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Micro wisdom delivered to your ears every morning in voice notes ranging from 3 to 15 minutes long. Wisdom on how to live a healthier and more fulfilling life. Every podcast will ground you in the present moment to ensure you know what's important, the here and now.
So I'm not sure if any of you came to the first talk, but this is like the second one we decided to do on hormones and hormones through the ages. So for those of you that don't know me, but I'm guessing you came to the first one, I'm Doctor. Aranya. So I'm a GP with a specialist interest in hormone replacement therapy. So that kind of spans from anything from young, what I still see children, but kind of over 18, any hormone problems through the ages.
Speaker 1:So I thought it would be a good idea to do a talk on hormones because it's such an important topic, but also, you know, it expands such a long lifetime. And I think there's so much mixed information out there on social media. It sometimes can be a bit overwhelming cause there's so much. Like I tell my patients, perimenopause is the new menopause. Because that is all over my Instagram now.
Speaker 1:It's like menopause was very 2024, 2025. The fashion seems to be peri and that's all I seem to get things on. So my kind of basis, I work as a GP and I do kind of quite a comprehensive approach to hormones. So it's not just a case of putting people on HRT and then sending them on their way. I try and cover the whole aspect of nutrition and exercise and all of those things, so to give you a much more holistic approach.
Speaker 1:So I'm going to try and do that in this talk. Now I'm going to share my screen because I like doing slides only because I'm visual. If So somebody were to talk at me for an hour, I would probably leave and not remember anything. So I'll talk and do slides. So I'm going to share my screen, Jebki, if that's okay.
Speaker 1:Because I'm not tech savvy, I was practicing this with my medical admin, and I'm hoping this is going to work. So tell me if you can see can everyone see the slides? Are we good?
Speaker 2:Yes, we're good.
Speaker 1:Perfect. So I'm going to run through these and I'm going to try and leave a lot of time for questions at the end because that seems to be the most common thing that people have. And I'm going to put a few case studies and things inside there. So what I thought I'd talk about is hormone health in general, and I'm kind of going to go through the decade. So it's a lot to cover.
Speaker 1:So I'm sorry if I talk quite fast, but an hour is not a lot to cover women's hormones through their entire lifespan. But let's give it a go. So what we're going to talk about, I'm going give you a bit of a basis of what hormones are, because I think that's a real key thing to also then understand what's going on in your body if you actually know what the key hormones are and what they do. So it's going be a little bit of biology at the beginning. And then I'm going to go through the stages.
Speaker 1:So really just clarify for you guys what premenopause is, what perimenopause is, what menopause is, when it happens. Then I'm going to talk about PMOS, which was formerly PCOS for those of you that weren't sure of the change, and then a bit on endometriosis again. And then we've got some case studies thrown in there so you can just see examples of what I do. So what are hormones? So they're really powerful chemical messengers in the body and they basically govern pretty much every function your body does, from how hungry you are to how irritable or moody or sad or happy you get, down to your metabolism, down to your energy, what your weight is, how fast you burn weight, your milk and hair production, your immune system, so your hormones have such an impact on your immune system as well, how your cells grow, your detox pathways, everything, sleep, mood, pretty much anything, you name it, it is related.
Speaker 1:It can be related to your hormones. So the key ones I'm going to talk about today are estrogen, progesterone, and testosterone. I'm going to start with estrogen because it's the one everybody talks about the most. And it's our main female hormone. So women are predominantly made up of oestrogen and progesterone with a little bit of testosterone, and men are made up of predominantly testosterone with a little bit of oestrogen and progesterone.
Speaker 1:So both male and female have all three hormones. And just an example, there's about 300 different tissue receptors in the body that have estrogen receptors from your brain. I mean, I'm not going to say a name 300, but for example, brain. That's why your cognition and memory changes when your hormones start to change. Your blood vessels have oestrogen receptors on them.
Speaker 1:Your vaginal tissue has oestrogen receptors literally every your joints everything. And so therefore they have such a wide range of action because every part of your body has hormone receptors. So you can imagine if your hormones are up or down or low around menopause, that will have an impact on every part of your body, not just having hot flushes and things like that. And obviously, oestrogen is important for men as well because it's part of what causes sperm maturation for them. So it is relevant for everything.
Speaker 1:So what does oestrogen do? So I'll give you some examples. I mean, my career, I've been doing this for about fifteen years now, just hormones. I see, God, 10 patients a day, three, four days a week. So I've seen a lot of people.
Speaker 1:And some people will come in with things. And even now, having done this as long as I'm, there are still things that I go, Oh, no, I don't know that that's hormonal. And then we fix everything and they come back and, you know, like it will be a painful middle toe. And I'd be like, could be, but don't know, it's not common. And they come back and go, My painful middle toe is gone.
Speaker 1:So it just shows you what the functions are. And oestrogen predominantly is mainly the one we associate with temperature regulation. So things like hot flushes and night sweats and things that's to do with how our body regulates its temperature. Then the most important one for me that I always talk about is bone density and muscle mass. So oestrogen is probably one of the key ones, but not the only one, in relation to keeping our bones strong.
Speaker 1:So one of the biggest risk factors that women have as they age is osteoporosis, which is brittle bones. And that's why we talk about HRT for the prevention of osteoporosis, because it is really important to help keep our bones strong. So it actually keeps building bone, not just stopping it breaking down. And then also that's related to muscle mass. So as we hit menopause, we lose muscle mass and that's related also to oestrogen.
Speaker 1:It's also important for sleep. So when your oestrogen declines, that's why your sleep can go off. Libido, so low oestrogen, also can impact your sex drive and how much you feel like having sex, along with your vaginal tissue and actually vaginal dryness and things like that. It helps your blood vessels stay elastic. So women are generally protected from having heart attacks and strokes until they hit menopause.
Speaker 1:So we have a much lower risk, really much lower risk than men before we hit menopause. And that's because oestrogen helps keep our blood vessels really elastic and stretchy like an elastic band. And the minute we hit menopause and our oestrogen depletes, our vessels become very hard and calcified. And that's what then increases blood pressure. So it's no joke that most women start getting blood pressure problems and cholesterol problems after they hit menopause and not before.
Speaker 1:So oestrogen helps that elasticity and that's why it's important to put oestrogen back. It helps maintain collagen, so for skin and hair. That's why after oestrogen depletes, people start noticing, you know, some people will just come in and say, my skin has completely changed, like it's sagging in places, their hair's falling out, their hair's not as strong, it starts breaking. So it is really important for that. And again, when it comes to collagen, that then includes joints.
Speaker 1:So some people get joint aches and pains. So it is really important to maintain the fluid in our joints and our sonovial capsules and the collagen that sits in our kind of knee joints and elbow joints and shoulders. Really important for cognition. So one of the most common things that people come in with me at menopause is, and even from premenopausal, is memory brain fog. And actually there are so many oestrogen receptors in the brain.
Speaker 1:They did a study in New York where they looked at a brain scan of a premenopausal woman and a postmenopausal woman not on hormones. And it was actually horrifying when you see it. So with the dermo scans they do, the premenopausal brain had kind of green and yellow and black and it was all colorful like a rainbow. And the postmenopausal brain, like five years postmenopausal, so they hadn't had hormones, was literally blacked out. So there was nothing stimulating the activity.
Speaker 1:So oestrogen is so important for brain function and cognition as well. Really important for eyes, so to maintain the eye structure, and that's why dry eyes is another common thing that people present with at menopause when their oestrogen depletes. It helps with balance, so it actually helps with our brain and our muscles in improving static balance. So that helps with trips and falls as we start to get older. And again, to do with the brain helps with neurodegeneration.
Speaker 1:So it stops our brain degenerating as we age. It slows that process down. And so symptoms of low estrogen, and I'll come to menopause and where we are, for now I'm just going to explain the symptoms of when your oestrogen depletes, which will be around the time your periods stop and your ovaries stop producing hormones. That is when your oestrogen depletes. And the common ones, I mean the one everyone talks about, is hot flushes and night sweats.
Speaker 1:That's the most common thing people come in with. But then you've got insomnia, so poor sleep, headaches, cognitive decline, both verbal and memory, joint aches and pains. And sometimes it will just be one of those symptoms. I think what people don't understand is you don't have to have all the symptoms of menopause. There are people that walk into my room that have zero symptoms.
Speaker 1:They've never had a hot flush or a night sweat in their life. No vaginal dryness. Mood is fine. Sleep is fine. Literally zero symptoms.
Speaker 1:But they might have one thing, like I've got really bad tennis elbow and shoulder problems and my joints are really hurting. And again, they don't put that down to menopause because a lot of people think, if I'm not having hot flushes and night sweats, it's not menopause. That seems to be what goes through a lot of people's head. Common things are vaginal dryness, you know, and that's not just to do with whether you're having intercourse or not, but for some people it can get so bad that, again, penetrative sex becomes absolutely impossible. You know, I had a patient a few weeks ago who came in and that was her only symptom.
Speaker 1:She was about fifteen years post menopause and her only symptom was that she physically hadn't had penetrative sex for five years. Never had flushes, sweats, anything like that, so nobody ever did anything about it. They tried a bit of vaginal oestrogen. It kind of helped, but of course, as soon as you stop it, everything comes back. And it was lovely because she came to see me for a follow-up after three months, and I put her on systemic HRT because I try and treat people it's treating me inside out.
