• Navigating emotions during hormonal changes and grief
• Why processing grief is so important
• Approaches to dealing with grief and accessing support

Perimenopause and menopause can be a challenging time in your life but if you’re also grieving, it can be particularly tough. You might feel you need to be strong for your family or feel so floored by your emotions and your menopausal symptoms, you’re not able to see the wood for the trees.

Leading psychotherapist Julia Samuel MBE, author of Grief Works, says: ‘Perimenopause and menopause are times of transition, where you’ll need to psychologically adjust to a new phase of your life. If a significant person in your life dies at this time, it can rock an already wobbly system. You are grieving while experiencing a living loss. This is an important context, because often women feel they are “doing it wrong”, but acknowledging the level of loss you are facing is an important factor in supporting yourself.’

Julia says it is important to take your physical and mental needs seriously. ‘The support you receive at the time of the death and following the death is the single most important factor in your capacity to grieve effectively. This means you need to give yourself permission to support yourself, and not pour all your energy into supporting everyone else.’ 

RELATED: Emotionally supporting each other through the menopause

How do I know if how I’m feeling is due to grief or menopause?

Grief cannot be fixed. However, perimenopausal and menopausal symptoms can be managed and improved with individualised treatment. Seeing a healthcare professional can help with this.

Some women find it difficult to pinpoint if their feelings – of sadness, hopelessness, anger, numbness, etc – are due to grief or menopause. Psychological symptoms are common during menopause common – in a Newson Health survey of 5,744 women, 95 per cent of respondents said they’d experienced a negative change in their mood and emotions [1]. There is also a significant increase – approximately three times higher – in the likelihood of depressed mood during the perimenopause and menopause than in other life stages [2]. 

If you’re overwhelmed by your emotions but unsure of the cause, consider if you’ve had similar symptoms in the past? How did you used to feel before your periods, or when you were pregnant, in times of hormonal fluctuations? Alongside your emotional symptoms, do you have physical symptoms, such as hot flushes, dry skin, palpitations, genitourinary symptoms? These don’t usually occur due to depression or grief.

However, it is possible to be menopausal and grieving, and you can have a bodily reaction to your grief. This is why it’s important to track symptoms and share this with your healthcare practitioner. Sometimes grief can lead to clinical depression but there are subtle differences between low mood due to menopause and clinical depression. In general, women who experience hormonal low mood, know how they are feeling isn’t right – they have insight and want to feel better. With clinical depression people tend not to have that insight nor care about how they feel. Your healthcare professional will be able to help you explore your emotions and possible diagnoses.

RELATED: Am I depressed or menopausal?

How can I handle my grief?

Julia stresses that grief is not something to fight and there is no one single approach to coping with grief. Here are some of Julia’s suggested strategies to consider:

Get support

‘We need to allow grief to process through us, and it is often experienced as waves of pain crashing through us. In order to withstand those waves, you need to access support. Support will look different for different people but it needs to include time to focus on your grief. You need time to feel the pain and face the reality of the person’s death. This could be with a friend, a family member, a therapist, or with the Grief Works app. Or all of them. It helps to create structure around it, so perhaps block out time to walk and talk to a friend. Or create a habit of journalling after exercise in the morning. If you can only manage small bites of support, connect with people who love you. When the person you love dies, it is the love of others that enables you to survive.’

RELATED: Families, relationships and the power of connection with Julia Samuel

Regulate your body

‘Choose to do things that help regulate your nervous system, because grief often feels like fear. This includes taking regular exercise (by this I mean moving your body, not running a marathon!) and remembering that whatever you do, who you see, what you watch, what you eat, what you drink, how much you sleep, all has an impact on your capacity to regulatory effect. And get outside for a walk, run, bicycle.’

Feel the pain

‘Grief is a tidy word that describes a complex and messy process. The task of mourning is to face the reality of the death, to let yourself know that the person has died, that their death is irreversible. Unfortunately, the mechanism for that is allowing yourself to feel the pain – pain is the agent of change. The model that is helpful to think about is the dual process: loss orientation where we, cry, emote, express our pain and then oscillating to restoration orientation where we have a break from the pain, do tasks, allow ourselves to be distracted, get on with life. Recognising the movement between the two orientations is helpful. Allow time for both.’ 

Accommodate your loss

‘Whilst culturally people often think of grief as something to ‘get over’, what we understand now is that we don’t get over someone’s death. Instead we learn to live with it, to accommodate the loss into our life. Which means we build our life around the loss. The intensity of the pain changes, grief is naturally adaptive so we have the capacity to live and love again, but we may find a wave of grief wash over us many decades after the loss.’ 

RELATED: Loneliness and the menopause

Create touchstones

‘The other important understanding is that the person we love has died, and we need to adjust to their physical absence. But our love for them never dies. Our love continues, and we have touchstones to memory that keep the person connected to us. These touchstones may be writing to the person, wearing something of theirs or cooking their favourite recipe. Creating a playlist in memory of your person can be helpful, or lighting a candle in their memory. I find that people instinctively know what to do once they have the idea of continuing bonds, and touchstones to their memory.’ 

Find hope 

‘My final thought is that hope is the alchemy that turns a life around. Hope isn’t just a feeling, it is a plan A and a plan B, and the belief we can make it happen. Picturing how you want to live your life now, whilst accommodating the person’s loss, will help you get there.’ 

RELATED: How friends can ease your menopause

Julia Samuel is a leading psychotherapist and author of Grief Works: Stories of Life, Death and Surviving. Her app, Grief Works, was created to help navigate grief after the death of a loved one.

References

1. Experiences of the perimenopause and menopause, December 2022
2. Freeman EW. Associations of depression with the transition to menopause. Menopause. 2010;17(4):823-827. doi: 10.1097/gme.0b013e3181db9f8b

The post How do I cope with grief during menopause? appeared first on Balance Menopause & Hormones.

• Women’s social lives can be impacted by menopausal symptoms
• Those in social networks are more likely to be positive about menopause and less likely to have depressive symptoms
• Starting menopause conversations can open up friendships

Right now, millions of women worldwide are menopausal. So, you’re certainly not alone even though it can, at times, feel that way. For some women, symptoms of the perimenopause and menopause can be isolating, for numerous reasons.

On a physical level, heavy periods, hot flushes, muscle and joint pain or tiredness may prevent you from seeing your friends as much as you used to or would like to. Psychologically, a lack of confidence, loss of joy, brain fog or anxiety can have an effect. In fact, a study found that over a third of women reported that their social life had been impacted by menopausal symptoms, with 26% saying they felt less outgoing, and 19% no longer enjoying social situations [1].

Users of the balance app’s community pages have shared their struggles with socialising – some women talk about wanting to stay in the safe space of home, others say they hide their symptoms, which can be exhausting, while another reported she ‘doesn’t have the energy or headspace for socialising at all’.

Beyond the desire to socialise, some women don’t feel understood. Even though you know that other women must be going through the menopause, it can sometimes feel like they might not understand your experience. After all, everyone’s experience is different and well-meaning friends might not appreciate the effect your symptoms have on you, especially if they seem to be ‘breezing through’.

Then again, you might be the first woman in your friendship group to be experiencing symptoms, especially if you are going through a surgical menopause or early menopause. It can be hard to confide in friends who may not be in a similar stage of life.

RELATED: loneliness and the menopause

Why friendships matter

While your instinct might be to become more insular, it’s worth remembering the importance of friendships on your everyday wellbeing and health. Adults who are more socially connected are healthier, live longer, and have a better quality of life than their more isolated peers [2, 3].

But when it comes to perimenopause and menopause, friendship can have a positive effect. To gain more insight into how friendships can be so valuable at this time of life, a survey asked women aged 37 to 65 to report their experiences. Common themes were that friends were a great source of support, comfort and understanding and that relationships with other peri/menopausal women were portrayed as akin to “sisterhoods”.  Meaningful menopause-related connections were forged in all areas of everyday life, with women connecting over their experiences in their workplace, or at the gym, for example [4].

As well as offering comfort, friends can be a great source of information about perimenopause and menopause – some women perceive social networks to be more useful resources than doctors or health professionals [5].

RELATED: families, relationships and the power of connection with Julia Samuel

How your friends can support you

You may feel unsure if menopause is something you can discuss with your current friends. But think of it this way – they might feel the same! Only by talking about perimenopause and menopause will we learn it. There is no shame in it and if you can talk openly and factually – about menopause being a long-term hormone deficiency – you might help someone else.

If you’re the first one in your friendship group to be experiencing symptoms, talking about it opens the door to others so they, in turn, can ask you questions when they (inevitably) go through it.

You might also be able to use a friend as a sounding board. For instance, if your mental health is suffering, a friend can help you make sense of what you’re experiencing – ask her if she’s noticed changes in you, or if you seem more down or irritable than usual. By initiating the conversation, she’ll know you’re open to support.

If you’re nervous about seeing a healthcare professional about menopause, you can ask a friend to accompany you – and offer to provide her the same support if she needs it.

How can I find my tribe?

While the benefits of friendship during menopause are indisputable, not every woman has a group of friends she feels she can confide in. Midlife can be a tricky time – you may have grown apart from some friends or been so busy friendships have drifted away.

As the previously mentioned survey noted, menopause friends can come from places as varied as work, leisure clubs and even neighbours. You can also ask your healthcare professional if they know of any local face-to-face support groups.

Social media can be helpful, whether it’s for finding local groups via Facebook or workplace events via LinkedIn.

Our free balance app has community pages, where women share their experiences. Since using our balance app, 79% of women said they felt less alone once they’d read other people’s stories that have resonated with them [6]. In one post on socialising, women shared their views such as how lunchtime get togethers are best as they’re quieter and shorter, and one user said ‘I seem to only be able to tolerate other menopausal/perimenopausal women. I have to mask so much with everyone else.’ Proof indeed that menopausal women make the best friends!

References

1. Currie, H., & Moger, S. J. (2019), ‘Menopause – Understanding the impact on women and their partners’, Post Reproductive Health, 25(4), pp183–190. Doi: 10.1177/2053369119895413

2. Umberson D., Montez J.K. (2010), ‘Social Relationships and Health: A Flashpoint for Health Policy’, J. Health Soc. Behav. 51(Suppl. 1), pp54–66. doi: 10.1177/0022146510383501.  

3. Scocco P., Nassuato M. (2017), ‘The role of social relationships among elderly community-dwelling and nursing-home residents: Findings from a quality of life study’, Psychogeriatrics.17 pp231–237. doi: 10.1111/psyg.12219.

4. Hayfield, N., Moore, H., & Terry, G. (2024). ‘“Friends? Supported. Partner? Not so much …”: Women’s experiences of friendships, family, and relationships during perimenopause and menopause’, Feminism & Psychology, 0(0). https://doi.org/10.1177/09593535241242563

5. Dillaway, H., Byrnes, M., Miller, S., & Rehan, S. (2008), ‘Talking “among us”: How women from different racial-ethnic groups define and discuss menopause’, Health Care for Women International, 29(7), pp766–781. https://doi.org/10.1080/07399330802179247

6. The Definitive Guide to the Perimenopause and Menopause Survey (2022)

The post How friends can ease your menopause appeared first on Balance Menopause & Hormones.

This booklet is designed for support workers and family carers – it offers information on the perimenopause and menopause and how it can affect women with learning disabilities, plus gives guidance on how best to offer support.

The booklet is downloadable and has been published to coincide with Learning Disability Week 2024.

Our previous booklet, Easy read guide to the perimenopause and menopause, is also available.

The post Learning disabilities and the menopause: for support workers and family carers appeared first on Balance Menopause & Hormones.

This week on the podcast, Dr Louise is joined by Tova Gillespie, a working single parent to two daughters, one of whom has severe disabilities and complex medical needs. Here she talks about the challenges of being perimenopausal while being a carer and how it’s easy to not recognise or understand your symptoms.

Louise and Tova discuss how it’s easy for your own needs to end up at the bottom of the to-do list when you’re a carer or have a busy family life, and Tova shares three tips for anyone who may not be looking after themselves:

1. Learn to ask for and accept help. People want to help, but very often they don’t know how to offer it and our usual response can be ‘no, I don’t need anything’. Instead, say straight out: ‘Please do my washing up. Or I have five loads of clean laundry that needs sorting. Or can you bring over some food?’ Anything really.
2. If your health isn’t what it should be, go to your GP. When you ring your GP, ask for an appointment to talk about perimenopause and hormones. They’ll know from the get go what it is you’re after and if they have anyone in the clinic with an interest in that area, they’ll put you in with that person.
3. Try to see the good every day. I do gratitude journalling, where I write down a minimum of three positive things that have happened that day, and they’re not big. It could be the sun is shining. It could be the taste of that first sip of coffee in the morning. I train myself to look for the positive because it’s so easy to get overwhelmed in the bad stuff.

Learn more about Tova on her YouTube channel. Or follow her on Instagram @parentXP

Click here to find out more about Newson Health.

Transcript

Transcript:

Dr Louise: [00:00:11] Hello, I’m Doctor Louise Newson, I’m a GP and menopause specialist, and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. 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 perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So today on the podcast we’re going to talk a bit more inclusively actually, because there’s lots of women we know that are struggling, but also as women, we often put ourselves right at the bottom because we’re too busy, often looking after others, concentrating on various things in our life. And so I’ve got someone with me today, Tova, who has been really inspirational. Hopefully after this podcast, many of you will follow her on YouTube and see how incredible she is. She’s got a really interesting but not unique story, and I want her to really share it with us and talk about how hard it can be, when really it’s impossible for us to concentrate on ourselves in the way that we should. So thank you so much for coming on to the podcast today. It’s great having you here. [00:01:46][95.9]

Tova: [00:01:47] Thank you so much for inviting me to be with you today. It’s really fantastic to be here. [00:01:51][3.9]

Dr Louise: [00:01:52] So do you mind telling me about what’s been happening to you over the last, well, since your oldest daughter was born really? How your life changed? [00:02:00][8.3]

Tova: [00:02:01] Yeah, absolutely. So I had children quite late in my life. I was 36 when I had my oldest daughter. And I went through a pregnancy that, from the baby’s point of view, was perfectly healthy and it was a highly monitored pregnancy because I live with a thyroid condition, so it feels like I had a million ultrasounds throughout to make sure that everything was fine with the baby. Then at the very end of the pregnancy, the baby stopped moving. I went into hospital to find out what was going on, and eventually she was born through an emergency C-section with something called meconium aspiration, which is when the baby’s open her bowels inside and inhale that, which can be extremely dangerous. In Elin’s case, this resulted in over ten minutes of no oxygen, and she suffered severe oxygen deprivation, injuries on her brain and all the other organs of her body. And all these other organs, they heal. But the brain unfortunately doesn’t. Once the brain cell is gone, it’s gone. And she now has brain damage. She has quadriplegic cerebral palsy, which means that she has very little to no control over any part of her body. She has very severe learning delays. She is non-verbal. She is non-mobile. Obviously she’s a wheelchair user full time. She has a lot of health issues. She has a feeding tube. It is not safe to feed her orally. And she has, quite complex epilepsy seizure disorder that lands her in hospital several times a year with medicine-resistant cluster seizures. So we try to record this a couple of days ago, Louise and I, and I was I was still in hospital then, and unfortunately, the NHS Wi-Fi wasn’t quite up to scratch. Yeah. So I’ve literally just come home from hospital after my daughter had to be taken in by an ambulance with medicine-resistant seizures. [00:03:57][115.9]

Dr Louise: [00:03:58] And you’ve got another daughter as well, haven’t you? [00:04:00][2.3]

Tova: [00:04:01] Yes. So my oldest daughter is ten, and then I also have a seven year old. [00:04:04][3.5]

Dr Louise: [00:04:04] So very, very busy at home. And most of us can’t imagine what it must be like because many of us, including myself, have children. But children with special needs and physical, mental, any disability, can be incredibly difficult. And I know when my middle daughter had sepsis and was in hospital for many days and took a long time to recover, you just forget about yourself because you’re only as happy as your least happy child. But when your children are ill, you just want to take that pain. You want to do everything you can. It’s a very weird thing until you’ve had children yourself, how you feel. But the last thing you think about is yourself. And so I can’t actually imagine, I can try and imagine, but I can’t imagine what it’s like living with a daughter that has a illness that is changing all the time as well, that you’re totally there, totally devoted to, and you have another daughter as well. So support is really difficult. And I’ve spoken on this podcast many, many, many times before, and I will do again, about the physical and psychological impact of perimenopause and menopause and how often we don’t know it’s happening. It’s not often actually until we have treatment, we realise how bad we’ve got. But tell me about your story, because obviously you’re here to talk about the perimenopause or menopause otherwise I wouldn’t have invited you. [00:05:28][84.1]

