What if many of the symptoms women experience in midlife aren’t simply part of getting older? What if they’re being misunderstood, misdiagnosed or treated in isolation, when the underlying issue could be hormonal?
It’s a question that has been at the heart of the menopause conversation for years, but one that still needs asking.
In this episode of The Midlife Mentors, James and Claire sit down with Dr Louise Newson, GP, hormone specialist, bestselling author and founder of the Newsome Clinic, to challenge some of the biggest misconceptions surrounding menopause, HRT and women’s health.
And it’s a conversation that goes well beyond hot flushes and night sweats.
From the legacy of the controversial Women’s Health Initiative study to the role of testosterone in women’s health, the long-term consequences of hormonal changes and the impact on relationships, Louise makes a compelling case for a much broader understanding of hormones and their influence on our health.
Most importantly, she challenges women to stop accepting that feeling awful is simply something they have to put up with.
The menopause conversation is still getting it wrong
For Louise, the turning point came in 2015.
While working with the Royal College of GPs, she was asked to review the NICE menopause guidance. As she started looking more closely at the evidence, she became increasingly frustrated by the gap between what the guidance was saying and what was happening in everyday GP surgeries.
At the time, despite guidance suggesting that the majority of women could benefit from hormone treatment, only around 10% were being prescribed it.
Even more concerning were the stories she was hearing from women who were experiencing classic perimenopausal and menopausal symptoms, only to leave their GP appointments with antidepressants rather than the hormone treatment they were asking about.
It’s a pattern that Louise says she continues to encounter.
The problem, she argues, is that menopause is still too often treated as a relatively short transition involving the end of periods, rather than a significant hormonal change with consequences that can affect a woman’s health for the rest of her life.
And that distinction matters.
Hormones are chemical messengers that influence almost every system in the body. When levels of oestrogen, progesterone and testosterone fluctuate or decline, the effects can be felt in everything from mood and sleep to energy, concentration, muscle function and long-term health.
It’s not simply about managing symptoms. It’s about understanding what is happening inside the body.
The HRT fear that refuses to go away
Few subjects in women’s health have generated as much confusion and anxiety as HRT.
For many women, the words still immediately bring one thing to mind: breast cancer.
Much of that fear can be traced back to the Women’s Health Initiative (WHI) study published in 2002. The findings generated widespread concern about the safety of hormone replacement therapy and fundamentally changed the way doctors and patients approached treatment.
Louise believes the study has had a lasting and damaging influence on women’s health.
She explains that the hormones used in the study were different from the body-identical hormones commonly prescribed today. Yet the findings became deeply embedded in medical thinking and public understanding.
More than two decades later, she believes women are still being frightened away from treatments that could improve their quality of life.
She also highlights the importance of looking beyond breast cancer when discussing women’s long-term health.
Cardiovascular disease, osteoporosis and dementia are significant health concerns for women as they age, and hormonal changes can play an important role in this picture.
The message isn’t that every woman should take HRT. It’s that women deserve accurate information, an understanding of the potential benefits and risks, and the opportunity to make an informed decision with an appropriately qualified healthcare professional.
Fear shouldn’t be the only thing driving that decision.
Bioidentical hormones: What’s the difference?
Another area where Louise believes there is considerable confusion is the difference between synthetic and bioidentical hormones.
The terminology can be confusing, particularly when women are trying to understand what they’ve been prescribed.
Bioidentical hormones have the same chemical structure as the hormones naturally produced by the human body.
These can include:
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Oestradiol: A form of oestrogen, commonly prescribed as a gel or patch.
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Progesterone: An important hormone involved in the menstrual cycle and reproductive health.
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Testosterone: A hormone that plays an important role in both women’s and men’s health.
Louise explains that some older hormone preparations used chemically altered hormones, which have a different structure from those naturally produced by the body.
She also makes an important point: bioidentical hormones are not necessarily something that can only be accessed privately. Many of the preparations she discusses are available through the NHS.
Understanding exactly what you’re taking, why you’re taking it and what alternatives are available is an important part of having a meaningful conversation with your GP.
Why a single hormone blood test doesn’t tell the whole story
One of the most interesting parts of our conversation was around hormone testing.
Many women will have experienced going to their GP, explaining a range of symptoms and being sent for a blood test.
The result comes back within the normal range, and the conversation effectively stops there.
But as Louise explains, hormones are not static. They fluctuate, sometimes significantly, particularly during perimenopause.
A blood test taken at midday might show an apparently normal oestrogen level, while that same woman could be experiencing night sweats, anxiety, disrupted sleep and other symptoms during the early hours of the morning.
This is why clinical context matters.
A test result should never be considered in isolation from the person sitting in front of the doctor.
Louise also highlights the importance of investigating other potential causes of symptoms. Iron levels, vitamin D and thyroid function, for example, may all need to be considered.
The key is to look at the whole person rather than relying on one number to explain everything.
Testosterone isn’t just a male hormone
If there’s one area of women’s health that deserves considerably more attention, Louise believes it’s testosterone.
We tend to associate testosterone with men, muscle mass and sexual performance. But testosterone is also an important hormone in women’s health.
In fact, women naturally produce testosterone, and Louise explains that levels can begin declining from the late twenties and early thirties.
Low testosterone can be associated with a range of symptoms, including:
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Reduced energy and persistent fatigue.
