Today, Karan invites Dr Louise Newson, GP and menopause specialist, on the podcast, to delve into the REAL truths of the menopause, how women can prepare their bodies for the lack of hormones it endures, and what she is doing to combat the stigma surrounding this often debilitating condition. 



Karan also brings you ‘What The Health’, the latest in health and science in the news, and he answers YOUR questions in ‘Crowd Science’.  



If you have your very own question and want to get in touch, simply head to TheReferralPod.com.



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Karan, and in this podcast, we talk about all things science, health and medicine, how to make your life better, how to make your life easier, how to live life more happily, and more importantly, disregarding all the misinformation and pseudoscience you see out there and also talking to interesting guests, to world-leading experts, to scientists, to doctors and taking their take-homes so you can apply it to your daily life.

On today's episode, we're going to be covering a condition that can increase the risk of heart disease, dementia, and even early death.

And it's been around with humans, well, for as long as we've been humans.

And some of the symptoms are pretty insidious.

Weight gain, low mood, anxiety, headaches, memory problems and even worse.

And it affects 50% of people at some point in their life.

Now you're probably thinking, such a serious condition, it's probably got millions and millions of research money pumped into it.

This is the menopause and perimenopause state.

And today I'm gonna be joined by British GP, Dr.

Louise Newsome, who is a menopause specialist, and she's helping to improve education around the perimenopause and menopause and hopefully de-stigmatise this crucial condition.

Why is no 1 thinking about their hormones?

If you think when someone's pregnant, 9 months of their life, the amount of investment we give to pregnant women is brilliant, but we should be doing that more for other women.

We shouldn't just be making them invisible.

I'll be answering 1 of your questions in CrowdScience.

If you have a burning desire to get in touch with me and ask me a question, drop a note at thereferralpod.com.

Also in the run-up, if it ducks like a quack, the bit where we debunk nonsense, myths, and general useless information.

What the Health is going on in the wide world of science, health and medicine.

This is groundbreaking stuff and it might sound a little bit dystopian.

Bear with me now, synthetic embryos are here.

Scientists have created synthetic embryos using stem cells that bypasses the need for sperm cells or even eggs.

So why are scientists growing these synthetic embryos?

Don't worry, it's not to grow a farm of lab-grown babies, rather, it's to explore the impact of genetic diseases and do a bit more of a deep dive into the earliest stages of human development.

Now, before we get worried that we're going to be messing around and experimenting with babies, these are synthetic embryos and they cannot be used clinically to be implanted into wombs.

They do not have a beating heart, they do not have any structures resembling the brain or a gut or anything like that at all.

But they do contain the same cells that would eventually go on to develop into the placenta, the yolk sac and the embryo itself.

The problem here remains an ethical and legal 1 because the pace of scientific development and research has been so fast, scientists haven't had time to draw up ethical guidelines, legal guidelines and moral guidelines as well.

So the current legal guidelines in the UK and most other countries allow scientists to look at embryos and cultivate them in a lab for up to 14 days.

After that point, you're not allowed to do any more.

But if these synthetic embryos are not real embryos or potentially embryo-like, should they then be made to stick to the same guidelines as we do for real human embryos?

This development was announced at the International Society of Stem Cell Research and so far it's not been published, it's not been peer-reviewed, so scientists are still waiting for this data to be made available so they can comment with a bit more authority.

So it's still just a bit of a buzz right now, we need more details.

Okay, this 1 might make you cringe and not in a fun way.

1 man has broken a world record you never want to break.

He's got the largest kidney stone in the world.

He is the proud owner of a 5.26 inch kidney stone.

That is the size of a 6-9 week old kitten, although slightly less cute.

Kidney stones are solid, stone-like objects that are made of a buildup of chemicals after the kidney has filtered them out of the blood.

When people have pain with kidney stones and talk about it being 1 of the most painful things they've ever experienced, the kidney stone, that phrase is a bit of a misnomer.

The most common type of stone that's in the urinary tract are called ureteric stones, not kidney stones.

Your ureters are the pipes which connect the kidneys to the bladder.

There are very thin pipes which measure a few millimeters in diameter.

So naturally, if you've got something which is bigger than a few millimeters, it's going to cause a hell of a lot of pain.

Now usually You can pass these kidney stones or ureteric stones on their own if they're 5-6mm in size, although sometimes you may need a medical intervention for those.

If they're any bigger, like this guy, 5 inches, that's gonna need surgery.

Although according to 1 study, there is a slightly more fun way to get rid of kidney stones, but don't try this at home.

1 study created a 3D model of a human kidney and then placed real kidney stones inside it and then took it on 20 rides of Big Thunder Mountain.

And stones placed in the upper part of the passage were dislodged 20 times.

