69. Joyce Harper believes in HRT and worries about it at the same damn time

Day raver, cold swimmer, rabble-rouser, educator, author, podcaster, academic and publisher of scientific papers: Joyce Harper is a professor of reproductive science at the Institute for Women's Health, University College London. 

She’s also author of the 2021 book Your Fertile Years and hosts the podcast Why didn’t anyone tell me this?

Harper is uncompromised and unflappable. She is all about the evidence. She’s not opposed to HRT but isn’t a breathless enthusiast either. It has to be about the evidence, she argues, otherwise it’s just stories and anecdotes that don’t add up to anything. 

NB: We are both members of a balanced-approach group called MenoClarity, and we recorded this podcast before Joyce was quoted in a controversial Daily Mail article alleging excessive and unsafe HRT prescribing practices at a chain of private clinics in the UK. 

When I followed up with her about it, she said: "We need to give women accurate information about the menopause and treatments. In the UK we've created huge negativity – some suggesting menopause is a disorder. It's not fair to women and I really worry for the next generations who are now nearing menopause. Menopause can be difficult for some. But for most it's a transition and life post menopause can be the most exciting and liberating stage of our lives."

(As always, I’m not a medical professional and this podcast is not medical advice.  Expert opinion varies widely. Please listen to the disclaimer at the end podcast as well.) 

Highlights: 

• Almost 30 years after she completed her PhD, women still don’t understand their bodies
• Why we need to teach people what’s “normal” so they know when to seek help
• How she approaches research – and how we need to as well 
• Her top myths in women’s health and menopause
• When you should go on HRT and why dosing matters 
• How overall health sets you up for perimenopause
• Issues with the push for testosterone
• Why anecdotes are not research 
• Her research-based conclusions the claims that can prevent dementia 
• Why being post-menopause is so great 
• Her homework assignment for every perimenopausal woman

Where to find Joyce:

Web: Joyceharper.com; Globalwomenconnected.com
Twitter: @profjoyceharper
Instagram @profjoyceharper

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Transcript

Joyce: 0:00

I worry that we'll end up in this really negative situation with H R t getting a hugely negative press. And I don't want that to happen. None of us are against H R T, we're absolutely for it,

0:11

hi there. I'm Annemarie McQueen, a menopause in midlife journalist. I have 25 years of experience covering science health, and. And I created hot flashing to inform, inspire, and entertain people who go through pairing menopause and menopause, and the people who care about them. This podcast brings you interviews with scientists, doctors, practitioners, entrepreneurs, thought leaders, and more. In the end, our menopause experience is about so much more than ours. Symptoms. I think it's a total and complete mind, body, and soul shift. It's taking radical responsibility for every single part of our lives. It's becoming who we were born to be. It's nothing short of a hero's journey, and I am here walking the path right beside you. We're gonna have fun.

Joyce: 0:55

60 in January 60.

Ann Marie: 0:56

Okay. Yeah. Well, you look And full of life and vibrant and energetic and your every day you're doing something different. I see you're at Beach Hus. You're cold swimming. You are

Joyce: 1:08

day raving. Saturday

Ann Marie: 1:10

day raving. Yes. You're day raving. Oh my gosh. That was the best one. I'm like,

Joyce: 1:14

cannot wait. It's gonna be wild, wild, wild. I'm gonna do some videos. I'll put them. Yeah,

Ann Marie: 1:18

you're, you're traveling in your car. Yeah. Yeah. And camping in your car's.

Joyce: 1:23

A mini camper man. Now. Woo. Freedom.

Ann Marie: 1:27

You are making the next couple of years look very good to me. You are setting an amazing example. Okay. So it's so great to meet you face-to-face. I've been following you on Twitter for a long time, and noting all this stuff and appreciating the information you share. And then we are part of a larger group. I'm outside the uk, but I've, I put my name in this group with Menno Clarity, which is just sort of bringing some balance to this really. Polarized and sort of, um, sometimes hysterical conversation about menopause in the uk. So, okay. First of all, let's just provide some context for everyone. You are not a clinician, you're a scientist. And how did you get into menopause? Like you started infertility, I understand. So just sort of explain your background, where you are based, et cetera.

