The Dr Louise Newson Podcast - 015 - Menopause and Nursing - Diane Porterfield & Dr Louise Newson

Episode Date: September 17, 2019

Diane Porterfield-Bourne is a Nurse Practitioner with over 30 years nursing experience. She runs www.bourne2care.co.uk and provides menopause education talks in the workplace and through organised events. She is committed to raising menopause awareness and feels very passionately about women's health and how menopause can affect women physically and emotionally. In this episode, Diane talks to Dr Newson all about her work as well as the ways she works with menopausal women from different ethnic minorities.  Diane Porterfield-Bourne's Three Take Home Tips: Read up on the menopause and discover how it may affect you. Talk to your GP and arm yourself with the correct, evidence-based information. Be open and honest with your families. Explain how you are feeling so they can support you.

Welcome to the Newsome Health Menopause podcast. I'm Dr Louise Newsom, a GP and menopause specialist, and I run the Newsome Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. Hello, today I'm really pleased and delighted to introduce to you Diane Porterfield, who's a nurse who I've known for a little while now, and I'm thrilled that she's been doing more and more with me in my clinic and also to improve care of menopause or women. So hi, Diane.

Hello, Louise. Thanks very much for coming. So you're a nurse practitioner, but you've also got your own company, haven't you, called Born to Care, but there's a bit of a play on the word born. So perhaps you could just say initially what you do and what your company is. I'm a nurse practitioner.

I've been nursing for over 30 years now. I developed Born to Care about five years ago because I realised that there was a need for more education with women generally in the workplace. and socially just to educate people on their health. And so really the last couple of years I've specialised more in menopause care and I've been giving talks

in different settings and workplaces and in social groups and individually to women really trying to empower them and educate them about their own health and how menopause can affect their lives and the families really. So how did you get into menopause more? I met a lady a couple of years ago

that had had a really awful time with her menopause and she didn't know anything about it. And she realised that there was very little help out there and she asked me for some support. So I did some research. And there were I read into it and read the nice guidelines and lots of your research as well.

And I realised that there was a real problem here that people didn't know enough about menopause. And had you realised that before at all? No, it wasn't anything I'd really been involved with in the past. But that was a real catalyst really. And everything changed from that point on. Because it is interesting, isn't it?

So I've always looked after women who have been menopausal, but I never realized there was such a big problem because I'm sure in your clinical practice as well, we see people who come to us, we treat them, and then we go to our next patient, we treat them and so on. And sometimes we don't realize how other people are maybe not being treated the same way or not having the same experience. And so the nice guidelines are the National Institute of Health and Care Excellence guidelines, aren't they? And they came out in November 2015. and they're the first nice menopause guidelines on the diagnosis and management of the menopause. And I don't know about you, but I was actually quite excited when they came out. It's a bit nerdy, being excited about guidelines. I've read them quite a lot.

Yes. And compared to a lot of guidelines, they're not too long, are they? There's a good summary. There's a good version for women as well, isn't there? So, yeah, they're very easy to read. And from a health professional perspective, it gives you some very clear guidance about when blood tests need to be organized. for patients and really what women need to expect as well. So for me, I then speak to my colleagues. Yes. I work in a walking centre, in a city centre, and I'm with lots of different nurse

practitioners and see lots of patients with lots of different health needs. Yeah. So for me, I can use the basis of the nice guidelines to make judgment calls on what treatments and advice these patients really need. Which is really good, isn't it? Because I think in the past, The menopause has been quite fragmented And I know certainly even in my practice Where I used to work as a GP We all had different views about the menopause And sometimes that would lead to quite confrontational

Practice meetings Because I was very adamant how safe HRT was And other doctors were saying Gosh no, it will give people breast cancer Yeah So actually to have a guideline that says For the majority of women The benefits of HRT outweigh the risks

