Updated 6th April 2022

Menopause: How your body changes and what you can do

There's a condition that leads to an increased risk of heart disease, dementia, and early death that's been affecting people for as long as they've existed. The many symptoms can severely impact quality of life — ranging from headaches and memory problems to anxiety and weight gain. 

This condition affects more than half of the world's population, but unbelievably, it's rarely discussed. And the scientific research that exists on it is limited. 

It's called menopause, and it affects 1.2 billion women worldwide. It's not a disease, but the effects can be just as serious for some women.

In this podcast, Jonathan talks to the British doctor who's working to educate us about menopause and bring the discussion on the topic into the mainstream.

Dr. Louise Newson is a GP, menopause specialist, founder of the Newson Health Menopause & Wellbeing Center, director of the Balance Menopause App and the non-profit Newson Health Research and Education, and founder of The Menopause Charity.

If you want to uncover the right foods for your body, head to joinzoe.com/podcast and get 10% off your personalized nutrition program.

Transcript

[00:00:00] Jonathan Wolf: Welcome to ZOE science and nutrition, where world-leading scientists explain how their research can improve your health.

What if I told you there's a condition leading to an increased risk of heart disease, dementia, and early death. That's affected humans for as long as we have existed. The host of symptoms can be very unpleasant ranging from headaches and memory problems to anxiety and weight gain. Then what if I told you over half the world's population will suffer from this, at some point. You might assume this condition would be a constant topic of conversation studied by many of the world's leading scientists and taught in schools. You would be wrong. The condition I'm talking about is menopause and it affects 1.2 billion women worldwide. It's not a disease, but its impact can be profound. In today's episode, I'm joined by the British doctor, leading a worldwide mission to educate us about menopause and make it a mainstream topic of conversation. Dr. Louise Newson helps us understand how menopause can affect women and the options available to help. 

Louise. Thank you for joining me today on a topic that is so important. And so under-discussed, and I have a whole bunch of questions from our members today, but I think we should start right at the beginning with a very simple question. What is menopause? And also, why is this a topic which is so sort of personally important to you? 

[00:01:30] Dr. Louise Newson: Oh, thank you. Well, thanks for inviting me today.

So the first question first, I suppose, menopause is just a word and it shouldn't be called that it should be called a female hormone deficiency, and I'd love to change the terminology, but we are where we are menopause just means, well, "Meno" is the menstrual cycle. "Pause" is stopped. So it's a weird one, actually a medicine because a retrospective looks back in time diagnosis for most of us, because it means a year without our periods. That's what it means. And so most women. What happens is we're born with a finite number of eggs in our ovaries. That number or the eggs run out eventually is the average age, not that of any women's average, but the average age is around 51 in the UK.

So because the eggs run out of the hormones associated with the eggs, the hormones produced by the ovaries also run out. And so they decline and hence the term female hormone deficiency, but it doesn't just happen overnight. It happens gradually for most women. And so a lot of women become peri-menopausal before they become menopausal.

And peri is just a medical term for around the time of. So often for many years, sometimes even a decade or so women's hormone levels will be declining at a slowish rate. Sometimes a hap has it, right? So they go up and down for many years. And so that means they get symptoms. So menopausal symptoms as well.

But they won't know that they are because they're still having periods and the periods can sometimes change in nature or frequency. But also there are a lot of women who never have periods because they might've had a hysterectomy or they might be using some birth control or have a contraceptive device, a coil.

So they're not having periods. So then they're just getting symptoms. And so with menopause and paramedicals, there are lots of symptoms because especially the main hormone estrogen, we have cells that respond all over our bodies. Every single cell in our body responds to estrogen. So that means every single system in our body can respond to low estrogen.

So symptoms can really vary and they can range from symptoms such as reduced stamina, brain fog, low mood, dry eyes, dry mouth, painful mouth tinnitus, hearing problems, palpitations muscle, and joint pains. Even stomach problems such as irritable bowel syndrome, digestive problems, urinary symptoms, vaginal dryness.

The list goes on and on and on because it affects us with this lack of hormones, but more interesting. Actually, for me, as a physician, of course, I worry about people's suffering, but it's looking at future diseases. And we know that women who have low hormones, such as menopausal women have an increased risk of diabetes, osteoporosis, various cancers.

So it's quite a doom and gloom being a menopausal woman. 

[00:04:17] Jonathan Wolf: I have to say, I'm listening to this and it's not very cheerful, is it? 

[00:04:22] Dr. Louise Newson: Absolutely not. So not only are women suffering emotionally, physically with their partners, with their jobs, everything else, they know that they've got this increased risk of diseases.

So it is doom and gloom. It's a natural process for most people. So a lot of people think, well, there's no treatment for natural processes, but it's not natural because evolutionarily we're designed to reproduce and then fade away actually. And so the most important treatment for hormone deficiency is having hormones back.

