The Dr Louise Newson Podcast - 029 - Life after Breast Cancer - Kirsty Lang and Dr Louise Newson

Episode Date: January 7, 2020

In this week's podcast, Dr Louise Newson is speaking to journalist Kirsty Lang about her experience with Breast Cancer and how life has been since her recovery. Together, they discuss the treatment that Kirsty received and the side-effects that she experienced from some of the medication, particularly those that blocked the effects of estrogen in her body. Kirsty talks openly about her menopausal symptoms relating to vaginal dryness and reduced libido and Dr Newson explains the effective treatment options available for these symptoms. They also talk about the differences between information given to men who have prostate cancer and women who have breast cancer. Men are usually given far more information than women, especially regarding the sexual problems that can arise during cancer treatment, and clearly this needs to change.  Click here to listen to Kirsty Lang talk about breast cancer in Liz Earle's weekly podcast. Kirsty's Three Take Home Tips for dealing with menopause after cancer: Try local vaginal oestrogen for vaginal dryness If you are struggling massively, go to your GP/surgeon/oncologist and don't be afraid to ask for help Don't feel like you have to struggle just because you've survived breast cancer. It's not true, there is help out there for you!

Welcome to the Newsome Health Menopause podcast. I'm Dr Louise Newsome, a GP and menopause specialist, and I run the Newsome Health Menopause and Well-Being Centre here in Stratford-upon-Avon. So today I'm delighted to be able to welcome to you, Kirsty Lang, who is a well-known and very well-respected journalist. So hi, hi, Kirsty. Thank you for coming today. Hi, hi, Lou. So I was just reflecting before I press record, that I first met you at a conference in London at the Royal Society. And it was a very interesting conference. I was really privileged to be speaking there. The main reason for the conference was I think it was titled Patient Choice. And Avram Blooming, who is a very respected oncologist from America, had come over and he gave the main presentation in the morning. And it was based

around his book called Estrogen Matters, which is an amazing book that I think as many women as possible should read. And you were chairing the session. And what really I found sad when I listened to you was you were talking about HRT and you said, yes, I used to take it and those were the good old days. And I thought, oh, I wonder what's going on. And then I thought, I'd love to talk to you, find out more. And then you left at lunchtime. And that was it. I thought, oh, dear. poor lady. Well it's funny for me it was it was a quite some sort of life-changing moment. Two years prior to that conference I had been diagnosed with breast cancer and I had been on HRT and because it was a estrogen-related breast cancer I was told to stop immediately the HRT which is you know normal

practice and two years on I was on a drug called letharzole which is sort of of inhibits estrogen in your body to protect me for breast cancer. And I was, I was suffering. I was suffering very extreme menopausal symptoms, hot flushes, terribly aching bones and joints. I mean, I would get up in the morning and I'd be like a little old lady. And it was almost like I could sort of see myself aging literally in the mirror. Yes. Yes. Just horrendous. But I felt, well, this was my lot. You know, this was kind of, I was lucky to survive and that was that. And I sat there and I listened to this lecture by Avran Broomin,

who is a very experienced oncologist, specialist in breast cancer. And he said, I put some of my breast cancer patients on HRT. And I thought, oh my God. And two of those patients, incidentally, were his wife and daughter, both of whom had had brain cancer. So I went up to him afterwards, explained my situation, He said, well, look, I'm not going to give you an instant diagnosis. You have to go to your own doctor and oncologist and surgeon and talk this through.

But, you know, in some cases, it is possible. And if your quality of life is really suffering, I would recommend you do that. And so that set me on a journey that led me eventually to your – I mean, I took a lot of opinions. The good thing about being a journalist is that I decided to write about it for the male on Sunday health pages and I was able to interview lots of people and get free consultations along the way. And anyway, that journey led me to your clinic in Stratford-upon-Avon. And, you know, I have to say, almost six months on. Six months probably, yeah. I feel so much better. And I should add, I just want everyone to know, I am on tamoxifen and that's quite important, isn't it?

