The Dr Louise Newson Podcast - 019 - What is Perimenopause? - Sheona Khan & Dr Louise Newson

Episode Date: October 15, 2019

Sheona Khan is a medical writer who has been working closely with Dr Newson for several months. In this weeks episode, Dr Newson and Sheona have an open discussion with about how much she has learnt regarding the perimenopause and how little she knew about it until recently. They discuss ways of improving knowledge for women about the perimenopause and the menopause and also the importance of women receiving evidence based and non-biased information. Sheona asks Dr Newson questions about changing hormones, making a diagnosis and HRT and Dr Newson explains why she feels that younger women should be equipped with the right information regarding their future hormone health.  Sheona Khan's Three Take Home Tips about Perimenopause: Talk about it - make those conversations happen. You could be going through the same thing as a friend! If you are in your 40s and are experiencing tiredness, forgetfulness or stress - don't dismiss it, start thinking about your hormones. Don't wait for your symptoms to get really bad before you consider HRT. The earlier you start replacing your hormones, the better!    

Welcome to the Newsome Health Menopause podcast. I'm Dr Louise Newsom, a GP and menopause specialist, and I run the Newston Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. Hello, today I've got Tiona Kahn, who is a freelance medical writer with me. And I first met her, we were saying just now about six months ago, and she's actually married to her local GP, and has been doing a phenomenal amount of work with me with medical writing, obviously all about the menopause.

So I thought I'd bring her in today to talk a lot about what she knew about the menopause and perimenopause and what she knows now and hopefully how that's changed her perception. So hi, Shiaena. Hello. So tell me a bit about what you do, first of all. So I sit at home in my kitchen on the laptop writing most of the time about. about two years ago I decided I'd been a speech therapist for over 15 years working with people with brain injury and I wanted to have a change and I'd always like writing and I was interested

in a lot of different medical topics and found more about medical writing and decided to just branch out on my own and give it a go and I think I emailed you about six months ago because I was looking for businesses that were fairly local providing healthcare in a topic that I was interested in and I thought, oh, this menopause clinic looks like the right kind of business. I'll approach them and, yes, you wanted my help, so that was great. Absolutely. So you don't want me saying you're 42. 43?

43, so you're 43. And what were your thoughts about the menopause before you became insmed into my trap of educated people about the menopause? What were your thoughts when you first saw the website or just thinking in general about the menopause? I had never really given it that much thought, certainly not for myself and the fact that I would be going through this within the next 10 years or so. It's not something I remember talking about in the past with my friends, although nowadays those conversations are happening. I had heard of the term perimenopause.

I have one friend who's a doctor who uses that term a lot whenever she's, you know, got a poor memory or she's done something silly or she's in a bad mood or, you know, she kind of jokingly. blames it on the perimenopause. It's not that she's really having any proper symptoms of it, but I knew the term meant before, you know, your period stop. Did you know what symptoms it were associated with it? All I knew in terms of symptoms was hot flushes and mood swings or being tearful or irritable. And, you know, the things you pick up perhaps from television or in a book about women of a certain age go through the change and how they might be. you know, moody or not themselves. So I just knew what anyone else would have known about

the menopause and what that might be like. All I knew from my own mother was she apparently went through it very smoothly and said, well, one weekend I was expecting my period. It didn't happen. So that was when I had the menopause where they just apparently stopped and that was it. She was very lucky. That's the story she used to say was that it happened one weekend and that she didn't really have many other problems with it. I can remember there being a time when she was more emotional, which I'm assuming was around that time as well, but she wouldn't necessarily have spotted that that was down to. Well, that's the thing, isn't it? Yeah. And I think the whole perceptions of the perimenopause and menopause vary so much between people

and I'm hoping some of the work that I'm doing and other people are doing is trying to change that perception. And I was thinking quite a lot this morning about the perimenopause because for some of you who might not know. The menopause is when your periods have stopped for at least a year. So it's a look back in time diagnosis. But the peri menopause, as you know, peri just means around the time of and clearly the menopause. So the peri menopause is when often periods start changing either in frequency or nature. And that means our hormone levels start changing. And with that, you can, or women can experience menopausal symptoms, which we'll discuss in a minute, but they range a lot and vary between women. But because hormones are constantly changing, symptoms are