And we'll talk about this in a bit. I'm sure, but a lot of people have been very scared about their own hormones. But I've said the average age is 51. We also know that around one in a hundred, probably more women under the age of 40, have an early menopause. And sometimes that is again natural. It's just, they've got fewer eggs and they run out a bit earlier.

Or, some women have their ovaries removed from surgery, or they have it damaged, their ovaries' damaged by drugs, such as chemotherapy or radiotherapy. So there are a lot of women out there who will be young. My youngest patient was 14 when she became menopausal. And so these women often become peri-menopausal before.

So there are teenagers who are perimenopausal there are women in their twenties and thirties and their forties. And usually either be perimenopausal or menopausal. So I'm very interested in health. I'm very interested in disease prevention. I'm not a gynecologist. I have a background in hospital medicine, so I wanted to do cancer medicine many years ago.

And then I got married and thought, how can I be a full-time physician and be a mother of children and be married to a surgeon. So I went part-time and became a GP and then I did a lot of medical writing, a lot of academia, and a lot of evidence-based medicine. I've got a degree also in immunology and pathology.

So I'm very interested in geeky science as well. 

[00:06:17] Jonathan Wolf: We, we like, we like that on this podcast, so that's good.

[00:06:21] Dr. Louise Newson: It's good. So I sort of carved this niche really that I've managed to have time to think, which is quite unusual in medicine. And I've also had time to explore my interests. And I've also had time as a GP to listen to patients which, you know, number one in my career, even now on my patients, they are the most important, well, actually my family, most important thing, but second to that, all my patients actually, because they have come to ask for professional advice.

But they don't want me to be dictatorial. They want to share their decision-making. I want to explore their concerns, their worries, their beliefs, their expectations, um, in a two-way process. And GP gives you great training for that. Or I was very, very blessed. I had an amazing trainer called John Sanders who helped me learn about the consultation process.

And so menopause ticks all these boxes, all my areas of interest. So I have the best job in the world. It's frustrating because I listened to stories all the time of women's suffering. And that's what I'm determined to change. 

[00:07:27] Jonathan Wolf: And can you talk a bit about the scale of the problem? Because I think you already touched a bit on maybe some of the controversies around hormone, but obviously we have a lot of listeners who are going through this many who feel that this is coming up for them.

And many who like me are not going to experience this, but of course, their mothers have their partners. Well, their daughters will talk a bit about this across the US and the UK. 

[00:07:47] Dr. Louise Newson: Yeah. The scale is phenomenal. There's no other condition that is guaranteed to affect us. When I say condition, people might say, well, it's a natural process.

It's not a disease where we can argue about that because there are health risks that I've already said the same way is obesity a disease or not. And again, we can argue about that. And I think a lot of people will say there are health risks associated with obesity. Is raised blood pressure. a disease. Not really cause it doesn't cause symptoms, but we treat it because it's a marker of future disease and menopause is the same.

But for many years we think about menopause as a transition. It's just going to last a few years. We also think about it just causing a few hot flushes. And a lot of people say, well, my mother's got through it. I'm going to get through it. And when we talk about getting through it, that's about getting through symptoms.

And for some women, they might not have any symptoms. We don't know the proportion. It's probably about 20% who might not have many symptoms or any symptoms. We know 25%. So one in four women have severe symptoms. That means that it's affecting them at work. And at home. But also whether a woman has symptoms or not, she has this hormone deficiency.

So she has this increased risk of disease. So you only need to look at figures for us to process. One in two women over the age of 50 who don't take HRT, we'll develop osteoporosis. One in three will have an osteoporotic hip fracture. Our risk of a heart attack increases by a factor of five after menopause.

Who's more likely to get dementia. It's women, it's not men, you know, so it's all there. We know it's there and no one's looking at it because everyone's scared of hormones, but you know, these health risks are there forever. And then you look at some of the other symptoms. So vaginal dryness, I'm sorry to talk about vaginas so early in a podcast, but vaginal dryness is very common.

It affects about 80% of women who are menopausal yet. Studies show. 8% of women receive treatment now because all the tissues everywhere in our body respond to estrogen the tissues lining the vagina, the vulva, even the urinary system respond to estrogen. So without at these tissues can become very thin.

Very, fryable not stretchy. You can imagine it causes pain and discomfort, but not just with penetrative sex. A lot of women, I see can't sit down for long periods some of them stopped wearing underclothes because that friction is painful. A lot of women experience recurrent urinary tract infections, some urinary incontinence, and this is affecting their quality of life.

But the minority of women are getting treatment, which is just a replacement estrogen in those tissues. And so the scale is huge. You only need to think about how this is affecting women in different cultures. You know, if women are incontinent in Africa, they're ostracized from their community, they can't work. Well, that's awful in 2022, you know, and then we've done some studies. We recently did a study of nearly 4,000 women, and we found that 50% of women answering have either given up their jobs or not taken a promotion at work as a direct consequence of their menopausal symptoms, mainly fatigue, memory problems, and anxiety.

