In my late 30s my periods, which had always been regular, started to become heavier and the premenstrual migraines I suffered from started to happen more than once a month. It got to a point where I felt I had more migraines than not and it affected my social life, my family life and my work life as all I wanted to do was take lots of painkillers and lay down in a dark room.

By the time I was 41, my periods were extremely heavy and the migraines off the scale. I also now had very low mood and seasonal affective disorder. On a flight home from a family holiday in Orlando, Florida, I had the most horrendous period and migraine – I could hardly move my head and I struggled to control the blood flow. Two days later my period stopped – and it never came back again.

I had scans, blood tests and pregnancy tests and the GP concluded I had had an early menopause, which took me by surprise. I already had two children, and didn’t plan on any more, but now the decision was taken away from me, I was a bit put out! 

RELATED: Am I too young to be menopausal?

Being a nurse, I knew enough to know that oestrogen is essential for healthy bones and the loss of it can lead to a decrease in bone density, so I asked my GP for HRT. He was reluctant and spoke to me about breast cancer risk but agreed to prescribe it for five years.

I took oral continuous HRT (Elleste Duet Conti) with no problems for the next five years. My migraines improved exponentially, my mood improved, and everything was great. However, true to his word, the GP stopped my HRT after five years and, now 46, I naively thought maybe he was right and it was safer to go without the hormones. 

Six months later, I was in a very bad way. My migraines were back, and I had mood swings and irritation with my husband and kids. I had very low libido to a point where I prayed my husband would leave me so I didn’t have to keep brushing him off. My joints ached, I experienced dizzy spells and to top it off, I was getting no sleep.

RELATED: Sex, hormones and the menopause

I was waking up umpteen times a night with nausea – it was like being on a rollercoaster or a boat, my stomach was up and down like a yo-yo!  But I didn’t recognise that it was menopause symptoms. I thought I had something wrong with my stomach and needed an endoscopy investigation. My GP gave me omeprazole and said it was reflux, oh, and would I like to try an antidepressant?

I didn’t have a clue about the reoccurrence of menopause symptoms so started reading up more.

One day I was doing some clinical research reading on dizziness, and I came across an article on vertigo in menopause and perimenopause. The relationship is not well researched but there seemed to be some evidence that pointed to oestrogen being one of the hormones that play a role in the development of vertigo. The vestibular system (inner ear) can be particularly sensitive to low oestrogen in perimenopause, and it affects blood flow and oxygen supply in the area, causing symptoms such as dizziness, brain fog or full on vertigo attacks such as nausea and vestibular migraine. I wondered if by going back on HRT, I could remedy this crippling problem and get some sleep?

RELATED: Dizziness and the menopause

I went back to the GP, but this time I saw a different doctor and explained my rationale for wanting to go back on HRT. I reassured them that I was aware of any potential risks if I restarted the hormones and it was agreed that I could go back on HRT.

Less than one month later, I was a new woman. I was sleeping through the night, I did not want to run away from home and I even started doing parkrun. I ditched the omeprazole and bought some trainers! I have never looked back.

This experience made me realise that perimenopause and menopause can affect women in so many different ways. I didn’t have a hot flush so that signpost wasn’t there. Looking back, I think I was having symptoms in my late 30s and I feel angry that I suffered unnecessarily for a long time.

However, I’ve vowed that through my work as an advanced nurse practitioner working in women’s health I will help other women navigate the choppy waters of perimenopause and menopause, and access support.

Keep pushing ladies – do your own research and remember that hormones are chemical messengers to all parts of your body and without them many different physical changes can occur.

RELATED: How to talk to your doctor about HRT and get results

Would you like to share your experience of perimenopause or menopause? Write to us at shareyourstory@balance-app.com

The post ‘I came off HRT and six months later was baffled by my new symptoms’ appeared first on Balance Menopause & Hormones.

• An adverse childhood and adult life can both affect your experience of menopause
• Women who need social support or with poor literacy are more likely to have their symptoms attributed to their circumstances  
• All women deserve equal access to information, advice and treatment

Most of us couldn’t have predicted how the perimenopause or menopause would affect us. You may have assumed your experience would be similar to your mum’s, or your friends, or not given it much thought at all. Yet while women are all individual, your background, childhood experiences, education, employment status and income can all have an impact on your menopause.

Women from disadvantaged social circumstances are more likely to experience poorer health. Dr Penny Ward, a GP and menopause specialist says: ‘We have known about the social determinants of health for some time. While this is well documented in chronic conditions such as diabetes and cardiovascular health, it is spoken about less in relation to the menopause. Given the menopause is one of the most important reproductive health events in a woman’s life, this is disappointing.’

Disadvantaged women are also more likely to reach menopause earlier, to suffer more symptoms or more severe symptoms, to undergo a hysterectomy, and have more barriers to treatment.

In order to best serve all women, we need to understand how our socio-economic background can affect the menopause and how to overcome the obstacles to ensure all women receive equal treatment.

RELATED: what is the menopause factsheet

Why might I have an earlier menopause?

The earlier you go through the menopause, the longer you will be without your hormones, which has an increased risk of osteoporosis and cardiovascular disease. Premature or early menopause is associated with adverse health outcomes and increased overall mortality [1].

There are numerous factors that can influence early menopause – one study of UK women found early natural menopause is associated with smoking, ever-use of oral contraception and sterilisation (amongst others), while surgical menopause was associated with manual social class and sterilization (amongst others) [2].

Interestingly, a study in the US found that amongst married heterosexual couples, women with lower education and income were more likely to undergo tubal sterilisation than those with higher income and education (while men with higher education and income were more likely to have a vasectomy than those less educated) [3].

Age of menopause has also been found to be affected by childhood. In a study of over 3,500 women from 23 British towns, certain indicators of adverse socio-economic position in childhood – the likes of coming from manual social classes, living in a house without a bathroom, sharing a bedroom, not having access to a car – were found to be associated with having menopause at a younger age [4]. One theory is that childhood malnutrition may lead to decreased ovulation and earlier menopause [5].

Adult indicators of adverse socio-economic position were similarly associated with earlier age at menopause. The study found that women who had 9 or 10 of these adverse indicators were on average 1.7 years younger at the age of onset of menopause than those who had none or only one indicator [6].

RELATED: menopause in overlooked communities

Why might I experience more symptoms?

Just as having a disadvantaged childhood can affect the age you undergo menopause, experiencing trauma in your childhood can affect your menopause symptoms decades later. Research has uncovered the potential long-term effects of psychosocial stressors, from childhood through to reproductive age, which include poorer wellbeing and worse menopause symptoms [7]. A history of physical abuse (reported by 37% of the women) correlated to worse menopausal, psychological, general health, and depressive symptoms. Nearly 8% of women reported a history of sexual abuse, which correlated with worse menopausal symptoms and general overall health. Those with a history of financial instability (10%) were found to have worse menopausal symptoms and general health, along with greater depressive symptoms.

Levels of education, employment status and income can also affect your menopause symptoms. Women with less education experience more severe symptoms while those with higher education are more aware of their menopausal symptoms and the strategies to deal with them, so are more likely to seek treatment [9]. Educated women are more likely to adopt a healthy lifestyle and have a higher quality of life, experience fewer sexual dysfunctions during the menopause and experience it later than uneducated women. Having a lower income is also associated with increased menopausal symptoms [10].

RELATED: menopause symptom sheet

Accessing treatment

Unsurprisingly, women from disadvantaged backgrounds are less well educated about the menopause, and are less likely to seek, and receive treatment. Dr Penny says: ‘Women who present as needing emotional and social support, or those who have poor literacy, are less likely to have hormonal changes discussed. Their presenting symptoms are more likely to be attributed to life events and circumstances or treated as depression. Some of these women will not have heard of the menopause – I spoke to one lady who thought the menopause was the single event of her periods stopping, she was unaware symptoms could start many years before this and continue many years after and had struggled alone for the best part of a decade.

Many women don’t have the resources to find the information themselves. There may be cultural barriers, lower levels of educational attainment or they may not be ‘of the age’ where medical professionals think menopause is likely. These reasons can lead to women not receiving the help they need, with many still not having access to the materials or information provided to them in a way in which they can understand.’

A 2018 study into GP’s HRT prescription rates in England found that it was 29% lower in practices in the most deprived areas compared to the most affluent [11]. Disproportionately more oral HRT was prescribed than transdermal in practices with higher levels of deprivation. The study’s authors remarked that this was interesting as cardiovascular risk (which is greater in areas of higher deprivation) is an indicator that might lead to a higher ratio of transdermal HRT prescriptions (which carries no increased risk of thromboembolism or stroke) compared with oral HRT preparations. It may also reflect patient choice.

One ray of hope for women from deprived backgrounds in England is that the HRT Prescription Prepayment Certificate (PPC), which was introduced last year, made HRT more affordable – at a cost of £19.30 per year (all NHS prescriptions are available free of charge in the rest of the UK). Since the PPC was introduced the number of HRT items prescribed on England increased 47% from 2021/2022, totalling 11 million items [12]. While there were more than double the number of patients prescribed HRT in the least deprived areas of England than the most deprived, we do not yet know if the PPC has lead to a proportional uptake in deprived areas.

RELATED: HRT prescription prepayment certificate: what you need to know

How can we improve things?

While it’s worth acknowledging that many of the studies on childhood factors that might impact menopausal age are retrospective, and could be limited by recall bias or a lack of in-depth analysis, we know that more help is clearly needed for women of disadvantaged backgrounds.

Recent conversations about the menopause have highlighted that many women are mistakenly prescribed anti-depressants for low mood, when they may in fact be experiencing symptoms of the perimenopause or menopause. Dr Penny Ward says: ‘I spoke to a lady who was prescribed anti-depressants for her low mood and anxiety. She had never experienced this before and thought it was bizarre that it would occur for the first time in her life at age 48. Due to previous visits to her doctor looking for respite care for her son with a life limiting condition she felt the scene had been set for the diagnosis of depression to fit. She received carer benefits and her postcode was in the poorer part of town. If she had been asked about other menopause symptoms she was experiencing, a connection might have been made but she just hadn’t the knowledge, time or resource to know this for herself.’

We know that we don’t need to be limited or defined by our life experiences, and that if women are given the knowledge and resources to help themselves, they embrace it.

The balance app is free – use it to track your symptoms and get expert advice on all things perimenopause and menopause.

Newson Health has a Confidence in the Menopause course, which is designed to increase awareness of the menopause. Click here for a free taster that will give you access to presentations on topics including an overview of the menopause and HRT, information ono testosterone and the importance of shared decision making with your healthcare professional.

Finally, the Dr Louise Newson podcast is another great way of getting free, expert-led information that can help inform and empower you – click here to see the archive.

