The Dr Louise Newson Podcast - 001 - Symptoms and Effective Treatment for Women Experiencing the Menopause - Dr Sarah Ball & Dr Louise Newson

Episode Date: March 19, 2019

In this first episode of a new podcast series recorded by Dr Louise Newson, founder and menopause specialist GP at Newson Health Menopause & Wellbeing Centre, Dr Newson discusses the symptoms and experiences of different patients with fellow GP and menopause expert, Dr Sarah Ball. Find out more about Dr Sarah Ball

Hello, I'm Dr Louise Newsome, I'm a GP and menopause specialist working in Stratford-upon-Avon. This is the first of a series of podcasts that we're recording for women to learn more about their menopause and their hormones. So we're very excited to be doing it in conjunction with the Primary Care Women's Health Forum, which I'm one of the directors for. So I'm here today with one of my lovely colleagues, Dr Sarah Ball, who's a fellow GP and menopause. expert. So we're going to discuss today and in fact in all the series we want to discuss different patients. So it's a bit of a flying on the wall experience for other women to listen and hear what we get up to in our day-to-day practice. So hi Sarah. Hello. So tell me about a lady that you saw recently in the clinic. So a lady that has especially resonated with me

recently as a lady who is 53 and she came along to see us really because she's been experiencing symptoms which she was thought were related to her hormones for a whole 10 years. 10 years. Yes. Yes. 10 years, yes. And she had been to her GP on three occasions over that time. And each time had asked about whether it could be related to hormones, but each time, unfortunately,

was given quite inaccurate information. what symptoms was she getting? So, so back when she was 43, she was she was aware that her periods had always been regular clockwork and they just weren't quite so regular, nothing too out of the ordinary but sometimes they were just a bit later, sometimes a little bit closer together. But mainly she had quite a full-time high-powered job

And she was normally quite a going, she just didn't feel quite like she was functioning at not quite on the ball as she had done. Yeah, just not quite, and felt a bit anxious in certain situations which normally wouldn't have worried her. So this must have been worried her though. It's affecting her work. Yes, she's in quite a male dominated environment and she coped okay, but she just felt slightly uneasy. doing presentations, you know, you know, and she just felt that there was something that wasn't quite right, but she couldn't quite put her finger on it. But because she'd noticed the change in

her periods, she did wonder if it could be the beginning of... So what information had she been given by her doctor at that time? So when she went to her GP at the time, she was simply told, you're too young, it can't possibly be anything to do with the menopause. Is that right? So people, they're like... Not too young, no. She's 43. So her periods were changing, is that quite typical? Yes. So, you know, we know really that often 10 years before the average age of the menopause, women can start to enter what we call the pairing menopause. So periods slightly changing, moods, maybe slightly changing, subtle symptoms. And the average age in the UK? So 51. So she's well within that.

Yeah, yeah. Yeah, so really any woman in her 40s can potentially start to experience symptoms. And, you know, and I think it's really important that women know that because they presume, a lot of women wrongly presume that until your periods have completely stopped, it can't possibly relate to mental. And if there are a difference between perimenopause or symptoms and menopause? To be fair, a lot of the symptoms are extremely similar. it's really just a way of classifying the name.

So we would say a woman is menopausal when she's, you know, when her periods have stopped, but because you don't know when that's going to be until you look backwards, then you wouldn't actually know until a year after someone's menopause that they were at the end. So really perimenopause really just implies that someone's periods are changing. and there could be symptoms around it. because I've read all these symptoms,

but they talk about menopausal symptoms. Well, I'm not menopausal, so therefore they're not. When we read menopausal, we should also think perimenopausea, shouldn't we? I think it's important really that women almost consider it a journey through the end of their reproductive life. It's not just a one day. Which is what? I don't know about you, but when I was at medical school,

I just thought menopause period stopped, game over. That's quite easy, isn't it? It was almost just, yeah, it's not. It's a journey, yeah. Yeah, because some people find their periods get heavier and closer together, don't they? Yes, yeah. And then other people, it's the other and they get more spread out and they feel they're missing periods and then they have a bit of a catch-up. Yeah. So it's sort of a lack of routine takes over, doesn't it? Yeah, and it's often, I mean, I mean, I was getting some perimenopause of symptoms. I had no idea it was perimenopause because I wasn't thinking about my hormones. And it often happens at a time when we're busy, isn't it?