Yeah It's really good isn't it? And it's something to back things up So when people say to me doesn't it cause breast cancer? And I say it doesn't cause breast cancer. I said if it did cause that many health problems, then there wouldn't be nice guidelines advising it to be first line treatment. And then people are like, oh, I didn't realize that. And that's, and that makes it a lot more credible, obviously. Also, you say we're just touched briefly about the blood test because that

causes a lot of confusion, doesn't it? Very much so. So what do they say? Just remind us what it says about blood tests. Well, the test are basic view, age of 45 and under. then blood tests can be indicated to check for certain levels to see if you've got some menopause or symptoms. If you're under 45, then it's incredibly important that you get further investigations. But if you're over 45, if you don't need a blood test to let you know whether you're actually experiencing the menopause or not. If the GPs want to test your thyroid or other levels, that's completely normal. But certainly not to identify menopause. Because I'm sure you've spoken to, and I've certainly spoken to hundreds of women who have said,

Oh, my doctor said my blood tests are normal, so therefore the fact that I haven't had a period for three years, I can't be menopausal. Well, that's rubbish. It's all about the symptoms, which is so important because also it means we can crack on and help people. And like you say, education is really key. We're not here to say that every woman has to take HRT. But I feel, and I know you do, that every woman should have the right education about the menopause and the effects that it has, doesn't it? So, as you know, it causes so many different symptoms, not just hot flushes and sweats. And one of the things we were talking about recently in your walking centre that you go to was the number of women that have urinary symptoms. Can you maybe just talk a bit about those?

And why would urinary symptoms be related to menopause? A lot of people can't understand the link. Yeah, I see this an awful lot. Ladies in the 40s and 50s coming into the walking centre, thinking they have a urinary tract infection. Take a four history, dip test their urine, and there's not a hint of anything in it at all. I then speak to them about their menstrual cycle, and then they'll tell me that either they don't have any periods anymore or they had a hysterectomy and they don't have periods.

And that brings me into the subject of discussing menopause and low estrogen. Does that surprise them? Yes. They can't make the link at all. And they're really surprised that I'm having a conversation about menopause. when they've come in because they think they need some antibiotics. But I identify that the most likely cause is the fact of there's something called the genitone urinary symptom syndrome of menopause,

which is a collection of different symptoms that women get when they're a pausal that has urinary symptoms, frequency, burning, stinging, vaginal soreness, vaginal dryness, incontinence, all these various things, painful sex. And all these are linked in with lower. estrogen. All the estrogen receptor cells are now depleted of estrogen, which causes the changes in the genitoneary tract that causes the problem. Yes. And it's interesting, isn't it? So not everyone even knows about estrogen receptors being present on our vaginas. And around 70% of women have some degree of vaginal dryness, so the lining of the vagina becomes thin,

less elastic. But also, like you say, these estrogen receptors are on our pelvic floor, aren't they? they're in our bladder. So a lot of women say they cough and sneeze and it's a problem. Or they put the key in the door when they come back from shopping and, oh my God, they've got to run to the toilet. And then when you talk to this, yeah, that has changed recently. I thought it was just because I was getting older. These women aren't old. They're in their mid-40s, mid-50s.

That's not old, is it? And it's usually related, isn't it, to the low estrogen levels that occur? And they've no idea that it's to do with menopause. They literally think it's this one particular problem. And in the past, they've been treated with antibiotics for neuro infections. Some women have had samples sent off to the lab to be tested. Obviously, if there's an infection, that's different. Totally.

Of the majority of women that I see, it's more to do with the fact they definitely have vaginal symptoms of the menopause. And when I discuss that with them, it's a bit of a lightbulb moment. And they realise they need to maybe investigate it further. Yeah, and it's very important because we know, don't me as clinicians, we shouldn't be prescribing as many antibiotics. It's a huge problem with antibiotic resistance. Dame Sallie Davis, the chief medical officer, has done a phenomenal amount of work,

making us aware of antibiotics overuse. But a lot of women still have been given antibiotics quite repeatedly, aren't they? Which they don't need, as you say, if they've had a dipstick or they've had their urine sent off and it's negative, then we shouldn't be giving them antibiotics. So what can we do? How can we help it? I think from a nurse's point of view, we need to be educating women about the signs and symptoms of vaginal problems during the menopause and encouraging women to read up on the information about vaginal dryness and urinary symptoms associated with menopause and be aware that it can quite easily happen and that it's something to be aware of and discuss it with your GP. There are vaginal lubricants and moisturisers you can buy over the counter.

But they vary, don't they? They do. Some are very good. There are some brands that I would recommend, such as Silk and Yes and Regal. Yes. And there are some that I wouldn't advocate because of the alteration in the pH.