Some of the classic symptoms of kidney stones include pain in your lower abdomen, in your groin, in your groin, sometimes even in your testicles, and maybe even your back, and you might even see some blood in your urine.

It might be associated with a urine infection.

So if you think you've got a kidney stone, go and see your doctor.

And fun fact, 1 of the most effective medications that your doctor might give you to help with your kidney stone pain is a rectal analgesia.

Yes, you will receive pain relief from the bottom end.

Okay, so I'm going to assume that your insides are not currently being sandpapered by kidney stones and that's a wrap for What the Health.

Tune in next week for more topical science and health news.

Now, let's get onto the main topic with our guest, Dr.

I'm Cameron Esposito, I have a lot of jobs.

You've seen me on ABC's A Million Little Things.

I'm a stand-up comic, best-selling author, but I am no expert at survival.

On my new podcast, Survivor Die Trying, we're gonna learn together.

From shark attacks to tsunamis and bad breakups, this is your one-stop shop to prepare for the absolute worst case scenario.

Join me and some special guests on Survivor Die Trying, a comedy podcast that prepares you for anything.

Listen and follow wherever you get your podcasts.

In this week's episode, we're gonna be talking about perimenopause and menopause.

Not only is she a doctor and a Menopause Specialist, but she's helping to provide free science-based, evidence-based information around the menopause to help women improve the education and their own health around this period of their lives.

So I'm so excited to have someone like this talking about a crucial topic.

Louise Newson, menopause specialist, thank you so much for coming down.

First of all, I want to ask, just for everyone listening at home, they're probably thinking, why the hell are we talking about this?

What is perimenopause and what is menopause?

Well firstly thanks ever so much for inviting me, I'm so excited to be here and I'm loving your studio by the way, I'm very jealous, I've got a bit of podcast studio envy, I don't know if that's a thing but I am jealous.

But it's interesting when we break down the words, which is what we do in medicine, isn't it?

Menopause, people just think, oh, we're overusing the word, it's in the media all the time, how annoying we're done with it.

Well, actually, let's break down the word.

Menomenstrual cycle periods, pauses, stop.

Now, I think that's really weird in itself because what happens in the menopause, our ovaries stop working.

It's often because we get older, they run out of eggs or the hormone levels are lower.

Some women have a menopause very abruptly if they have their ovaries removed or damaged by drugs or radiotherapy.

So it's actually a loss of ovarian function.

Some people define menopause as loss of fertility.

When I'm 52, I don't actually want periods and I don't want any more children and it would be a bit unusual to be 52 and pregnant.

But actually what I do want is my hormones to work in my body.

So we need to think about menopause in a slightly different way.

Women, even if they don't have many symptoms, can still have the long-term health consequences of not having their hormones.

But there's estrogen and testosterone receptors on every single cell in our body.

So, you know, symptoms can vary from the odd headache to dry eyes to irritable bowel type symptoms to breathing symptoms even.

You know, commonest symptoms are brain fog, memory problems, anxiety, poor sleep.

And then the perimenopause, peri is just the time around, isn't it?

So in the run-up is when people start to experience menopausal symptoms but their hormone levels are starting to change but if people are still having periods, their periods change.

But a lot of people think their periods become less frequent and lighter.

I see a lot of women whose periods become closer together and very heavy.

So, and again, in the perimenopause, our hormone levels can be very high and very low, literally in the same second sometimes.

And a lot of women actually have worse symptoms in that time, especially the brain symptoms.

We're funding a PhD in suicide prevention at the minute because a lot of women are in real crisis in this time.

And I think it's because, you know, our brains like homeostasis, they let everything nice and calm, don't they?

If anybody's been hungry, you know that feeling when you're not quite...

So, with our hormones up and down, our poor brains are just all over the place.

So, the perimenopause can last for around a decade before the menopause and then once people are menopausal, whether they still having symptoms or not, they're still menopausal until the day they die because they still have low hormones.

I didn't realise how little I knew and that most people knew or know about both of these conditions And it wasn't until a few years ago, I was doing some rotations in breast surgery.

And in those clinic appointments, almost every clinic, there was 1 to 2 women, they were mentioning other symptoms they were having.

And I was of this archaic, outdated thinking then, this was only 2 or 3 years ago, that it's a transitional phase that people go through.

And, you know, that's it, it's something to go through.

I mean, my mom's gone through it, and for whatever reason, I never took notice of that.

But then doing a deep dive, doing my own research, am I missing something here?

And I realised it could be classified, and it maybe should be classified as an actual disease because it's not just a transitional phase but a quite a deleterious, insidious physiological state.

You know, I don't know how much menopause education did you have.

That's the worrying thing in medical school.

I cannot remember a single lecture or module that I had about menopause.