So this is awful. So this is where the scale is mind-blowing actually, and the work I'm doing. There's so much because I'm on a real mission to improve the future health of women, not just in the UK, but worldwide. So we have to do it in a grown-up way and we have to empower women, but we also have to give healthcare professionals the tools and knowledge and evidence to support them, helping these poor women.

[00:11:42] Jonathan Wolf: And could we talk a little bit about that? So, Louise, I know you were telling me just before we started, I think that you're seeing something amazing like 4,000 women a month. I think you said, uh, just in the clinics that you've set up and that's here in the UK. Can we talk a bit more broadly? I think you've already touched a little bit on this topic about hormones and hormone replacement. What is the situation in the UK and the US today? What's the latest scientific evidence and what's going on. And what do you think should be going on.

[00:12:08] Dr. Louise Newson: Yeah. So it's a huge problem because women aren't able to access the treatment. And so I set up a clinic three years ago, really to get some of my friends off antidepressants because antidepressants are not a treatment for the low mood associated with perimenopause or menopause.

And, you know, the demand has increased exponentially, but people shouldn't be coming to my clinic. They should be getting it from their local health care provider in the UK. 14% of menopausal women receive HRT in the USA, some figures are about 4%.

[00:12:41] Jonathan Wolf: And Louise, just to explain for a bit what exactly is HRT?

[00:12:44] Dr. Louise Newson: HRT is hormone replacement therapy, which is what we call it in the UK and other countries. It's MHT and menopausal hormonal treatment. It is just hormones. And I'll talk about it, what it is in a few minutes, but. We have really good guidelines. So in the UK, we've got nice. The National Institute of health and care excellence guidelines came out in 2015 internationally.

We've got the international menopause society guidelines that came out in 2016. They're very similar. And actually what they do show is the huge benefits of taking HRT, not just to women's symptoms, but to their future health, especially for osteoporosis prevention. So we have these great guidelines that as clinicians, we should be working out of whichever country we're in, but we're not always because the minority of women can access it.

And this isn't because the minority of women want their hormones back. It's because they're struggling to get them. And so we need to think about why, why are people so scared about. Their hormones and that's because we look back in time in 2002, there was a massive billion-dollar study. So 20 years ago, I mean, it's now a lot of money, isn't it to spend on research a billion dollars, but then. 

[00:13:57] Jonathan Wolf: Even today that's a lot of money.

Yes. 

[00:13:59] Dr. Louise Newson: Massive amounts of money. And it was looking at how the future health benefits of HRT or hormonal therapy will help women, but it was not a great study in the way it was set up. So, and this is important to understand what they were doing was giving hormones to women. But the average age of women where they were starting MHT or HRT, depending on which country you're in women who were in, who was 64 was their average age.

A lot of these women were obese and they had heart disease already. And so if you give them HRT or hormones, the way that they gave it, they gave tablets, estrogen, which we know has a risk of a clot. And they gave a synthetic progestogen. So it's modified progesterone, and that has affected negatively on the heart system on clots as well, gave them these women quite high doses.

So women in their sixties who had become menopausal maybe 14 years ago, gave it to them. And then they found that there was a small, increased risk of a heart attack. And these women not surprising me because we know about how these hormones worked, but also they weren't getting very good results and they were spending a lot of money.

So what they did find was that there was a little bit of an increase in breast cancer with women who took combination HRT. They hadn't analyzed the data properly. And what happened was some of the investigators just went to the New England medical journal. They went to the lay press and said, HRT causes breast cancer.

You can imagine it went wild. And some of the investigators such as Robert Langer, who's very outspoken about this said I went to the chief scientific officer and said, you cannot do this. This is going to be the biggest travesty to women's health for decades. And they said, it's too late, it's gone to press.

And isn't that awful. And now we've got 20 years of data from this study we have seen from this study. Very eloquently that women who have had a hysterectomy only needed estrogen to have about a 25% level of risk of developing breast cancer. For the ones who were taking this combination, estrogen-progestogen there might've been a small increased risk, but it was never found to be statistically significant.

And what's very interesting actually, is that when they looked at women who have this supposedly increased risk, what they were doing was increasing their risk back to baseline in women who had taken HRT before and women who had taken HRT before were found to have a lower risk of breast cancer. So actually the data's already teasing out that hormones are safe, but the way it was misreported, it doesn't matter what the data shows because that's all everyone knows. 

[00:16:43] Jonathan Wolf: And we know this is always the danger of taking very complex sides and the press wants to jump away with a very simple... 

