The Dr Louise Newson Podcast

187 - My experience of long COVID and changing hormones with Dr Marianne Tinkler

Dr Marianne Tinkler is a respiratory consultant from Swindon. In March 2020, Marianne contracted Covid-19 and had to take a month off work with a severe cough and extreme fatigue. She returned to frontline work on the wards at the height of the pandemic but found it difficult due to ongoing symptoms of tiredness, breathlessness, a racing heart rate and significant brain fog. Later that year, when long COVID became more recognised and Marianne was continuing to experience severe symptoms, she was encouraged to take an extended break from work, and this gave her time to reflect on her hormonal journey as well as learning how to navigate life with long COVID.

In this episode, the experts discuss the relationship between long COVID and the perimenopause/ menopause, the barriers to accessing treatment and some of the benefits of diet, movement and HRT for those suffering with long COVID.

Marianne’s advice if you have long COVID:

1. Pace yourself carefully and don't ‘push through’.
2. Track your symptoms on the balance app and consider HRT if you think some of your symptoms may be due to perimenopause or menopause – even if you think you’re ‘too young’.
3. Look at your diet and activity levels and eat foods that are good for your gut microbiome. Try and get outside every day, even if your energy levels will only allow you to sit on a bench.

186 - Bleeding on HRT with Consultant Gynaecologist Mr Osama Naji

Mr Osama Naji is a consultant gynaecologist at Guy’s and St Thomas’ hospital in London and he leads the busy department of women’s cancer diagnostics at Guy’s Cancer Centre. Mr Naji specialises in early detection of pre-cancerous conditions and is an international expert in advanced gynaecological scanning, contributing significantly to scientific research in women’s gynaecological health.

In this episode, the experts discuss the complexity and influence of the menstrual cycle, bleeding on HRT and when it should be investigated further, and the safety of HRT with regard to gynaecological cancers.

Mr Naji’s three take home messages are:

1. The workforce of women is needed now more than ever, therefore we must invest in women’s health and wellbeing and paramount to this is education about HRT.
2. Endometrial cancer is on the rise but can usually be detected at an early stage and treated very effectively through raising awareness, identifying the causes, managing risk factors and engaging and empowering the patient.
3. HRT is the very last item on the list of risk factors for endometrial cancer, therefore believe and trust the patient on whether the bleeding is abnormal for them and work through the management process using a shared decision-making approach.

For more information on Mr Osama Naji, visit www.rylonclinic.com

185 - Exploring experiences of menopausal women after breast cancer, with Dr Sarah Ball

GP and menopause specialist, Dr Sarah Ball, makes a record fifth appearance on the podcast this week to discuss her work exploring experiences of menopause care in women who have had breast cancer.

The experts discuss findings from a recent survey carried out by Sarah and the Newson Health team to highlight how things have improved in recent years and identify some of the ongoing needs.

You can read more about Sarah’s survey and other recent menopause research carried out by Newson Health here.

Follow Dr Sarah Ball on social media on Instagram and Twitter.

View the breast cancer booklet here.

184 - Reflections on 2022 with Dr Rebecca Lewis

Clinical Director of Newson Health, Dr Rebecca Lewis, returns to the podcast this week for a special end of year episode with Dr Louise Newson. The business partners and friends reflect on some of the positives over the last 12 months and discuss the continued challenges in trying to help more women with their experience of perimenopause and menopause.

Rebecca’s three hopes for 2023:

1. Testosterone needs to be licensed for women (and not just for low libido)
2. Treatment for significant and severe menopausal symptoms in the workplace to help keep women in work
3. Education about the perimenopause and menopause reaching out to other medical specialties so more healthcare professionals understand how it affects the patients they see.

 Follow Rebecca on Instagram at @dr.rebecca.lewis

183 - Urinary tract infections in women with Professor Chris Harding

Professor Chris Harding is a Consultant Urologist working at the Freeman Hospital in Newcastle upon Tyne and at Newcastle University. He has a particular interest in bladder dysfunction, continence and urinary tract infections (UTIs). In recent years, his research has focused on non-antibiotic treatments for recurrent UTIs and developing targeted treatments for specific patient groups.

