Sex, hormones and the menopause with Dr Kelly Casperson | The Dr Louise Newson Podcast

[Music] hello I'm Dr Louise n I'm a GP and menopause specialist and I'm also the founder of the new health menopause and well-being Center here in Stratford paven I'm also the founder of the free balance app each week on my podcast join me and my special guests where we discuss all things per menopause and menopause we talk about the latest research bus myths on menopause symptoms and treatments and often share moving and always inspirational personal stories this podcast is brought to you by the news Health Group which has clinics across the UK dedicated to providing individualized per menopause and menopause care for all women this week's podcast I'm delighted to introduce to you someone else from America who is a urologist like my husband but not like my husband because she's female and um she's wonderful so I've got with me Dr Kelly casperson who is a urologist who specializes in sexs and hormones and helping people feel better and reduce the risk of diseases and everything else so um I've been stalking her quite a lot on social media more than she realizes and I love her openness I love her evidence-based approach and I just love her way that she's just going to cut through all the noise and just get to her patience and really help so welcome Kelly thanks for joining me today thank you for having me it's a great honor so my husband as as many people know is a urologist and what he knows about menopause now is very different to what he knew 20 years ago or longer when we were medical students what I know about the menopause is very different and actually today early I was talking to an ovarian cancer charity about menopause and I was rereading some papers that I read many years ago about um how women after a cancer diagnosis fall off a cliff and no one talks about sex and the majority of women do have problems with sex um and not just sex but sexuality actually and not just libido as in sex drive but just the libido Joy of life and it's all awful actually and I we can talk about so many things and we're going to have to talk quickly because we've only got half an hour but I'll probably have to get you to come back that's okay Kelly but you know last night I was sitting there thinking I've always been really open as a doctor and I allow people to say exactly what they want but actually you have to ask the right questions and yesterday I saw a patient of mine who had cervical cancer several years ago she's really young she's in her early 40s now the cancer diagnosis was seven years ago she's had surgery she's had chemotherapy she had radiotherapy she's I hope cured from her cancer yet she doesn't think she'll ever be able to have sex again and she's been told that things won't feel the same for her I asked her if would you like me to examine you and she burst into tears and said oh my goodness that would be amazing because it feels and looks different I'm too scared to look but I don't want to be 42 and never have sex again and actually examining was really reassuring that was easy but actually this is awful so the more I ask the more I see the more I hear the more frustrated I am and I mean are you frustrated Kelly or is it just me oh no it well I'm a lot more optimistic now like five years into this journey than I was in the beginning you know now I'm like because I actually see that it's getting better I truly believe that this there's something that's happened this year it is getting better but you're right like on the importance of asking the right questions I think that's very poignant because if you ask a woman are you doing okay and you have a power differential you're the doctor she's the patient you say are you doing okay she wants to be doing okay she's probably gonna say yeah I'm doing fine you're never G to know what's actually going on like asking the right questions like you know is is incredibly important to hear the story and and the other thing I notice a lot you know in my clinic because I'm more Urology based is they'll come in for the Urology problem right bladder leakage or urinary tract infections right and you ask the questions or you do an exam and you see that you know there's no labia manora the clitoris is atrophied the clitoris has fosis so that's it's covered by skin right and then you say you know do sure you're sexually active is it pleasurable and then I've never had an orgasm in my life right that's not what they came in for they did not come in for that problem they came in for recurrent urinary tract infections but there's so much under the surface absolutely and we do a symptom question on every patient in the clinic and it it talks about liido and actually it's a segue in really because they answer the questions before they come so they know that if appropriate we will be talking to them and I remember when I first started the clinic seven8 years ago and asking women you know about not just about whether they feel like sex whether they have SE sex and most women it's at least two years that they've had sex and I was talking to someone yesterday and she said do you know what I hate sex it just does nothing for me I lie there and think oh no I'm going to have to go through the motions and she said do you think that's my hormones and she's been married for ages she loves her husband I know she does but it's that whole like it's awful actually that men are allowed to talk about sex they can just go and buy Viagra they can do all sorts but women it's like shameful if we want to have pleasurable sex almost and that's just gone on in the history of women for