RELATED: how to talk to your doctor about HRT and get results

References

1. Faubion S.S., Kuhle C. L., Shuster, L.T., Rocca W. A. (2015), ‘Long-term health consequences of premature or early menopause and considerations for management,’ Climacteric, 18(4) pp.483-491. doi: 10.3109/13697137.2015.1020484
2. Pokoradi A.J., Iversen L., Hannaford P.C. (2011), ‘Factors associated with age of onset and type of menopause in a cohort of UK women,’ American Journal of Obstetrics and Gynecology, 205(1) pp34.e1-34.e13. doi: 10.1016/j.ajog.2011.02.059
3. Anderson JE, Jamieson DJ, Warner L, Kissin DM, Nangia AK, Macaluso M. (2012), ‘Contraceptive sterilization among married adults: national data on who chooses vasectomy and tubal sterilization’, Contraception. 85(6), pp552-7. doi: 10.1016/j.contraception.2011.10.009
4. Lawlor D.A., Ebrahim S., Smith G.D. (2003), ‘The association of socio-economic position across the life course and age at menopause: the British Women’s Heart and Health Study,’ BJOG, 110(12) pp1078-1087. https://doi.org/10.1111/j.1471-0528.2003.02519.x
5. Gold E.B. (2011), ‘The timing of the age at which natural menopause occurs’, Obstet. Gynecol. Clin. North Am, 38(3) pp425-440. doi: 10.1016/j.ogc.2011.05.002
6. Lawlor D.A., Ebrahim S., Smith G.D. (2003), ‘The association of socio-economic position across the life course and age at menopause: the British Women’s Heart and Health Study,’ BJOG, 110(12) pp1078-1087. https://doi.org/10.1111/j.1471-0528.2003.02519.x
7. Faleschini S., Tiemeier H., Rifas-Shiman S.L., et al. (2022), ‘Longitudinal associations of psychosocial stressors with menopausal symptoms and well-being among women in midlife’, Menopause, 29(11) pp1247-1253. doi: 10.1097/GME.0000000000002056
8. Carson M.Y., Thurston R.C. (2019), ‘Childhood abuse and vasomotor symptoms among midlife women’, Menopause, 26(10) pp1093-1099. Doi: 10.1097/GME.0000000000001366
9. Namazi M, Sadeghi R, Behboodi Moghadam Z. (2019), ‘Social Determinants of Health in Menopause: An Integrative Review’, Int J Womens Health, 11 pp637-647.
   https://doi.org/10.2147/IJWH.S228594
10. Brzyski R.G., Medrano M.A., Hyatt-Santos J.M., Ross J.S. (2001), ‘Quality of life in low-income menopausal women attending primary care clinics,’ Fertility and Sterility, 76(1) pp44-50. https://doi.org/10.1016/S0015-0282(01)01852-0.
11. Hillman S., Shantikumar S., Ridha A., Todkill D., Dale J. (2020), ‘Socioeconomic status and HRT prescribing: a study of practice-level data in England’, British Journal of General Practice, 70(700), e772-e777: DOI: https://doi.org/10.3399/bjgp20X713045
12. NHS BSA HRT

The post How your background can affect your menopause appeared first on Balance Menopause & Hormones.

• Early symptoms of cervical cancer can be confused with other conditions, including the perimenopause
• Treatment for cervical cancer can trigger menopausal symptoms
• Women treated for cervical cancer are able to take HRT to ease symptoms

Cervical cancer is when abnormal cells in the lining of the cervix (the opening between the vagina and the uterus) grow in an uncontrolled way. Nearly all cervical cancers are caused by an infection from certain types of human papillomavirus (HPV).

Most people who are sexually active will become infected with HPV at some point of their lives but most HPV infections go away on their own within a year or two as the immune system controls the infection. However, when a high-risk HPV infection lasts for years, it can lead to changes in the cells, resulting in a precancerous lesion that can then develop into cervical cancer.

Other known risk factors for cervical cancer include smoking, early age at first sexual intercourse, multiple sexual partners, the presence of other sexually transmitted diseases and a compromised immune status [1]. Taking the contraceptive pill for more than five years is associated with a slight increased risk of cervical cancer, but the risk begins to drop as soon as you stop taking it [2].

According to Cancer Research, cervical cancer is more common in younger females and most cervical cancer cases diagnosed in the UK each year are in females aged 30 to 34 [3].

What are the symptoms of cervical cancer?

In its early stages, cervical cancer often has no symptoms. When symptoms are present, they usually include: vaginal bleeding that’s unusual for you, changes to vaginal discharge, pain during sex, pain in your lower back, between your pelvis or in your lower tummy.

These symptoms are very common and can have other causes – for example, if you have fibroids or endometriosis. And during the perimenopause your periods can change and become unpredictable. It’s important to get any of these symptoms checked out by a doctor to help determine the cause.

How can cervical cancer affect menopause?

If you have not had menopausal symptoms before your cancer treatment, you may find that the treatment – for example, radiotherapy, surgery to remove your ovaries and some chemotherapy drugs – brings on an early menopause.

Menopausal symptoms after treatment for cervical cancer can be more sudden and intense than if you went into a natural menopause. For example, surgery, such as a hysterectomy, will immediately trigger the menopause, while pelvic radiotherapy can damage your ovaries, which can trigger the menopause – usually about three months after cancer starts.

Ideally you should be supported by your healthcare team regarding the menopause before your cancer treatment starts, but sadly this doesn’t always happen. Ask to speak to a menopause specialist at the hospital where you are receiving treatment.

How can I treat my menopause after cervical cancer?

HRT is the first-line treatment for symptoms of the menopause. When people experience an early menopause, including through cancer treatment, it’s advised to take HRT to replace the hormones your ovaries would naturally be producing, until around the age of 51 (when the menopause would usually start). You can then review it, depending on your symptoms and risks.

If you’ve had a hysterectomy, you’ll be offered oestrogen-only HRT (women who still have a womb need combined HRT). A review of studies found there is no evidence of a harmful effect of HRT on cervical cancer oncological outcome, and several benefits – such as reduced metabolic risk and increased quality of life – were reported [4].

HRT is an effective way of helping menopause symptoms but if you’ve had radiotherapy, you may have side effects such as vaginal shortening and narrowing, and sensitivity of the lining of the vagina. Vaginal oestrogen can be effective in treating symptoms.

References

1. Shiraz A, Schiemer R, Staley H, Matsushita T, Hasegawa T, Bryant A, Inoue E, Egawa N, Gajjar KB. (2023), ‘Human papillomavirus (HPV) self‐sampling to encourage the uptake of cervical screening’, Cochrane Database of Systematic Reviews, Issue 11. DOI: 10.1002/14651858.CD014502.
2. Cancer Research: cervical cancer risks and causes
3. Cancer Research: cervical cancer risks and causes
4. Vargiu V, Amar ID, Rosati A, Dinoi G, Turco LC, Capozzi VA, Scambia G, Villa P. (2021), ‘Hormone replacement therapy and cervical cancer: a systematic review of the literature’, Climacteric. 24(2):120-127. doi: 10.1080/13697137.2020.1826426

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

Here, she shares her story – and her advice for other women in similar circumstances.

‘In my only appointment with the gynaecological surgeon before having my ovaries removed at the age of 41, I told her I was worried about the impact of going through an instant menopause.

‘She barely looked up as she replied: “You just don’t have periods anymore, it’s great.”

‘In one sense she was right, I don’t miss the inconvenience of my periods. But, as I suspected, I definitely do miss my hormones.

RELATED: Surgical menopause

Deciding to have surgery

‘I decided to have surgery to remove my ovaries and fallopian tubes after I found I was the carrier of the BRCA1 (breast cancer 1) gene.

‘This is a deeply unpleasant mutation which gives me an up to 90% chance of developing breast cancer and up to 60% chance of getting ovarian cancer.

‘I was tested for the gene after my younger sister was diagnosed with terminal breast cancer when five months pregnant.

‘Leah died at the age of 34 when her son was 18 months old. She never heard Seth call her mummy or take him to his first day at school. Listing all the things she has missed out on, and the ways we miss her, is impossible.

‘After finding out I had the same faulty copy of the gene I was keen to do anything to protect my health and hopefully avoid cancer.

‘I found the choice to have a double mastectomy, which would remove as much of my breast tissue as possible, very straightforward, and couldn’t wait for it to be done.

‘For this I had an incredible team of surgeons and specialist nurses, and – under national guidelines – I had to undergo a psychological assessment to check I had made the right decision.

‘There was excellent care before and after, and the breast reconstruction specialist nurses were always on the end of the phone if I ever needed help. I had this procedure done when I was 39 and felt mainly relief.

Preparing for an early surgical menopause 

‘When it came to my ovary removal, I was referred to the gynaecological surgery team at a different hospital.

‘My care was absolutely fine, but just much more perfunctory – with the surgery seen as routine and not a big deal.

‘Throughout there was a sense that all women go through the menopause, so why would I be concerned about going through it a decade early?

‘But for me the instant and early loss of the hormones produced by my ovaries was very worrying.

‘While I have two children, and didn’t plan to have anymore, knowing that my fertility would abruptly end on that day felt very strange, and hard to accept. I felt it changed my identity, pushing me into a new phase of life I didn’t really feel ready for.

‘I also worried about the physical and emotional impact of menopause which, thanks to my job as a health journalist, I knew a bit about.

‘When I asked my surgeon if I would feel the same after my ovary removal as I do now, she was honest. “Not everyone does,” she said.

How talking helped process my feelings

‘The day before the surgery I felt wretched. I was surprised how strongly against it I felt, despite knowing I was lucky to have options that I wish my sister could have had.

‘I called the phone line of the gynaecological charity the Eve Appeal where a wonderful specialist nurse listened to my fears, let me cry and told me what I felt was completely normal. She had spoken to women diagnosed with ovarian cancer who still found the idea of ovary removal difficult.

‘Hearing someone say that was so profoundly helpful. 

‘I always knew I would go through with the surgery; I want to be around to watch my children grow up and I knew it was the right choice for me.

‘But someone telling me the turmoil I felt was completely normal helped me enormously.

The day of my operation

‘On the day of the operation, when I was dropped off alone due to COVID-19 restrictions, the surgeon asked if there was anything I needed that she could help with.

‘I was last on the Friday surgical list, due to be discharged that night, and I asked if I could leave with some HRT.

‘While HRT may not be available for some women with a higher breast cancer risk, I had already had my mastectomy, and was told I could have it safely.

‘The guidance from the National Institute for Health and Care Excellence (NICE) recommends that women who have a BRCA mutation, have not had breast cancer and have had their ovaries removed, have HRT until the age of 51 or 52 – the average age for menopause in the UK.

‘My surgeon seemed surprised I was worried about accessing HRT promptly and said it was something I should go to the GP about. I said: “But what if menopausal symptoms kick in straight away this weekend?”

‘She listened to me and kindly came back before my operation with a pack of estrogen patches.

Starting HRT

‘I put my first patch on two days later as I felt pretty unwell and in pain after the surgery, and didn’t want to add menopausal symptoms into the mix.

RELATED: Endometriosis: I went through a medical menopause at 24

‘Looking back, I think my experience has been much better than I feared before surgery. I have had virtually no menopausal symptoms, I do all the things I did before and I have never regretted my choice to have my ovaries removed.