It is, absolutely. And I think let's shelve that a little bit. Let's go back a bit more because I don't want this podcast for every woman who's had breast cancer to think, right, let's go on HART first off, and that's, because that's obviously not what I as a menopause specialist would do or recommend to patients. But what I was doing at that presentation, or the day that we met, I was giving a presentation about patient choice. And I very strongly feel as a doctor, I'm not paternalistic. I think we should be giving people the evidence and sometimes sharing uncertainty as well and weighing up risks and benefits of everything that we do. So it's not just about HRT,

it's about whether we take a statin for our raised cholesterol, whether we take a blood pressure treatment, whether we advise someone to cross the road or not, because there's risks in whatever we do. This is what I was talking about at the presentation. And, you know, there's lots of food for thought. Medicine's really changed over the years. We're now thinking more about preventative care as well.

Obviously, there are diseases that need treatment, but if we can reduce diseases by our lifestyle, by looking at the way we live our life, the way we eat, the way we exercise can reduce disease, and that's got to be a good thing. So your breast cancer test, that was picked up by breast screening, wasn't it? That's right. It was put up by a routine mammogram. So I was extremely lucky. You know, I was called to my local men in the best testing facility.

They found something, it was, you know, quite a fast-growing grade 3. but it was small and I was able to have a lumpectomy, which was great. So I kept my breast. And I also had a fantastic thing, which is only available in certain areas, a bit of a postcode lottery, I'm afraid, called interoperative radiotherapy where I just had one dose of radiation while I was under anaesthetic during the operation. So they take out the tumour and they blast the tumour bed with radiation. Which is incredible, isn't it? It's absolutely incredible. And I was in and out one day, Yeah, and that was spoken about a lot at the conference as well, wasn't it? They had a whole session about interoperative radiotherapy because it's very commonly used in Germany, isn't it?

Germany, America, Australia. Yes, I mean, nice, somewhat dragged its feet over this. I think there's some kind of institutional resistance from radiotherapists and radiographers because a lot of work that they get in those departments is from early stage breast cancer patients. And the machine, it's a special machine made in Germany, is only available in a few hospitals. I was fortunate to be able to have it in the Great Western Hospital in Swindon, where they do have a machine. Because particularly for women from rural areas, it's really important. Otherwise, you have to drive in every day, quite a long journey to have radio therapy.

So, I mean, I had so in terms of my initial treatment for breast cancer, it was excellent my treatment. Really, really, really good. I can't fault it. But when it came, I would suppose, to the sort of long-term after-care and quality of life, I came to realise that there really wasn't much out there for breast cancer survivors. And I certainly, more and more, we now talk about life beyond cancer. And certainly even since I qualified in the mid-90s, cancer treatment has thankfully really improved and changed and a lot of cancers that picked up earlier, like yours, for example, which is fantastic.

But it also means that certainly with breast cancer, most women who have had breast cancer actually don't die from breast cancer, which is fantastic. but what women tend to die from, the commonest cause is cardiovascular disease, so heart disease. And one of the things that low estrogen or no estrogen in our bodies does is that it affects us all over our bodies. So it causes symptoms like you were experiencing, and it's often the psychological symptoms, the lack of estrogen in our brains can really affect mood. It can affect memory, it can affect concentration, energy levels. but it's also the effect on our bones on our heart. So a woman is five times more likely to have a heart attack after the menopause.

One in two women have osteoporosis and about one in three women will have a fracture. And it's these long-term effects of living without estrogen that worry me. And women who have aromatase inhibitors like the first drug you had that block our estrogen can really increase the risk even more. So what I'm very interested in from your experience, and obviously it's only one experience, but were you given any written information or any information from any of the doctors or nurses or team you saw about long-term effects of the drugs that you were given? No, never, never.