centuries hasn't it I remember yeah I remember talking to a big expert in female sexuality as I was kind of going through my journey and still learning this is before I wrote the book and we were talking about desire right and I'm like now you're assuming the W the woman's having good sex when she's having it and he's like well of course we're assuming when she's having it it's good sex and I'm like and this is a man expert and I'm like there's the problem right because here we think like you don't desire sex but then sex is amazing when you have it just don't desire the amazingness and it's like no sometimes you don't desire mushy broccoli like and there's nothing wrong with not Desiring mushy broccoli right so you really do have to ask all the different questions because a lot of women will come in thinking they have low desire when in fact it's incredibly painful right and so I tell women like you don't have two problems you don't have low desire and pain of course you don't desire hitting your thumb with a hammer and that's really important you know especially thinking about urinary simpons so I see a lot of women as I'm sure you do who have urinary tract infections or cytis after having sex it's can be very common when you've got some changes that occur when you've got low hormone levels and it can occur women with contraception if their testosterone levels are low of course um and so a lots of women are so scared of having sex because they're worried about having a UTI or cystitis after so they might find the actual sex amazing they might have the most incredible orgasm but if they know they're going to be BL Ed with getting up in the night having cystitis not being able to function at work feeling in a lot of pain discomfort and not wanting to take antibiotics then and no one's talked to them there is treatment that can prevent that it that will affect your experience w't it oh 100% you start avoiding it right and if you start avoiding it especially if you're not communicating with your partner about why you're avoiding it then they have to assume because they have to try to figure it out does she not love me is she seeing somebody else like it goes poorly quickly especially when we we've never been taught how to communicate about sex right there's people who've been together for years who've never talked about their sex life everybody's just sitting around assuming things about each other yeah I think the only thing that's more embarrassing to talk about in sex is money and people don't talk about what's in your bank account but but we should be talking to our partners and I've been horrified over the years women telling me how painful it is how it's just the most uncomfortable thing it brings tears to their eyes and yet they won't talk to their partner because they say I know sex is really important and I know he enjoys it and I want to give him pleasure and and I'm just like hang on a minute like if he had a big swore down his penis he would be telling you like why can't we be talking and then it's not even just about penetrative sex or sex with another person it's any sort of sexual pleasure um and we we know and we don't need to go into big detail because I've talked before in another podc about this diagnosis of hsd hyperactive sexual desire disorder even that's a mouthful it's a mouthful I think it's actually worse than GSM yeah it is because we know that it affects around 25% of menopausal women from the studies but if you look how you make the diagnosis it's the most barbaric old-fashioned degrading thing ever I don't know about you but you have to wait till women are severely affected and it has to be for a minimum of at least three months so you can't have two months of feeling like awful and load sexual desire you have to wait for three Mon it's so many things I don't know what you think but it just doesn't feel right somehow well yeah the bar is so much higher I mean viager has been around in the US at least since 1997 1998 and we it's it it has side effects Viagra has side effects people like this is not a sugar pill it's not without its issues but by and large it's it's very safe right and we give it to men whenever they think about it right we're like oh you need just a little more confidence in the bedroom have some Viagra oh like we're just giving it out like it isn't anything and that's the power I would say of the female urologists in the menopause Movement we take care of men we know how they're treated we don't say I'm sorry you're having erection issues and low energy and you you have low testosterone that's just what getting old is have you tried acupuncture and wine right but we'll say the that same statement to women and I just think the gynecologist do not have that male lens that the urologists have yeah that's very interesting perspective and and I've spoken before and aan blooming who we both love and admire talks about if you say to a man you are going to be guaranteed to have a condition where your penis is going to shrivel it's going to be painful to have sex and your brain will become like mush you won't be able to think properly and 10% of you will give up work because of this condition but there's a treatment but we're only going to give it to the minority of you it it just wouldn't happen but especially when you focus on sex and it's a generalization here of course but for many men sex is really important it's a it's really important for for men and women and everybody actually um or sexual pleasure so why should it be stripped away from us when we become menopausal the number of women I have messages from and you probably do all over the world