We've got this sort of sandwich generation. We're busy with our children. We're busy with our lives were quite, I'm certainly quite chaotic with everything. And then you just think, well, I'm tired because I should be tired. Yeah. You always think there's a reason for it, don't you? And maybe, I guess this woman's probably no different if she'd been told it, wasn't related to her hormones. But then what does she'd been three times to a doctor? Yeah. So,

well, so she went at that stage and was sort of told you're too young. So she sort of got on with things. I mean, she, you know, she managed to work okay. She just knew she wasn't quite the same as before. But also she was a very keen runner and does a lot of exercise. So, and she has a very healthy lifestyle. So she concentrated on keeping up the exercise and eating healthfully. You know, she's, you know, she's sort of muddled through. Yeah. Because she felt that was the best option she had. Yeah. Yeah. Yeah. And that's hard, isn't it? Because we know how important it is to optimise our lifestyles and we know how diet exercise is really important. But actually, for a lot of women, I'm sure you find I certainly do that they, they find.

it really hard to optimise their health. Yes. Yes. And I think this is the prime sort of stage in life, isn't it? And you say the, you know, busy women, moms often that are struggling, especially with mood swings. And juggling as they do, they then end up adopting unhealthy lifestyles to try and cope. So, you know, drinking perhaps to help sleep or just to help mood or to. Yeah, I've heard a lot of patients said to me, oh, I just drink alcohol to numb my symptoms. It's awful, isn't it? Yes. Yeah, and then, of course, that worsens your sleep even more.

And then that tends to... And it's a depressant, so actually you end up in a worse state. That's not good. And then a lot of women I speak to you also say that they get quite a lot of sugar cravings. And I think, don't you think it's related to the low estrogen levels? Yes. A bit like before your periods when you were teenagers. Exactly. I quite liked it when I thought I've got an excuse to eat a bit more chocolate because my period's coming.

Exactly. But it's the same isn't it? It's that drop of oeodin that you guess, isn't it? Like in the first trimester of your pregnancy, you have those carbohydrate cravings because it's all hormonal mediated, doesn't it? And then, but people put on weight around this time anyway, don't they? Yes, so it's, I mean, metabolism changes, doesn't it? And people often blame the menopause, but actually it would happen around that time. regardless and then when you make than sensible the problem then gets worse it's a combination I think our metabolism

so down because we get older doesn't it sadly we can't eat the same as we used to but also there is some theory that I'd read that if you're not making enough estrogen your fat cells make small amounts so your body clings onto the fat

to try to do yeah bit like going into hibernation yes and it's often in that midline area isn't it where people just I mean, I don't know, God, I don't have one of those before. Become more afl-shaped, don't think. Yeah. And then, but that's a risk for heart disease, isn't it?

Having a better tummy. Yes. So, but then having their estrogen is a risk for heart disease as well, isn't it? Yes. So, but a lot of women don't realize that, do they? No. No, not at all, no. So, yeah, so going back to this lady, so she, you know, she actually, she did well for five years.

And then her periods did stop. Oh, okay. Okay. So in a way, because she then thought, well, okay, you know, you know, see my GP again. Yes. Hopefully, you know, see what I should be doing about this. But sadly, she was then told, well, you're not actually having any hot sweats. So, you know, we're a bit worried these days that HLT is quite dangerous. So, you know, I think you should just push on with what you've been doing. And in what way did they say it was dangerous? I mean, she didn't, you know, really sort of, you know, she was just put off.

She was going to, as most people were worried about, breast cancer. And people worry about blood clots and heart disease and that sort of thing as well. But mostly, sadly, it's just from media hype. Yeah. We're still living with the hangover of badly reported. studies. So we'll be talk about that for a minute. Shall we think it'd be good, wouldn't it? Let's go back then. So, well, before we talk about that, so she appears just stopped. She's not officially menopausal yet then, is she? She's got to wait a whole year. Well, so this was five years ago

her period stopped. So she had been, yes, because that's confusing as well, isn't it? I see a lot of women that get told, come back and see me by their doctor when you're officially, when you've had that whole year. Nothing happens to us, does it, in that year? It's just a date in our diary, isn't it? Yes, exactly. So we don't need that date for anything, do we? It's just so if we started HRT when we were perimenopausal, that's fine, isn't it? It would make far more sense. Yes. So people worry about HRT.

