The Dr Louise Newson Podcast - 021 - MPowered Women - Saska Graville & Dr Louise Newson

Episode Date: October 29, 2019

In this episode, Dr Newson chats to Saska Graville, co founder of Mpoweredwomen.net; a community of doctors, wellbeing experts and brilliant women, to power you through menopause. Despite a career in women’s magazines, including being the deputy editor of Red, Saska had no idea that anxiety and loss of confidence were classic perimenopause symptoms. Hot flushes were the extent of her knowledge, and she’d never had one. She blamed her anxiety and loss of confidence in her late 40s on a career change.  MPowered Women ensures that no woman has to struggle and be uninformed about what the hell is going on with her physical and mental health, and what she can do about it. With no subject off limits, MPowered Women has her back.  www.mpoweredwomen.net Saska Graville's Three take Home Tips: Don't panic! Don't believe the headlines - search for factual, evidence-based advice. Take someone with you to your doctor's appointment if you're feeling nervous, and before you visit, look at the Menopause Doctor website and arm yourself with information and advice. Also, visit the Menopause Support website and download the 'Ten things your GP should know about the menopause'.

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. Today I have SaskaGravel from Mpoweredwomen.net, who I'm not sure how I met actually. We'll maybe talk about how we met, but I've been liaising and frantically emailing to a... over the last few months. So hi, Suska. Hello. I'm really pleased that you're here.

I'm very pleased to be here. So up until probably a couple of years ago, before I started my clinic, I had very little contact with journalists. And I've played a little bit with the media on and off in the past about various GP related issues. But when I sat in a conference two years ago, it was a big International Menopause Society conference, I sat there listening to very clever people, far more clever than me, talking about the ins and outs of menopause care, talking a lot about how safe HRT is. And I sat there thinking, actually, I don't think women are hearing these stories and I wonder why. And there is a lot of scaremongery going on and there still is about HRT. So I thought, rather than being another clever doctor doing lots of research, which I'm not,

I thought, right, I'm going to try and play with the media and empower women. through getting really good journalists on board. So Saskia is one of those journalists who I have met and engaged with and she's been doing some really inspirational work for women, which we will discuss. So before we talk about what you're doing now, Suska, just talk a bit about what you've done in the past and your background. I was the deputy editor at Red Magazine. I've been a journalist all my career, always worked in magazines and newspapers.

and when I was at Red, I'm ashamed to say we never wrote about the menopause. She's quite something, isn't it? So I remember buying it as a student thinking it was quite grown up because it was not quite Mary Claire, different to cosmopolitan. And I thought, wow, this is really grown up. But it's, what's its target readers? So it's aimed at what it calls middle youth, which is this idea of women in their 30s and 40s, and older.

Yeah. And we're growing up without growing old was the original premise of it. And I think that's still a brilliant way of thinking about midlife. And it's a brilliant magazine still is deals with all sorts of things and deals with health absolutely brilliantly. Things have changed now and they have written a lot about menopause and perimenopause in recent years. But certainly when I was there and I'll probably go.

harsh looks from any of my ex-colleagues, as I say this, but we didn't want advertisers to think that our readers were old enough to be menopausal. And that's interesting, isn't it? Shocking. Well, I mean, it's shocking in many ways. Firstly, because it's, you know, you shouldn't be thinking like that anyway, full stop. But also, I think it just exacerbates that myth that menopause is an older, inverted commas issue. Whereas what it, what it fails? to acknowledge was perimenopause, which was absolutely something that women reading red would have been experiencing. And it came to bite me in the bum, really, because when I myself was perimenopausal in my late 40s, I had absolutely no idea. I hadn't even heard of it. I didn't

know what it was. So, you know, I suppose there's a bit of divine retribution there. Yeah, but it's interesting, isn't it? So I think if I'd met you 10 years ago, I would, have thought, well, there's no need for any menopause education because it's something that happens to us when we're older. And although as a medic, I knew about, a lot about the menopause, but not nearly as much as I know now, I wasn't really in my radar, the psychological impact of the perimenopause and menopause and the way it really flaws a lot of women. So I can see when you're young, you're doing magazine, it's all very dynamic. It's very, you know, you're wanting to empower women and these women are strong women. Why would you think?