Tova: [00:05:30] Yeah, absolutely. And I think, you know, I’m just going to very quickly touch on what you said here, that it’s so easy to forget about yourself when you are busy caring for another. And that’s not exclusive to special needs parents, anybody who a lot of people care for partners or spouses or they care for elderly parents. But also even if you just have kids, as you said, and I’ve got a cat tail right in my face here. This is my emotional support cat. But, you know, I have somebody in my life who I have to be there for. She has to come first because if I don’t put her before anything else, it is dangerous. And if I spend well, when I spend so much caring for her that there’s no space left to care for me. And my perimenopause story is very much one of hindsight, which I’m sure a lot of you who are watching or listening to this recognise that it’s not until afterwards you go, oh, hang on. So I well, we all remember that fantastic year when Covid came and lockdown hit and my marriage did not survive lockdown, which I was rather expecting. So a few years ago I left my husband. I found a place to move into, and I was made redundant in a time span of six weeks. [00:06:47][77.2]

Dr Louise: [00:06:48] Oh gosh. [00:06:48][0.3]

Tova: [00:06:49] Because I’ve don’t do things by halves. And in the aftermath of that, I burnt out. I went into a deep burnout, depression, very severe anxiety. I completely lost my energy and my mojo. I was in survival mode. I was looking after my kids and that was it. And then I sort of slowly recovered from that. But I never recovered from the anxiety. I had other symptoms too. And if I give you a little list of symptoms, I’m sure you’ll recognise this. We have things like anxiety, fatigue, joint and muscle ache, irritability, brain fog, and all of these are very common symptoms of being a special needs parent. And they’re also very common symptoms of perimenopause and menopause. And I also had night sweats. And I think the night sweats were the only thing I could not explain away. Through other things. But everything else was, well, of course my muscles hurt I have a child who requires 100% manual handling. Of course I’m anxious. I’m a single, working, busy, special needs mum. Of course I’m irritable. I’m stretched way too thin. You know, all of these things. And I kept telling myself that I had these reasons to feel the way I was feeling. But really, it was the irritability that was the final sort of, no, hang on a second there’s more to it here. I dropped a bottle of vinegar and it smashed and it smashed spectacularly. I had glass splinter and balsamic vinegar in three rooms. That should not be possible. And I just stood there and I screamed every swear word I know in both English and Swedish. And my oldest daughter, she jumped at every shout. And my youngest daughter, she slowly backed out of the room and it suddenly just dawned on me. This can’t continue. I need help. So from there I booked a GP appointment and I called up my GP surgery and I said, I want to talk to somebody about perimenopause. And the receptionist said, I’m going to book you in with one of our women’s health specialists. And I got an appointment within a week. I came in to see a doctor. I explained how I was feeling and what I wanted and she went, we’ll get you onto HRT straight away. [00:09:08][138.3]

Dr Louise: [00:09:08] Amazing. [00:09:08][0.0]

Tova: [00:09:09] Yeah, really good experience. And, I know I’ve heard from your podcast, I’ve heard so many times that women are struggling to find doctors to listen to them, or struggling to find doctors who know about this. And I’m with a GP surgery that has no less than three women’s health specialists on the staff. [00:09:25][16.0]

Dr Louise: [00:09:25] So brilliant. And I do think things are changing. You know, I see the tip of the iceberg. I see people who are really struggling. But I know because I know a lot of GPs who are absolutely brilliant and find like I do menopause care so rewarding. And the earlier we can start people on HRT, the less they’re suffering. And it is interesting because it can be so easy to misdiagnose as depression or anxiety or like you say, even burnout. But when we actually ask the right questions and that’s all it is in medicine, is asking the right questions often and thinking about the right questions to ask because you don’t know what you don’t know. So you can’t ask questions if you don’t know what you’re asking them for. But actually, and I wish I could go back in time as a GP and a hospital doctor, because anybody who’s having any psychological symptoms, like you say, the low mood, the anxiety, the fatigue, we always need to be asking, are there any other physical symptoms such as the palpitations, the night sweats, the flushes, muscle and joint pains? And also, are there any changes? Are there any other reasons why this could happen? So, you know, you’ve been lifting your daughter for many years, so to suddenly get muscle and joint pains is a bit unusual, if you see what I mean. Having night sweats, of course, is a new symptom, and there are medical reasons why people can get night sweats. But the most common reason, of course, is changing hormones. But the other question that I also wish I had asked for many, many years is to women. Do you think any of this could be related to your hormones? And I think asking that because if you say, could it be related to your menopause? Often, myself included, would say, oh no, I’m not old enough for that. But which is rubbish, of course. But saying hormones does make us then think, oh yes, I have been a bit like this before my periods over the years, but it’s just been a day or two and I’ve not really thought about it. And it’s, I think so much for us as when I say us, I mean us as menopausal women or perimenopausal women. For us to join the dots to help the clinician because in ten minutes it’s very overwhelming having a short appointment and trying to get everything in. So that was amazing that your GP was so helpful in such a prompt way. [00:11:42][137.5]

Tova: [00:11:43] Yeah, I think I was very lucky as well. We have a fantastic charity here in Bedford where I live. Called Bedford and District Cerebral Palsy Society, and they support families with any complex needs, not just cerebral palsy. And they don’t just support our children, they support us parents. [00:12:01][17.8]

Dr Louise: [00:12:01] That’s wonderful isn’t it? [00:12:02][0.9]

Tova: [00:12:02] Yeah. And a few years ago, I cannot remember her name now, which is a real shame. But they invited a menopause specialists to do a presentation to us parents. And she came with a long list of symptoms and talked through what we might be experiencing and why it might happen and things that could happen. And I remember sitting there and that was sort of the first thing of, well I do have the night sweats and they don’t fit into, you know, symptoms of special needs parenting. And I thought maybe I am perimenopausal and then going, oh but I’m only 44. And it still took me a couple of years to actually go and seek help for it. [00:12:44][42.0]

Dr Louise: [00:12:45] And then did the HRT, has it made any difference at all do you think? [00:12:48][2.9]

Tova: [00:12:49] Has the HRT made any difference? It’s made an amazing difference. I started off on patches and the combined patches because one of my perimenopause symptoms was a very short but also very irregular period cycle. So my period was anything between 22 and 28 days, not the period, the cycle. So I never quite knew when it was going to come. And we were sort of talking, when do you start progesterone? And she went if you go on the combined patches, it takes all of the guesswork out of it. And so I went on the combined patches and it took two days and I felt improvement in my symptoms. And that was really amazing. I did three months on the combined patches, no two months on the combined patches, and then I changed and I went onto gel and progesterone tablets instead. I just didn’t get on with the patches. I found them very itchy and uncomfortable and I always felt them. And then when I swapped from patches to gel, my symptoms started coming back because somehow I seemed to be absorbing better from patches than from the gel. And my GP had already given me permission to play about as she said. She basically went, you can adjust your own dose. And so I increased. So I had two pumps. I increased to three pumps. My symptoms immediately improved. I have recently gone up to four pumps because over time symptoms have come back. But my anxiety is so much better. My irritability is much more manageable. The brain fog is I mean, the brain fog got to some not so funny and some kind of hilarious effects. In June last year, in the month of June alone, I lost my car keys between unlocking the car and sitting down in it six times. And now that’s funny, at the time is super frustrating. More dangerously, I forgot my daughter’s medicines. She’s on ten different medicines a day in different doses and different times to be giving. And I can’t forget that. And now I feel I actually have my brain with me. I can do things. [00:14:55][126.6]

Dr Louise: [00:14:55] So that’s really scary. We talk about the impact of menopause in the workplace, and often it’s with reference to changing temperature of rooms, which drives me crazy because it’s not just about flushes and sweats, as you know. And we talk about the impact of not remembering at work, but actually, I’ve been doing a lot of talking recently about the impact in the workplace and saying it’s not just at work, it’s at home as well. These women don’t change when they get home, but when you have someone who’s completely dependent on you, it’s really important. And I was talking to someone on Friday who’s suffering and is unable to get help from her GP, and she’s got a son with special needs, and she said her sister now comes over every day after school to look after him because she doesn’t trust herself, because she can’t remember things the same way. But she’s now worried because her sister is five years younger than her. So she said, what’s going to happen in four or five years time when she becomes perimenopausal? But actually, we shouldn’t be having to make these adjustments like that. This woman is desperate to try hormones and all she’s being given is antidepressants. But you know, if your daughter didn’t have her medication for a length of time, there are very difficult, hard consequences. And there’s, you know, you’ve already said you’re a single parent, so who’s going to remind you, who’s going to help you? [00:16:16][80.5]

Tova: [00:16:16] A seven-year-old child? I mean, my seven year old is amazing. But it’s also part of my responsibility to protect her from too much caring responsibilities too early because it’s not her job. It’s not her responsibility. [00:16:30][13.5]

Dr Louise: [00:16:31] So we forget this when people are thinking about the menopause. And I spend a lot of time thinking about the injustice to women and how or why people are refused an evidence based treatment that can really be transformational. And you look in history about the misogyny of women and it’s gone on and it’s going on for ages, but actually it’s a whole different level when it’s affecting others as well. There’s one thing being directly affected, and women can hopefully be advocates for themselves and work out what’s wrong and how they can get help, but it’s completely wrong on a different level when innocent people, especially children, are being affected by the menopause. And I know it happens a lot. And, you know, in a very small way, when I was experiencing symptoms, I was just so tired and irritable. I wasn’t really interested in cooking, so my children didn’t eat as well. I didn’t really want to play board games because I couldn’t remember how to do them, and I was, they always ended in tears because everyone was frustrated. So I ended up just switching on the telly and just go, oh go on just go and watch something. And the children obviously would love that. But my parenting was not great. But I’m very lucky. I’ve got a stable relationship, you know? I mean, a nice home that’s warm. I have three children that get on with each other. If I was a single mum of many children and had difficulties at home and then you throw the menopause in. We know that domestic abuse increases during the perimenopause and menopause. And when I first read about that, I couldn’t really understand why. And I do. And some of it is emotional abuse and it’s not intentional. It’s because we are just worn out and then we think it’s because we’re not good parents or, you know, we… And I certainly did I internalised this, I thought, well, I maybe I can’t be a working mum. Maybe having three children has broken me, whereas two was OK. And maybe it’s, you know, and you just don’t realise that it’s something that is reversible, that could, with treatment, really make a difference not just to you as an individual, but your whole family unit. [00:18:44][132.9]

Tova: [00:18:46] And I think HRT is so important. I mean just looking at the effect it’s had on me and how it’s regulated my entire body, I don’t feel I’m at 100%, I know I’m not at 100%. But compared to where I was and I said this to myself even when I started HRT, that if I can get back up to 60%. That to me is an enormous win. It really is. I mean, I full on hear what you’re saying there in terms of not having the energy to parent, not having the energy to cook. And of course I have to cook. Because, you know, there are two children here that have to be fed and I have to function. And so many times it’s just been to my youngest here are the headphones, here is the tablet. Because I don’t have more capacity or just curling up with both of them on the sofa and turning on the TV and just trying to hold it together and not break down in front of them because it’s not good for them. [00:19:46][59.5]

Dr Louise: [00:19:46] No. It’s so difficult because, you know, there is fatigue and there’s different types of fatigue, and many of us are tired. I mean, I’m quite often tired, especially in the evening. And I think, oh, have I got time to go through my emails or should I go to bed? And I’ll often push myself and go to bed a bit later. But actually the fatigue often of perimenopause and menopause, I used to think it’s a bit like drugs, you know, when you’re drunk. Not that I’ve ever been drunk, but I imagine. But also like when I was pregnant, the early stages, because it is a biochemical thing. And I kept saying to my husband, I just cannot stay awake. I feel like a zombie. It’s a very weird tiredness to explain if people haven’t had it. And it’s really like thinking through treacle. You can’t just think, right, I’ll have a coffee and I’ll keep going, or I’ll just go outside and get some fresh air and then I’ll be fine again. It’s a very crippling tiredness and with children it’s so unpredictable when they need you as well, that you can’t just have a nap in the day or go to bed a bit earlier. It doesn’t work like that when you’ve got children. [00:20:54][67.9]

Tova: [00:20:55] No it doesn’t, it doesn’t. And then if you add a complex needs child in the mix, it is getting up in the middle of the night because she’s had a seizure and she needs help, or she’s just had a muscle spasm and ended up in a position that she doesn’t like being in, and she can’t get herself back again to a position where she needs to be. And I mean, if we take this week as an example of just the broken or non-existent sleep you get. It was Tuesday evening, I took her into hospital, so we arrived in A&E around 8 pm. I went to bed the first time at 1 am, and then at 4 am she was having cluster seizures again and I was up for another hour before we had a medicine that worked. And then I got another three hours sleep and the parent beds in hospital they are not comfortable. [00:21:41][46.7]

Dr Louise: [00:21:42] No they’re not. [00:21:43][0.4]

Tova: [00:21:44] And you know, these are things that you just have to do. And of course, when I’m in the middle of it, I am the most capable person on the planet. I know exactly when the last seizure was, what the last medication was, what the history is, all of those things. You know, I’m standing in the middle of that room with an oxygen mask, a suction pump, and I’m directing the doctors as to what they need to do. And I’m the calmest woman ever. And then on Friday, when we came home from hospital, my brain trickled out of my ears and I could not function whatsoever for the rest of the day. [00:22:14][30.3]

Dr Louise: [00:22:15] Well, it’s very, very hard. It’s really difficult. And I think it’s amazing that there was a group where you could have support and information, because it’s often when others tell you, you get that lightbulb moment and I know, like just watching some of your YouTubes, you know, that’s what you’re trying to do with others. You’re, when I say normalise, nothing is normal. I realise that but and I would not want the conversation, the menopause, to be normalised so much that people think they have to cope with symptoms. But what you have done is you’ve normalised the treatment of the menopause. You know, when you’re talking about the treatment that you’re getting and what you’re doing and how it helps you in a, not a sensational way, just a matter of fact, it’s the same as cleaning your teeth. It’s just something that you’re doing to help improve how you are. And there’s a lot of demands on us anyway. But when we have children, especially children that are dependent on us, there’s a whole new dimension. Many of you might know my oldest daughter is registered disabled with chronic migraine, and when she’s well, it’s amazing. I don’t, you know, if I have a day without hearing from her it’s wonderful. But so many times she’s in despair and she can’t, you know, her speech goes, her coordination goes, you do this remote parenting. And so many times my husband and I have just got in the car or the train and gone to see her. And you don’t understand what it’s like to have someone completely dependent on you until it happens. And it’s so unpredictable. And that’s why you want to be as healthy as you can as a parent. Of course you always do. But if you’ve got someone who’s more dependent rather than less dependent on you, then you have to look after yourself. And that’s, you know, we don’t have a choice, unfortunately, because we can’t say to someone else like you can with a baby. Here you go, just look after her for the afternoon. It doesn’t work like that when you’ve got children with different disabilities and they need their mother. And you, like you say, you know your daughter inside out. It’s not the same as someone else taking her to a hospital or lying in that hospital bed next to her. So there is so much that we need to do to educate people. And the other thing before we finish really is thinking about cerebral palsy, thinking about physical and mental disabilities. Your daughter’s only ten. But, you know, give her another ten, 20, 30, 40 years. Who knows when her hormones are going to be changing in a negative way. And I recently did a presentation for people living with cerebral palsy. And it was really wonderful. I really enjoyed doing it. And the feedback was quite humbling, but huge because a lot of women said, oh, I’ve been told it’s my cerebral palsy that’s progressing. But it was only just before my periods I was getting more muscle spasms or unusual symptoms, and I knew it wasn’t quite because the women know their bodies as well. And there’s so much gaslighting going on generally in menopause and perimenopause. But I was really saddened to hear. And even at the end someone said to me, Dr Newson, you seem to be the first person I’ve ever met who really understands cerebral palsy. And I thought, gosh, I am not a cerebral palsy specialist, but I have a huge amount of experience in general medicine and empathy. And I’m also very, very open about saying the things I don’t know or don’t understand. But I would never make up a diagnosis to suit that patient because I don’t know what’s going on. And that’s often what happens in medicine when we don’t know what’s going on. We try and shoehorn people in to a diagnosis. So for these people being told, oh, it’s a progression of your cerebral palsy, it probably makes the doctor feel better because they’re saying something that they probably think is right. But if the patient is not agreeing or doesn’t think it doesn’t quite work, then it’s OK in medicine to say, I’m not sure what’s going on, but let me have a think and let me talk to other people. And in medicine, that’s what we’re doing all the time. We’re learning all the time. And ten years ago, I would never have been able to give any presentation because I didn’t understand the important role of hormones in our brains and our muscles and joints and our nervous system as well. But now I do, it’s really important to share that knowledge. And a lot of these women were really reassured, but also because they’ve got physical problems, many of them are being told they can’t have HRT because of the clot risk. Well, we know there isn’t a clot risk with the natural body, identical hormones with the oestrogen through the skin as a patch or gel. So just for them to know there are options for treatment. And as you know, anyone with any physical disability, especially when they’re not mobile, have an increased incidence of osteoporosis. So, you know, we’d need to be looking at future health of people with disabilities. And so it’s an area that’s really important, every area is important thinking about menopause and perimenopausal women. But this is really important. And I’m sure a lot of people with physical and mental disabilities will have an earlier menopause at a younger age, and if their behaviour is changing, they won’t necessarily know that it’s due to their hormones. And so it’s something else to be thinking about. For your daughter it’s in the future, but there are a lot of women out there now who are experiencing symptoms and not able to get treatment. [00:27:35][320.2]