Joyce: 2:16

Yes, it's a real pleasure to be here. So I'm, I'm based in, university College in London. Um, I actually live near Cambridge, so I'm quite away away. So I'm sitting there in my lovely village, near Cambridge. So I finished my PhD in 1987. And I found a job as a clinical EM embryologist. So they are the people that work in the fertility lab and do all the magic in the fertility. And this was, as I said, 1987 and Louise Brown, the world's first I v f baby was only nine years old. So it was very new and very exciting and controversial and a bit edgy. I'm just reading a book now. It talks about sexy science, and I love that phrase. I talk about sexy science a lot, so it was sexy. So I thought, let's do it. So when, when I started it, I was learning so much about fertility and reproductive health. And then we were all trying not to get pregnant. And when I started talking to my friends, I realized that none of us really understood even our menstrual cycle. We'd been taught such basics at school and. I started writing a book about reproductive health in 1987, but I wasn't qualified to do that. I was still learning, and I don't know where life goes, but, almost 30 years disappeared. In 2015, I thought, it's time to look at this book. Why aren't, why aren't I writing this book now? All my friends were menopausal and, we had, nothing had changed. We still didn't know how our bodies worked. And actually the best book in 1987 was called Our Body Ourselves, which is a US book, which I loved. But we hadn't really gone much further than that. So in 2015, I set up a website where I just blog and some, we have some guest blogs, called Global Women Connected. And then I started writing the book, which was published in 2021, I can't say last year anymore, two years ago. And I, I obviously wrote about the menopause. I've, I've got chapters on fertility and pregnancy and. And contraception, but also about the menopause. And around 2015, my interest really, obviously friends going through the menopause, and I think it's good to work on something that's very dear to you. And for me, I thought, wow, my friends need to understand about the menopause, so that. Really, I still, I'm still working in the facility field. I feel that my agenda is teaching reproductive health and I'll, I'll tell you about the, um, international, group that we have started. That is, that's our number one aim. So my view on reproductive health is from puberty to the menopause. I think that's very much included and so much that I've. From how we can deliver information about fertility and infertility, et cetera, absolutely applies to the menopause. So I wanted to do research in this area, and about four years ago started my first research in menopause and it was very much listening to women. I want to listen to women to hear what they have to say and how we can help fix. Lack of education. And so, I've got a few papers out already. We've got two papers coming out in the next few weeks, and we're doing other studies this year,

Ann Marie: 5:38

We don't understand our reproductive health very well, even by the time we hit perimenopause. Part of the reason we may be having such a problem is that we don't really understand our reproductive health. So can you talk about that a little bit when you're talking to menopausal, when did you see They don't understand it either.

Joyce: 5:55

So from my research, the absolute top issue they all talked about and, and we are at the moment, we're doing focus groups. I did one last night. All of the focus groups. Every time I talk to women, the biggest. Issue is that they didn't understand this, so they're going into this key stage in their life, which is not hugely complicated once you know it. But if you don't know, if you don't know that brain fog, lack of motivation. all, you know, vaginal issues, all these issues that you may go, you might, you may, you probably know about hot flashes. But if you don't know about all these other issues, so many women don't join up the dots. They think they're going crazy. They think they're having a midlife crisis. They then have problems with their relationships, problem with their work environment, and that's not fair. It's quite simple for us to be able to teach them this information, but we've never done it. And if we've never done it, they're literally going into a black box and this can last for many women. They told us, it's been years since they joined the dots and realized. And then sometimes their doctors told them, oh no, it's not the perimenopause. You are too young. Or things like this, which was total misinformation on their part. That was the other big theme that's come outta my research that their physician didn't understand, so then gave them bad advice. So then they thought, I'm not menopausal. There must be something else. I'm Ill, you know. You know, got a brain tumor or something. Cause I'm not, my brain's not right, my emotions are not right. Everything, depression, anxiety, you know, the list goes on. So I think it's been hugely unfair. What I do think's great now is that we are talking about it. So we, we, we are, we are in a way over the wall. We're, we're, we are getting it on the table, but now we've got to talk about it in a sensible way and give women, and I think everybody, cause I think. Men. Yeah. They are affected by this indirectly for sure. And so everyone needs to understand about the perimenopause and the menopause with accurate information so that they can enter this stage. Understanding what may happen to them and joining the dots. I, I did a survey of women under 40 because I wanted them to start thinking about it. Don't think about it when you are, you know, I, I asked women in the survey, what, when did you start thinking about it? Not of them said, years after my symptoms started. I said, oh my goodness. And, but some women in their forties said, oh, we are too young. Why are you asking? We're too young. No, you are never too young. So I teach menopause in schools. I've been very lucky in the uk. It's in now the UK curriculum. We are teaching about menopause in schools

Ann Marie: 8:43

because if you understood what's going on with your menstrual cycle, And that was, and you learned that when you were young, then you would understand perimenopause because in a lot of ways, I feel like it's almost a macro of your monthly cycle in a way. Like, you know, there's a lot of parallels, but I've been a health and wellness journalist and I couldn't off the top of my head, 10 years ago, tell you what's going on with my menstrual cycle, or tell you how important ovulation is and to the health of our body. Tell you, when I have progesterone, ri, ry, estrogen, I, you know, none of it. And so all of the things that we encounter, and I'd love you to talk about this just before perimenopause, all those other things that we're all experienced like fibroids, polycystic ovarian syndrome, and endometriosis. Infertility, we're so ill-equipped to face these things before we hit perimenopause and we're just flying blind at the doctor. We don't know the basics. Right.