‘The main aspect I have found challenging is one I hadn’t really considered. I have had chronic eczema and very dry skin my whole life, and going through the menopause has definitely worsened the condition.

‘While I knew my skin was never going to age well, I can feel and see that it has aged quite dramatically since I had the surgery two years ago. 

RELATED: Will menopause make my eczema worse?

‘Ageing is a privilege that too many women in my unlucky family were not offered but, occasionally, guiltily, I wish my skin looked different. 

‘It is sore and fragile, and I wake in the night scratching, something that probably hasn’t happened since it was a child.

‘My bad skin also reacted to the estrogen patches, so I quite quickly moved over to taking estrogen oral tablets. I had a Mirena coil fitted during the surgery which provides me with the progesterone element of HRT for five years.

‘I have the option of seeing my surgeon every year or to check my HRT, and currently I’m on a relatively high dose of 3mg of estrogen a day.

Be informed and advocate for yourself: my advice to others

‘For someone else considering this surgery, I would say be informed and find out as much as you can before seeing your surgeon, as you probably won’t have many appointments with them. 

‘Also ask about HRT and if it could be suitable for you, as I think my journey would have been very different if I hadn’t been able to take it.

‘And if you find it a difficult decision, know that you are not alone. It is a very personal decision, I feel I took the right option for me and I have never regretted it.’

Would you like to share your experience of perimenopause or menopause? Write to us at shareyourstory@balance-app.com

The post My story: early surgical menopause appeared first on Balance Menopause & Hormones.

• The average age of menopause in the UK is 51
• While menopause can’t be predicted, certain factors can influence when menopause happens, including genes
• Tips on talking to your family members about their menopause

The average age for menopause onset in the UK is fifty-one.

But it is exactly that – an average.

Menopause before 45 is known as an early menopause, while menopause before the age of 40 is known as premature ovarian insufficiency (POI). POI is a lot more common than most people think: it affects about 1 in 100 women under the age of 40, and 1 in 1,000 women under 30 [1]. Even girls in their teens can be perimenopausal or menopausal.

And while there is no definitive answer for when the menopause will happen for you, sometimes your genes, including when your mum went through her menopause, can give a good indication of when it may happen for you.

RELATED: Am I too young to be menopausal?

This family link has been explored in research over the decades. In 1995, a study looked at the likelihood of an early menopause in women with and without a family history of early menopause – defined as younger than forty-six for the purposes of the study.

Overall, 37.5% of the early menopause cases reported a family history of menopause before age forty-six years in a mother, sister, aunt or grandmother. Risk for early menopause associated with family history was greatest for those who had a sister who’d had an earlier menopause [2].

And it’s worth remembering that there are other factors that can influence when you go through menopause, including certain types of surgery, radiotherapy to the pelvic area and some types of chemotherapy drugs used to treat cancer.

In addition, women who have autoimmune diseases (where the body attacks its own cells) are more likely to have POI – for example, Addison’s disease, thyroid disease, diabetes and coeliac disease are all autoimmune diseases. Genetic conditions such as fragile X syndrome and Turner syndrome may also lead to POI, but this is very rare and, if it does occur, it is more likely in much younger women.

RELATED: Premature ovarian insufficiency (POI)

What’s the bottom line?

While there is no definitive way to predict when you go through the menopause, genes may play a part, so it worth asking female family members about their menopause.

You could ask questions such as:

• when did they become menopausal?
• what sort of symptoms did they experience?
• can they remember when other female family members became menopausal, such as their own mother, grandmother, sister or aunt?

References

1. The Daisy Network, ‘What is POI?’

2. Cramer, D. W., Xu, H., Harlow, B. L. (1995), ‘Family history as a predictor of early menopause’, Fertility and Sterility, 64(4), pp. 740–5, doi:10.1016/s0015-0282(16)57849-2

The post Will I have an early menopause like my mum? appeared first on Balance Menopause & Hormones.

It’s a common misconception that the menopause only happens to women in their 40s, 50s or beyond.

Let’s take a look behind the science behind this claim to get to the facts.

Can you be ‘too young’ to be menopausal? What does the evidence say?

In short, no.

The menopause is when your ovaries stop producing eggs and levels of hormones estrogen, progesterone and testosterone fall.

The average age of the menopause – that is, when you haven’t had a period in 12 months – is 51.

But 51 is exactly that, an average.

Menopause before 45 is known as an early menopause, while menopause before the age of 40 is known as premature ovarian insufficiency (POI).

POI is a lot more common than most people think: it affects about 1 in 100 women under the age of 40, and 1 in 1,000 women under 30 [1]. Even girls in their teens can be perimenopausal or menopausal.

RELATED: podcast: the challenges of accessing menopause treatment as a young woman

Why can menopause happen at an earlier age?

For most women with POI, the underlying cause is ‘idiopathic’, or unknown, but causes can include:

• having your ovaries removed during an operation (in which case the term premature surgical menopause is technically more accurate as there can be no return of ovarian function)
• radiotherapy to your pelvic area as a treatment for cancer, or if you have received certain types of chemotherapy drugs that treat cancer
• if you have had your womb (uterus) removed in an operation called a hysterectomy, even if your ovaries are not removed [2]
• an autoimmune disease, for example, type 1 diabetes, thyroid conditions or Addison’s disease
• genetic conditions, the most common of which is Turner syndrome, in which one of the female sex chromosomes (the X chromosome) is missing.

What’s the bottom line?

The menopause can happen at an early age.

If you notice any changes to your periods, or other symptoms you may think are related to the perimenopause or menopause, make an appointment to see a healthcare professional (you can use the balance app to track any symptoms). Your pathway to a diagnosis may differ from older women, and involve blood tests and other investigations to rule out other causes. You can find out more in this booklet Menopause and Me: a Guide for Younger Women.

References

1. The Daisy Network, ‘What is POI?’, www.daisynetwork.org/about-poi/what-is-poi
2. Moorman P.G., Myers E.R., Schildkraut J.M., Iversen E.S., Wang F., Warren N. (2011), ‘Effect of hysterectomy with ovarian preservation on ovarian function’, Obstetrics and Gynecology, 118 (6) pp.1271-79. doi: 10.1097/AOG.0b013e318236fd12

The post Am I too young to be menopausal? appeared first on Balance Menopause & Hormones.

In this episode, Georgina talks about her challenges of accessing menopause treatment as a young woman. Georgina explains her struggle to get a diagnosis for her erratic periods since she was 15. In her early 20s, her concerns around fertility were brushed off and she acknowledges she didn’t have the strength and resolve to pursue the issue. Georgina then began to experience low mood, muscle fatigue, joint pains, hot flushes and night sweats. When her mental health dipped further, this became the tipping point and with the help of a supportive mother, Georgina pushed for a formal diagnosis and treatment for her debilitating symptoms.

Dr Louise Newson explains the impact of premature ovarian insufficiency and the risk a lack of hormones presents to your future health. Georgina shares the struggle she went through to access the right type and dose of HRT and reminds others to advocate for yourself to get the right help.

Georgina’s three tips to young women:

1. Talk openly with other women about periods, sex and vaginal dryness to understand what is and isn’t common
2. Do your own research about your symptoms and the menopause to get enough knowledge to advocate for yourself
3. Be patient with your HRT and give it time to work

Read our article on premature ovarian insufficiency (POI)

Episode Transcript:

Dr Louise Newson [00:00:09] Hello. I’m Dr Louise Newson and welcome to my podcast. I’m a GP and menopause specialist and I run the Newson Health Menopause and Wellbeing Centre here in Stratford upon Avon. I’m also the founder of The Menopause Charity and the Menopause Support app called balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence based information and advice about both the perimenopause and the menopause.

Dr Louise Newson [00:00:46] So today on my podcast, I’d like to introduce to you Georgina, who I’ve known for a few years now, who is a very inspirational person who has grown with a lot of this because she’s had to be quite feisty and be a real advocate for herself in her treatment, but she hasn’t given up, and I’m really pleased that she’s a lot better than she was, but she’s very kindly agreed to talk a bit about her experience. So Georgina thanks for coming today.

Georgina [00:01:10] Thank you for having me.

Dr Louise Newson [00:01:11] So do you mind me asking how old you are?

Georgina [00:01:14] I am now 25.

Dr Louise Newson [00:01:15] So you’re now 25 and you’re talking on a menopause podcast. So that means you must be – no it doesn’t mean you must be – but it’s highly likely that you’re menopausal? Is that right?

Georgina [00:01:25] It is.

Dr Louise Newson [00:01:25] So 25 year old menopausal. So I was just googling in case things had changed over the last few years when I Google menopause and go to images and it still comes up as the grey haired woman with a fan. Now you do not look like a grey haired woman and you haven’t got grey hair and you certainly haven’t got a fan. And so it can be really difficult for women, for men, for healthcare professionals, for media, for anybody actually to think that the menopause affects people who are not over the age of 50. And there are a lot of people like you around aren’t there?

Georgina [00:01:59] There are, unfortunately.

Dr Louise Newson [00:02:01] Yeah. So tell me, how old were you when you were diagnosed as being menopausal?

Georgina [00:02:05] So when I was diagnosed, I was 21. However, I’d been seeking a diagnosis from about 15 or 16 years old.

Dr Louise Newson [00:02:13] So did your periods start sort of naturally or what happened?

Georgina [00:02:16] So they started when I was about 14, but they were never regular or consistent, so I’d have maybe a period and then maybe three or six months and then another one. And then I had a horrendous run where I bled for about 12 weeks, and that’s when I actually went to the doctors to try and find out what’s going on.

Dr Louise Newson [00:02:35] And what happened then?

Georgina [00:02:36] I got referred to see a specialist because they saw that my estrogen and my testosterone were all fairly low. And I went over to Salford Royal to see a consultant endocrinologist who unfortunately wasn’t the best.

Dr Louise Newson [00:02:51] So how old were you then when you went to the consultant?

Georgina [00:02:53] I think with the delays in having all the blood tests and everything done, by the time I actually got to see him, I think I was about 18 at that point.

Dr Louise Newson [00:03:02] Right.

Georgina [00:03:02] But he made quite a big deal about me being in a same sex relationship and not to worry, because the only effect of having a menopause so early is fertility and I don’t need to worry about that because they’ll always be two wombs in my relationship.

Dr Louise Newson [00:03:15] Gosh.

Georgina [00:03:15] So I didn’t do anything further than that after that situation until I saw another menopause specialist when I was a bit older, about 20, 21.

Dr Louise Newson [00:03:24] So you had a few years then of not having any help.

Georgina [00:03:27] Yeah, I felt quite embarrassed and I didn’t feel at that point I had the strength to carry on pushing when I was struggling kind of physically and mentally. At the same time, I didn’t feel like I had that internal strength to fight for myself.

Dr Louise Newson [00:03:41] And were you getting symptoms at that time?