And do you think that would have helped? Because you obviously know a lot more now, but looking back, do you think it would be useful to have a booklet about life beyond your cancer? I think it would. I think, I mean, look, I can see their. difficulties because if they tell you what the possible side effects are, and I say, and they are possible, because unfortunately we're all unique, we're all different. Absolutely. Absolutely. Yeah. And, you know, I remember meeting women who are, you know, I really struggled with electrosol, the erotase and inhibitor, and I met women who didn't, who were fine, you know,

who didn't have the same reaction that I did. So I think that's what the doctors would say, but it would have been good to have some statistics, certainly on osteoporosis. I mean, I was really shocked when I found out how much I was increasing my chances of osteoporosis. I was just talking to a distant family member recently. You had breast cancer shortly before me. And the other day, she was lifting something out of the car, had a terrible pain in her back. And scans have now revealed that she's got osteoporosis in her spine and a little fracture. and that's directly resulted to the drugs that she's taking, I think, you know.

Yes. And she wasn't warned about that. She was never offered a bone density scan, nor was I. No. So I think the long-term effects, I think you should be told about, I think I can understand why they don't always tell you about potential side effects because they're worried that will suggest something in our mind. Absolutely.

But I think also I see a lot of women who have bone pain who've had breast cancer. and they're automatically worrying that they've got bone metastases because obviously breast cancer can spread to the bones. Whereas like you're saying you were getting up in the morning, bone ache, feeling like an old woman, people can be very scared that actually it's all related to their cancer. And obviously it's very important that any symptoms get checked out. But for a lot of women, they're having these symptoms.

And most of us who haven't had breast cancer, still when menopoles or symptoms come on, we're not expecting them. So it's even harder because I think when someone's having, a disease and especially with cancer, every ache or pain or headache, you're constantly thinking about the breast cancer, which is hard because you're a woman who's happened to have breast cancer, but you don't want to be known as, you know, every day thinking about breast cancer, which hopefully you've put behind you. No, I always mean. I mean, I kind of always pride myself and I'm not a hypochondriac, you know, I'm pretty tough and blah, blah, blah, but I have to admit

about an 18 months after I'd had my breast cancer, I had a pain on one side of my back, left side, which was where I had my cancer, and, you know, it wouldn't go away and blah. And eventually, you know, I went and sort of demanded a full body scan because I was completely convinced I had, I had bone cancer. And, you know, not without reason, because I, you know, I'd had a friend who also had breast cancer and had gone to her bones quite quickly. And her first symptom was back pain that didn't go away. I mean, I waited two to three months and it was nothing. But in those two to three months, I, you know, I lay awake at life and I imagine that it was, it spread to all my bones. Yeah. And I, you know, I think things have changed. When I was a medical student, I did a

project with Tony Howell, who actually was always also talking at that day. And he's very amazing professor of medical oncology, and he does a lot of preventative breast cancer work now. But we used to go to his clinics. And people would be seen every three to six months and they would just be seen, even if they had breast cancer 10, 20 years ago, it would just be everyone would be followed up. Whereas now, it's good, things are changed. So once the initial treatment's gone, you often have a review and then the reviews become less and less frequent, don't they? But then I was just reading an article recently at the weekend, and it talked about falling off a cliff after surviving from cancer. And this was all cancers. And I think you're

quite very vulnerable. You've had a lot of support, a lot of information, a lot of treatment often. And suddenly it's the big outside world. And it's good because it means you can live your life, but there's other diseases, there's other conditions. And, you know, people who take aromatase inhibitors, for example, have a three times increased risk of osteoporosis. And some guidelines, I was trying to find some and they haven't been updated for the last 10 years, would you believe, say that women who are going to start on these drugs really should have a dexas scan beforehand to see their bone density. And then, there are lots of ways of improving bone density, not just taking HRT because that's not

appropriate for every woman who's had breast cancer, but looking at taking vitamin D, calcium in your diet, weight bearing exercise. And if you know that your bones are slightly thin, like your relative, if she had had a bone scan before, she might have been able to do something to try and prevent osteoporosis and a fracture. So it's this sort of information, which I think is really important. Exactly. And when you're discharged from hospital, that's And that's where it comes back to patient choice, you know, that if you're, the more information you're given, the more able that you are to be able to make those choices.

