Rebranding Menopause: Glycans, Hormones and Inflammation with Louise Newson

Podcast published on 7/18/2023 • Show notes written by Vanja Maganjic & Rina Bogdanovic

37 minutes reading time
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Episode summary

Does menopause hold implications beyond reproductive health? This episode reveals that the shift in hormonal balance affects inflammatory patterns, mediated by complex carbohydrates called glycans. We unravel the overlooked role of perimenopause in chronic disease onset and debunk common myths. Exploring hormone replacement therapy, we discuss its wider health impact, beyond mere symptom management. Louise Newson, a distinguished GP and Menopause Specialist, is the founder of the Balance App, The Menopause Charity, and the Newson Health Menopause Society. An active member of the UK Government Menopause Taskforce, she continually works to elevate menopause understanding and care. Listen in as we discuss the potential of glycans as biomarkers for menopause, surpassing existing diagnostic tests in their predictive capacity.

 

Conversation timestamps

We discuss: 

• Menopause Specialisation: Why Choose It? [02:11]
• Menopause: Myths vs. Facts [04:12]
• What Exactly Is Menopause? [05:33]
• Testosterone's Role in Female Health [08:04]
• Sex Hormones and Immune Regulation [09:18]
• Menopause and the Rise of Chronic Illness [12:36]
• Viewing Menopause as a Hormone Deficiency [15:22]
• Menopause and Metabolic Syndrome [16:57]
• Menopause and the Gut Microbiome [18:20]
• Oestrogen's Role in the Cardiovascular System [24:03]
• Is Perimenopause Contributing to Chronic Disease? [26:59]
• Limitations of Current Menopause Tests [30:53]
• Introducing the Balance App [32:00]
• Glycan-Based Menopause Tests [34:05]
• Addressing the Lack of Menopause Education in Medicine [35:36]
• Common Questions About Hormone Replacement Therapy [38:50]
• A Look at the Newson Clinic [41:26]

About the guest

Conversation highlights

"Most of our hormones oestrogen, progesterone, and testosterone get produced by the ovaries. We were born with a finite number of eggs. So as our egg number declines, the associated hormones decline as well. So the average age, not that any woman's average, but the average age of menopause is 51 in the UK, and that's when eggs are very low. So, therefore, hormones are very low as well. One in 100 women under the age of 40, can have an early menopause. So there's no lower age limit to be menopausal."

"A lot of people think our immune cells are just to fight diseases as in infections, whereas it's more important than that, actually. So our immune system is, as you know, very tightly regulated. Actually, there are lots of things that can change and alter our immune system. And that might be something that we eat, it might be if we don't sleep properly. But it also might be other substances in the body. So if we drink lots of alcohol that's going to affect our immune system. But also if our hormones change that can affect our immune system as well. Our immune system, obviously, is very anti-inflammatory. But if there are things that prime the immune system, so it's pro-inflammatory, then that's when there can be problems. And so if it's pro-inflammatory, then it increases inflammation. And we know then that infections can occur more commonly, but actually more important, if there's inflammation in the body, there's an increased risk of inflammatory diseases. And these diseases include important diseases such as heart disease, osteoporosis, type two diabetes, dementia, even Parkinson's disease and clinical depression, often considered inflammatory conditions. And we know that estradiol can genetically reprogram the way that our immune cells work, it can also increase the number it can alter the way that they function as well. So when we have low oestrogen, it switches our body from an anti-inflammatory state to a pro-inflammatory state." 

"So many women, and physicians and men as well, are thinking - Oh no, HRT equals breast cancer. Well, of course, we know from the studies that it doesn't. But it's made a massive difference to the way we think about hormones and the way we've neglected hormones as important biological agents that can reduce disease." 

"So, worldwide, the commonest cause of death in women is cardiovascular disease. And most women are more scared of breast cancer than they are of heart disease, and they think breast cancer is more common. Actually, even if you look at women who've had breast cancer, most of the women who've had breast cancer die from cardiovascular disease. So if we're looking at menopause as a global health problem, which indeed I think we should do, then we should be looking at what we can do to reduce cardiovascular disease in women. Yes, of course, they can exercise more. Yes, of course, they can improve their diet, but actually reducing their hormones can lower cardiovascular disease incidents quite significantly, especially when it started within 10 years of menopause, so when women are perimenopausal, or their periods have stopped for less than 10 years. But the body-identical hormones we prescribe are likely to still be beneficial when started at an older age."