to say I can't find my clitorus it's really shrunk I am unable to walk out I know it's related to my hormones but I'm not being listened to like I don't really quite understand the big problem well what we've done you know what we've done in urology is we've treated the male sexual dysfunction without addressing the partner and 90% of men are partnered with women right and so now men get the Good Fortune of seeing me in clinic and I'm like what's your plan and they're like well I don't they just want an erection right I'm like well you know who do who who are your partners you have a partner you got to start there and yep my wife yep and we haven't had sex for eight years and I'm like is she seeing somebody is it painful have you talked about your new plan I wish I could tell you 50% of them have talked to their partner about this I'm at a 100% that has have not talked to their partner and so I give them a tough time about it I'm like listen you are at the doctor you're going to get a medication that's going to make you want sex more and have a better working penis and you've not communicated that to the person you want to use your penis with sorry for being crude the UK the The Americans on but absolutely but it drives home a point yeah and it's very important so my husband is you might know a genitor urinary reconstructive surgeon so he will rebuild penises often when there's been trauma or um other conditions and but often the male and female partner will come in together and he'll more in increasingly look at the woman especially if she is of a menopausal age and say directly have you had any have you any discomfort problems or and the man's like hang on this is my consultation he said no you've already talked about you know sex and how important it is to be able to use your penis in that way and the women are so relieved like their shoulders just go down inches and he says I'll write to the doctor and see if they can prescribe you some vaginal hormones and it's like Paul this is amazing you'd never have done this five 10 years ago he said no I didn't think because I've just been blinkered thinking about the man but actually I realiz from talking to you and actually the response I get from the women is huge and that's one of the sort of Throwbacks about Viagra and Calis and these drugs is that the more they're used wonderful but then it's unmasking these women who might have thought their urinary tract infections was an aging related thing they might have not really thought that they had any problems with their vvo or vagina or surrounding tissues but then when they have sex my goodness it's really uncomfortable but they think it's because they haven't used it for a long time that's right yeah I mean one of one of my platforms as you know is that a penis will not fix a hormone problem this this myth of use it or lose it right is is from a very old Gynecology study that was correlation not causation ter but I still hear it you just use it all day every day it's all over the Internet yeah or then you just get some dilators and just use those and that's really doesn't feel right so we're talking about home now we've always been naively taught that estrogen is the most important hormone we have progesterone just to protect the Min learning of the womb and there's a bit of sort of chatter about testosterone but that's the male hormone now the more I read about physiology of hormones um and I've read some amazing papers recently all three hormones are really important actually progesterone is not just to protect the lining of our womb our brain produces it as well as our ovaries it's very anti-in inflammatory has really important biological effects estrogen is important and testosterone is important but we've always been taught the menopause is when our estrogen levels Decline and our periods stop but what about testosterone levels they they're not all in line with each other these hormones so and and we have testosterone receptors on our vula our vagina our perenium our pelvic floor our urinary tracts so why are we saying have your estrogen make sure you're well estrogenized and then think testosterone if you've got severe psychological distress with your reduced libido I don't quite understand is that the same for you over in the that you have to do that absolutely I mean and to step it you know out another 10 10,000 foot view is we have more hormones than those three we've got tons of hormones those are just the only three that we know how to test and actually have a medication for right and I like to say that to be like you guys we are we're going to look back at this era as like blood leing with leeches we are doing the best we can with a little bit of information but what we did is we gendered the hormones we said estrogen is female testosterone is male and once we gendered that we made it disappear from 50% of the population I actually Googled the other day I'm like Google what's an androgen and it says the male hormone responsible for male sexual traits is kind of what Google told me so I'm like we've got a lot of work to do to get all the hormones back in the bodies and this is a meaningful thing that I do so I see a postmenopausal woman in clinic she's with her male partner and I'm try talking to her about hormones and why they're important so I point at him and I say do you know that his estrogen is higher than yours right now and it blows their freaking mind for multiple reasons because the man doesn't think he has an estrogen right and then now her estrogen is lower than his it's like that's you guys our education is so poor it's really interesting because even um my