Joyce: 9:40

Are you finding this. Totally. This is why I don't work just on one area because you've got it exactly right. They're all linked. So in my view and and in my book it's called Your First Idea, it's from the menstrual cycle to the menopause. I think everyone needs to understand that as soon as we can. So in schools, I teach the whole reproductive health and we did a survey of UK and it's been done in Belgium and Greece as well, UK teenagers to ask them. What topics did they learn in school and endometriosis and P C O S, 2%, 2% of kids teenage. These are 16 to 18 year olds, and this affects both of them. Affect one in 10 women. And in the uk the data at the moment is that it takes about eight years or more to diagnose a woman with endometriosis. And I tell you the crux of the problem, we don't tell a woman what's normal. Mm-hmm. So teenagers are thinking this excruciating period pain they have, or they're irregular cycles with P C O S. They don't know what's normal and what's abnormal and so, They don't know to go and seek help. And, and this has nothing to do with wanting to have children. Reproductive health is all of those bits and bobs that, you know, menopause has not to do with having children. And neither is, is these other, those many other issues as well. You know, um, cancers, gynecological cancers, again, understanding what's normal. Is this pain normal? It's this cycle normal. Yeah. So that's where we need to start. We've got a, we've got a lot to do. We've got a lot to do, but we need to start in schools, which is the biggest one I've been chipping on. We've, we've made, made now a really comprehensive teaching guide for teachers to, to use, and we're doing some research with teachers to how they, how they're going to implement it and how they're finding it, and hopefully, Teenagers will tell us, yes, we've learned about some of these topics now, but we've got to teach everyone what's normal. This will help a woman's reproductive health, through her whole life, and she will go into the perimenopause, totally informed, and I think that will absolutely reduce some of the major issues, a misunderstanding that we have currently and, and one of the things I have, Myths. We have so many myths. We have lots infertility and infertility treatment. And I've been working on years of trying to debunk myths. And we have the same with menopause. And this is, I find really annoying that we have to spend time debunking myths when we could be doing something much more constructive. But with social media, these.

Ann Marie: 12:25

Tell me, tell me what are the things you see that make your, uh, hair curl? What do you see? What are the top myths that you're seeing?

Joyce: 12:34

So if, if we look at before menopause, if we look at, fertility, It's that supplements are going to help. I wish they would. I wish they could. You know, there's, there's one of the logos many people use for infertility is a pineapple. Cuz there's myths around eating a pineapple will help, you know, I'm a scientist. For me, I need to see evidence-based research, good quality research before I will say, That this, you know, I recommend X, Y, or Z. And even then, we have to keep an open mind. We have to question, question, question because when new research comes out, Then we might need to change our mind and say, actually, this much bigger, more, better, better quality study is now showing that doesn't work. So in my book, what I did is I went and read many of the papers, almost every paper I could about all the myths. So even things like our 28 day menstrual cycle and ovulation. On day 14, I went and read the original papers that said that they won a few hundred. Middle class, middle, white women, you know, middle income, normal B m i. And in, in our study we did looking at hundreds, I mean, looked over 600,000 menstrual cycles. It's not that, it's, it's, it varies. We we're not an algorithm. We, women are, we are very varied individuals, so, Again, even with young people saying, oh, you're gonna have a 28 day cycle, and then women not having a 28 day cycle and they're actually still having a normal menstrual cycle, but they've got it in their head that that's not right. So myth Smith myths. But if we look at the menopause, there's many being generated, but the biggest one by far at the top of the list for me, you are not gonna be surprised is. Now, I know you, we, we call it different things, but, hormone therapy, so whatever you want to call it, hormone therapy where we know that estrogen and progesterone go down in our, perimenopausal years. And then postmenopause, they're, they're almost non-existent. And so people are suggesting that if you replace them, so in the UK we call it hormone replacement therapy. Then everything will be wonder. But again, I've read all the evidence on everything that's, the people that are saying this are claiming and, you know, it's, it's just not true. There is quite a lot of evidence for, hormone therapy to help hot flushes, for example, flushes. But. Yesterday I did a focus group. Two of the women who were on there have H R T, they've had it for years and they still go get hot flushes. So, you know, we are, we are individual. We're very, very varied and my biggest worry about HR T is that people are saying, gonna cure everything. Oh, actually also, one of the women had osteoporosis who take takes h r t. So it worries me that we're misleading women. If you take. It's gonna cure everything. And you know, it's even been out on social media, don't worry about exercise, you know? And the list goes on. Whereas for me, I think we need to worry about exercise. We need to worry about nutrition, and we need to worry about our sleep. Not in a negative way. I'll turn that around positively. We need to manage those three, make sure they're really great and optimal. And listen, there will still be women who lead the healthiest lives ever, but who need hormone therapy. Absolutely. Just showing that we are absolutely individuals, so I think every woman needs to do what's right for them. I think some will find. Hormone therapy, an absolute game changer for their life, and they will never want to come off it, and that's fine. But we shouldn't have a narrative that every woman should be on H R T forever because they will, some of them will still get symptoms, some of them will have other underlying diseases, which will really. Made much worse from taking hormone therapy and suggesting to women that you can take this and then not worry about exercise or nutrition and still drink alcohol every night and not sleep very well, is going to be really problematic because those women are going to get sick.

