Just As Well, The Women's Health Podcast - Hormones, HRT, Libido & mood with The Menopause Medic

Episode Date: March 24, 2026

This week on Just as Well, Claire Sanderson and Gemma Atkinson sit down with Dr Fionnuala Barton, The Menopause Medic, for a fascinating conversation about perimenopause, menopause and hormone health. From HRT and sleep to libido, vaginal dryness, confidence, weight changes and strength training, Dr Barton shares practical, evidence-based advice on how women can better understand and support their bodies through this stage of life. A must-listen for women of every age — and for the people who love and support them. Learn more about your ad choices. Visit megaphone.fm/adchoices

At Medcan, we know that life's greatest moments are built on a foundation of good health, from the big milestones to the quiet winds. That's why our annual health assessment offers a physician-led, full-body checkup that provides a clear picture of your health today, and may uncover early signs of conditions like heart disease and cancer. The healthier you means more moments to cherish. Take control of your well-being and book an assessment today. Medcan. Live well for life.

Visit medcan.com slash moments to get started. At Desjardin, we speak business. We speak equipment modernization. We're fluent in data digitization and expansion into foreign markets. And we can talk all day about streamlining manufacturing processes. Because at Desjardin business, we speak the same language you do. Business. So join the more than 400,000 Canadian entrepreneurs who already count on us.

And contact Desjardin today. We'd love to talk. Business. Hi, I'm Gemma Atkinson. And I'm Claire Sanderson. We have just wrapped up on our chat with Dr. Fenula Barton, aka the menopause medic. And we've had to end the episode by saying we're going to have to get a back.

Absolutely. Because we could have chatted. I mean, it's very late in the day now. It's pitch black outside and everyone is gone. But we could have kept talking to her. That was fascinating. Yeah. And we could have kept going for another hour, I think.

I felt we sort of had to wrap it prematurely. but she is so knowledgeable and there's so much to discuss about a subject that I feel I know already know a lot about but every time I speak to experts like her I realise I know very little. She covered things we can eat

during perimenopause and menopause symptoms, how you can manage them. I asked about vaginal dryness and stuff because I'd read, I'm not there yet but I've watched Samantha on Sex and the City slabbing that cream on in her office And I remember watching that in the cinema thinking, is that really going to happen to us?

She confirmed how it happens, why it happens, what you can do to stop it. She touched on HRT. Low libido. Low libido, sleep. Fluctuating confidence. Stress, yeah. And body confidence and how it can fluctuate dramatically

over the space of three days, which is impossible for your body to change shape in three days, but your mind can convince you. Can you think you might. And she also went into detail about the, the coil that some women have because although you don't have a physical bleed, you're still having a cycle.

Yes. Which is not a lot of people know about. Yeah, so the marina coil is part of your HRT protocol, which a lot of women have for their progesterone rather than taking oral progesterone. You don't necessarily bleed, so you don't feel like you're having a monthly cycle. But if you're going through the perimenopause

and have the marina coil for HRT, the chances are you still are having a cycle. So these fluctuations in moods, And in my case, there's times of the month where I want to go ahead first into the chocolate tin. She did this all to do with cycle. So even during the perimenopause, you should try and track your cycle, which I don't do when I'm going to start. I like how you go into the biscuits tin. My snacky snacki is cheese.

When I get it, I'm like, I just want to go to the fridge and eat cheese and biscuits. But it happens to all of us, as Dr. Fanola has just confirmed. So this episode, everyone needs to listen to it. Please send this to any female in your family. And any male, actually, because one of the points she made was that she called them our allies. She said if our allies, our male allies know what we're going through, it makes the household, the workplace, everything, run more smoothly. So, yeah, please like and subscribe to us. Please enjoy this episode.

And we will do a follow-up because as you'll see how it ends, you're just going to want more. Welcome to Just as well. Today, we're tackling a subject that will affect half the population. yet it's a subject that remains shrouded in silence, sometimes shame as well and also outdated advice. We're talking about the M word which is menopause. Now, it's not just a medical event, it's a transformative life stage

that deserves proper understanding, support and treatment. So joining us today, we're very proud to have Dr. Fenula Barton better known to her thousands of followers as the menopause medic. And she's on a mission to revolutionise how we talk about and treat menopause, and she's armed with evidence-based medicine, and a refusal to accept, just deal with it as an acceptable healthcare approach. So whether you're in your 30s, wondering what's ahead, or whether you're navigating perimenopause right now,

or you're supporting someone or your partner through this transition, this chat will really change how you think about menopause. So let's dive in. Thank you so much for joining us. It's brilliant. We're learning so much about peri's and menopause now, which is very much. much needed. What was it about your journey becoming the menopause medic? Why did you want to

delve into it for yourself as a career? So I've always had a really passionate interest in women's health specifically through my undergrad postgraduate training as a doctor. And when I became a GP, I became quite frustrated about the limitations, I suppose, on the amount of time that we have with some of our patients in clinical practice. And I remember vividly a few patients in particular who there was just lots going on. They were really really. suffering actually and it was really difficult for the patients themselves to join the dots. Equally, it was quite difficult to feel like I could support them adequately in that, in that context, in that setting. And that was back at a time when perimenopause and menopause

weren't so widely spoken about, weren't so sort of well understood and certainly treatment strategies for them were definitely not as well as well understood as they are now. And it really galvanised my sort of passion really to want to really improve the lives of women because it's so fundamentally important that women at this life stage in particular do feel well because we're at our most dynamic, we're often at our most productive and, you know, everything relies upon us. You know, the world would cease to exist without women and particularly wise women like us. It's incredibly important that we're supported, that our needs are met and that we feel well through this transition.