about the menopause, but if you'd gone back in time now, wouldn't it be different? Well, I think now, and this is the sort of article that they publish now, and they've published stories on perimenopause, and they get a huge response. Yes. Because also it's allowing women to be honest and vulnerable about feeling anxious, losing their confidence, having those daily feelings of foreboding, which many of us go through when we're in the perimenopause years and hopefully more women are realising what that is and what it's all about but certainly back when I was there it wasn't something we ever covered no and for those of you that don't know the peri menopause so peri is just a medical term for around the time of

menopause as a lot of you know is when you haven't had a period for a year so even the menopause is a look back in time retrospective diagnosis so the peri menopause is when our hormones start changing and because of the changing levels in hormones we often get symptoms and most women have changing periods either in nature or frequency. Some people can still have regular periods and it often happens very gradually. It can occur for many years, sometimes five, even 10 years before the menopause and I'm ashamed to say that even I had symptoms and had no idea what was happening to me. I thought I was just working too hard and I was really tired, really irritable. having worsening migraines, having night sweats,

which is a really common symptom of the menopause and perimenopause, but I didn't even realise it was my hormones, which is shocking. It always makes me feel better that story, that even the great Louise Mason did not know. I mean, I didn't know. I had the Myrina coil. Yes, so then you weren't having periods. I wasn't having periods anyway,

so I didn't even have that as a clue. And I'd left Red after a long time there and actually had a career change into, a big PR and communications agency and I found myself at work having fight or flight panic feelings very tearful not feeling I could cope brain fog beyond anything I'd ever known what did you think that was happening well I thought I'd made the worst career mistake of my life I simply thought that was it it did not occur to me that it might be anything to do with the menopause so what did you do? I eventually, after about a year of sobbing, went to see my GP and I was very lucky that I had a

good GP at that point who said, right, let's do a blood test. And the blood test came back. And how old were you then? I was 49. So she shouldn't have done a blood test though? We came back within menopause. Yeah, but she still, you see, this is what's really interesting, is it? So the nice guidance, as you know, the National Institute of Health and Care Excellence guidelines in diagnosis and management of the menopause came out in November 2015 and they are still what we work towards. They don't need to be changed despite recent media scares, but they show that women over the age of 45 do not need a blood test to diagnose the menoples or perimenopause and in fact a staggering £9.2 million a year is wasted by these blood tests. So although

women might find them useful, like you're saying yes it was useful, actually think of all that money. some really good menopause, NHS. Absolutely. And the reason being is that the menopause and the perimenopause is a clinical diagnosis. It's not a biochemical diagnosis. It's not like trying to diagnose diabetes or underactive thyroid where you need a blood test. Because hormones change. So you were almost lucky because your blood test was abnormal.

So that helped. But if you'd gone back another day, your hormone level might be normal. And then you would have been like millions of other women. in and said, no, it's not your hormones, Saska, it will be because of your job, because of your whatever's going on at home or at work or whatever. And that's when it's really misleading. And we see loads of women who have been told, oh no, my blood tests are normal. Well, they will be normal at some times, certainly the month if your perimenopause or because your periods are changing, but if you're still having periods, you're still producing hormones. So there

will be some times in your cycle where you have normal hormones. Well, actually, the GP went down. hill after that because the very nice GP left. She gave me all the literature on HRT. Like many women, I had, you know, paid too much attention to the scaremongering, was worried about it, had had breast cancer in the family. So you're very scared about HRT. I was scared of it. And I wanted to speak to somebody in depth about it. And at that point was told by my GP practice, we don't have anyone here who is a women's health expert and I nearly said to them, why would you? It's just 50% of your patients. Why would you? It took me four GP visits to eventually push for a referral to an NHS clinic. You were lucky because you've gone to an NHS menopause clinic.

I was lucky in that I'm able to be pushy. I had a job where I could take those four appointment visits. I was confident enough to push. for what I knew I needed and eventually sat down in front of an incredible consultant in a gynecology clinic who completely put my mind at rest about HRT and she couldn't prescribe it to me fast enough. I couldn't take it fast enough

and it sorted everything. But it was at that point that I thought if it's this difficult for me, if I'm this ignorant and I've spent my life working in women's magazines, then this is a terrible state of affairs. and something needs to be done about it. So that's why I launched Empowered women.

Yeah, because it's, I mean, you're lucky because there is an NHS menopause clinic near you. Around here, as some of you might know, I can't get a job as an NHS menopause specialist because there are no clinics. And when I've approached two different CCGs, so the health authorities, they've said, no, it's not a priority for us. We're not going to do menopause, which is disgusting. It's a scandal. It's a scandal. It's a scandal. It's a scandal.