So I would say the number one worry is breast cancer. Would you say that? Yes, absolutely, yes. So should we go through? Who doesn't get a risk of breast cancer with HRT then? It's very much a woman's and actually go through some of the basics with her

whether she would be at any increased risk to start with. So that just involves us needing to know whether she's ever had any biopsies to her breast or had any previous worrying biopsy results. And also the family history is often the most important. It's quite common to have someone in your family that's had breast cancer purely because one in eight women do get breast cancer.

That's a lot, isn't it? One in eight, the course of a lifetime. So most of us will know someone or at least one person's have breast cancer. Yes. But also I think the important thing, you know, one in eight is a lot, of course, but seven in eight of us won't get it. And actually, we often forget in life and in medical profession to remember the flip side of the. the coin. So breast cancer is not the most common condition in women is it? No, absolutely it's not going to kill us the most, is it? No. No. So we're far more likely in this country,

in this day and age to die of dementia, then heart disease, you know, then some lung things. So we need to think about when we're looking at our house, it's looking at cardiovascular disease, like you say, dementia, anything that can help with us. Okay. And then the one in eight, most of those aren't in the family, are they? They're not a familial breast cancer. Very few. So if I had an great auntie who was 82 who had breast cancer, that's not going to increase in concern whatsoever. So that might be quite reassuring for people myself to realise that. Yeah. It doesn't always run in families. No. And if there is what we call a first degree relative, so that's your parents, your brothers and sisters and your children, if there was a first degree relative that had had breast cancer at a relatively young age, that will sometimes raise alarm bells. to want us to it a bit more, or sometimes if you've got more than one,

first-degree relative, with breast cancer or possibly avarian cancer, that's also something that we might want to think about. And that's usually those people have had it when they're younger, isn't it? Yes. So even if, say, this woman had had a sister who'd been 40 and had breast cancer, once she'd got to 50, then her risk is the same as, more than mine, one in eight, isn't it? It's sort of, it might be slightly higher, but it's not as high as often people realise is it? And I think the other important for ladies to realise is that yes, there will be some people

with a family history that means that they are at a slightly increased risk to the normal population risk. But even if they were to consider having HRT, that doesn't make their risk any higher. No. So they can still have HRRT, can't they?

There's a lot of women that are told they can't because of their family history and it's knowing And a lot of women don't realise other risk factors for breast cancer, do they? No, not at all. No. So often the ways they've tried to manage their menopause themselves by drinking more than two glasses of wine a night or becoming overweight is actually far more risky for your chance of the breast cancer than taking HRT is. Yeah, because I read some of that obesity, as you know, is increasing worldwide, isn't it?

But obesity is one of the leading causes of all types of cancer. Yes, is it nearly or has overtaken smoking? shocking, and so breast cancer is no different, is it? Obesity is a big risk factor. So a lot of women, we've already said, put on weight during the perimenopals and menopause and drink and not exercising as a risk factor as well, isn't it? So those three we call modifiable life or risk factors, actually women who don't want to say actually because they're worried about breast cancer risk are increasing their risk. We're not taking HRT, so that's quite important,

to make people understand, even if they don't want HRT, they've got to look at their lifestyle, which is interesting, isn't it? So then going back to HRT, everyone's scared about breast cancer. So not all types are associated with increased with, are they? So if you're having your estrogen only, so if you have had a hysterectomy, then there is no risk that may even be a risk. there may even be a slight decrease risk. Yeah, because the WHI study, this big scary study that was misinterpreted,

actually didn't it? It showed there was a reduction in risk of breast cancer in women that took. That was the older cell, wasn't it, the conjugated at cry in history. Horses urine. Tablet form of estrogen, which I don't know, do you prescribe? I never prescribe it. No. But it's interesting because there might be something about that estrogen that reduces the risk.