Ann Marie: 17:29

That's one of the thing, you know, it's ironically someone yesterday. To me on social media, I get the sense that you're anti H R T and I said, it's interesting that you say that just because I take ask questions and I point out some of the things it can't do for you. I had done a post that was like, can it talk to your husband about the problems you are having in your sex life for 20 years? Can it, can it. Align you with your values and goals. And a lot of women said, look, I wouldn't have been able to address any of these things if I hadn't gone on h r t. Fine. But I do find we're in an interesting place where you, you are painted as anti if you're asking those questions. And that's where we are. And maybe this is beyond you, but why do you think in the UK that that is so controversial now to just be like, Hey, I'm in the.

Joyce: 18:19

We've, we've got some people who are very vocal, who really believe, that every woman needs H R T forever and it's going to prevent lots of diseases that I've looked into and I can't see any data that suggests it's definitely going to prevent disease. If I thought it would prevent dementia, I've got dementia in my family, I would definitely be on it. All the other people I know who are not of that frame of mind, none of us are anti H R T. I've never met anybody. There may be people, but I've never met anyone who doesn't agree that for some women, H R T is a lifesaver. But everyone I've talked to in different countries about their data, et cetera, they're shocked at the. What's happening in the UK and they don't understand, you know, most countries it's about five to 10% of women who are on H R T. Don't forget, there's about 20% of women that don't get any symptoms. Right. One of the women on my, um, focus group yesterday said, I feel really bad. I haven't heard anything. Um, and she said she felt brilliant. Also there's the suggestion that even if you don't have symptoms, you should take H R T, which again, many of us do, do not agree with. If you don't have symptoms, H R T is a drug and H R T is a drug that will help some women with certain symptoms. So if you have those symptoms, try it. If it doesn't, Don't increase the dose you get, there's a certain amount you should do within guidelines where you can play with the dose. I think h r T prescribing is very complicated and it's certainly way beyond me. It's not my area. So I think having. An expert tweak your h r t if it's not quite working, may, you know, is it is important if it's not working, but for some women it's, it's not going to work. For some women, they don't have symptoms, so I wouldn't see why you would take it.

Ann Marie: 20:22

Sometimes I wonder if the doctors who are so vocal about. They women are lining up in my office. They're crying in my office. I think to myself, yes. All the women who are this upset about it are coming to you. That's who you're seeing. So I understand your, catchment area. It's a bit skewed because the women who are dealing with it, and they're okay, they're not.