Yes. I mean, we don't want to name and shame, but I do think it's worth saying K-Y jelly, which is something we use to examine women. It's fine in the examination room, but it should say in the examination room. And not to be used. I do hear women using this a lot and to colour must drain from my face when they tell me that.

Yeah, because it's quite drying. And also it can. cause some irritation as well, can't it? And then other people go to chemists and they'll buy something that's scented or your face is going on already. Or some of them are flavoured and it's a massive market out there, isn't it? And then some patients say to me, well, my husband's so desperate for sex, he goes to Anne Summers and he'll pick something off the shelf. And then a lot of them say it's smarts, it makes it more painful, but they're so desperate to please their partner. They think that's as good as it gets.

So it's very important and certainly, I know you do and we do here. We have lots of samples of these products you've mentioned and we give women a choice because it's like choosing your face moisturiser, isn't it? So these have not got hormones in them at all and they just draw the moisture in, don't they, to the cells. And they can work really well and some women won't notice they reduce the frequency of urinary symptoms as well. So that's one treatment. What else can women do? Well, there are lubricants as well that they can use.

before they're having sex and certainly, you know, clothing, underpants and trousers are causing invitation. But also the things like vaginal hormone replacement therapy as well as systemic hormone replacement therapy. So the two are quite different, aren't they? So the vaginal treatments are not the same as systemic HRT. So we just usually call vaginal estrogen. So women who can't take HRT for various reasons or don't want to can have vaginal

estrogen quite safely, can they? Absolutely. And there's virtually nothing that's absorbed into the systemic system. It just stays in the vaginal area and feeds the estrogen receptor cells there. So they start to flourish again really and preventing all the symptoms that they've been experiencing. So how do people use that? What's just to explain? Well, there are the creams.

The most common one is a pestery in which you insert a little bit like a tampon applicator into the vagina. And it's like a maintenance. So you might put it in every night for two weeks. and then you use it a couple of times a week for the rest of your life really. Yes, and that's really key, isn't it, the rest of your life? Yeah. And the reason I'm picking up on that is that traditionally in the past, we were told that women could only have it for a few months.

When their symptoms improved, you stop, which is the worst thing to do, isn't it? Because all the symptoms return. And once the lining of the vagina is thin, it stays thin and gets thinner without treatment, doesn't it? So the guidelines, the nice guidelines are very clear that local vagina on estrogen should be used in the long term. So for women, that usually means it can be put on their repeat prescription, doesn't it? And they should carry on. So that's really important.

So you can have it as a pezzary, have it as a cream. And then there's also this esterring, isn't there, this little plasticated ring that's got estrogen in, which some women use that lasts for three months, isn't it? Yeah. There are lots of different ways of getting the estrogen there. It's whatever suits you when you're happy with, really. Yes. And there's also a new person.

product that's just been launched. I don't know if you're aware of that has got DHEA, which is a precursor for estrogen and testosterone, which is as, it comes as a pezzary actually. And that can stimulate the testosterone receptors, which we have in our vaginas too. So that's interesting. It's all about choices, isn't it? And having that's right. Options. And these can be used with moisturisers as well, can't they? So, yeah. And I think the moisturizers are really important. Totally. Yeah. I think you really, I say to women, I know it sounds an awful lot of information. to begin with. But once you've achieved

stuff like a maintenance in your body, then everything will start to improve and it's literally just sort of top-ups in a way and keeping everything to a certain level that you've now achieved. And it can make a huge difference, aren't it? And I mean, I've certainly seen women

who have stopped wearing underclothes or even sitting down is really difficult. Someone told me the other day that she'd stop going out with her friends and the friends were laughing and saying, oh, is that because you've got a new man in your life and joking? And she actually became more, more,

withdrawn and then one of her friends took to one side and said, you're okay, what's going on? Why you're coming out? She said, because I can't sit on a rubber ring and I can't come out to you to the pub or the cinema because it's too embarrassing and she said, gosh, don't you need help? Well, yes, but I don't know where to go. And women don't talk about the vagina or symptom. No, of course not. You can talk about hot flushes and have a bit of a laugh almost with a fan but you can't talk about how sore and uncomfortable your vagina is so easily, can you? Well, I give I give menopause awareness talks and I always discuss about vaginal problems and it's women go fairly quiet. Everyone listens very intently and everyone, I always provide lots of samples.