Are you surprised still by the number of women whom presenting your surgery who are not joining the dots? I'm not and I think the reason for that is because the number of symptoms that we can experience as a result of these ovarian hormone changes are hugely vast and often very different from person to person and even from day to day or week to week as an individual are ovarian hormones which are declining over time through perimenopause and then persistently low after menopause are really powerful chemical messengers that have an impact at every cell of every organ system in our body. And so when those levels are fluctuating and in decline, it can have an impact throughout our whole body. And it may not affect the same set cells in every

individual. And as I said, it may not affect the same, you know, part of you, every single day in the same way. So it can be enormously confusing to work out whether what you're experiencing is due to hormonal change or whether it's due to life stress or because you haven't slept well or perhaps you've over-exercised or you've undernourished or quite the opposite. You know, you haven't done enough exercise or, you know, you've eaten too much, or it's your metabolic health. Or at this stage of life, there are also lots of other things that can happen. And it can be incredibly confusing to sort of determine whether what you're experiencing is, you know,

ovarian hormone-related or whether it's other stuff, whether it's just life. I think it's because I was shocked. I always assumed up until a few years ago that your peri-meripause and menopause happened from 50 to 60 or when you're in your 50s around. But I've heard research that it can start, symptoms can start as early as 30, 35. Is that true? Absolutely. And this is what I'm on a bit of a mission to myth bust around, actually. So average age of menopause, as we currently understand it,

based on the data sets that we currently have, which might argue are probably even slightly outdated as it is, because self-identification, people don't understand if they're, I mean, they don't necessarily recognize if they're going through it, for example. But at the moment, average age of menopause is between 48 and 52 roughly. Now, we know that the average duration of perimenopause, this sort of more ill-defined period of time in the run-up to menopause, can be between two and eight years in duration,

but actually for some women might be 10 or even 15 years in duration, which means, I mean, I'm no math genius, but means that actually most women in their mid-30s should be thinking about their hormone health and how they can put in place strategies to optimise their hormone health as much as possible. and maybe even women in their earlier 30s. And a statistic that I think is often misunderstood

is that premature ovarian insufficiency or what we used to call premature menopause is really common. And it will happen in one in 100 women under the age of 40, one in 1,000 women under the age of 30 and one in 10,000 women under the age of 20. So this isn't something that's only relevant to women over the age of 50.

Yes, it's more relevant potentially to women in that age group, but it's something that we should all be aware of. as women, but also as men, because like you said in the beginning, 51% of us will experience this directly, should we be lucky enough to reach this age and stage of life. But the other half of the population will have a mother or a sister or daughter or a friend or a colleague who is likely to experience this. And so it's in everyone's interest to understand what it is that's going on

so that we can have empowered conversations about it. Is there a main difference? Because you talk about your in perimenopause. I don't know if I am, I think I will be. from what I've told you. Is there a difference between perimenopause and menopause in terms of one being easier to cope with than the other? Is it a case of the peris is difficult

because you don't know what's happening? Once you're in it, it's like, bam, you're in it, you know this is happening. Are they different or is it one long right? Yeah, so they're different because the underlying biology is slightly different. So in perimenopause, essentially, what you're experiencing is that kind of surface level experience of your hormone levels, being in fluctuant decline over time. And so it's going to be changing, it's going to be variable, it's going to be unpredictable.

And that can make perimenopause incredibly difficult because your symptoms might be, you know, variable, changeable and unpredictable. At a time of life when, let's be honest, it's nice to have a bit of predictability and stability, isn't it? But then when menopause happens, our ovarian reserve is exhausted. We've run out of follicles or eggs in the ovaries and therefore we're no longer ovulating. At that point, you have persistently low ovarian hormone levels. so low estrogen, low progesterone and low testosterone. So a lot of women will find that the chaos of perimenopause

does sort of settle a little bit and they might have ongoing symptoms, but rather than it being chaotic and a bit of a roller coaster, actually it feels more level and steady. And potentially that's where those really important lifestyle interventions can actually have a really valuable role because when you're standing on steadiest sort of ground, it's much easier to build those strong foundations,

whereas when everything's all over the place, it can be quite difficult to maintain consistency. You mentioned women in their 30s, optimising their hormone health. What do you mean by that? Well, I personally don't think there's ever too young an age to be aware of how important our hormones are. And by that, I mean all of our hormones,

not just our ovarian hormones. We have a number of different hormone systems in our body, and they all interact with each other in order to help essentially to create an internal equilibrium within our internal environment. And that is what then helps us to maintain good health and well-being in our external environment, in our external circumstances. And I, for one, am absolutely guilty of completely ignoring the value of my hormone health in my 20s and 30s. You know, burning the cattle at both ends, stressful work life, stressful home life,

probably drinking a little bit too much wine at times, over-exercising, under-eating, as was pretty normal for a lot of us back then, and none of that was conducive to healthy hormones and healthy cycles. And I think that the sort of sooner we're able to identify what works for our hormones, the more likely we are then to approach this perimenopause-to-menopause transition in a positive way that won't necessarily impact us as significantly. And so, So what I mean really is getting those lifestyle foundations in place. And it might be very difficult for, you know, somebody in their 20s or 30s to listen to this and think that it's potentially relevant to them.

But, you know, getting good sleep, prioritising it. You know, if you are going to have a late night because you've got a big party to go to or a big celebration to have, then make sure that in the days around that you are prioritising better sleep. Actually, think about where things are landing in your menstrual cycle. And actually, if you've got lots going on in your luteal phase, that second half of your cycle, it's much more likely to be disruptive in terms of, you know, poor sleep and difficult recovery. Likewise, your exercise, you know, meet yourself where you're at. It's really important to be moving as often, as intensively and for as long as you can.

Baseline guidelines are 30 minutes, five times a week. But I think we probably need to be doing a little bit more than that. Walk when you can, take the stairs when you can, but also integrate some more formal forms of exercise into your lifestyle and make them a non-negotiable. And it's terribly sad. I see a lot of younger women in my sort of non-menopause clinics who are burning the candle at both ends. They've got really stressful roles at work, for example.