mother who is well educated but she's not MediCal we don't come from medical backgrounds said to me a few years ago I didn't realize that people have hormones in their bodies I just thought hormones was just HRT so then I thought oh gosh and I have been a for many years yeah and I remember years ago writing about cancer and interviewing some people because this was before the internet and saying what's cancer and they said that means death and I thought hang on no it doesn't but who's taught them no one's taught them you pick and it's just like anything you learn from whatever you read or what your best friend tells you and so then I'm thinking more and more about hormones you're absolutely right Kelly because we've got hundreds thousands of hormones in our body and they work so beautifully to help our bodies to function because they're just these chemical Messengers but then they've been defined as sex hormones well they're not all about sex because we've already said they regulate every single cell process actually but then and they're not about gender either because we've already said women have have testosterone and men have estrogen but then actually people talk about ovarian hormones because apparently the menopause is when we haven't had a period or we're not fertile but I don't really like those definitions and they're not just ovarian hormones we've already said they're produced in other areas of our body yeah so yeah why are we trying to put them into this box and you know um it's a real problem when we trying to dispel all these myths and talk about how testosterone can improve brain function not just about liido or we're talking about e reducing risk of cardiovascular disease and being a vasodilator and lowering blood pressure people who have never thought beyond the ovaries are like wow hang on I don't understand well how is this happening and then if people don't know that our hormones are natural that they're going in our bloodstream and they're doing this all the time when we're younger then it it's quite hard to understand as well it's yeah I can see where why we've gotten this mess but we need to unpick it don't we to help yeah and I think it starts with education I got I was at this Symposium in New York City this past week and somebody said does the pain with sex end when menopause is done and so to me I'm like okay we gota we have to go back to the basics right you are in a low hormone State for the rest of your life unless you take a medication and even like you know even ridiculous to me people are like don't call menopause deficiency we don't like how it sounds and I'm like well I'm sorry you don't like how it sounds you let other people know how you want it but when a woman is walking around with less hormones than any man like compare compared to how she was functioning when she was saying she was functioning at her best what do you want me to call that if you don't want me to call that a deficiency of what her other Baseline was it's really interesting isn't it I spoke to someone at the Royal College of GPS about eight years ago and I was probably more gobby than I am now maybe I'm the same I don't know but I anyway I contact them and said how do you change the name of something I would like to change the name of menopause to female hormone deficiency so fhd and they were like oh my goodness and I said because once you start talking about deficiency you're imediately thinking how do I replace that so if I said to you Kelly you're ion deficient I think the first question you would say to me if I was your physician oh how do I get more ion is it in my diet do I take a supplement or whatever yeah I wouldn't say you offended me right like where people are getting offended about this and so if I'm thinking about a female hormone deficiency and I know it's a bit crash saying female hormones but if we because you know or an estrogen deficiency and a testosterone deficiency and a progesterone deficiency they're all different because some people certainly in our clinical experience benefit most from testosterone and least from estrogen or the other way around or they benefit from all three because they all work together in a beautiful way everyone's different so that's fine but we can't just be calling it menopause and period it's doesn't doesn't just doesn't it covers up yeah it covers up what's going on right um yeah it's it's the the deficiency I think they I think they don't want because some people can't take hormones currently and I think they don't want them to feel bad but to me I'm like but the 97% of women who can take hormones safely like we need to educate them about what's actually going on in their body because if you say menopause it doesn't explain what's going on right and I think that's really important because we don't know who can enom take hormones there isn't enough evidence and actually the more I read estrogen obviously we know is not just one thing it's it's there's estradi and estrone and estrone is the pro-inflammatory part of estrogen that our fat cells produce that um some oral estrogen is broken down to and I've been reading some really good papers looking at the pathophysiology behind breast cancer and it's more estrone driven than eile driven thank you for realizing that yeah so so it's really important and we're doing a lot of work behind the scenes for women who had breast cancer trying to really unpick this evidence because for them to be told they can never have estrogen actually is denying them from lots of benefits without knowing whether it they probably can't have eone but they probably can have Easter we don't know but this