In this episode, Professor Chris talks to Dr Louise about the challenges of diagnosing UTIs accurately, the severe impact recurrent UTIs can have on your life, how antibiotics can be used appropriately, and how to prevent UTIs occurring. The experts share some of their plans to study the effects of systemic HRT and vaginal hormone treatments on UTIs in women.

Chris’s advice if you have recurrent UTIs:

You don’t need to put up with UTIs in the perimenopause and menopause; there are many proven treatments available

Acknowledge that current tests for UTIs are not 100% accurate. If you think you have a UTI, you probably have, even if your test was negative - the diagnosis can always be questioned

Discuss with your doctor how you can prevent infections if you have had 2 episodes within 6 months, or 3 within a year

Hormone replacement, particularly vaginal treatments, are significantly protective and preventative against UTIs.

Follow Prof Chris Harding on social media at @chrisharding123

182 - Mental illness and the role of estradiol with psychiatrist Professor Jayashri Kulkarni

This episode contains reference to suicide

Professor Jayashri Kulkarni is a psychiatrist working in Melbourne, Australia, specialising in women’s mental health and researching the role of estradiol in mental illnesses such as schizophrenia and depression. She founded and directs the Monash Alfred Psychiatry Research Centre, a large clinical research group in Melbourne.  In 2022, Professor Kulkarni launched and directs HER Centre Australia – a Monash University Centre delivering Health, Education and Research in women’s mental health - dedicated to improving the quality of care for women with mental illnesses by developing specific treatments tailored to suit women’s needs.

In this episode, the experts discuss the different ways estradiol influences brain health and function, what this means for healthy brain aging and longevity, and they share some of their experiences when helping women with mental health changes during the perimenopause and menopause.

Prof. Kulkarni’s tips for women experiencing mental health changes:

1. Trust your instinct – you know you best. If you think it might be hormones, help is available.
2. Look at your background history. If you had premenstrual mood changes or postnatal depression in the past, this may mean you are particularly sensitive to hormonal changes.
3. Early life trauma (e.g. neglect or emotional/physical/sexual abuse) can disrupt hormone signals and brain chemistry and this may make you more vulnerable to mental illness.
4. Whatever your past history, there is help available in the form of HRT. See your local healthcare provider or a menopause specialist if needed.

You can find the Meno-D questionnaire here. This tool identifies the specific mood changes that are more typically present in perimenopause and menopause related depression.

For more information on Professor Kulkarni’s work and research, visit www.maprc.org.au

181 - Supporting women’s hormone journey with Dr Samantha Newman

Dr Samantha Newman is a British doctor working in Hawkes Bay, New Zealand. After training in obstetrics and gynaecology, a moving encounter with a patient led her to re-train as a GP and develop an interest in supporting women’s health and wellbeing. Samantha’s clinic, FemaleGP, was established in 2016 to improve access to focused healthcare for women including gynaecological and sexual health and treatments for perimenopause and menopause.

In this episode, the experts discuss shared decision making with their patients, symptom improvements with HRT, and supporting women to ‘listen’ to their hormones. Samantha also shares some of her experiences working with women from the Māori community and culture.

Dr Samantha’s three tips:

1. See your hormones as a journey and not as separate, distinct phases of life. Find support along the way – wherever in the journey you find yourself.
2. For healthcare providers: see your patients as a whole person and as part of their families and find out their true thoughts and desires.
3. Be honest with your patients and encourage them to be honest with you. If they haven’t taken your advice, revisit things and find out what didn’t align with their values rather than viewing it as a negative.