And one of the things that is the thing that goes by the wayside is their exercise routine and their commitment to their exercise. And actually it would be really great if workplaces, for example, would embrace that and allow women of all ages to make sure that they can. prioritise that. Nutrition, you know, I think I'm really passionate about women knowing that it's more important to be nourished and well fed than to be restricting and trying to shrink, particularly at this stage of life, when we need to take up more space. We need to own the room and own the wisdom that we've earned. And that starts earlier on. And I think that I'm really

pleased to see younger women having potentially a more positive relationship in many ways with nutrition, particularly women who are exercising. But I do think that is a trap that a lot of my younger patients fall into because one of the symptoms in perimenopause is often weight gain and will often lean back on, you know, old learned habits of how to maintain weight, which is often move more, eat less, and that can sometimes be counterproductive. And stress management, if someone had sat me down in my 20s or 30s and said, you need to be more proactive about your stress management, would have scoffed, but I really wish somebody had, and I really wish I'd sort of put that into place. You know, in this country, we're still not very open-minded about proactive therapy. We tend

to go for reactive therapy if there's a problem or go and talk about it. But actually having a really safe space to offload and to help you manage your stress levels on a day-to-day basis can be enormously valuable, especially if you're somebody who's ever experienced trauma. And I feel that by this stage of life, and actually probably even by our 20s and 30, most women have experienced some degree of trauma, whether that is being bullied, whether it's losing a loved one, whether it is, you know,

other kind of violent or, you know, sexual assault or anything like that. Pregnancy loss, you know, birth trauma, all of these sort of things, they can really imprint on us. And if we don't proactively manage those experiences, they can sit within us and we can hold them physically

and it will often then end up causing problems further down the line. So they're the kind of. things that I would say we can proactively do to help optimise our general hormone health long before we've even reached perimenopause. We need to dig into each of those in more detail because there was so much detail there. We need to break each one down and let's maybe focus on training and fitness first and then go into nutrition and I'd love to talk about supplements as well. Because I kick my younger self for not sleeping as much as

I could and exercising as well as I could because it's only now having kids I realize that it's sometimes not an option to get a full night's sleep. You know, any, any more or dad will tell you, especially in that newborn phase. And it does make you feel like you're going crazy, lack of sleep. And I kick myself when I think, you lived alone, you had your weekends off. Why did you not sleep? And with training, there's lots of research out now, isn't there for women with strength training and like you say taking up the room filling up the space we're trying to flip the whole switch of you have to shrink you have to be really size eight not just for how you look but for how your body performs and how it carries you through perimenopause so like

claire said we'll break it down when it comes to the training why does strength training play such a key role in perimenopause and menopause it's a key role for everybody actually from midlife onwards and so again really important to make it a non-negotiable if you can it's really easy for me to say it's actually much harder for people to do but when we age we see an age related sarcopenia or muscle loss and that can have a significant impact on our general health our metabolic health but also our risk of future disease so it's really important to maintain or even build lean muscle mass as we age. When we reach perimenopause, our estrogen and testosterone levels, as I've said before, will be in a sort of progressive fluctuate decline. And after menopause, they'll be persistently

lower. And these are two hormones that are really important for building lean muscle. And so when we move into perimenopause and menopause, you've got the aging process, but that is often exacerbated by those hormonal changes, which can leave a lot of women with a significantly lower muscle mass in their 50s and beyond. And that may increase the risk of sort of instability. So a lack of strength. It may increase the risk of lower bone mineral density, which is a problem that we start to experience from our mid-30s, you know, independent of hormone health. And we know that resistance-based exercises, you know, the pulling, the tension that that that stress on bones is really important for helping to maintain good bone mineral density and reduce our risk of

future osteopinium and osteoporosis. It also helps to keep our scavenom. It also helps to keep our skeleton really strong so we're less likely to fall over which is really important as a age. You have a fall, don't you? After a certain age you don't fall over. It goes from being falling. Yeah, she's had a fall. Yeah. And also, you know, in terms of energy availability, our muscle mass is where we store glucose from our bloodstream. And if we've got less muscle mass, we won't be able to store so much in our muscles. So we have a higher blood sugar level. And when blood sugar levels are higher, we get more inflammation, that can have a negative impact on how we're feeling day and day out, but also increase the risk of that blood sugar being stored as visceral fats,

a fat around our internal organs, which in turn, then worsens your metabolic health. We also know that, you know, strength training is really good for our mood, and we know that from sort of epidemiological studies when people train, they feel better, but also from sort of scientific data that finds that when we do strength training, actually that tension on our muscles and our bones releases chemicals and hormones from the bones and muscles that then go up to our brain and send positive mood messages and can really improve with cognitive health. And there's more data now coming out supporting the idea that strength training and an increase in lean muscle mass as we age is a strong predictor of better cognitive function and reduced risk of cognitive

disease such as dementia. So there are multiple reasons why it's important. Yeah, we have to be doing there, don't we? We genuinely have to be lifting weights. And for you, Years and years when we were told not to. You had the Jane Fonda, who I love, but it was all aerobic, just cardio, nothing else, just do your cardio, few stretches. We were at an event together last week, Funula, and we were discussing strength training,

and I said that my understanding is that as we go through the menopausal years, we need to lift heavy, lower reps. At the end, a sports scientist who was in the audience, came up to me and very respectfully said, would like to challenge that. And she said that rhetoric, which is commonly being quoted now, is putting women off and actually just lifting any weights is better than nothing. And I absolutely take that on board.

But is the optimal way to strength train at this age higher reps and lower weights? Whereas when we were younger, 20s, 30s, you know, we all did the Barry to Boot Camp type classes. where we were lifting lower weights, higher reps, to, you know, getting very fatigue, maybe then transitioning into cardio stations and stuff. But my understanding is as we move into this stage of life, the heavier the weight, but failure after six reps is the optimal way to train.

But as I say, this woman politely challenged me at the end. So I think that this is where there is an important distinction between kind of research outcomes and real world data and real world. data and real world outcomes. And actually with so much scientific research, what works well in a lab situation isn't necessarily accessible, feasible, practical within the constraints of a busy modern woman's life. And that's why I said that I think it's important that we meet ourselves where we're at. I would never be able to lift a super high weight to six reps, you know,

feeling comfortable about that if I had never lifted weights before in my life. And I think that any form of movement is better than no form of movement. So we need to make sure that the messaging that we provide women at this quite vulnerable stage of life, I think, isn't then another stick to beat ourselves with. And like, oh, gosh, I'm not doing the resistance training. Therefore, oh, I'm just going to give up and I'm not going to do anything at all. Actually, doing something is better than nothing. And what I would say is probably more important than focusing on number of reps or even the amount of weight is ensuring that the work that you do is progressive. So if you start with body weight exercises, for example, you can only do six press ups before you are at exhaustion, you know, then that's great.