It's a scandal. It's a scandal. So there are a lot of women out there. and I hear a lot through my social media of women who, like you, go back and forth to their GP, and they're not getting the help, but where do they go? And we always say try and find a doctor who specialises in the menopause or women's health. But to stick out for a lot of these doctors, we don't get any training. No, no.

Some of the campaign work I'm doing with Diane Danzabrook, as you know, the hashtag Menopause Matter campaign is actually about trying to introduce mandatory training, but it's really hard to get any more mandatory. Any sort of training is good because it affects us in so many different ways and often doctors aren't asking the right questions. And so certainly if a woman's had a hysterectomy or had a marina, we can't look at their periods. If they're over 45, the chances are they're going to be perimenopauseal.

Well, knowing what I know now, I would have saved myself a year of stress. I would have saved my partner a year of having to deal with me under all that stress. things would have been very different. So, I mean, for me, I think perimenopause is the biggest message to get out there. And to get women in their 30s aware of it. And I think, you know, Diane Danzabrane deserves a medal for the work that she's done and to get it on the school curriculum. Is it England, Scotland and Wales?

Yes, but we're still trying to battle how that's going to happen. Right. I mean, that is an incredible thing to have that. It's really, it is really good. it's people are talking but I think like you say the perimenopause and actually although I've said it commonly occurs in the mid-40s one in a hundred women under the age of 40 have an early menopause sometimes that's genetic so if you've got a family history sometimes it can be iatrogenics are caused by drugs such as chemotherapy or radiotherapy sometimes women have their ovaries removed

I saw a lady this morning who's got the bracketoo gene so she's had her ovaries removed because she's got an increased risk of ovarian cancer yet no one told her that that would cause the menopause. I'm shaking my head in disbelief. Yeah, so actually for your red readers, to get women who are in their 20s, 30s is really important because I don't know about you and I finally realized that I was perimenopausal and told my friends, they all said, gosh, don't you feel really old? Well, no, I was in my mid-40s and it's the average age, but it did make me think, how would I feel in my mid-20s, mid-30s, telling my friends that I was menopausal and then the whole fertility issue, everyone's wanting to have, not everyone, but a lot of women are trying to get pregnant

and I'm there telling my friends I'm menopausal and it has huge psychological effects. Of course it does. You could have done so much more. But I think, you know, they are, it doesn't surprise me that they get a huge reaction to perimenopause stories that they run now. But I think as well, the other issue that we're up against with this is. is ageism in general and how women are made to feel about growing older. I mean, if I see, God love Helen Mirren, but if I see one more ad with Helen Mirren, as if she's the only older woman out there that brands can use in ad campaigns.

So I think the whole topic is about raising the visibility of older women and also, you know, communicating and talking amongst ourselves that this is a brilliant time of life. I'm happier in my 50s than I was in my 30s and my 40s. I've launched a new business. I'm at the gym more than I was in those. You know, so many things. And it is, I think, a lot of women, you know,

they've worked really hard in their careers. And you reach this time where you might have a career change, but you've got all that experience, you've got all that knowledge. You've got life experience as well. And then often it's wasted because of the menopause. You know, the number of women I see here who have given up their jobs, They've given up their lives. You know, I saw a lady yesterday actually who had really struggled and she was on the mini

pill so she'd had no periods. She was on it for 20 years. And now she's better. She's actually lost two stone in weight. She's exercising. She's absolutely brilliant. She said, I think I've had symptoms for 10 years and, you know, no one had helped her. So it's like women fall off a cliff.

It happens when women have children and that drop off of them not. coming back to work. So we lose one group of brilliant women at that stage. And then this happens. But I think people are recognising it because if like us, they're not recognising it's related to their hormones, they think, oh well, you know, I'm getting older now or I'm slowing down and it's just my body telling me, but actually there is something that can be done. So I looked when I was, I was watching the Glastonbury coverage this year. And there was Kylie, there was Joe Wiley. And I thought that's what a midlife woman looks like. We're up on stage, we're presenting Glastonbury.

There is no need to be so down on it. And I think there's a lot of move about anti-aging. Well, actually, we're all ageing. It's the way we age is what's important. We can't stop a natural process. There's actually a shift now within that language. So a lot of brands are shifting from talking about anti-aging to talking about pro-aging. because what they're finding quite rightly is that women are saying,

well, there's no point being anti-aging, because what's the alternative? There's nothing wrong with ageing. I'd rather age than not be ageing. Many of our friends by this stage haven't had the benefit of not ageing. But it's all about pro-aging, aging well, and doing everything you can to support yourself as you age, but not deny it. I'm very happily 52.

