the dose of estrogen and progesterone and sometimes the dose needs to be altered um but sometimes people need a different type of HRT as well but fibroids um can be present whether people take HRT or not but usually people can still take HRT if they have fibroids um for

my first appointment oh with news and health should I see a doctor rather than a nurse It's actually an individual Choice our nurses are really qualified they're very experienced if there's something that they're not sure then they they have doctors who work with them in the same day so they can always ask um and that we can always um you know we always give feedback as well um so it really is very individualized obviously if you've got a more complicated medical history then it might be worth seeing seeing a doctor um ADHD during per manopause

only just being done diagnosed um help so ADHD can be more common during per menopause as our hormone levels fluctuate in our brain we see a lot of women in the clinic with ADHD and find that actually when they're on the right dose and type of hormones especially with testosterone it can make a huge difference testosterone is very calming on the brain and can really make a difference um should I take HRT I'm diagnosed with chronic migraines as I said before can often help actually um being a migraine suffer myself I know that taking hormones

can be beneficial for a lot of women but it's also looking holistically other triggers for migraine as well and actually I've just recorded a podcast that came out I think two weeks ago about migraine so it might be worth listening to that as well um Can HRT help with bladder frequency yes it can actually so um it can help to um reduce irritability of the bladder it can help reduce incontinence can help reduce any urinary symptoms and also uninary tract infections as well um so both systemic HRT and local vaginal hormones as well can make

a difference um Can HRT give you reflux um so reflux is a very common symptom actually and actually it often improves with the right dose and type of hormones and in our Clinic often we find that people using testosterone um actually a lot of reflux and nital bow symptoms improve so I would always optimize hormones but obviously look at your nutrition as well um as which can make a big difference as well is it dangerous to start Easter 20 years after surgical menopause no for the same reason as I said before usually it's very safe

especially with the natural um body identical hormones um is there a link between HLT and thrush I developed one um I developed thrush in my esophagus um so thrush is a type of caner it's a yeast infection it can occur anywhere actually it's more common in the vagina but it can occur in the mouth and the esophagus the um the gullet as well um so we we often find that when people have hormones that can improve um many many times in the past I used to not even think about hormones and give thrust treatment um

and then it's only with time and experience I've realized that some of it could be related to hormones um but you can still have thrust treatment as well as taking HRT can HRT improve any symptoms for people with multiple SC sclerosis now I have spoken about this before hormones are produced in our brain they help the way that the physical nerves work and they help the conduction so they help build myelin which is the conduction sheath around the nerves as well and often in people with Ms that myin doesn't work quite as well and so

actually having the right dose and type of Easter d progesterone and testosterone all three of them can be very beneficial and I've got quite a few patients who have have multiple sclerosis they still have it of course and they still often need treatment but they find that many of their symptoms can really improve or stabilize when they take hormones so you can still have it um I've had a clot in the past in my lung and I'm scared to take HRT what's safe so we know that the natural Easter dial through the skin p natural

gel natural progesterone natural testosterone don't increase risk of clot even in people that have had a clot before or have a high risk of having a clot um so it is absolutely safe and I've seen quite a few women who have um certain clotting disorders such as um antithrombin 3 or protein C or protein s deficiency and actually their cloting markers have improved when they've been taking HRT um some of these are a repeat that's why I'm hesitating ing um muscle nerve pain in the thighs which hormone needs tweaking or adding it really varies actually

so muscle and joint pains pin pins and needles especially with Easter dial actually but all three hormones can make a difference um wood vagina or estrogen hat with pelvic Tremors I already take HRT through gel and orally possibly but I would also consider testosterone as well because testosterone has quite an important affect the way that our physical nerves work and the sort of internal Tremors that people get can be related to the low hormone levels as well I'm using vagina Easter dial cream in my ears to stop them itching how should I do that well

often if you're getting um itching in the ears or of the skin it's looking systemically rather than just putting up um any cream on that area so I would consider if you're on HRT optimizing it fully and that's where being a menopause specialist can be really helpful to make sure that you're on the right dose and type of hormones um any time limit on testosterone I'm 57 been taking it for two years and Dread my GP stopping it well we don't have longterm data about testosterone because the studies haven't been done but it is a

natural hormone and we are allowed to choose as patients and there's some guidelines called shared decision making so even if there's uncertainty or there is is risks as as long as you're aware of those you can still consider continuing a treatment um when people are on the right dose of testosterone the risk of side effects is very very low and it doesn't seem that their risk increases the longer they're on it the testosterone only works the day that you use it anyway it doesn't build up in your body um so you shouldn't be taken off

it after a certain length of time at all how long do symptoms last from per menopause to postmenopause well that really varies actually everyone is really different and some people find that symptoms um Can persist some people find that symptoms change so they might start off having some flushes and sweats and they might find that they have mood changes or or sleep interruptions or they might then get pins and needles or headaches or palpitations so not everyone has every symptom um and some people like I say have a collection of symptoms or some people might

just have the odd one or two symptoms when you look at the studies it's perelal can last around 10 years so that's around 10 years before period stop and the menopausal symptoms when you read the articles say on average it's about 7 years but I've certainly seen women who have had symptoms for decades I saw a woman recently in the clinic who had a hysterctomy when she was 43 and she's now 75 and she still has symptoms every night she wakes up drenched and she has lots of other physical and and mental health symptoms as

well so it really varies but it's not about trying to get through it because once we're menopausal we're always menopausal those hormones will beow forever and there two reasons that we address them by taking HRT is one is to improve symptoms of course we want people to feel better but the second thing is to improve our future health we know taking hormones reduces the risk of diseases and so when we have a lower risk of heart disease osteoporosis diabetes even some Studies have shown dementia as well we reduce inflammation in our body it helps us

to keep healthy and we want to stay healthy as well a lot of people say well I don't have any symptoms of menopause but actually when they do take HRT they find that a lot of symptoms that they've just attributed to getting older or just just due to life have really improved um and that's why it's so difficult to actually make the diagnosis often because it's not just a certain symptom or a certain type of symptom if you download balance app um and monitor your symptoms you'll see there's lots and lots of symptoms that we've

added which make it easier to to build up this bigger picture really as to what's going on so thank you very much for all your questions if you enjoy the question and answer sort of freestyle of um um format then let me know I'll post this on my grid if you've got ideas for other topics that you'd like me to to cover um then please do that and in the meantime go to my YouTube and look at ones that I've done in the past and obviously download um my podcast every week because I've got some

amazing episodes lined up as well as having done some fabulous ones in the past so enjoy the rest of your Sunday and uh have a great week