Georgina [00:03:42] Yeah, I had a really, really low mood, horrendous fatigue and muscle pains and joint pains and hot flushes and night sweats were the worst for me. But I think until it got to a point where I felt so low in my mental health that I felt like I needed to seek help. That kind of spurred me to do it, but it had to get bad enough, if that makes sense.

Dr Louise Newson [00:04:07] Yeah, it does make sense, but it’s very sad that you had to do that. So when you went to see the consultant who focused on your fertility and outrageously said that it didn’t matter if you couldn’t get pregnant because your partner could get pregnant, did you have… explained any symptoms then at the time.

Georgina [00:04:25] He didn’t really want to hear. I don’t think he was very interested to be fair. I don’t think people understand the impact that it has on your life, especially when you’re so young and you know you’ve got to have it forever, really.

Dr Louise Newson [00:04:37] And at the time, did you know anything more about POI or premature ovarian insufficiency or menopause? Did you know anything about the sort of health risks or was it just the symptoms that you were really seeking help for?

Georgina [00:04:49] I am quite lucky to have a mum who is a healthcare professional who’s quite, she’s feisty herself and she’s very intelligent and knowledgeable. So she was constantly behind me pushing me because she obviously knew of the adverse health effects of being deficient in your hormones for so long.

Dr Louise Newson [00:05:06] So a lot of thanks to your mother, actually, because just for everyone to know, we call it premature ovarian insufficiency, which actually affects one in 100 women under the age of 40. One in a thousand under the age of 30. So more common than actually a lot of other diseases and conditions. But we do know that a lot of women have the same menopausal or perimenopausal symptoms that we get when we’re older. Quite a few women actually have less symptoms. I don’t know why, but also every single woman who has low hormones has an increased risk of disease like – you know Georgina – but the risk of diseases such as heart disease, osteoporosis, diabetes, dementia, clinical depression, even some studies have shown things like lung diseases, actually, because we’ve got estrogen receptors in our lungs. Psychosis, even drug addiction, kidney disease. Sorry this is quite doom and gloom. But you do, though, because hormones are very important, very anti0inflammatory in our body. The good news, however, is that if women have their hormones replaced, the risk of those diseases really does reduce because you’re just replacing what’s missing. So although it is bad news, there is a good news side of it. As long as women can access the help and get the right hormone replacement, because that can really make a big difference. And the problem is also is when you’ve had a diagnosis like that, of course it’s going to play on your mental state. And I see and speak to a lot of women who are told, ‘well, of course you are going to feel like that because you’ve just been told, you know, you can’t have children’ or whatever. But actually, even without that news, you haven’t got the hormones in your brain working in the same way. So your brain is not going to function. And you felt firsthand how the lack of hormones to your brain was.

Georgina [00:06:49] Yeah, I think that was quite apparent in work because I was struggling to retain information and to do things that you do frequently. Things that you’re so used to doing you could do with your eyes closed. All of a sudden I was like, ‘Oh’, like I can’t remember how to do it.

Dr Louise Newson [00:07:05] And it’s very scary. I remember actually you telling me – I can’t remember it was a while ago now – that once you were, a few times you were in your car and you couldn’t actually remember to open the door. I don’t know if you remember you telling me.

Georgina [00:07:17] Oh… [stumbles] oh, I can’t get the words out, sorry. That’s another thing that I struggle with, and still do on HRT, I lose like it’s like the word’s getting lost between my brain and my mouth.

Dr Louise Newson [00:07:31] And that is actually very common. And we see and speak to a lot of women who worry that they’ve got dementia. And obviously we know dementia does increase in the menopause. It’s far more common in women. And there are lots of women who find this word-finding really hard. And someone said to me, it’s like ‘monkey chatter’. I have my mouth and all these words come out, but it’s not what I want to say.

Georgina [00:07:52] So relatable.

Dr Louise Newson [00:07:53] Yeah, but that’s because we know hormones are so important and you know, it makes sense really. If we haven’t got the hormones, how can you… will the same processes occur in the body? And the problem is when it’s older women in the, when we’re in our fifties, people would go, oh, you know, ‘that’s because you’re a bit older, you’re slowing down’. But actually, when you’re in your teens and twenties, you’ve got your whole life ahead of you. You can’t be not remembering how to find the handle of the inside of a car door so you can open the door, you know, or how to do simple tasks, because then it will make work difficult, but also it will make life very difficult.

Georgina [00:08:29] Yeah, I think, so I was in, not a new relationship, I’ve been with my partner for a couple of years when the diagnosis came, but it still has such an impact because I felt crazy and she probably thought I was too, because I didn’t feel like I could regulate myself, my emotions properly and you know, remember things. And it’s hard enough when you’ve been with somebody for years and years and years and you’re in your fifties and they’ve known you for all that time and can see the changes. But when you’re young, I felt like it was even more of an impact on our relationship.

Dr Louise Newson [00:09:03] Yes. And it often really does. And your partner’s been incredibly supportive, but there are lots of partners that aren’t. And we’ve just done a survey actually with a family lawyer that I know looking at divorce and unsurprisingly, divorce rates increase in the forties. And there are a lot of people who are not understanding that it’s related to their hormones. And I mean, I know even the short time I was perimenopausal, my husband just annoyed me in everything that he did and at the time, my children still remember, I just would shout at him for no reason. But it’s like I had this demon in my head telling me that it was quite alright to be cross and I think it is a common nature, isn’t it, that you take things out on your nearest and dearest because you can sort of get away with it, but actually you forget what it must be like for them.

Georgina [00:09:50] Yeah.

Dr Louise Newson [00:09:50] It’s really difficult because they’re seeing someone that they love and have chosen to be with, but that person’s changed in front of them. And you know, a lot of partners then think, ‘Oh, well is it me?’ And maybe I’ve changed rather than this person’s changed. And it can be really difficult. And certainly we see a lot of women who are in same sex relationships who are both menopausal together.

Georgina [00:10:13] That must be really difficult.

Dr Louise Newson [00:10:16] Yes. Because neither of them can quite work out what’s happening. And it usually takes one of them to come and seek help. And then, you know.

Georgina [00:10:24] I think even when you know what’s wrong, it’s still hard to regulate that when you have that kind of rage burning in your chest that’s completely irrational, monitoring that can be quite hard, even though you know what’s going on, it’s kind of hard to rein it in sometimes.

Dr Louise Newson [00:10:38] Absolutely and I think the thing with people who are young, then they’re just not understood. And I’m doing some research with an amazing researcher actually who’s in Australia looking at the gender bias and the gender inequality for research, but also for women and the mislabelling of women as well. Because we’re not often listened to and then women are given labels such as depression or there’s now a term called ‘MUS’, which is Medically Unexplained Symptoms. And a lot of women we see have been diagnosed with that because no one can put them into a box, you know, not definitely clinically depressed. You know, you’re having maybe some muscle pains, but you haven’t got arthritis, you’re having some urinary symptoms, but you don’t have a urinary tract infection, you know, having headaches, but you haven’t got a brain tumour, you’re having palpitations but you haven’t got heart disease. So then you either the choices, no one listens to you because they say, well, you haven’t got anything wrong with you because it doesn’t fit into their categories. Or you just go, well, no one’s listening. So you then you’re labelled with something that you’re probably not. And we know from some studies it takes an average of seven years for people with POI to be diagnosed and at least 7 to 10 consultations. And that research came out a few years ago now, but I don’t actually know that it’s got any better.

Georgina [00:11:57] No and it’s just demoralising for those people that have to spend all that time knowing that something’s wrong and nobody actively listening to them.

Dr Louise Newson [00:12:08] Absolutely. I mean, we’ve got the women’s health strategy that the government worked on and they’ve had over 100,000 responses to it. And normally when the government put something out, you have a handful or a few hundred responses, maybe a thousand…. huge. So people are listening. But women’s health in general, not just menopause, is really very neglected and there’s a huge amount of work to do. But a lot of, I think, it is common sense medicine and listening medicine as well. You know, I’m not doing a new type of brain surgery that you have to be really technical for, I’m just allowing women to have their own hormones back and looking holistically at how we can improve their future health. So when you did get help, I know you had to pay private initially, didn’t you, to get help and that doesn’t come cheaply. So it was a big financial sacrifice, wasn’t it, for you?

Georgina [00:12:56] Yeah, it was at the time for the interim, because we didn’t know how long we’d have to pay. Well, I’d have to pay for the medication. We did downsize to make sure we had that money available.

Dr Louise Newson [00:13:08] So you sold your house?

Georgina [00:13:09] Yeah. It just, it made it the easiest way to deal with otherwise there would have been as well as the stress of not feeling really brilliant, there’s all the extra money that would needed to be found for treatment. And rather than have more things to worry about, we thought that the alternative would be better to downsize until we knew that I’d definitely be eligible for treatment on the NHS.

Dr Louise Newson [00:13:30] So that makes me, I just want to cry, that makes me really sad because you know, I’m here founding and running a private clinic and you know, prices are expensive, but overheads are huge and we give a lot of money out, as people know, to balance app to fund that we don’t have external funding for it, for our free education programme, but no one should be paying. You know, my biggest marker of success would be to close my clinic because it means that people would get help elsewhere. But actually all we’re doing is expanding and expanding because more and more women need help they’re not getting elsewhere. And we’re doing a lot of work behind the scenes to work out how we can reduce costs and make it easier and allowing women to have more choice. But for somebody as young as you to have to sell your house so you could get HRT, which is available through the NHS at a very low cost, a lot of estrogen preparations cost £4 a month, progesterone £4 a month, testosterone can be a bit more expensive, but 50p to a pound a day. So we’re not talking about you know, we always see don’t we people who have want to fund a very expensive cancer treatment, maybe to go abroad and it’s hundreds of thousands of pounds. And I can understand then when people have to really crowdfund and sell everything. But actually you’re talking about some basic hormones, like I can’t imagine if you had an underactive thyroid gland, you’d have to do that.

Georgina [00:14:50] Or diabetes.

Dr Louise Newson [00:14:51] Yeah. So I think the system is failing. So you got your HRT and started to feel better, but quite rightly so the people that you saw, like we do in the clinic, we hope the NHS would take over your care. So you went to go see a gynaecologist in the hospital hoping that you would get help and it didn’t really happen did it?

Georgina [00:15:13] Yeah. So I did go to see a gynaecologist on the NHS as per the advice of the private clinic that I was seeing. And when I went to this appointment it was quite an old man and he said that I was on far too high a dose and that I shouldn’t be on testosterone. For the main reason being it’s too messy, he doesn’t like it. He doesn’t think I should be on transdermal HRT because again, that’s messy I should just swallow a tablet. And he said there’s no such thing as a body match in HRT. There’s no HRT that’s better for you, he said all HRT, synthetic, it doesn’t matter. But yeah, I needed to completely reduce the dose down to barely anything. And that the private clinic was taken advantage of me, apparently.