Speaker 1:So I say when you're putting hormones back in the body, and especially when you've been five, ten, fifteen years post menopause and you haven't had hormones for a long time, I kind of describe it like if you've been on a holiday and you've got a really floppy limp plant in your house that hasn't been watered, and it's kind of the difference between spraying it with a bit of water on the leaves and watering the soil. So it's same with hormones. You kind of need to treat from the inside out. So, you know, I put her on hormone replacement therapy, gave her some vaginal estrogen as well and quite a loading dose to try and get the tissue back, some vaginal moisturizer. She came back three months later and for the first time in five or ten years, she's actually managed to have penetrative sex, which is quite amazing when you think no one's been able to help her.
Speaker 1:And she's seen a gynecologist, she's seen a GP before. It's not like she hasn't sort of helped. So that can be one of the simple symptoms. So I think it's important to understand that it's not just one symptom you might get. Again, to do with that, cystitis, recurrent UTIs is really common.
Speaker 1:One of the most common reasons women get admitted to hospital when they're elderly infections and a completely reversible cause is if they gave people oestrogen vaginally, it would never happen. Mood swings, depression, anxiety. So that's really a common thing. Heart palpitations is another one that people don't recognize and they get sent to cardiologists and all kinds of people having ECGs and things, it's actually just related to hormones. Dizziness vertigo is another less common one, but it does happen in some people.
Speaker 1:And again, some people just present with osteoporosis. So I've had a couple of patients in the last few months, interestingly, who have come in in their mid-70s with a diagnosis of osteoporosis, and they've had a bone scan or a DEXA scan over the last few decades, and they've been osteopenic and no one's done anything and then they wait. And that's where kind of, I think, the NHS fails us slightly because we don't really focus on preventative medicine. We could have prevented most cases of osteoporosis in women, and it's the most common cause of hip fractures in elderly people. And again, it's all to do with hormones.
Speaker 1:Progesterone. Now, progesterone is actually my favorite hormone because I don't think we talk about progesterone enough, but it's mainly produced in the corpus luteum. So after you release a follicle during your menstrual cycle, the corpus luteum is what releases the progesterone and that produces progesterone. So it's mainly to do with maintaining the lining of the womb. But again, it helps.
Speaker 1:It's produced in the placenta in pregnancy. So that's why we call pregnancy progestation because it's a progesterone, a high progesterone state. And so it helps support the female reproductive cycle as well and helps the uterine lining for implantation. So it helps keep the lining thick for the embryo to implant and then also helps maintain the embryo. So often your progesterone starts to decline from your 30s and 40s onwards.
Speaker 1:A common reason for recurrent miscarriage is actually that people are not producing enough progesterone to maintain their lining for implantation, and that's the reason they're not getting pregnant. And it's quite a common thing that's not picked up. So what does progesterone do? So it helps with energy, stamina. Most importantly, it is our sleep hormone.
Speaker 1:So it is the hormone that really helps with sleep. So often in your 40s, then through menopause, sleep starts to decline gradually. And I guess most of the time people put it down to being busy with work and kids and stress and things. We actually don't realize that our hormones play a key role. So progesterone is your key hormone for sleep.
Speaker 1:It actually also helps normalize blood sugar. So helps stabilize your blood glucose levels, Helps with hot flushes. So again, like estrogen, it helps with hot flushes, especially if people are getting flushes when they're cycling still in the second half of the cycle. Some people get sweats at that time. That's to do with having not enough progesterone.
Speaker 1:It also helps with cholesterol, so it helps you keep up your good cholesterol, your HDLs, protects against uterine cancer and breast cancer, protects against breast cysts and ovarian cysts. So all of these disorders are disorders of high oestrogen state. And it's having enough progesterone helps to balance that out. It's also your natural antidepressant. So we always call it Wahhappy hormones.
Speaker 1:So that's why mood swings happen because of the lack of progesterone. And again, it's really important for bones because it actually helps osteoblasts, which are your little cells that build bone. So progesterone actually works on those as well. So when you're looking at treating osteoporosis or somebody that's got weak bones and you're trying to build them up, you always want to make sure they have all three hormones. And it's also a natural diuretic.
Speaker 1:So when you take progesterone in the second half of the cycle, if you get a lot of bloating and breast tenderness, it helps with all of that. And it helps to use fat as energy. So when you're trying to lose weight, if your progesterone and oestrogen are out of balance, progesterone is really helpful to use your fat as an energy source as well. So the symptoms of low progesterone commonly, as I talked about before, infertility. So recurrent early miscarriage is quite common due to low progesterone.
Speaker 1:Depression, endometriosis, postnatal depression is another common one that we don't talk about enough. So again, it's really due to the hormonal shift that when you deliver a baby, your hormone levels rapidly drop overnight. And that can be a common cause of postnatal depression. And we used to treat it with I'm high dose progesterone injections. But as medicines evolved in antidepressants and things have come about, we tend to not use the older treatments that people will opt for antidepressants.
Speaker 1:So low progesterone also causes premenstrual syndrome, which I'll come back to when I talk about PMS, anxiety, weight gain, bleeding disorders. So again, in the run up to menopause, people start to have some people, women start to have much heavier periods. So after kids, they start developing flooding heavy periods and it's often due to not having enough progesterone. Fibroids are driven by oestrogen, so keeping your progesterone can help balance that fibrocystic disease of the breast and also ovarian cysts like we talked about. Testosterone.
Speaker 1:Now, this is predominantly made in the ovaries and the adrenal glands. So again, it's a big fashion at the moment. Everyone's talking about testosterone or everyone's going to their GP asking for testosterone. And small amounts of produce have been converted in peripheral tissues, but predominantly it's made in the ovaries. So it does start to decline really in your 40s onwards, but you get a sudden drop of about 50% around menopause because actually most of it is made in the ovaries.
Speaker 1:So when your ovaries stop working and your periods stop, you stop producing testosterone as well. For some women, they actually still produce a good amount of testosterone. So I always do a blood test before I start people on things because if some women have very good adrenal function, their adrenal glands actually take over at menopause and they are still producing a good amount of testosterone. So that's where doing a blood test to look at all the hormones together is really important. So what does it do?
Speaker 1:Helps with well-being, strength, endurance, energy is really important. Helps with sex drive. Again, with bone density, so it helps build bone back. Muscle mass and metabolism, so that's a really key one when you hit menopause is you lose, a lot of people notice, they lose muscle mass quite quickly. So despite weight training and eating enough protein, they cannot build their muscle.
Speaker 1:Testosterone is a key component in that. Again, collagen, skin thickness, testosterone is also really important for that. We all talk about estrogen, but to help maintain your collagen in your skin, face, joints, it's really important to put back testosterone. And again, it's really important for metabolism. So one of the missing hormones to help reduce visceral fat, which we talked about last time, is the fat around the middle.
Speaker 1:Testosterone is really key for that and also helps with cellulite. Again, memory and cognition, really important for that. Predominantly, oestrogen seems to have an impact, but definitely for some women, testosterone is a game changer. If they're on oestrogen and progesterone and their memory is still not quite right, their cognition, they've still got a bit of brain fog, testosterone can be the missing piece of the puzzle there. Unfortunately, there's no licensed testosterone for women in The UK.
Speaker 1:So some GPs are a bit reluctant to prescribe it, but there's lots of good advice on the British Menopause Society, or if you go privately, then it's very commonly prescribed. Also helps with cardiovascular protection, so keeping our blood vessels and our hearts strong. And again, to do with weight, it lowers insulin resistance. So as we all age, we become more insulin resistant, which is why we get more visceral fat around the middle. And testosterone is one of the key hormones that helps with that.
Speaker 1:So what are the stages? So I'm going to try and break this down. And I try and break it down for patients in that I talk about premenopause. So premenopause, it really covers the longest period, which is from when your period start up until your period stop around the age of fifty-fifty one. So anything in that time, you are what we call premenopausal.
Speaker 1:And the main disorders and things people will suffer with around those years will be things like, you know, polymetabolic endocrine ovarian syndrome, which was formerly known as PCOS, as we know it, endometriosis, premenstrual syndrome. Those are the common things that people come in to see me with from there. I mean, I don't see under 18s, but from anything from 18 to 50, that is the main things that people come in with. And then you've got perimenopause. And I think there's a lot of misinformation out there at the moment because perimenopause is really defined as the turbulent phase between being premenopausal and menopausal.
Speaker 1:So menopause is when your periods stop, ovaries stop producing hormones, you're in the menopause. And peri is kind of that bit in between. And if I'm honest, not everybody goes through perimenopause. You know, over the years I've had some patients that come in and they go from a twenty eight day cycle literally twenty eight days every month for their life. Boom, they stop.
Speaker 1:They never have another one in. They've gone straight into menopause. And peri is really where you go through this stage that could be months, it could be a few years, where your periods become a little bit erratic because the ovaries are kind of going up and down. So your periods might stop for a few months. You get some menopause symptoms like hot flushes and night sweats and vaginal dryness.