[00:16:50] Dr. Louise Newson: They want to sell bad news stories don't they, and so we've now got 18-year follow-up studies that came out recently and they found that women taking any type of HRT have a lower risk of heart disease, osteoporosis diabetes, dementia, death, and also colon cancer, but also other cancers as well. And women taking any type of HRT are less likely to die from breast cancer. So there might be some women who are, have a higher diagnosis, but they're still less likely to die from it. 

[00:17:24] Jonathan Wolf: One of the things that I'm struck again, every time you or anyone else talks about this is how little is talked about this.

You're talking about really severe symptoms. I can tell you right now that if men were going through half of those, we’d be talking about it all the time. So not only are you saying that many of them are faced with quite a difficult choice around whether to take these hormones because of what people have been talking about in the past and potentially some trade-offs, how are they supported?

I think we talk a little bit more about it than we did, but you know, my mother got through this. I can tell you that the generation didn't say anything about it. So is it changing?

[00:18:01] Dr. Louise Newson: I think it is changing actually. So when I went to my first international menopause society meeting, it was in 2016.

So the guidelines had just come out for the international medical society. And I was sitting there in the lecture theater with some amazing academics who I've now got the privilege of connecting and knowing. And they all were talking about HRT and saying how secret is and how great the guidelines are and how amazing all their patients are.

And I sat there thinking, what can I do? I'm struck by these stories. And I had just started doing my clinic. I was just working one day a week. Like I say, seeing some of my friends, some people, and I'd started a website. To help give people some evidence-based information. And I was quickly seeing stories of women who had given up their jobs.

Their partners had left them. They were, some of them suicidal and struggling with no help. So I sat there in this lecture theater thinking, well, what can I do? I can't run a massive research project. I'm just a woman on her own who has just started taking HRT. and it's given me my life back, but I couldn't get HRT or menopausal or hormonal therapy from my GP my primary care physician. They said, no, it's too risky. You can't have it. So I had to go and seek it elsewhere. 

[00:19:13] Jonathan Wolf: So I just want to sit there for a second because that's an amazing thing for you to say. You said, here are these new guidelines, you know, global guidelines saying this is safe. Could you explain how it was that your physician is then basically just saying, no, because I'm hearing that and it sounds extraordinary?

[00:19:30] Dr. Louise Newson: I know, I know it's shocking, isn't it? And I'd like to say things have improved but they haven't. Um, because when they were being trained and most of us don't have formal menopause training, but all they read was the hormones are bad and they're going to cause breast cancer.

And we still see that MHR medicines have regulatory authority yet. telling us that estrogen is dangerous and it's not. So I sat there and was thinking, what can I do? I can't just have a really big clinic because I'm not business-minded. And you've already said, I do now have a big clinic. It's not enough.

It's not enough. And I don't want to be having a clinic empire. So what I worked hard the last few years doing is empowering women with knowledge and education because as much as people think women are stupid, we're not, but we have to be given the right tools. And so I started developing this website, menopause doctor- it was called - co.uk. It's now being taken over and it's balance hyphen menopause.com. So I could reach people through a website, but not everyone has the luxury of a computer and internet access. So then I developed the free balance app, which has, has a lot of information on it I've also played a lot with social media, mainly just to stalk my children.

So a few years ago I set up Instagram and I've now got, I dunno, 270 something thousand followers. It's just grown organically. And every day when I get up at six in the morning, I just post something and that's been an amazing platform for people to share knowledge and to learn evidence because so many women and men have been given misinformation about menopause and especially hormonal treatment. And then that's great. But then what I have found is that more women are understanding that they don't need antidepressants. That there's, that fibromyalgia might be due to their low hormones or their headaches or their palpitations or their urinary symptoms.

But then they're going to their clinicians who were saying no like-minded. And so what I set up. Three or four years ago, it was a not-for-profit company that couldn't use in-house research and education. And it does what it says. So we launched an education program, which is an online program. I did it online, not because of COVID I set it up before COVID, but I was very.

Just worn out, really with going to lectures, where I had to find childcare pay for it, take the time I had to work. So, and I also found that I learned the most by sitting in clinics, by being with very esteemed clinicians, asking them questions, seeing how they consult with patients. So we did some videos with some actresses who pretended to be different patients.

We also filmed some lectures and we've linked it to evidence and also linked it to patient resources. So we've worked with 14 fish and appraisal companies, and we've got this platform and we've had over 21,000 downloads of this education program over the last six to nine months. But we've made it free because my mission really would be for women to empower themselves wherever they are in the globe for healthcare professionals to have the right knowledge that is evidence-based. And then the dots can be joined and then I can just go and lie in a dark room. You know, it'd be lovely wouldn't it? 

[00:22:44] Jonathan Wolf: Your job will be done. I feel you'll be campaigning on this topic for a long time Louise. So just before we move off this, we, one of the questions we ask a lot of our members on social media this week, and there were loads of questions on this topic, but one of them was I think directly into this, you're talking about hormones, replacing the natural hormones you have. Uh, but one of the questions was what's the accurate tests that can tell me if I'm in peri-menopause because you described menopause as, Hey, it's a year after this stop. So that's quite a funny sort of diagnosis.