But other studies have shown there's no increased risk, are they? So women that we're being removed, they're quite lucky, yes, and that's any age, isn't it? Yes. Yeah. So that's good. That would probably reassure quite a few women. And then what I agree is. And then what I agree is. Combined HRT. So if you still have your womb, you've got to have your combined HLT. And then the important thing is for women is understanding that if you have the combination, there is a no risk. for five years of use. When you say combination, because they've got their womb, they need to protect the lining of the womb, don't they? Yes. Yes. So, and then certainly the first five years is with the

microinise the body identical progesterine, isn't it? Yes, absolutely. It's a long time, isn't it? Five years, no risk. So you can, you can see how you feel on HRT before worrying about breast cancer, can't you? Exactly, yeah. And, you know, and usually that first five years, it does because you feel so much better in yourself and you are able to make more sensible lifestyle choices that you then reverse your other risks somewhat. Yeah, I mean, I don't know, you often say to women, when their lifestyle's better,

actually your risk of breast cancer is lower. Yes, exactly. So then after five years, they still argue, it's probably not even significant that increased risk, is it? No. You're talking about very small numbers. And certainly the WHO, study was quite a skewed. Very skewed. Do you want I just mentioned? Yeah. So it was, I mean, the WHA, it's been so, you know, it came out a year after I qualified as a GP. Oh, did it? Yeah. So having been initially very keen on pursuing hormonal. Because before then, we used to disprescribe HIV all the time, didn't I? Yeah. And it was. My first year as a GP, I remember we had a menopause clinic in the GP surgery and we were giving it to everyone.

and it was very much the fashion. Yes, yes, yes, yes, yes, yes, yes, it will make you feel better now. But also it's going to help you going forward and reducing your risk of fractures and heart disease and things like that. And it, you know, it was very much. And people came back very happy, didn't they? Yeah, they loved it. And then within a year, suddenly this WHI hit. So, I mean, what the WHI set out to do was to look to see if what was suspected at the time was actually HLT was helpful for,

improving your long-term health, was actually the case for all women, not just women around the time of the menopause. Yes. So the women weren't average menopause or women, were they? Like your lady? Yeah. They were, you know, they were American women.

The average age of all the women in the study was 63. So those women often didn't have symptoms, did they? They didn't have the typical symptoms because they've gone through the menopause, haven't they? Yeah, so, you know, they were all a long way through the menopause. some had already been taking HRT before the trial actually started and that wasn't taken into account at the time So and not so overweight weren't they and obese yes yeah and quite a few had had heart disease as well hadn't they Yeah so they weren't it was it's kind of no surprise that their their their horse had bolted if you already see that their

their their arteries had already diseased and then when they were given HR too late, yes, yes, you know, you know, some, you know, some events which... So that's why the daily man and all the papers were saying increased risk of heart attacks, wasn't it? Because those women did have, but they had an increased risk anyway, didn't they? And they were all tablet estrogen, weren't they? And it was an older type of progestogen as well, wasn't it? Exactly, yeah.

So even us that give a lot of HRT, I don't think I would give those women HRT, would you? No. So it's very weird. And I also heard that it was reported, the initial results came out in the summer holidays, they couldn't get hold of any experts. So it went to print. And before it actually got printed, one of the key people said, no, stop the printing, this is wrong. But they said, no, we can't. Did you, have you ever you have that? Yes. Yeah. It's awful. It's a real scandal, isn't it? Yeah. And to think that 17 years later, we're still living with the effects of it. Yes. And when you think of.

All the damage that's been done to all the world. It's a travestle. It's not their HRD. You know, they've, you know, postulated how many heart attacks have happened as a result of all the women that stopped their HT and all the fractures that have happened as a result of all that. And, you know, finally it's actually nice to know, the authors have actually apologised. Yes. You know, it's taken a long time, but it's happened, which is good. Yeah.

And they've now re-analyzed all the data. They've analysed it so many times, haven't they? out the older women. And actually when you reanalyze it on the younger women, it proves exactly what we always thought, which was that it helps at the time if you start it at the right time. Yes. So I think that's within 10 years really about menopause, isn't it? The crucial thing is making sure that women know that if they could start it within 10 years, their menopause, or before the age of 60, that the benefits are going to vastly outweigh. Yeah. So the risk of heart disease is so much lower, isn't it?