 

Episode transcript

Rina’s Intro

Rina Bogdanovic [00:05] Hello, hello, and welcome back to GlycanHub - the podcast in which we explore health, disease, and longevity through the lens of glycobiology. My name is Rina, and I am your host. What is menopause? Most people will tell you that it is the termination of a woman’s menstrual cycle as the number of eggs in her ovaries depletes. This would be correct, but is there more to menopause beyond viewing it from a strictly reproduction-focused point of view? What is the reason behind the menopause symptoms numerous women experience? And why do so many women develop chronic diseases around the age of menopause? My guest today is rebranding menopause as a female hormone deficiency to emphasise the integral role of sex hormones in healthy physiological function. We will discuss how this reduction of sex hormones during menopause impacts the immune system, the composition of the gut microbiome and the incidence of chronic diseases. We will address some of the myths surrounding hormone replacement therapy, discuss the role of HRT in improving the quality of life of postmenopausal women and consider the potential of using IgG glycans as biomarkers of perimenopause. My guest today is a GP and a Renowned Menopause Specialist. She is the founder of the Balance App, The Menopause Charity, Newson Health Menopause Society, a bestselling author as well as a member of the UK Government Menopause Taskforce. She works to increase the knowledge of perimenopause and menopause and campaigns to improve menopause care for all women. A warm welcome to Louise Newson. 

Louise Newson [02:09] Hi, thanks for inviting me.

Menopause Specialisation: Why Choose It?

Rina Bogdanovic [02:11] So I think the first question that comes to mind is that you are a GP, so why did you choose to specialise in menopause?

Louise Newson [02:19] So I never really chose initially, it just happened. I'm a GP, but I've got a background in Hospital Medicine. And when I was training, I took a year out and did a pathology degree. So I was very interested in basic science and disease and the sort of molecular basis of disease as well. And then I changed track when I had my children actually. So I could be a bit more flexible with my career and look after my children because my husband's a surgeon. I really enjoyed seeing menopausal women. Actually there's a lot in medicine that you can't make a huge difference in or it's more complicated or as a GP, you'd have to refer people if they needed surgery or other treatments, for example. Whereas menopause was something that I could do quite easily. And I quite quickly found it's very transformational, someone comes to see you and they are debilitated with night sweats or memory problems or joint pains or headaches and giving them some HRT, you know, within three months, they'd come back and say, well, thank you for giving me my life back. And more than that, actually, once I started to understand the effects of HRT, the beneficial effects on our heart, our brain, our general health and well-being and disease prevention, I thought I wanted to do more because there are so many people that are being denied the treatment. And so I became a menopause specialist and thought I would just see a few people one day a week in a clinic, and obviously, it escalated. I hadn't realised the enormity of the problem. It's like anything, isn't it? Once you get in there, you think goodness, why didn't I know this before? But once you see the menopause, you can't unsee it so it's quite addictive actually trying to help and reach more and more people. So my work now is a lot more than just my clinical work.

Menopause: Myths vs. Facts

Rina Bogdanovic [04:12] No, absolutely. And we will touch upon just the amount of information you've put out there and how much you've helped break the stigma around menopause. But I do think it's still a quite sensitive issue for many people. And so I thought a fun way to start with may be to have a few truth or myth statements, you can say whether it's truth or myth, and we're going to come back to them during the conversation. So the first statement is - menopause only impacts the health of some women.

Louise Newson [04:40] Depends on how you define health, doesn't it? But it certainly impacts the health of all women. When people don't have hormones because our hormones are biologically active and without them then our bodies change so our risk of disease and so forth, can increase so yes, that's false.

Rina Bogdanovic [04:57] There is a difference between male and female sex hormones.

Louise Newson [05:01] Actually, that's interesting, isn't it? No, there isn't.

Rina Bogdanovic [05:05] Menopause is linked to an increased incidence of chronic diseases. 

Louise Newson [05:07] Yes.

Rina Bogdanovic [05:09] Diet cannot help with menopause symptoms.

Louise Newson [05:12] Interesting. I mean, like a lot of things in research, it's not black and white. But there is some evidence that it can reduce and help some symptoms. If you change your diet.

Rina Bogdanovic [05:22] HRT is dangerous and causes breast cancer. 

Louise Newson [05:25] No, that’s ridiculous. 

Rina Bogdanovic [05:30] HRT is only beneficial to women who started early.

Louise Newson [05:32] It's probably more beneficial, but not only.

What Exactly Is Menopause?

Rina Bogdanovic [05:33] Okay, great. So before we get into the proper conversation, I think the key term we have to define is - what is menopause? 

Louise Newson [05:40] I think about this a lot because the actual definition is a stop of our menstrual cycle. So when we haven't had a period for a year, but actually lots of women don't have periods. They might have had a hysterectomy, or they might have a Mirena coil or use contraception. So that's quite a hard definition. And it's also difficult because you have to wait a year before you can get a diagnosis. Most things in medicine, if you see the right doctor, and you have the right investigation, you can get a diagnosis within sometimes hours, days, weeks, or months, but not a year. So then some people think about it is whether it's our post-reproductive life when we're menopausal, as in we can't conceive, but actually, as a woman myself, who's menopausal, I want to be thinking beyond my womb and beyond my reproductive status. So it is actually when our hormones deplete or are reduced because usually, it's because our ovaries aren't working or they might be removed. So it's more of a hormone deficiency that lasts forever, which may or may not cause symptoms, but it also does become associated with health risks.