Isn't it? It's like waiting for a year. It's already happened generally in medicine. We like, and I think this is something we believe a lot in ZOE, right? Like sort of preventative health. How do you understand early? So how do our listeners test for themselves and understand where they are and what you described as quite a long sort of slow transition?

[00:23:30] Dr. Louise Newson: You know, what, wouldn't it be lovely if I could say there was a test and there isn't, and it's really important to say that there isn't because even in the UK figures from about four years ago showed that 9.2 million pounds are wasted on inappropriate hormone testing. Now my clinic is private because I can't get a job in the NHS. After all, there aren't enough NHS menopause clinics.

If someone gave me 9.2 million pounds, I tell you I could do some really good clinical medicine with that. So we know that the human blood tests aren't reliable for the simple fact is that I've already explained when your perimenopausal hormone levels fluctuate. So if I was perimenopausal and I went to my doctor or nurse and had a blood test at three in the afternoon. I probably would feel not so bad. And my hormones levels will probably be okay if at two in the morning, I wake up drenched with sweat, having a night, sweat, palpitations, intrusive thoughts, crippling anxiety. I can pretty much tell you my blood tests will be low.

No, one's going to take a blood test at two in the morning. And so that's why they're very unreliable. So there are lots of women who are told it can't be your hormones. Cause your hormone blood test is normal. Well, at that time, you know, it's like looking out the window when it's raining and then 23 hours out of the day, it's sunny. And you say to me, what was the weather like? And I say, it's raining. I said, don't be ridiculous. It's sunny. 

[00:24:53] Jonathan Wolf: Interesting. Cause we see the same thing with a lot of metabolic tests that we do. So, you know, people historically measure all the things like blood sugar and blood fasted… 

[00:25:02] Dr. Louise Newson: Well, is the same, isn't it.

And so, you know, when I was a medical student, I did a lot of diabetes work, you know, You would diagnose diabetes, wouldn't you by fasting? Well, sometimes you do random blood sugar. That's completely useless if someone's just had McDonald's of course they're going to have. And so then we did fasting. That was a bit more out there.

And then we did the glucose tolerance tests. We had to bring people in as an inpatient out. It's just ridiculous. And then HBA one C came out. So this is your average as you know, average sugar. Oh, brilliant. That was pivotal actually. And so what we want to do, what I would love to do is can we have a test to show everyone's so focused on is estrogen being bad and let's delay the menopause, let's delay treatment to people are bad because estrogen and hormones are so dangerous. Well, they're not. We know from studies that the earlier women take hormone replacement therapy or menopausal hormonal treatment, the better. So let's start it in perimenopause. Let's not wait until these women have given up their jobs and they're struggling.

Let's do it early, but how do we find these women? So actually let's look back into common sense medicine. Let's see what's happening in the body. So rather than relying on symptoms, and I've already said, a lot of women don't get symptoms or symptoms that they recognize. It's been related to the low hormones.

Let's see what's going on. So we know these inflammatory processes start quite early because estrogen works very well on every cell, but especially our cells that work for inflammation. So if we think of all those cells are monocytes or macrophages or our white cells. They're very good at fighting infection. That's what we need.

Aren't they, if you have a virus, it will eat them off and sometimes about antibodies, but we know, especially macrophages, if they're switched on wrong, they become pro-inflammatory. And if there is Pro inflammation in the body, then it increases the risk of disease. We know that for diabetes and heart disease and dementia and osteoporosis.

Oh, isn't that a coincidence? All the diseases I've mentioned are related to low estrogen. And we've got some really good work. Some of it's from the eighties. So before the WHI came out, looking how estrogen is an anti-inflammatory, it's an immune modulator. Genetically reprograms the white cells. It changes the number.

It changes the function. It changes the way the cytokines work. It's really powerful actually. And so when they are in the paramedicals, these hormone levels start reducing these pro-inflammatory effects start working. So what we need to do, I think is develop a test where we're looking at this biological aging.

So not just aging with a bit of gray hair, actually internal aging of the body, this inflammation that goes on, and this is some of the work that we're starting to do and starting to get some results. I know myself, you start to feel a bit rubbish, but you've got like, I've got three children. I was setting up my website.

I was opening my clinic. Of course, I'm going to be tired. Of course. I'm going to be. Forgetting things. So how do you know?

[00:28:10] Jonathan Wolf: Hard to tell whether these symptoms are related to menopause or whether they're related to the fact, this is tending to hit you in your forties, which is, we all know, even for men, right?

A particularly tough time with aging parents, often children work all these things together. 