And I bet they all go. They all go and women often speak to me in private about it because it's a big issue. Relationships are suffering because of it. It totally are and it's quite staggering when you look at some of the research. So around 70% of women we think have symptoms. I'm sure it's even more, but only 7% of women have treatment. And I read recently that around 40% of women, it takes three years to actually ask for help. And then what's even worse, which has frustrated me beyond belief,

is that around 50% of women who actually see a healthcare professional for their symptoms come away without treatment. I hear that all the time, unfortunately. And I'm always lost for words, really, when people clearly have... It's quite severe or certainly has significant menopausal symptoms that have an effect on their physical and their quality of life. They can't function correctly. Their relationships are suffering. Yeah.

And they're being refused. Yes. Yes. Even though there is no need, there's no reason why they can't have it. So that's certainly something needs addressing. But even those women who don't want, like I say, to take HRT or even women that have had breast cancer who taking HRT needs to be very individualized, these women can still usually have vaginal estrogen. That's right. And I think that's really important because a lot of women

are being turned away for treatment for their local symptoms because they, people think it's the same as HRT. Yeah. And it's again, it's educating women that the vaginal estrogen that they can have doesn't affect them. It doesn't go into their main bloodstream. It just treats the cells in the genitonearer, the urinary tract. So all the vaginal, the urethra, all the vaginal symptoms will be relieved by having. So even though it's in the vagina, it still helps the urinary symptoms as well, which is really good. And then there is another treatment that's also coming out called ospernapine, which is a tablet. I don't know if you've heard of this, this oral tablet. And it's a firm. It's called a selective estrogen receptor modulator, a bit of a mouseful. But it actually stimulates and helps

estrogen receptors in that area. So some women who, sometimes it's too uncomfortable, isn't it, for them to assert something in their vagina, are also elderly people who have got less manual dexterity or a tablet is actually quite a good choice and I'm thinking about those women in nursing homes who have symptoms. It's a lot easier to give someone a tablet rather than having a district nurse to come and give something vaginally. That's right. Again, it's another option. And it's the practicalities and it's like you said it's a very individual thing, HRT. Custis. So what suits some women doesn't suit others. So for the elderly people in the nursing homes, but you know, vagina problems can be quite significant as well.

Totally. And so we were also talking earlier about you working in an inner city area in an out of hours. So the population there you were saying is quite ethnically mixed, isn't it? Yes, it is. So you see quite a few women from ethnic minorities who aren't really allowed in their culture sometimes to even talk about the menopause. Is that right? That's right.

And again, it's only because I'm so up to date with menopause symptoms that I start to ask a question about their menstrual history. and if they're having any menopause or symptoms, because most of them have come in with either joint pains or they think they've got a urine infection or a vaginal infection. And once they actually tell them and explain to them what the symptoms of menopause are, they start to disclose the problems that they're having. And again, talking about painful sex isn't something that they would be open about. But because I've actually asked the question direct to them in a confidential way, they feel quite comfortable to be open and talk to me. me about it. This is something, certainly some Asian communities they really can't talk

about, can they? No. No. And I've spoken to quite a few ladies that have just said that they have to have sex and it hurts a lot. And I'm saying that it doesn't have to hurt with the right treatment and at least we've discussed it today and I can certainly guide them to get some lubricants and

moisturizers that they can literally buy there and then and use as a starting point. It's really important, isn't it, that people get the right information and don't see it as an embarrassment. No. something that's almost a necessity as they get older. And do you think these people that you talk to will talk to their friends and try and educate them? I do say that to people, but I think we're a long way off yet.

Long way off. I think it's just if we can help one individual person and then they'll realise that their symptoms are improving. I just think it's going to be quite a slow process because it's not something. We're a lot more vocal about our symptoms. Some of the minority groups that we see don't. like to discuss things that are quite intimate. Yes. So it's changing that culture, isn't it?

But if we have the information more accessible, then it's easier, isn't it? I think certainly with my website, it means you can hide in the toilet and have a look, can't you? Yes. You don't have a leaflet lying around at home for your partner to see and almost be disappointed that you're having these symptoms. You don't have to disclose it in the same way, do you? And it's acknowledging, it's making people realise it's actually, it's quite normal when you become menopausal to get these symptoms.