Rina Bogdanovic [06:51] Now, you said men and women do have the same sex hormones. But what happens to the female side? Well, sex hormones and women around the age of menopause?

Louise Newson [07:01] Yeah, so most of our hormones oestrogen, progesterone, and testosterone get produced by the ovaries. We were born with a finite number of eggs. So as our egg number declines, the associated hormones decline as well. So the average age, not that any woman's average, but the average age of menopause is 51 in the UK, and that's when eggs are very low. So, therefore, hormones are very low as well. One in 100 women under the age of 40, can have an early menopause. So there's no lower age limit to be menopausal. So, the ovaries aren't the only source of our hormones. Our adrenal glands do produce hormones as well, but not as much. Testosterone is a biologically active hormone that we actually when we're younger produce more of the oestrogen but it generally declines with age as opposed to it being a big hormonal drop when we're menopausal. Other than those women who have their ovaries removed, their levels of testosterone can then plummet quite quickly.

Testosterone's Role in Female Health

Rina Bogdanovic [08:04] Why do you think testosterone is often overlooked when it comes to female health?

Louise Newson [08:08] I think it's because there's a misunderstanding. And I think, you know, haven't we always grown up thinking oestrogen is for women and testosterone is for men, but actually, men produce oestrogen as well, which has been very neglected. I mean, I didn't know at medical school or as a postgraduate that women had testosterone, it wasn't something that was spoken about. But it is really important when we think there are testosterone receptors on cells all over our body. So we're not designed to have receptors on cells unless the hormone or substances activating those substances are relevant to us. I think the other problem with testosterone is that the research that's been done has always been about libido, or mostly about libido. And don't get me wrong libido is very important for many people. But it's not the only thing that happens when you have testosterone deficiency. So we desperately need more research in this area. And we need to not be so worried about testosterone, lots of people are scared about the fact it's been prescribed or the fact that they might be offered it. And for a lot of women, it can be very beneficial. 

Sex Hormones and Immune Regulation

Rina Bogdanovic [09:18] In this conversation, we are going to focus quite a lot on chronic diseases, where chronic inflammation plays quite a big role. And I'm also going to take advantage of the fact that you have a degree in immunology. So could you tell us what the role of sex hormones is and the regulation of immunity and inflammation?

Louise Newson [09:38] It's a great question. I think if you take a step back, really think about the immunity and inflammation in your body. A lot of people think our immune cells are just to fight diseases as in infections, whereas it's more important than that, actually. So our immune system is, as you know, very tightly regulated. Actually, there are lots of things that can change and alter our immune system. And that might be something that we eat, it might be if we don't sleep properly. But it also might be other substances in the body. So if we drink lots of alcohol that's going to affect our immune system. But also if our hormones change that can affect our immune system as well. Our immune system, obviously, is very anti-inflammatory. But if there are things that prime the immune system, so it's pro-inflammatory, then that's when there can be problems. And so if it's pro-inflammatory, then it increases inflammation. And we know then that infections can occur more commonly, but actually more important, if there's inflammation in the body, there's an increased risk of inflammatory diseases. And these diseases include important diseases such as heart disease, osteoporosis, type two diabetes, dementia, even Parkinson's disease and clinical depression, often considered inflammatory conditions. And we know that estradiol can genetically reprogram the way that our immune cells work, it can also increase the number it can alter the way that they function as well. So when we have low oestrogen, it switches our body from an anti-inflammatory state to a pro-inflammatory state. 

Rina Bogdanovic [11:18] For a short time, I'm going to talk about the IgG glycan. You have collaborated with Genos, our lab in Croatia, and released a study earlier in 2022. Now when it comes to the IgG glycome composition, it has been shown that it changes as we age, as well as increases the level of chronic inflammation which allows us to calculate one's biological age. What happens to the biological age of women as they enter into menopause?

Louise Newson [11:48] Well, we know that it does increase and it can increase quite rapidly. There have been other studies that show that if young women have an ovariectomy, a bilateral ovariectomy so they have both their ovaries removed, that means they become menopausal literally overnight. They have rapidly accelerated ageing. So the biological age increases. And we know probably around the perimenopause, menopause, there's again this increased inflammation, which if you think back and I often do, when we're uncertain about something, you think back to basic pathophysiology, and it's all there for us, we know that, okay, we've got low oestrogen, therefore, our immune cells aren't primed properly, they're not working properly. Increased inflammation equals increased disease and increased biological age as well.

Menopause and the Rise of Chronic Illness 

Rina Bogdanovic [12:36] Which kinds of diseases are more often observed in the age of menopause?