No, I tell you 1 thing that I was taught actually in medical school and I'm older than you, so this was in the 80s, was saying that women are protected from heart disease until after the age of 50.

And I've got quite an inquisitive mind, I've also got a pathology degree, so I was thinking well what's the difference between a 51 year old and a 49 year old?

And the only thing I could come up with was with hormones.

You know, if you think about the history of our hormones, when estrogen was discovered, if you like, it was associated with vasomotor symptoms, which is the hot flushes and sweats.

When thyroxine was discovered as a hormone, it was associated with hypothyroidism.

And then if you think of insulin, it was associated with a disease, diabetes.

But then menopause is not, it just seems to be these symptoms.

And as you say, even now, if you look on social media, a lot of people will say, it's not a hormone deficiency, it's a transition.

And it's like, what are we transitioning into?

I've got no idea as a menopausal woman I want to be really healthy actually and the way that I can improve my health is by having my hormones and We have to remember it's not just a middle-aged woman problem either.

There's a lot of young women who are menopausal and perimenopausal yet being fobbed off all the time to say, no, it can't be your hormones.

I was literally having a conversation yesterday with my mum, you know, in light of me chatting to you today.

And I was talking to her and said, when you were going through menopause, you didn't take HRT.

So immediately I was thinking, you know, estrogen has a role on bone density.

If you have low estrogen, you have lower bone density, increased risk of osteoporosis and bone fractures.

You know, it's gonna affect your heart, increase your risk of dementia if you've got low estrogen.

So I was saying, why haven't you taken that?

But just like you said, the number of women who, first of all, because of probably societal issues, They're not taking up HRT, but also they're not, you know, almost taking knowledge and being cognizant of the fact that menopause is a serious thing that affects your future health risk and current health risk because it's kind of been brushing the carpet as just this thing that we need to get through.

Well it is and I think it's also stems a lot from the WHI, the Women's Health Initiative study 2002, many years ago now, which showed this risk with breast cancer.

But what people have forgotten is there are still benefits from hormones.

So we can talk about the risk, that's fine, or potential risk, but actually what are the risks of not taking HRT?

So, you know, more and more, and wrongly or rightly, I've worked really hard to empower women with the knowledge so they can understand that they haven't got clinical depression, that they haven't got fibromyalgia, that they haven't got early dementia, they haven't got, you know, worsening migraines.

It's all related to their hormones often.

But time and time again, women are told, oh no, have some antidepressants, you're too young, it can't be, go and buy a relaxation tape.

A lady told me a couple of days ago that her doctor had just said, it's just a natural process, you've just got to go through it.

Well, why have we just got to go through something that increases our risk of disease?

I mean, you mentioned that Women's Health Initiative study in the early 2000s, 2002 when it came out into the media.

And I think there hasn't been another paper, a landmark paper, which has ruined the lives potentially of so many millions of women more than that.

And I'm a sucker for stats and particularly bad stats.

And I often see people quoting various statistics on social media about this can increase X, Y and Z by 10% or whatever.

But actually, in that study, the increased risk of breast cancer and blood clots that they noted from the group which had HRT, the absolute risk was 6 in 1000.

And in the non HRT group, it was 5 in 1000.

So the absolute risk is non significant, but the relative risk that they put out there was 10%, 25%.

So that turned women and doctors away from prescribing HRT for millions of women and who knows what the cost was to the healthcare providers, but also to the individual women who had maybe lost life years.

We know since 2002, the incidence of breast cancer has increased because of other factors, mainly Obesity as well.

We know obesity can contribute to many cancers.

A lot of women I see are putting on weight because they're so tired, they're comfort eating, their metabolism changes without their hormones, and also they're not exercising, they're drinking more wine, so they've got more modifiable risk factors for breast cancer.

And actually, I'm a menopausal woman, but I've got a brain, I can decide what I want to do.

I am more worried about osteoporosis because I've seen so many people with osteoporosis of their spine.

I'm actually quite worried about dementia and I've made an informed choice that I want to take HRT.

I was literally looking at patients thinking, I can't remember what you've told me.

I'm looking at my examination couch thinking, I just need a nap.

And I was only working 1 day a week as a GP.

So, you know, as a government, telling men and women, reduce your hours, have flexible working, work from home.

Well, you know, less hours means less pay, less income to the family.

Yeah, and actually, I've worked really hard to be a doctor.

I don't want to have a second rate job that isn't suited to my professional career.

Why isn't it at the top of the conversation rather than us having to have a podcast to then, you know, destigmatise it?

Well, you know, I was, as you know, I was just chairing a conference, it was a women's health session this morning and I just had to give an address.

So I was reflecting the last few days, what can I talk about?

And actually what I did talk about was medical gaslighting, which is what's happening, misogyny.

