MNHQ here: AMA with hormone specialist and leading voice in transforming hormone healthcare worldwide Dr Louise Newson

[RhiannonEMumsnet]

Hi there,

We’re delighted to announce an AMA with GP, hormone specialist and leading voice in transforming hormone healthcare worldwide Dr Louise Newson on Wednesday 3rd June, 7-9pm.

Dr Louise is an award-winning physician, educator, podcaster and author, committed to increasing awareness of hormone health including perimenopause and menopause, PMS and PMDD. She is also founder of the free Balance hormones and menopause app.

Dr Louise is currently in the midst of a nationwide live tour Breaking the Cycle: The Power of Hormones, where she unpacks the history of hormones and reveals how decades of misinformation and medical misogyny have harmed the health of women – a topic also covered in her new Sunday Times Bestselling book, The Power of Hormones.

Please post your questions for Dr Louise below and join her on the thread on Wednesday evening to hear the answers.

As always, please remember our guidelines - one question per user, follow-ups only if there’s time and most questions have been answered, and please keep it civil.

Thanks,
MNHQ

Hi Dr. Louise, thank you for doing an AMA.
I’m 49 and post-menopausal. Uterine lining was 2mm at a TVS in January. I’m on 2 pumps oestrogel, 100mcg utrogestron vagnally and vagifem daily. All this was fine, except it’s aggravated my endometriosis, but lately I’ve had a vague, rusty kind of discharge frequently (since about a month or two after a hysteroscopy), and a 5 day episode of brown discharge preceded by PMT. My last proper period was over a year ago . I started regular continuous HRT last June. I have had a hysteroscopy, biopsy, TVS, pelvic US, smear, and swabs and all are fine. The GP suggested changing to maybe a combined patch. I can’t tolerate an IUD or oral progesterone. What would your suggestion be for a potential change in HRT if at all? Thank you.

I’m 56 and had my last period 5 years ago. I’m lucky enough to have no menopause symptoms. Occasionally I feel hot but I don’t get flashes. Should I go onto HRT? For the health benefits rather than alleviating symptoms?

I’ve been on 3 pumps and 2 progesterone capsules for 14 days of my cycle for a long time. It used to be that my periods would start pretty much the day after I stopped taking the capsules. Recently, however, my periods have become more erratic (and shorter cycle) and I’ve also found that I go through days of feeling deeply depressed (but not on the days I’m on progesterone). I was told to keep taking the progesterone at the same intervals, regardless of when my periods are. Is that really the case?

if I’ve been doing the right thing but now entering a new phase as suggested by the “depression days”, what does it mean for my prescription? Do I need more or less of either progesterone or oestrogen? I’m lucky to have avoided things like hot flashes so far but those low days are utterly debilitating.

I'm 44, still having natural periods. In January 26, I was put on Everol 50 patches and oral progesterone 100mg on days 15-28 of my cycle. I still seem to be bleeding in line with my natural cycle (22-24 days) and not having the progesterone withdrawal bleed. Is this ok? I feel better in my mood when I have progesterone in my system

Is taking hrt after endometrial cancer a no-no? My oncologist advised me not to go back on hrt after my treatment. Tbh, my post menopausal symptoms are now ok, but I do worry about osteoporosis, as there is a family history of it.

Edited to say, I have increased my calcium intake and now do daily weight training.

Hi Dr Louise,

Thank you so much for your podcast and book. They have both been invaluable resources of information to help me navigate perimenopause and menopause.

I’m on oestrogen patches and they have changed my life so much for the better. I want to keep taking oestrogen forever (!) but can’t imagine me as an 80 year old woman still putting the patches on. Is this something that happens? Will I have to go through the full gamut of menopause symptoms as an octogenarian? Will my GP still be happy to prescribe HRT when I’m an older adult?

Hi, I've recently discovered Dr Louise and her app. I am 40 and have had peri symptoms for about 2yrs. I am really struggling with tiredness, muscle fatigue and brain fog. GP is reluctant to offer HRT due to breast cancer risks and because I am young. GP has suggested Sertraline to help with mood symptoms but I rely need something to help with the constant exhaustion. Is there anything you suggest?

I am 46 and have been taking HRT for 4 years mainly due to low bone density. I have struggled with the progesterone causing reflux and have tried utrogestan both vaginally and orally, dydrogesterone and mirena coil. I decided to take a short break from hrt and have been feeling largely better (my rhr dropped and hrv and sleep improved since stopping) although it has only been 3 weeks so symptoms may still emerge. I am getting headaches but hoping these ckear as my hormones settle.

I think I would like to go back on hrt to protect my bones but am thinking a very low dose might be best. If I say take 25mg would this be sufficient for bone support and could I pair it with a lower dose of utrogestan than the standard 200mg 12 days a month? It seems odd that the utrogestan dose is never prescribed in proportion to the oestrogen dose.

Hi Dr Louise

I’m 55 and been on letrozole for 3 years following breast cancer.
My scalp is dry and flaky and when it flares up it itches like mad.
Is this the letrozole?

Hi Dr Louise, In many countries women have access to a Gynecologist as they would a GP in the UK. The gynecologist does a yearly exam and is seen during pregnancy and post natal and deals with contraception etc.
Why don’t we have this model in the Uk? Are there historical reasons for this?