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Low mood and anxiety.
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Poor concentration and brain fog.
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Muscle and joint pain.
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Reduced libido.
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Urinary symptoms.
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Worsening migraines.
Louise believes that some women experiencing these symptoms may be treated for individual problems without sufficient consideration of whether an underlying hormonal issue is contributing.
She also discusses the potential role of testosterone treatment where a woman has symptoms and a confirmed deficiency.
Importantly, medically prescribed testosterone treatment is not the same as the synthetic anabolic steroids sometimes used in bodybuilding.
It’s another example of why the conversation around hormones needs to become more informed and less influenced by outdated assumptions.
And this isn’t just a conversation for women.
We also discussed testosterone in men, particularly as they move into their forties, fifties and beyond. Louise highlights the importance of recognising testosterone deficiency as a legitimate health issue rather than dismissing testosterone as a recreational or lifestyle drug.
When hormones start affecting relationships
This is where the conversation became particularly relevant to our work at The Midlife Mentors.
In our book, Couplepause, we explore what happens when menopause meets andropause, and how hormonal changes can put enormous pressure on even the strongest relationships.
Louise sees this regularly in her clinical work.
Hormonal changes can contribute to irritability, anxiety, low mood, exhaustion, weight gain and reduced libido. Physical symptoms such as joint pain, vaginal dryness and discomfort during sex can also have a significant impact on intimacy.
And then there are all the little things.
The washing that doesn’t get done. The lack of energy to cook dinner. The inability to find the patience for another conversation. The feeling that everything is just a little bit too much.
Individually, these things might seem insignificant. But over time, they can create distance between two people.
One partner may feel rejected, frustrated or confused. The other may feel exhausted, misunderstood or simply unable to explain what’s happening.
For men, erectile dysfunction and changes in sexual function can add another layer of difficulty, particularly when embarrassment prevents an honest conversation.
Before long, the emotional and physical distance can become enormous.
As Louise points out, hormonal changes don’t just affect the individual. They affect partners, children, family life and the way people show up in their relationships.
This is why understanding what’s happening biologically can be so important.
Sometimes what looks like a relationship problem has a significant health component that needs addressing.
That doesn’t mean hormones explain every relationship difficulty, but ignoring their influence can mean missing an important part of the picture.
You don’t get a medal for suffering
One of Louise’s most powerful messages during our conversation was simple:
You don’t get a medal for suffering.
It’s something that really resonated with us.
There is a tendency, particularly among busy, high-achieving people, to put their own health at the bottom of the priority list.
We look after our children, partners, businesses, careers and everyone else who needs us. We push through tiredness, ignore symptoms and tell ourselves we’ll deal with things when life becomes a little less hectic.
But that moment rarely arrives.
Louise believes that many women also see seeking treatment as a sign of weakness or even indulgence.
Some compare themselves with their mothers or older relatives, assuming that because previous generations managed without hormone treatment, they should be able to do the same.
But why should suffering be the benchmark?
Looking after your health isn’t selfish. It’s fundamental to being able to live well and show up for the people who matter.
And it’s not about automatically taking medication or assuming hormones are the answer to everything.
It’s about understanding your body, recognising when something has changed and seeking the right support.
We need to rethink women’s hormonal health
Towards the end of the conversation, we asked Louise what she believes the next big conversation in women’s health needs to be.
Her answer was interesting.
She believes we need to stop thinking exclusively about menopause and start thinking more broadly about hormonal imbalance.
Because hormonal health doesn’t suddenly become relevant when a woman reaches her late forties or stops having periods.
Louise highlights conditions such as premenstrual dysphoric disorder (PMDD), endometriosis, polycystic ovary syndrome (PCOS), postnatal depression and postnatal psychosis as areas where hormonal factors deserve greater consideration.
Her argument is that healthcare professionals need to become more curious about the potential role of hormones throughout a woman’s life.
She also believes medical education needs to improve, with better training for GPs and other healthcare professionals.
Perhaps most importantly, she wants women to feel empowered to ask questions, challenge assumptions and participate in decisions about their own healthcare.
As she explains, medicine has to evolve. Doctors should never stop learning, and having a medical degree doesn’t mean having all the answers.
It’s a refreshing perspective, and one that applies far beyond menopause.
The bigger picture: Take responsibility for your health
Our conversation with Louise highlighted just how much we still have to learn about hormones and their influence on our physical, mental and emotional wellbeing.
It also reinforced something we talk about regularly on The Midlife Mentors.
Midlife is not a period of life that we should simply endure.
It’s an opportunity to reassess, understand what’s happening in our bodies and make informed decisions about how we want the next chapter to look.
If you’re experiencing changes in your energy, mood, sleep, concentration or relationships, don’t automatically dismiss them as stress, ageing or something you just have to put up with.
Start asking questions.
Find reliable information. Speak to a healthcare professional who understands hormonal health. Explore the options available to you.
And remember that looking after yourself isn’t an indulgence.
It’s an investment in your future health, happiness and relationships.
A final thought from us: the more we understand about what’s happening inside our bodies, the better equipped we are to take control of what happens next.
Listen to the full conversation
This episode of The Midlife Mentors features Dr Louise Newson discussing menopause, HRT, testosterone, hormonal health and the impact of midlife changes on relationships.
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