The next time you try, maybe try progressing so that you're doing slightly more or if actually you can do body weight press ups without any problems whatsoever, then maybe you need to be adding extra resistance to that or an extra challenge to that. And so thinking about it on an individual basis because, you know, somebody squatting their body weight is as hard as somebody else. you know, squatting, you know, very high weight in a gym situation. And I think we need to be encouraging all bodies, all shapes, all women to be just doing what they can when they can. So yeah, ideally we need to be doing it as frequently as we can. But let's be absolutely honest. Like you said yourself, like it's quite hard, squeezing it in. And if you can do something, then you can give yourself a tremendous pat on the back. But don't beat yourself up if you haven't necessarily managed to do what, you know, the influence

they're on, you know, Instagram or, you know, the research data tells you should do. You've got to be realistic and fit it into your life. What would you say to women who are, you know, there's a lot around HRT at the minute and how for some it's a godsend. And for others, some of them physically can't take it, you know, with all the health risks associated to them only. But it's not like an umbrella fix, is it? It's different for each women.

What would you say to any women who are contemplating going down the HRT route? So I feel quite strongly that all women should have the opportunity to have a conversation as to whether hormone therapy is something that's in their interests because the vast majority of women will get benefit from hormone replacement therapy in terms of improving their symptoms, optimising their quality of life, helping them to live more in the moment, enjoyably, but also safeguard their future health. So as mentioned earlier in the context of resistance exercise,

we know that bone mineral density starts to decline and muscle mass starts to decline as we age and it progresses through perimenopause. We also see changes to our metabolic health, so a sort of tendency towards hyperglycemia or higher blood sugar levels, increased weight gain. We also see changes to our cardiovascular system and our blood vessel health. And estrogen is very protective to all those things. It can help maintain bone mineral density, help maintain muscle mass, help, you know, maintain normal metabolic function. and crucially help to keep our blood vessels really healthy. And therefore, for a lot of women, even if they don't have huge numbers of symptoms

or their symptoms aren't being significantly improved with hormone therapy, hormone therapy may be important for them in terms of safeguarding, their risk of diabetes, their risk of cardiovascular disease, ischemic heart disease, stroke, etc. And so, you know, just an example, I've seen somebody recently in clinic who had held off hormone therapy because she felt there was a shame and a stigma associated with it. But actually her mother had had a heart attack by the age of 60

and her maternal aunt had died under the age of 60 from cerebrovascular disease, so a problem with the blood vessels in the brain. So for her at 45, it was really important to make sure that we were doing as much as possible to optimise her cardiovascular health because she has strong genetic risk factors for that kind of disease. And it goes back to your earlier point that actually it's a very individualised thing,

which is why I really want all women to have an opportunity to talk about it in depth specific to them. You know, as I've said, it has the scope to improve quality of life and improve future health risk for the vast majority of people. There are a small subset of people

for whom HRT isn't suitable. If you've had an estrogen receptor positive cancer, like a breast cancer, an endometrial or an ovarian cancer, for example. But for most other women, it is, there are potentially options that could suit. And even in those women who have had eustrogen receptor positive cancer, there are some really interesting clinical trials actually undergoing or being undertaken currently

to explore whether there are ways that those women can access hormone therapy safely in the future, which is really exciting. And is it something that you can take forever more? Yes. There's some belief that you take it for the period of you go into the menopause, last period and then you stop your, so I've heard some medic say you take it for the shortest period possible or you take the lowest dose possible to get you through. What are your thoughts on that? So I think historically when there was more fear around hormone therapy and breast cancer specifically,

so there was a study that was published over 20 years ago now, which was actually back when I was at university learning about all of this, that suggested that there was a link between hormone therapy use and increased rates of breast cancer. And at that time, you know, we learned at medical school that hormone therapy should only be prescribed in minimal circumstances should be not used for more than five years and that should definitely be only prescribed in very low dose or whatever dose is the minimal amount of dose required. But subsequent research to that study and actually looking back at the data from that study, we now know that the fear around hormone therapy was massively overstated. And actually even from that study, they found that

women using estrogen-only hormone therapy after hysterectomy, if you've had a hysterectomy, you don't need the progesterone component of hormone therapy. You can use estrogen alone. That group of patients had lower breast cancer risks compared to non-HRT users, which I think is really valuable information because it kind of breaks that myth that estrogen causes cancer. If estrogen caused cancer, we would all get cancer because we've been producing abundance of the stuff throughout our premenopausal, you know, menstrual cycles. But that's just not the case.

But it was something to do with the combination of estrogen with some certain types of progestogen that would potentially increase the risk of breast cancer. Now, fast forward 20 years. And actually, we've got a number of options available that use different types of hormone that are known to be safer. And so we don't have that five-year limit anymore. And the current advice is that a woman should be able to continue hormone therapy

for as long as her benefits outweigh her risks. and actually for a lot of women, that will be long term, potentially even lifelong. And it's something that, again, is a very individual thing based on your own risk factors, both your risk factors for vascular disease, metabolic disease, bone disease versus your risk factors for things like breast disease. And it can be really tricky to make that decision. But I think that it's often easier to make that decision when you've got all of the information relevant to you to make that decision.

I'm going to ask something which I know, Claire, you won't ask and you'll ask, and you'll blush. But there's going to be a lot of women interested. Viginal health during the perimenopause and menopause. I've read there's going to be changes similar to when you're going through puberty and the discharge can change. Is that true? Is the vaginal dryness?

I mean, I remember watching an episode of sex in the city. And Samantha was going through a vaginal dryness stage. So she was constantly putting in her office. In her office. And I remember watching that thinking, is that really going to happen? So what's everything around that? That's something I genuinely know nothing about yet. So I'd be nice to be prepped.