Joyce: 20:46

Yes. This, this is very common. So for example, in obstetrics, the obstetricians always see this is Aryan sections. They don't see the lovely home birth happen in three hours in a water bath, you know, blah, blah, blah. You've absolutely got it right. The, the doctors that are seeing women in these clinics that are paying, you know, the private clinics as well. They're the women who are really desperate. So that's a very skewed population. The 20% of women who are not having symptoms, and the bigger percentage of women that are managing their symptoms, they're not going to see those doctors. So that's absolutely, so in my research, I'm trying to speak to everybody now, all researchers, a little bit biased. I always worry when I do research. Probably when you do a survey or a focus group or interviews, you are getting the people that have more problems with it. So if anything, I'm also seeing the, the, the people that are worse off. A, a few of the women have started my focus groups or say I really wanted to talk to someone about what I've been through. We have had a few that have had a fine time. So I even, I'm seeing probably the more problematic ones, but we, I am seeing lots who, who say it was fine, and they're, they're the ones I really want to hear from as well. Well, we, we've also got a problem now. In one of the national papers, a few months ago, there was somebody who put a very positive menopause story. They said it was fine. I didn't have any problems, blah, blah, blah. She got ripped to shreds and the term people use was medical gaslighting. So now it seems that if you have, if you've gone through an illness and you've been okay, then that story's not valid. And I think that's totally unfair to the younger generations who are coming up. I think we have to listen to everyone's story and everyone's voice, so I think that's very unfair. We are not undermining anybody and saying it's all in their head or anything of anyone that's having severe symptoms. And I do a lot of work in companies and I say, The people, the women sitting around this table are all having a different experience. So if you work with someone who sailed through it, please don't put that onto the next woman who you might be working with, who's having a really tough time. We are all different and we're all gonna have a different experience. So the, the person with the really troubled perimenopause is someone we really need to support and. And it's lucky to be able to have a, a positive story, but we need to share it. It's not all doom and gloom and the light at the end of the tunnel is for many women. Not, not all women, but for many women, postmenopause is an amazingly wonderful liberating time of their life when, when they're free from, I asked them in, in my focus groups, what are the positives and negatives of being postmenopause? And, you know, they shouted everything out. Is there. No more contraception, no more periods, you know, no more crazy mood swings every month. You know, the list went on, you know, so there is are many things to celebrate and I, think we are unjust to our next generations if we only tell them that this stage of their life is a terrible brick wall that they've got to try and get over. And that's the only way it's going to happen. I think that's really unfair.

Ann Marie: 24:14

Well, I, I met a hairdresser this weekend. I spoke at an event, she's 42, and she said, every woman that comes and sits in my chair says, just you wait. Your stomach will grow and your hair will fall out and your skin gets awful and saggy. And I thought, what are you saying? Like, just you wait. Like what? This is not what we do to our younger sisters. And I know what you're talking about, some of this positive stuff. Cause I'm starting to feel it. I'm starting to feel like a clarity and I'm starting to feel what people have talked about and it's a really beautiful, like it's an emotional thing and I've had a long time, but just back to medical gaslighting. Like medical gaslighting is when you're in your doctor's office and your doctor doesn't listen to you or discounts your symptoms. That's what medical gaslighting is. And I've seen some people who should really know better taking that phrase. Like completely misusing it.

Joyce: 25:04

I've heard so many people misuse it. So, so many people, hon. Honestly, so one of my students once said that I was doing it and I. I was showing them something that was controversial, which I said I didn't agree with, and then they said, oh, you are medically gaslighting. I was like, I just told you I don't agree with thing that you also don't agree with. We're agreeing and then you're gonna tell me I'm medically, so listen, people always use words. Yeah. I think language is really become distorted. Yeah. But we have to be fair to our younger sisters, we really have to, many women in their forties, when you say, I think you might be para men. No, no, no. Don't tell me this. You know, they're fearful. We shouldn't have women in their midlife be fearful of something that they're going to be going, maybe going through difficulty or maybe going through easily. We've got to give them. Their whole information and not worry them. And I do think even for our, going back to our reproductive health and our menstrual cycle when we are teenagers, I really think that looking after our nutrition, our exercise, and our sleep at. If we can get this sorted out while we are younger, it helps with our menstrual cycle through our whole life. It helps with our, if we want children, it helps with our fertility, and we will get women to the perimenopause at a much. Higher level of wellbeing. So hopefully there will be less of a problem for some of those women. As I said, not all. And then I, I've had so many arguments about this with people on, on, social media one woman said to me last week, you can't have sex unless you've take, estrogen because your vagina will be. Not everyone's vagina goes dry. Ok? It depends on our body composition, what we've done to our body in all these years. Are we deficient in any nutrients? Are we drinking alcohol every night? Are we exercising? And, and as I said, even if you do all of those, you've got a different body. If you have two super fit women, they've got d. Compositions. They're genetically, we, you know, we haven't mentioned that, but genetics is really important. It is nature and nurture. Yeah. So with all of those, you know, it, we know even from twins, even with the genetic side, there's variations so. That's the whole package. So again, two women will never have the same experience, but looking after our wellbeing is a really good starting point and it's better to do it before we get to the premenopause. Before we want to have children and even as teenagers for some that will really help with our menstrual issues that we may have. It's not going to eradicate and we still need medicine. We still. You know, our doctors to look at us and give us advice at certain times, but it can really, really help. I'm, I'm absolutely convinced if you look at all the long-term data, heart disease, dementia, cancer, you know, all of these, all of these chronic conditions, everyone will say, exercise, nutrition, sleep, everyone.