constantly changing and they can alter sometimes by week by week or day by day or even month by months. So a lot of women feel fine for months and then they suddenly get these symptoms. And like you say, it can be very hard to recognise. And the problem is often is that the menopause is still a bust of many jokes. Like you're saying, your friend is sort of saying, I'm having a menopause or moment. And then it can be amusing for those people that aren't menopausal to say that, but actually when women are menopausal, it's very frightening or even perimenopausal, it's frightening, it's scary, it's isolating, you don't know what's happening to you, your brain is not in control, and often people don't know that it's related to their changing hormone levels. And even,

I'm sure you're aware that I had symptoms for six months or so, and I had no idea what's happening to me. I kept forgetting dates. I kept forgetting even drug names, my children. I kept forgetting to take swimming lessons and everyone was saying it's because you've got working too hard, you've got too much going on. And I said, but I've always worked hard. What's happening? And it's very, very scary. And even me as a menopause specialist had no idea. I think that's something I've definitely learned is that the symptoms can just creep up and you can put them down to other things I think as women, when we're busy and we're doing for everybody else all the time, we can easily just not necessarily dismiss, but just put on the back burner how we're feeling

or how tired we are or how stressed we are. And you think it's just because of everybody needing you and wanting you. And they're having a piece of you, so therefore it's just you haven't got that extra. And, you know, as we get older, people say, well, gosh, I'm now 52, I'm now 57. and I can't expect to be how I was 10 years ago, but that's still quite young. And certainly, perimenopals or ladies are often in their mid-40s because the average age of the menopause is 51, so often in the mid-40s, symptoms start. But as you know, the early menopause is under the age of 45, and then we often define

it as premature ovarian insufficiency if women are under the age of 40. But one in 100 women under the age of 40 have an early menopause, which is really, really, common. So you're 43. So you, do you have friends, do you think, who are perimenopausal? I do actually. I was having a walk with a friend the other day who's exactly same age as me and she said she hadn't had a period in five months. Okay. But hadn't been having any other symptoms, although she was going through quite an emotional time and again, she was putting it down to another situation going on in her life. So again, having worked with you for a few months, I did say to her, well, just remember if your periods are changing,

then hormones are going to be playing a part in how you're feeling as well and how you're thinking, not just periods themselves. So was she going to do anything about it? I just wanted to sow the seed with her that, well, because she wasn't that concerned that she hadn't had a period in four or five months, but I said, well, if changes are happening, just be aware. Because if you're starting to feel worse, either physically or, or emotionally, psychologically, then you should definitely consider that as a possible.

Yeah, and I think it's really important. I was actually talking to Meg Matthews, who some of you know who runs Meg's menopause. She's a phenomenal advocate for getting good menopause education. And she was saying to me, she's being stopped by a lot of friends of hers or people even on the street who are young in their mid-40s, early 40s, who were having brain fog, memory problems, energy problems, poor motivation, and they're still having their periods. And they're saying to make, what do I do? It sounds like a menopausal, but I'm still having my periods. And a lot of the times these women are going to try and get help and they're getting

antidepressants or being told, or just carry on, it's just your life. But they know something's different. And so we often in the clinic use the green chlamatheric school, which is a menopause waiting questionnaire. And if you go on to my website, and just search questionnaire, you'll find it. And so often it's useful for people to fill out the questionnaire, and there's different symptoms, and they're rated. And we often say that if people have some of those symptoms and their periods are changing or stopped,

and certainly if they've had a hysterectomy or had a marina coiling or take the mini-pill, they might not have periods. They can still fill it out. And if they're ticking lots of boxes, they need to think about their hormones. But it's difficult. I don't know if people talk to you about it, but lots of people want to go and have blood tests

to see what their hormones. Yeah, because they probably have heard a few different opinions from friends or family already and then they'll go and see the GP with another opinion and they feel like the blood test would be the accurate truth as to what's going on. Can I ask, because I have the myrina coil, so I don't really have periods.