Speaker 1:And then suddenly your ovaries wake up, your periods come back for two to three months, the flushes subside, and you think, oh, that's weird. Sometimes the bleeding can be quite heavy. That could be three months, six months, and then they disappear again for a month, and then you miss one, and then you miss two, and then they come back for three. So that is really perimenopause, whereas a lot of people are being diagnosed with perimenopause when they're 35 or 40. And they're not actually perimenopausal yet.
Speaker 1:They're still having regular periods. But what they may be suffering from is hormone imbalance, so premenstrual syndrome or something like that. And normally it will be low progesterone because from your 30s onwards, your progesterone and testosterone start to decline. And so that's why people tend to start noticing symptoms around that time of a bit of brain fog, bit of low energy. But they're still having pretty regular periods, which then doesn't really put them in the perimenopause category.
Speaker 1:Because if you're having regular periods, it means you normally are producing enough oestrogen to cause the lining of the womb to thicken, to bleed everyone. Therefore, putting oestrogen back in people like that can actually make things worse. And then when you cycle hormones, it makes it all over the place. So that's where the difference is when you do come and see somebody like me. I take a proper history, I do a blood test, I'll see where you are at that point in time, and then I tailor make a regime for you.
Speaker 1:Because as we know, one size doesn't fit all when it comes to hormones. And I always say this: we don't give every diabetic the same dose of insulin. We don't give every thyroid patient the same dose of thyroid. The same with all of these things. So the argument is, well, why would you ever give the same woman the same dose of hormones for everything?
Speaker 1:And unfortunately, that's how our health system manages it, is it's kind of a one size fits all. So, that's just a little bit of the menstrual cycle. You can see, so for example, that's day one of the cycle at the beginning of the chart. Your hormones are very low because when your period starts everything drops quite low. So that's oh god, don't they?
Speaker 1:And then you've got, as you see the cycle goes, you've got the follicular phase there and your hormones start to increase. And as you can see, estradiol is the blue line that starts to increase around ovulation. And then you have a peak of LH and you've got a little peak of progesterone, it starts to increase then. But in the second half of the cycle is when you're producing the most amount of progesterone. And if you're not producing enough and it starts to decline, what will happen is the yellow line will start coming under the blue line.
Speaker 1:And actually, you're not producing enough progesterone, so you're starting to get some symptoms in what we call the syndiotyle phase of the cycle, which is just before the period. So, the first thing I'm going to talk about is premenstrual syndrome. So, what it's defined as is distressing physical, behavioral and psychological symptoms not due to organic disease, but which recur during the same phase of the menstrual cycle every month and then they disappear the rest of the cycle. Now, lot of patients come in and some will come in with a very clear day 14, they're like, I know when I ovulate. From ovulation until my period, I feel awful.
Speaker 1:I'm like a different person. I'm irritable. I'm angry with my husband, angry with my kids. I'm trying to get hold it together at work, or I'm crying or mood swings and I don't know whether I'm coming or going. Some people get very physical symptoms like breast tenderness, bloating, migraines are a common one, fatigue, small food cravings in the second half of the cycle, and people tend to crave more sugar.
Speaker 1:They're like, It was weird. I just want chocolate sugar in the run up to my period. And the rest of the cycle, I don't think about it. Weight gain, again, tends to be water retention, to be honest, more than anything else. And so they're the common things.
Speaker 1:And then often what happens is, if it's PMS, is the period comes day one of your cycle and they're like, Oh my god, everything disappears. I feel like myself again. And then they get that for two weeks and then learn the whole day 14, it all starts again. Now what some people notice is as they head into their 40s is sometimes that window of when they feel good starts to get smaller and smaller. So it's different for everybody again with hormones.
Speaker 1:Some people feel good for two weeks and bad for two weeks. Other people, what they notice is that good period starts to get smaller and smaller. So the period comes, if it's heavy, they start feeling tired in that time and they maybe have a few days after their period when they actually feel good, where they can go to the gym, exercise, eat well, and then the whole thing starts again. So it's different for everybody. There's not an exact pattern for it.
Speaker 1:And the lower your progesterone goes, the longer you find those symptoms last. And so what the management I generally tend to do is, because it's normally an imbalance between estrogen progesterone in the luteal phase of the cycle, I normally will just replace progesterone in the second half of the cycle. So I'll normally cycle them and obviously I only use natural and body bio identical progesterone. So that could be a cream or a capsule or something like utrogestan, or I get something compounded like a lozenge. And normally I will give it to them in the second half of the cycle.
Speaker 1:Again, if some people have symptoms at the beginning, I might give them just a little bit of progesterone in the first half of the cycle because they sleep better. And what some people come in with after the first few months is they say, Well, now I feel really good in the second half of the cycle, but really when I stopped taking the progesterone, I thought I felt fine in the first half and I don't. So, you know, it's just about tailor making for each person. Then it's also important to talk about nutrition and exercise because if people are eating a lot of sugar or they've got a very high refined carbohydrate diet, that tends to fuel PMS symptoms, especially things like breast tenderness and bloating and gut problems and water retention. So I do always try to get people on a good nutrition plan.
Speaker 1:Also by eating, again, I tell everyone, more protein, loads of vegetables. You then get to keep your blood sugar more regular, which then helps balance your hormones out. So that's super important. And then trying to get regular exercise. And if you do have bad PMS, then you know, there's lots of doctors out there that now talk about I think is it Stacy Simms or I can't remember which one it was one of them talks about exercise through your cycle.
Speaker 1:So again, beginning of the cycle after your period, might have better energy, better cardiovascular strength. You can do more runs, can do more weight training, and then maybe in the run up few days before your period, things like yoga and pilates and stuff might be better. But again, I always say there's no right or wrong. Life is also busy, so you fit it in where you can. But it's important to understand what's happening in your body so you know if you're going to do weight training the day before your period, maybe you're not going to hit your personal best and you've just got to do the best you can.
Speaker 1:Then I also look at supplements with people, so things like DIMM is very good for oestrogen metabolism. Ashwagandha is another good one for cortisol. Then there's some good ones like pre menstrual complex, that's a PMT complex for wild nutrition that is really helpful for some symptoms. And then things like evening primrose oil if you've got breast tenders and things like that. I always say with supplements, you need to see a healthcare provider because just kind of dabbling and buying stuff online, you never really know.
Speaker 1:People end up with like come in with buckets and buckets of things that sits in the cupboard. So I always say it's good to have a plan. It's good to either see a nutritionist or someone like me and not just go on hundreds of things that you don't know what they're doing. So I'm just going to give you a quick case study of PMS. So she was 38.
Speaker 1:And these are all patients that have come in over the years. And she had very severe PMS symptoms for decades. She'd been struggling. And again, she only really feels like herself for one week out of every month. You can imagine if that's happening every time and you're feeling awful the rest of the time, you pretty much can't function.
Speaker 1:She had pretty heavy periods after kids, so five days and quite heavy flooding periods. And again, PMS starts on day 15, breast pain, bloating. She literally goes up to she'd had two wardrobes, a pre period and a post period wardrobe, feeling very moody, overwhelmed and not sleeping. Other health was very good. She'd had three kids, no problems with that.
Speaker 1:Most of her symptoms had started after that. So when we did a blood test, I do a full hormone panel looking at the hormones, and I generally will do it on day 21 of a twenty eight day cycle, but I will adjust it depending on the cycles. Because blood tests are common, and now I think it's just good to be aware that there's lots of places like Randox and Medichex that offer blood tests that you can do yourself. It's not a bad idea, but I generally think it's better to do it with a doctor or somebody that can interpret them for you. Because going and doing a random blood test, for example, if you do a hormone blood test on day one of your cycle, as you saw on the graph, everything will be zero.
Speaker 1:So that's where, you know, as GPs, we're not educated when on hormones and doing blood tests, that's why we don't recommend doing it, because they change through the cycle. So if you don't know when you're doing them and what you're looking for, people will get diagnosed with menopause when they're 30 because their oestrogen's zero, but they did it on day one of the cycle and they get put on oestrogen. And I've seen this happen a lot, you know, it horrifies me, but it does happen. So it's important if you're doing blood tests to do them at the right time and to make sure you've got somebody that can help you interpret them. For her, she had low progesterone in the second half of the cycle with a good oestrogen, good testosterone and DHEA.
Speaker 1:So I just put her on some progesterone and she wasn't very good swallowing capsules. So I actually ended up compounding something for her that was a lozenge. So it just goes up in the bloodstream. And I gave her a little bit in the first half of the cycle because her sleep still wasn't great, even though she wasn't having all the terrible symptoms. And as I said, she only had a week of feeling good.
Speaker 1:And then I increased it in the second half of the cycle. So she kind of took it cyclically. And then at three months, her PMS symptoms had completely dissipated. She had no PMS at all. Literally changed her life.
Speaker 1:She was sad she hadn't done it sooner. And because of the progesterone, her periods were actually lighter and a bit more manageable. So she came in mainly for the PMS, but the progesterone helped with the lining. So that was one of the other benefits that she got is her periods became more manageable. Second thing: endometriosis.