Louise Newson [12:41] Diseases I mentioned. So heart disease, cardiovascular disease, osteoporosis, type two diabetes, dementia, but also some autoimmune diseases as well, can be associated, even MS might be an inflammatory disease, there's a lot we don't know about the aetiology of these diseases. And, actually, what's very interesting is that not every menopausal woman will develop cardiovascular disease or osteoporosis. So we know there are other factors as well, of course, but we do know that there's accelerated atherosclerosis or increased risk of heart disease after menopause. We know that one in two women, compared to one in five men, over the age of 50, will develop osteoporosis. So there is a gender difference. And I'm sure it's not just because we've got different chromosomes, it will be related to our hormones as well. Because research in menopause has been neglected so much over the last 20 years, as you know, a lot of people are forgetting the important role of estradiol. It's interesting, your question that we're getting about HRT and breast cancer, so many women, and physicians and men as well, are thinking - Oh, no HRT equals breast cancer. Well, of course, we know from the studies that it doesn't. But it's made a massive difference to the way we think about hormones and the way we've neglected hormones as important biological agents that can reduce disease. 

The Current State of Menopause Education in the Medical Community 

Rina Bogdanovic [14:20] Do you think in education, we've been able to kind of catch up and update efficiently our educational materials about sex hormones, HRT and breast cancer?

Louise Newson [14:31] Well, we are trying, but it's difficult and I think it's like anything when you challenge beliefs, it can be very difficult to be listened to, especially if you're a minority voice. And it is very hard to change when people have very instilled views. But I think what is happening is that women are actually understanding quicker than maybe some of the healthcare professionals and you know, we can all access the same studies we can all learn for ourselves and women are more desperate to have the knowledge because they're the ones that are suffering. I think there's a lot of change. There are a lot of healthcare professionals that are reading the science, that are understanding, that are encouraging women to take a look at their hormones. So I think things are changing, but it's just slow. 

Viewing Menopause as a Hormone Deficiency

Rina Bogdanovic [15:22] Why are you encouraging the rebranding of menopause as a hormone deficiency?

Louise Newson [15:27] Because that's what it is, isn't it? I think there's, I don't know why there's a big pushback. There are people who say it's not a hormone deficiency. I'm happy to be challenged. Of course, I am. But I think if you have your ovaries removed and they produce hormones, then it's going to cause a deficiency in the same way an organ in our body that isn't working would. It causes a hormone deficiency. And some people have criticised me for comparing it with hypothyroidism. But I don't quite understand why because it's another hormone. And if your thyroid doesn't work, or if it's removed in an operation, then you lose your thyroxine. I think it's because people have just thought about our ovaries as producing hormones that help with reproduction, and the menstrual cycle. And then that gets back to why the definition of menopause is about menstrual cycle and fertility.

Rina Bogdanovic [16:18] Yeah, it's almost like it's compartmentalised. You know, reproduction is put into a single box. And all the other benefits of sex hormones are just neglected.

Louise Newson [16:27] You're absolutely right. And that's where we've got to change perceptions. You know, someone recently said to me, gosh, I didn't even know that hormones, estradiol and testosterone even went into the brain. It's like, well, it's so obvious. They’re neurotransmitters, they help the circuits in the brain. They've got receptors for these hormones in our brains. But I think if you haven't been thinking about it, it's quite hard, isn't it to then just think, wow, I didn't know that. And it always takes time to change when you're challenged with beliefs.

Menopause and Metabolic Syndrome

Rina Bogdanovic [16:57] And when it comes to chronic diseases, one, which is, I guess, an umbrella term that encompasses many is metabolic syndrome. Could you perhaps define what it means?

Louise Newson [17:06] Yeah, it's interesting, isn't it? I think there are different definitions, but metabolic syndrome is sort of linked with pre-diabetes. So it's one of those things it's hard to diagnose. But what happens in our bodies is that we have increased, or we have less ability to clear glucose in our body. So we're more likely to find that our pancreas is working harder than it would have been otherwise to break down the food and to cause our glucose levels to be normal. But also it's associated with other inflammatory diseases, so cardiovascular disease as well. And we see metabolic syndrome more in people who are overweight. You see it with people with an increased risk of cardiovascular disease, there's some genetic component to it as well, people who smoke, and people who don't have the best diets have an increased risk of metabolic syndrome. But we also know that menopause is a cardiometabolic syndrome as well. Which again, links in with why we know what we know about oestrogen and the inflammatory cells in the body and our immune system.

Menopause and the Gut Microbiome

Rina Bogdanovic [18:20] Another study of yours that recently came out, well, recently in the last year was a study that collaborated with the ZOE team looking at, among other things, the metabolic syndrome. And if I'm not mistaken, the findings showed that there is a difference in the abundance of bacterial species in the gut microbiome post menopause where there were more pro-inflammatory and obesogenic bacteria. So what did the study show or indicate about the impact of oestrogen on the gut microbiome?