Tova: [00:27:36] I mean, we’ve got puberty to look forward to with my daughter, and that thought terrifies me. And I think, you know, you’re, there’s so many people out there who have no idea just how much hormones work on the brain. And if you then have a brain with injuries on it, and this is what’s cerebral palsy is a type of brain damage. So you have a brain where the signals aren’t moving as they should do, the synapses aren’t firing as they should do, and then you’re adding a crazy hormonal cocktail to the mix. It’s not pretty puberty in these children, and I don’t personally know of women of perimenopausal age with cerebral palsy or with similar brain injuries. But I mean, if I’m looking at my brain that isn’t damaged and how massively it affected me, I can’t imagine how bad it is when when you have additional… [00:28:30][54.5]

Dr Louise: [00:28:30] It’s very interesting actually, because we know actually the first thing our brain does, if we have any injury is to actually produce more oestrogen, progesterone and testosterone. So these hormones are really powerful in our brain. They help improve the transmission of nerve impulse. They help build the myelin sheath, which is a conduction part of the outside of the nerves. They actually help the plasticity of the brain. So the way the brain develops and functions. And it would be amazing if people were doing some research in cerebral palsy looking at the benefits of oestradiol, progesterone and testosterone on the brain, because for so long we just think about them regulating periods or making moods worse. But actually, and for men too, men have oestrogen, progesterone and testosterone in their brains and produced in their brains. And so, you know, there’s a huge amount of work that should be done. And it’s not being done because HRT is very cheap. There’s no big pharma behind it. There’s no priority. It’s thought about just due to menopause. But, you know, we have got some data showing that there’s beneficial effects of hormones, especially progesterone and oestrogen in our brains. So there’s a lot we need to do to think about, you know, the hormonal benefits in brains of people who either have normal or abnormal brain function. So lots to do, lots to think about. But I hope this podcast has allowed people to really reflect and think again about perimenopause and menopause in different ways, and the potential impact it can have through other generations as well. So I’m really grateful for you sharing your story, because I know it’s always hard talking, and I know you’re so pragmatic and it’s not a sympathy vote because you’re just someone who just gets on and does things. But big respect for what you’re doing and your children are very lucky to have someone as caring as you, there’s no doubt about that. So.. [00:30:26][115.8]

Tova: [00:30:27] Thank you. [00:30:27][0.3]

Dr Louise: [00:30:27] Before we end, there’s always three take-home tips, so you’re not escaping without them. So three things, if people have been listening, they might not have a disabled daughter. They might not even have a daughter. They might have children though or a relative or a friend or somebody that they’re caring for. And they’re not looking after themselves in the way that they should. And they might be perimenopausal or menopausal, what are the three things that they should be doing? [00:30:53][25.9]

Tova: [00:30:54] OK, so my first take-home tip, and this is something that I say a lot on my YouTube channel as well, is learn to ask for and accept help. People want to help, but very often they don’t know how to offer it and that, you know you’ll get a, oh, let me know if there’s anything I can do to help. And then you do your usual. Oh, no, I don’t need anything. Say straight out. Please turn up and do my washing up. I have five loads of clean laundry that needs sorting, can you help me? Bring over some food for me? Anything really. Learn to ask for and accept that help is so important and people want to help you. They just don’t know what it is that they need to offer. So that is my first tip. And that also obviously goes to, you know, if you feel that your health isn’t what it should be, go to your GP and ask for help. Another take home tip is to do what I did when I rang my GP. I didn’t just ask for an appointment, I asked for an appointment to talk about perimenopause and hormones. They know from the get go what it is you’re after and if they have anyone in the clinic with an interest or an expertise in that area, they will put you in with that person. And third take-home tip, look after your mental health and try to see the good. Little tiny good things every day are so important. I do a lot of gratitude journaling, where I write down a minimum of three positive things that have happened that day, and they’re not big. It could be the sun is shining. It could be just the taste and feeling of that first sip of coffee in the morning. Or hearing from a friend on WhatsApp or just little things. But I train myself to look for the good and the positive. Because it’s so easy to get overwhelmed in the bad stuff. [00:32:41][107.0]

Dr Louise: [00:32:41] I really, really like that third tip. I’m quite a negative person, and I’ve really trained myself the last five years or so to just focus on the positive and let the negative trickle off. I feel often I visualise that I’m wearing a Teflon jacket or armour and I won’t let negativity come inside. I just deflect it out because otherwise it’s overwhelming. And then you wallow in self-pity, and that doesn’t do anyone any good at all. Especially not the people you’re caring for. So thank you again. It’s been really enlightening and emotional a bit and wonderful too. So thanks ever so much for today. [00:33:18][36.9]

Tova: [00:33:19] Oh, thank you for letting me come on here. It’s been amazing. [00:33:21][1.9]

Dr Louise: [00:33:26] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk, and you can download the free balance app on the App Store or Google Play. [00:33:26][0.0]

ENDS

The post Coping with the perimenopause when you’re a carer appeared first on Balance Menopause & Hormones.

Look through the menopause library on balance to find articles, podcasts, and videos relevant to you. You can search through the full list of content or filter by topic and type of content.

Below is just a very small selection of some of the helpful content we offer. If there’s a topic we’ve not covered or you would like more information on, let us know! We’re dedicated to making sure all women have equal access to information. Email us with any suggestions at comments@newsonhealth.co.uk.

Accessible resources

• British Sign Language library
  A series of British Sign Language videos, accompanied by a transcript, about the perimenopause and menopause.
• Easy read guide to the perimenopause and menopause
  A downloadable booklet created with Dimensions, explaining the perimenopause and menopause.
• Learning disabilities and the menopause
  A podcast with a woman with learning disabilities who shares her experience of the menopause and her advice to others.

Making menopause more inclusive

• Menopause in overlooked communities
  A podcast about the challenges faced by vulnerable groups of women during menopause, including the homeless, those with alcohol or drug addictions, and those engaged in sex work.
• Menopause in ethnic communities
  A selection of features, podcasts, and videos focusing on how the perimenopause and menopause affects women of ethnic backgrounds and how to improve access to information and help.
• How menopause can affect women from disadvantaged backgrounds
  A look at how adversity in childhood and adult life can affect the menopausal experience and how to support women in getting the care and information they need.

Menopause at different life stages

• Early menopause
  Explore factsheets, podcasts, and personal stories about experiencing early menopause.
• Premature Ovarian Insufficiency (POI)
  Factsheets, podcasts, personal stories, and support for women with Premature Ovarian Insufficiency (POI).
• Menopause for older women
  Explore resources on starting or continuing HRT years after your menopause, and what to do when symptoms persist.
• Surgical menopause
  Explore features, podcasts, and personal stories on surgically induced menopause, including how to prepare for it and risks and treatments.

Advocating for yourself

• How to talk to your doctor about HRT and get results

Translated resources

Managing your menopause alongside other health concerns

The post Your menopause resources appeared first on Balance Menopause & Hormones.

• Race, ethnicity and cultural beliefs can affect a woman’s experience of the perimenopause and menopause
• Language barriers and a lack of awareness can stop women accessing help and treatment
• More resources are needed for ethnic minority women

All women will go through the menopause, but not all of us will have the same experience or symptoms. We’re all different of course and our genetics, existing health conditions, income, race and ethnicity can have an influence. Research into how the menopause specifically affects ethnic minority women in the UK is limited, which can make it frustrating when you’re trying to find out more information about your health. But on top of any physical differences, there are cultural ones and attitudes to menopause can be affected by our community.

Do symptoms vary in different ethnicities?

While there is limited research into menopausal symptoms carried out in British ethnic minority women, we know from other studies that ethnic variances occur. The Study of Women’s Health Across The Nation (SWAN) is an important longitudinal study that began in 1994 – it examines menopausal changes on a racially and ethnically diverse cohort of women [1].

It has found that women of Afro-Caribbean origin reach menopause earlier (49.6 years as opposed to the average of 51) and experience a longer menopausal transition. They are the most likely to experience hot flushes and sweats and experience them more severely and intensely than women of other ethnicities. They are more likely to suffer sleep problems, including shorter sleep, more awakenings and poorer quality sleep, and weight and mental health issues.

In women of southeast Asian origin (such as China or Japan), while they may not be as likely to complain of severe flushes, they suffer more from low libido and sexual pain, and may suffer more from forgetfulness, joint and muscle pains. A new study has found that, for women in Singapore (of Chinese, Malay and Indian origin), joint and muscle pain is the top menopausal symptom [2].

Meanwhile, south Asian women (India, Pakistan, Bangladesh, Sri Lanka, etc) are likely to experience the menopause at a younger age than Western women – the mean age for Indian women is 46.7 years and for Pakistani women is 47.16 years. Indian women are more likely to complain of vulval and uro-gynaecological symptoms.

Finally, the SWAN study found that, for Hispanic women, vasomotor symptoms were more prevalent as was vaginal dryness.

It’s worth remembering though that the data is limited, and this is a broad overview of the information available. Women of any ethnicity can experience any symptom – your experience will be unique and may be vastly different from what’s described here.

RELATED: empowering women unheard during menopause

What about the impact of medical conditions?

While the reasons behind women’s varying symptoms can be varied, pre-existing medical conditions and some physiological differences can contribute.

South Asian women are more prone to weight gain, according to scientists, particularly around the middle, increasing the risk of insulin resistance and diabetes. Hypertension is more common, increasing the risk of cardiovascular disease [3].

A study of pre-menopausal south Asian women living in the UK found they could be more at risk of developing osteoporosis in later life than white women [4]. There is also a potential for vitamin D deficiency for women who cover up, for instance with the burqa or niqab [5]. Low vitamin D levels can increase the risk of osteoporosis.

Afro-Caribbean women have been found to suffer from a higher allostatic load than Caucasian women [6]. This refers to chronic, ongoing stress that can have a wear and tear effect of the body – a potential factor behind their severe menopausal symptoms and longer menopause.

What about lifestyle?

While physiological differences play a part in women’s menopause, it’s important to remember that there can be variations within ethnic groups and that some differences may also be down to socio-economic factors, rather than ethnicity, or cultural attitudes or lifestyle.  

Exercise can have a positive impact on wellbeing during the menopause, but participation levels can vary. Among women aged 45-54 in England, 50.4% of Asian women are physically active (compared to  55.2% black women, 61.9% Chinese women and 69.8% white British women) [7].

Diet can also help alleviate menopausal symptoms and some believe that the Japanese diet, with its high soy content, could be a reason behind Japanese women experiencing fewer menopausal symptoms. Soy contains isoflavones, which mimic oestrogen, which declines during the menopause.

The impact of cultural beliefs

Another interesting thing to consider about Japanese women’s experience of menopause is their attitude towards it. The Japanese word for menopause is ‘konenki’, which means ‘renewal’ and ‘energy’. Having a positive outlook can make a physical difference – women with a positive attitude are reported to have lower severity of menopausal symptoms [8].

Conversely, in some cultures the menopause is firmly associated with loss. Dr Maqsuda Zaman, a GP who works in a practice with a significant number of women from various ethnic communities in Greater Manchester and who is a menopause specialist at Newson Health, says: ‘Women of Bangladeshi origin tell me menopause is associated with loss of fertility and youth. A patient of Iraqi Kurdish origin also told me it’s generally not discussed in her community as women feel embarrassed about getting older and the loss of fertility.’

For others, menopause is a taboo subject – it’s not talked about, and women may be expected to stay silent and not complain about any symptoms they may be suffering from.

RELATED: menopause taboo in women from different ethnic groups: Dr Nighat Arif

Barriers to accessing help

In conservative cultures where the menopause isn’t talked about, women can suffer in silence, which means their symptoms may worsen before they do seek help, or that they try other treatments before seeking out support from a doctor. Dr Maqsuda says: ‘A common presentation is women with vaginal itching who have believed it’s due to thrush so have tried over-the-counter treatments before seeking help.’

Mental health is not frequently talked about in some ethnic communities and there can be a prevailing attitude to just get on with it [9]. Alternatively, some women may be reluctant to seek medical help for something they believe is a natural process.

A lack of awareness and knowledge about the menopause can also be a barrier to accessing treatment. Even when a woman from an ethnic minority background does see her GP, language can be a barrier.  A woman may need an interpreter or arrive with a family member, which may inhibit her further if she needs to talk about vaginal dryness, or a doctor may miss a subtle cue they might otherwise have picked up on. Alternatively, a woman from an ethnic minority might not be familiar with the language commonly used to describe symptoms or may get misdiagnosed because of her description of symptoms and a clinician’s understanding.

Dr Maqsuda says: ‘Bangladeshi patients commonly say “I keep getting fevers” – this term is often used to describe hot flushes and night sweats, or “I have a urinary infection” – to describe urinary frequency, urgency and dysuria. Or they’ll say they feel tired all the time and have concerns over possible anaemia or diabetes, or are worried about “body pains everywhere”. Many present with heavy or irregular periods but are unaware that this may be due to the menopause. They often request treatment to regulate their periods as they are concerned about “where all the blood is going”.

Language may be one reason behind the differences in access to care and treatment amongst women in ethnic minorities. The Fawcett Society’s 2022 report Menopause and the Workplace found black and minoritized women reported increased rates of delayed diagnosis (45% compared to 31% in white women) and lower rates of HRT uptake (8% compared to 15% in white women).

However racial bias may also be a factor – black women are less likely to be offered pain relief in childbirth, and a study found black patients are about half as likely to be prescribed pain medications in hospital emergency departments than white patients [10]..

RELATED: Menopause specialists advocating for women of colour

What needs to be done?

Clearly more resources, posters and videos need to be created for ethnic minority women – not only in their languages but women need to see, through imagery, that menopause is something that affects them, not just white women. Dr Maqsuda agrees: ‘In the six months that I’ve been working for Newson Health in Altrincham, I have only seen one Pakistani and two Indian women; one was a pharmacist and the other a hospital consultant. I have had no patients from an Afro-Caribbean or Arab background.’

For women, the first step is to keep a symptom diary – the free balance app is an easy way to do this, or write down your symptoms on a paper calendar that you can share with your GP.  Remember that there is no need to suffer in silence or deny yourself treatment, and that you can’t get help if you don’t ask for it. Open your mind to treatment options and, if it will help, take a friend or relative to any appointments for support.

Where to get help

• The balance website has videos, articles and factsheets on the menopause that have been translated into Punjabi (click here) and Hindi (click here). There are also podcasts with clinicians advocating for women from ethnic minorities, which contain helpful advice.
• Pausitivity has a Know Your Menopause poster in Urdu.
• Jane Lewis, author of My Menopausal Vagina, has translated her Leaflet on vaginal dryness into Urdu.
• @shadesofmenopause is an Instagram group for ethnic minority women to be heard and seen
• The British Menopause Society has a useful article on Menopause in ethnic minority women

References

1. SWAN study

2. Logan S, Wong BWX, Tan JHI, Kramer MS, Yong EL. (2023), ‘Menopausal symptoms in midlife Singaporean women: Prevalence rates and associated factors from the Integrated Women’s Health Programme (IWHP)’, Maturitas. 178:107853. DOI: 10.1016/j.maturitas.2023.107853

3. Pandit K, Goswami S, Ghosh S, Mukhopadhyay P, Chowdhury S. Metabolic syndrome in South Asians. Indian J Endocrinol Metab. 2012 Jan;16(1):44-55. doi: 10.4103/2230-8210.91187. PMID: 22276252; PMCID: PMC3263197.

4. A.L. Darling, K.H. Hart, F. Gossiel, F. Robertson, J. Hunt, T.R. Hill, S. Johnsen, J.L. Berry, R. Eastell, R. Vieth, S.A. Lanham-New. (2017), ‘Higher bone resorption excretion in South Asian women vs. White Caucasians and increased bone loss with higher seasonal cycling of vitamin D: Results from the D-FINES cohort study’, Bone, 98, pp 47-53, doi.org/10.1016/j.bone.2017.03.002.