[00:28:25] Dr. Louise Newson: Absolutely. And so most women, even those women who say they have no symptoms, once they start on some HRT or MHT then they come back and go wow God, it's the best. I felt for ages. And I know personally, I had my third daughter when I was 40.

I started HRT when I was 45. I felt after a couple of years when I got the right dose and type, I felt the best I've felt for about 10 years. So I wish I'd started it earlier, but of course, I didn't know, did I? Just thought it was having the third child that broke the back of me. So. If I had done some biological thing because I started to notice that I was putting on a bit of weight in the midline and I've always been quite slim and I, I, but I couldn't be bothered to do yoga.

I just, everything was an effort. I knew I wasn't sleeping well and had poor sleep. We know increases weight. So I still didn't pick up these subtle signs. Whereas if I had been doing a test, like looking at inflammation and then all my biological age, and it had been the same for the last three or four years, and then suddenly jumped up, that would be a warning sign and it might not be diagnosing perimenopause or menopause, but it would be a wake up calling it's a bit like doing your blood pressure. Isn't it? Every time you go to the doctor to a clinic, suddenly it goes up and you think, right, well, what can I do? I don't want to take drugs. I want to think about it, is it my lifestyle? Is it cause I started smoking or drinking or not exercising.

And that's what we do with blood pressure. That's what we do with, even with diabetes type two diabetes. We'll think about lifestyle. Well, actually with perimenopause, we cause we have to think about lifestyle, but we also have to think about our hormones as well, but we need this. Biological sort of marker.

And that's what I think would be interesting. And then it helps with my whole thing about thinking of menopause as a female hormone deficiency with health risks, not about, oh, let's just stop this poor lady having 20 hot flushes and you know, make a bit, a bit more comfortable giving her a fan.

Let's work out what's going on, biologically in the body and help prevent disease. 

[00:30:29] Jonathan Wolf: Part of the reason that we first got to meet you, Louise. Right. We suddenly woke up and Sarah Berry, our chief scientists sort of realized we've got the biggest in-depth study of nutrition and menopause in the world with all of this information about the microbiome and metabolic responses.

And actually this has hardly been studied. Shockingly already that first study with a thousand people was like 10 times larger than anything that we had done that anyone had done. And now we are, you know, sort of 20 times bigger than that. And I think what's interesting is that we have seen this first paper that you are north run, which will be coming out shortly.

These profound changes in biological responses in the period around menopause. Some of which we see very much, you know, just within the 12 months around menopause. Right. But also we see these big changes and maybe sort of the five years on either side. And so I think what people have said a lot, right?

Which is, I feel like my body has changed. You can measure this, right? We can see that your blood sugar suddenly has completely different in terms of your responses to food that your blood fat is suddenly completely different, that your inflammatory markers are up and interesting that your microbiome, right.

These gut bacteria are, we're also seeing these big changes. We are early in this journey of understanding how to piece all of that together, but we can already see. And I guess this is a way to talk a bit about nutrition, which is something we always like to talk about here. But if your responses are changing dramatically, then clearly, how you should be thinking about what you should eat is also got to change.

So maybe on that topic, Louise, you know, we talked a lot about hormones, but I know the other question for listeners. And I think maybe it's talking about food and others is what else can you do? Do you have these symptoms? You can take these hormones. What else can you do when you're going through these really sort of profound physiological changes?

[00:32:08] Dr. Louise Newson: Yeah, it's really important. So whether someone takes hormone replacement or not, they still have to think about their food, but there's also a lot of talks out there that you can help your menopause, or you can get through the menopause with a certain diet, a certain supplement, a certain this phytoestrogens always come up because they contain some estrogen.

Do you know what you'd have to eat so much to stimulate your estrogen receptors properly? And so any supplements that are labeled menopause, I would just put in the bin, or I wouldn't even buy and waste my money on them. Or any sort of specific foods. You have to think about what you're doing.

And I think. Yes, there is some work to show that not eating processed foods, not eating spicy foods, not drinking alcohol, reducing caffeine can improve symptoms, but I've already said the medical is not just about symptoms. So we're kidding ourselves as women. If we think that our future health is going to make a big difference if it's just about diet.

Absolutely. You know, I already said I take MHT or HRT, but what would be the point of me eating McDonald's and smoking 20 a day? It would just be stupid. Wouldn't it? So we have to take responsibility for what we eat as well. But I say it with a bit of caution because I also know when women have low estradiol levels, they often get sugar cravings.

They often comfort eat because they're feeling bad as well. And then metabolic processes. Again, we haven't got good studies about this, but slow down. So they're going to put on weight more easily. We also know that fat cells or adipocytes produce quite a toxic type of estrogen. It’s a pro-inflammatory estrogen.

But that's all the body's got, if it needs estrogen so, people will lay down more fat and increase their weight without changing their lifestyle, especially in the midline, because their body's saying, give me some estrogen. And so these poor women then often feel like failures and they're feeling bad anyway, because of the psychological impact of low hormones.