It can be up to 30% to 30% Yeah, can't it? I read a cochrane review and it was 52% risk reduction and then I was trying to compare it I don't know if you know the exact figures giving a statin which we use a lot in general practice and also giving blood pressure treatments for reducing the risk of heart disease Neither of which are good. They're not effective. So it's incredible we've got this treatment that reduces your risk heart attack alone and we know that heart disease kills more women than anything else

but we're being denied it a lot of women think it increases our risk it's really important isn't it? Yes and that's why I find it very strange when some or many women come and say oh our GP says we don't give HRT we don't

believe in HRT we don't and you just think well you wouldn't expect to walk into your GP surgery and be told I'm sorry we don't deal with high blood pressure or we don't deal with cholesterol you know it's part of it is isn't it A woman's health is. It is a health of 50% of the population. Because even though the menopause isn't it, it's a natural phenomenon, isn't it? Clearly, we all go through it. It can cause diseases. That risk of heart attacks about five times, isn't it? Because estrogen works to reduce inflammation in our blood vessels, isn't it? And that's why less women compared to men have heart attacks than the foreshies.

I mean, we were essentially designed, as women, evolutionarily speaking. to reproduce and then our job was done. because we were in, we died quite soon. So we were in 1900, you had your menopause at 57 and you were dead two years later on average. Yes. And now, of course, you know, times moved on and medicines moved on and public health moved on,

which is all great and we live far longer. But we haven't got those hormones that we were supposed to have. So, and actually, I'm explaining, I'm trying to reassure women about HRT, you know, and I do like to simplify things. But I think it's a bit like we just need to preserve you. So when you get to the age of around the menopause, we just want to try and preserve your body in that healthy state. Yes. And that's essentially what giving hormones. So this is regardless whether they have symptoms or not really, isn't it?

There's still enough evidence to show. So they don't have to have that. hot flushes they can have anything. But then some people say, well, it's anti-aging, we all need to age. Well, why are you giving us an anti-aging treatment? Do you ever get that tool? No. But, you know, yes, our, you know, our hair does improve with it and our, you know, our skin and our bones and, you know, the joints feel better. Yeah. But again, it's because you're, you know, you're giving back that main hormone. No, I totally agree. I mean, I think some people have said, and I say, well, you wouldn't deny a diet better insulin. No, for

all of these are known to improve the quality and quantity of our life. So everything is, but it's amazing that we're not looking at the bigger picture more. And so we mentioned about our bones. So during the perimenopoles, so when this lady, although she was a runner, which is obviously really good exercise, she was healthy, eating great, hopefully taking vitamin D, which we all should take. her bone density would have been falling quite quickly during the perimenopause, wouldn't it? Yeah. And I suspect that she has kept her bones out of relative trouble by running.

And I also suspect that she actually kept her emotional health relatively good because she was able to carry on her running and cling on to that. But, you know, I think that's the main thing. You know, everyone knows that the menopause is about hot sweats and flushes. and we make jokes about it because that's an easy thing. but actually I think what we see even more of, especially here in the clinic, is actually it's the emotional and the cognitive problems. It's the forgetting things.

It's the mood swings. It's the lack of confidence. It's the low level anxiety. Sometimes even, you know, kind of worse than that and depression. Yeah. And women feeling like they've lost control, they've lost their sense of themselves. It's very scary, yeah. Yeah, yeah, yeah, yeah, I mean, yeah, yeah, I've been suicidal before. They've actively thought about killing themselves. And one lady came from Leeds and said, I didn't know at the time,

but she did say to me after Zunuchin, she was better, you were my last hope. I'd written my suicide notes. I mean, and but she got better. And I, when we, when I did psychiatry in medical school, we never taught about hormones for you. No, no. So, because there are those women, aren't there, that have postnatal depression, yes, then PMS, PMS, POMT, whatever you call it, pre-inventurental syndrome. And then they often get worse, they're very sensitive hormones.

Yes, some sort of reproductive depression, but also they often, when you talk to those sorts of ladies, they have maybe tried the combined contraceptive pill during their life and they didn't get on with it. And again, it's because of that sensitivity to progestogen, which we all have, we've all very different sensitivities to it. But the combined pill is very different to HRT. Exactly. It's often lumped together into one thing. But actually, you know, the combined pill is quite synthetic and higher doses, whereas HRT is one of a natural sort of occurring product, lower doses.