Louise Newson [18:51] It's very interesting, and it fits in with what I've thought for a while, really, but there is a difference in the gut microbe before and after menopause. So, with hormones and without, we know increasingly how important our gut microbiome is for keeping us healthy. Not just our physical system, but also mentally as well. And so not having estradiol alters that. What we need to know is, if you have HRT back, how does it reverse or improve that some work that we're trying to do with Tim Spector in the ZOE team, because it's so important to put all this puzzle together. And it's so obvious to me because it fits in with the science. But again, people haven't thought about menopause as something more than that something that causes hot flashes and night sweats. They think more about symptoms rather than disease processes. And it's very important because we also obviously, hormones are important, but we need to also think about other ways we can improve our nutrition to improve our gut microbes if we know they're changing at a certain time in our lives, it's a really good, good time to start thinking - Well, what should I do about my diet? Should I be eating as much processed food? Or should I be eating some slightly different types of food to alter that gut microbiome? So it's a really important study. But there's clearly a lot more that needs to be done.

Rina Bogdanovic [20:24] It's quite a strange thing that the same diet might impact our body differently before and after menopause. And I think it's also very important to remember that the gut microbiome has so many important roles in our body beyond just helping us digest our food. So when it comes to our current understanding of diet and its potential impact on menopause, how significant of an impact can it have on managing our symptoms?

Louise Newson [20:53] I think it's very difficult to know because everybody's menopause is different. And different people have different symptoms, but they also have different symptoms at different times. So most people don't have two days the same when they're menopausal. So then it's very difficult to study and see, is there a change just because it is menopausal? And that's what happens, symptoms change each day? Is it because I had a slightly different night's sleep? Or is it because I had a slightly different diet? And that's where it's very difficult. You know, we do know from some studies that, for example, reducing spicy foods, reducing caffeine can help with hot flashes. But then this is where I get frustrated because menopause is not just about symptoms, you know, I could stop my HRT tomorrow, and I might have no symptoms at all. But I then have this increased inflammation in my body because of the low hormones that will occur if I stop taking HRT. I'm personally very worried about the osteoporosis of my spine because I've seen enough people to know how crippling that can be. So I have as a menopausal woman made a personal choice that I know that taking HRT will reduce my risk of disease and hopefully lower my biological age. But I'm more worried about my heart, my brain, my bones than I am about my symptoms. So I could eat the best diet in the world and have no symptoms, but I can't replace hormones unless I take them. There's no other way of doing that. 

Rina Bogdanovic [22:23] Do you have many women who perhaps ask for HRT, even if they don't have many symptoms, because they're looking at that long-term impact? Or do you think most people just want to stop the symptoms as soon as possible?

Louise Newson [22:35] There's a bit of both. Most women do have symptoms. So they take HRT for their symptoms, but they also are conscious of their future health. Increasingly, we do see women in the clinic, who say - Well, I don't have any symptoms, but I've read about the risk, or my mother's got dementia, or my auntie had really bad osteoporosis, I would like to consider. We know from all the menopause guidance worldwide, they don't indicate that HRT should be given for primary prevention of disease. And I find that’s quite disappointing because there is good quality evidence, even if you just look at cardiovascular disease or osteoporosis. So then I think a lot about patient choice. And I'll often say to women, well, you could take HRT for three months, and then see how you feel about it. And what's very interesting is they often come back after three months and say goodness, I've got more energy, I've got more clarity, I'm sleeping better. I don't have joint pain anymore when I exercise, I thought that was just part of getting old. So a lot of people think they haven't got symptoms, but maybe they have. So I feel no, we're looking more at the risks of not taking HRT because, for 20 years, we've been speaking about the risks of taking it. But there are risks to avoiding it. And I think women should be allowed to make a decision based on what's right for them. And then their choice, you know, the decision can change with time as well, which is really important.

Oestrogen's Role in the Cardiovascular System

Rina Bogdanovic [24:03] What is the leading cause of mortality and morbidity in postmenopausal women?

Louise Newson [24:09] So worldwide, the commonest cause of death in women is cardiovascular disease. And most people when they've done surveys, women are more scared of breast cancer than they are of heart disease, and they think breast cancer is more common. Actually, even if you look at women who've had breast cancer, most of the women who've had breast cancer die from cardiovascular disease. So if we're looking at menopause as a global health problem, which indeed I think we should do, then we should be looking at what we can do to reduce cardiovascular disease in women. Yes, of course, they can exercise more. Yes, of course, they can improve their diet, but actually reducing their hormones can lower cardiovascular disease incidents quite significantly, especially when it started within 10 years of menopause, so when women are perimenopausal, or their periods have stopped for less than 10 years. But the body-identical hormones we prescribe are likely to still be beneficial when started at an older age.

Rina Bogdanovic [25:07] Could you perhaps give a little explanation about what it is that oestrogen does in the cardiovascular system, and perhaps why its absence might contribute to cardiovascular diseases?

