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

I have only tried estring so far for urinary symptoms with no systemic hrt, but am getting daily spotting (only had it for three months, menopausal for 2 years). GP not concerned yet as ultrasound before I started (for other reasons) showed normal endometrium. At what point should I be concerned - and would something like mirena help and/or be necessary or useful in order to continue with estring or add hrt patches? No need for contraception. (I would like to continue with estring as I prefer a fit-and-forget type of solution rather than something I need to do daily). And would this bleeding need to be sorted first before I could start anything else (like an additional cream for external dryness, or systemic hrt for hot flushes)

also do you know of any research that suggests estring can be used beyond two years? The medicine guidelines say no longer than two years, but as far as I can tell, this is only because no research has tested it longer than that, rather than anyone thinking that there are any likely issues with using it longer. But my GP is very much a guideline follower, not very familiar with estring (was recommended by a different doctor) and will not prescribe longer than it says, unless new research/guidelines come out.

Thank you so much for your talks, I have learned a lot from you. I am 35 years old, in peri, and I started the estradiol 0.075 mg patch almost 2 weeks ago. I feel great but once starting the second half of my luteal phase my sleep began to suffer again. I will start progesterone soon, but should I increase my estradiol the week before my period? Also does caffeine effect our hormones?

What is your opinion on the fat in dairy? Is it better to have non fat, skim or full fat dairy and does it effect our hormones? I read very contradictory information on the health risks.

Does a genetic predisposition to oestrogen receptive cancers affect the type of HRT I should have? Should I be taking it at all?

Good evening Louise,
I am a 55 year old generally fit and healthy woman who is 12 days post-op for a total abdominal hysterectomy retaining ovaries. Prior to this (large fibroid and adenomysosis) I was taking HRT for 3 years - Lenzetto spray and Utrogestan progesterone. My surgeon has said that I can resume taking HRT 4 weeks after surgery but my concern is oestrogen dominance. I am guessing my HRT will need to be reassessed before starting it again but really want to get the dosage right without guesswork. Any advice please ? I understand testosterone is not available unless ovaries are removed so may need to go privately ??
Many thanks x

I seem to be intolerant to progesterone and progestogen. Tried utrogestan orally, vaginal, cyclical and continuous. Mirena awful and Slynd made me wired but tired. What else can I try? I’m 44

Thanks @Pinklightning - great your restuls were normal
We find in our Newson Health clinic many women's bleeding settles completely with Cyclogest pessaries which is a progseterone pessary
A combine patch contains syntethtic hormones

Have you tried Cylogest? Also some women tolerate progesterone more when their other hormones progesterone and testosterone are balanced
More information about progesterone and progesterone intolerance on my Balance app - https://balance-app.com/

Estring will only help with localised symptoms and contains a type of estrogen. Often prasterone (vaginal DHEA) is more effective. There are many reasons for bleeding so would be good to get checked. There are also benefits from systemic hormones. Estring can be used longer than 2 years - all vaginal hormones can be used in the long term as they are low dose and safe

It is still early days but you may find adding the progesterone is beneficial. It would be worth seeing a doctor who is experienced at individualising doses of hormones if you do not feel better after 2-3 months. Also testosterone may be beneficial. You may find this article useful - What to expect when you start HRT https://link.balance-app.com/content/iqDPlMQEh12ym7JiRgbVIB

Hi Louise, I had a troublesome fibroid partially removed abd at the same time my mirena coil was removed and I was told to stop my estrogen pump as it was growing the fibroid.

Is there any options to help with perimenopause symptoms in this instance.
Thank you

Thank you - many women continue to take hormones for ever. There are many health benefits including improving bone strength and reducing future risk of osteoporosis. I have written a lot about this in my new book The Power of Hormones https://bio.to/ThePowerofHormones?mc_cid=50db8125f1&mc_eid=9520600d61

Natural body identical hormones can still be taken if you have fibroids - there is information on Balance app and I have done a podcast about this. There is no reason to stop your oestrogen if you have a fibroid

It is always better to have natural, body identical hormones which are the same structure as our own hormones. Women with a genetic predisposition can still take hormone treatments and they are beneficial both for symptoms and future health. Also oestrogen is associated with a lower risk of breast cancer. The risk of cancers is with synthetic hormones that are in older types of HRT and also in all "hormonal" contraceptives.

Hi Dr Newson , i have been presxribed utrogestan continouosly depsite im in peri becaus on going bleeding , but when i take it beofre bed it make me awake hour or twonkater why is that ? If i take if during the dau i sleep better . Had appoitment at your clinic and it was the best !

I want to know this too!

You can still take HRT straight after any surgery if it is body identical as it is not associated with a risk of clot. Testosterone is available on NHS in some areas and can be prescribed to women who have their ovaries too.
These may be useful to you
Testosterone in women Balance+ live: https://link.balance-app.com/content/DOeP2C7Hmj0TTerQDEPBUX
Refused testosterone? How to navigate ‘no’ (Balance+) https://link.balance-app.com/series/TlluIszWg348suZqnwMxP1
Prescribing testosterone Balance+ live: https://link.balance-app.com/content/hIixU8KOBQBPcnKJ4UmCx8

Many women take progesterone each day which is better for them, also it may be worth you having your oestradiol levels undertaken to determine if you are on the right dose for you. Testosterone can also improve mood and other symptoms.

Yes but many women change to continuous progesterone (one each evening) after 6-12 months of taking cyclical progesterone

There is no evidence of risk of recurrence of cancer if women take hormone treatments after endometrial cancer. There are risks of not having hormones to your future health. I would suggest seeing a doctor who understands hormones and individualised care. Your oncologist is ignoring the evidence

See a different doctor - this is wrong advice. There is no cancer risk with body identical hormones. Being prescribed the right dose and types of hormones - progesterone, estradiol and testosterone - are likely to improve both your symptoms and your future health. Sertraline is associated with risks of addiction, osteoporosis, bleeding, dementia and earlier death - so I would ask your GP why she is happy to prescribed that medication to you?

the balance of all 3 hormones - including testosterone - is really important. It may be worth having your testosterone level undertaken and speak to a doctor who understands hormones and the balance of all 3

Hi, i'm 35 and I'm pretty sure I'm entering peri. Is there anything I can be doing to help, in particular with brain fog? Natural if possible...

Good evening Dr Newson. I’m convinced progesterone is causing ligament laxity in my body. I’m not sure where to turn for help. It’s a problem with my neck that a neurosurgeon has said is psychosomatic. I’ve recently connected the times it has worsened to changes in my progesterone dose ( sequential to continuous then the dose was doubled). I can see from research that this is a known problem but there does not seem to be a solution. I cannot discontinue HRT as I would be debilitated without it.

@IAMFLUFF Sorry to read this. Letrozole blocks oestrogen and hormones in the body so these are common side effects - it would be worth you talking to your oncologist about alternatives to this drug or some women benefit from taking testosterone with letrozole which has been shown to improve prognosis too after breast cancer. We have a lot of articles and videos for women who have had breast cancer on the Balance+ section of the Balance app - Breast cancer: your complete guide (Balance+): https://link.balance-app.com/series/VhQ4BkYVuKRnspScelsfXu