5. Marie France Le Goaziou, Gaelle Contardo, Christian Dupraz, Ambroise Martin, Martine Laville & Anne Marie Schott-Pethelaz (2011) Risk factors for vitamin D deficiency in women aged 20–50 years consulting in general practice: a cross-sectional study, European Journal of General Practice, 17:3, 146-152, DOI: 10.3109/13814788.2011.560663

6.  Richardson LJ, Goodwin AN, Hummer RA. Social status differences in allostatic load among young adults in the United States. SSM Popul Health. 2021 Apr 2;15:100771. doi: 10.1016/j.ssmph.2021.100771.

7. GOV.UK: physical activity

8. Kwak EK, Park HS, Kang NM. Menopause knowledge, attitude, symptom and management among midlife employed women. J Menopausal Med. 2014;20(3):118–25.

9.  MacLellan J et all. Primary care practitioners’ experiences of peri/menopause help-seeking among ethnic minority women: British Journal of General Practice 3 March 2023; BJGP.2022.0569. DOI: https://doi.org/10.3399/BJGP.2022.0569

10. Astha Singhal, Yu-Yu Tien, Renee Y. Hsia. (2016), ‘Racial-Ethnic Disparities in Opioid Prescriptions at Emergency Department Visits for Conditions Commonly Associated with Prescription Drug Abuse’. https://doi.org/10.1371/journal.pone.0159224

The post Menopause in ethnic communities appeared first on Balance Menopause & Hormones.

Menopause often happens at a time when you are juggling a career, relationships and caring responsibilities.

Here Dr Nadira Awal, a GP and menopause specialist, joins Dr Louise to discuss her work in raising awareness of the menopause and the importance of partners and families understanding what their loved on is going through.

Dr Nadira’s personal experience of the menopause helped drive her passion for educating and supporting other women, especially those in ethnic minority communities who may not feel able to speak openly about it. She talks about increased health risks owing to genetics, particularly with diabetes and increased blood pressure, and the challenge of treating a woman’s symptoms holistically in a ten-minute GP appointment.

Follow Dr Nadira on Instagram @pauseandcohealthcare and on Facebook at Pause and Co Healthcare.

Click here for more about Newson Health

Transcript

Dr Louise Newson: [00:00:11] Hello, I’m Dr Louise Newson. I’m a GP and menopause specialist and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. 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 perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So today on the podcast, I’ve got a fellow GP, someone who I’ve met a few times in real life, unlike some of my other podcast guests. Who’s very inspirational. Who’s doing a lot of work behind the scenes actually to really help women in many ways. So, Nadira, thank you so much for coming on my podcast today. [00:01:20][17.6]

Dr Nadira Awal: [00:01:21] Thank you, Louise. Thank you for inviting me. [00:01:22][1.4]

Dr Louise Newson: [00:01:22] So we’ve known each other for a while and recently we met again in Liverpool, actually. I’d gone up to the Royal College of Psychiatrists conference, annual conference, and you were there as well. And we were in the same group, actually. They kindly invited me to be on the panel. And you were talking about your own experience, actually, weren’t you? [00:01:40][17.8]

Dr Nadira Awal: [00:01:41] Yes, that’s right. Which has gone down very well on your Instagram post, which I’m very grateful for you sharing. So thank you very much for that. [00:01:47][6.5]

Dr Louise Newson: [00:01:47] Well, I felt a bit naughty because I stepped away from the panel to go in the front row so I could take a few videos. And your one was just amazing. And we just look just now and it’s had nearly quarter of a million views. It’s resonated with a lot of people. And I’ve been told off quite a few times for talking about my own personal menopause experience in the media by other health care professionals. But actually, if I wasn’t a menopausal women and if I didn’t take HRT and if I hadn’t struggled, I think doing my work, I could still do it, but I couldn’t do it with as much energy and passion and determination as I do. So I think people like to know, this is going to sound really awful here, they like to know that healthcare professionals suffer and are human and actually sometimes struggle. We don’t get it right the first time, and I had to see a specialist to get the right dose of HRT that was right for me, and I learned a lot from him actually. He really taught me, actually, and I’ve still got his clinic letter telling me to increase my dose because my level was low and I clearly wasn’t absorbing it well and increased the dose. And it really made such a difference. And I’m very grateful to him. But you talked about your struggles to get the right dose from your own doctor and having to see a gynaecologist. And you know, we are humans, aren’t we? And we can’t always access the right person first time or know everything. And it’s very different when it’s ourselves that are experiencing symptoms. [00:03:11][83.1]

Dr Nadira Awal: [00:03:12] Completely agree with you, Louise, actually. And almost as clinicians, we’re probably the worst patients, aren’t we? We’re completely in denial of what’s happening to ourselves and it’s actually makes it a little bit more fuzzy to connect the dots together. And you actually need that outside approach to sort of say, actually these are the things that are happening to you. But yes, you’re completely right. It’s made me more passionate talking about the menopause, educating my patients, educating anyone who will listen, really. So it’s not just about the patient, it’s about their family as well, and how the menopause can affect everybody, really. So it’s not just women, it’s the men need to listen as well and really appreciate what’s going on. [00:03:49][37.1]

Dr Louise Newson: [00:03:50] Because you’ve got two young children. When I was experiencing symptoms, my three children were obviously a lot younger and really were suffering, but not realising. I just presumed I was very irritable and short tempered because having three children is difficult. Having any children can be hard. And I just thought, oh I can’t cope very well. And then I sometimes think about this one time that I was called in by two of the partners because I’d prescribed a lady some morphine who had some really awful arthritis of her knees. Terrible. She was housebound and I just gave her Oramorph. So it’s not even, as you know, a controlled drug. And I put it on a repeat prescription because she couldn’t get out to the pharmacy and her daughter lived a long way away and it was causing a lot of work. So she just had one bottle every month. And I said to her, well look, I’m leaving the practice soon so if I put it on a repeat, it will be very easy for you to get it. And I used to inject her knee every three or four months or so if it was a lot more painful. And she tried so many other painkillers and this was the only one that worked for her, she’d just take a spoon in the morning and a spoon in the evening. Anyway they called me in to say, how dare you do this? This is absolutely outrageous and you shouldn’t do this because people could overdose on morphine. I said, well, she’s 91. She probably would have overdosed if she was going to. And I will take full responsibility because I’ve signed the prescription. I’m an independent prescriber. And then I walked away into my room and I burst into tears. And Helen, who now actually works for me, came to my room to cheer me up because she’d never seen me cry at work before. And looking back, I know it was related to my hormones and I knew I was going to get too cross to sort of retort to these two male doctors who were telling me off in their room. So I withdrew and then just thought, well maybe I am really dangerous, maybe I shouldn’t be doing this, maybe I shouldn’t be looking at what’s best for my patient and catastrophising, really, and then had no self-confidence, feeling of low self-worth and being very tearful. And those are all classic perimenopausal symptoms, aren’t they? [00:05:45][115.6]

Dr Nadira Awal: [00:05:46] Absolutely. Yes. There’s so many women and myself included, that you do feel like you’re questioning what you’re doing on a daily basis. And, you know, we’re always describing, we’re always hear about it on social media, that we’re the sandwich generation. We’re looking after our elderly parents. We’ve got young children. As you know, in that podcast I talked about, you know, I was renovating my house and I had my young children as well, dealing with builders on a daily basis. And it was really difficult. So you think, oh, gosh, you know, there’s all the stress that’s coming with it. You know, we lead busy lives. I mean, think about it, 100 years ago, women weren’t working. They were looking after the children, but not really. We had potential. We had maids. We had people who were helping, looking after our children, the sort of family network as well. And so, we’re well worse now. We’re busier. You know, we’ve got full time jobs. We’re trying to hold down a job. We’re trying to hold down a relationship. We’re trying to look after our children. There’s a lot of social media sort of presence as well, and saying that actually we should be better at things. We’re always negating ourselves, aren’t we? And I think it’s important to actually be really empowered and say we’re doing a great job. You know, we’re working really well. We’re looking after our kids. They’re happier. You know, if you think about it, we were talking about this the other day, that actually our parents’ generation only took us to the zoo. You know, we didn’t have things like soft play. We didn’t have iPads and we didn’t have mobile phones. We went out on our bikes and we just came home at dusk didn’t we? So, you know, whereas now we have to entertain our own children. And it’s hard work. [00:07:16][90.2]

Dr Louise Newson: [00:07:16] It is, it’s very different. Yeah, we used to just play in the street and sometimes remember to come home for a meal and so it’s very, very different. But also I was talking to somebody in America yesterday, actually it was Sunday and I was trying to arrange all week to speak to this person. The only time I could find was on Sunday. I’ve just got back from being with my husband in the Lake District and my mother-in-law wanted to come for supper, which is great, lovely. But then I had to cook supper. So as I was talking to this woman, I said, oh, look, I’m really sorry you’re going to hear the oven door open and close. And I’m chopping some vegetables because I’m cooking at the same time. And she said, I love the fact that you’re multitasking. And I said, but, do you know what? I sometimes joke with my children and say, Goodness, I could do so much more if I didn’t have children? But actually I also laugh about it because I’m a lot more productive because I’ve got three children, because if I have five minutes between, I don’t know, picking one of them up or taking one of them somewhere or doing that, I will do that work in five minutes. Whereas before, with or without children, I’d probably be thinking, I’ve got all day, I could just have a little cup of tea and I’ll just listen to the radio and then I’ll sit down and my nice tidy desk whereas I literally just am something on my phone while the kettle’s boiling and then I’m going to the next thing. [00:08:27][70.3]

Dr Nadira Awal: [00:08:27] But on the other hand, you’ve got women who’ve not had children. And they’re busy with their life, aren’t they? And they’re busy doing all their extracurricular activities or holding down their job as well, and busy and yeah, so. [00:08:38][10.6]

Dr Louise Newson: [00:08:38] But I think it’s also the way that women’s brains are wired and it is a gender difference. So it’s not just about children, of course it’s not. But I think women are used to multi-tasking. They’re used to, you know, if they’re working, sitting in meetings, thinking right, what am I going to have for supper or what am I going to do at the weekend? Whereas men, and this is a generalisation of course, but in general men a lot more focused. So I think it’s good and bad, actually. Women probably need to focus maybe sometimes a bit more. But actually that ability, which is often lost in the perimenopause because our hormones work very well on our brains, don’t they? And for many years we’ve just learned about flushes or vaginal dryness and the menopause just being a natural process. But actually, for a lot of us, it can really affect the way our brains work and think and function can’t they without hormones. [00:09:30][51.5]

Dr Nadira Awal: [00:09:30] Absolutely. And I actually use the analogy and I’ve used this in interviews actually as well, where women spin lots of different plates and they’re spinning, yeah, the work plate, the kids’ plates, you know, kind of life at home plates, the relationship plates. And sometimes it’s okay to drop your plates. And what you don’t do is you don’t try and pick up that plate, piece it back together again. How about you just drop all your plates, smash them, make something new? And that’s kind of how I describe the menopause as well. You know, this is a new stage of your life. Don’t try and be what you were in your 20s. Let’s try and embrace it. It’s actually, you know, don’t think I can do everything I did in my 20s and I can do it now. Make it new, make it exciting. And that’s that’s what I’ve done. [00:10:12][42.0]

Dr Louise Newson: [00:10:13] I really like that. I think that’s a really good analogy, actually, because we are different. Our life experiences are different, aren’t they? And I feel it’s a bit like, if you’ve got the privilege of being able to plan maybe when you want to have a baby, you want to make sure if you can that you’re healthy, that you’re not smoking, that you’re not drinking alcohol, that you’re taking folic acid, that you’re fit and hopefully not too overweight or whatever. So you can make sure that, you know, you’re giving everything the best chance for those next nine months. Obviously, for some people it doesn’t work like that, but it’s still something that we always advise as medical practitioners. If people can, this sort of pre-conception counselling really, isn’t it? Whereas I think with menopause it’s even more important because for most women it’s decades, not nine months. And so actually to have some time before your brain goes that you can’t read a book or listen to a podcast or think about everything, almost think about, right, how is my hormonal health? How is my perimenopause and menopause going to be as healthy as possible? And you’re right, you know, what we ate when we were 20, we probably can’t get away with eating in our 40s or 50s. [00:11:20][67.7]

Dr Nadira Awal: [00:11:22] No, and we digest things differently don’t we as we enter the perimenopause because the oestrogen declines and so the gut becomes more inflamed. So when it’s inflamed, you don’t absorb the good bacteria. And you know, the gut microbiome makes a big part of the menopause, doesn’t it? So if the gut’s inflamed, you know, obviously you’re not absorbing all the right nutrients, therefore you might get that gut changes as well, the diarrhoea or the constipation, and therefore you might get joint aches as well. So, yes, you know, which we’ve both experienced, I think so. [00:11:50][28.1]

Dr Louise Newson: [00:11:51] Absolutely, I mean it’s this anti-inflammatory properties of our hormones throughout our body are really, really important and misunderstood. And and you’re right, actually the sort of bowel symptoms are very, very common. I mean, for many years I’ve seen so many women with irritable bowel syndrome, didn’t think about the hormones at all and even heartburn and like you say, diarrhoea can be related to hormones. So there’s all these symptoms that affect people in different ways, different stages, different types of women, but often they’re not recognising and I know a lot of the work I do, but also the work you do, is trying to educate and allow women to understand what’s going on. And traditionally, if you Google menopause, it will be a white middle class woman who is, usually got a fan or just has a glass of water with her hand on her brow, and that’s not most women. And I did a presentation recently, at an international conference about ethnic disparities with menopause. And we were asking women what their views of the menopause were. And some people from ethnic minority groups said things like, It’s a dirty secret, it’s a shame, it’s an embarrassment, it’s something I want to hide away. It’s something that we just have to endure and suffer. And all these words I feel, are really sad because it shouldn’t be something that you have to just battle through. And there are certain groups of populations that I think it’s harder to reach as well, isn’t it, culturally? [00:13:22][90.7]

Dr Nadira Awal: [00:13:23] So, absolutely. I mean, if you can think about it, my parents’ generation, so my mother never, ever talked about sex, ever. You know, my mother never talked about it. My sister, who’s ten years older than I am, didn’t talk about sex. And it’s a cultural thing. It’s something to be feeling almost ashamed about. Or it’s about being hidden. You can’t really openly discuss about it. My cousins and I, you know, there’s five of us, and there’s six months between all of us, and I remember about ten years ago, and I’ve already been married 18 years, so ten years ago we were talking about sex and I’d been married eight years by that time. So you can imagine it’s something that is just not culturally talked about and not open about it as well. So my my focus is about talking in the ethnic minorities. It’s about being open with them and saying it’s okay to talk about it. So yesterday, you know, we’re trying to change the mindset of the older generation, but the newer generation who are, you know, have social media, they can see that actually they’re getting their education through that, which is great, you know, but change doesn’t happen instantly. Unfortunately. It comes about slowly. And so people are becoming educated through social media, through your podcasts, for example, as well. And, you know, Instagram and Facebook, it’s great. Tik Tok. But change needs to come and it is rolling in, it is getting better. And I think it’s really important to be educated. So I go to mosques and I very openly talk to women about the menopause and there’s lots of giggles. We know we do it very, very, very informal. And it’s so important. And I use questionnaires as well. I think it’s important. So anonymous questionnaires and I have people, you know, saying do you find sex is important? Do you find that sex hurts? And it’s anonymous so they don’t feel ashamed of it, which is great. But I think we need to talk about it more openly, Louise. [00:15:09][106.3]

Dr Louise Newson: [00:15:10] And I bet you hear stories that are sad. I know I’m overwhelmed with sadness actually listening to so many stories from women from all over the world. But I’m sure when you go to the mosques and people know it’s safe to talk about. [00:15:24][13.5]

Dr Nadira Awal: [00:15:24] I have to say the most interesting one is I worked in a quite a socially deprived area, quite locally to where I am, and actually I had a lady come to me and she went, My vagina is so dry, I just can’t have sex. But my husband really wants to have sex, so I just have to lie there and just basically take and I hate it. And I said, Well, do you say no? And she said, no, because it’s part of my role as a wife. I need to have sex with my husband. And I went, You can say, no, it’s almost like rape. And she went, No, it’s not rape. It’s my husband. I went, If you say no, it is rape. And it was really quite distressing, actually. And I said, Look, let’s give you some vaginal oestrogen and let’s talk about HRT as well. And she came back to me, went, actually, sex is so much better with some vaginal oestrogen. [00:16:10][46.2]