Yes. I don't want to be 30. No, no, no. It seems like my 30-year-old knees, but that's about it. So tell me about your business then. So what are your ideas for it? Well, Empowered Women is a website. So that's M as in the letter M and then empoweredwomen.com.

And it is a community of doctors, well-being experts and brilliant women to power you through menopause. So the idea is that we have. medical advice only from doctors. So from doctors like you, I have my opinion on HRT, but that is not relevant. Everything that we publish medically is from experts. Which is really important to know, isn't it? I mean, as you know, I've got my website, Menopause doctor, but it's full of evidence-based, non-biased information because, as you know,

menopause isn't just about HRT. There's lots of things, but it's really important to get the right advice. So important. Talk before. or maybe off air about different websites that are coming up. And women have to be really careful what they're reading. Yes. Who's written that information?

Who's written it and who is the expert? So we have doctors. We have well-being experts, fitness experts, nutrition experts, writing. And then we also have well-known, inspiring women talking about their menopause experiences. Because part of the way to break the taboo around this is just for all of us to talk about it. So we have some amazing women on there like Patsy Kensit, chef Sky Ginjell, designer Kelly Hoppin, the columnist Indian Knight, the novelist Lisa Jewel. We've got some absolutely brilliant women. Just talking about what happened to them. I mean, the chef Sky Ginjol is absolutely extraordinary.

I don't know if people remember, but she'd won a Michelin Star at her restaurant, Petitium Nurseries, and then she suddenly left. And she told me, she said it's only now. that I realised I had menopause insanity. I left my job. I left my marriage. I had three months money in the bank. I mean, that's extraordinary. At the peak of her career, having just won a Michelin star.

So, you know, I think the more women share, the more... It helps other women, doesn't it? It helps all of us. So that's what the website is. And it launched in May. I'm so proud of it. It's beautiful. Brilliant.

Yeah. Many of you that haven't seen it, The colours, the design, the pictures, it's, I mean, I know that took longer than you wanted to get, but it was worth the way. It was worth it. I mean, I'm very, I am determined to avoid what I think of as the sort of misery menopause coverage that is out there. And there is a lot of it. And I am not denying the fact that women, many women have a horrible time. But I sometimes look at some of the menopause forums and it.

just descends into a bit of a slanging match about women's lives and their husbands and blah, blah, blah. And I absolutely want to avoid that. I want women to come to us, get the evidence-based information they need, be inspired by reading about some really interesting women, and then go off and get on with their lives, not be defined by being a menopausal. Because I mean, I'm sure you agree. If I wasn't doing so much menopause work, I would forget that I'm menopausal, you know? And that's perfect.

I fine tune my HLT, but I also do good exercise. I eat well, I look after myself. But then I want to just get on with my life. It's not how I define myself at all. It shouldn't be. So have you had some good feedback? We've had absolutely brilliant feedback. On Instagram, we get lovely comments and engagement and women thanking us

and telling us that they don't feel alone with this anymore. That's really key, is it alone? Really key. Really key. So how do people find you on Instagram? So we're empowered. underscore women. Okay.

And women are funny as well about this. You know, I think that sense of, we're all in this together. We are all going through it. You know, when the broadcaster Trisha Goddard did an absolutely brilliant interview for us, where she talked about her vaginal chafing when she went on her daily runs. And I thought, God love you, Trisha. Like, that is one of the biggest taboos of all. Nobody talks about that.

But there she was, happily sharing it. It's brilliant. Because 70% of women. at least will experience vaginal dryness if they don't get treatment. That's seven out of ten women. Seven out of ten women. Even these women who, for various reasons,

decide they're going to get through the menopause, they're going to battle through their symptoms, unfortunately they will still end up with vaginal dryness where the lining of the vagina becomes very thick, thin, becomes sore. And it's not just about intercourse. I see loads of women who can't sit down, they can't wear trousers.