So there's lots of people who can't tolerate or couldn't tolerate the pill are fine with HRT when you get the right one for them, isn't it? Exactly. But you can see why a lot of people are. misdiagnosed with depression, yes, yeah. And I'm sure you've seen, around 70% of women I see have been offered or given antidepressants for their low mood associated. Is you all similar? Yes, absolutely. Yes, so many have. And a lot of the women, because usually by definition of the fact they're in an emotional state where they are being offered antidepressants, that a lot of them don't have the confidence or the self-esteem to actually say to the GP, no, I don't want this. I really want the HRT, which I've been reading up about. It's quite scary. I mean, I don't know about you,

but I get quite scared going to the doctor, because I'm always looking at the clock thinking, oh, they're running a bit late, oh, I don't want to hold the time. And then I go there and I forget what I'm going to say, and I feel all dithering, which is ridiculous. And even when I realized, finally that I had perimenopause of symptoms, I knew I couldn't see my GP because they're quite anti-HRT. So it must be quite hard for women to know how to get the right health, isn't it? Yes, extremely. And, you know, in some surgeries there is a GP that is, you know, a bit more clued up. Yeah, glued up with the menopause.

But, you know, in many surgeries, there just isn't somebody. And you can't always get to see the person you want to see anyway, can you? And it's very difficult for, you know, you know, you know, but, you know, that time of life anyway, and they often can't navigate a complicated system to find the help they need. Yeah. I mean, I often say to people, print off information from my website or get the nice guidance. And actually, when GP's a challenge, they often works, isn't it?

But it's hard. And also just getting women talking about it. Yeah. You know, you know, you know, you know, you know, at a party or in the pub or on the football sidelines watching my son, that actually, if you just start a conversation with some of the mums, it's amazing how they've actually, they've all got symptoms. And they all want to. Yeah, and actually no one's ever really talked to them about it or they've never really understood them. They all then. Yes.

And they're like, all they want is honest, true information. And I think that's a bit of scary, don't they? I thought I thought I thought I thought I thought I thought I had a brain tumour so that people feel quite isolated and actually they really benefit from knowing that actually they're virtually every other woman is going through the same thing. Yeah. So just tell me about this lady again. So you, so she's through the menopause, so she's postmenopausal. Yes, so she's getting symptoms. Yeah, so she's getting symptoms and then she started to get sore in her vagina.

And actually, actually, she's a very together lady. Actually, she started to get quite tearful. And, you know, and talking about sex for a lot of women is not an easy thing to do. And actually, you know, so for the past three years, things were really dry in the vagina. It was really hurting, you know, to have penetration. They tried lubricants. It didn't really work. And, you know, although her husband was extremely supportive, She just found the whole thing very straining on their relationship because that was a big part of their relationship. So that was the third time she went back to the GP and she was examined, which was good. And it was advised that she had some Fadgifem, which is a capessary, so it's a local estrogen. So it's not HLT, is it? No, so it's not HRT, but it just puts estrogen in the vagina, which it can help. And it did help her a little, but she was only given one pack of it, which last. a couple of months, actually, if it works, you're highly likely you're

long term, or actually it didn't then start a further conversation about the menopause in general. So it wouldn't help all of other symptoms, would it? No, it was only going to help the vagina problem she was having. So, you know, it's really felt for her because, you know, at each of the three points in her journey, she'd done the right thing by going to get help. and each time she'd been denied it. and, you know, you know, you know, you know,

you know, so I've explained to her now about HRT in general and said, look, the chances are that taking the HRT is going to help the vaginal symptoms as well as early with the symptoms, but not to be concerned if it doesn't because actually about one in four women on HRT still need some local estrogen as well. Yeah. And, you know, a lot of women and doctors seem very concerned about

you can't have both. But it's not like that at all. Yes, the dose is tiny. Yes, the dose is tiny. Yeah. If you put it in the vagina, it's a drop in the ocean. So there's really no problem using both at all. And you, and vaginaldinas is one of those symptoms that often gets worse with time, isn't it? So once someone's got it, it probably is lifelong treatment, isn't it? And then also you get these ladies that are then starting to get problems with cystitis and recurrent urine infections. Yes, because we've got estrogen receptors in our bladders, haven't we? And that's all tied up with it. And so sometimes we might see quite elderly that are getting recurrent urine infections and they may well be quite long past the menopause. So you wouldn't necessarily give those ladies HRT would you? But certainly if you give them hormones down below, you can make a huge difference. Yeah, I mean I've stopped a lot of women needing anti,

sorry, antibiotics. Yes. Because they keep going, having causes of antibiotics and then the Vagifem just melts it away. And a lot of women think that having a bit of soreness and dryness is just part of getting older, even if they're not sexually active, it can be a real disability, aren't it? They're itching in the night and just not being able to wear trousers the same way.