But also if you think back about the word hysteria, you know, hysterical but also hysterectomy.

So if you look back in the history of women, which is always fascinating, isn't it?

People thought that our wombs were our cauldron.

The wandering womb and the treatments that people had for that.

And you know, they were quite barbaric treatments.

But in my clinic, I can't even begin to tell you how many people I've seen that have been given quite heavy duty anti-psychotic medication.

Recently I've seen a few that have been given ketamine infusions for their treatment resistant depression in inverted commas but no one's thought about their hormones.

But I think some of it is because it's a female problem and actually people are scared of strong women.

Women who take HRT, especially when they take testosterone as well, you know, we stand up for ourselves a bit more.

We contribute more but actually that is a good thing, you know, men do need women as well and I really worry about women who haven't got money, haven't got English as their first language, can't speak for themselves.

We know more and more, as you do as a doctor, with chronic diseases and, you know, areas of deprivation, are really struggling with heart disease, with mental health, with obesity.

These women are just being told, oh, you will feel like that because of your way of life.

Of course, but actually, why is no 1 thinking about their hormones?

I think, you know, we were talking a bit before about, you know, you worry about the risk of dementia, etc.

You know, when it comes to dementia and Alzheimer's, they often say, you know, actually the disease process starts decades before.

And, you know, the perimenopause and even before pre-perimenopause, probably the disease process or that kind of decline into that physiological state would maybe start several years before that average age of 51.

So in your experience and expertise, what would someone be able to do to just to optimize their hormones in themselves in the run-up to that before they're at the stage where they need HRT?

Yeah, so you don't want to wait till you're too late.

No 1 gets a medal or a badge for suffering or for being menopausal.

And as you know, the diagnosis of menopause is weird because it's a retrospective diagnosis.

You have to wait a year until your last period.

And that's madness because then it's defining menopause as something to do with our womb rather than what is going on with our hormones.

So the perimenopause, as you say, can last many years before.

And so 1 of the reasons I developed the free Balance app is that people can monitor their symptoms and I really strongly feel that every 6 months any woman of any age should be monitoring and looking at their symptoms and of course many symptoms can be due to other things, they can be just due to life stresses or they can be due to other diseases.

But if someone's getting changes in symptoms with no other apparent cause, then we as individuals should be thinking, or could it be our hormones?

And we know from the evidence the earlier women take HRT the better.

And so it shouldn't really be HRT, it's not replacing, it's just topping up.

So it's just hormone support treatment really, derived from yam plants, really safe, same structure as the hormones we produce when we're younger, so a lot safer than the contraceptive pill of course.

And then women should really consider just topping up a bit.

they're getting that dip just before their periods, well, just take a bit of oestrogen then.

You know, think about testosterone as well, maybe progesterone, and then you just gradually increase with time.

So what you want to do is sort of morph into the menopause without symptoms because We also know as soon as your hormones start reducing, that's when you've got this increased risk of inflammation and this inflammatory conditions that occur, all the diseases that we know are associated with the menopause.

So also, you know, a lot of women often just feel so awful that they've not just reduced or changed their job, but they've started to put on weight, their cholesterol started to creep up, they started to take a bit more medication, they've started to just not feel themselves.

Well, wouldn't it be great to just prevent as many diseases as possible, do it as early as possible, so then women can carry on being the best form of themselves.

So the HRT is an important and essential adjunct for women undergoing that perimenopause stage or the menopause, but it's not a golden bullet to just change someone's life.

They also need to do the peripheral things like optimising their sleep hygiene, their diet, exercise, all of these other things, in addition to the HRT, can get them back to at least somewhere close to where they used to be maybe.

I mean I feel, you know, I'm not 1 of, you know, me too big-headed, but I feel the best I've felt for many, many years and I wish I'd started testosterone probably 10 years before I did, but it's enabling me to sleep better, to think better, to work harder, perform better, but also it enables me to exercise.

If I didn't do yoga regularly, my mental health would be terrible, my physical health would be awful.

You know, so there's no point me taking HRT and having, you know, whiskey on my cornflakes every morning and McDonald's every evening.

I've got to be thinking in a different way and we need to, I think, as healthcare professionals, really help people think, well, you're perimenopausal or menopausal, you might have the next 30, 40, 50, 60 years if you're young when you're menopausal, how are we going to help you?

You know, if you think when someone's pregnant, 9 months of their life, the amount of investment we give to pregnant women is brilliant.

But we should be doing that more for other women.

We shouldn't just be making them invisible and thinking, oh, their menopause or their transition through it and never mind, it doesn't really matter.

See all The Referral with Dr. Karan transcripts on Applepodcasts

Menopause: The Truth, with expert Dr Louise Newson