needs to be done urgently to look but actually every time I put something on my Instagram to say menul women have an increased risk of heart disease there's always two or three women will go that's really scare mongering please stop talking like this but that's like saying if you've got raised blood pressure you've got an increased risk of a heart attack or stroke it's just fact like I am just a messenger for a lot of this and I think it's blowing people's minds because they've just thought about HRT is dangerous hormones are something that we may or may need and menopause is just a natural state but actually we've got to think Beyond because I worry as I'm sure you do about population health and looking at all those diseases that are affecting us not just killing us but affecting the way we function um and live and a lot of those diseases are the inflammatory diseases that increase when we don't have our hormones and I think if we know that more as menopause or per menopause or women then we can make a choice that's right for us but we can't make a choice on our treatment if we don't know all the facts I see a lot of women say well I want to I want to do something natural I want to do something natural and to me I'm I I've looked at the data I've looked at the death records that the world's kept right we are at an unprecedented time where we've never lived this long as a global Community ever before we are literally writing the rules for how to age well we've never done this before right so I would say aging like this is not natural it's never been done before infectious diseases and blunt trauma killed everybody before the age of 50 except for the outliers and my second now natural comeback would say people are like I want to do it naturally I want to do it natural giving yourself hormones that your body makes they're I identical is as As Natural as you can get and we have data to show those women are actually going to take less other medications less anti-depressants less high blood pressure medications less other things for their bones because they're taking a hormone that's natural it's the most natural thing that we can do to keep you off other medications you're totally right I did a a lecture last week for the Football Association actually with women's football because I really like what they what they stand for and I'm you know we're doing the same with how we're helping women of course but the doctor there who was fantastic I think I blew his mind because he'd only been taught that HRT is dangerous and it causes breast cancer so then he said well we need another randomized control study Louise don't we otherwise we'd never know the the benefits and what if there's a study in the future which shows how dangerous hormones are which was a great question but first doing a randomized control study a is really expensive and no one will spend money on women B doesn't have to be not everything is done with a randomized control study penicillin wasn't founded with a randomized control study also it wouldn't be ethical to deny people an evidence-based treatment for a study if you're looking at dementia risk you're going to have to wait decades and we'll be dead by then sorry Kelly but you know if we did that sort of study but also I said to him regardless of the evidence it's just natural hormones so why would we have hormones that would suddenly turn against us it it just doesn't make sense like I've never known this narrative about anti hormones with insulin thyroxin there's always a bit of debate about T4 and T3 and the different types of thyroid hormones but we we don't unpick the evidence or try and sensationalize the evidence about natural hormones for anything else and so why would it be dangerous it just doesn't make sense if you think basic physiological processes does it I agree in the Urology World prostate cancer is a big big cancer right which is fascinating if you look at testosterone treatment and prostate cancer survivors you're gonna have to have me back for this but it's an allegory for what's going to happen with breast cancer mark my word I'm seeing it coming because I've lived I've lived through the testosterone fear with prostate cancer and now we're like hey you have prostate cancer and it's mild and you want testosterone great 10 years ago you couldn't touch this stuff we've come a long way but to go back to the randomized control trial with prostate cancer you can get radiation or you can get surgery if your prostate cancer is bad enough to be treated we've never done a randomized control trial we never will do a randomized control trial because we need to treat guys and it would take decades to do and we don't tell guys well we're just not going to treat you because we don't know which one's best we don't say that we say there's risks and benefits let's let's pick one we'll never have a randomized control trial we're not going to sit around and wait we're going to treat you yeah absolutely I was talking talking to some people not so long ago who were very anti the work that I'm doing and we were they were talking about the percentage of women that should be taking HRT and they said in the UK 14% of women take UK take HRT and they said that's probably too high and I said well in areas of deprivation it's as low as 2% they said well maybe we should go back to doing that and then I said I don't actually care percentage I think it should be a lot higher but in my mind 100% of women who want to have HRT which is an evidence-based treatment should be allowed to have it first choice before being offered ssris or whatever else they're offered and so this is exactly