Dr Louise Newson: [00:16:12] Yeah, and it’s, I’ve heard so many stories that are similar. A first lady who spoke to, it was many, many years ago. And I suppose the beauty of the clinic that I have I have longer to talk to women. In general practice to having eight, 10 minutes is quite hard to ask intimate questions. But because on the questionnaire it talks about libido, I will usually, if it’s appropriate, ask women about sex and if it’s uncomfortable because vaginal dryness means nothing to a lot of people. And it’s one of those horrible terms. It’s really difficult, isn’t it? Because then you talk about vulva vaginal atrophy, and if you look up the word atrophy, it means withering or wasting away, well I don’t want to think any part of my anatomy is withering or wasting away. So and it’s not just about penetrative sex sometimes, it’s actually externally can be very painful. So a lot of women don’t want to be touched or explored or anything happening in that area. And one lady said to me many years ago, she said she had no libido, She loved her husband. And really, you know, their relationship was good, but she had no interest. She said, I would prefer to drink toilet water than have sex with my husband, but he needs to have sex. And we do sometimes. And I said, Well is it painful? She said, Oh, gosh, yes. It’s like having a red hot poker shoved inside me. And I said, Well, do you tell him? She said, No, because I know it won’t last very long. So I just lie there and just wait for it to finish. And I said, Don’t you tell him? She said, No, but I can’t because I know how much he wants sex. And there’s so many layers to that conversation aren’t there? And I feel really sad to think that people are in relationships that they can’t even talk, but also more sad that there is a treatment that’s available that women are not able to access in an easy way. [00:17:57][105.4]

Dr Nadira Awal: [00:17:57] Yes, I completely agree with you, Louise. The impact on relationships can be quite horrific, actually, can’t it? And you can actually see that some people actually have marital problems as well. And you see people separating sometimes, unfortunately. [00:18:09][11.5]

Dr Louise Newson: [00:18:10] Yeah. I mean, divorce rates really do increase in the perimenopause and menopause. And often, like you said earlier, you know partners need to understand, really need to understand as well. And we see a lot of people in same sex relationships. And if two of them are perimenopausal or menopausal at the same time, it can be a double whammy, of course. But it’s not just the immediate partner, it’s the wider community, as you were saying. And certainly a lot of the work that you’re doing, with ethnic minorities, the communities are there, more than for a lot of us Caucasians, actually. But they don’t know how to help because they can’t understand. And I think that’s really important. And I was talking to someone recently who’s based in India, and I really worry because menopause age is often younger, you know the average age is probably in their early 40s as opposed to early 50s. And there’s an increased risk of diabetes, heart disease in these women. And we know that in the menopause there’s an increased risk of heart disease and diabetes. And so it’s a double whammy that really needs to be discussed more, doesn’t it? [00:19:15][64.9]

Dr Nadira Awal: [00:19:15] Absolutely. Unfortunately, sort of our genetic makeup is that we are increased risk of heart disease. We are increased risk of diabetes. Often our parents and grandparents have had these health conditions and yes, we can change it through lifestyle, but actually we can’t change genetics. And you can appreciate actually, you know, our diet is often made up of a lot of carbohydrates, and so we’re increasing our risk even further as well. So it is really, really important. Yes, we maintain a healthy lifestyle and have a look at our guts. Having a look at kind of our exercise and we are getting better, definitely. But if you can appreciate when you see that lady who comes in from an ethnic minority background, we’re having to deal with her diabetes that might be poorly controlled. We’re having to deal with her blood pressure that’s maybe poorly controlled. As GPs, we’re having to do that in ten minutes. And yes, you know, there’s a lot of information out there that says no this is menopause related. Not everything is the menopause, it’s not the panacea, you know, giving someone HRT, it’s not the panacea, it’s about the holistic approach to that woman as well. [00:20:17][61.8]

Dr Louise Newson: [00:20:17] I totally agree. And I think it’s a shame, actually, because there’s so much conversation that’s trying to be negative about HRT. We know that in the UK, about 14% of menopausal women take HRT. Worldwide, it’s as low as 6%. So it is low, but it’s a bit like treating blood pressure. I never as a GP and I’m sure you hopefully agree, I would never just put someone on a blood pressure lowering treatment. It would just wouldn’t be doing my job properly. I would talk about lifestyle, I would talk about exercise, I would talk about the different types of drugs and the different side effects they might get and how we might need to change the dose or maybe add in another drug because often two lower doses of drugs is better than just increasing one. And I would review and things would change. And often there their treatment actually, if you get it right and their lifestyle improves, you can lower the dose as well. But it’s the same with menopause. It’s not just, oh, here you go, have some HRT. That would just not be doing our jobs properly. It’s about what it means, because I’ve done and I’m sure you have done many home visits where you open the kitchen cupboard and literally packets of medication fall out. But you think you’ve been prescribing really happily for years. And the women and men have said, Oh, no, doctor, I read the insert. There’s no way I was going to take that medication. And I’m thinking, Well, no wonder your blood pressure hadn’t gone down because you’ve never taken this medication. So if we want to improve concordance, compliance, if we want to really work in a partnership with our patients, they have to have a full understanding. But they also need help to change and improve their lifestyle, to look at their mental health and other things that are going on. You know how you said before this sandwich generation, well, you know, HRT is not going to improve the fact that they’re looking after their mother in a care home who’s 100 miles down the road and they’ve got children and whatever else. And certainly, often as a GP, a lot of my role was sort of also listening and understanding and saying to women and men when they were having difficult times, I can’t change your life, but I can help you improve the way you deal with it. And that makes quite a difference, doesn’t it? [00:22:26][129.1]

Dr Nadira Awal: [00:22:27] Absolutely, Yes, sort of. I always use the analogy with my patients. I’m like your satnav. I can help guide you and tell you which way to turn. But really, it’s up to you to make the decision making. And whichever way we go, the ultimate destination is going to be the same. And the ultimate destination is death I’m afraid, you know, which where we get it or how we get there. It’s, you know, we can either have a great journey together or we don’t have a great journey together. [00:22:51][24.4]

Dr Louise Newson: [00:22:52] Yeah. That’s so important, isn’t it? And I learned so much in my training year as a GP, actually, with Dr John Sanders, who is my trainer in Manchester, about looking together with your patient. And everyone’s different and everyone’s expectations of what they want. You know, I could be expecting all my patients to do a regular yoga practice and do a headstand three times a week because that’s what I do. Well, of course, some women are very happy just sitting on the sofa watching telly. And actually, who am I to judge? They probably have a far better time than me, constantly working and fitting in yoga in between a hectic schedule, but actually it’s working out what they want. And this is the same with HRT. If a patient or a woman really doesn’t want it, that’s fine. But they have to understand the risks of not taking medication as well as the risks of taking it. The same as the risks of eating McDonald’s or, you know, smoking. I would never judge a patient and treat them differently because they decided to carry on smoking. But I do feel it’s my role to tell them that smoking is not the best thing for their health. But I think being a GP actually gives you some great skills where we’re not judging, we’re not preaching and that helps with all the education work certainly I do, and you do as well, because we’re used to dealing with different people and speaking to people in different ways and giving them the information in the way that they want it as well. Because you know what I might give a professor of neuroscience who’s a patient might be very different to someone in inner city who doesn’t speak English as their first language. They both are entitled to as much information as possible, but they might want it in different ways and different stages by different people as well. [00:24:38][106.0]

Dr Nadira Awal: [00:24:38] Absolutely. And I think it’s really important. As you say, it’s a professor of neuroscience or neurosurgery, for example. Even though they’re a doctor, they probably know nothing about the menopause, actually. And actually, it’s really important to explain it in layman’s terms as best as possible. And actually, I often find that my patients actually have more education than I do. And it’s great. I love it. I love hearing from my patients, actually, what the latest research they’ve found. And I will embrace it because you have to embrace it. [00:25:07][28.2]

Dr Louise Newson: [00:25:07] Yes, I love it. I mean, when we when I first started as a GP, the internet only really started going. And it used to be the front page of the Daily Mail saying, I would like this treatment. And then you look at it and it’s been a study of four people have found that something and you’re like, Oh, but now actually they learn from their communities as well. And there’s a lot of pushback about social media, but actually it can be very useful if it’s done in the right way. And it can also allow people just a bit of space to think and they can communicate with others that they might not meet in a mosque or the supermarket or a church or with their local communities. And it allows them probably to ask things in different ways because they are more anonymous as well, which I think is really important. So the huge amount that we need to do. There’s a huge amount, we need to carry on educating women, men, families, but also health care professionals as well. And all the work you’re doing is helping with that. Well it’s great to connect and I hope we can carry on doing things together. So before we finish, though, Nadira, I’d really like to ask you three tips, actually. So three tips of how women and healthcare professionals and anybody so professional or nonprofessional people can just become more educated, more empowered to help more people. [00:26:23][76.0]

Dr Nadira Awal: [00:26:24] I think the key thing is, as a GP, I would really appreciate if somebody, if they were concerned about the menopause itself, I think my top tip is download the questionnaire. Have a look at it. Fill it out beforehand. Tell me your symptoms within that first two to three minutes. So we’re both singing on the same hymn sheet just so that we know we’re tackling with menopause. Please don’t be alarmed if I’m going to be ordering blood tests, looking at vitamin D deficiency, looking at iron levels, looking at your thyroid function. I won’t be prescribing HRT on the first consultation. I have ten minutes as a GP. I need more information from you. And the menopause isn’t the, you know, it’s not the only diagnosis out there. You know, it’s really tough as a GP, we need to rule out more sinister causes. So I think that’s my top top tip. Two other tips. I’d say be wary that actually women of ethnic minority, we often need higher doses actually compared to our Caucasian counterparts, everybody absorbs their oestrogen differently. And that’s my third tip. So please, if you’re going to the maximum doses, check oestradiol levels. You know, we’ve got a lab for a reason, you know, so just everybody is individualised. Everybody has a different story. So please tailor it to your patients. [00:27:41][77.1]

Dr Louise Newson: [00:27:42] Very good. Very good. Everything we do in medicine should be tailored to our patients. So important. So I’m very grateful for your time and keep doing the work you’re doing. And thank you again. [00:27:53][11.0]

Dr Nadira Awal: [00:27:53] Yeah, thank you, Louise. Thank you. [00:27:55][1.4]

Dr Louise Newson: [00:27:59] You can find out more about Newson Health group by visiting www.newsonhealth.co.uk. And you can download the free balance app on the App Store or Google Play. [00:27:59][0.0]

ENDS

The post The juggling act: how to navigate menopause and midlife appeared first on Balance Menopause & Hormones.

In this week’s podcast, food writer, author and award-winning entrepreneur Freda Shafi talks about her work raising awareness of menopause and recording the experiences in the Pakistani community in West Yorkshire.

Freda shares her own menopause story, and she and Dr Louise discuss key barriers women face accessing care, and ways to improve knowledge to empower women to advocate for themselves.

‘I’m a South Asian woman, I’m a Pakistani, I’m a British Pakistani woman, and I know I represent a certain demographic,’ says Freda.

‘I feel as though I can reach many women through the fact that I am from the community. That may be platforms for women like myself who are able to cascade that information and let that reverberate across those communities.’

Freda’s top three tips: 

1. Help represent your community to spread awareness of menopause symptoms, treatments and services and help tackle the stigma that still surrounds this area.

2. Get a second opinion if you don’t feel your healthcare professional has given you the right diagnosis. Explore the materials that are out there, including the balance app, so that you’re informed when you see your doctor. 

3. Boost training in the menopause for community leaders so that they can signpost women to local services that can help support them.

Follow Freda on Instagram @fredishafi_spiceitup

Transcript

Dr Louise Newson: [00:00:11] Hello, I’m Dr. Louise Newson. I’m a GP and menopause specialist and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. 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 perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So very excited for today’s podcast. I’ve got with me in the studio someone called Freda who approached me, like lots of people do, and told me about the incredible work that she’s doing. And for those of you that might know, I spend a lot of my time trying to work out how to reach people who have really been unheard, have been sort of vanished from society with their perimenopause and menopause. And the more work I do, the more I realise, sadly, there’s lots of those women. And it’s actually, I think the majority of women who are not able to access really good quality care, advice and treatment. So Freda has been doing some really great work. So I’m very privileged to have you here today at my studio. So welcome today. [00:01:44]

Freda Shafi: [00:01:44] Thank you. Is it’s a privilege to be here, actually. [00:01:46]

Dr Louise Newson: [00:01:47] Oh, thank you. So just tell me a bit about you first and your background and why you’re doing what you’re doing, if that’s okay. [00:01:53]

Freda Shafi: [00:01:55] As you may have gathered from some of my background information, I am a creative person who works across the cultural sector and at the moment I’m working in the culinary world. So everything to do with food, health, wellbeing and being equipped to understanding our bodies and how we can make really the best of our our health through food, through nutrition, through lifestyle. And in the current world that we’re living in, we need to be fully aware of how our longevity impacts our family and our communities. So just making sure that we are, I suppose, making the best choices when it comes to food, nutrition and even lifestyle. And that extends to, as I said, the creative sector, the creative industries. I came across the work that you are doing obviously through my own journey and wanting to know more. And I equipped myself with a lot of knowledge, a lot of background, and being in a perimenopausal state myself, I felt I needed to reach out and talk to you about some of the, I suppose, the inequities that still exist, even though there are some brilliant services out there and some great research and work. Sadly, there are still pockets of communities that are not accessing the right care and the right treatment, especially when women of my age bracket approach menopause and perimenopause. [00:03:26]

Dr Louise Newson: [00:03:27] Hmm. Absolutely. It’s an interesting one. I trained in Manchester many years ago now, there is a huge ethnic minority population, and when I was working in casualty, lots of women would come in with total body pain and they would be almost dismissed to say, well, they’re on antidepressants. There’s nothing wrong with them. We’ve checked their thyroid. There’s probably other issues at home. It’s very difficult to get a history because they’re not speaking English. They haven’t got an interpreter with them. You know, what can we do? And I look back in horror because I know a lot of these women were either menopausal or perimenopausal because they were the right age. And I don’t know how much of their symptoms were related to their hormones, but no one even gave them opportunity to have any education or even to talk about it. [00:04:15]

Freda Shafi: [00:04:16] I think that’s very sad. And I think that pertains to a lot of the cultural taboos and stigmas associated with perimenopause and menopause, especially when you think that a woman’s currency in many communities, not just Pakistani and Asian community or ethnic communities, but across the whole spectrum, I would imagine, a woman’s currency is linked to fertility, to use, to abundance, and sadly, it is overlooked and not actually talked about, not even overlooked. That’s probably the wrong word. It’s not even addressed because it is considered almost like a failure on the part of a matriarch, on the part of a woman and part of a family, which is very, very sad. [00:05:00]

Dr Louise Newson: [00:05:01] It’s the same as so many people, because when we’ve looked at the menopause for so many years, it’s been about periods which is associated with fertility, like you quite rightly say. And because we know a lot of women are younger when they’re menopausal as well, at an age where perhaps they would be expected to conceive. It’s a double whammy for those people that are young when they’re menopausal. But actually, even when people are older, you want to cling on to your youth, if you see what I mean. But our youth should not be defined as whether we’re fertile or not, but there is this identity for women. And like you say, in some cultures it’s more than others. But actually the menopause isn’t about losing fertility. And there are some women actually who have an early menopause who are still fertile. Their fertility isn’t as good, but they are still fertile, yet they’ve got this shame that they don’t want to talk. And we see a lot of women who’ve been to fertility clinics and they have reduced fertility and everyone’s been blaming their anxiety, their mental health issues, their poor sleep on their worry about whether they can get pregnant or not. But actually it’s because they’ve got a hormonal deficiency due to their perimenopause or early menopause. So there’s been this misinterpretation of what the menopause actually means and some people refer to the time after menopause as post reproductive health, well it’s not actually. And that’s really confusing for a lot of people. But like you say when you’ve got this added burden actually of being a woman who has to be fertile, it adds a whole new dimension, doesn’t it? [00:06:36]