Dr Louise Newson [00:16:02] Which is a horrible thing actually, to hear, isn’t it? When all you want to do is get help. And I think, you know, it’s very hard, obviously, for healthcare professionals to know everything about every condition and treatments change, you know? I mean, I’m quite old and when I started prescribing HRT, it was very different to the HRT I prescribe now. And the HRT is, you know, from 20 years ago, the WHI study, very different. It was horses’ urine, it came from pregnant horses urine and it was a tablet. You know we fast forward and it’s the same as the hormones that ovaries normally produce and it’s through the skin. So there’s no risk of clot. So it’s comparing apples with pears anyway, but it is… people seem to get very scared about the dosing that people have of estrogen. And I know when you couldn’t get it, then actually that’s when you got in touch with me. And because of the work I do with NHS England, I actually presented you as a case, with your permission, to NHS England to say this lady who is – I can’t remember how old you were then, maybe 24 – is unable to get HRT, which she needs to be on until at least the average age of her menopause, which is 51, but probably lifelong. So for the next 25 years, it is not reasonable for her to buy HRT privately when she’s already had to sell her house to get HRT. And also she’s got a whole career ahead of her. She wants to carry on working and at the minute she can’t work without HRT. So what are you going to do about it? And it went up to Ruth May who’s the chief medical officer. It went to where you live, for prescribing. And I had some quite heated discussions actually with the lead of the CCG because their prescribing guidance was quite out of date and it was suggesting the older types of HRT should be given first. And actually the type that they were recommending is more expensive than what you were on as well. And also about the dosing as well, because they were saying you shouldn’t have above licensed dose. But we do know that actually a lot of young women need higher doses just to function, which is absolutely fine. It’s safe because all we’re doing is giving you back what you should be producing. And often we do estrogen levels and people tend to need a higher dose and that’s fine. As long as you’re not having any bleeding or any problems, then it’s perfectly fine to do that. So it has been a real battle. And then you went to see a different specialist, an endocrinologist, and things thankfully have got easier, haven’t they?

Georgina [00:18:30] Yeah, thankfully. Thankfully it’s not a battle much more.

Dr Louise Newson [00:18:34] But it shouldn’t be a battle, should it?

Georgina [00:18:36] No, it really shouldn’t be a battle. And I think the hardest thing is as a female, being told that you’re not eligible or you’re not licensed to have these hormones that you desperately need. And you have people, or healthcare professionals, doctors telling you that you don’t need them because it might have an adverse effect on your health long term. And I think as a woman, that should be my choice. It’s my choice to make whether I want those hormones because of the effects that it’s having on me now, not having them, and whether I think that that risk, you know, whatever that may be, whether that is a high enough risk to negate the need for it or whether it’s something I still want, it shouldn’t be for somebody else to make.

Dr Louise Newson [00:19:18] And I think that’s crucially important in everything that we do. And I was lecturing yesterday at the Royal Pharmacology Society meeting in Liverpool and a lot of it was about patient choice. And the other thing is we’re trying to do some work about what are the risks of not taking HRT. So actually for you as a young woman, you don’t really have any risks of taking HRT because you’re just replacing what’s missing. So we know there’s no increased risk of breast cancer. There’s no risk of clot or stroke because you’re having it through the skin. So actually the risks of not having adequate HRT, are as we’ve already said, risk of all these diseases, but also the risk that you’ll lose your partner, risk that you’ll lose your job, risk that your poor mother is going to… you’ll be dependent on your mother probably to look after, you know, there’s all these other risks, but then does boil down to choice. And, you know, we’ve got shared decision-making guidance from NICE, we’ve got the GMC consent. So we are allowed to, as patients, make choices that are individualised to us. And that’s where I feel it’s let you down really, the system, because you weren’t allowed to make a choice.

Georgina [00:20:26] No and I think when something has such an impact on your life, I felt like I couldn’t function without those hormones as a person. I was, I felt so low. I just my brain wasn’t working. And I think any risk I would have taken to be able to live again.

Dr Louise Newson [00:20:41] Yeah. And so this is where education comes in, isn’t it? I think it’s… now I do a lot of work, obviously, with women, but also with educating healthcare professionals. And a lot of people I talk to, healthcare professionals, don’t even realise that, you know, the HRT we prescribe is very different, is very safe, and also that it’s very cheap, I think because we prescribe it in the private clinic they always think it’s going to be expensive stuff, but this isn’t anything different to what we prescribe in the NHS and it’s allowing people to know that it’s really important and other healthcare professionals, because it’s really important I feel as a healthcare professional that I’m giving people choices that allow them to improve their future health as well, because we don’t want to be a drain on the NHS, you know, you don’t want to have osteoporosis when you’re older or heart disease, you don’t want to be a drain on your partner because you’ve got dementia. You know, we want to be the best version of ourselves. And if that means having our own hormones back at age 20, isn’t that okay? Why is that not allowed?

Georgina [00:21:45] I know. I just I don’t see why there is an issue surrounding it. You’d think it would just be a given.

Dr Louise Newson [00:21:51] Yeah, I think someone said to me recently, it’s quite a famous person I won’t say who it was said to me ‘Louise in ten years time, we’ll all be laughing about this because it’s so obvious what you’re trying to do, but the blocks that you’re getting are just phenomenal. Why is this?’ And, you know, I wish there was an easy answer because women know what they want, a lot of healthcare professionals are learning what’s needed. But there is still a block by the establishment and by others. And then I feel like it’s just been pushed back on women. And, you know, you could have, as a late teen, just left that clinic when you first got seen and I dread to think what your life would have ended up like. It’s quite scary isn’t it?

Georgina [00:22:31] Yeah. I think people are so scared of the unknown and scared to start to prescribe all these hormones. They worry that it will have the wrong impact and don’t give it the opportunity to work. I think as well, you have that settling in period, don’t you? And so many people throw in the towel because it can aggravate your symptoms first rather than just persevering because it does take time to settle.

Dr Louise Newson [00:22:57] Yeah, and that’s really good advice actually, for whatever age, we often see people who say that they got worse before they got better. And I always said, ‘Well, why didn’t you tell us?’ And they say, ‘No no because you always said, give it 3 to 6 months’. And it really can take that time. And often with time going forwards, people need different doses as well. And I know when I started my HRT after about three weeks, my mother in law, who’s been taking HRT for 50 years, came round and she said, ‘Oh, you feeling better Louise?’ I said, I remember I was chopping up some vegetables for supper and everything was an effort, just cutting onion was ‘urgh’. And when she asked me I just said, ‘Do you know what Kay? No I’m not’. And I thought this is just a waste. So… and it wasn’t until I got the right dose and then added in testosterone and then waited. And it must have been about nine months to a year that I just thought, wow, I wish I had started this ten years ago when my youngest child was born, because I’m sure my hormones just fell off a cliff then. But I didn’t know, I didn’t realise, I thought I’d just been tired because I’ve got three children and I’m busy and then my work’s escalated. So it’s not often until you – because it can be a very gradual increase as well. And then, you know, there’s still life that is going to make you feel down and frustrated. And, you know, if I don’t do yoga at least two times a week, I know my mood will go. So I can’t blame my hormones for that. That’s just because I’m not exercising or if I eat the wrong food or if I don’t sleep properly. But that’s why it’s really important we get this joined up care. But even if I did yoga seven days a week and ate the best diet and slept well without my hormones, I still wouldn’t feel well and I’d have these health risks. So it’s really important, isn’t it, that as women who are patients that we can work out for ourselves but then get the help that we want when we see somebody.

Georgina [00:24:47] Yeah, it is important and I think as well because it’s so hard to recognise by the time you realise what’s happening you’re so far down the line already, it can be hard to take that step and ask for help.

Dr Louise Newson [00:25:01] I totally agree and I think that’s a really good point. And I think, you know, you having your partner but also your mother and often we need to look to others to help us. And I think that’s where a lot of the work we’re doing with education, with the balance app, with the website, with these podcasts, is allowing anyone to sort of join that conversation and account for others actually because that’s really important. So I’m very grateful to Georgina for you giving up your time and talking so openly, actually. And I, it’s always difficult talking about yourself, but especially when you’re so young as well. So I know this will have really helped other people, but there might be people who are listening, whose daughters or friends or relatives or work colleagues might be young and not being able to receive help. So just before we finish for three, take home tips, if I may, what three things would you say you think others should do that have helped you to get on the right course for getting better treatment?

Georgina [00:25:58] I think one thing would be to talk openly, especially with like older females that they’re close to, maybe their mums, their nanas or other people like that. Because I remember sitting in a doctor’s appointment and it was it is a quite simple question. I think the doctor asked me, ‘well, do you have any vaginal dryness?’, you know, ‘when you’re having sex, is it lubricated enough?’ And I remember thinking, I’ve got no idea what should it be like? I’ve had hormone issues before I was sexually active. I don’t know. So I think being able to talk openly is one thing that is really important. And to know even then what periods should be like, how regular they should be, because not everybody does get the opportunity to know that really. I think secondly, you have to really research. I think you have to have the knowledge there to be able to champion for yourself because if you can’t advocate for yourself, you’re unlikely for other people to do that. And thirdly, definitely be patient with your HRT to find the right one.

Dr Louise Newson [00:27:04] Yeah, that’s really great advice and I know that will help so many people say thank you again Georgina and just keep going because you’ve got such a great future ahead of you. So thanks so much for today.

Georgina [00:27:14] Thank you so much for helping to raise awareness.

Dr Louise Newson [00:27:17] Thanks Georgina take care.

Georgina [00:27:19] You too.

Dr Louise Newson [00:27:22] For more information about the perimenopause and menopause, please visit my website balance-menopause.com. Or you can download the free balance app which is available to download from the App Store or from Google Play.

END.

The post The challenges of accessing menopause treatment as a young woman appeared first on Balance Menopause & Hormones.

Susie Crowe is a consultant obstetrician and gynaecologist who is passionate about advocating for and empowering women to understand their bodies and supporting them to make choices about their medical care and their lifestyle.

In the midst of the pandemic, Susie noticed fatigue creeping in and put it down to burnout from her busy job. When she began having night sweats and saw her doctor, the menopause was the initial diagnosis suspected but there were no other symptoms of perimenopause occurring. Susie became more unwell and after months of having normal blood tests, further investigations revealed that she had non-Hodgkin lymphoma – a type of blood cancer. In this episode, the experts discuss women’s experiences of sudden onset menopause after treatments for cancer and the benefits and safety of HRT.

Susie’s advice to healthcare professionals:

1. Listen to your patients as they know their bodies best
2. Have empathy for a women’s menopausal symptoms (as they may be worse than those from the cancer or side effects from treatments) and she may feel very vulnerable
3. Prioritise personalisation and choice by providing the right information and encouraging your patient to make their own decision based on what’s important to them and their life.

Follow Susie on social media on Twitter and Instagram

Episode Transcript:

Dr Louise Newson [00:00:09] Hello. I’m Dr Louise Newson and welcome to my podcast. I’m a GP and menopause specialist and I run the Newson Health Menopause and Wellbeing Centre here in Stratford upon Avon. I’m also the founder of The Menopause Charity and the menopause support app balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence-based information and advice about both the perimenopause and the menopause.