the same with prostate cancer or anything we do in medicine it's about Choice informed consent sharing uncertainty sharing benefits sharing potential risks and listening to what the patient wants at that time now until that happens I can't shut my mouth because I'm hearing all the time from women all across the world who are were struggling to access hormones so it just seems such a frustrating narrative actually it's insane 25% of American women in midlife are on an SSRI and I always say we need to treat depression absolutely but the amount of people who say they're treating my menopause symptoms with this and it's not helping right of like and those medications have significant risks right here we are here here we are saying hormones are so unsafe we give unsafe medications every day and don't think about it we know there's risks to them why why are we so unique with this hormone discussion it it doesn't make sense does it because um you know we know that for example ssris increased risk of osteoporosis we know not how HRT increases the risk of osteoporosis you've got double whammy actually and we also know that the mortality after an osteoporotic prit fract is about 20% in in a year so if you'd been diagnosed with some really aggressive cancer there's not many that would kill 20% of people in a year whereas an osteopor hit fracture people go oh that's a bit of a shame but it's just osteoporosis isn't it actually no let's wake up to the fact that you know these conditions can be really really affect people it's a very painful way to die by the way it's it's very it's very horrible to watch somebody go through that you know and I think a lot of people don't know that and I I want to mention that in casee anybody missed it the ssris have an increased risk of fracture I did not know that I asked my family practice friend she did not know I asked my orthopedic surgeon friend he did not know we don't communicate then there's been Decades of research on this nobody's talking about this risk so we we think you know hormones are so scary and we're like 25% of the US population female in midlife are on a drug that increases your risk of bone fracture and nobody knows that well that's right and and there are is some studies now it's observational studies which we know are not great showing there's increased risk of cancer with some ssris now it's not being replicated but actually when you look at the method methodological approaches for those studies is very similar to ones that have done in the past for HRT like the million women study that people still still report and still can't back on so you've got like double standards of of the the studies that you use you know there was one um um a review recently an observational study for Alzheimer's and HRT it was in the British medical journal it wasn't a great study even the conclusion said we cannot say whether it's cause or effect it's might be Association you've got Lisa mone's work fantastic that doesn't get in any of the papers they just want to talk about the the risk but if that risk for SSRI and cancer with the same sort of methological approach that's never mentioned you know or like you say the osteoporosis risk which is more out there it's still never mentioned and it it's like you can't have one rule for one and one rule for the other treat all drugs the same it's fine yeah yeah yeah but the the U cholesterol lowering medications are not without risks they're the most common medication prescribed in this country right and cholesterol we know cholesterol goes up in in the postmenopause so yeah I I mean I think of the work you're doing the work I'm doing is like education education this is what I know women are smart when given the information they make exceptional decisions about their healthare the education piece is missing once they get educated they're going to want hormones the doctors need to get ready our Health Care Systems in your health care System Too is already full and and spilling out the sides were so busy and so full and I'm telling you these women are coming they need people to take care of them abs absolutely you're so right so thank you ever so much lots to think about and we are I am going to have to ask you to come back don't you worry so before we finish there's always three take-home tips um there's so many tips really but three three things let's go back to sex because I not scared or embarrassed and you certainly aren't either talking about sex so three things if people are listening and thinking you know what I need to sort out my sex life but I've not done it and I'm ignoring it but I still love or adore my partner whatever three things that you think they should do learn how to communicate the communication is huge is like you know and I realize that cuz I'm like I can make your pelvis pretty functional but if you can't talk about your sex life I haven't helped you the communication lubrication is everybody's friend it only makes things better and vaginal estrogen is everybody's friend very good very easy tips actually but the first one is probably the hardest is is talking and probably the most important and it is the most important without shadow of a doubt so keep the conversation going and thanks I've really enjoyed today it's been brilliant thanks Kenny thanks for having [Music] me you can find out more about n Health Group by visiting www.ne health. co.uk and you can download the free balance app on the app store or Google [Music] Play [Music]

Channel: Dr Louise Newson

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Id: 3uhrLravmec

Length: 33min 48sec (2028 seconds)

Published: Tue Feb 06 2024