So I mean our genital tissue, so the skin that lines our genital tract and our genital structures themselves are really hormone sensitive. And so at any time when estrogen in particular is low, those tissues and structures can start to change. So a lot of women will experience vagina after pregnancy, for example,

if you're breastfeeding, if you're breastfeeding and you're not ovulating, you're going to be in a relatively low estrogen state. And that can often cause some vaginalditis. So if that's happened to you postpartum, then it's probably a sign that that might be, you know, a part of your perimenopausal picture as well. And that dryness or that change in the kind of integrity to the surface of that mucose

or that wet skin that we have internally can then predispose to a whole host of symptoms. So changes to your vaginal discharge. One of the really common ones is people just don't like using tampons and things anymore because it just doesn't feel comfortable. It doesn't feel right. There's less lubrication. It can make intimacy incredibly uncomfortable. If the tissues or the skin is very fragile because it's become quite dry, then it can easily tear, which can give rise to bleeding symptoms, either spontaneously or bleeding in and around intimacy, which of course then has a significant negative impact on your experience during intimacy.

And that might negatively influence things like your motivation and your drive and your desire and libido in the longer term. But it can also, it's the same kind of skin that lines are genital tract, that also lines are urinary tract. So we can also see changes in the bladder. So increase cystitis symptoms, having to go more frequently, more urgently, or even leaking sometimes. If you can't quite get to the loo in time, having to pee often at night is another really common symptom. And, you know, these are all symptoms that can respond really, really well to the use of vaginal estrogen treatment. So creams or peisseries that you use internally. and that are very, very low risk.

So actually even women who have breast cancer and are on breast cancer treatment, for example, normally can use these sort of treatments effectively and safely because the hormone within these treatments isn't absorbed significantly into your circulation, but can have a tremendously positive effect on those genitoneal urinary structures, which in turn can then have a positive effect

on things like your general comfort, not having to go for that just in case we all the time, or not having to get out frequently in the night to pee, but also your comfort and your pleasure during arousal and I don't think that's something that should be underestimated because I think that in a world where we're so busy and there's so many things going on, often the opportunity for intimacy is quite rare

and so the last thing you want is for it to be really uncomfortable when you finally got that opportunity and you're in the mood and the moons have all aligned. That unicorn moment then. The last thing you want is for it to be, dry and uncomfortable and not feel pleasurable. And actually vaginal estrogen can really help with that if you're experiencing these problems as part of your perimenopause

or menopause picture. Low libido can be common at this time of life. We've spoke, well, Gemma has spoken about this quite a lot because she overshares more than me. She, Claire showed us, Gawker was on men's health recently on the cover and we looked at the pictures and he looked gorgeous, but I still didn't want to sleep with him at that moment because I was just like, you look beautiful

and I fancied the pants off you, but if I could just lie next to you with a coffee watching telly, I'll be happy. And to do what, it is really common, and I think it's probably more common than we realise because I think there's probably a lot of people out there in the same way that perimenopause is probably under-recognised. The problem of low libido and hyper-arousal symptoms or having a lower arousal during intimacy

isn't something that we're necessarily talking to our doctors about. It's probably something you're talking to your girlfriend about over coffee or wine. I mean, I know it's a topic of conversation that comes up a lot for us. But it's probably not something that our partners, our male partners are necessarily talking about. And there is often a very big disconnect in terms of pleasure. And there's this thing called the pleasure gap, which often opens up in, you know, our 40s and beyond, where male pleasure can often be, or desire, can often be very reactive in the heat of the moment. Like it's much quicker. for women desire motivation, libido, all of those sort of things

and actually pleasure and arousal is much more complicated because we're much more complicated human beings. You know, if you've got a massive to-do list in your head and you've got lots of things that you're thinking about, your stress or you're anxious, you're worried about your parents, you might not be well, you're worried about who's done the laundry and has your, you know, have the kids got uniform for the next day, then you might have an opportunity moment,

but actually if your brain is preoccupied with that really big mental load, it's very hard to push that aside to make space for that kind of spark of desire and drive. And ultimately, libido is a neurological function. You know, it's a mood at the end of the day. And it's reliant upon your brain having the capacity to, you know, to change lanes very effectively. And to kind of, you know, go down that route rather than being preoccupied with all the other things on our tremendous mental load. It's sometimes as well, you say it's part of the mood and obviously some symptoms of perimenopause. are you get angry, you see red mist

and your partner can do, you can just smile at you and say, you're okay and you think, shut up. Do you know what I mean? So that in itself, they've done nothing wrong, bless them. But that in itself doesn't make you want to do that because they've annoyed you just for walking in the room. Well, they're eating. Yeah, they're eating loudly.

They could do the smallest of thing, which makes you then think, oh, what did I ever see in them? And it's... Coming in drunk three o'clock in the morning. Yes, which you did. but it does, do you know what I mean? Like they haven't really got a leg to stand on, bless them. And you do feel for them in that way,

because for them, nothing's changed, really, has it? It's just, what's wrong with you today? Why are you being like this? But for a woman, everything internal is changing. Everything's up and down and up and down. So I do kind of feel for the male partners to be fair in it, because it's something that they don't have enough information about, you know. We were saying only recently when it came to sexual health in school,

they separated the boys and girls in our class. So the girls got told about periods. The lads went and did P.E. And really, it should have been a group conversation. Yes. You know, because they will all know someone who's going through it. And I think that, you know, it is really valuable when our male allies are understanding what we're going through

and can empathise with it. I think sometimes men have a tendency to, to solve problems and often actually this isn't something that can be solved but you might just need some you know you might just need your needs met in in a way and I think anger rage you know irritability all of these big emotions they are very common in perimenopause and menopause likewise tearfulness sadness these sort of waves of big emotion that's come over us I think it's important to think about what is that emotion telling us so it's an experience that is happening to us and that we're recognising as a kind of feeling or emotion in our bodies.

But it's in response to something, even if it's a kind of a glitch response to something because our body's in this real recalibration state, it might be telling us something really important that there is a need that is unmet or that there is a burden that's feeling heavy. And actually what I'd love for our male allies to be doing, our partners, our colleagues, you know, whoever else, you know, cares for women is what can you unburden? what can you take away or what can you meet the needs of in terms of the women in your life that you love and support without them having to ask you

and without it necessarily having to be something that you solve but just being there to listen, to stand by and to try and kind of unburden things because we'll all be a little bit more easier going if actually that big mental load doesn't necessarily feel quite so heavy all the time when especially when our external circumstances are often really complicated at this stage of life.