Hi, I have struggled with my hormones all my life (I'm 44). I have had 5 rounds of IVF (last 4 years ago) and have three children. I have significant PMDD (medicated with sertraline and pregabalin) and this has been from my teenage years. It has now been suggested that some of my symptoms are caused/exacerbated by MCAS (I am also hyper mobile, which I think has contributed to this thinking). I am currently failing at the elimination diet to test that.

I have tried everything: diet, HRT, supplements, Nettle device, and yet again a week before my period I am struggling not to blow my life up. I'm exhausted, and I don't know what to do. Any suggestions? Thank you.

I hope it’s ok to ask 2 questions. I forgot to mention that when I try to take the progesterone capsules on an empty stomach, I feel woozy and like I’m going to pass out. So I’ve been taking it before bed, and sometimes that means it’s not on an empty stomach. Could that explain my issues?

Lastly - I’m still sleeping badly - waking up twice a night and sometimes struggling to get back to sleep. As a result I feel constantly exhausted. I sleep better when I take the capsules. Is it indication I should take more, or…?

Better sleep would be such an improvement! I long for the days when I might wake up feeling rested.

Hi Dr Louise, im 38 and 10 months post partum with first and only baby. Im still breastfeeding although not loads, and my period returned at 4 months post partum.

During the first 2 days of my period, my mental health plummets, sometimes I cant get out of bed, im planning my divorce and escape from the house (which i dont plan otherwise and am happy when not pms'ing) and really struggle to work. Is this normal and am I expected to just deal with it? It wasnt this bad before pregnancy. My skin has also been horrible since 1 week post partum although eased off around the 8 month mark.

Hi Dr Louise
I recently noticed that nice had approved Fezolinetant as a non hormonal alternative to hrt. I am 59 and had oestrogen and progesterone driven breast cancer in 2019 with a lumpectomy followed by a dual oophorectomy in 2020. Since 2021 I have had abdominal pain which various pain consultants have diagnosed as anterior cutaneous nerve entrapment syndrome (ACNES), following the 2021 laparoscopy. I have had multiple nerve blocks, electricity has been driven down the nerve, etc. etc. to no effect, and Guys has now discharged me from their pain clinic as there is nothing more they can do. I am back on the gynaecologist waiting list for a full hysterectomy as a last resort in the hope they can patch up the adhesions while they're at it. Plus I have a 46 year history of endometriosis and have now discovered that endometriosis can continue post menopause.
Anyway after that ridiculously long history, I have been taking venlefaxine for anxiety for about 3 years, as one gynaecologist recommended that it would cause less sweating than sertraline. In fact the sweating with venlefaxine is much worse and combined with the menopause is horrendous. Venlefaxine apparently is useful for nerve pain however, and despite trying 3x to switch back to sertraline, the pain breakthrough is too much. Have also tried duloxetine which is little different to venlefaxine.
I have asked my GP about fezolinetant but it is so newly approved by Nice that she has referred the question to the gynacology department and I haven't heard back. My question would be, will fezolinetant start the endometriosis off again, while I'm waiting (about a year apparently) for the hysterectomy, and can I be prescribed it with my breast cancer history? Will it be effective for venlefaxine driven sweating as well as standard menopause hot sweats?

Sorry for such a long and involved question and thanks in advance for any help you can offer.

Jacky

Have you come across patients with oestrogen intolerance ie it makes their symptoms worse?

Hi Louise,

Thank you for everything you do I have learnt a huge amount from following you over the last couple of years.

My question is about managing PCOS and PMS in a 15 year old girl. She’s tried several different contraceptive pills, Dianette helped her acne loads but it gave her awful low mood and anxiety so she had to come of it. Yasmin didn’t really help her acne and gave her low mood, Microgynon made her acne worse and also gave her low mood.

We’re certain that trying pill after pill is not the answer! But what is the alternative? The GP just keeps offering different contraceptive pills (she’s not sexually active it’s purely for her acne and to give her a bleed)

We just feel so stuck, is there anything else we can do / try please?

Hi Dr Louise. I take daily hormones (combined pill and a high dose of Norethisterone) due to thoracic endometriosis, will this mask or amplify perimenopause, or not affect it? Thanks

Hi Louise, is there evidence that testosterone supplementation can help with muscle and joint aches? I am 52 and on HRT for 5 years - currently 3 pumps gel and 1 Gepretix every night. I have started to have painful joints and nothing shows up on blood tests. I wondered about either more gel (but concerned about womb lining) or testosterone, any advice?

Edited to add that I do not get along very well with progesterone!

I breezed through perimenopause, but as soon as I was in menopause it was hell! Dizzy, low blood pressure, had to start eating every 3/4 hours, lost weight, low energy, raging anxiety!
6 months later and I started Estradot Conti 30/95.
After only 5 days i feel so much better!
I have been to my Gp several times, of course he prescribed sertraline which I didn’t want and had to go private in the end. To this day he still hasn’t prescribed HRT for me via the NHS.
Mainly as I had a scan showing 9mm womb lining and a few v small fibroids.
I paid for a private scan showing smaller fibroids and 4.2mm lining, and very much retired ovaries.
Can more be done to help women through this very daunting and scary time of life? I really feel for people who can’t go private.
thank you for highlighting and advocating for womens health .

Hello Dr Newson
Can women in their 70s, who have never been on HRT (because GPs were refusing to prescribe after the medical paper that reported it was harmful to women was out) start on it now to prevent the many health conditions that female hormones are known to protect against?
Thank you.