But it's not the end of the world. It's just something that you need to recognise. And get treatment for it. Yes. And it's as simple as that really. Because like you say, we now call it Genitia Unary Syndrome of the Menopause, GSM. It used to be more cold. And some people still do call vagina vulval atrophy.

If you look at atrophy, the meaning in the dictionary, it means wasting or withering away. It's not a great term is it. It's a bit depressing. If you're only in your 30s, 40s, you know, and they have these symptoms, because it's not just older women that have symptoms. No. I've seen some women who have started their menopausal symptoms by having vaginal soreness or itching. And it's completely throwing them.

They haven't realised at all. So talking about some of your events, you've done some here at Winton House, where I run my menopause clinic. And you've got this lovely tree, haven't you? Which, the first time I saw you, you came upstairs with this tree. Hi, Diane. What's you doing? So just tell me about your tree.

It's my, I call it my menopause tree. Basically, it's the branches of the tree. My logo on my website, my menopause or just me website, is a tree. So the root causes of the menopause are the reduction in estrogen, progesterone, testosterone. But it's about aging as well. So those are the root causes of what causes the menopause. So on the branches of the tree will be the symptoms. So what I like ladies to do when they come to my talks here, particularly at Winton,

is that we've got little labels and they write down their main problems or their symptoms or their worries related to the menopause and they hang them on the tree. And we talk about their symptoms. So they can do that anonymously, can they? Yeah. I just give them a little label just to add on really. And they like that? Yeah.

Yeah. It's a bit of a novel thing. But it's just emphasising the fact that, you know, and the majority of women, when I give the talks, that they all have the same problems. Yes. And it's just normalising it and making people think, that they're not the only ones for these problems. I mean, people become very relieved, don't they, when they know they're not alone?

Absolutely. Because it can be very isolating and quite scary. I know I had symptoms for a few months and I had no idea, embarrassingly, what was going on. But I had so, my motivation was so low, my energy was so low. I just felt generally flat and joyless and I just didn't want to do anything. And if I had to then come to one of your talks and realise other people were feeling the same, You can't say to your friends, oh, you know, I feel so fed up. I don't know why, but I really do.

It's almost like admitting your failure, whereas actually it's because of your failing hormones. So it's good. And I think, like you say, if you give women a passport to talk, then they really talk, don't they? Yes. And it's something that women need to do a lot more about. Yes. It's really got to open up, remove the taboos and the shame associated with it.

Yes. Because it shouldn't be a shame. I mean, it's a natural process, isn't it? isn't it? And we're not here to medicalise the menopause, but if we go through or when we go through the menopause, we do have an increased risk of really important conditions, don't we? Yeah, and that's what I'm more concerned about really, the long-term effects of low estrogen in the body, the risks of heart disease, stroke and osteoporosis. Yes, because these are really important. Most of us will die of a heart-related condition,

won't we? I've worked in the emergency department for years, and I used to see four-year-old men having heart attacks all the time. Never did I see a 40-year-old woman coming through the door with a heart attack. And it was only when I learned about the menopause. I realised it was the estrogen that was protecting women against heart attacks. Of course, when it starts to deplete, particularly in the 60s, that's when you start to see some changes occur. Totally.

That's why it's important that people know if they can have HRT and it's something they'd like to do, the sooner they start it, the better protection. Yes, because it's an anti-inflammatory on our blood vessel walls. and it reduces that atheroma. It can also lower cholesterol as well. So it's very important to think of it almost as a treatment to reduce the risk of heart disease. Yes. Which is quite weird for some people because some of the misinterpretation in the media from studies has said that HRT increases the risk of heart disease.

I know. But we know it doesn't. No. So it's very important to get the right information, isn't it? And like we said before, it's very clear that that's documented on the nice guidelines as well. So it's also got some very good news which I'd like to share with everyone that's listening in that you've recently been working really hard, really hard, and you've passed something. So tell us what you've done.

I did. I did the non-medical prescribing course at uni and I passed my prescribing course, which means that I can prescribe medications now. Yes. And so, yes. Which is phenomenal. So we're going to get you here to stay some patients, see some women. Describing HR too. Yeah, so you can prescribe HR too.