Dr Louise Newson [00:00:46] Today on the podcast, I’ve got a patient and a healthcare professional. So it’s really, really interesting because I’m going to listen to two perspectives, actually. So I’ve got with me Susie, who has recently reached out to me and has a very interesting story that we will go through. So thanks Susie, for joining me today.

Dr Susie Crowe [00:01:02] Thank you so much it’s really nice to be here.

Dr Louise Newson [00:01:04] So you were very complimentary in your email to me, which is very nice, but that’s not why I invited you to the podcast. I have all sorts of emails and some are not as complimentary, but that doesn’t matter. I think the important thing is about listening to women, actually, and we’ve all got different journeys, we all have different backgrounds, we have different lives, we have different experiences, but we also have different health as well. And I don’t… we’ll tease this out, but I know from my own personal experience, being a medical professional and a patient is just awful actually, because you think you have more knowledge than you have. And the first time when I was ill with sepsis, after my first daughter, I thought I knew everything and actually I didn’t because I was ill, and I needed someone to take control. But the junior doctors were too scared because I was a doctor. So then I got Consultant led care, which they never wrote in the notes, and there were all sorts of things that really quite scared me about being a patient because I don’t think you get always the best care. People are a bit apprehensive, so there’s lots of things going on. So if you wouldn’t mind Susie just explaining, because you are a gynaecologist aren’t you, so just explain a bit about what you do and then about how you became a patient, if that’s okay.

Dr Susie Crowe [00:02:14] That’s fine. So yes, I’m a consultant obstetrician, gynaecologist. I’ve been doing it for 20 years this year actually, and I love my job, so I’m a general obstetrician, gynaecologist so I do intra partum care really, is my specialty around high-risk pregnancies but also managing risk, managing the labour wards, etc. And on the gynaecology side, I’m a benign gynaecologist and I’m really passionate about advocacy for women and that’s why I went into the job. And one of the things I love about being a gynaecologist in particular, is around informing women about their bodies so that they have the same amount of knowledge I have, and then helping them to make the right choices. On the obstetric side, I run a Birth Options clinic, or ran a Birth Options clinic, that really was around supporting women’s choice and personalisation. So in particular, women who want to birth outside guidelines, for example. So yeah, that’s who I am professionally.

Dr Louise Newson [00:03:08] Great. And so important. I think being an advocate for our patients is really important actually. And I don’t know about you, but I didn’t really learn much about that at a medical school. I had some great training actually with – quite unusual then actually – a psychiatrist that specialised in oncology. And I always wanted to do oncology cancer medicine. I did a lot of training towards it and then changed my job really just for lifestyle and getting married and everything else. But he taught a lot about involving the patient right from the outset and sharing any concerns, and also not just the patient but anyone close to them as well. And also knowing that there’s not a rush in medicine, you know, there are some things don’t get me wrong, if someone was having a heart attack, then time is of the essence. But a lot of things even more serious diagnoses like cancer, we’ve got a bit of time to make sure we’re really on board with our patients and we explore every concern and it might not be apparent initially. So I think being an advocate is really important part of a job, isn’t it?

Dr Susie Crowe [00:04:13] Again, I agree. But it’s also I think, you know, I think I really hope that I provide really holistic care as well. So I’m a really massive believer in looking at the whole picture, but also thinking about advising women from the whole picture’s perspective. You know, I’m a big advocate of diet and lifestyle and kind of weaving that into my practice as well. So it’s about thinking about how we can help ourselves whilst also helping women to understand their bodies and the potential treatment options. Because often things will go hand in hand won’t they, where we’ll need conventional medical treatment. But actually that, you know, we all know that there are things that we can do to boost our own health. And I think particularly with women’s health, I think we have massive opportunities particularly through pregnancy, but then as a life course to actually really pick up and be promoting optimal health for women. And I really see my job as being a big part of that.

Dr Louise Newson [00:05:04] And pregnancy is a massive time because I don’t think there’s any other time in certainly, a woman’s life that she has that much involvement with healthcare professionals, not just doctors, but also other healthcare professionals who can drip feed information, actually. And certainly, when you’re pregnant, you want the best outcomes for you, but also for your unborn baby as well. So it is.. if you can’t get as healthy as you can or get as much knowledge then, then it’s really hard. But to have months of time actually, and even postpartum, you’ve still got time. Most of us never go and see a healthcare professional at all, do we? And we want to avoid it. So actually it’s a really prime time to get as much information. And like you say, holistically is really important and certainly as a general practitioner, it’s really important that we’re not just focusing on one symptom or one disease it’s looking more and preventative medicine has got to include holistic lifestyle, education and information, hasn’t it?

Dr Susie Crowe [00:06:01] Yeah, I absolutely agree. Yeah.

Dr Louise Newson [00:06:02] So then moving forward, as I said at the beginning, you’ve been a patient, not one of my patients, I hasten to add. But what happened for you to become a patient?

Dr Susie Crowe [00:06:10] Yeah. So it goes back a couple of years now. So I think I was reflecting on it this morning. I turned 40 in 2018 and just oh, I was so happy to turn 40. I felt like I was in the prime of my life. I’ve got three children. I got my consultant job that I absolutely love and we have to acknowledge the effects of having pregnancies and children and the effects on your career and, you know, you’re stopping and starting. And I finally felt like I was in just such a great place. I was really fit. I was really healthy. And with hindsight, it was probably in the latter half of 2019 that I started becoming unwell but didn’t realise it. And obviously beginning of 2020, we all know what happened in 2020. So the pandemic hit and at the time I was clinical director of women’s services in the large teaching hospital in which I work. So changing and delivering the care that we needed to was just huge. Maternity care had to keep going throughout the pandemic, but we also had to completely change the way we worked. We had to make new guidelines, we had to work so hard and we also had to really sadly, and really awfully, pause all the gynaecology which we had to deal with as well. So I think in the midst of that context, where I was working all the time, which I really was and was also… had lost – as we all did – the normality of our lives at the beginning of the pandemic. So those things that help us to feel well, we couldn’t do anymore, you know, I’d have these big sessions where I’d go to the gym on these two days a week and do what I did, which I absolutely loved. I love going out to gigs. I couldn’t do that anymore. And so in that context, I was becoming more unwell but not really recognising it and obviously thought it was burnout. I think there may have been a degree of that as well, being completely honest, because trying to work at that level, given the NHS, that much pressure, can be quite challenging. By the autumn of 2020 my night sweats started, so essentially I was getting fatigued but without really recognising it, still managed to do lots of exercise, still managing to work. And then my night sweats started at that point, interestingly, that I went first went to the GP probably in about the autumn and really interestingly, everybody said that it was menopause. So this is the interesting thing about my story and I remember saying ‘It’s not, I know it’s not menopause because I am a gynaecologist, but also I’ve breastfed three babies and when you breastfeed, you have lower estrogen levels’. I know what it’s like to have low estrogen…

Dr Louise Newson [00:08:37] Was it a different sort of sweat?

Dr Susie Crowe [00:08:39] Yeah, it is so different. It’s so different to the sweats you get with menopause. It was just completely drenching. They just come on out of the blue. So, you know, they weren’t every night, obviously, because they kind of start quite slowly. But I would be in a really deep sleep and I would wake up initially like, say a bowl of water being thrown over me. I suppose towards the end it was like a bucket had been thrown over me.

Dr Louise Newson [00:09:01] Did you feel any warmth at all?

Dr Susie Crowe [00:09:03] No, no. No, no. And so I felt really strongly that actually if it had been menopause, and I had that bad night sweats, I’d have other symptoms that were associated with low estrogen levels. So I couldn’t have night sweats that bad without having hot flushes as well.

Dr Louise Newson [00:09:19] And it’s interesting. I mean I had night sweats and never had a hot flush at all, but I did have other symptoms as well. And I did feel this sort of warmth. But also when I woke up, I felt that I was then become more anxious, you know, very common isn’t it, in the early hours when your hormone levels are low. My sleep was very interrupted. I got quite a lot of muscle and joint pain. I sort of.. these early morning symptoms were, so I did have this sort of variation with the day. So there are little things that.. but the other thing is what’s really interesting is that you as a woman felt that, you know, and we learn so much from our patients, don’t we? And I think certainly in women’s health issues, not just in menopause, but endometriosis and PMS, women actually often know don’t they, whether it’s their hormones or not. I know that sounds a bit weird, but they do, don’t they?

Dr Susie Crowe [00:10:05] They do. I think this is it, you know, women understand their bodies. I think because of our hormonal fluctuations, we see it all the time. You know, I see it all the time in my gynae clinic, I see it with my pregnant patients as well. But actually, women know. They know their bodies. We become quite attuned to them. And I knew as well, that I had had no perimenopausal symptoms, none whatsoever. I’d felt completely well up until the point at which I was starting to get tired, essentially, and then these night sweats started. So, yes, initially the first set was done in terms of blood tests and they obviously came back completely normal. And so we were kind of said we’ll watch and wait because all my blood were completely normal. And then we did another set of blood tests. And they were still completely normal. And by this point, actually, I was just getting more and more unwell. So it was the fatigue. And I think if people haven’t experienced fatigue, you can’t… it’s quite difficult to describe it actually. It’s just this absolute exhaustion I felt. I literally felt exhausted to my bones and I would wake up in the morning having had a full night’s sleep and just I would want to cry because I was just so tired. In the midst of it all I’d self-referred into the Practitioner Health Programme. Practitioner Health is it’s name, which is for doctors with burnout, mental health problems. I’d been seeing just the most amazing woman through that who is a GP by background, who I’d been talking to a bit about this who was saying ‘actually you need to go back. I’m a bit worried about your physical health’ but also recognised actually, that I was becoming really unwell and kind of really advocated for me to go off sick, which actually we know what doctors are like, you know, and we’ll be completely honest. I felt terrible about it. I felt terrible about letting my patients down, my colleagues down, but actually went off sick around the Christmas which was around the second wave of COVID hitting. And it was during that time, that having that space, made me realise just how unwell I was. And in that time, that’s when I started getting other symptoms. So the other symptoms I felt: getting abdominal pain and bloating, feeling sick most of the time and just not being able to eat properly. So by the early part of the next year I went back to the GP again because it was really difficult to get, you know, face to face appointment because that was the nature of it, but saw a really wonderful, and amazing GP who did a battery of tests, you know, this poor doctor sitting with a doctor sitting in front of her going ‘I feel genuinely a bit unwell’, you know. But at the same time, I was still really active, I’d cycle there and it was quite a long way, you know, it must’ve been quite difficult for her. It’s hard, I think, treating doctors. But anyway, she did a battery of tests and ultimately what then ended up happening was it came back that I had non-Hodgkin’s lymphoma, basically.

Dr Louise Newson [00:12:43] Right. So that’s a type of – well if you just explain what it is, some listeners might not know, if that’s okay.