Louise Newson [25:19] Obviously, as I said before, estradiol is very anti-inflammatory. And if you look at the endothelial lining of the blood vessels, it's quite biologically active. It's not just something that lines the blood's first vessels to stop the blood vessels from leaking, there's quite a lot of dynamic processes going on. And there are lots of chemicals there that can reduce inflammation. So if you've got oestrogen in your blood vessels, it reduces that inflammation and there's lots of feedback, chemicals. So there are things like nitric oxide, prostaglandins, prostacyclins, there are all sorts of other chemicals that can either damp down or increase depending on whether they're good or bad chemicals, with estradiol if that balance is good, then there's less inflammation, so therefore there's less atheroma. We know that with cardiovascular disease, you get a buildup of these fatty deposits, this plaque that occurs, and then it narrows the blood vessels, it also makes the blood vessels firmer, so people are more likely to have raised blood pressure. And so all these processes occur more quickly when there are lower oestrogen levels, and probably also lower testosterone levels as well, because we know certainly in men, if they've got low testosterone, they have an increased risk of cardiovascular disease. And although our amounts physiologically of testosterone are lower than men, it probably still hasn't the same sort of process that occurs with the anti-inflammatory process in the lining of the blood vessels as well as testosterone in women.

Is Perimenopause Contributing to Chronic Disease? 

Rina Bogdanovic [26:59] And even with cardiovascular diseases being the leading cause of mortality and morbidity they are still being underdiagnosed and misdiagnosed in women. When it comes to perimenopause, why do you think it is often overlooked as a contributing factor in chronic diseases?

Louise Newson [27:16] I think this because perimenopause is often misunderstood by patients but also from healthcare professionals. And because we don't have a diagnostic test for the perimenopause, then it's going on symptoms. And this is increasingly what we know for decades, women haven't been listened to when it comes to symptoms, you know, we only need to look at the word hysteria and hysterectomy, you know, they're associated and the Victorian times lots of women were locked up in asylums. And the people just thought they were mad, but actually looking back how many of them didn't have their hormones and how many of them were menopausal, or perimenopausal? And so the only way you know whether someone has a hormone deficiency or not, or if they're perimenopause or not, is by sometimes giving them HRT to see if it helps their symptoms. And we often do that, because there's no way of knowing otherwise. And, you know, if someone's tired, and they're irritable, and they're not sleeping well. And they've got headaches. Well, could it be because they've got four children at home and they're struggling as a single mom? Or is it because they've got hormones and the hormones have dropped? It's impossible to know. And it probably could be both that's causing, you know, but I think, because we're looking at trying to improve future health, and the risks of HRT are either non-existent or very low, depending on what type is given, then it certainly seems wrong to not believe women and deny them something that might help how they're feeling.

Rina Bogdanovic [28:50] As you said, it's very difficult to diagnose perimenopause, would you say it's still possible to diagnose even if it's not possible to measure very accurately? 

Louise Newson [28:58] Yes, it is. And I think it's harder in younger people because they're often it's not thought about the menopause, either. The women themselves aren't thinking about it, or the clinicians themselves. And we know certainly with younger women, often they have some pain, PMS, for example. And just feel bad for a day or two before their periods, and then it extends, so it's more than just a couple of days, and then they become perimenopausal, and there's no magic way of making the diagnosis, or knowing what the difference is. And often with women, there's a bit of blurring between PMS and perimenopause. And it's usually just with time that you go from one to another. But it's really important that we consider hormones in more women because there are a lot of women who are denied their hormones or they're given the contraceptive pill or even the progesterone-only pill or implant, and that might be making their own hormones worse, so making them feel worse as well.

Rina Bogdanovic [29:57] And so basically what you're saying is that an early perimenopause diagnosis might really help with disease management of other diagnoses and perhaps prescription of proper and correct therapy.

Louise Newson [30:10] Yes, absolutely. And I think that's really important because a lot of women especially so for PMS, perimenopause, and menopause are offered antidepressants, which we know won't make any difference because you're not treating the underlying cause. And so this is where I think women need to be their own advocates and try and do some homework, you know, download the Balance App that's free, monitor your symptoms, and then go to your GP or your healthcare professional and say - look, I think this could be my hormones, and before you give me a drug for my blood pressure, or sleeping tablet, or painkiller, or an antidepressant, can I just have a bit of my own hormones, send some hormones back? And then can we review after three months? 

Limitations of Current Menopause Tests

Rina Bogdanovic [30:53] Now, as you said, there isn't currently a very precise, correct diagnostic measure for menopause and perimenopause. And yet many women listening to this might say - Oh, well, they actually measured my hormones before I got my treatment. So what are the limitations of measuring hormones? 

Louise Newson [31:12] I think it's really important that people are aware that there isn't a blood test, a saliva test, a urine test, and any test for perimenopause or menopause. And because our hormones fluctuate so much when we're perimenopausal, you might have days when your hormones are very high. And if you have a blood test at that time, then you'll be told all your hormone levels are normal, or they're raised. But actually, at three in the morning, when you're having a night sweat, it's often then that symptoms are worse. And that's when your hormone levels drop, but no one's going to come and do a blood test at three in the morning. So having normal blood tests doesn't mean anything. If they're abnormal, it can help. So that's why making a diagnosis of symptoms alone is often more important and more relevant.