Speaker 1:So again, this is a painful disorder where your endometrial tissue, which is the tissue that normally grows inside the womb, actually grows outside the uterus. And it can grow actually anywhere in the pelvis and the abdomen, even up to the thorax. It commonly affects your ovaries, your bowel, and your bladder are the common things around. But I've seen people with endometriosis tissue that's been found up in their diaphragm, so up around the liver and the spleen, even around the lung area. It's gone above the diaphragm, it's gone out of the capsule, which is rare, but it can be that severe.
Speaker 1:And it basically continues act like endometrium tissue. So during the course of the cycle, the tissue thickens up and then it bleeds with the menstrual cycle. So it then leads to a lot of inflammation anywhere in the body, in your ovaries, in your bowel. It can cause scarring and then adhesions is where basically the tissues stick together. So people with really bad endo, when you scan them or you do a laparoscopy, sometimes the ovaries can almost be stuck down so that everything's just stuck in the pelvic area.
Speaker 1:Whereas normally everything should be kind of flinty and wobbly and you should be able to move the ovaries around. Endo just causes chronic inflammation there. And then the honest answer is we don't really know what causes endometriosis still. We think it could be due to retrograde menstruation where the endometrial tissue goes backwards. Could there be some genetic component because it often can run-in families?
Speaker 1:If have, moms have endometriosis, it can commonly happen in teenagers. They notice. It definitely is immune mediated. So the more we do studies, the more we look into it, it's definitely immune response. So hormones are involved in that, the environment is involved in that.
Speaker 1:So things like exogenous estrogens from food, from animal products, from, you know, hormones we pump into food and pesticides and, you know, estrogen blockers and things like that. It can all be related. So I think we don't entirely know what causes it yet. And it's not diagnosed well because the only real way to diagnose, the only well, by the guidelines, the only way to diagnose endometriosis is by laparoscopy, which obviously involves two tubes, cameras going into the pelvis to have a look. Now again, you can have somebody with incredibly severe symptoms of endometriosis where they are healed over every month in pain with their periods and they can't walk.
Speaker 1:But when they go in and have a look, there's actually not much in there. By the same token, we've had patients over the years who've gone into hospital for, I don't know, something to do with their kidney or a hernia repair, and their lining is riddled with endo, but they never had any symptoms. So it is really difficult to diagnose. And again, with the NHS, the GP has to refer you to a gynaecologist. And we all know it's difficult to get in to see a GP, let alone get a referral to a gynaecologist.
Speaker 1:And equally for GPs, it's quite hard to know who to refer because you can't refer every young woman that comes in with heavy painful periods to gyneec because it's incredibly common. So I think a lot needs to be done on looking at the diagnosis. But as I've seen over the years, women have suffered and been you know, sent away so many times and they get so desperate because it really can be disabling. And I think, you know, if you're a good doctor, you can diagnose it without doing a laparoscopy in that. When the symptoms are when the periods are so painful and disabling, like somebody is crawling along the floor to the bathroom when their period comes, that's not normal.
Speaker 1:Know, period pain for some people is normal. You can take a bit of ibuprofen, paracetamol, hot water bottle and it should settle. If it doesn't with those, that's a key sign that it's most likely going to be endo because, you know, it's so severe that people can't just lie down, have a hot water bottle, and then go back to school or work. So I think a bit of education in schools is also important. Again, you can get chronic lower back pain.
Speaker 1:So another common symptom with patients with endometriosis is before the period or around ovulation, they get very bad lower back pain and also pain in the legs. That's another common one I see. Painful bowel movement. So that's really common because again, the endo tends to wrap around the bowel. So that can cause a problem.
Speaker 1:And again, with urine. So passing urine can be painful because the endo can affect the bladder. Often they can have heavy menstrual periods, but not always. People can have light periods, but very painful. Again, people present with infertility, so they've never had major issues, but actually they can't get pregnant.
Speaker 1:When they have a laparoscopy, they see that actually they've got endometriosis. And again, sometimes low mood, which could be related to the pain that they're in. It can really be debilitating for some women. And so, how do we treat? So, the first thing I would always do is again nutrition and lifestyle.
Speaker 1:So, there was a really good study that came out recently on they took a group of women with endometriosis symptoms and made half of the group gluten free. So they cut out gluten. And we know gluten is quite an inflammatory food for a lot of us. It's not to say you should never eat it. It's not to say everyone's coeliac, but it is a common irritant to most people's inflammation.
Speaker 1:So a lot of nutritionists, people are suffering with bowel problems, endometriosis, inflammation in the joints, cutting out gluten and too much dairy, depending on that, and keeping sugar down can really help with endometriosis symptoms. So they're the first things to add because there's no point putting people on treatment if they're not doing the things that they could do to help at home. And again, progesterone is my mainstay of treatment. Rather than sending people for a laparoscopy or some patients are on the waiting list for a laparoscopy, I give them natural progesterone and sometimes throughout the cycle to help balance out the oestrogen because it's the oestrogen that's stimulating the endometriosis tissue that's causing most of the symptoms. So we've had a lot of success over the years of treating people with progesterone for their endo and they've never needed to have a repeat MRI or laparoscopy.
Speaker 1:And again, I try and put people on high doses with endometriosis. So either lozenges or even sometimes vaginally can be really helpful because then the progesterone gets to if you give them a pessary, for example, it gets to the endometrial tissue in the bladder and the bowel. So it can be really helpful for that. And other alternative treatments can be really beneficial. So I've got great osteopaths that I work with that do a bit of pelvic physio to help release the fascia and the tissue if it is really stuck down.
Speaker 1:And also acupuncture can be really good as well. Menopause in endometriosis is something I just wanted to mention quickly because, again, when I talked about one size fits all is when it comes to hormones, NICE guidelines are just bam, slap it on, start them on HRT. And women are much more complex than that when it comes to hormones. If you've had a history of endometriosis, you are very oestrogen sensitive. And the thing that I've seen over the years is a lot of women who've had endometriosis, a lot of them will end up with a hysterectomy at some point.
Speaker 1:And then the issue with that is then when they hit menopause, they don't get given progesterone. They just get given loads of oestrogen and lo and behold, their endometriosis comes back. Because as I said before, it's not confined to the uterus. So just because you've taken someone's uterus out, it doesn't mean they're not going to get endo if you whack them on loads of oestrogen. And I've seen it happen in people.
Speaker 1:And that's why, you know, I try and say if you've had complex hormone problems, it is good to go and see a hormone specialist, specialist because I would always put patients with endometriosis who go through menopause on lots of progesterone first so that that's all there in the body. And then we do the oestrogen very, very slowly and titrate up because anyone that's had severe endometriosis pain known to what it's like, you do not want that coming back in your 50s. And it's very classic. They will know within the day that sometimes, oh yeah, no, that's my endo pain coming back. And then I'll just teach them how to balance it.
Speaker 1:But the further you get into menopause, generally it's better controlled. So PMOS, this is probably a common one and I'm seeing more and more of it in clinic and I'm not entirely sure why, but somebody quoted the other day they think probably fifty percent of women now have PMOS. So it was formerly known as PCOS, which was polycystic ovarian syndrome, and it got renamed a month or so ago to poly endocrine metabolic ovarian syndrome. And that's super important because for so many years people have been misdiagnosed with PCOS because of the name polycystic ovary syndrome. If they don't have any cysts on their ovaries and they get a scan, they get sent away.
Speaker 1:And even since I qualified, things are changing in that I probably see about three patients a week with PCOS. And it's managed very badly because we don't know enough about it, and the guidelines are bad, and the name was bad. So it can cause really debilitating symptoms like weight problems. People could struggle with their weight for years, and by the time they come in to see me, a fair few people have an eating disorder because the only way they've managed to lose weight over the years is to literally starve themselves to have like six hundred-eight 100 calories, and then they might lose a few pounds. And then the minute they, again, they put it back on, and they've struggled with years for this.
Speaker 1:Acne is a really common one, so some people could have really bad cystic acne. Hastetuism, which is basically excess facial hair, so thick. And I'm not just talking about, you know, if you're South Indian like me, or Greek or Italian, a lot of people are a little bit hairier from that side. But I'm talking like women that have to pluck their hair every day or shave their face every day, and it tends to be thick hair. It can be that you are generally a bit hairier, but his situation is when you really have a problem.
Speaker 1:Irregular periods is another common symptom, so some people have no periods, or a period once a year, or have a few months off. Hair loss, so thinning on their head, is really common. So, almost you can see people's scalp, you know, their hair is so thin and breaks. Fertility problems. And again, with PMOS and what we see now, you can have all of those symptoms, you can have one of those symptoms.
Speaker 1:I have some patients that just have acne. They've never had weight issues, their periods are regular, they've got thick head of hair on their head and they just have acne. And that is basically related to the fact that it's a more complex endocrine problem. And the root cause of it really is a genetic predisposition to insulin resistance. So there is some genetic element to it.
Speaker 1:And it is very complex because it's the excess insulin in the body that's then stimulating the ovarian cells. So they're these theca cells in the ovary that are what produce testosterone. And it's the insulin that stimulates these to then cause the testosterone increase and cause the symptoms like excess facial hair and acne and hair loss. And then that then triggers the weight problem. And then the other thing you tend to find is a low sex hormone binding globulin, which means there's more testosterone swimming around the body.