So it's this downward spiral for a lot of people. And a lot of women listening might acknowledge that even if they're getting regular periods because we've most women experienced some sort of dip in their hormones just before their periods. And that's often when they're craving sweets or sugars or whatever.

Um, but it's only a day or two a month. So people often just ignore these signals from their brain or succumb, but it's only short-term, but that all the time is having an effect. So. It's difficult actually, but certainly, most women can take HRT. We're just writing up some work actually for the counselor journal, which will be out soon.

And I've written about vagina estrogen. You know, I've already said from vaginal dryness, how safe it is for women, who've had breast cancer. And I've run blooming. An oncologist in America is looking at a review of studies of giving hormones to women. Who've had breast cancer and 24 out of 25 studies have not shown a detrimental effect.

So this is going to be important. So I would hate people here listening to think, but that's fine, but I can't take HRT or MHT most people can, but we need to look at diet as well. And if women are not able to receive the right treatment or they're struggling to see the right clinician, then they should be looking at diet.

And you're right. Thinking about insulin is evil. If we get too many peaks and so looking at this sort of process food, those fast food, those sugar hits. Yeah. It's bad for us in our system, metabolically as well. And if we've got a metabolic insult, IE, perimenopause, or menopause, don't throw more metabolic insults at your body.

So looking at foods, looking at the glycemic index of foods, looking at the whole range of foods, so that we're feeding our gut microbes as well, and adding things to our diet, even if it's just adding a handful of seeds to a salad. Or trying a new vegetable that's hopefully in season, that's going to be good for your gut health as well.

And so the last thing I would want, and I see it a lot is that women restrict their diets because they're so scared of putting on weight. So they come and say to me, oh Jesus, I'm putting on weight, but I'm now not having breakfast. I'm just having a cheese sandwich at lunchtime and I'm having low-fat something rubbish...

[00:36:32] Jonathan Wolf: Given up gluten and I've given up lactose and I've given up all these other things.

[00:36:36] Dr. Louise Newson: Yeah. Precisely. And I don't have any fat in my diet. So the brain fog is, even worse than ever. And so it's like, no, you've got to feed these microphones and we worked with Emma Ellis, Flint. Who's an amazing nutritionist and a chef. Yeah. She's one of our balances gurus and if any of you watch the way she cooks, it's so exciting.

You can smell that food coming from the video. You know, she, and its food, we all need to eat. Don't we, we can choose whether we drink alcohol or exercise or smoke, but we have to eat, but it should be a real pleasure. I love my food, but I'm really careful about what I eat. And I know that if I just went off now and had a packet of crisps and a Mars bar, well, firstly, I'll get a migraine, so I can't do it because I can't function without a migraine. But secondly, I might still be fine for 10 minutes when my sugar level changes, am I incident or, and then suddenly I will just burn and that's what's happening all the time. We're giving ourselves these insults, we're having these juices or these low-fat sugar drinks or whatever.

And it's a car crash, isn't it? For our gut microbes and metabolically. 

[00:37:43] Jonathan Wolf: Right. And I think what is interesting, I think what is new with some of the research that we've been working on and that ZOE has been published and otherwise is how we see these profound changes in people's responses to food as they age.

And so I think what is interesting, um, we see this huge personal variation. Um, but we can also talk about, you know, in general differences between men and women, because there are big average differences. And I think one of the things that are really striking is that on average women in their twenties and thirties can eat much larger quantities of food.

That's high in fat or high in sugar before having these inflammatory responses on average. And we see these huge variations. And then what we see in this paper, that's been coming out shortly that you were involved in, right? It's this profound change sort of during your forties, where at the start of this, you've probably had this food that you've been eating for 20 years and it's been causing no problem. And you haven't put on any weight and you feel good. And then suddenly you're 50 and you look at, and you say, well, yeah, I'm not surprised that you're now having problems. Because if you look at the amounts of blood sugar impact, that's happening, if you look at the amount of blood fat Well, now you're not managing to clear that, right?

It's still there after six hours, you're having these inflammatory responses. And so this idea that your body has changed, you know, it's not just in your mind. It's real. And I think the positive news is that it doesn't mean there's nothing you can do about it, but it does mean that probably essential if you've sort of been able to get away potentially with eating these foods, that was fine.

And now some things don’t mean you can never eat them, but you've got to think more about, well, if these are treats, how do I sort of feed myself around it and how do I support those, those gut microbes, right. To try and, um, you know, generally reduce this inflammation. I think that's exciting. And one of the things that, you know, we're looking to get much deeper into with you and some of these other experts on menopause. 

[00:39:31] Dr. Louise Newson: It's very interesting. I mean, I've talked to us about estrogen, but also, I don't know if you know this Jonathan, but women produce three times more testosterone than estrogen.