Freda Shafi: [00:06:36] Absolutely. And as I said before, I’m not dismissing some brilliant work that’s going on in terms of outreach and engaging more representation. There are some brilliant doctors out there like Nighat Arif reaching out to the ethnic minority communities through her social media platforms. But what worries me is that there are still pockets of ignorance within communities. And again, ignorance is not used as a derogatory word here. It’s ignorance, because a lot of the women I have been exposed to sadly have been misdiagnosed, and many of them are on anti-depressants. And as a result of that, they are being labelled as mentally ill. And that’s what probably perturbs me more than anything, is the fact that they are not being, first of all, diagnosed properly or even aware of their local amenities and resources. Even in West Yorkshire there are some brilliant resources that exist like Livve UK run by Melissa Sookia and she is doing some great work. I spoke to her and she said if they approach me, that’s the only way I can help them, Freda. And she absolutely would go in and do some voluntary work. But the fact is they are not even in a position to access those services because they are not aware. And just looking at the actual statistics, 78% of women from ethnic minority communities are actually still very much unaware of their menopausal symptoms. And given that there isn’t a definitive word for it, there is a very broad spectrum word which is very similar to the menopause. You know, the Greek word meno pausis, which is literally everything’s shuts down, which isn’t a very glamorous word either, but it pertains to shut down, which again, is not a word that makes women feel good about their bodies and their health and their sexual health, which again, should not be a taboo subject. But sadly, it is and it has a cascading effect onto their families, onto their husbands and across the community. And it resonates. And that’s one of the reasons why I feel it needs to be addressed. Even though there are some great resources out there are still women not accessing them. [00:08:49]

Dr Louise Newson: [00:08:50] Yeah, it’s very interesting and it’s so frustrating actually, isn’t it, when this is something that happens to 100% of women at different ages, of course, yet we still don’t understand what’s happening. And in fact, seven years ago I used to work with West Midlands Police and we did a survey then to try and understand what women understood by the menopause and about their symptoms, and it’s a very similar figure. It was about 75% of women didn’t realise that their symptoms that they were having were related to their menopause, and the commonest symptoms affecting them at work were anxiety, mood problems, fatigue, memory problems. And they’d been signed off work with depression, headaches, with migraines. And a lot of them were just telling me that they were retiring early because they couldn’t carry on. And this was seven years ago. So hardly anyone was talking about the menopause then. And I remember sitting in this room with these lovely officers and police staff and just saying, but you’re only 50. You can’t give up your job now. And they said, well, we can’t even go to the playground and lift our grandchildren to put them on the swing because we’ve got such bad muscle and joint pains. We’re on antidepressants and they’re not helping. And so you don’t seem depressed, why are you on antidepressants? Oh, well, because that’s all I could be given. And it was then that I really had this sort of almost lightbulb moment thinking, goodness me, this is to me, very obvious, but people aren’t accessing it and obviously developing then the website and then the app. Isn’t it great? It’s got a wonderful reach and everyone says, oh, isn’t it amazing, Louise, you’ve had over a million downloads of balance app. And I think, no, it’s not. It’s 1.2 billion women worldwide. How do we access them and how do we enable them to find out information? Because I think women are very good, lots of communities of women are very close, but they’ve got to know how to start the conversation, how to open up the conversation, isn’t it? And I know you’ve been working really hard in some areas haven’t you to really start that going. [00:10:48]

Freda Shafi: [00:10:50] I feel really passionate about it because I feel if you fail one woman, you are failing a whole entire community. And within the South Asian community there are lots of different demographics. You have a Bangladeshi community, you have an Indian community, have a Pakistani community. So it’s a whole demographic there. And it can take one person’s mindset changing for that to cascade and reverberate through an entire community. And it can be as simple as that, Louise. And I’m on a mission, actually, I’m on a mission because I’ve seen generations before me. I actually have an older family. I’m the youngest of quite an older family, so I have sisters in their 60s and I know I’ve actually interviewed women of different age groups and I’ve interviewed women in their 60s and asked them if they would have done anything differently. And it’s very sad to hear them saying, had I known about this, I would have done things very differently. And now they are on a whole spectrum of medications ranging from thyroid right through to blood pressure and antidepressants. I was offered antidepressants when I approached my GP, but thankfully, Louise, I’d already found you. I’d already found you, and I knew exactly what the protocol would be. And as an articulate Pakistani woman, British Pakistani woman, I was capable of knocking on the GP’s door three times. And in fact, that’s how we met, because it took me three knocks on the door to get my HRT. And can you imagine a woman whose language is not English? Who’s not very confident, who trusts completely and implicitly what the GP is saying, which we should actually, I’m not undermining that. But sadly, even somebody like myself who is articulate and adept at getting through to my GP and armed with a whole arsenal of research and statistics, even then I was refused three times. So I think therein also lies a problem because it’s still happening. And I think if we enable and empower one woman to knock on that door however many times it takes, and if it means me going in and making sure this is happening at a pedestrian level, I’m not a clinician and I don’t profess to be anybody from a medical background. But as a person who can give women a voice and enable them and maybe empower them to just keep pushing and not accept the first port of call, which sadly is always antidepressants. From what I’ve learned from the communities I’m working with. And like I said, the system is still failing many women. [00:13:33]

Dr Louise Newson: [00:13:34] It is. And I don’t quite know why. One day maybe I’ll find out. But I really don’t understand why. And I am, I’m a fellow of the Royal College of GPs and I did speak to some people quite high up, I won’t mention any names, recently and asked them where the antagonism is for my work and for menopause and why is it the women are being underserved. And one of the responses was, well, Louise, your media attention to the menopause is quite difficult because it means so many women now are coming asking for hormones to the detriment of other patients. And I feel really sad about that because I think if we can invest time-wise, but also economically in women in their first or second consultation, sometimes it can take more than one consultation to go through everything. But then these women will then often be liberated and not come back into the general practice or to other healthcare systems, because many women and we know that from just doing some research in our clinic, once they are better and have the right treatment and looking at treatment, when I say holistic treatment, looking at changing, improving their nutrition, exercise, sleep, wellbeing and hormones, if they want them, then actually they don’t then go back to their GP in the short term because they don’t have symptoms. But in the longer term we know they’re less likely to have cardiovascular disease, diabetes, osteoporosis and so forth. And we know that women from certain ethnic minorities have a higher risk of obesity, type two diabetes, cardiovascular disease. Many of these women have a younger menopause. We know women who are younger when they’re menopausal have a higher risk of these diseases as well. We wouldn’t allow women to be walking the streets with raised untreated blood pressure or raised untreated type 2 diabetes. Yet we’re allowing them to have very low hormone levels with risks and symptoms affecting the quality of their life and almost being annoyed that they’re coming to ask for treatment. I don’t really understand that. And the more work we do, empowering people, this side of the stories are that I hear of people being turned away and I can’t quite understand, and I wish someone could tell me in a very reasonable way why it’s so awful. But I haven’t had a reason yet. [00:15:51]

Freda Shafi: [00:15:51] Well, therein for me lies the injustice, Louise. And I think you hit the nail on the head. If a woman is misdiagnosed, then it does sadly lead to many of the conditions which you have shown to be linked to the menopause, dementia, osteoporosis. All of these conditions could quite easily have been, I’m not saying remedied, but you know, HRT isn’t always the answer, but an awareness of just something as simple as diet and, you know, changes to a woman’s diet when certain hormones go out of kilter. I specialise in food, whilst I’m not a nutritionist, I understand what foods work and it’s pretty common sense for me. I’ve been cooking for many, many years where things were cooked from scratch in most instances. And I know that fresh unprocessed foods help certain menopause conditions, and it’s as simple as just awareness and information in many instances, which that in itself doesn’t necessarily involve a medical intervention. That isn’t something that a woman necessarily needs to reach for the antidepressants. It’s just on the first port of call it should be have you accessed this service that is available to you in your community? That’s something I really want to do. If that’s a bridge that I represent, then I would be happy to do that, to signpost women from my community. And I suppose I have a special interest in my own community. I can’t speak for the wider community, but having worked and being from that community myself, I understand the cultural sensitivities, the taboos and everything else I’ve mentioned, but I certainly can support women and signpost them to accessing the right healthcare before they go down a slippery slope of once they are on something, sadly, there are side effects and those side effects can lead to more and more medication. I’ve seen it happen. I’ve seen it happen in the older generations of, say, for example, of my mother’s generation, when a lot of the women in her generation were bedridden at the age of 50 plus. Thankfully, my mum’s very, very well in her 80s, but she had a very different approach to it and it was more about mindset, health, wellbeing and food actually, which is probably where I took my inspiration from food and do what I do. But there are a lot of women who did even at that time, and we’re talking about the 80s and 90s, well before you came on the scene Louisel, even less knowledge and understanding of menopause, many women became bedridden and I often used to wonder why. And I know now and I know lots of it, you know, a certain percentage of that would have been definitively linked to menopause. [00:18:46]

Dr Louise Newson: [00:18:48] So tell us about some of the work that you’ve been doing, some of the research you’re doing. I know you’ve been speaking to a lot of people, and I’m really keen to hear a bit more about that, if that’s possible Freda. [00:18:58]

Freda Shafi: [00:18:59] Well, I’ve interviewed over 20 women. I have case studies of 20 women written down, the ones that I found quite interesting and as I said before, quite definitive in terms of some of the really interesting points that came out. And it’s a very broad demographic from very highly adept and articulate, educated women right through to and again, I’m not using this as a way to undermine women who have come from South Asia, who are housewives and just as adept but in a different way. So women who are articulate enough to access services. I interviewed them and I interviewed housewives from certain communities who are not necessarily medically literate enough to access services. My findings are very interesting, Louise, because even within the more capable, as in able to approach their GP confidently, even those women are not necessarily accessing the right treatment. And the women in the community centres they have been offered certain treatments but are refusing. And I also interviewed daughters of some of the women I interviewed to see what effect it was having in a more family environment and men as well. And looking at the way men approach or don’t approach or even want to engage in the conversation. So my findings are interesting. Some of the older participants sadly said that they felt that they’ve been let down by the system. Had they known about it they would have accessed treatment because now they’re on a spectrum of medications which they are certain in themselves that they probably wouldn’t have had to because of some of the joint pains that they’re suffering, some of the cardiovascular symptoms that some of them have suffered. Had they accessed treatment maybe 10 or 15 years ago, they wouldn’t have done that. So it’s almost like it’s a little bit too late for them. They think, even though I’m trying to push them to have a look and see if there are still options available to them. I’m not pushing for HRT. I’m not pushing them to go down any road other than to be more aware. But like I said, my findings are a lot of stories and anecdotes about the effect it had on their lifestyle, their marriages, their family life, right through to, as you’ve mentioned, some of them stopping work and feeling as though they couldn’t carry on in the workplace. Their brains weren’t functioning. There was the classic symptoms, brain fog, anxiety, and their husbands sadly not being very amenable or supportive to that. And the words like psychosis were being used to describe how they were being labelled by the community, by close family members. And that resulted in many of these women taking alternative treatments, which again, I’m not a clinician, but I know that it just didn’t seem to fit very well with what I was hearing. So it’s quite alarming that the system has failed a generation before us. But looking at some of the younger women, thankfully they are more aware of what’s going on, even though they’re not in a perimenopausal, menopausal age bracket. They know from their mothers. They know from the experiences of what their mothers are going through and are more adept and probably will be more adept at accessing the services. But even then, many of them, because they’re not in that age bracket or even thinking about perimenopause, they’re still very, very much unaware of what’s to come. Some of them even use the word frightened and scared. You know, the idea of the menopause fills them with dread. And again, one of my roles, I feel, is to advocate that it shouldn’t have to be like that for a woman who is perimenopausal. And I feel it’s a game changer. And I feel that there are so many things and opportunities available. If all I can do is reassure a lot of the younger women, then I feel as though there is an awful lot of value in that. I also interviewed some of the people who were running some of the community centres. They too recognise there is a problem. Their hands are tied. It’s a very political situation. As I’m sure you’re aware of when it comes to medicine. But my job is to make them aware of services outside of the GPs that exist, such as I’ve already mentioned in West Yorkshire, we have some great resources like Livve and other things, and high profile doctors like Nighat Arif are doing brilliant things and just seeing if they can be woven into some of the sessions, some of the workshops, some of the coffee mornings. But these gatherings usually are about lifestyle and accessing healthcare and make it a point of menopause being a very targeted thing that they talk about once a month. I’ve gone in and spoken about it and some of the perceptions that came out were very, very interesting. We did posters, we did some notes and some of the quotes that came from that. I wrote them down and some of them were quite discouraging, but some of them were very positive in the sense of that women felt empowered enough to feel like there was an opportunity for them to come back. And one of the quotes was, I’m going to start driving again. I can’t believe I’ve stopped driving. You know that in itself. Right now, it’s sad because it means that a lifestyle, something that’s so relevant to somebody’s lifestyle, driving somewhere, somebody stopped because of the debilitating anxiety. If there is an opportunity to reverse that or address that and, you know, get that woman back. There’s a bit of work to be done. So that’s what my findings have revealed across a range of demographic, as I’ve mentioned. [00:25:23]

Dr Louise Newson: [00:25:24] Which is no surprise from me, because I hear stories all the time from people from all backgrounds saying similar things. But it is absolutely shocking that we’re talking like this in 2023. You know, I speak to a lot of women who are too scared to go out the house, they’re too scared to use public transport. They’ve stopped driving. Like you say, they’ve given up their jobs, but also their role in society. And, you know, older women often have a really pivotal place and role in society, even within families and communities, to really educate and learn and be part of something. And if they can’t do it they’re losing out, but other generations are losing out. So there’s so much that we need to do because there’s the older generation that you say have been lost out and they went on all these other medications. They’re not too old to consider the right treatment that’s individualised for them. But really crucially, and I clearly think about this a lot, having three daughters, the new generation coming in need to be educated really early so they can make choices when they haven’t become this shadow of a person that has withdrawn from society because it’s too hard when you’re riddled with anxiety and you’re a shell of yourself and you’ve knocked on that door too many times to try and get help or you’ve received the wrong help. So it’s empowering women. And the work you’re doing is incredible. It’s really making a dent and a start. And we’re making lots of dents in the work we do. Every day I feel inadequate about the work I do, but actually, it can be amplified by us all working together. And I think that’s where it’s absolutely crucial that we all work together to help as many people as possible, because if each of us just helping a few, if there’s enough of us, then it really gets amplified and resonates. And that seems to be what’s happening. But we certainly have to do so much more work to get to certain communities. So I think your work is incredible and any of you that follow you on Instagram will see how amazingly talented you are, not just, you know, with the work that you’re doing beyond home and everything else, but the way that you design and cook food. I just feel incredibly inadequate looking at some of the things that, you know, it’s wonderful and it’s actually a very, very calming Instagram page just to look at actually with all the craziness of everything that’s going on. So there’s so much you’re contributing to. Before we finish, are you able to give three take home tips for those women who may have listened to this and are struggling, or those women who think, yes, I might be able to help people in my community just by talking and how do I start or what do I do? Are you able to help at all with three tips? [00:28:11]

Freda Shafi: [00:28:12] I think my three tips would definitely start with representation in terms of possibly seeing something that’s culturally relevant. And I don’t want to duplicate what’s already going on because I know that, you know, there are some materials that have been transcribed into South Asian languages, but just to reinforce that, you know, through marketing, videos, posters. I’m a South Asian woman, I’m a Pakistani, I’m a British Pakistani woman, and I know I represent a certain demographic. I feel as though I can reach many women through the fact that I am from the community. That may be platforms for women like myself who are able to cascade that information and let that, as you said, reverberate across those communities. Because if you’re amenable and you’re relatable, I think you will get through. If there is something that is accessible about a woman of colour speaking sense and taking away the taboo and the fear and a lot of the flawed research that as a clinician, you know, you know, just dispelling all of that, that representation I think is really important that Pakistani women of all demographics can relate to somebody from their community that is in the same space as them. I think the other important thing, is diagnosis being more considered. So when that first port of call, may be getting a second opinion. So if the first port of call to the GP based on symptoms and that first diagnosis is sadly or is antidepressants, I would urge many women to get a second opinion and explore the materials. I recommended the balance app. I’m trying to introduce the balance app into various community centers so women can chart their experiences and go to their GPs like myself, fully armed with an arsenal of research stats, even charting their day-to-day symptoms. So the doctors and the GPs, who are much more aware now, more capable at proper diagnosis and then maybe finally training not necessarily for clinicians, but training for gatekeepers such as leaders within the community. And they often are the community centres who look after the wellbeing and the lifestyle of these women who are approaching are in the menopause or even post menopausal, those women displaying classic symptoms of menopause. Those community leaders should be more aware of what they are and able to signpost them to resources outside of GP services. So to summarise, representation, diagnosis, and more training, I would say. [00:31:03]

Dr Louise Newson: [00:31:03] Very good. And keep going with the work that you’re doing and look forward to doing more together in some way as well. So I’m very grateful for your time Freda. Thanks ever so much for coming today. [00:31:12]

Freda Shafi: [00:31:13] You’re very welcome. Louise. Thank you for your time. [00:31:15]

Dr Louise Newson: [00:31:20] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk and you can download the free balance app on the App Store or Google Play. [00:31:20]

END

The post Empowering women unheard during menopause appeared first on Balance Menopause & Hormones.