I mean, I'm sorry if men had to deal with that. Yeah, absolutely. there would be recliner beds on every high street for them to have a lie down. You know, it's utterly ridiculous. Yes, I don't know if you read Deborah Ross did a brilliant. I could not have loved that article more. In the Times. And I've said it a lot that if men were castrated at the age of 51

and being told that their brain would go to much, they wouldn't be able to function, and they certainly wouldn't be able to have had sex, but don't worry, carry on. I'm not sure quite, we'd be in this mess that we are now with the menopause. Well, she talked about there'd be a pop-up shop at Selfridges, didn't she selling menopause products? No, we actually posted a quote from that on Instagram and got a brilliant response. I mean, I love her writing anyway, but I think that was one of my favour. Yeah,

so that was brilliant. So you're doing it alone or you do it with... No, I have a business partner, Alison Bakunewicz, who, we both have day jobs to pay the mortgages, but Alison and I've worked together for a very long time and this is our first. We've always talked about, you know, like many women. We've always talked about what can we do together. So finally we got around to doing this. So she is the commercial brains of the operation. She can do an Excel spreadsheet, which I wouldn't even know where to start with. But you have to understand the money when you set up your own business. So she's absolutely on that. And then I am the content editorial side. So it's a good pairing. And we trust each other, which is great.

important having set on my own business. It's incredibly stressful and you need trust because you can't do anything alone. And you need and you need to not, you need someone who's better at the things that you're not good at. So you've got, there's no point having somebody who's got the same skills. No, absolutely. And I was saying to someone this morning actually, I think one of my qualities is that I have insight. I know what I'm bad at and reading spreadsheets is something I'm very bad at. So there's no point me learning. I might as well concentrate what I'm good at. There is no point me learning PowerPoint at 52 because Alison is very good at it and but she can't write like I can write. So it's, you know, it's a complementing to them.

And are you finding it's a UK-based audience that you're reaching? At the moment, at the moment it's UK based. I mean, obviously we want global menopause domination. Yes, of course. But at the moment it's UK. And we were very new. It's only, it's only since May. So, I mean, what's amazing is the women who, you know, the well,

known women who are talking to us is fantastic. People like you, who we've worked with, is so inspiring. You know, you and Diane Danzerbrink and Dr. Stephanie Goodwin, you know, just these incredible women. So I feel like it's this community of like-minded women. And what I think is lovely about menopause world is everyone supports everyone else. Absolutely. There's no one. It's really important. You know, as you know, I've worked very closely with Liz Earle and Mac Matthews has done the most amazing work. Incredible. Incredible. Incredible. You know, all our websites are different, so we're not competing. It's just different platforms, and we can all share knowledge and congratulate each other and work together.

Well, every woman will be menopausal, so it's a pretty big market. Absolutely. Liz Earle is brilliant. She often comments on our posts, which always makes me quite proud. Yeah, no, she's brilliant. But it is. It is about working together, because if we don't work together, nothing will get done, which I've learnt very quickly. And I think women are good at working together, I think.

Yeah, get things done. There's not so many egos in the room when it's women involved. So one of the things I wanted to talk to or just ask you about with your journalist hat on is, as I mentioned at the beginning, a lot of journalists have got it wrong about HRT. But when I sort of take a step back and reflect, it's not really the journalist's fault, is it? Just to explain the process. So some of you who are listening might know a couple of weeks ago, an article came out in The Lancet, which was a review of old literature. So it wasn't a new study. and with it, it produced a press release.

And lots of journalists read it and they said, oh my gosh, now we know that breast cancer is caused by HRT, which is not true. And if you want more information about the facts, go onto my website, look at the news section. But just talk me through that journey there, Saskia. So if there's some medical research that's published, how do journalists find out about it?

So a journalist will typically be sent a press release ahead of that article being published and the press release will have an embargo on it so that you can't talk about it before the article is published. There are good press releases and there are bad press releases. And who writes the press release? So the press release will probably be written by the PR agency working for the organisation that's publishing the piece of content. So if you're a good responsible journalist like Bridget Moss, who is contributing health director at Red, and who writes for Empowered actually as well. She's brilliant. So she would get that press release in. She would see that it was a study that had been published in The Lancet. It would have very

credible names and organisations on that press release. So she would feel that was a credible press release. You then have a million, I mean, we used to joke at Red. You know, you have a million press releases that come in that are just tied to completely random facts, you know, where they try and align something Kate Middleton wore with some random product. You know, so you get those kind of rubbishy press releases that are churned out all the time. But if one comes in, a study published in The Lancet, a credible researcher attached to it, you're going to look at it. You're going to look at it.

Yeah, you're going to look at it and report on it. So I think that's... that's why what happened a couple of weeks ago happened. Yeah. And I think also it depends on the time, doesn't it? Because I think a lot of journalists try and get hold of experts. But if they're on holiday, then they'll go through different levels of people, weren't they, to try and get a quote from someone.