Introducing the Balance App

Rina Bogdanovic [32:00] What you've done with the Balance App where women can access evidence-based information, they can track their menopause, and can essentially diagnose themselves as menopausal. What has been the aftermath of launching this app?

Louise Newson [32:15] It's very phenomenal, actually, what we've been very lucky with, yeah. And how you look at it, but we've not had external funding for the app, because I was very clear that I wanted to make it grow organically. And everything I've learned about external investment. I mean, I've never had it but from other people is that you have to be very rigid and what you do. And so what I wanted to do was have an app where it really helped people to try and understand the symptoms, what was happening to them, try and help them make a diagnosis, but also feel like it was there to support them and help them and to shape their future health as well. So we give a lot of information about nutrition and lifestyle. And even that women can share their stories, so then they don't feel quite so alone. And also the ability that we can monitor symptoms with different treatments as well.

Rina Bogdanovic [33:08] Have you seen an increase in the number of women who come to your clinic and have been using your app and say - Okay, I've actually been following my symptoms, I think I'd be perimenopause or menopause, do you see this increase since the launch? Since the app has been available?

Louise Newson [33:21] Yeah, we do a lot. And also, I hear a lot on social media as well. And actually, even I was at an event last night in London and complete strangers came up to me and said - I just want to thank you, you've completely transformed my life. And I've never come to your clinic, I've never met you before. I just downloaded the app, and it told me everything I needed. And I went to my doctor who was amazing. And I've now been on the right dose and type of HRT, and I feel incredible. So it's having a really big effect, not just in the UK, but worldwide. We have many hundreds of 1000s of users in many countries. And we're doing a lot of work with translations as well. So it's hopefully really reaching a huge number of people, which is really exciting. 

Glycan-Based Menopause Tests

Rina Bogdanovic [34:05] It's incredible work you have been doing, it's crazy. It's available in so many languages in so many countries. And so your work extends way beyond what you do in your clinic. But now we've talked about different diagnostic potential methods. When it comes to the study you've done with IgG glycome. Would you say it is potentially a good candidate as a novel diagnostic and predictive measurement for perimenopause and menopause?

Louise Newson [34:34] My gut feeling is yes, we need to do more research on it. And it's been really disappointing because we've had some grants turned down as you know, but I really feel that it would be really useful because if your GlycanAge changes, of course, it might not all be due to the perimenopause or menopause, but it's usually due to something and so that's something we need to explore. And it might be that you know, I've taken up (I haven't by the way) but if I had taken up smoking 20 a day and McDonald's burgers three times a day, then I'm sure my Glycan Age, my biological age would change. And that's important because then I could think - Oh, right, what have I done? What do I need to do differently? But if I had done nothing different to my diet, and I started to track symptoms, for example, on Balance, and my biological age with GlycanAge was changing, then I should really be thinking - Oh, what's going on? And then I also would love to see how it reverses and improves because that's really important.

Addressing the Lack of Menopause Education in Medicine 

Rina Bogdanovic [35:36] In contrast to measuring hormones. glycans actually show the level of oestrogen over a longer period of time. So it is potentially much more representative than what current hormone measurements are. Could you talk a little bit about why doctors and nurses are still so resistant to prescribing HRT?

Louise Newson [35:59] I think it's like me, they haven't had training and education. I mean, before I became a medical specialist, I didn't have any formal training. And so all my knowledge, lots of it is self-taught or going to courses. So I think there's this misconception that menopause is just a transition that people just need to put up with. That there are more risks than benefits of HRT. So a lot of it comes from a place of misunderstanding, actually. And also, I think, people just, again, women aren't always listened to. I've been to quite a few meetings where people have said, well, joint pains, poor sleep, urinary symptoms, that's just an ageing problem. That's not a hormonal problem. But I would beg to differ that and of course, not every symptom is going to be due to hormones. But we still need to consider it first. And I think we also need to be asking the question as clinicians to the women, do you think this could be related to your hormones, and most of us know when our hormones aren't quite right. So we need to be listened to and then given the appropriate treatment.

Rina Bogdanovic [37:09] And I think your clinic is a perfect example of how to do it right. Now that we've talked about chronic inflammation, we've talked about the impact of sex hormones on immune regulation as well as biological age. An interesting pilot study you've also done in collaboration with GlycanAge is looking at how HRT impacts one's GlycanAge. And I think you measured the biological age, before starting HRT, after three months, and another six months in these women. Now, I don't think the study has been published yet. But could you tell us a bit about what the findings were?

Louise Newson [37:47] Well, it's very exciting, actually, and it sort of fits in with what we were hoping for in that women who take HRT, their GlycanAge improves. And it's different because we, you know, there are different doses of hormones or so different lifestyles, of course, it's not, I wouldn't expect it to be linear. But the small number that we looked at, there certainly was an improvement with GlycanAge and it just lends itself to having a bigger study where we can have a really good look at GlycanAge, before and during HRT. Because often with HRT, certainly in the clinic, we spend a lot of time and effort optimising hormones. So it's not just a single tablet or a single dose patch, it's often optimising the estradiol to the right amount for that individual and then considering testosterone as well. And it would be great with GlycanAge to work out the difference with estradiol, as well as testosterone. So it sort of whetted our appetite that we need to do more, for sure.

