5 MINUTES WITH… DR ITUNU JOHNSON-SOGBETUN

Dr Itunu Johnson-Sogbetun shares how her personal experience fuels her passion to centre women’s experiences at the heart of healthcare

WHAT DREW YOU INTO WOMEN’S HEALTH AND HORMONES?

My journey stemmed from interest, but also from personal experience of women’s health problems. I’ve lived with PCOS since my twenties, and as a result of that, I’ve had a lot of different health problems.

At age 27, I was diagnosed with high blood pressure, which was obviously really young. I went on to struggle with fertility, required fertility treatment, but then lost a twin pregnancy at 22 weeks. Thankfully, I managed to have my child seven years ago, although even that pregnancy was quite challenging.

Then, to my shock, at age 35, I was diagnosed with stage three endometrial cancer, which is a known complication of PCOS. I’ve also struggled with my mood from time to time. The struggles have been stronger at some times than others, but all of them have been related to hormonal issues and other lifestyle intersections.

That brings me to my great passion, which is the mental load and how it impacts hormonal health issues. Whether it goes from PMS to PCOS, right up to perimenopause and menopause, and everything in between, including postpartum and the biopsychosocial intercept.

My interest comes from clinical work, but also from lived experience. That means I have a perspective from my own journey. I can help patients look at this from a biological standpoint and by looking at the psychosocial factors as well.

HOW CAN CLINICIANS BEGIN CONVERSATIONS AROUND WOMEN’S HEALTH AND HORMONES?

It’s a really important discussion to bring up. I find myself asking in pretty much every conversation I have with women.

If a woman comes in with headaches, I’ll ask if she’s noticed any pattern or relationship with her periods or her cycle. If a woman comes in with gut issues, you can have hormonal IBS, PMS, PCOS, perimenopause intersections, so I often ask if they’ve noticed any hormonal patterns.

It doesn’t really matter what symptoms a patient may present with. For perimenopause and menopause, there are over 70 symptoms. Oestrogen affects so many functions, from the gut to our blood vessels, to our blood pressure, to our bone health.

Everything is intrinsically linked with our hormones. As women, we are circles, and unfortunately, medicine and the world have been a square for so long. We are cyclical, hormonal beings, and we now need to be thinking of women’s health as embedded into everything, not sidelined as a separate reproductive health issue.

HOW DOES PREVENTATIVE CARE FIT INTO WOMEN’S HEALTH?

Prevention is so important. We know about changes in the brain that occur in menopausal women. MRI scans show changes that can look like pre-dementia changes. We also know about bone density loss in postmenopausal women, changes in fat distribution, increased abdominal girth, weight gain, increased risk of metabolic syndrome, and increased risk of heart disease. All of these are a consequence of hormonal changes. Since we know we have the option and the ability to biohack, to prevent and to reduce risk, even if we can’t completely eliminate risk, we should start with the basics. Lifestyle medicine is the pillar of everything.

Then, of course, we might need medication to prevent disease.

As clinicians working in midlife or hormonal health, including PCOS, which impacts much younger women, we know there’s an increased risk of heart disease, endometrial cancer, and mental health problems. We can be prophylactic by putting lifestyle measures in place and by regularly monitoring patients and acting as needed.

It’s really important that we empower patients to be proactive rather than reactive.

WHAT MISCONCEPTIONS DO PATIENTS MOST COMMONLY BRING TO YOU ABOUT HORMONES?

One big misconception is that internal hormones are good and external hormones are bad. This is a product of social media misinformation. Hormonal treatment isn’t for everybody, but there are situations where it can be life-changing or restorative. External hormones can be powerful treatment tools. If we look at the last century, the three health innovations that completely changed our world were vaccinations, antibiotics and contraceptives. Contraceptives gave women the opportunity to live a life that was within their control, to enjoy life, and to have choices.

Hormonal treatment isn’t perfect, but there are now many different options. There’s no one-size-fits-all. We now have bio-identical hormone options, plant-derived options, and many different types of treatments. If someone struggles with certain symptoms or side effects, we can often find alternatives depending on their needs.

There’s no need to fear external hormones. What’s needed is more information, direction, and education. It’s not for everyone, but the conversations are important.

HOW IMPORTANT IS CULTURALLY COMPETENT CARE IN WOMEN’S HORMONAL HEALTH?

We know there are ethnic differences in how people present and how they experience hormonal issues. With PCOS, Black and Brown women are more likely to experience complications such as obesity, diabetes and infertility.

With menopause, the average age for a South Asian woman is around 46, almost five years younger than a Caucasian woman, whose average age is 51. For Black women, it’s around 48 or 49.

But it’s not just about numbers. It’s about experience. A South Asian woman might present with all-over body pain. She may not use the words hot flushes or night sweats, even if she’s experiencing them. In some cultures, there isn’t even a word for menopause.

With Black women, we know vasomotor symptoms are often worse. There’s also a bigger intersection with mental load and static load. These factors affect experience.

Cultural implications matter. With PCOS and infertility, women may fear abandonment. With menopause, women may fear loss of usefulness, sexuality, or value within their relationships. There may also be cultural trauma.

All of this affects how hormonal issues are experienced. Clinicians need curiosity, humility, and openness. We need to understand context without making assumptions. Every patient is an individual.

WHY IS EDUCATION SO IMPORTANT IN THIS FIELD, BOTH FOR CLINICIANS AND PATIENTS?

Education is key. We can’t empower patients if we don’t have accurate information ourselves. Clinicians need to upskill using credible sources.

There are organisations such as the British Menopause Society, the International Menopause Society, the European

Menopause and Andrology Society, and the Menopause Society in North America. There are also charities such as Verity for PCOS, NICE guidelines, RCOG, the Faculty of Sexual and Reproductive Healthcare, and the Primary Care Women’s Health Society.

There are conferences like Menopause in Practice and British Menopause Society conferences. Online education isn’t all bad. While there is misinformation, there are trusted educators providing accurate, bite-sized information that’s helpful to clinicians and patients.

WHAT AREAS OF WOMEN’S HEALTH ARE MOST LACKING IN CLINICAL TRAINING?

Hormonal health in general is poorly understood. We still don’t have enough research. Even what we think we know is incomplete.

We need a better understanding of ethnic experiences, the relationship between hormones and the gut, hormones and the brain, and hormones and mental health. Women are suffering, and our understanding is still basic.

I’m particularly interested in the hormone-gut relationship. For many people with high stress and mental load, the gut is where symptoms first appear; bloating, pain, discomfort. We must exclude serious disease, but we know stress hormones and cyclical hormonal changes can drive these symptoms.

It’s an area we don’t talk about enough, and it can be deeply distressing for people.

WHAT DEVELOPMENTS IN WOMEN’S HEALTH ARE YOU MOST EXCITED ABOUT RIGHT NOW?

I’m excited about the increased focus on women’s health. The government’s women’s health strategy is coming out this year, and I was privileged to take part in a Department of Health ministerial roundtable.

There are also new medications, including non-hormonal treatments for menopause symptoms, combined contraceptives with body-identical estrogen, new progesterone options, and updated PCOS guidelines, possibly even a name change.

There’s so much happening, so much that’s interesting, and it’s incredibly exciting.