Dr Susie Crowe [00:12:47] Exactly. So it’s a type of blood cancer, essentially, and it came completely out of the blue. I think one of my interesting things to learn about was that I had obviously thought about it. I know that night sweats are a symptom of lymphoma. What I didn’t realise was that you could have completely normal blood tests and still have lymphoma which is obviously you know my education.

Dr Louise Newson [00:13:11] Yeah. And that’s really hard, isn’t it. So I mean, when I..my first symptoms where fatigue and night sweats and I felt like I’d been drugged and it was just this most horrible…. but I did have these other subtle symptoms, but I did a haematology job as part of my medical training, and I worked with a haematologist who was an oncologist. And we did a lot of especially leukaemia, but some lymphoma patients came through the unit in Manchester as well. And so I kept saying to my husband, ‘I think I’ve got lymphoma, I absolutely do’. And he said, ‘Oh gosh, Louise, oh, come on, you’ve just got over pancreatitis, you know, there can’t be something else going on’. And so I was convinced, but I knew that my blood test would be normal because I’d done enough training, if you see what I mean. And for those of you listening, obviously blood tests for menopause and perimenopause are a waste of time usually, so we can’t do it. So how do you know the difference? And some of you might be listening, thinking, ‘oh, my goodness me, have I got a lymphoma?’ And how do you know? And a lot of times with patients, we don’t know. And I could have been right or wrong… you didn’t know. And actually often within the clinic we will give HRT. But if we’re worried then we would carry on with the referral to a haematologist and have investigations and also night sweats often improve very quickly with estrogen. So if, for example, someone had, you know, given you some HRT to try, it wouldn’t have harmed the lymphoma. But also, if you were still having symptoms a few weeks later, then you would have known it definitely wasn’t. So it’s just to reassure people that are listening because I don’t want everyone to then go to their GP, over night sweats to think that it could be. But.. and that’s why actually – no disrespect to gynaecologists – I really feel like as general practitioners, we’re in a really good place to help menopause because we’re used to seeing people with unexplained symptoms or symptoms that could be due to other diseases. You know, how do we make sure that someone who’s got brain fog, memory problems and headaches doesn’t have a brain tumour, and palpitations doesn’t have a, you know, a difficult heart arrhythmia? And that’s what we have to do. But we’re used to that. So sorry to interrupt, but I wanted to just reassure people.

Dr Susie Crowe [00:15:18] And I agree, and I think I did have an unknown diagnosis at the time. You know, nobody knew what it was. You know, I think people thought that it was likely to be a cancer diagnosis. But I think we have to be really clear about the fact that I was really unwell. This wasn’t like… I’ve been through menopausal symptoms now, which is why I’m here. But, you know, this is very different and that kind of lassitude and just being so unwell but also other symptoms can start creeping in as well. But at the time it was unknown, you know it was query ovarian cancer, query bowel cancer, query lymphoma, query other you know, there were other endocrine things. We did a battery of tests and in the end, I had an MRI scan and that’s where my lymphoma was picked up. So I was diagnosed with something called follicular lymphoma, which is a low grade lymphoma. Thankfully it’s very easily treated, which is great. Technically it’s incurable, so you’re always in long term remission. But actually, the likelihood is I will be in remission for a long time. And I know that’s life for you.

Dr Louise Newson [00:16:18] But one of the treatments is chemotherapy, isn’t it?

Dr Susie Crowe [00:16:20] It is. And so interestingly my haematologist who’s been amazing, we’re talking about personalised care, has been brilliant and he’s so good at listening to me and he really, really listened to me. He really emphasised that also based on my history in the scan findings so far, stating that this is what I think it is. It had all started in my mesentery, which is this piece of tissue that kind of holds your bowel together. So that’s why it was all hidden as well. I didn’t have any obvious lymph nodes because it was all contained in my abdomen and pelvis. And interestingly, he kind of said to me at the time, ‘Look, I’ve seen this pattern before really interestingly, I’ve seen it in younger men. I was in my early forties with a very similar lifestyle to you’. Interestingly kind of kept talking about the impact of stress on disease, which I didn’t really understand. Talked a bit about you know ‘I’ve seen these men with this particular pattern of follicular lymphoma and you know, you’re going to be fine. We’re going to offer you chemotherapy’. And it was said to me at the time, you know ‘I’ve got these male patients that I’ve seen who’ve got back to their normal functionality, they were all running ten kilometres a day. You’re going to be great very soon’. And obviously recommended chemotherapy to me and my instinct again because I’m a gynaecologist and I thought, oh my goodness, I’m going to have chemotherapy. I’m in my early forties. This might affect my ovaries. So interestingly, one of the first things I actually did because I knew I was due to have a Mirena coil change anyway, was going to get my Mirena changed just in case I went through the menopause, just in case I needed that part of my HRT, basically. So essentially – because in my head I knew it was a risk but at the time the quoted risk is about 4% of cancer. It’s quite low, actually.

Dr Louise Newson [00:17:56] I wonder how they get these levels, though, because it’s very difficult to know because so many symptoms especially even post chemo are attributed to ‘chemo brain’ or.. and because there’s no diagnostic criteria other than symptoms, I think it’s probably a lot higher. I don’t know what you think about that. I think it probably is.

Dr Susie Crowe [00:18:14] I think so. I mean, subsequently I then read every paper I could because that’s the kind of person I am and don’t get me wrong, I trust my haematologist absolutely implicitly. He’s been so brilliant at walking that line between treating me as both a doctor and a patient. But he’s also brilliant because he’ll say, ‘This is what I recommend, this is the evidence base’. But he’ll also tell me the randomised controlled trial which it’s based on so that I understand where that’s come from. I’m not here to challenge him. I’m not, you know, I trust him, but it’s around that understanding that absolutely I had done all the reading. I think it’s a lot higher than that. Absolutely. Yeah. So I went through, I had six cycles of chemotherapy last summer, which finished probably about a year ago, something like that. And I was coming out the other side of it interestingly, because my B symptoms were being so severe, and interestingly the other things I had by this point were weight loss as well. So I was very unwell. But interestingly, because for me my lymphoma symptoms were quite predominated by night sweats, one of our concerns initially was are we missing menopause as well, actually.

Dr Louise Newson [00:19:17] Yeah.

Dr Susie Crowe [00:19:17] So my haematologist had done some extra blood tests and actually my hormones, my ovarian profile, for what it’s worth, was completely normal and still was undergoing chemotherapy last year, again, I didn’t have any menopausal symptoms then. And I think again the interesting thing – and I think this is where we will have to appreciate that as doctors we don’t know everything even when it’s about ourselves and people make mistakes even when it’s about ourselves – what I didn’t realise was that my ovaries could stop working several months afterwards. I think I thought if it was going to happen it’s going to happen at the time. I’m an optimist and so I was kind of coming out to the other side of it, was starting to feel better. So my lymphomas symptoms had started picking up, probably mid-chemotherapy. And then the cumulative effects of chemotherapy meant that the chemotherapy symptoms then started. And then probably by around the autumn of last year, that’s when I started feeling quite a lot better and we started to think about phasing back into work, although that needed to be different because I’m still being treated with a monoclonal antibody that lessens my immune system, so I can’t work clinically. So there’s a lot going on. But overall, you know, I carried on exercising throughout the whole thing. I’ve done loads of yoga. I’ve worked a lot on acceptance and balance, you know nutrition and diets and all of those things. And actually I felt quite well. And then in probably about September time, my first symptom was anxiety.

Dr Louise Newson [00:20:39] Interesting.

Dr Susie Crowe [00:20:39] I got to feel really anxious and really anxious about little things, which just isn’t me at all, I’m an obstetrician. I deal with.

Dr Louise Newson [00:20:50] Lots of anxiety.

Dr Susie Crowe [00:20:51] Exactly. You know, I deal with adrenaline. And that’s what I love, you know? So at first, the anxiety, then a little bit of hot flushes, not huge actually. I was applying for new jobs at the time. We kind of came off a couple of kind of pre-interview meetings, Teams meetings and thinking, I feel a bit hot!

Dr Louise Newson [00:21:07] Yeah.

Dr Susie Crowe [00:21:08] And then interestingly, woke up in the middle of the night one night, with the night sweats. But interestingly, I just didn’t think it was lymphona I just knew it was menopause. And it’s because I was hot.

Dr Louise Newson [00:21:18] Yeah, isn’t that interesting? So quite different experience to before.

Dr Susie Crowe [00:21:22] Completely different experiences. So I basically woke up fanning myself in that very typical kind of way, was fanning myself, I’m really hot and I kind of sat on the side of the bed and thought, ‘Oh my goodness, this is menopause, I’m a gynaecologist. I’ve only just realised it’. So I think the other thing about it is that – and this is where I think it’s different for the women who’ve been through chemotherapy – is it’s not gradual. You don’t go through the perimenopause, it hits you really hard. And that was it. I got hit really, really, really hard by it. So it kind of ramped up very quickly from kind of these mild symptoms to quite severe anxiety and insomnia. And I couldn’t sleep. So I went to the GP to say, and I have to point out I was with a big conglomerate GP practice at the time which isn’t necessarily set up for chronic disease and I’ve changed since then. I’ve got really wonderful GP practice that I’m with now. So they said, ‘Well, no, because you’ve got night sweats again, you’ve got to go back to haematologist’, which is also this whole thing about, you know, I suppose what I want to say is it’s just about listening to patients really. But I can see why people are anxious about these things.

Dr Louise Newson [00:22:33] Yeah.

Dr Susie Crowe [00:22:33] So I went back to my haematologist who said ‘I think it’s menopause, your scans, we just scanned you, we couldn’t find’. I said ‘No, I was in remission’. So went back to the GP and said, ‘No, we’re happy for me to have HRT’. And essentially, they weren’t happy to prescribe it because they said that I needed to be counselled on the risks because I’ve already had one type of cancer. And this isn’t …obviously this is my story, but this is one of the reasons I reached out to you is because actually this is very universal for women with blood cancers actually.