Ann Marie: 28:24

They always say walking. You don't even have to make it complicated. Like walking is just a, I'm concerned, about women having other health issues and then being treated for perimenopause and menopause. I'm concerned about the rise in autoimmune disorders. If you've got a thyroid condition, if you have problems with your liver, if you have gut problems and adrenal problems that are all connected. Obviously I'm not a doctor, I'm not a scientist, but it, it strikes me that if you went on hormone therapy, you might feel better, but those things could be continuing in the background, and I wondered if you'd come across any research on that.

Joyce: 28:59

I've come across lots of comments about that, which I ha really haven't agreed with. I think you really need to make sure that you are talking to the consultant who's dealing with that under underlying health condition. So, I have heard the last few weeks in the UK there's been this big discussion about taking testosterone and I've talked to the, well, the, one of the world leaders is Professor Susan Davis from, Australia. I've had some correspondence with her. I heard her give an excellent talk last year at the British Menopause Society, and you know, her reach research has said that for people with a pathology in their sexual health, then testosterone can work. But there's, there's, there's a narrative going around the uk. Everyone, every woman should take testosterone. And so the other issue that I heard, in the last few days was women with, with polycystic ovarian syndrome, they have higher testosterone anyway. Mm-hmm. So there's some of them that have said, well, we are now being told that we should take more testosterone. And, you know, we need to look at that. So the, the, the issue with all of this is, That women are being Guinea pigs and we have the same again, with fertility treatment. I hear people say, in my clinic, I have found that this helps women. Okay. I've had it, as I said, across the board, that's not research. That is biased analysis. You know, you give someone something, are you actually getting them to. Complete a robust survey about how they're feeling before, how they're feeling after if you measured everything, or are they just coming to see their doctor who prescribe that and saying, oh yes, I feel fine. You know, that's not, that's not research. And I always say to everyone, if it's robust research and you've done a proper study, then please publish it in a peer review journal and let's read it. And they never do. I mean, I've had this infertility treatment for decades. They never do because it's not robust, it's hearsay. It's, it's just, I've gone in a huge route with someone on, on Twitter this week, and I, I've just stopped replying and they talked a lot about anecdotal evidence. It's not, that's not evidence. Anecdotal is anecdotal and it's just people in conversation. And yes, we want to women's voices, but we want to do it in a methodical way. So it needs to be done in a, in proper, in a proper, validated way, and not just a, a chat in your doctor's surgery. I'm very worried and I'm, I tell you, I'm very worried that. Your listeners may know that, a problem happened with H R T years ago. There was some data from this, robust, huge study that that was showing an increase in breast cancer. So everyone stopped using it and I worry now that we are going to get back there. We are going to get all these people who really probably shouldn't be using it, using it, and people having higher doses. And I worry that we are then going to have a lot of bad press about it. And then everyone will stop using it again because they'll all get worried. So when we see that, you know, if, if we saw that women taking h r t don't exercise as much and they have more risk of heart disease, et cetera, et cetera, then um, you know, and P C O S, if we see problems there, if we see other issues, I really worry. That we're going to come all back to full circle and women will say, oh, I'm too scared to take it now. So I think it's really important to practice good medicine and good science and make sure we do this and don't run before we can walk, we have to do the science. Someone said to me, but if we haven't got any data, I shouldn't, we just tell No, we shouldn't just make it up. If we haven't got the data, we have to say, we haven't got the data. You can't, you can't say anything else. That's it. I, I worry that we'll end up in this really negative situation with H R t getting a hugely negative press. Mm-hmm. If it continues along this vein, and I don't want that to happen. None of us are against H R T, we're absolutely for it, but those, those that are taking it need to take it. But those that don't need to, or shouldn't, shouldn't be taking.

Ann Marie: 33:16

And that's the prevention question. You've been reading all the, you've read all the papers that you could find on dementia. Dementia and cardiovascular disease are the two I see consistently stated as fact that it prevents cardiovascular disease and it prevents dementia with minimal, minimal risk. And that's where, you know, there is more, evidence, I think for osteoporosis. Um, but yeah, could you, everyone wants to know this and practitioners are just as confused it seems to me. It's a very large topic, but, but is the evidence there