And so testosterone is a female hormone, as well as a male hormone. It's produced by the ovaries, whether it's a menopause decline or an age decline, there's a bit of a debate, but it doesn't matter. It gets lower as we get older. And so testosterone again, we have receptors all over our bodies in our brains. So have low testosterone, often find they have brain fog.

They have memory problems, reduced stamina. It's also very important for muscle. So muscle mass can reduce because of stamina and must reduce. That can be a real problem with exercise, but we do see a lot of women who once they start estrogen, especially when it's given through the skin as a patch, gentle spray, the weight starts to reduce this midlines red reduces.

And then when they have testosterone that body shape, rather than the actual weight changes as well, um, whether that's because they're exercising easier and better and more effectively, I think that is partly to play. But I think also there are metabolic changes. We don't know enough about it. Testosterone and women, this is research testosterone in men, but obviously, they have higher doses.

What I'd love to do is more research on that. And we have a DEXA scan here in the clinic looking at bone density, but it also can do body composition. And so I'm interested in looking at visceral fat and how that changes with estrogen and testosterone. Because I think if we got some good studies we would show both of these hormones, probably independently have an effect on our visceral fat, which is, you know, as a marker for cardiovascular disease. And metabolic disease. 

We actually 

[00:41:10] Jonathan Wolf: had a lot of questions about body shape change. So, and what you're saying is this is real? 

[00:41:13] Dr. Louise Newson: Yes. You know, it's real, but there isn't any evidence. So there's a lot of these people who only believe in randomized controlled studies say, but there's no evidence. Well, you know, I've seen thousands of women. And so I have some real lived-in experience actually of this. And you have to learn from patients, you know, it's very good. We have to have evidence as well, we have to have studies, but if we only looked at randomized controlled studies, we wouldn't have penicillin. Would we? 

[00:41:40] Jonathan Wolf: And also you have to do the studies, right, Louise? I mean, I think one of the things that's striking is how little science has been done on women compared to men is one of the things that are, I think been shocking for me as I've got into this over the last five years.

If I try and playback a little bit of what we've just covered today, I think we started by saying. Menopause is interestingly defined as something that's stopped 12 months earlier. And, if we want to understand what's going on, we have to think about this peri-menopause, which is very variable between women, that no test allows you to understand that you're already in this.

And so a single hormone test, for example, you know, if it said that your hormones are fine, you're dubious because it could well be that it's just the point in the day and that we need to develop a better test to understand this, that. Hormones replacement is now viewed through global guidelines, as well as the guidelines you described in the UK as the right solution for many women, and there's been a lot of debate about this impact, particularly to do with breast cancer.

And that your strong view is that when you look against the benefits that you get, including things that are affecting health and death rates, as well as just your quality of life. You are a strong campaigner for the ability to take these hormones that as you say, all women have in their bodies all the time until this and this point and that this is sort of transformational and that there are shockingly low levels of this you described even between the US and the UK, right?

I think you said between 4 and 14%, is that right? So that itself is interesting, right? That you can have two countries. Did we very shared views about the health system and such a big variation. And then I think we talked a bit about nutrition and the way that this does not replace this question around hormone replacement, but is incredibly important.

In addition, and the way, there is the sort of profound changes in the way that women's bodies metabolize food through this period. And so it is true that you know, your body is different from before some of these things, people are feeling like body shape changes are real, and that therefore understanding like what's right to eat.

Now, which is different from before is important. And then I think we just wrapped up by saying, it's sort of amazing how little this has been studied, how much opportunity there is, therefore to understand all of this better. And, um, you know, I know I speak on the ZOE side, this has become one of the things we're most interested in because it's just such an enormous impact on our members. And there's been so little investigation. So we hope to have you back again in the future and to talk about some of the further studies and the guidance that, that comes out of this. 

[00:44:14] Dr. Louise Newson: Thanks ever so much for inviting me today. 

[00:44:16] Jonathan Wolf: It was a real pleasure, Louise.

Thank you so much. I think that it's amazing to hear your sort of personal champion of this. And I think for many people listening, whether it's affecting themselves or affecting people that they love, I think it's a really powerful message. So thank you so much. 

[00:44:30] Dr. Louise Newson: Thank you. 

[00:44:31] Jonathan Wolf: Thank to Louise Newsome for joining me on ZOE science and nutrition.

We hope you enjoy today's episode. If you did, please be sure to leave us a review and subscribe. If you're interested in learning more about ZOE and the best foods for your body and what to do during menopause, you can head to join ZOE.com/podcast and get 10% off your personalized nutrition program.

Finally, if this episode left you with questions, please contact ZOE on Instagram or Facebook, and we will try to answer them in a future episode. As always. I'm your host, Jonathan Wolf, ZOE science and nutrition is produced by Fascinate Productions with support from Sharon Feder here at ZOE. See you next time.