Yeah, it's really important. Yeah. The other thing, before we talk about HRT, because estrogen gets all over our bodies and it can affect us, like I say, in different ways, we have estrogen receptors on our vaginas, on our bladder, on our pelvic floor. So it's very common.

Some studies have sewn up to 80% of women after the menopause. have symptoms related to vaginal dryness. And obviously that can cause pain and discomfort during penetrative sex, but it also can cause discomfort walking or sitting or I see some women who can't wear underclothes because it's so painful. We know that breast cancer patients, especially on tamoxifen and aromatose inhibitors, are more likely to have vaginal dryness

and libido problems and sexual dysfunction. Did anyone talk to you about any of those potential symptoms, Kirstie? No, and this I feel quite strongly about, actually. Nobody mentioned this to me, and it had a very profound impact on my sex life. I'd had quite a good sex life before. I have a very good marriage and that's part of it. And I got extreme vaginal dryness and it was sort of like kind of sandpaper, very, very painful. Penituary of sex was incredibly painful. And so I sort of had to bring it up. And I think that's, you know, and I'm somebody who's fairly open. about talking about sex. Yes. But even so, you know, both my oncologist and my surgeon male, and it is awkward. And what happened when you did bring it up? Well, I brought it up, so I've done some reading about having estrogen pesseries,

and to what extent that was a risk for somebody like me. And they look sort of surprised. Like, oh, oh, yes, no, yes, you could do that. Yes, I think there's very, very almost no risk at all because it's very localised. locally applied. And, you know, I got a prescription, but, you know, and it made a huge difference. It really did make a huge difference straight away. But it took me a long time to pluck up the courage.

Quite some time had gone by. And I think what I feel really angry about was that I had a friend, a male friend, who was diagnosed with prostate cancer at a similar age to where I was diagnosed with breast cancer. And a huge amount of time was spent advising him on how. he could maintain a healthy sex life and get an erection and so on. And that was all part, that was built into the treatment. Whereas for women, we're expected to bring it up. And I don't think that's fair because I think a lot of women find it very embarrassing to bring it up.

I found it embarrassing. I didn't want to bring it up. It is embarrassing. And yeah, I mean, my husband, as you know, is a urologist. And if someone's deciding, if they've had prostate cancer, they're deciding whether to go for surgery or for radiotherapy, talking about impotence and ejaculation is really important. And like you say, before treatment, it's decisions to be made. Whereas there's something about women and sex, it shouldn't be talked about. And it's disgusting, really. The other thing is, because the estrogen receptors are also on our bladders and pelvic floor, a lot of women get urinary symptoms. So they get recurrent urinary tract infections, cystitis, just incontinence. They can't hold on to the urine as much. And a lot of

people don't realise that's related to localised low estrogen and can improve with things like estrogen pezzaries. And I've spoken to a lot of patients and women who have said to me, well, they're oncologists there's, well, if you've not got an infection, don't worry about it. You've had your cancer treatment. Everything's fine. Any problem see your GP. Well, actually, it's part of, because it's been caused by the treatment. And I feel it's really important that women are warned about that as a potential symptom because, you know, sex is very important. We're British. We don't talk about it enough. But we know that having regular sex is obviously very important for a couple. But we know from studies actually it can improve quality of life.

It can reduce the risk of depression. It has even been some work that men who have sex at least twice a week have a lower risk of cardiovascular disease and also better performance at work. So there's, you know, there's lots to be said. about regular sex that isn't painful, you know. And I think as a breast cancer survivor, I would say, I remember kind of thinking that breast cancer must have been sort of invented by some kind of, you know, evil Greek God who didn't like women because, you know, it comes down and it chops off your breasts and, you know,

and it happens just at a time, well, for me, you know, where I was going through menopause. So you're already feeling, you know, you're feeling unattractive. Your powers of attraction as a woman have waned. So you're feeling very, very vulnerable about those sort of things already. And so then for your libido to disappear, which it very much does. And then even if you want to have, you know, sort of think, well, okay, I'll still have sex because I know it's important for my marriage, my relationship. And to find it so unbelievably painful and you're right about urinary tract infections. I got several of those and they're very uncomfortable.