Joyce: 33:49

I teach master students at my university and they're with us for a year. And in that year I tried to spend that year teaching them how to read papers. And we do various tasks along the way. It's difficult to know how to read a paper and there are lots of people including health professionals, and we've had this with the fertility field. Don't know how to read the studies properly so they don't come away with the right information. That's, I mean, maybe it's partly the person who wrote the paper's fault, and I would try to be really clear, but it is difficult to know for, so for example, if there's a, the, the biggest. Most important clinical trial is a randomized control trial where, for example, you'll give half the women, h r t and half the women, not H R T, and then they'll, they'll look okay, in 10 years, how many got dementia, how many got heart disease, et cetera. But they're hard to understand and some of them are good quality and some of them are not good quality. And there's something called a meta analysis. You, someone will read three or four or five or however many there are of these randomized control trials, and then look at all the data together as you've got thousands and thousands of people. And then they'll, they'll do some high statistics on it and see, is this showing a significant result or not? Is, is this going to help if I do this treatment, is it going to help? And unfortunately when you see a lot of these meta-analysis, they say the evidence was too poor. So even though there's been trials done, they weren't of good enough qu quality and there were problems in them, or it didn't really show what, what, what happened. So I, I spent a few days reading all the papers on all the recent clinical trials on H R T and dementia, and there was some that said they got a, a. Less dementia. There was some that said they got more dementia and there was a lot that said they didn't get any difference in the two groups. Now, when you dig, really dig into the papers. And look at them. They all have lots of variables and what we call confounders. There, there's all these differences going on. Obviously we said h r t, there's different ways of giving it. There's different brands, there's different doses, et cetera, different times that women started, et cetera. So my, from reading them all, and I'm not the only one who feels this, I do not feel that that evidence. That taking h r t will reduce dementia. It seems that there's an effect of the, we give estrogen progesterone, and it's the, the progesterone or the type of progesterone that's being given. The conclusion of some of the papers was that that may counteract any positive effects of estrogen, and there were some very small amounts of data that for women that have had a hysterectomy. So we're just taking estrogen. They seem to have had some protection, but then we get into very, very small numbers. And when we get to small numbers, it's something that you've now got to do a big study on women that have had a hysterectomy that are just, taking estrogen. So at this moment in time for me, if I'd have read the papers and felt that it absolutely showed that taking h r T would reduce the risk of dementia, I tell you, I would've taken. I absolutely would've taken it because, I have a big family history of dementia and it's something that's always worried me, but for me, I could not, conclude that the evidence actually showed this. And I've spoken to many other people who totally agree. It, it has sort of escalated a little bit. We, we did wonder where it all started and there were some studies that showed that estrogen, may be important in the brain, et cetera, et cetera. And people have done brain, MRIs and, and other brain scans of people in the perimenopause and premenopause and postmenopause. But used like in puberty. In puberty, our brain connections change. And in the menopause, I mean, you, you said it as well, I feel for me, Post-menopause, a fog lifted from my brain. I felt that I went through puberty very yet. I was nine, so I don't remember a time when I haven't had eastern and progesterone buzzing around my body day in and day out, not knowing when I wake up, how am I going to feel? What are these powerful hormones going to be doing today? And a lot of the time feeling I was in the eye of a storm. And then post-menopause. I was like, wow, my brain is clear. This fog is gone. I apologized to two of my ex-boyfriends and said, I'm so sorry. I think I was a bit crazy when I was younger. And now I feel level and calm. I mean, I show, I'm a cold daughter swimmer, so I show pictures of us in a big wave, then pictures of us at sunrise and a calm sea. And that's how I felt for the first time ever in my life. And so for me, I'd need a very strong argument to start putting those hormones back in my body. But that's me. And I'm a scientist and we don't, normally, I'm sharing my story, but it's not scientific to do that. It's not an end of one, it's nothing. I just want people to hear all stories, so I wanted to share mine.

Ann Marie: 39:14

And tell me a little bit more about on the other side, because you literally, he, you hear it and it's horrible and it's a direct line to disease and decrepitude and, that doesn't seem what I see with my eyeballs, in the world. So tell me about it.