Yeah. How would I know? if things are changing? So it's really difficult. It's a great question because periods are a sign that our hormones are changing. But like you say, if you don't have them, what do you do? Certainly we just do all our work out of the nice guidelines, the National Institute of Health and Care Excellence guidelines,

which are very clear about the diagnosis. So if a woman is over the age of 45, then you don't need hormone levels. And the reason being is that hormones are changing all the time. and I could do a blood test on someone who's 46 with a marina coil who's got some symptoms that she's ticked on the questionnaire and she might have a normal, it's normally the FSH, the follicle stimulating hormone level. And then I might see her a week later do the blood test again and it will be elevated. So if the blood test is abnormal, it can be helpful. But if it's normal, it just means it's normal on that day.

So then a lot of women are told incorrectly by their doctors or their nurse or whoever does the blood test, oh, it's not related to your hormones, but that's only about that day. So there's a lot of false reassurance that's going on. And then the guidelines say, if a woman is between 40 and 45, so this is where you come in, and has symptoms that could be related, then blood tests may be helpful. So that's not very helpful, suggestion, really. And it's really only, if we're really not sure, then it can be helpful, again, if it's abnormal. if you had some symptoms, I did your FSAH level and it was elevated, then I'd say, well, it's likely to be related. If a woman's under 40, then the guidelines recommend women should have

an FSA level taken at least six weeks apart. And if there's two elevated ones, you make the diagnosis. But I have seen and spoken to a lot of women who, even the underage of 40, have had normal levels. And that's just because you depend where their cycle are. One lady I saw had been suffering for 18 months and she'd had one elevated level 18 months before I saw her and then another one six months later which was normal so she was told she couldn't be her hormones her periods had practically stopped she'd given up her job her partner had left her she spent most of her day staring at the walls in her house because she had no motivation no energy but people kept telling her it's not her hormones and in fact she was getting night sweats and somebody said to well just buy a stronger

deodorants so really awful advice um and often we don't know for sure because even i know you've seen the questions on the questionnaire they can be related to like you say life changes so if someone's got low energy low mood reduced motivation you know that could just because they're tired or stressed for other reasons so often we'll say to women they haven't got any contraindications we can try some hr t and see and if after three months when they come back to the clinic, they say, do you know what, I feel so much better, then they've answered the question. If they come back and say, do you know what, I don't feel any different whatsoever, then it's unlikely to be related to the hormones. A lot of people don't feel completely better

after three months because, as you know, we often need to change the dose, sometimes the type of hormone, but it gives us an indication. And because HRT is so safe, it's very low risk giving someone something to try. Sadly, what's happening is now a lot of women with symptoms are getting antidepressants and they'll say, oh, they numb my symptoms a bit, I don't feel much better. And we know those women aren't depressed. So it's having an index of suspicion is really important. And a lot of women are thinking they have to wait till their menopausal before they get help. And it's confusing because when you read about the menopause, it's always about menopausal symptoms whereas we should call them peri menopausal symptoms because they're exactly the

same symptoms yeah so there's not symptoms that younger women tend to have more often than in if they older no not necessarily and traditionally if you read a textbook they will say that people start with baser motor symptoms so hot flushes night sweats and then they can develop other symptoms such as palpitations migraines and then traditionally people say later on people then get women often get vaginal dryness, soreness, urinary tract infections. But there are a lot of women that have it the other way around. So I'm sure you know Jane Lewis, who wrote my menopause vagina.

She actually had normal periods, very regular, and then suddenly got vaginaldriness. So she was perimenopausal, and everyone just said, oh, it's not related, not related. And then she got to the stage where she couldn't sit down, wear trousers. She was actually talks about being suicidal. She was in so much pain and then started to develop a few but not many other symptoms.

So that's why it's really important that women are aware of all the potential symptoms quite early on. Yeah. Rather than thinking, oh, it won't be me because I'm too young. Yeah, it does seem like a lot of value is placed on the hot flushes and night sweats when diagnosing, maybe especially for younger women. Yeah, absolutely. And I'm just wondering whether some women don't have those.