For more information about Samantha’s work, visit www.femalegp.co.nz

Follow Samantha on social media at https://www.facebook.com/FemaleGP and https://www.linkedin.com/in/samantha-newman-34223b230

180 - Improving menopause care in Hong Kong with Dr Laurena Law

Dr Laurena Law is a general practitioner working in Hong Kong who has a special interest in nutrition and lifestyle medicine to improve healthy aging and prevent chronic illness. When Laurena gained personal experience of perimenopause and saw the impact it was having on her own life, she decided to learn more about hormone health and evidence-based treatments for the menopause so she could help herself and her patients.

In this episode, Louise and Laurena discuss cultural differences and similarities between British and Chinese approaches to menopause from both an individual and healthcare perspective. Laurena emphasises the importance of educating women so they know how to recognise their perimenopause or menopause and to empower them to make their own health needs a priority. She educates healthcare professionals in Hong Kong and further afield to ask women the right questions in consultations and to know how to prescribe body identical HRT.

Dr Laurena’s three tips for women:

1. Complete a menopause symptom questionnaire and repeat it every few months. This can form the basis of a conversation with your healthcare provider
2. Find a healthcare provider that is educated and updated in menopause care
3. Find a support group of women also going through the menopause to talk about the problems and challenges you’re going through – you’re not alone.

179 - Advancing menopause care after breast cancer with Dr Sarah Glynne

GP and menopause specialist, Dr Sarah Glynne, joins Dr Louise Newson on the podcast this week to discuss menopause care after breast cancer.  The experts share more about the breast cancer steering group established as part of the Newson Health Menopause Society that is working towards producing a consensus statement to support clinicians and improve the quality of life for menopausal women who have had breast cancer.

Dr Sarah Glynne discusses the importance of individualising the risk-benefit ratio for every woman when making decisions around treating the cancer and weighing this up with treating menopausal symptoms. Sarah emphasises the importance of talking through the implications of each of these considerations using a shared decision making process.

Sarah’s three tips for women after breast cancer:

1. Understand the risks and benefits of the drugs used to treat your breast cancer and what this means for you personally. Ask your oncologist for more information about your own breast cancer, if you are not sure. You can then use the PREDICT tool online for understanding more about your own cancer risks and what additional benefits any treatments may offer.
2. Read about non-hormonal options to help your menopause symptoms and cancer recovery such as diet, yoga, or acupuncture. Try various approaches to find the ones that may bring some benefit to you. Vaginal moisturisers and lubricants may also help and these do not contain hormones, and there are other medications your GP may be able to prescribe for some of your symptoms such as hot flushes.
3. If your menopause symptoms are severe and your quality of life is suffering, ask your clinician to explain the risks for you regarding your cancer prognosis if you decide to take HRT, versus the risks to your quality of life and long-term health if you choose not to take HRT. If you have genitourinary symptoms of soreness and dryness, vaginal hormones are very safe for improving these symptoms. Read information on the balance website and the book ‘Oestrogen Matters’ by Avrum Bluming, and make a choice that is right for you through discussion with your clinician using a shared decision making process.

178 - My story of ‘treatment resistant depression’, ketamine and HRT

In this episode, Sam shares her moving account of the journey she has been on for the last five years when, after a miscarriage and losing her father, things started to unravel and her mental health suffered. A difficult few years followed spent navigating depression, trialling several antidepressants and anti-anxiety medications, and seeking help from psychiatrists to try and understand what was going on. At the time, Sam believed she was years away from becoming menopausal and through her own research sought treatment privately in the form of ketamine due to her desperation to feel better and function again. Through learning more about hormones and their effects on the brain and mental health, Sam has recently begun to take HRT and feels she has started on a more positive path to health and stability.

Sam’s three tips for those struggling with mental health:

1. Try and be assessed by a menopause specialist before accepting a diagnosis, medication or treatment from a psychiatrist – it may save you a lot of unnecessary suffering.
2. If you do start taking HRT, be patient. It can take time and the dose and type may need tweaking before you feel the beneficial effects.
3. Become as well informed as you can about your hormones and the menopause from good sources online. And talk to other women – you’re not alone.