And I literally haven't had one since my 20s, you know. All of that was depressing. It was really depressing. And I agree with you. I think regular sex is important for a relationship. And, you know, often at women are diagnosed with breast cancer around my age in life in the early 50s. Your children have left home. You know, it's a difficult transitionary stage. Absolutely. And maintaining that intimacy with your partner at that point is important. Of course it is. Absolutely. And there are non-hormonal treatments as well. So there are some really good vaginal moist. that can be used regularly. And then there are some vaginal lubricants that can be used during sexual intercourse that are non-hormonal companies such as yes, regal and silk, S-Y-L-K are the best. We have lots of samples that we give out to women in the clinic because there are a lot that

are not so good. There are certain manufacturers that do scented ones and a lot of people buy them and they find them really uncomfortable. So you have to be careful what you use. Yes. I mean, I was recommended by somebody to use the yes, lubricant, which you can, if you're, you don't have to go into a pharmacy. You can buy online, which is great. Absolutely. And yes, do different ones. So they do a water base and an oil base lubricant and they also do a moisturiser and they're organic. So, but it's about trying the different ones and seeing. And a lot of these companies will give samples as well before you even buy. And then like you say, there is vaginal estrogen. And that can be given as a pezzary, which is usually used twice. a week or it can be used as a ring that lasts for 90 days and it can be taken out if women want to when they have sexual intercourse or there's creams as well and all of these give a very very low dose of estrogen locally and we know from studies that the absorption into the body is the same as placebo so the first couple of days there's a very small amount that is absorbed and that's

usually because the lining of the vagina is so thin it gets absorbed very easily but once the estrogen works to build up the lining of the vagina, as you can imagine, it becomes thicker, so it's harder to penetrate. So we know that women who have had breast cancer can still safely use this. And unfortunately, I don't know if you read the insert, but the patient information in the packaging is completely incorrect because it talks about the estrogen like it was a systemic estrogen. So it will say risk of clot, risk of stroke, risk of breast cancer. It is horrendous. It is horrendous and it's completely factually wrong. So women, I didn't read that.

No, but a lot of people don't because if you read the paracetam or one, it's going to tell you you're probably going to die. So a lot of women who are understandably anxious about hormones who've had breast cancer want to read and it's important that they have the right information and this is actually wrong information. But the International Menopause Society, the British Menopause Society are very clear that we can safely use localise estrogen. Women who are on aromatase inhibitors probably shouldn't

just because they want to block every scrap of estrogen in the body. But certainly people on tamoxifen can still use localised estrogen. Yeah, on tamoxifen you can. On metrosol, that was the other thing that led to, so postmenopausal women pretty much always put on netrosol. And premenopause were on tamoxifen. So when I said to my doctor, that was the first step that I wanted to try to localise.

estrogen. And until that point, I had just thought, like, many, many breast cancer survivors that all estrogen was bad. It was evil, you know, and so I was even frightened of using the localized one. And my doctor said, no, no, it's okay, it's safe, but you can't use it on tetrazole because the lactoseol just block it. That's how it works. Tumoxifen works in a different way, which I'm not a scientist, so I'm not going to go into, but it's been explained to me. So you can use it to moxophen, and it's perfectly okay. for postmenopausal women to take to moxfen. And I'll probably take it,

I'll certainly probably take it for 10 years. I mean, certainly with localised estrogen, women have to carry on taking it forever. Because as soon as you stop, the lining of the vagina becomes thin and sore again. And so because the dose is so low, it doesn't build up in the system, so it's absolutely fine.

No, I meant I was going to take it to moxfen for 10 years. Oh, I see, so. Yeah, yeah, absolutely. Yeah. Yeah. Well, yeah. It's longer. Who knows.

