Dr Louise Newson is a GP who has spent more than a decade campaigning for women to get access to hormone treatment. She set up her own clinic, the Balance app and an education programme for doctors, and her work has made her one of the most polarising figures in her profession.
In this conversation she tells Laura how it started: rereading the 2002 Women's Health Initiative study when NICE published its first menopause guidance in 2015, and realising HRT prescribing had fallen off a cliff. She explains why she believes the risks of hormone treatment have been overstated, from testosterone to starting HRT after 60 to women who have had breast cancer.
Louise also talks about the backlash: 350 pages of British Menopause Society emails she obtained through a subject access request, the BBC's Panorama, and the inspection that ended with her clinic rated outstanding by the Care Quality Commission. And why, with only 5% of menopausal women worldwide prescribed hormone treatment, she says most women who would benefit still aren't getting it.
HRT prescribing fell off a cliff after 2002
Louise kept prescribing HRT as a GP for decades and only realised after NICE's 2015 guidance that many colleagues had stopped, while her friends were being given antidepressants instead.
Guidelines are only a guide
She says the NICE guidance mentions risk 22 times more than benefit and groups synthetic and bioidentical hormones together, which leaves busy clinicians confused.
The over-60 risk came from synthetic hormones
The heart attack signal in the Women's Health Initiative study was in women given horse-derived oestrogen and a synthetic progestogen, not the estradiol and progesterone she prescribes.
Testosterone has a long history in women
It was prescribed in the 1940s and '50s for period problems and menopausal symptoms, and she says its reputation comes from the synthetic anabolic steroids of the '60s and '70s.
Some women need more than the licensed dose
Skin varies in how much estradiol it absorbs, and her clinic's published data shows about a fifth of patients need a higher than licensed dose.
Progesterone changed her thinking on PMDD
A colleague's own postnatal illness led Louise to Katharina Dalton's work, and her clinic now prescribes progesterone for PMS, PMDD and postnatal depression.
Ten years of being targeted
Louise says the emails she obtained show people trying to silence her, and the pressure on her and her family brought her close to giving up.
Only 5% of menopausal women get HRT
Every menopause guideline calls HRT first-line treatment for most women, yet she says only 14% of menopausal women in the UK and 5% globally are prescribed it.
The hormone clinic Louise co-founded with Dr Rebecca Lewis
Louise's free app for tracking symptoms and learning about hormone health
The hormone health education programme for doctors and healthcare professionals
00:00 — Welcome to The Laura Dowling Experience
03:47 — Rereading the WHI study after NICE's 2015 guidance
11:18 — Why HRT is scrutinised like no other medicine
15:43 — Testosterone's forgotten history in women
20:43 — Starting HRT after 60
24:43 — "A body of people trying to take me down"
29:33 — If she were a male gynaecologist
32:07 — Are her doses too high?
35:45 — HRT after breast cancer
39:43 — Progesterone, PMDD and postnatal depression
42:16 — The Care Quality Commission inspection
45:47 — Running a private clinic
48:27 — Has the pendulum swung too far?
53:02 — Advice for young people and the meaning of life
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