I guess I remember seeing a lady last year who she was in her late 60s, I think, and her daughter had dragged her in. Yeah. To say that she was really struggling with a vagina, you know, even it wasn't just about having sex, which she hadn't been able to do with her husband for years and years and years. But she was uncomfortable just on a day-to-day basis and sitting down and was getting a lot of urine infections and was itching all the time. And, you know, it was really affecting her quality of life. And so, you know, I examined her in there. She did have quite bad vagina-o-a-trophic changes.

And I gave her some Vagifem and I saw her again after a couple of months. And she came in, I just had the biggest hug. And she had told everybody in the waiting room, apparently, how one of the first. Wonderful her she'd rediscovered it and she had just presumed all that time that this was normal and she wasn't supposed to expect anything more out of life. Isn't it amazing? Yeah. I saw a lady yesterday in my clinic at she was 62 and she'd had a hysterectomy because she had cervical cancer when she was 38. So a long time and she only came to see me because her daughter had been to see me before and I'd been very gradual over the last two years giving small amounts of estrogen, no risk of breast cancer.

as you know she's had a hysterect to me. She's got a new partner. He's 15 years younger than her. Oh, so that's good going. And she said she used to have never think she'd be able to have sex at all. And she's just started to have penitry of sex. And she had a real cheeky grin yesterday. And we're very British. We don't talk about sex, do we? But it's really important. So this lady's on HRT. She's now. So she's given her what the estrogen is a gel or patch or? So, yeah, so what we call body identical, HRT.

which we really believe at the gold standard. It's good evidence, established evidence. It's not a fad, is it? No, absolutely not. No, so you've got the safety of the eustrogen because it's going through the skin, so there is no risk of blood clots or strokes. She's reassuring, isn't it? Brilliant.

And then you've got this micronized progestogen, which is, you know, it's a relatively, it's not a new concept for us, but in the public, it's a relatively new concept, but really it just means it's, It's naturally occurring. It comes from yam plants. So no horses. No, no horses involved. And it's essentially like sort of ground up progestergen so that it gets into our body in a slightly different way and is a lot better tolerated. It has left side effects. Yeah, it's their side effects. So there aren't any contraceptive pills with that in, are there? No, there isn't. No, no. And there's, you know, evidence to suggest that it's safer in terms of our breast. Yes. So that's the one to know for it.

Yeah, you know, there'd be very few reasons to not go for that combination. Yeah, yeah, so she's gone away with that. And I also gave her some vagifem to help with her vagina because it might be that the HRT is going to help her in that respect, but it's going to take about three months. Yeah, for most symptoms. Hot sweats do tend to go away very quickly with HRT and they're a useful barometer. But actually a lot of the other symptoms of the menopause, the more subtle symptoms, the mood symptoms, the joint pain. the vaginas, yeah, yeah, usually three months and then things should all be starting to fall into place. She'd have symptoms for so long. Yeah. And, but they, people get, still get better quickly, don't they? It's quite incredible. Yeah. It's why it's such a rewarding job. Yes. Yeah. So, well, that's been brilliant. Thank you very much. I think we've covered quite a lot, haven't we, in a short space of time. But I hope it's probably brought out lots of questions, but I hope it's reassuring and can just help people think a bit more about their own hormones really. So if you want more information about the menopause, the nice guidance are readily available through the nice website, but there's also my website which is www. menopalsdoctor.com. UK which has a lot of information, it has a lot of articles, it has some videos which is all evidence-based and non-biased information so you can download, print off, challenge your doctor or your nurse and just talk. Talking is really important.

Thank you. This podcast was produced and edited by E4H. All rights reserved. This podcast is provided for information purposes only. Please consult your healthcare provider regarding any medical conditions you may be concerned about. Podcast guests, views and opinions are their own.