Studies have changed, and they used to just give it for five years, and then increased it to 10 years. But it's very much looking at individually what women get out of it. And tamoxifen is what's called a serm. So it's a selective estrogen receptor modulator. Like you say, it's not a pure anti-estrogen. It's anti-estrogen on the breast tissue. But actually, it's pro-estrogen on other tissues, including the womb.

So there is a small risk of cancer of the lining of the womb with tamoxifen. So nothing is without risk. No. Yeah, that's one thing that my doctor sort of said to me is that with what I'm doing now is that having my womb scan from time to time to just make sure that everything's healthy. But you know, you would tend to have some breakthrough breeding or something like that, wouldn't you? And so in the moment you had some bleeding, you take yourself off. Then that's the time that you really need to have a scan. And then I'm just going to only really

mention briefly because I know there's a fantastic podcast that you and Liz Earle have recorded about your decision to take HRT. And in fact, a lot of my colleagues have listened to it. And we have all thought that both of you sound far more knowledgeable than many of our colleagues because you've both, well, no, the reason being, and I'm not being rude about my colleagues, but actually we never get taught about menopause at medical school. And certainly, we just get taught, if we have any teaching, that HRT you cannot give to women with breast cancer end of. And that's as much teaching as we will get. Whereas actually what you and Liz have done is really researched it, like you say for your piece in The Mail on Sunday, you've,

spoken to lots of experts and you've got your own personal experience and you've made an informed choice. And I think that really comes across in the podcast. So any of you want to listen more about Kirstie's decision to take HART, I would really strongly say to listen to Liz's podcast with you because it's very important. What you have decided to do is not going to be right for every woman. And some women will choose not to. And we have very strict sort of guidelines that we use in my clinic. as you know I have lots of doctors at work in my clinic and there's a Kirsty Lang effect so we see lots of women who have had breast cancer

who decide they want to be on HRT and so we obviously wouldn't give it to the first person who has just been diagnosed with breast cancer and had a few hot flushes that would not be appropriate at all but there are a lot of women who have tried alternatives as indeed you had that are not hormonal they're tried improving their lifestyle and they're still really struggling

and in fact I saw a woman in my clinic recently who had been a hairdresser for a long time, loved her job, and about 12 years ago who had been diagnosed similar to you with a breast cancer, picked up on screening, very small, had treatment. Hers was actually estrogen receptor negative, which in some ways is even easier when you're thinking about hormones, but she said to me, do you know what, if my breast cancer came back, I think my friends would be really happy because if I died, I wouldn't be a burden, because at the moment my life is horrible. I'm hating my job.

I'm not going out. I'm generally miserable. I just feel awful. And I just thought, this is terrible. You know, she's 52, and she said, I'm just not happy. I really, there's nothing in my life that is giving me pleasure anymore. And so someone like her has really, I think, got a right to try HRT for a few months and see. She knows that the evidence is quite uncertain.

There isn't strong evidence to say women who take HRT increase their risk future of having breast cancer recurrence. There's somewhat that shows that it might reduce. We just don't know. And as you know, if you've had breast cancer in the past, there's always a risk. But actually, there's also a risk of depression and heart disease and osteoporosis by not having HRT. So a lot of women we see, try it for three months and then they can make a more informed choice. because it's very hard, as you know, to know how you're going to be once you take the right dose and type of HRT. And sometimes even very low doses can make a big difference.

And we do estrogen levels in women as a guide when they come to the clinic often. And I've seen a lot of women who have not been on hormones and still have estrogen in their body and sometimes fairly high amounts more than we would give estrogen too. So we know our fat cells make estrogen are adjudging. adrenal glands make estrogen. So we can never, unless you're on a romaase inhibitor, you can't block it completely. So, you know, estrogen's not all evil, but we need to just make sure that women have the right information. And it often isn't a quick decision. And it's giving women the right support and the right knowledge and making it right for them. I think it's what's really important. I think that's right. And I think it also makes you, I think very often when you're feeling ill or you're feeling down,

you feel like you've lost control of your life. And so actually to influence, form yourself and to read up on these things, you know, read Avran Blumming's book, as you suggested, Eastern matters. It's quite heavy going, but you can go. Yeah, yeah, yeah. Let's read it, scream read it. And, you know, listen to podcasts like yours and so on. So that at least when you go and see your doctor, you're armed with options. You know, there are options. But I absolutely agree with you, you know, try lots of other things. You know, I've always found acupuncture very, very helpful for some menopausal symptoms, you know, and for some women, that's enough, you know. and plenty of expertise and so on and altering your diet.