Absolutely, yeah. So Jane didn't have them. I had nights sweats, but I thought I had lymphoma type of blood cancer because as a medical person, it's always something awful. And I didn't have any hot flushes at all, but I had lots of other symptoms looking back. And as you know, the main hormone is estrogen. So when women have low estrogen levels, often that can affect the thermoregulatory part of our brain that affects our temperature control. So can have hot flushes and night sweats. But the other hormone that's very important, for a lot of women is testosterone, which we produce from our ovaries. And low testosterone often causes memory problems, mood changes, reduced motivation, just general flatness, really, and reduced libido. So if women start with having low testosterone before their estrogen drops too much, they're not going to get flushes and sweats either. So it can be quite confusing, really. And I think because it's not really spoken about when we're younger,

you don't know what to look out for. Yeah. I mean, I certainly didn't know before working with you that it caused changes to the hair and skin. Yeah. And some of the cognitive problems. All I knew, like I said before, was the stereotypes of being moody or... Yes, that's right. Yeah.

But not the brain fog so much. No, that's right. We see a lot of people who really worry they've got dementia. Some have even gone to clinics. and had brain scans. And, you know, the doctor sat there and said, well, it's great. Your brain scan's normal. And they're saying, but I don't feel normal. And so it's reassuring they haven't got dementia, but they still don't know what's going on. And because we've got cells that respond to estrogen and also testosterone all over our body, that's why we can get so many

symptoms. And I think a lot of people find that they have muscle aches and joint pains. So a lot of people are misly diagnosed with having arthritis or fibromyalgia. Like you say, the skin changes can be really common. And I know last weekend, Caitlin Moran wrote in The Times about having formication, which is this sensation of feeling like spiders crawling across your skin, which is very bizarre, but it's often related to low estrogen levels, sometimes when it's very itchy, dry skin. And again, you wouldn't necessarily put that down to being related to the perimenopause or menopause.

talking about dry skin, some women get dry eyes. And I was with my optician last week and he said, I've referred so many people to your clinic Louise. He said because these women come in in their mid-40s with dry eyes and I was asking them about their hormones and they're looking at me. You're an optician. Why are you asking? And just because it helps with the lubrication in our eyes as well.

So it's because it gets everywhere and I've got teenage children and my older two have just been taught at school that estrogen is important. important for your periods and your menopause is when your period stop. So they know nothing. So it would be great, wouldn't it, if you knew a bit more about what your hormones did. Speaking about your daughters, what would you hope when they go through the menopause, what would you hope that it is common in terms of healthcare provision for women? What would you hope it's like for them? Well, I hope it's better than it is now. I really hope that this is two real things that I feel my works sort of takes me. One is to empower women. So I really feel, and I know my children are very empowered,

because all I do is talk about the menopause, but I feel that women need to have responsibility for their health in general. So we need to think about what we eat, the life that we live, the exercise that we have. But we also need the right knowledge. And what's happened in the past is that women haven't had the right knowledge about their own hormones, which is a massive travesty. So I'm hoping that with some of the work that we're doing, working together, some of the work, other really inspirational people are doing that girls, younger children, girls, teenagers will have that knowledge. And wouldn't it be lovely if even when you have your smear test, someone gives you some information or when you're pregnant, you know,

when you've got children, when you're pregnant, you have so much care. You have midwives, you have health visitors, you have doctors, everyone's involved. and you're only pregnant for nine months but then suddenly you're menopausal for 30, 40 years and no one helps you, which is wrong. So if we can drip feed information, the right information at the right time, I'm not saying my eight-year-olds needs to know everything,

but just do it gradually. They will feel more empowered, like you hopefully are already, that you can look out for any symptoms, so you have that lower threshold. You're not waiting until like a lot of patients, I sadly see, who have suffered for so long. And then I'm also hoping that when these women who are empowered with the right information,

go and seek help, they get the right help. Because I know just from my experience of reading my Instagram posts and social media and feedback that I get and seeing the women in the clinic is that sadly too many women are not getting the right help, even if they have the right information, they're being turned away for the wrong reasons. And although we've talked a lot about symptoms, it's not just symptoms, as you know, it's about our future health. So, you know, you look after yourself and it's great if you can keep looking after yourself. But often, because the low hormone levels that occur, we get these metabolic changes that occur in our body. So we have this increased risk of diabetes, type 2 diabetes, increased risk of heart disease, increased risk of heart disease, increased risk of

depression, also osteoporosis, osteoarthritis, dementia. It's really doom and gloom for menopause or women. So despite trying really hard with your lifestyle, you can't replace those hormones. And without the hormones, there's this increased risk. And that's where people have to think differently about the menopause. So you're absolutely right. A lot of people think, well, it's about a moody hormonal woman with a fan. But actually, even if that's, That woman had no symptoms. She's still got five times increased risk of a heart attack just by being menopausal. So that's quite shocking.