And as I said, our hormones are desperately trying to recalibrate our internal environment in order that we can still function in the environment that we're living in. And sometimes there's a disconnect there and actually identifying that and kind of working out what that is. It's often the key to then not feeling all these big emotions all the time. You start losing your confidence. Well, I'm in my late 40s now. And part of me feels the most confident I've ever felt,

the most able, you know, I'm smashing my career, you know, I'm doing well. But then I have days of cripplingly low confidence. And that's, we spoke to someone earlier and she called it negative Nelly, although my daughter's name is Nellie, so we then changed it to noddy. But that voice does tap in, doesn't it? And it's really hard to quiet, to quiet, you know, and especially when it comes to things like body confidence, and our body confidence can fluctuate wildly.

over two or three days when biologically is impossible for our body to have changed shape in two or three days. Do you mind me asking when you have that feeling and that change in your confidence? Have you ever tracked when that lands in your cycle? Well, I have the marina coil as part of my HRT so I don't have a cycle. So it's a tricky one. Although if I really did pay attention, I could see where I was. Because am I going through a cycle even though I've got the coil in? And actually it's a really important point to make.

So myrina coil is amazing. I've got one too. I'm a big fan. But what it means for the majority of users is that you stop having a period. You stop bleeding. But you are still having your cycle. So my arena won't suppress your natural cycle. You're still having your cycle in the background.

But what the myrina is doing is it's inhibiting the womb lining from getting thick. And therefore there's no blood to shed, which is why you then don't have a period and why it can be an absolute godsend to so many people. So it's inside you. So it's a little inert piece of plastic that just sort of T-shaped device that's impregnated with a form of progestogen, which is then released locally inside the womb. And it's a really great form of contraception, so over 99% effective of contraception. As I said, we'll stop bleeding for most women, but also can form the progestogen component of hormone therapy.

So that in addition to my renal, you can just have then your estrogen plus minus testosterone. But what it means is that you then don't recognize when you're having a cycle, which can be really good. confusing. There's lots of women who don't have a regular bleed but are still potentially having a cycle and sometimes just tracking it can be really helpful even if it's not tracking it alongside a bleed so that you can potentially recognize you know in your busy and you know incredible career when are the times when perhaps you don't want to schedule that big board meeting or when you don't want to schedule a big event because if if that confidence drop is happening roughly every 28 days you may be well placed to then predict when it's going to happen next time or indeed

when your energy levels drop or when you're feeling a bit more bloated. And actually PMS and PMDD, I know are topics that you've covered with some of your other guests previously. And actually you can experience tremendous physical changes as a result of the hormonal changes that you have in that second half, that luteal phase of the cycle when progesterone tends to be more high or dominant and estrogen tends to be a little bit lower. So you can often, you know, get fluid retention that means you go up a dress size potentially or you've got lots of abdominal bloating. your breasts might increase in size or become incredibly painful yeah and so you know there are as well as these big kind of emotional symptoms that are very variable and chaotic and disruptive you can experience profound physical changes as well which is you know difficult to deal with especially if your physical appearance which for most of us is a big part of where our confidence comes from so but also on a biological level those hormonal changes will be having you know, a change in how they're influencing your neurological confidence circuits, as it were. And so if your body changes coincide with when actually your nervous system is also, you know, at a bit of a low ebb, then it's going to be even more of a problem.

Hormone therapy should help with that to an extent. But if you're still having a cycle, then, you know, there is still going to be a degree of variability there. Oh, I'm definitely having a cycle because there's a point in the month where I am head first in the biscuit jar. Yeah? And it almost takes control of me. Oh, snucky, snucky, I use that. For me, it's chocolate. And, you know, if it's a working from home day, it's game over.

Because you're... But again, what is your body telling you that at that point in time? They're saying I need energy. Eat that chocolate digestive. Yeah. And maybe it doesn't need the chocolate digestive. But what it does need is energy. And it needs nurturing and it needs nourishment.

And it needs for you to reflect and treat your body rather than, you know, restrict it or punish it. And I think that's an important thing to recognise. Are there also points in your cycle when you are flying and unstoppable? Yes. See, that is phenomenal, isn't it? Like, harnessing that part of our cycle, I think, is enormously helpful and beneficial. It's hard when we have to go through all of that. Whilst some, you know, working, people are working full-time jobs. Then they're coming home to being mum, some of them single moms.

And I know guys work hard as well. And I know the single dad's out there. but they don't have to deal with the hormonal challenges we do. And it's like you go through it as a teenager. And then if you're fortunate enough and you become a mum because you want to, you go through it as pre-imposed partom. And then you go through it again. It's like relentless, isn't it?

The more guests we speak to on this pod, the more I think, plumbinette, women really are incredible. We're phenomenal. And it gives you an appreciation for what they're all going through. Like whenever I see a pregnant lady now, I feel like saying to a fair play because I know like you're probably uncomfortable and hot and getting shooting pains up your ass when you go to the toilet

having all them horrible pains. And you know, you understand the struggle. Yeah, but we all just keep... Yeah, but we all just seem to crack on anyway. And men have this kind of 24-hour rhythm, right? Yeah. And that's quite normal. We have a 24-hour rhythm as well in, you know,

our circadian rhythm. But we also have this, what they call sometimes an infradian rhythm. so there's more cyclical rhythm that influences that. And yet we are expected to still show up consistently 100% of the time, irrespective of what is going on internally, even just in our normal menstrual cycles before perimenopause, when there is still going to be big fluctuations that will impact both our mental health, our cognitive health and our physical health.

And I think sometimes just understanding that as a woman and sitting with that without judgment or without negative judgment is really valuable because I think we have enough to beat ourselves up about without also sort of berating ourselves for something that we ultimately don't have a huge amount of control over and actually trying to harness it and work with it but also, you know, get the people around us to buy in and kind of support us when we need, you know, help. It takes a village, doesn't it? It really does.