There are lots of things you can do. But that's the importance of just getting as much information as possible. And it just, as I say, it makes you feel more in control. But it is also about the medical profession not being afraid to inform patients, to allow us to make a choice, to arm us with information. And allow us to take slight risks if necessary because all of life is a risk. I'm not going to deny that I'm not going to deny that. I know some people listening will be horrified that I'm increasing my risk, but I feel I'm

balancing it out with quality of life and other risks like osteoporosis, as you say. I think so. I think it's really important looking at the bigger picture. And certainly women who don't exercise, women who are overweight or obese have a higher risk of developing breast cancer than taking HRT. So it is looking overall. And you've got to be happy with the decision that you make. and no decision is irreversible, but I think it's very important to have a good conversation with your doctor. I know personally when I go to visit my GP, I'm very conscious that they've only got 10 minutes and they're often running late and I'm trying to get my words out really quickly. And actually, if a patient comes to see me, this is look, this is what I want to talk about in my 10 minutes. I've made this decision. I've read this research. I've read this paper. Can we have a focus talk about this?

Then actually the conversation is so much easier. So women can help, I think, as well. So, well, that's been really useful, and I hope it's been very informative and useful for lots of women and men, hopefully, listening. Yes, I hope so. I think the more information you can get, the better. So to anyone out there in my situation, don't despair, you know, there is a way out. Good, thank you.

And so just before we finish, Kirsty, could I have three take-home tips? So for women who have had breast cancer either recently or in their past, what would you recommend to help them if there's to? struggling with symptoms? Well, I would definitely recommend local vaginal estrogen or pestries for vaginal dryness, which I think that's really actually quite important. And there's no risk there at all. So don't worry about that. I think that's very important. And then I think, you know, look, it's a difficult thing to judge. You know, how much are you struggling? You know, if it's just the occasional hot flush or whatever, you know, there are things that you can try. I mean, I certainly took a mild anti-anxiety or

antidepressant for a bit, which helped a little bit. I do weight-bearing exercise. I walk every single day. Those kind of things are important. But, you know, if you are still really struggling after that, you're feeling, you know, tired, emotional. I mean, I was getting hot flushes and sweats, you know, pretty much every hour, 24 hours a day. And it was becoming, you know, I was having to take a change of clothes to work with me. That's kind of thing. Then I think, you know, if it really does feel like life is so difficult, then go to your doctor, go to your oncologist or your surgeon or whatever and have this conversation with them or try and find a doctor who is sympathetic. And there are, you know, there are doctors out there. Remember, you can always, on the NHS,

you can always ask for a second opinion. If you don't get the right one, you want, you know, you are allowed. And look into the possibility. Find out the risks and make an informed choice. But, you know, there's a lot of information out there. But don't just assume because you've a survive breast cancer that you should just feel, you know, oh, I'm lucky to have survived. And now I'm going, this is a cross I'm going to have to bear if life is going to be difficult. It doesn't have to be. Absolutely. I think that's so important.

More and more work is being done into improving the lives of women who have survived breast cancer, just as a lot of work has been put into improving the lives of men who've survived prostate cancer, as we've said before. So don't be afraid to ask. Yeah, I think that's such key advice. just be strong and try and get the right advice pertinent to you and not listen to too many opinions, I think sometimes as well. So thank you so much for giving up your time today, Kirsty, and joining me in this podcast.

It's a pleasure. Thank you, Louise. Thank you. Bye-bye. For more information about the menopause, please visit our website www.menopausedoctor.com.