Yet people aren't addressing it in the right way. I don't think people, they probably know that you're more likely to become ill as you get older. But I don't think most people would put that down to hormones. No. The menopause. No, that's right. At all. It's just part of being older and that's the end of it.

Yeah. But when you tease out the statistics, for example, before the age of 50, men are far more likely to have a heart attack than women. But over the age of 50, that gender difference narrows. And that's purely because of the hormone protection effects of estrogen on our bodies before the menopause. And then if you look at the incidence of osteoporosis in over 50s, so it's about one in five men, one in two women. Well, what's the big difference? You know, you don't have to be a brain surgeon to work out. hormones are related yet most osteoporosis experts won't talk about hormones because everyone's scared about hormones so why do you think that is i think it's because um they did more in the past but i people are still scared of hr t so it's a lot easier to prescribe something that isn't hr t or because it's not controversial yeah yeah i think so um mind you there is some controversy now with the bisphosphonates that are used because they can lead to something called osteoneate necrosis of the jaw or atypical fractures. So they're not as safe as they were 20, 30 years ago when I started prescribing them. So with HRT, as I'm sure you know, or hopefully, from doing all

your reading, is that there's more benefits than risks with HRT, and all we're doing is replacing the hormones. And we do know more and more from research that if women start taking HRT when they're younger, so when they're perimenopausal, they'll have more benefits to their health. So not only will their symptoms improve, but they've got this reduced risk of all those conditions, such as heart disease and osteoporosis. And a lot of women I speak to say, well, I'm just going to battle through. I'll try and see how I get on. Things might improve or I'm going to wait until I'm menopausal. And a lot of women are even turned away from their doctors because their doctors say, well, come back when you're menopausal.

But that could be years down the line. and the women's bones are thinner, they're more likely to have high blood pressure, more likely to have heart disease or diabetes. And it's harder them for the estrogen to work as well as when people are younger. Yeah, because I've learned that they could have the symptoms for years and because you don't class menopause happening

until a year after their periods have completely finished. So so much change has already gone on, hasn't it? And if a GP, for example, wouldn't consider prescribing HRT until they were officially menopausal, then you already missed the boat in a way on a lot of help that they could have had. Yeah, totally. And, you know, we see this lot. I saw someone in my clinic a couple of weeks ago, and she had been on the mini pill, so it's a progesterone-only pill that she'd taken for 20 years. So she hadn't had periods for 20 years. She's now 48. But she now is better, because she came to see me a while ago. I've started her on HRT. But now she's better. She looks back

and says, I know for 10 years, so since she was 38, she started experiencing symptoms, but she'd gone through a divorce, she'd changed her job, she'd moved house. So she'd put it all related to that. She had no idea. And that's, the travesty really is that people don't realise at the time. Whereas if someone had said to her in her late 30s, had you thought it could be related, she could have, and sadly she's got early stage, and she's got osteopenia, so the bone thinning before established osteoporosis, which hopefully will reverse with our HRT. So can bones actually show an improvement on the scan?

It doesn't just stop deterioration. It actually shows regrowth. Yes, it does. So actually, HRT is licensed for treatment of osteoporosis, which even a lot of osteoporosis specialists don't realize. But it's the best treatment for not just preventing osteoporosis, but improving bone strength. and it works quite differently to the bisphosphonates.

So if you think we want our bones to be strong but slightly flexible as well. So if we fall over, it's not like a glass shattering. It takes a bit of impact. And the bisphosphonates often make the bones strong but a bit stiff as well. So they're more likely to crack uncertain impacts. Whereas the estrogen helps build the collagen and build the internal structure as well as the external structure of the bone. So it's stronger, but it has a bit of cushion.