And there's a lot of nurses who are nurse prescribers, aren't they, which is so good because it's the missing part sometimes of your consultation, isn't it? Yes. And nurses, I know, we've been always more hands-on. Yes. And it's nice just to be able to sort of like, it's a complete holistic approach to patient care. Yes. In which you're seeing patients assessing them, diagnosing them and prescribing them treatment and giving them follow-up advice. So it's that lovely continuity really.

and particularly with the menopause, I find there's a lot of satisfaction from that. Because once you've identified what the problem is, you've explained what they need to do. It really is it's a bit of a turning point in their lives. And they realise that, you know, there's hope and there's light at the end of the tunnel. Yes. So it's really good. And I think more and more nurses traditionally have been involved with contraception, haven't they? Certainly in primary care and GP practices, it's usually been nurses that have done contraception very well indeed. and then certainly through my training they started to do asthma, diabetes, high blood pressure

because nurses are so much better than doctors sticking to protocols and doctors got off at tangent quite often. And sometimes nurses have slightly longer appointments in private care as well, which does make a difference, especially think about the menopause. So actually there's a lot of move now to think about nurses helping GPs to help with the menopause. And a lot of nurses are of menopause. people's all age, aren't they? So when I lecture nurses, there's a whole stream of questions and it's often about them as well. So if we can help nurses to educate women, but in the

same way helps themselves, it might keep them staying at work a bit longer as well, might, isn't it? Yeah. This is something that I'm really concerned about. It's a huge problem, yes. I'm of the same age. It's taking years of hard work and training to become quite senior in your nursing roles. And many people of my age, the women, are leaving. because they've got menopausal symptoms that aren't being addressed and they're not being helped in the workplace. So again, what is worrying is all that knowledge and all that experience that they're leaving or reducing their hours.

It's wasted. So they're not mentoring other students and passing on their information because they're leaving the workplace because nursing is a difficult environment, hot hospitals, aprons, gloves, long hours, very little breaks. It's detrimental to your health really.

When you look at the figures, it's huge, isn't it? And some of them will leave for other reasons. But we know from research that we've done in West Midlands Police that around 20% of women give up work because of the symptoms of the menopause. The most common symptoms that affect people at work are anxiety, fatigue and memory problems. So, you know, when you add that to a really busy job,

then that's understandable that people are leaving, but it's a shame because there's true. treatment if they have the right education. Talkingmenopause.co.uk have just started working with our local hospitals is actually here, so Heartlands, Good Hope Hospital and Queen Elizabeth to give education into NHS employees, which is brilliant. Desperately needed. It's desperately needed because if we can look after our staff in the NHS, the NHS is at breaking point anyway, isn't it? So actually to help retain staff. And it's not just about what's, the problems to the NHS, my worry is that these women are leaving work early, but they're not

having good lives. They're at home, they're tired, they're falling asleep on the sofa, they're not enjoying their grandchildren. And then, like you say, they've got this increased risk of heart disease, osteoporosis. So we have a duty to help those for their future lives as well, don't we? And also the nurses that are there that continue to work, if they have the right education and the right advice, they can continue working, but they can also identify patients on the ward, women on the ward, that may be experiencing menopausal symptoms and they can identify with them and say, well, actually, maybe you need to be thinking that you're menopausal and looking for some treatment and providing some advice, or at least having that

conversation with them. And again, the patients might not even realise that they've got it. Absolutely. And it's about passing the information on, really. And coming from a health professional to the patients, the ladies on the ward, you know, that's what's needed. It's huge. Totally.

So it's all about education. It is. Very much so. So thank you ever so much. That's been brilliant and I hope that's been very informative to you listening. So just before we end, I would like to ask Diane three take-home tips just from our brief conversation today that people can reflect and hopefully learn from. I think one of them is to read up about the menopause and see how it could affect you. Discuss it with your GP but always make sure that you take plenty of information with you so that you're armed with the information about the menopause. and be very open and honest with your families as well and explain to them how you're feeling

and so they can be supportive of you and you can all find a solution together. Brilliant. Thank you. Very wise words. Thanks ever so much. Thank you. For more information about the menopause, please visit our website www.w.menopausedoctor.com.