Speaker 1:So that's where blood tests are so helpful to look at it. And they're not just the only way you diagnose it. But actually, when you're looking, and I do a really full profile looking at the FSH, the LH, the SHBG, Because now what I'm seeing is not everybody has a classic picture on their blood test that I could go, Oh look, this is definitely PCOS. Some people just have one or two things that when I look for, I'm like, they do. But again, they've seen gynecologists, they've seen endocrinologists, and because they're having regular periods or they're not overweight, someone will go, well, you can't have PCOS because you don't have all the symptoms.
Speaker 1:And I think now we're beginning to understand it's much more complex than that. It's not a tick box diagnosis. Again, there's a lot of inflammation in there, so I always get patients to look at gut health because there's a big link between PMOS and gut health. So making sure their gut microbiome is intact. And also their diet's good, so they're not starving themselves, but they're eating a good nutrient dense I try and get people to do a high protein, lower carb type diet because with insulin resistance, if you have a lot of high carbs, it will stimulate your pancreas to produce more insulin and make it worse.
Speaker 1:And again, these patients have a long term increased risk of cardiovascular disease, diabetes and breast cancer. So if they're not treated, they're going to have multiple problems later in life. So this is a patient that came in. She was 22. She was diagnosed with PCOS at 13, always had irregular periods and suffered with excess hair.
Speaker 1:She was put on the pill, referred to a gynaecologist, put on the combined pill, which is the really common management. And not everybody wants to go on the pill. And secondly, it doesn't get to the root cause of the problem. It just might help with the hair loss and acne and give you a pill free bleed every week. But she had terrible mood swings on it.
Speaker 1:So she tried herbs and Ayurvedic therapy over the last few years and nothing had worked. She'd had irregular periods, maybe two to three in the past couple of years, quite severe hair loss on her head, excess facial hair and body hair. Again, she was one of those examples of she was very slim, never had a weight issue, so that was an issue for her, but feeling very tired and not sleeping. Because often patients with PCOS also, or PMS, have low progesterone as well, so they often tend to get PMS if they are having cycles. So my management is I use things like androgen DHT blockers like spironolactone, which helps block the testosterone causing the hair loss and the excess facial hair and body hair.
Speaker 1:Again, it can be teratogenic for fetuses, so you need to use contraception or at least make sure you're using adequate contraception. And because it's a potassium sparing diuretic, you need to have your kidney function checked. But in younger people, it rarely causes a problem. And then metformin is the mainstay of treatment because that is really Metformin is a drug that helps reduce insulin resistance. So all my patients with PMOS, whether they're slim, whether they're overweight, will get metformin.
Speaker 1:And it just depends on the dose because the root cause, despite your weight, will be an insulin problem. So all patients should be put on metformin and depending on what their issues are, the higher or lower dose. And then for this lady, because she had PMOS, she was on progesterone in the second half of the cycle to help with sleep and things. And so that relieved all her symptoms, and I've got a lot of patients with PCOS and PMOS now that I see. Next thing, perimenopause.
Speaker 1:So I kind of covered this before, and that's to do with fluctuating ovarian function. So you tend to have quite erratic periods, sometimes months with no periods and sometimes menopausal symptoms. Then they come back and they can be very heavy. And it is difficult to diagnose because your blood levels can fluctuate. So that's why keeping a diary of your periods and doing a blood test at the right time and taking a history from someone of their periods is really super helpful.
Speaker 1:And the management of perimenopause, so how I manage it, is the mainstay of treatment is progesterone because that's your sleep hormone, your happy hormone. It just helps buffer when your oestrogen's fluctuating up and down. It can be anything from one hundred to eight hundred milligrams from an oral or a lozenge. And again, some people do require a little bit of oestrogen because sometimes giving them a little bit of oestrogen can just help the fluctuate going up and down because what it is is your ovaries are responding to your brain. So if your oestrogen's fluctuating up and down and your brain's telling your ovaries do something, don't do something, do something, Sometimes doing a little bit of oestrogen every day just helps the brain recognize, Okay, there's oestrogen in the body, there's oestrogen, and it stops that ovarian fluctuation.
Speaker 1:So different women will get treated differently depending on what they need. And again, testosterone in that department can really help if their testosterone is low because it just helps keep everything level. So menopause, this is on average around 51 years old is the average age of menopause, but 48 to 52 is the norm. And anything from 45 to 55 is actually normal. I think the latest I've seen someone's period stop is 60, so it can still go on till 60.
Speaker 1:Just because you're 57, it doesn't mean you're in the menopause. So you also need to look at whether you're having periods or not. And it's when your ovaries stop producing hormones, so estrogen, progesterone, testosterone, and your FSH, which is your follicle stimulating hormone, goes up. So when your FSH goes up, that's when you know your ovaries are starting to slow down. And what I try and explain to people with menopause, it's a state of hormone deficiency.
Speaker 1:So it's a permanent state we're in. And there's so many people that will come in and go, Oh, you speak to an old granny, you know, and she'll say, Oh, don't worry, darling, my menopause was fine. I'm out the other side. I had some flushes and sweat sore. I didn't have anything, and I'm on the other side of menopause.
Speaker 1:And what I try and explain to people, which my mum told me never to say to patients, but I still do, is the other side of menopause is death. So when you finish menopause, you are literally dead, because we don't stop being menopausal through our lifetime, okay? So as horrible as that sounds, that's how I'm trying to educate people. Because an example is, and if people don't have symptoms, they sometimes don't think they're in the menopause. And I think there's so much understanding there.
Speaker 1:And people think the menopause is this transient period of time of something you go through. But again, it's different for every woman. You can have no symptoms at all. So as I said, I've got patients that have zero symptoms, but they come in because they want the health protection benefits of taking HRT. And then I've got other women that come in and tick every box: flushes, sweats, vaginal dryness, everything.
Speaker 1:So it's a different journey for everyone, and everyone has to find they're comfortable in. And there's no right or wrong really to it. But, you know, we age because our hormones decline. So our hormones don't decline because we get older. The reason we get older and we get issues of aging, so that the illnesses of aging predominantly we talk about are osteoporosis, cardiovascular disease, and dementia, because they're the three main illnesses that women have as they get older.
Speaker 1:And the reality is, yes, menopause is a normal part of aging, but the reality is we live longer. So for some people, you menopause at 51, your genetics might be you're going to live till 95. So you've got another, you know, God my maths is that bad I can't figure out, another forty years, you know, after menopause that you're going to live. And what I try and explain to people is how do you want to live in that time? And a good example of somebody that doesn't have any symptoms, so didn't think menopause, is I've had a couple interestingly in the last couple of months, a couple of my best friend's mums that have come in.
Speaker 1:So they're now in their mid-70s and they've sent them in because they've had a bone scan for whatever reason and been diagnosed with osteoporosis. And now they're needing drugs. And when they come in, it's really interesting because they were obviously people in their mid-70s were around that time that the WHI study came out and everyone was a bit panicked about going on HRT, everyone said, Oh, you're going get breast cancer and die. So all these women, if they were taking it, came off.
Speaker 3:And the thing
Speaker 1:is, a lot of women will come in and go, Well, you know, I never really had symptoms. You know, I had a few flushes, so I thought I was through it and out the other side. And then now I've got them in their mid-70s with full blown osteoporosis. And it's not impossible, in my opinion, it's never too late to start HRT. If you're 75 and you've got good genes, you might have another ten, twenty years.
Speaker 1:So do you want your bones to continue to weaken in those ten and twenty years? Or do you want to try and build them back? And so I wish that women understood more that taking hormones is not just about treating the flushes and the sweats. It's actually about the health prevention for preventing osteoporosis and helping us stay strong and being able to go to the gym or garden or travel or do what else we want to do. Because the reality is we are living longer, but women especially are living in poorer health as we get older because of all of these problems.
Speaker 1:So that's where strength training So both of my friends' moms, they're now in the gym lifting weights, having never lifted weights in about thirty, forty years. But now, at least we know now, we need to strength train. We need to eat enough protein. We need to educate people to try and stay healthy because we know by default the amount of muscle mass you have as you age, the better quality of life you have. And so symptoms of menopause, as I said, the flushes, the sweats, the insomnia, sometimes it's anxiety and depression, painful sex, brain fog.
Speaker 1:I've kind of covered all of these things. So this is an example. A lady came in, was 53. Last period was about eighteen months ago. Getting some flushes and sweats, mood swings, lack of concentration, low energy, fatigue, but otherwise pretty healthy.
Speaker 1:So I started her on what's called body identical. So this is the licensed version that you can get on the NHS. And I actually started her on estradiol tablets because she wanted something orally. She travels a lot. Then utrogestan was her progesterone, and I normally give people one to two at night.
Speaker 1:And then a bit of compounded testosterone to do every day. Eight weeks later, flushes have completely gone. All of her symptoms have gone. No night sweats, no flushes. She was on two progesterone and she was sleeping much better.
Speaker 1:And interestingly, she didn't even think her sleep was that big an issue because she'd been so used to having kind of disrupted sleep from her 40s. She kind of just thought that was normal. Then when she started progesterone, she was like, My God, I didn't realize how bad my sleep was. Now I'm sleeping through the night, whereas I thought waking up at kind of four and a six and not getting back for a while was normal. The mood was much better, and then her energy was better.