Dr Louise Newson [00:23:04] Yeah. And we see it with all types of cancer actually. So just to be clear, we’re not talking about breast cancer. We’ve talked about this in other podcasts, but there are so many other cancers and people then seem to think that HRT is bad. And when I do training for healthcare professionals, because I was never taught any of this stuff at all and actually I feel really embarrassed now saying that I worked for six months in a leukaemia and lymphoma unit and we didn’t even ask them, we didn’t give them any information, didn’t tell them they could become menopausal. Anyway, I can’t go back, but it’s not on a lot of people’s radars. And so I often, maybe it’s very simplistic of me, but I love this when I teach healthcare professionals. I’ll say ‘would this lady have a type of cancer if she was young and would part of that treatment be to remove her ovaries?’ So if you, as you were menstruating when you had your lymphoma diagnosed, did any of the cancer specialist haematologists ever offer you ovaries to be removed as part of your treatment? Well, of course not, because your own hormonal function, estrogen and progesterone, testosterone, are not interfering with the cancer. And in fact, they were helping you to function. And we also know that estrodial and testosterone are actually very anti-inflammatory. And that’s probably one of the reasons that women probably have less cancers actually when they’re younger. And this is the really key work that we’re doing with some really big team of people. So actually that it makes it very easy. And then it’s not just with cancers, actually, if someone has, you know, a clotting disorder or if they have migraines or anything, I’ll often say to medical students and nurses and doctors and pharmacists, ‘well, would you advocate taking her ovaries out then? No? Why would you do that? Okay. Well, then HRT is just replacing that’. And also, you know, you’re young, so it’s important that you do have the replacement hormones, as we know for many reasons, for your future health. So in that way, I think it’s almost easier to conceptualise, isn’t it? But there’s still this myth and we see it sometimes in medicine when we’re out of our comfort zone. And I’m sure you’re very aware when we’ve got pregnant women – and goodness only knows pregnant women can still have other diseases and symptoms – but it’s very much… when I was working on labour ward I’d often get phoned up ‘Oh, this lady’s got a migraine. Can she come into labour ward because she’s 36 weeks pregnant?’ ‘No, you can treat her migraines’. And I think you get clouded because people get scared.

Dr Susie Crowe [00:25:28] Absolutely. Again, we see this all the time, as you said, with pregnancy as well. We see this all the time. Where actually we have these gender biases. We’ve seen it with COVID. You know, the data with COVID showed, yes, pregnant women, unfortunately, had worse outcomes because people were scared to treat them with the appropriate medicines. Now, I’ll say just because they’re pregnant. You know, we’ve seen the same around things like heart attacks in pregnancy, etc. And that’s one of the reasons that, you know, again, to reassure people this is getting much better. This is how we just you know, this is all about how we’re improving medicine, improving our understanding. You know, on that side, we got these massive maternal medicine networks that are making a big difference, I suppose kind of going back to the ovarian issue, which is exactly as you described. If I as a gynaecologist, took out women’s ovaries, which sometimes I’ve had to and I’ve had to remove both ovaries, I would give them HRT straight away and that would be our practice. And I suppose I also understand the history of HRT was, I suppose I was at medical school in the late nineties when it was the wonder drug, and I remember sitting in a lecture with this lecturer saying, ‘You have to tell your mother to take it because it’s the best thing ever’. And I was an obstetrician, gynaecologist in the early noughties when those big studies came out. But actually interestingly, I was working in the menopause centre that was one of the big research centres for menopause where we were already saying, ‘Actually we don’t think this data is right’. You know, we were getting into it all the time. That’s been a part of our teaching. And so I suppose again, just thinking about my own personalised care, I completely understand that there are all sorts of ways you can treat menopause and there are all sorts of ways that women want to deal with it and everybody’s individual. But for me as a gynaecologist, I’d always looked at the risks and benefit profile of HRT. I’ve looked at the risks of breast cancer associated with drinking or obesity. And, you know, we can’t modify all risk factors that present as cancerous, as I have found, because, you know, I suppose I’d always I’ve made the decision many years ago that I was going to have transdermal estrogen when I went through the menopause. So for me, it was just like well there’s no difference. But also I didn’t feel as though it was a gradual transition. I didn’t feel like it was traditional menopause. I felt like I say somebody had taken my ovaries out. It was so sudden. And having looked after women who had their ovaries taken out, I feel like I kind of knew what that was like. And so I felt that actually this was a hormone deficiency that I just needed replaced. And if it be my thyroid gland, there wouldn’t have been a problem over it essentially. But it’s that fear, isn’t it? There is that huge fear around HRT that had crept in 20 years ago that I think is still just hopefully starting to eb away a bit now.

Dr Louise Newson [00:28:09] Well, only a bit, unfortunately, because it’s 20 years. Earlier in July 2022, it was 20 years, and the 9th July is 20 years since the publication went out. And we’re still trying to reassure. And I think it’s a great way to end, isn’t it? Because the most important thing for me actually isn’t the evidence. It’s about patient choice, and it’s about understanding and allowing women to make the decision. When she’s been given the right information, she’s had the right time. She’s not pressurised. She’s just deciding for herself and also knowing that any decision for treatment can change at any time. Everything we do is reversible in medicine. Well, not everything, but certainly prescribing HRT is definitely reversible. Having a baby is not reversible! And I think knowing that we’re there at every stage of the journey with our patients is really important. So we can help with doubt, we can help with uncertainty. We can also reassure and educate those around them. So it might be their relatives that are more scared than the actual patient. So, you know, the experience you’ve had and very kindly have shared so openly. So thanks, Susie, because that’s I’m sure will help a lot of people. So just before we finish, Susie, I’m going to try three take home tips on you. And I’d really like you to try and help really answer three ways that you think women could be more listened to by the healthcare professionals to have this united journey together.

Dr Susie Crowe [00:29:31] Absolutely. I think the bottom line is, is that we just have to listen. It’s about listening to people and understanding their experiences. And so I think the first thing is about listening. The second is about empathy. And what I have found on this journey is that actually my experiences of my menopausal symptoms, actually in many ways were worse than many of the other symptoms that I had through other things. And as I said, I’ve got the advocacy to have got the treatment I needed, but not everybody else has. But despite that, actually what I found dealing with people is that when you’re unwell, you’ll feel very, very vulnerable and just empathy goes a really, really long way. And the other thing is just around personalisation and choice. So kind of having that really solid understanding of what makes a difference to people and giving people a really open choice that’s not paternalistic and actually is ‘this is the information I have, you make the right choice for you and for your life’.

Dr Louise Newson [00:30:26] Yeah, really sad because we’re all individuals, aren’t we? We choose every day what we’re going to wear or how we’re going to spend the day, and that needs to continue in the conversations with health as well. So thank you so much for your time. And just to finally tell everyone that Susie’s going to work with my team to produce more literature actually for women who’ve had cancer, but especially haematological cancers such as lymphomas to help educate them more so thanks in advance for your help with this and thanks for your time today. It’s been great.

Dr Susie Crowe [00:30:54] Thank you so much. Thank you for having me.

Dr Louise Newson [00:30:58] For more information about the perimenopause and menopause, please visit my website balance-menopause.com. Or you can download the free balance app which is available to download from the App Store or from Google Play.

END.

Listen to more podcasts.

Read more about menopause and cancer.

The post When night sweats are not the menopause with Dr Susanna Crowe appeared first on Balance Menopause & Hormones.

In celebration of International Women’s Day 2022, we hosted an Instagram Live on our Instagram channel featuring balance app founder, Dr Louise Newson, and Corinna Bordoli.

Corinna has been involved in our #IamMenopausal campaign, sharing her experience of early menopause. We launched our campaign to highlight to the world that the menopause affects individual lives in every corner of the globe, all with their own unique story and experience.

In honour of the theme for International Women’s Day 2022, #BreakTheBias, we wanted to raise awareness of the biases of the menopause by giving Corinna a platform to share her story that goes against the stereotypes of the menopause.

Watch the live in our video above, or

The post Breaking the Bias of the Menopause for International Women’s Day 2022 appeared first on Balance Menopause & Hormones.

• It can be hard to distinguish between postnatal and perimenopausal symptoms
• The effect of HRT in breastmilk
• How vaginal hormones can treat a range of symptoms – postnatally and for perimenopause

It can be common for symptoms of perimenopause to start in your mid-to-late 30s or early 40s, when you may still be fertile and having periods. Many women therefore seek treatment – especially hormone replacement therapy (HRT) – well before the average age of menopause which, in the UK, is 51.

Increasing numbers of women are starting families later in life too, and may be relying on fertility support such as IVF to help with this. Phases of life don’t neatly stop and then another starts – there can be overlap between perimenopause and pregnancy. In addition, if you choose to breastfeed for more than a year, you may reach the point where you become perimenopausal or menopausal while you are still breastfeeding your baby.

RELATED: Fertility, pregnancy and perimenopause with Rhona and Tanya

Dr Wendy Jones, a pharmacist with a special interest in the safety of drugs in breastmilk, runs the website Breastfeeding and Medication. She says, ‘As many women now give birth later than in the past, due to changes in work and finance, and feed until they and their infant choose to stop, I have received a substantial increase in questions from mothers experiencing signs of early menopause.’

RELATED: Premature ovarian insufficiency (POI)

Breastfeeding during perimenopause

It can be difficult to access effective and safe treatment for your perimenopause or menopause if you have recently given birth or are breastfeeding. In addition, hormone levels drop after childbirth and during breastfeeding, which can result in symptoms that often mimic those experienced during perimenopause, such as hot flushes, headaches, or joint pains. The psychological symptoms of perimenopause and menopause, such as low mood, irritability and trouble sleeping, are also familiar features in the postnatal period.

RELATED: Fatigue and menopause: tips to boost energy

‘Medical understanding of perimenopausal symptoms can be poorly understood, and probably more so if the woman is breastfeeding as well, particularly outside of the perceived “normal” timeframe,’ says Dr Wendy Jones.

For this reason, it’s helpful to keep track of your periods (if you have them) and log all your symptoms on the balance app, in preparation for an appointment with your healthcare professional. This will help convey to your clinician the range of relevant information relating to your hormones, especially if you’re tired and might struggle to remember everything in the moment.

RELATED: A guide to period tracking

Taking HRT while breastfeeding

HRT often contains the hormones oestradiol, progesterone and testosterone. These are similar but have less risks and side effects than the hormones found in the combined oral contractive pill, which can be prescribed to women who are breastfeeding. HRT contains much lower amounts of these hormones, and body identical HRT (transdermal oestradiol, micronised progesterone and testosterone) mimic the natural hormones that your body produces. Although there are some studies that suggest the these hormones can pass into breastmilk, there is no evidence that this leads to any effects on the baby as they are the same as natural hormones.

Dr Wendy Jones says, ‘There remains no conclusive research on the passage of HRT medication into breastmilk but, anecdotally, HRT has been used by nursing women without impact on the infant or breastmilk supply.’

Dr Wendy Jones says, ‘If you take HRT when breastfeeding, there is a possibility of reduction in milk supply as the oestrogen content may inhibit the production of prolactin (the hormone that is responsible for the production of breastmilk). However, it appears anecdotally that there is less impact from using transdermal preparations, such as a gel, patch or spray, instead of taking oral HRT. The decision to take HRT should be that of the lactating mother, after discussion with her healthcare professional.’

RELATED: Oestrogen in patches, gels or sprays

Using vaginal hormones while breastfeeding

Local hormones (that are placed directly into the vagina) can be prescribed when breastfeeding, usually to help with the healing of stitches after childbirth, prolapses, or ongoing vaginal dryness. Breastfeeding can reduce natural vaginal lubrication for some women, so vaginal dryness can become a particular problem for those who are already in perimenopause.

Clinicians may prescribe vaginal hormones in the form of a pessary, cream, gel or silicone ring.

RELATED: Vaginal hormones: what you need to know

The post Breastfeeding and HRT appeared first on Balance Menopause & Hormones.