And good journalists will then check with the people they're quoting. So I know, you know, Bridget has written for us and quoted you, and she will always check, and she's written for red and quoted you. She will always check the quotes. So those good journalists would have... would have checked everything and gone with what the press release was saying. So it's... But it's very hard because at the end of the day,

journalists have to sell newspapers, or the newspapers have to sell, or the magazines have to sell, don't they? So anything that's a bit more sensational. And also, you know, the media lover clickbait, a bit of HRT scaremongering. You know, they know that women will click onto that. Yes.

So there is that as well. It's immediately giving them an HRT headline that they can... go big with and well because as you know as we know already from both our work that women are desperate for information there's so many mixed messages out there so anything

else I think right this is it I'm going to really be given the facts and and this has been really damaging what has happened because it's made people more uncertain about it. Well I read it and my heart sank I thought oh god you know is it back to square one

do I need to come off HRT so immediately it was really only in the morning. It was before I was going to the gym, I immediately went onto your website. I was like, God damn it. She's already written about it. She's already on it. So I knew quite quickly that it was fine. I didn't have to come in HR. But, you know, I had that moment of panic and I'm immersed to that extent in this world. Yeah. I mean, it reminds me a bit of the MAMR vaccine when all that scare came out and with Andrew Wakefield. And we knew that it was not good data. Again, it was published in The Lancet. But then actually when I took my oldest daughter to have her

MMR vaccine, I still felt a bit, oh, should she be having this knowing full well? And likewise, when I read this, I read the press release and then I went straight to the Lancet article, which I must say is very heavy to read and read that. But I still on the back of my mind was thinking, should I be ripping off my patch? But what we've talked about and actually what all my patients that I've seen since this study has been published, they're all saying, actually, we need the choice. And even if this study showed there was an increased risk, which it doesn't confirm, I would still take my HRT because of the benefits, as we've already said, the health, mental health benefits, but also for our future health, for our bones, for our heart,

our estrogen receptors get all over our body, so we know there's a lower risk of diabetes, there's a lower risk of dementia. And actually the studies have shown women who take HRT have a lower risk of death and about a 20% lower risk of bowel cancer. cancer. Right. So, you know, we've got to look at the bigger picture. So yeah, but it is, it's about, and I think what's lovely about your website, clearly it's not just about HRT. What you're doing in your life isn't just because HRT is making you feel better. You've already said you're exercising better. We've talked earlier about Otolengian, all these lovely food. So your diet's really important. I'm drinking less for once in my life. When I go to the doctor and they ask, you know,

how much do you drink? And I think like many women, I sort of squinted a bit and, you know, ticked social drinking. They thought, well, that was not the correct answer. Now it's the correct answer. You know, white wine, I can't really drink any more one glass and I'm a cheap date. So everything is healthier. Yeah. Everything is healthier. And so when all these pieces of the jigsaw, whoever you like to look at it are put together, it can make a real difference. And that's what a lot of what you're doing is all about just educating women. So they're given a choice about how they live their lives. Yeah, make your choices and be informed by the right people and be inspired by other women like you who are doing interesting, great things at this time of life.

Yeah. Don't get sucked into a narrative about I'm old, I'm invisible. You know, this is, midlife is brilliant. Yeah, we only live once, don't we? So we've got to make the most of it. We don't know what's around the corner. Exactly. We don't know what's next.

Yeah. So thank you. That's been really, really interesting to hear all about that. And what I would like to do, as I know you've been very good girl and you've done your homework, is to have your three take-home messages from your work and your thoughts about all of this. So my first message is I do think that the NHS is guilty of menopause neglect, which sounds harsh. But, you know, I think there are some wonderful GPs and I think there are some not-so-wonderful GPs. So I think we all have to be prepared to be a little bit pushy when we go to the GP.

I think we're used to being well-behaved and nice, and sometimes you might have to be a little bit pushy to get what you want. My second take-out is ignore the HRT scaremongering headlines. Just ignore them. It's clickbait. Go straight to Louise's website or, obviously, empoweredwomen.net and get your information from the experts. And then thirdly, embrace midlife.

This is an absolutely brilliant time. You know, this is, I think, one of the happiest day. ages to be a woman. You just need to know the health challenges you're dealing with, deal with them and then get on with the rest of your life. Brilliant. Excellent. Thank you. They're really, really sound advice. So thank you ever so much for venturing out of London to come to. Thank you very much for having me. Thank you. For more information about the menopause, please visit our website www.menopausedoctor.com.uker. Thank you.