Speaker 1:So she was back exercising and doing the things that are going to keep her healthy. So, quick thing on the difference between bio and body identical for anyone that wants it. Bio and body basically mean the same thing. So, they're the same as your body's hormones. But body identical was the name given by the British Menopause Society to the licensed forms of bioidenticals.
Speaker 1:So oestrogen, utrigestan, oestrogen patches. There is only one form of progesterone, which is utrigestan, that you can get that's licensed. But oestrogen comes as a gel or a patch or a tablet. Whereas synthetic hormones are chemicals that are very similar but not exactly the same. So the combined pill or old fashioned HRT is basically where the symptoms come from.
Speaker 1:And the old fashioned HRT the it was the progestogens that increase the risk of breast cancer. So it wasn't oestrogen. Everyone always thinks of oestrogen as causing breast cancer, but it wasn't that. It was the synthetic progestogen. And now we've got bioidenticals and bodyidenticals.
Speaker 1:The studies so far show there's no increased risk of breast cancer, of blood clots, of strokes. So the question really is, well, why don't we put everyone on hormone replacement therapy if we've got more natural and better alternatives? And it does show to prevent all of these things. And the bio identical is where you compound things. So an example is for the lady that doesn't like swallowing progesterone, I'm then stuck.
Speaker 1:So I do licensed stuff that you can get from the NHS, from your GP, and then I also have worked with a compounding pharmacy that can make things up for people if they don't tolerate things or they can't swallow or anything like that. Top five supplements. So generally my top five supplements that I will put people on if you're going to take anything, and this is just basic, would be a good probiotic, a good liposomal vitamin C because it absorbs better, it's good for skin, it's good for collagen. Vitamin D3 and K2, again, I would always get a blood test done for that because everyone's vitamin D is going to be different. As we're going into summer, some people make it in the sun and some people don't.
Speaker 1:But vitamin D really is a hormone, not vitamin. So it is super important to help balance your hormones as well. Magnesium is really important because it's good for sleep, it's good for muscle recovery, it's good for our nervous system, and then a good quality omega-three fish oil. So those are kind of basic things because I just thought if somebody wants to know what are the basic things, obviously, if you're menopausal, if you're premenstrual, as I said before, there are different supplements that might help with that. But again, you want to do that under supervision.
Speaker 1:So that's where to find me. Sorry, that was a real whistle stop talk because I wanted to try to ask some questions. But it's a lot to cover: hormones through the ages. I don't think I realise how big a topic it actually is. But if you need me, I work at a clinic called Omnia.
Speaker 1:My brand is called Hormones Wellness Clinic. I've got an Instagram post so you could always follow on that. I try and put loads of helpful stuff on there for people so that, you know, I know private care is expensive, so my social media is kind of to try and put as much as I can and do talk so that I can teach people. And if you can help with your GP, you can go to your GP kind of governed with the information of what you need. There we go.
Speaker 1:That's everything.
Speaker 2:That was absolutely amazing. Thank you so much. I've got a question here from Claire. Claire, do want jump on and ask it?
Speaker 3:Yeah, and I'm so sorry if you covered it already because I was like in my head it was
Speaker 1:like 08:00, 08:00, don't forget to join at 08:00 and I was like
Speaker 2:you just put yourself on mute, I think.
Speaker 1:Yeah, did.
Speaker 3:So excited. I just want yeah, my question was about how long it can actually take to find an HRT regimen that works. I feel like it's I think it's nearly two years since I started on HRT, and it just feels like guesswork to me in terms of going back and forward to the GP.
Speaker 1:Yeah. It is, Claire. And that's where it's complicated, because our training as GPs for menopause and hormones we don't we don't want training We don't have any training. You might be lucky if your GP's done a British Menopause Society course or something like that, but again it's very basic. So I generally give my patients look, it's really hard to give a full, like a ballpark figure, Ideally, people should feel better within a couple of months.
Speaker 1:But again, it depends on where they are and what they are. So an example is kind of a 55 year old woman whose period stopped two years ago. They're fully in menopause and you're literally just putting oestrogen, progesterone, testosterone back. That's a little bit more simple. So normally they should feel better, you know, within a couple of months and they're a bit easier to manage.
Speaker 1:Perimenopause can be a bit more complicated, as I said, because of the fluctuating levels. And that's where as GPs we don't have much training to manage it. And if people still aren't feeling right after two years, I think you should be feeling better. So part of the problem could be the balances are quite right. And the problem is, as GPs, we've had no training on when to do a blood test or what to look at.
Speaker 1:And you're not wrong. It's basically guesswork. They'll be like, Oh, just maybe try this patch. Oh, no, that doesn't work. And then they try some gel and a tablet.
Speaker 1:Okay, well, I still don't feel right. We'll pump up the gel and maybe take And because we don't have any training and that's where you know, I've done this for a long time and I've done it, you know, I've trained with Marion Gluck. So, it's a much more bespoke thing. So, in answer to your question, by two years, I think you should be feeling better if it's a hormone problem. A common thing I see why people don't feel better, and this is what kind of goes back to the thing when I was talking about perimenopause and premenopause and this one size fits all, is you only really need oestrogen once your periods have stopped.
Speaker 1:But the issue is a lot of people are going in in their 40s, and this is some of my friends included, who've been to their GP and they're like, they might have a Mirena Coilin, for example, so they're not having any periods. They go to the GP and go, well, I'm having some, you know, my mood's a bit up and down. I don't feel quite right. And they're like, Oh, well, you're not having periods. You've got point in.
Speaker 1:Let's just whack you on some oestrogen gel. And then they might feel better for a month. Then they get And the issue is, if you're still having regular periods, your focus really needs to be on progesterone and testosterone, and then maybe a bit of oestrogen. What I find in my clinic, where patients have come to see me exactly like that, they're like, I've been CYGB, I've been doing things for like two years and I just don't feel any better. Some people actually come in and they're like, I feel worse.
Speaker 1:My bleeding's irregular now. I don't know what's going on. I feel like my PMS is worse. I then almost stop everything. I go back to basics and be like, Right, where are you in this journey?
Speaker 1:Because as you can see, you've got a journey of kind of pre menopause to peri menopause, and the treatment really depends on where you are in that journey. And if you get started on stuff too soon, or the balance isn't right, like they've got you on too much oestrogen and not enough progesterone, then you're going to feel all over the place. So when you feel good hormonally is when your hormones are balanced. And most of the time it's just because they don't know how to balance, if that makes sense. And it is a bit of guesswork.
Speaker 1:Yeah. GP. So you know, I know it's not cheap, but if people can afford to just go, at least go and get things sorted with someone like me, and then often I'll try and push people, know, I get people stable and work and then push them back to the GP, it can help if you're still not feeling right and you're like, okay I've been doing this for how long now? Yeah. In terms of blood tests, I've heard that a lot
Speaker 3:of them aren't actually accurate. So like I did have my oestrogen levels checked probably a year ago and despite having been on oestrogen like pump thing a few months a day and my oestrogen was still like through the floor was really low and they were like, oh, well, you're obviously not absorbing it transdermally,
Speaker 1:so let's But switch to something
Speaker 3:I did hear that actually the blood tests aren't particularly accurate because it depends on time of day or like time in a cycle.
Speaker 1:Or very specific when I do blood tests. So, for example, you know, and it's difficult to give advice and tell you what to do now because your GP won't necessarily know. For example, if you're looking at oestrogen, if you're trying to measure an oestrogen level and somebody hasn't used their hormones for twenty four hours, and I'm talking about menopause, not premenopausal, when you're still producing your own, your estrogen is going to be zero. Because with biodentables and things, with a gel, for example, you metabolize it out in twenty four hours. So, I can look at a blood test with my yearly patients because I do yearly bloods on people and I'll go, You forgot to take your oestrogen that morning.
Speaker 1:And they're going, Yeah, didn't take it. Because they did it the day before and then they went for a blood test at lunchtime the following day when it's out of their system. But again, your GP is not going to know that. So then you can use the estrogen day before and they go, Well, that's not working because your level's still low. Or you might not be absorbing.
Speaker 1:You know, some people don't absorb estrogen transdermally, patches work or tablets work. So it's quite complex, Claire, because kind of and that's where you have to take a history, do a blood test at the right time because, and I can't really tell people when to do it because again, it depends if you're having periods, then if you're taking hormones, are they causing a period? You know, it's complex. So again, kind of, if you're cycling, you want to do it day 21. If you're menopausal, you can do it any time.
Speaker 1:And again, it's when you take stuff, we'll look at that. But the problem is with GPs is we don't have any training on that. So they don't know. They'll just send you for a blood test and it is just unfortunately a bit of a stab in the dark. So you, some places can, you know, if you need to use the NHS, a menopause clinic.
Speaker 1:Some areas do have a menopause clinic. Is that better? Again, can be. But again, often it's if you're not on the right regime for where you are in this whole phase, that's the key problem here.
Speaker 3:Thank you. It's just so complicated, isn't it? And all you get in social media is like messages about and
Speaker 1:you must balance your hormones, and when I
Speaker 3:did I lost seven stone.
Speaker 1:I was like with a sneeze. I mean, yeah, say that and I use my social media, but it is really difficult because everyone will go like, Oh my god, well I did this and felt amazing, and it changed my life. And then my brain fog's gone. And most of I've got to be honest, I mean, I was having this conversation with a friend yesterday. I think social media now, in my opinion, does more harm than good.