Joyce: 39:31

It's, it's not so, so I've started a podcast, recently this year. Um, and I started by interviewing some really motivating women who are, are really on my page. So, um, last week's one is song called Joe Mosley, who's a, a paddle, but she, she started paddle boarding when she was in the per. And she's written a book, she's made a film. She's just so inspiring. And there's many other women I'm gonna be interviewing, so many other motivating women. And now I, I totally agree with what Joe would say to you and all these other women, we, we really feel the best we've ever felt because, you know, if you think about when you're 18, 20, 20 old, there's all these things you are trying to do, you know? Trying to get educated, trying to get your career, trying to get a partner. You might wanna be trying to get children. You know, you want to buy a house, you want all these things you need to do, blah. You get to my age, they're done. They're tick, tick, tick, tick, tick, tick, tick. I've still got teenagers at home actually, but they're almost, they're almost flying away, almost. Not quite. But it's a time when you can do whatever you want to do and that freedom, freedom is a word that I use all the time. It's incredibly freeing and, and I, I'm doing a lot about happiness. I really feel that we can be the happiest we've ever been and we can lead the best lives we've ever wanted to, to live and but to do that, You have to stop and reflect and think about what actually makes you happy. So I know a lot of women that aren't in a happy place at, at my age, but I know a lot of women that are. But the ones that are, are really people that have thought about it. And I hear so many people say, I'm going to retire. And I say, what are you gonna do? And they say, I don't know. No, no, no, no, no. That doesn't work. Okay. You should be knowing now what makes you happy and what you'd like to pursue more. When you retire. So I think reflecting on, you know, waking up every day, what's going to make me happy today? What could, it might be a candle at bath, it might be dancing around the kitchen for 10 minutes, might be singing a song, going for a walk. I think spending time in nature, we live on a beautiful planet and you know, watching the sunrise and the sunset, I never did that as much as I do now. And being feeling free. And being with your girlfriends, going dancing, you know, go doing all the things you want to, and also spending more time alone, I think covid for many people, and not just being at home alone, but doing quality things. So I started going to gigs on my own. I go to the theater on my own. I've got lots of friends that want to come, but sometimes I just think. I'm just gonna go on my own and not, you know, so I don't do it all the time. But, you know, it's, it's a really freeing time for many women, but life is what you make it, it's never too late to turn it around. So think about it. It doesn't need to cost money. It could just be going for a walk, standing on a hill and watching the sunrise or the sunset, you know, looking at the beach. It's a available to everyone, but we have to, we do have to work at it because we have probably spent the whole of our lives looking after everybody else, you know, around us. We do, women do look after yourself, put your own oxygen mask on first and think, right, I'm going to, and that now you have to find the time. Spend some time on you and don't worry about anybody else. You know, they can, they can do whatever they want, but, you know, I think, I think we can.

Ann Marie: 43:09

I love it. Figure out who you are and what you want and then go do that. I love it. You make it look so good. So I'm just really, really happy I connected with you. Where can people find your podcast and your next book?

Joyce: 43:22

And so my next book, my my mother, who's not with us anymore, my mother had a saying, good Health and Happiness, and I think my next book is gonna be called Good Health and Happiness, and it's gonna be subtitled over 50. So I want to interview 50 women. Over 50 to, because the other thing is that what makes everyone happy is totally different. We are very, very different. So there's no one size fits all for all of these things. So I have a website, it's joyce harper.com, so all one word, joyce harper.com. And there you will, you can get my book from any retailer as far as I'm aware. My podcast links on there. But they can go to all the podcast channels. Just put in Joyce Har. And it will come up and it's called, why didn't anyone tell me this? I ask all my guests what makes them happy, and where is their happy place? And I want all of your listeners to think about it cuz some people don't answer. Some people say, work I know works fine. It's good. I'm glad people are happy at work, but we shouldn't just be happy at work. I shouldn't be the only answer. Okay. Yeah. So everyone can think about that. They're a bit of homework from me. Amazing. And. Really let's all work at making our lives the best life we could ever have.

Ann Marie: 44:40

Mm. This is going somewhere good. Thank you so much.

Joyce: 44:43

Thank you. Thank you so much for joining me. If you like this conversation, I hope you'll check out some of my other interviews on the Hot Flashing Podcast, subscribe, give a rating, maybe a review, and come back for more next week. Hot Flash Inc. Was created and is hosted by Annemarie McQueen, produced and edited by Sonya Mac. The information contained in this podcast is intended for informational purposes only, and is not intended for the purpose of diagnosing, treating, curing, or preventing any disease. Before using any products referenced on the podcast, consult with your healthcare provider, read all labels, and he all directions and cautions that accompany the products. Information received through the podcast should not be used in place of a consultation or advice. Care provider. If you suspect you have a medical problem, ie. Menopause or anything else or any healthcare questions, please promptly see your healthcare provider. This podcast, including Annemarie McQueen and any producers or editors disclaim any responsibility from any possible adverse effects from the use of any information. Contains herein opinions of guests on this podcast. Are their own, and the podcast does not endorse or accept responsibility for statements made by guests. This podcast does not make any representations or warranties about a guest's qualifications or credibility. This podcast may contain paid endorsements and advertisements for products or services. Individuals on this podcast may have direct or indirect financial interest in products or services. Referred to here in this podcast is owned by Hot Flash, Inc. Media.