So when you fall over or fall up the stairs, you're less likely to have a fracture. Because, as you know, osteoporosis is a sort of silent killer, really. It's not a condition that the media like to talk about. It's something that most women and men don't know they have until it's sadly too late. A lady recently told me her mother had just been diagnosed with osteoporosis and the only way she knew she had osteoporosis

was she tripped up the stairs carrying her washing basket and sadly she had broken her neck. So she was paralysed from the neck downwards and when they did a scan her bones were just so thin. So isn't that awful? Yeah. So she hadn't even had any other signs until the point where she was just,

it was going to break very easily. Absolutely. And that's sadly, that's very extreme but often it's when people break the hip. Or people have fractures in their back and that can affect their posture, the way they eat, they're in constant pain. And when it's severe, it's a lot harder, as you can imagine, to reverse. So even if people aren't thinking about their symptoms, we need to be thinking about our bones and our heart.

And so many women, as you know, are worried about the potential risk of breast cancer with HRT. But actually, the risk is very low, and in women under the age of 45, there's no risk. a woman is seven times more likely to have a heart attack than she is to get breast cancer. So we need to look at what's more common and what can we do to reduce that as well. So what are your friends who know about your sort of role working with a menopause specialist? Do they think that's interesting getting more questions from friends? Yeah, it depends what situation it comes out in. But if I'm with a group of women friends, there's always at least one or two that will say,

oh I'm going to have to pick your brains or else what I need. But I have been surprised how the conversation still don't happen that easily. Even with close friends, women might refer that they need some help or maybe you're going through it. But in terms of talking about any actual detail or asking me specific questions, they're not really wanting to do that in a social situation. So I'll normally just send them a text later with your website or something. or saying if you've got any questions, I'm perfectly happy to find out for you. Yeah, which I've been really surprised about because, you know, with each generation as it goes by and you think it becomes more liberal, more open, more willing to talk about a whole range of different topics.

But I think menopause is still not really spoken about amongst my friends anyway, particularly, like I say, if it's a group of women when it's more social, perhaps more one-to-one, it might be, or if a friend was really suffering. But I know several of my friends are going through it and they admit that there's problems but they're not talking in depth about it. It's almost, like I was saying before, it just sort of gets brushed aside.

And a lot of women feel that it's inevitable, they've just got to put up with it. And like you say, I can totally understand why women don't come and see you until things are really, really bad because we're just so used to getting on with life and putting other people first. Yeah, it's interesting.

And I know even when I finally realized what was going on and I said to some of my friends that I realized that I was menopausal and going to start HRT and I was 46 then. And a lot of people, my friends, said, gosh, that makes you feel really old, doesn't it? So I'm not old at all. It's the average age, you know. And there is this sort of stigma that it's an older person's condition really. Yeah, someone who's retired. Yeah, I know. Likes their crosswords or something.

Yeah, which is completely wrong. Yeah. Well, that's really interesting, and I hope it's given listeners out there a perspective as to how people think about the perimenopause and hopefully some facts that you might be able to use. So if you do think you might be perimenopausal or one of your friends, then download the questionnaire on my website and get them to fill it out discreetly at home and then get help if they're suffering. So just before we end, Shiaa, can you just give me some three take-home tips that would be useful for? people who are thinking about perimenopause. Yes. I mean, if you'd ask me this before we were working together, I honestly would not have known anything at all, but from reading a lot of your information and listening to other people going through it, I would say, talk about it, make those conversations

happen, even if it does feel a bit awkward. You could be going through exactly the same thing your friend is and you don't know that that's what each other is going through. So just start the conversations. I'd also say when you get to my kind of age in your 40s and if you are really tired or if you're feeling stressed or if you're feeling forgetful, even if your periods are completely normal or you don't really have any because of the contraception you're using, don't always put them down to being busy or the kids doing your head in or stresses at work. Just start thinking, could this be my hormones? Because I've learned that there can be signs that the pen of menopause is happening several years before your periods actually stop and the earlier you take

HRT the better so you don't want to miss that opportunity of really having an improved quality of life and don't wait for the symptoms to get really bad basically just just think could it be hormones and then look into it more if you think it could be absolutely so thank you so much and thank you publicly for all the work that you're doing to help me thank you ever so much and speak to you soon thank you For more information about the menopause, please visit our website www.menopausedoctor.com.