Speaker 1:Because we all get and especially there's kind of this for women, we seem to get caught not all but in this kind of doom scrolling. And as I said, all I get now is perimenopause perimenopause perimenopause. And I like, what has changed? Everyone's like, Oh, perimenopause, start HRT early. Start this, start that.
Speaker 1:And I think it's best to just kind of go and see somebody, you know, like try and go see somebody if you're really not feeling right and you can't get anywhere with your GP. Just wipe the state game, start again, see where you are, and then hopefully your GP can kind of take over from there. Which often they do because they get a bit fed up because they're bit like, god, we don't know what to do now.
Speaker 3:Yeah, thank you. Sorry, I
Speaker 1:can't give people like individual do this, do that, this is gonna make you feel amazing.
Speaker 3:Yeah, definitely not asking for that. Thank you very much.
Speaker 2:And I've got some quite specific questions, but I just had one submitted before the talk that's quite general. I wanted to ask where has it gone? Sorry. If someone wants to come and see you, what sort of things should they be tracking and monitoring that would be useful information before they had an appointment with someone like yourself?
Speaker 1:So really good question. Obviously, track cycles. If you're still having cycles, track your cycles and see. Obviously, that will depend on if you're having if you've got a Myrina coil. And actually, I've kind of trained my staff up to know, like, we'll ask you before you come in, are you on the pill?
Speaker 1:So if you're on the combined pill, for example, there's no point doing any blood work because it will all come back as zero because it suppresses. So track your cycles, track your symptoms. So again, you know, people get misdiagnosed because in their 40s they might start having hot flashes and night sweats. So they'll go, Oh God, you must be menopausal. But actually, they're having night sweats a week before their period every month if they track it.
Speaker 1:In which case, it's not menopause, it's the lack of progesterone that's causing thermal regulation. So, I'll say track your cycles if you're having them. If you've got a coil in, for example, or you're on the pill or something and you're not bleeding, but you're noticing symptoms every month, track all of that because it's still relevant. So things like breast tenderness, bloating, pelvic cramps, you know, acne, anything you get, just track it all. And those are the key things that I'd say to track and to know.
Speaker 1:Then that gives me because part of it is getting as much history as I can from somebody. It's not just about blood work. Because as I said, blood work can go up and down in the cycle. So you do it at the beginning of the cycle, you do it in the second half. So I will then normally, from that, will then figure out when to send you for a blood test.
Speaker 1:If you're taking HRT and still feeling rubbish, we'll tell you when to use it so we know the absorption. So it's kind of all of those things are the good things to track.
Speaker 2:Amazing. Thank you. Irene, do you want to jump on and ask your question? Oh, you're on mute. Oh, Aurelie, you're on mute.
Speaker 3:Sorry. I showed it to myself, but didn't talk my thing. I was just wondering about NAD and whether you think that's a good thing, moving sort of post menopausally, especially as we know sort of levels of NAD when we're young are really
Speaker 1:high, and then as we get
Speaker 3:older they're much lower.
Speaker 1:Yeah, it's a common thing actually people are asking at the moment. Mean, it's not something I specialise. NAD is a bit more of like a functional medicine thing, so it's kind of on my list of things to read and research about, but it's just time for me really. So a lot of people do take it because obviously as we get older, like a lot of things, our NAD levels start to decline and some people find a lot of help from taking it. And I think some people use living as in The States it's quite common, but it's debated as to whether actually oral absorbs or whether you need to take an injection or have a drip and things like that.
Speaker 1:So it gets a bit more complicated, but definitely some people can benefit from it. It's not something I currently prescribe at the moment, but definitely a lot of clinics are looking into it from the longevity aspect, know, to help with mitochondrial function and things like that. But again, it's not going to be a replacement for hormones, but definitely can help with symptoms. Okay, thank you.
Speaker 3:I think I know somebody works in your clinic actually. Marion.
Speaker 1:Oh yes, oh lovely Marion! Does. But I
Speaker 2:went round the corner
Speaker 1:from you. But anyway, okay.
Speaker 2:Kiara, sorry if I'm saying your name wrong. Do you want to jump in and ask your question?
Speaker 4:Sorry. Are you talking to me?
Speaker 2:Yes. I am. Sorry. I probably said your name wrong, and I apologize.
Speaker 4:Kiara, I didn't hear the name. I didn't hear the name. I seem to not be able to to absorb progesterone. Well, that's what my my HRT nurse seems to think. Yeah.
Speaker 4:So I was all nicely balanced for a long time, and then two years ago, things started to go awry. And in the last forty weeks, I've been bleeding for thirty of them. Jeez. And I took two progesterone at night, and I also take a desogestrel on top of the oestrogen, and nothing seems to be working at all. And I've done a bicorneate wound, which they think has got something to do with it.
Speaker 4:Yeah. And so I'm going for yet another hysteroscopy.
Speaker 1:Oh god.
Speaker 4:And then potentially hysterectomy after that. I wondered, did you have any advice on how to get progesterone to actually absorb?
Speaker 1:So the other option so the thing is, Karam, it's a very good question actually, because eutogestan, because of the way it's made in labs, and a lot of it is made in China now, it's not properly micronized. It's not made amazingly well. In addition to that, and so it doesn't absorb well. So my standard dose for utragestan for progesterone in patients' menopause is two capsules. It's two hundred milligrams if they can take it, if not more.
Speaker 1:And
Speaker 2:again,
Speaker 1:it depends when they say you're not absorbing, when are they doing a blood test? What time are you taking everything? You know, if you take it the night before and then you go and do a blood test the following evening, it's not going to show up. It can be to do with gut health and your absorption in general. But in short answer, that's where kind of I use a compounding pharmacy as well.
Speaker 1:So if people's progesterone is low and they don't seem to be absorbing utrigestan or it's just not enough for them or they tend to bleed, I sometimes use a compounding pharmacy where I make up a different kind of progesterone for you. So sometimes eutrogen, I've had people where their level on two hundred, three hundred milligrams is still like two and their oestrogen is 500, so that will trigger bleeding. And then sometimes I'll give them progesterone as a lozenge, so I give it as a different form. Now again, the issue with that is that's not available in the NHS because it's made for you and it's compounded. So that is an option for people.
Speaker 1:So for example, you could get, let's say you wanted to go down that route and explore it because you really didn't want to have a hysterectomy. That is something that you could do, get a compounded progesterone where we see whether actually if we change the method we give it to you, you might absorb it a bit better and that might help. And then your GP could do the rest of the prescription. You just have to get the progesterone nozzage privately. Does that make sense?
Speaker 1:At the end of the day, trying progesterone vaginally, I'm guessing they've tried that, you can get eutrogestone and psychologestone. But again, no woman really wants to be shoving things up all the time because it can get a bit irritated. And again, you don't necessarily get the benefits of sleep and things like that. But that is an option, to try compounded progesterone, which is what I do for people if I don't think they're absorbing utrigestan. I mean, can try going up to three or four utrogestine if you're not getting any side effects.
Speaker 1:But again, I kind of find it a bit academic because if you're not absorbing two, then is four going to help? If that makes sense? I don't know. But I would say if you're doing a blood test, you'd want to take your utrogestan the night before and go for an early morning blood test, like eight to ten hours later if you can, because that's when it releases. And utrogestan is quite short acting, So it will release quite quickly, and then by the next morning the levels will have dropped quite quickly.
Speaker 1:So it's a tricky one, to be honest, guys. There's no right or wrong answer, but it is hard because then the only option they end up with is a hysterectomy. But it's not the end of the world if that's what you have to do and that's what you have to do. What I would say is if you do go down that path and that's what happens, make sure they give you progesterone after your hysterectomy because then what they're saying, Well, you don't need progesterone anymore because you've had a workload. A progesterone is super important for your sleep, for weight.
Speaker 1:You know, you still need a balance. Just because you don't have a uterus, it doesn't mean you don't need progesterone. So that is just my one key. If you end up going down that route, tell them you still want your progesterone.
Speaker 4:Okay, thank you for that. I appreciate it.
Speaker 2:Zara, do you want to ask your question?
Speaker 5:Yeah, mine's progesterone related as well. So when I went on to HRT, every time I took the progesterone I felt really depressed. Yeah. I then had a HRT review with a male GP and they just said to me always woolly your head. We then stopped my HRT repeat prescription so I couldn't get hold of any HRT at all.
Speaker 5:So I ended up coming off of it. I mean I feel absolutely fine, but I'm starting to worry. So it's been a year since I've had a period and I'm starting to think there are health benefits to having the hormones, but progesterone does scare me. Yeah. I mean it was so as soon as I would start to take it, my mood would get lower and lower and it would just be awful and I'd just be waiting to come off it.
Speaker 1:I was aware of it but I was really depressed. Yeah. Did you try it asylally, Zara?
Speaker 5:No, so it was just a tablet.
Speaker 1:Okay, and it was eutrogenstan, was it? It was micronized progesterone. It wasn't a synthetic progestogen.