Common Questions About Hormone Replacement Therapy 

Rina Bogdanovic [38:50] I think it's just amazing to think that this increase in chronic inflammation, which we might think is inevitable, as our hormones decrease, it's actually reversible. HRT, which for many women, for all women, I suppose who are using it gives them many years of their life back. What is the impact of HRT use on the prevention of chronic disease? Is there enough data in your opinion in that area?

Louise Newson [39:15] Yeah, like I said before, it's not in the guidelines, in the menopause guidelines, but there is enough data, especially looking at cardiovascular disease and osteoporosis, even with type two diabetes. There's a big debate about dementia. But if you look at the good, there are better studies using body-identical hormones. So the natural oestrogen through the skin as a patch or gel with natural progesterone, then certainly there does seem to be a reduction of dementia as well. And so I think there is enough evidence and I think women should be allowed to make the choice if they want to consider it for disease prevention or reduction of diseases rather.

Rina Bogdanovic [39:53] And how does this preventative potential of HRT compare, and women who started HRT really early on compared to those who maybe waited a few 5-10 years after their menopause?

Louise Newson [40:03] We haven't done the studies, a lot of it is interpreting the WHI the Women's Health Initiative study. But it does seem that the earlier women take HRT the better. But I think there's a lot that can still be reversed, still, some studies show that even low doses of estradiol can strengthen bones, for example. And we haven't got any good quality studies starting HRT at an older age. So we're just extrapolating old data with all types of HRT, which is just not good to do in clinical practice. And we have quite a few women in the clinic who are older who start HRT, and they certainly get benefits for their symptoms, and likely benefits for their future health. But of course, they're harder to prove.

Rina Bogdanovic [40:49] Would you say there is an ideal type of HRT, or does the optimal type for each person have to be assessed on a case-by-case basis?

Louise Newson [40:59] Yeah, I think the doses need to be optimised but the best type is the body's identical hormones. So it's got the natural estradiol through the skin because there's no risk of clot or stroke. With the natural micronized progesterone and testosterone again through the skin. The micronized progesterone is usually a capsule taken orally, but it can be used vaginally. They're derived from the yam plants as well. So very safe and as natural as you get really was something that's prescribable.

A Look at the Newson Clinic

Rina Bogdanovic [41:26] For our listeners, I will, of course, include plenty of resources in our description, because I think you are probably the guests with the most resources in terms of your topic and your area. So your websites and your app are incredible resources. Could you tell us a bit about your clinic? And a bit about your app?

Louise Newson [41:46] Yes, of course. So the clinic we set up four years ago, and it's become very busy. We see around 4000 women a month through the clinic. I have over 120 clinicians who work very closely with me. I'm very privileged to work with such amazing people. And it's based in Stratford upon Avon, although we do have rooms in London and Bournemouth now, actually. And the clinic has been great because it's enabled us to finance other things. So we financed the app, which is this free app called Balance. And then it also has financed our education programme, we've developed a free education programme called Confidence in the Menopause, which actually has been downloaded more than 30,000 times by different healthcare professionals. And increasingly now it's enabling us to start doing more research by looking at what we do in-house, our clinical data, but also looking at Balance and then working collaboratively with other universities as well.

Rina Bogdanovic [42:47] It's amazing work you've been doing. Thank you very much for coming on to our podcast.

Louise Newson [42:52] Oh, well, thank you for inviting me. It's been great. 

Rina’s Outro

Rina Bogdanovic [42:55] Now speaking to our listeners and especially to the women in our audience, I hope this conversation inspires you to approach this phase of life with more understanding and less apprehension. Remember, menopause is a transition into a new chapter of life – and being informed and prepared can make all the difference. If you would like to access more information about this conversation and all of the wonderful materials Louise has made available, follow the link in the description to the show notes for this episode. Equally, if you want to find out more about GlycanAge, head on to glycanage.com where you can access a whole list of our scientific publications, blog posts, testimonials and of course this is where you can order your GlycanAge kit. Watch out for our next episode where I will be joined by Vered Padler-Karavani, the Associate Professor in the Department of Cell Research & Immunology at Tel Aviv University. Her research focuses on studying mechanisms of glycan immune recognition and responses, Particularly, the immunological basis of anti-carbohydrate antibodies and their implications in cancer and heart diseases, she also focuses on developing novel diagnostics and therapeutics for such diseases. We will discuss cancer personalised medicine, innovative therapeutic methods as well as diseases associated with the consumption of red meat. Please don't forget to leave ratings and reviews for this episode and engage with us on social media. Thank you for listening and have a great day.

 

Disclaimer

Please be advised that this show is for information only and should not be considered as a replacement or equal to medical advice.