It’s like you hit middle age and someone turns the light off.

Midlife invisibility is something so many women experience, the sense that people are suddenly looking through us rather than at us, interrupting or ignoring what we say, giving us the restaurant table at the back by the toilets instead of the one in the window.

Much of this feeling of invisibility is directly linked to the perimenopause and menopause, as if visibility is somehow connected with fertility.  Men, potentially always virile, remain ever visible. We might be able to take these daily slights on the chin, but things take a different turn when switch to the workplace and see how consistently middle aged and older women are looked over for promotion. 

RELATED: My story: menopausal migraines, memory slips and hot flushes

And if you have been out of the workplace for some reason – family, health, redundancy – as a middle-aged woman it is almost impossible get back in.  Men are often promoted on promise, a belief in what they can be, whereas women are promoted more on experience, so it becomes a Catch 22. There also seems to be a desire, whether conscious or unconscious, to sustain women’s midlife invisibility because it supports the status quo – leaves the high-status directorships for men who often don’t see a gender gap in the workplace because it has always been there.

Why language matters

Until recently so much language associated with women’s menstrual health has been cloaked in invisibility. For example, the secrecy around tampons and periods – the words themselves whispered in code, as if they are unmentionable.  Everything is couched in discretion.

Thankfully things have started to shift. This has seen World Cup football commentators discussing the importance of taking players menstrual cycles into consideration and Wimbledon finally relaxed its all-white dress code to ease the stress around periods. The menopause however remains the outlier, retaining its shroud of invisibility because, at the end of the day, it’s just not sexy. It is seen as the end of something, not the start. The word itself is kept at a distance, mouthed rather than spoken, ‘the change’ accompanied by the raise of a brow and a knowing nod. Or, when it is given voice, it is often to get a cheap laugh, the hilarity of a hot flush on par with the mother-in-law joke. 

RELATED: What does the future hold for menopause and HRT? With menopause activist Kate Muir

A further issue that compounds a woman’s sense of her invisibility is timing. When perimenopause happens, women are often sandwiched between caring for teenage kids, going through the angst of puberty, and looking after elderly parents often struggling with dementia or mobility problems.

Women putting themselves last

Women tend to prioritise the needs of their family over their own, which can exacerbate that sense of loss of self. Part of what is crucial is opening up intergeneration conversation. Looking back, I realised I never asked my mother about her own menopause, had no idea why for a couple of years she was so sad. But now I know why.  As well as feeling unseen I think women of a certain age feel unheard and unheeded. During perimenopause and beyond a lot of us feel frustration or even anger that can be hard to articulate.  Menopause can’t be a word we pincer in tweezers and hold at arms-length, we have to name it and we have to talk about it, because it affects all of us, those of us women going though it physically as well as our partners, families, employers and friends.

RELATED: Author Joanne Harris: ending the invisibility of menopausal women

When I was writing The Invisible Women’s Club, my novel about ageing and visibility, I was experiencing my own perimenopause, struggling with anxiety and seismic mood swings.  It was only when I found the Newson Clinic that I started to fully understand my symptoms and how to treat them. I don’t think I could have finished writing the book without the help and advice I received, alongside the hormones which finally made me feel like myself again.

I charged myself with writing relatable female characters who talk frankly about the menopause. One of my protagonists, Bev Bytheway, is a Scottish midwife struggling with the perimenopause and fighting for women’s health care. She is warm, upbeat and has a great sense of humour. I wanted to create an ally for my readers, a chum who was in it alongside them.  

Writing about the perimenopause

I think it is incredibly empowering to laugh, that humour is a revolutionary tool, one that can be so central to female friendship.  We laugh with Bev, not at her. In Bev I wanted to create a character who struggles to give voice to her frustration and rebels against a certain placatory or mystical language around the menopause.

Bridget Christie’s recent TV series The Change does so much work through deploying comedy to break taboos around the menopause and in Broken Light Joanne Harris fearlessly confronts the viscerality of the menopause. Sharing our experiences of the menopause with each other, in whatever ways we can is vital.

The more society renders us invisible the more opportunities we need to give each other to be seen and heard.

The Invisible Women’s Club by Helen Paris is published by Doubleday (£16.99).

The post Invisibility and the menopause appeared first on Balance Menopause & Hormones.

In this podcast, Jill Chmielewski, a nurse, educator and women’s advocate, talks about her mission to guide midlife women to greater wellbeing.

Dr Louise and Jill discuss the powerful and poorly understood role of hormones in women’s health throughout their life, HRT and the importance of women advocating strongly for their own needs. Jill advises women should prepare well in advance for the menopause, as hormonal changes can begin earlier than you may expect.

Jill’s three top tips: 

1. Educate yourself on the role of hormones and the impact these can have on your health, so that you are informed.
2. Start thinking about your menopause early – and probably earlier than you may expect. You may notice hormonal changes in your thirties, so be prepared and plan which healthcare professional may provide the support that you need to manage your perimenopause and menopause journey.
3. Embrace patient power – act as your own advocate and be persistent with your healthcare professionals about what you need. This includes if you are on HRT, as you may still benefit from tweaks to your current regime.

For more about Jill visit her website here and you can follow Jill on Instagram @jill.chmielewski. 

Transcript

Dr Louise Newson: [00:00:11] Hello, I’m Dr. Louise Newson. I’m a GP and menopause specialist and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford upon Avon. 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 perimenopause and menopause. We talk about the latest research bust, myths on menopause, symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So today on the podcast, I’ve got an American lady with me and I’ve had a few people from America, and I’m sure I’ll have a few more. So Jill Chmielewski. She is with me remotely, not actually in my house, unfortunately. And we’ve been having a remote friendship, if you like, for, I don’t know, over a year or so. And Jill’s a nurse and she spends her life probably as frustrated as me, but as passionate as me to help as many people and empower as many people as possible. Is that fair to say, Jill? [00:01:34][83.6]

Jill Chmielewski: [00:01:35] That is… you said it just perfectly. We share the frustration. Yes. [00:01:40][5.3]

Dr Louise Newson: [00:01:41] So tell me a bit about you and your background and why you’re doing what you’re doing, if that’s okay. [00:01:45][4.0]

Jill Chmielewski: [00:01:46] Yeah. Yeah. So I’ve been a nurse for 30 years and about I would say about ten years ago I started well, I had really always been of the mindset. I was more in kind of the prevention side of healthcare. So like our system is so designed for sick care. And I always wondered why we weren’t doing more to prevent disease from happening. And so that was sort of even throughout my 30 years as a nurse where I was coming from. And I started shifting then about ten years ago and I went and became a health coach. I went through a health coaching programme, then I went through a functional medicine programme, and I started to find that when I was working with patients, I was drawing in, I guess, attracting women, of course, more than men. And when I was finding in my conversations is these struggles. And as I was thinking about them and having had learned more about functional medicine, which is looking at, you know, the root cause of things, I was really connecting a lot of their symptoms to hormones. It related to perimenopause and menopause. And at the same time, I was going through perimenopause and I was having a lot of those same symptoms. And so I guess it just started to really occur to me that women were struggling with this. And I was seeing women over and over and over. And it just sort of opened Pandora’s box where I had realised as a nurse and I worked in women’s health. So I didn’t know anything about hormones or this level of hormones, especially that I do today. And so I realised women didn’t know about hormones. If I’m a nurse working in women’s health and didn’t know that much about hormones, women certainly didn’t know about hormones. So I just started going down that rabbit hole and have found myself with just this love for working with these women and just helping women to understand their bodies and understanding their hormones and really advocating for themselves. So I’ve just shifted so much in my work and now I’ve really I’m spending the majority of my time just educating patients. I stepped away from working with patients one on one about a year and a half ago. And I’m just doing education solely at this point. [00:03:34][108.0]

Dr Louise Newson: [00:03:34] Wow. So you can reach even more women in a more productive way, I’m sure. [00:03:38][3.7]

Jill Chmielewski: [00:03:38] Yes. Yes, exactly. [00:03:40][1.3]

Dr Louise Newson: [00:03:40] Yeah. And it is so interesting, isn’t it? I mean, I qualified. Oh, gosh, nearly 30 years ago. I feel very old. I qualified in ’94. And, you know, someone said to me recently, once you see the menopause, you can’t unsee it. It’s absolutely right. But I wish I had seen it 30 years ago. You know, I reflect and I keep thinking, is it because I fell asleep in that lecture? Is it because I wasn’t interested? But no, it wasn’t. I just wasn’t taught. And when I started to read quite a lot more about the menopause eight years ago now, just before NICE guidance came out, I started to become more interested in it and I had to keep reading and rereading the articles and thinking no I’m missing something here because everyone’s telling me it’s so dangerous HRT. Everyone’s telling me there’s risk where every single paper I’m reading actually is showing me benefits. And I’ve done a lot of cardiology in my time. I’ve done a lot of oncology, I’ve done a lot of respiratory medicine, I’ve done all sorts of things and also I’ve done a lot of rheumatology. So you think, well, what about diseases such as heart disease? What about osteoporosis? And then I did a neurology job for six months as well as part of my medical training and, you know, dementia, all these really, really important diseases. It’s almost that we know that taking HRT is, you know, reduces the risk of these diseases. But we’ve been told time and time again there’s not enough evidence. And I know in the UK our societies keep saying there’s not enough evidence for primary prevention. So that’s giving HRT to reduce risk of disease. Your North American Menopause Society and various other committees have recently produced a taskforce, haven’t they, a document to say we should not be prescribing for primary prevention yet. You know, HRT is licensed as a treatment for osteoporosis. We know it reduces risk of osteoporosis. We know it reduces risk of heart disease. So why are people so scared of HRT, do you think Jill? Because they’re scared over here. But I know they’re really scared over with you. [00:05:41][120.9]

Jill Chmielewski: [00:05:42] They’re really scared over here. I mean, it’s so interesting. I think it really stems, I think we go back to the WHI, the premature, you know, ending of the WHI think still the messaging, sadly, 21 years later, if I’m doing my math right is that hormones cause breast cancer. That was debunked long time ago but that is still then the messaging. And I think kind of back to your point about what you learned in medical school and what I learned even in nursing school, yes, it’s about HRT, but it’s hormones themselves. We know that hormones physiologically, what they do in the body, we’ve learned so much about their impact and that there’s hormone receptors from head to toe, from the brain to the blood vessels to the muscles, the vagina, the urinary tract, digestive tract, you know, everywhere, the immune system. So when we’re talking about especially bioidentical hormones, replacing hormones with bioidentical hormones, the same hormones that are found in the body, knowing what hormones do in the body, we can make some generalisations and conclusions just based on what we know about hormones in the body. Somehow these hormones have been so demonised, yet, you know, we freely give insulin and we freely give thyroid hormone. Although for some women it’s a struggle to get even thyroid hormone. But these sex hormones and maybe it’s because they’re considered sex hormones, quote unquote, that they’re just been tied to reproduction, I think. [00:07:01][79.2]

Dr Louise Newson: [00:07:01] I think you’re absolutely right. [00:07:02][0.0]

Jill Chmielewski: [00:07:02] Yeah. Yeah. [00:07:03][0.5]

Dr Louise Newson: [00:07:04] I think this is what’s, when I’ve been trying to reflect and I do it’s a bit like when I argue with my children when they were teenagers, you try and look at it on their side as well, because otherwise it gets too difficult. So with this, I’ve really tried hard to think about the other side, like, what is the reason here? And I think there is two things actually. I think people are so scared about breast cancer that they won’t look beyond it. And we know and I’ve talked about this a lot on the podcast in previous episodes, that the risk of breast cancer, even looking at the WHI with the worst type of combination HRT, the risk was not statistically significant and it was lower than other risk factors for breast cancer, such as being overweight, drinking alcohol, not exercising and actually longer follow up data showed that women who’d had a hysterectomy and had estrogen only had a lower risk of breast cancer. But all the women had a lower risk of dying from breast cancer. So there seems to be still this fear of breast cancer. And we now obviously none of us want to get breast cancer, but it’s common. It affects one in seven women and so one in seven women taking HRT will develop breast cancer. It might even be even less if it is protective in some way. But even so, there will be women across the world who will be taking HRT and develop breast cancer. But actually also we know from studies that women who develop breast cancer when they’re taking HRT have a better prognosis than those not taking HRT. So there’s this fear of breast cancer, but there’s also this complete, like you say, misunderstanding. And people think that sex hormones, I think because they’ve got the word sex in, maybe it is more of a sort of nice to have rather than a necessity. And I know you follow me on social media and every so often it’s been a quite a lot the last few days is all you’re doing is talking about HRT. Women have survived for years without HRT. Why are we having to be, you know, taking it now? And of course, women have survived. They’ve existed. But you have to look at basic, I think pathophysiology. You look at what these hormones are designed to do. They’re not just designed to live in our reproductive systems, like you say. They’re designed to help our brain our bones, our hearts, our bodies function. And this is where it’s such a struggle. And I think people forget that there are benefits of HRT. And a lot of the work I’m trying to do at the minute is look at the risks of not taking HRT because then it changes the conversation quite a lot more. And you’re absolutely right, we need to be thinking about preventing diseases rather than treating diseases. None of us want to be ill. We want to be healthy and our health systems are not able to treat the people that they have now. And certainly just looking in our country, but also in the US, the rates of incidence of obesity, of cardiovascular disease, of dementia, it is out of control, but we have a treatment that we know reduces the risk. And if I if I was comparing recently from the studies, the risk reduction of giving HRT to reduce the risk of a heart attack compared to the benefits of using a statin to reduce a heart attack. And, you know, actually when you look at some of the figures, HRT reduces the risk of a heart attack more effectively than taking a statin. Yet certainly over in the UK when I was a GP, we were encouraged all the time to prescribe statins and I don’t know what’s it like over with you with statin prescribing? [00:10:42][218.2]

Jill Chmielewski: [00:10:44] Yes, statin prescribing is from my perspective, it’s out of control. That is sort of like the go to for everyone. And as you know, I mean, 50% of people who have heart attacks have high cholesterol, 50% low. So to say that lowering cholesterol is the key, you know, it’s more about inflammation and other things, I think we’re always looking for this one thing. [00:11:03][19.4]

Dr Louise Newson: [00:11:03] Yeah, absolutely. And I think also sometimes people want to take a tablet because it’s easier than thinking, taking a step back, looking at their lifestyle. You know, if there was an exercise tablet, we’d all take it wouldn’t we to save as having to exercise. But actually, when you do exercise, you feel so much better and you wish you did more. And it’s one of those things that I think when I look at statins and obviously they do have a role for people that have had a heart attack, people that are high risk. But this is talking about people who haven’t got heart disease who have been picked up by the high cholesterol. There’s been very few good quality studies. I don’t think any good quality studies looking at women. So we’re just extrapolating men’s data when we talk about this. But also when you look at the pathways where statins work, where they affect the enzymes, it’s comes from obviously cholesterol, but our sex hormones actually come from cholesterol as well. And so I don’t think any work’s ever been done on it. But I often think I wonder if statins are reducing our own hormones as well, because we know that a lot of people who take statins feel more tired. They get muscle and joint pains. They don’t feel great. I would love to measure their hormone levels before and after. This is men and women, actually their testosterone and their estradiol levels before and after, because I think there would be a decline. But it’s…you’re right. We just don’t think about hormones in the way that we should. And I think the other thing is that is the biggest motivation for me really is thinking about women’s choice. And that’s the saddest thing, is that women have not been allowed to make a decision, but they’ve also not been listened to. I go to lots of meetings where I hear people say women expect to feel better with HRT and it’s ridiculous. They think that their sleep is going to improve or their muscle and joint pain or their memory, and they’re putting everything down to their hormones. And it’s a very sort of patronising society I think we live in. And anyone that’s worked in women’s health will have listened to some horrendous stories from women. And I am not saying that every single symptom is due to hormones. You know, we all have bad days. We all have symptoms. You know, when I get a headache or a migraine, I can’t always blame my hormones. But if my hormones aren’t right, my migraines are triggered all the time. And I know I feel awful. But, you know, listen to me as a patient. Help me, talk to me. You know, and this is what we’re hearing all the time on your social media or my social media. And just whenever we speak to women that they’re not being believed somehow. Is that the same in America? [00:13:40][157.0]