But we don't have villages anymore, do we? Not in the way that perhaps our mothers or our grandmothers used to. But, you know, tracking is one of those things that I talk to a lot of my patients about and I try to do myself because if my husband knows when I'm at a low ebb, then, you know, that is going to be easier for us all to manage at home and the kids as well. But it's true, when you were growing up, did you have on your street, like we had my next-door neighbour to my Nana, wasn't a relative, but to me she was my anti-oggy.

Yeah, my uncle Clive was my dad's best mate, anti-Shiel, anti-Gladis. I could go to anyone's house on the estate and it was my auntie and they'd help us out with anything whenever we needed and that it's not there anymore. I think in certain cultures it is. I think that is there where I grew up in the valleys in South Wales. You all know each other. The doors are still open and people do pop in and see each other.

But you're right. I don't think the way we live our lives now lends itself to that way of living. No, and it's a shame really Because I remember the days Like my mum and dad had take me everywhere Like if it was a house party Or even in the local Like cricket club or working men's club

And you just fall asleep on a pile of coats In the back And then wake up in your own beds All cozy again But it was everyone helping and chipping in I want to talk about nutrition Because we could literally talk to you all night But we can't, we can't

We need to wrap this up at some point But I do think nutrition is such an important topic for us to cover. And the first question I want to ask you, because it is really important to so many women, is weight gain inevitable as you go through the perimenopause and menopause? It's not inevitable. It's really common and it can be, you know, incredibly distressing, but it's not necessarily inevitable. And I think this is one of the reasons why it's useful to try and get ahead of things and to try and get those kind of foundations and that toolkit in place as soon. or as early as possible before paramanopause.

And there's a reason for it. And this is something that I think, again, important to understand because I think when we think about our biology in a kind of an understanding way, it can help us in some ways sort of cope with what the changes we're experiencing. So when our ovarian hormone levels are in decline in paramanopause, our body detects lower levels of estradiol, and the ovaries are the only place that we can produce estradiol.

So what it does is it sort of, compensates for that. There's lots of different compensatory mechanisms, but one of them is that it upregulates fat cell production because fat cells can produce a weaker form of estrogen that your body can then use when your ovarian estradial level is very low. So that extra weight is not necessarily just something that is problematic in terms of our aesthetics or problematic in terms of our metabolic health. But it's actually your beautiful body's way of like signaling potentially, but also compensating for this biological change that's happening under the surface. So it may be one of the earliest symptoms that you start to experience.

And quite often I'll see patients who say, I'm gaining weight and I haven't changed anything. Like I'm still doing exactly the same thing, but I'm gaining weight and I can't lose it. And that might actually be a very early sign. If you can get ahead or on top of it as soon as possible, then it doesn't necessarily have to be something that gets progressively out of control. And it is looking at your nutrition, getting good sleep, doing the movement that you know you need to do and then potentially utilising

whatever pharmacological medications that you might need in order to help support you on that journey and HRT is possibly one of them So what does looking at your nutrition look like these years? What changes do we make? Are there certain food groups that we need to

prioritize, others we need to dial down and supplements? I'd love to hear your thoughts on any supplements any vitamin nutritional needs that we may have now that we needed less of when we were younger. So I'll try and break that down. So first of all, I think it's important to recognise that our energy needs might change as we move through paramanopause to manopause. And this is, I think, one of the big pitfalls that people make. They might be doing the same, but actually if the energy needs have reduced,

they may need to be doing things slightly differently. So it can be really helpful to calculate your basal metabolic rate or your daily energy requirements and needs. And when I did it for myself recently, I was actually quite surprised at what my daily caloric, intake needed to be. And actually, if you can stick within that sort of, you know, envelope, you shouldn't necessarily then have an energy excess which gets stored as, you know, fat. So I think that's an important thing to consider because, you know, even if you're still eating the same and exercising the same, your energy needs as a result of your, you know, biological changes may have changed. In terms of food groups, I do think we probably need to be

thinking about eating slightly differently. And I think we need to prioritize protein. As mentioned earlier, we tend to lose muscle as we age, and that can potentially accelerate, you know, during perimenopause to menopause transition. So how do we prioritize building lean muscle? Well, we do the exercise we know we need to do, but in order to build lean muscle, you need amino acids. And amino acids are going to come from dietary protein. And there are lots of different equations out there that say that we should be having X amount of protein per kilogram of body weight. And, you know, the science behind those claims is not always, you know, abundantly robust. I would say a good ballpark to aim for for most women, which is probably

achievable for most women, is about 90 grams of protein per day. If you're somebody who is doing a lot of exercise and you're breaking down a lot of muscle fibre because you're doing lots of resistance, then actually you may need more like 1.5 or 2 grams of protein per kilogram of body weight, which actually may be more like 160 or 170 grams of protein a day, which can be really difficult to get in within your, you know, daily energy time. So you may need to, if you're prioritising protein, think about deprioritizing other food groups. Now, I wouldn't say ever to cut out carbohydrates because carbohydrates are a really important source of glucose. Glucose is our brain's primary energy source and we need that because, gosh,

paramountopause is as hard enough as it is without being hypoglycemic. But it's really important to make sure that you're getting your glucose from a low-gri-fiber carbohydrate source so that you're getting a slow release of steady glucose into your bloodstream over the course of the day, avoiding those big peaks and avoiding those big dips, which can often then cause changes in energy and mood and irritability and all of those sort of things. So that's what I would suggest in terms of protein and carbohydrate. Increased dietary fibre, we talked about this before, but aiming for 30 grams of fibre a day, which is really hard unless you actually look at like focusing on it. If you're not getting nearly that amount, then think about introducing or adding more

fibre slowly and gradually over time so that you don't end up giving yourself, you know, a stomach upset or IBS-type symptoms. Making sure you're getting adequate dietary calcium. So there are lots of calcium calculators out there on the internet. Just Google it. Go through, make sure you're getting enough dietary calcium. Because often I see people who've developed sensitivities to things like dairy in paramedopause. And they've cut dairy out of their diet, which means they then may be at a bit of a back foot in terms of calcium intake, which is, of course, crucially important for our bone health at this time.