Speaker 5:I have no idea if I couldn't So be that's
Speaker 1:the key to whether it was a synthetic progestogen or micronized bio identical progesterone. So progesterone can make you feel depressed. And interestingly, the synthetic forms like the combined pill or the mini pill and stuff can really make people feel depressed. That's why some people don't tolerate the pill. But actually, interestingly, there's a very small proportion of people that are intolerant of progesterone and it can make you depressed.
Speaker 1:It's not in your head. Often they sometimes people have had problems in pregnancy and things that they'll know, but it can eutrogenes. And the common side effects I always warn people of is it can make you feel groggy, so hungover in the morning, and in very few cases it can make you feel depressed. Again, I think you need to do a bit of research and find out what it was you were given. Was it body identical or was it synthetic?
Speaker 1:If you were given synthetic, then I'd try body identical something like utrogestan and see. If you can't take it orally, some people manage it vaginally and you can get a vaginal progesterone capsule. So some people, they get depressed with it when they use it vaginally. It's not an ideal way to use it, but some women manage. It's fine.
Speaker 1:And they don't get the depressive symptoms, but you've got the progesterone there. Again, like I said to Cara, the other option is sometimes if people don't tolerate utrigestan, I then compound progesterone for them. And weirdly, some people, it's utrigestan and the way it's metabolized in that particular kind that you don't like, rather than progesterone as a whole. Okay, yeah, that's super useful. Quite try those two things first and see how you get on.
Speaker 5:Okay, thank you. In fact, thank you for the whole thing. It's just been so good to listen and
Speaker 1:get all the information. It's a lot to cover. I feel like I could do an hour just on menopause, an hour just, you know, I'm sorry I'm going so fast, but I just thought because we've got all age groups, thought I wanted to try and cover everything. But yeah, I hope that was helpful. Oh, brilliant.
Speaker 1:Yes, thank you.
Speaker 2:I am astounded at how much I don't know about my own body, actually, is what I'm learning. Another question from someone who couldn't make the call. I'm on Mounjaro and the weight's finally shifting, but I'm 47 and I'm worried I'm losing muscle with fat. Is menopause making that worse and what should I be doing to hold on to my strength? Is Mounjaro helping me at all?
Speaker 1:Interesting. So, don't know if that person went and listened to the Mounjaro weight loss talk. It might be helpful to listen to that one because that covered kind of weight loss and muscle mass and things. If you were on Mounjaro, I think, yes, you can lose muscle. It's worth having your hormones checked because as we talked about before, testosterone, I mean, estrogen, progesterone, testosterone, they're all relevant.
Speaker 1:But if you're not fully menopausal yet, maybe a bit of testosterone, but your testosterone's low, for example, replacing some testosterone could help maintain your muscle mass. So I do think it's really important to try and optimize your hormones if you're doing something like Mounjaro so you're not missing that piece of the puzzle because muscle mass is a very common thing people lose. Obviously, strength training is super important, eating enough protein because that will all help maintain your muscle. Yeah, balancing the hormones can help and also slow weight loss. So do it, make sure it's gradual.
Speaker 1:So if I'm doing weight loss with patients, I go very gently because the slower you lose, the less likely you are to shed muscle very suddenly.
Speaker 2:Makes sense. Then, Claire, this posted one from someone else who couldn't make the call. Can hormones be to blame for not losing weight age 34? She feels like everything is ballooning at the moment and doesn't understand why.
Speaker 1:Definitely can be, because obviously you've got things like common hormone problems that can impact would be thyroid. So, common reasons why people struggle with weight could be an underactive thyroid that's not been diagnosed. Again, I say you want to have optimum levels. Unfortunately, in the NHS, normal, if you're just in the normal range, that doesn't necessarily mean optimal. And the range for T4, for example, which is your thyroid hormone is 12 to 22.
Speaker 1:So I say, where would you rather be? 12 or 22? And so it could be thyroid. Again, it could be something like PMOS because very commonly I see in younger people that can't lose weight. I mean, look, if you're not menopausal yet in your 30s, which is unlikely if you're having periods and things, it's unlikely to be menopause.
Speaker 1:It could be a bit of estrogen progesterone imbalance. But the key one I would be thinking about would be PMOS because it could be the insulin resistance that's triggering that. And so that's why a lot of people come in and maybe you've got regular periods and you don't have any other symptoms and your only symptom is weight, it can still be PMOS. So I think that's kind of the key thing to get some proper blood work done and get that ruled out.
Speaker 2:Amazing, thank you. And then Claire you had a question around progesterone if you want to ask.
Speaker 3:Yeah, thank you for answering the other one as well. And it was just in relation to what you said about being sensitive and progesterone making you feel like more down and depressed because I was told that I'm progesterone sensitive. So when I'm not taking it, that's when my
Speaker 1:mood drops.
Speaker 3:So I tried it on the two weeks on and then the two weeks off. And when I was on the two weeks off, it was literally, like, made all my PMDD symptoms so much worse. So now I have to, like, take it twenty five out Wow. Of twenty
Speaker 1:So I take it every day, that's kind of part of the thing is I don't take things. I have known patients that cycle progesterone who are on oestrogen. Because if you feel better on progesterone, that's the hormone that's missing. And for PMDD and PMS, it's the lack of progesterone that's making you feel bad. As I said, if you remember, that's why I kind of like to do the bit on what estrogen does, what progesterone does, because progesterone is your happy hormone, it's your calming hormone, it's your sleep hormone.
Speaker 1:So actually you need progesterone. So ideally, you need progesterone throughout your cycle, Claire, to When you're just taking oestrogen, you're making your PMS worse because your body doesn't have oestrogen by itself. It needs progesterone to balance it out.
Speaker 3:I think I need to go back and have more chats. Thank you. If you're
Speaker 1:still feeling like this and everything's all over the place, I think you need to go back and get a proper review. And I do start from scratch with people, you know, as horrified as people are when they come in and everything's all over the place, was like, you know what we're gonna do? We're gonna stop everything and we're gonna see what your symptoms are now and where they are. And that's how sometimes it has to work is, okay, where am I? Am I still having periods?
Speaker 1:Am I not having periods? And then do a blood test and then go back to baseline and work back. Because if it's been two years, something's not working.
Speaker 3:Thank you.
Speaker 2:I realise we've kept you for a whole hour and I'm Just so if anyone's listening and didn't see the slide, is it the Omnia clinic in Knightsbridge?
Speaker 1:Yes, it's Omnia. So if you want, I can send the details, Jackie, to Scott, just so everyone's got them. So my clinic is called, well it's Hormones Wellness Clinic, is my brand. So if you Google Hormones Wellness Clinic, on my website I've put a lot like I put a lot of stuff on the website. So you'll get pricing, you'll get appointments and stuff like that.
Speaker 1:And I've put all the conditions that I treat and a little bit about them. And then I work out of a clinic called Omnia. So yeah, if you want to get in time to contact, you can either contact Omnia or then also if you want to follow on my Instagram, that's just Doctor. Amalia Hana Radnam, so that's just my name. And it will have Hormones Wellness Clinic, so you know it's me.
Speaker 1:So that's just got like stuff I've put stuff that's kind of helpful to people. So sometimes people find, Oh my god, I didn't think of that. That's what it is. So if you do need anything, either contact me on my website or Instagram, or you can contact Omnia. And the girls are really good.
Speaker 1:They'll tell what to do and when to go for bloods and things like that.
Speaker 2:Amazing. I can't say thank you enough. I think that's been one of the most useful talks I've listened to. And I'm sure so many of us have gained critical insight into our own health, which is extraordinary that we don't know it, but very grateful that you're here to help us all. And I'll certainly be giving you a follow.
Speaker 2:I'm sure most of us will be. So, yeah, thank you again so much.
Speaker 1:Thank you for having me and taking the time out on Thursday. I hope it was helpful. And yeah, if you've got any questions, I know it's hard to answer kind of medical stuff because it's so difficult, but you know, if you need any help, then just message me and find me on Instagram. But yeah, just go empowered. And there's lots of good books out there as well.
Speaker 1:Know, if you want, Jackie, just drop me an email and I'll send you my reading list. Because I think Instagram is a little bit much at the moment, and there's too much, and it's just do this, do that, do that. And I think sometimes people get a bit rabbit in their headlights and they're like, oh god, I don't know what to do. So they don't do anything. And I know that NHS care, and I know this because I work in the NHS a bit still, it's just we don't have good hormone healthcare unfortunately, and I think it's something women need.
Speaker 1:If you can kind of go empowered and sometimes figure out what's going on in your body. And I always say the most important thing, key thing I would take away, you know your own body better than anyone else. So more often than not, your body will tell you what it needs and what's wrong, and your instinct is so important. Like people will come in to me like you can be like, I don't know, I just want to come off everything. And I'm like, if your body is telling you, Okay, I just need to come off and start from scratch, and that's what your gut feeling is to do, that's the right thing to do.
Speaker 1:So I say, don't ignore those instincts that you have. If you feel like something cyclical, despite what doctors will tell you or things like that, you know your body better than anyone else. So that's the biggest piece of advice I can give you.
Speaker 2:I love that. Thank you. And I definitely yes, I'll get that book and reading list off you. And, thank you so much. You've been so generous.
Speaker 1:Thank you, everybody. I hope it was helpful. Have a good evening.
Speaker 2:Have a good evening.