Jill Chmielewski: [00:13:41] Totally. I mean, it’s not only it’s just their symptoms are dismissed or seen as unimportant or, you know, I think women have such great intuition anyway. I mean, we typically know when something’s off in our body. We’re the ones living in our body. 24 seven. I mean, men too, but we’re living in our body 24/7. So to see a doctor one time a year, you know, they’re not living with us day to day. So I think, you know, our health system is not set up in a way where there is even time to like how this really thoughtful discussion back and forth between patient and provider. And I think that’s a huge issue that we see over here. There aren’t really, you know, menopause conversations. You only get a 15 minute conversation with your doctor as it is. You know, our doctors are not in the know, as you were saying, it’s not for lack of maybe not wanting to know, but doctors were not trained. I mean, I think in the United States, I remember an article that came out in 2018 and it was like 20% of medical schools even offer a menopause training course. And it’s an elective and this includes ob gyn. So your obstetricians and gynaecologists and most obstetricians and gynaecologists, unless they’ve sought out additional training in this, aren’t comfortable having conversations about menopause. They don’t know what to do with menopausal women because, again, hormones haven’t been taught. So we as patients don’t know, right? [00:15:00][78.2]

Dr Louise Newson: [00:15:00] Absolutely. And I think it’s really hard to know where to go because although it’s traditionally been gynaecologists or ob gyns, you know, why should they? Because actually what happens when we’re menopausal is we don’t have periods, we don’t have any gynaecological issues. Yeah, we’re all told we need to go see a gynaecologist. Well the poor gynaecologists, they’re actually trained in surgery. They’re trained in you know, when people have gynaecological problems. Well, actually, just taking me as a menopausal woman, I’ve had a hysterectomy. I haven’t got any gynaue organs. I’ve still got my ovaries. But even so, I don’t have any problems. I don’t have any symptoms, so why should I see a gynaecologist? And so I feel sorry for the gynaecologists, actually, that they’ve always been pushed to menopause. But then family physicians aren’t being taught. But then actually a lot of work I’m doing is about nurses and pharmacists, actually because they, including you, but certainly over here, the nurses and pharmacists are really motivated because it’s a bit like years ago, we used to do all the pill checks and contraception and asthma and diabetes and long term conditions. And then quite rightly, the nurses then became trained and it freed us up to do other things. And it’s very empowering. And I think there is something about talking to a nurse, actually people open up a bit more. Doctors as you know are quite chaotic. We go from one thing to another to another, whereas nurses are very, a lot more structured with the way that they listen and talk and go through protocols better and, and often they have longer appointments. But I think there is this sharing that happens a bit more, doesn’t it, with nurses sometimes? [00:16:39][98.6]

Jill Chmielewski: [00:16:40] I totally think so. I mean, I think we are. Yeah, we’re just caregivers. It’s not that the doctors aren’t, but we’re really trying to just offer our. It’s like the nature of our conversation is just this more back and forth. They probably are more relaxed with us. They feel a little bit more as we’re asking questions, especially because we’re taught to ask these very open ended questions and they start to pour in their answers and then it just, they keep going and keep going. And, you know, lo and behold, you realise they’ve really been struggling with this. So I think, you know, having education not only among our…I mean, our patients need the education as well. Like we were just talking about sex hormones are not just about periods in pregnancy. They’re about the whole body. So I think for a lot of the women here, they’ll say, you know, I’m mid-30s, late 30s, and I think something is not right in my body, but they’re absolutely not connecting it back to hormones. So if they had a little bit of that, know how that would be really helpful because they would know that this has something to do with hormones changing. If we could get the nurses on board to sort of start understanding this as well. I didn’t learn this at nursing school, but you know, this is where I think this holistic approach, getting everybody in every specialty as well. Because like you said, patients are often here referred to the you know, if they’re having mood issues, it’s going to be the psychiatrist. Well, the psychiatrist doesn’t know much about hormones or if they’re going to the cardiologist for issues, the cardiologist doesn’t know and they’re sort of being sent from doctor to doctor. So it’s like we need to get everybody just on the same page knowing that this is something that happens to women. It’s not going to happen when they’re 50. It starts way earlier. And I think, you know, here in the United States, that’s another big, I think, myth. Women think about menopause happening at 50 or 51 or 52 and they’re not expecting any changes to start happening before then. They see it as just the end of a period and that’s it. And there’s this whole other set of there’s a journey to get there and there’s a set of like silent physiologic changes, bone loss, blood vessel changes, cognitive changes, all of these things that they’re just not made aware of. And that’s stuff that I think is so important that we continue to share with our communities and just get women in the know. [00:18:42][122.5]

Dr Louise Newson: [00:18:43] Yeah, it’s so important because, you know, I’ve mentioned before that I have quite a lot of young patients actually who are still in their teens and 20s. But the more I speak to women, there’s a lot of women in their 30s and 40s who are having symptoms, but they’re still having periods and they’re being told they absolutely can’t be related to their hormones. It’s very hard to know whether it’s related to hormones or not. Of course it is, but I’ll often say, well, if you feel as a woman, it’s related to your hormones and I’m happy to listen to you as a doctor, and I’m happy to give you some hormones to see if you feel any better, because we know they’re really safe. And if they don’t improve your symptoms, then stop taking them. It just seems to me really weird that we can prescribe the contraceptive pill very, very easily, very quickly. And actually the contraceptive pill has synthetic hormones in them. They have more risks and actually the risks are still very low. That’s why we prescribe them a lot. But certainly over here, I don’t know what it’s like contraception in the US, but we’re encouraged as GPs, to prescribe progestogen implants and progestogen we used to be a depo injection, but we can still give that and the mini pill as well, which is progesterone. Now, one of the ways this work is obviously stopping ovulation. If you stop ovulation, you’re blocking your hormones. And so I really worry that we’re actually giving a lot of women a chemical menopause and there are a lot of people who are teenagers and they feel really tired, they feel really demotivated, they feel really flat. And we have a big mental health crisis, don’t we? Especially post-COVID and teenagers. But I do wonder what their hormones are doing. And we know that the combined contraceptive pill increases sex hormone binding globulin, so it reduces freely available testosterone as well. So are a lot of these young girls testosterone deficient? I’m sure they are. But why aren’t we looking at them? I don’t know whether you ever think about it, but it’s something else I do think and worry about it, but. [00:20:48][124.5]

Jill Chmielewski: [00:20:48] I do, too. And I think even in the I mean, definitely in the young girls. And I think that just is such a sign of what we don’t know about our hormones, because if we knew what our hormones were doing, we probably wouldn’t be so willy nilly about just taking the pill again. There’s a right time. It doesn’t mean that it’s not appropriate at some times, but so many women are prescribed it with zero risk benefit conversation. They don’t really understand what it’s doing in their body. It’s really shutting down their own, you know, hormonal production and interrupting that. And some women are on it for years, decades sometimes. And to your point, their testosterone is low, they have no progesterone and they have no idea. And then we see this again in perimenopause, this sort of there’s going to be no conversation about HRT. They’re denied HRT, but they’re given the contraceptive pill. So we have a lot of work to do over here. I mean, it’s you know, if I had to, like, pick a word for it, I think it’s just frustration. Everyone is very frustrated. Patients are struggling and frustrated and just needing support more than ever. And this is the sort of sometimes the best they’re being offered is the pill, either for reproductive issues when they’re younger, or period issues. And now here it comes again in perimenopause when there’s a much, much, much better option. [00:21:56][68.1]

Dr Louise Newson: [00:21:57] Yeah, And I think there is this real…people are so scared when we mention the three letters HRT or MHT menopause, hormonal treatment. And, you know, I’d love to call it just hormone support treatments, actually HST, it would be so much nicer, you know, my 20 year old daughter, I hope she doesn’t mind me saying, a lot of people know she has really, really bad migraines so contraception is difficult for her, but she’s elected to have a Jaydess coil which is a like a mini Mirena so its a low dose of synthetic progestogen. But it’s very low. So it’s very good contraception, but it doesn’t really often interfere with her own hormones, but her own hormones trigger migraines as well. And so she uses HRT, so or HST hormone support, whatever. She just uses estrogen patches. So she has a constant amount of estrogen in her body. And she does use a bit of testosterone as well. And she feels great. Absolutely great. But when she mentions that to people, they get really freaked. And even my husband recently said, are you sure that this is okay? And I said, well, she’s seen a specialist. I don’t prescribe obviously, for her and it’s fine, but it’s actually lower dose than if she was on the contraceptive pill. There’s no risk of clots or stroke, which is really important because she’s got such a severe migraine sufferer and she feels better. So but there is this sort of, what are you doing giving her HRT? Well it’s just, you know, I’m just not replacing her hormones I’m just, she’s just having them supported so that she doesn’t have these fluctuations. And it’s the same in people with PMS, PMDD. A lot of people are given antidepressants or they’re given actually drugs such as Zoladex, which absolutely floors their hormones and gives them a chemical menopause, whereas I think actually just rebalancing their hormones and keeping them smooth and flat, at a level that’s right for them can be transformational, can’t it? [00:23:54][117.0]

Jill Chmielewski: [00:23:56] Absolutely. I think the same thing all the time. Oral contraceptives seem like nobody even blinks an eye. And when we say HRT, that’s to your point, I always say hormone optimisation or let’s optimise hormones because I feel like just the word HRT has this sort of I don’t know, there’s something about it and it must go back to again to like the WHI but if we think about hormone optimisation, that’s really all we’re looking to do is just optimise hormones. And I think to your point about if someone’s in their 30s, you know, if you’ve never had symptoms and all of a sudden in your mid 30s, late 30s, you’re not sleeping, you’re having anxiety, you’re starting to have those symptoms, it probably is hormones that are changing. We know that hormones peak in their 20s. So on the way to menopause we know they’re changing. So treating with hormones or optimising hormones at that point, HRT, optimisation, whatever we call it, we see what remains after that. When you give someone hormones just a little bit to support, make sure that they’re more balanced, oftentimes their symptoms are gone or just about eliminated and you can see what’s left behind. That’s the most, I think, logical first step versus going to an antidepressant or sending someone for, you know, additional testing, which oftentimes women are getting sent for expensive testing. Yes. Because of symptoms when we know it’s related to hormones. So start with the hormones. Optimise the hormones first. Then let’s see what else remains, right? [00:25:17][80.9]

Dr Louise Newson: [00:25:18] Well, let’s keeping it really simple and cheap as well. Absolutely. And I think there’s been a well, I know there’s been a big push back to some of my work talking about we’re medicalising the menopause, whereas I know it’s been medicalised already. Most people we see are taking antidepressants. They’ve been on painkillers, sometimes taking sleeping tablets. They’re on blood pressure lowering treatment. As I’ve already said, they’re on statins, so they’re on treatment already. But say this is treatment that isn’t reducing their risk of future disease. It’s often not improving all their symptoms. Otherwise they wouldn’t be coming to the clinic. And a lot of medicines have side effects, certainly the more senior a doctor I became the less I would prescribe. And, you know, I actually shudder to think about what I was like as a junior doctor because I would do these ward rounds. My job as a junior doctor would be to fill in the drug chart. I would just be told to fill out all these drugs and I would write them all up and then the patient would go home with this massive bag of drugs. No one would tell them what they meant because again, this was in the nineties. We didn’t really have any shared decision making. And so if someone had come in with a bit of chest pain, even if they didn’t have a heart attack, they were automatically given all these, you know, blood pressure, drugs, statins. Looking back, a lot of them were women who probably had pains because of their menopause. And so as I became older and wiser, I would end up reducing drugs rather than adding to them. But we’ve still got this culture, and I don’t know how much is driven by pharma, how much is driven by targets, how much is just driven by uncertainty. Because sometimes if you’re uncertain as a medical practitioner, you feel your patient’s going to be happier with the treatment. But actually often patients are delighted not to have treatment. They want to be listened and spoken to and they want to decide whether a treatment is right for them or not. And more often, people don’t want to take medication, do they? [00:27:15][117.0]

Jill Chmielewski: [00:27:15] No. And if we’re really talking about addressing the root cause of the issue, we go back to hormones. But when we go back to basic physiology, when these hormones change, we know that this is what happens behind the scenes. Even the women that say, well, I had no symptoms whatsoever in menopause. We know that behind the scenes her bones are changing, her blood vessels are changing. You know, there are cognitive changes. So, you know, we’re just really looking at trying to optimise the body, help the body stay healthy for as long as we can. And if we’re going to you know, we weren’t living this long. We’re now living to be 80 years of age. You know, I think in the year 1900, the average life expectancy I know in the United States was like 50 years of age. Well, it’s now extended. Women didn’t go through menopausal until 51. So women didn’t experience these symptoms or these physiologic problems. Right now, we’ve extended people’s lives artificially through all of these other means. We’re keeping people alive with medications and surgeries. So to your point about medicalising things, we are already medicalizing. So why not go back to the root cause of the issue, address the hormones, and let’s see what remains versus just throwing a bunch of pills at people. And yes, we talk you and I both talk about lifestyle. Yes, we want to support people and, you know, encouraging them to exercise and sleep and, you know, eating good foods. But when women are going through perimenopause and menopause and they’re trying to sleep and they want to exercise, but they feel like garbage. [00:28:42][86.7]

Dr Louise Newson: [00:28:43] It’s so hard. [00:28:43][0.0]

Jill Chmielewski: [00:28:44] Getting some HRT on board oftentimes is the one thing that will help them to finally go, okay, I’m sleeping again. Now I feel like I have enough energy to go exercise or make a good meal or, you know, just really pay attention to my life and take good care of myself. It’s hard when you’re feeling flat and tired and having, you know, lousy sleep consistently for a lot of women, which is, you know, weeks to years, as you know. [00:29:07][23.6]

Dr Louise Newson: [00:29:08] Yes. Yeah, absolutely. I mean, it’s so barbaric. It’s so horrendous what’s happening to women. We’ve got a long way to go, but it’s been great having your knowledge and your enthusiasm shared on the podcast. I’m grateful for your time, Jill, and we’re recording this on a Sunday night. So, well Sunday night for me, but it’s still a Sunday, so I’m very grateful for you giving up your time and I just hope that you’ll be able to come back to the podcast in maybe a couple of years time and tell me that things are improving. I think things are starting to improve because women are starting to understand and, you know, have a voice, which is really important. But I’d be really grateful before we end, just to ask for three tips. So three things that you think are making a difference to the work that you and that I’m doing over in the UK, three things that you think actually we should really carry on doing because they are helping. [00:30:07][59.2]

Jill Chmielewski: [00:30:08] Yeah. So I think I mean, the first thing is I think just for women, I have to say women getting educated. I think that and providers too, if we can get both providers and patients educated and on the same page, that’s why I do, I hope in two years we are having this conversation and saying things are really looking up because we have providers who are in the know and we have patients who are in the know, and we’re starting to see that we’re having more shared decision making. I think that’s probably the number one thing that we need to keep doing on both sides. I would say, you know, my second sort of tip is really towards for women is to shop for a provider early. I think women are really surprised by how early these changes are happening in their body. And just like we shop for our obstetrician or our pediatrician, I think it’s not too early in your 30s to start trying to figure out who that support menopausal support person is going to be for you. And if you’re educated, you’re going to know what questions to ask. So that you’ll find the right provider. But start early. You may find yourself having to, you know, speak to five, six, seven providers before you find one that really is in that space with you where they’re willing to do shared decision making. So in that one sort of is on the onus of the patient. But I think so important for women to just shop early because it will happen to you. It happens to every single woman. Everybody goes through perimenopause and menopause. So it will happen. So it’s one thing to prepare for. And I think the third thing I guess is and I guess it goes I’m going back to I think women more than the providers is really for women to be persistent, advocate for what you need. Don’t be afraid to advocate for what you need. If you feel that something is happening in your body, it probably is. Track your symptoms. I think we’ve been so trained, especially in the United States, to just sit on the sidelines and let our doctors, you know, make the decisions or go in for that annual appointment or whatever it is. And if a doctor says no, oh, well, I think we have to advocate for what we need, even if we’re using HRT. I always tell women it’s not a one and done. Your first dose is not going to be your last dose. So if you get that prescription, don’t feel bad about calling the doctor for follow up. Don’t feel bad about saying, hey, you know, my symptoms are improving, I think, but I think I need some more tweaking. That’s what this should be about. So I think for women to stand in their power and say, you know, be persistent in advocating for what you need. [00:32:23][135.3]

Dr Louise Newson: [00:32:24] Brilliant, love it. Patient power is really, really good. [00:32:28][4.0]

Jill Chmielewski: [00:32:28] Patient power, right? [00:32:29][0.7]

Dr Louise Newson: [00:32:29] Yeah, absolutely. So thank you ever so much for your very wise words and look forward to having you back soon. Thanks Jill. [00:32:36][7.0]

Jill Chmielewski: [00:32:36] Oh, my gosh. Thanks for having me. It’s so fun. I’m so glad we connected and I would love to come back. So thank you. [00:32:42][5.5]

Dr Louise Newson: [00:32:42] Brilliant. Thank you. You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk and you can download the free balance up on the App Store or Google Play. [00:32:42][0.0]

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