Fats are really important. But we don't want to be eating a lot of saturated fats, those inflammatory fats that are going to increase our risk of heart disease. But we do want plenty of omega-3s. So, you know, oily fish in the diet, salmon, mackerel, anchovies, sardines, herring. I'm probably only getting one of those a week at the minute. If you're not getting two portions of oily fish a week, think about an omega-3 supplement, about 1,000 milligrams a day of both the DHA, EPA would be a really great place to start. That's really important for maintaining good vascular health, good neurological health,

but also good mucosal health. We mentioned earlier about genitoneitone urinary symptoms. Actually, that wet skin, that mucosa, really needs a sort of source of healthy fats. in the diet in order to maintain itself adequately. In terms of other supplements, I would absolutely recommend everyone's using a vitamin D supplement. And actually, if you're at risk of having vitamin D deficiency, I would suggest trying to get a vitamin D test

because if you're deficient in vitamin D, you'll need a treatment dose of vitamin D, not just a supplement dose. And actually that, you know, there's a big difference there and it's particularly important for your bone health, but also neurological health and emotional health. So it is worthwhile getting that checked. if you're somebody who is plant-based and not eating any meat or animal products, I would also recommend thinking about having your iron checked and your B-vitamine levels checked

because you may need to be supplementing or taking a treatment dose of iron and B-vitamins as well. They can often end up being a little bit low, and they are really important for maintaining normal health in terms of your hormone health, but vascular health and neurological health as well, which is really important. Creatine, I think, is a supplement that's worthwhile mentioning, particularly, you know, women's health, you know, exercise is a big part of our health and well-being. And if you're exercising on a regular basis, then creatine can really help you build lean muscle. But also in more recent clinical studies, it's been shown actually to improve emotional health in midlife women,

which I think is a really nice side effect. And there have been some really interesting studies looking at creatine supplementation to help with cognitive health, actually, in older adults with Alzheimer's disease. So there's a lot of really interesting research going on in that creatine space. And it's something that I do recommend to a lot of my patients, something that I take regularly myself, because I think you can get it in the diet, but predominantly from sort of pork and turkey

and I don't eat nearly enough of those two things in order to get add to quit creatine daily. We have one's of creatine, aren't we, at women's health? Yeah, so I think it's a really great add-in. Anything that you're not likely to get in the diet, I think is a good thing to be thinking about supplementing. But I truly think that, you know, a food-first approach is really important. If you can get, you know, the nutrition piece right,

then really you should just be supplementing it with, you know, the things that you need individualised to you. There are lots of herbal supplements and things out there that, you know, might improve things like libido, might improve your sleep, etc. But I think it's really important to be careful that you don't overdo the supplements because every different supplement you take, your body's having to digest, your liver's having to process. And actually that adds a bit of burden. So thinking about it, you know, being as simple and streamlined as possible, but as, you know, as focused and specific to you and your needs as possible. The other thing I think is really important in terms of supplements and nutrition

is thinking about your gut health and the health of your microbiome. So again, something that we're learning more and more about important, you know, as being important in perimenopause and menopause. Often, I mean, I was somebody who loved a good processed meal in my 20s and definitely had lots of ultra-processed foods when I was growing up. And now I don't have a huge palate for it, which is great. but we do have to improve our gut health by reducing ultra-processed foods, eating lots of fibre and pro and prebiotic rich foods,

and reducing the amount of toxins that we're consuming. So dare I say it, alcohol. You know, it's really bad for your microbiome. It's really not great for your liver health. And it can really negatively impact a lot of perimenopausal symptoms. So alcohol can disrupt sleep. It can, you know, reduce energy. It's silent calories ultimately end of day.

So it can significantly increase that energy intake that you're having on a daily basis. It is one of the reasons why a lot of, of people will gain weight at this stage and age. There's probably lots more to say, but that would be the kind of nutshell. The bulk of it. Well, I've genuinely learned a lot. We could be here online.

I think we need to get you back on. Yeah, we do. There's lots of questions. I know people will have lost of questions and we can maybe do an episode. We will do a follow-up. What we'll do is we'll open the questions out again to the audience because, yeah, there is lots we need to discuss.

So anyone listening right now, if you have any questions, send them to us on you can DM or DM me Claire we'll put all the input at the bottom and we'll have you back if that's okay to answer the listener questions Absolutely

Before you go we have some quick fire questions Okay And we ask all our guests these So Gemma and I are quite cheeky Because we're inviting ourselves to dinner At all our guests' homes What are you going to cook us? Oh gosh that's a really good one

So probably something Italian because I do I love Italian food. It would probably be something with lots of leafy greens and maybe even some preserved bits as a starter and then something really anxious and delicious and warming and nourishing for dinner, probably something pasta. And then, I don't know, tiramisu or something for pudding.

Lovely. Sounds good. We're sending you off to a desert island. Yes. 12 months in the sun, but you can only take one thing. What are you going to take? My SBF. Yeah.

Smart. And a hat. That's what Trinney said. That's what Trinney said. Yeah, she said that. Coffee or wine? At the moment, I'm probably erring more towards wine just because coffee's giving me the jitters.

So it's another thing you need to have to think about. Yeah, yeah, yeah, yeah. Dear. Yeah. What is the last thing that made you belly laugh? Joanne McNally on her podcast with Vogue Williams. My therapist ghosted me. I've been listening to that lot.

Oh, yeah. It's supposed to be good, that. Yes, it's very fun. Almost has got us just as well. Not quite. Not quite. Not quite. It has its other benefits.

And finally, what's one thing people listening today can do to make themselves feel just that little bit better? So this is a bit of a cop-out, but I'm going to say prioritise themselves. Actually, genuinely put themselves at the top of their to-do list because that's the only way that that needle is going to move because there are some things that are non-negotiable and you need to be in a position where you can implement those changes. But the first thing is putting yourself at the top of that list, knowing that you deserve to be at the top of that list.

What a lovely thought to end on. Well, thank you so much for coming in. It's been brilliant. And like we say, we will do a follow-up. But thank you for listening. Thank you.