The Dr Louise Newson Podcast - 042 - The Big M - Kate Irvine & Dr Louise Newson

Episode Date: April 7, 2020

In this podcast, Dr Louise Newson is joined by Kate Irvine and together they discuss Kate's online perimenopause and menopause survey, The Big M.  Kate began her survey as a way to find out how women really feel about the perimenopause and menopause, including which aspects of the Big M women find the most difficult, whether they felt they could discuss it with anyone and whether they had any help getting through it. Kate hopes to be able to use the information given to help other women in the future. Kate also intends to compile the detailed responses into a  book which helps women to feel better about what they are going through, she and Dr Newson discuss how the idea for the book came about, and how Kate hopes it will work.  During this podcast, Dr Newson and Kate touch on several different topics which the survey highlighted, such as realising you are perimenopausal, how helpful GPs can be (or otherwise), women leaving the workforce because of their symptoms, the over-prescribing of anti-depressants and symptoms such as vaginal atrophy. Ultimately they agreed that talking is vital and makes you feel better, and Kate hopes that (if published!) reading her book will be like having a chat with friends about a common issue.  The survey is still open for responses, or if you just want to email her about any aspect of your menopause experience you can reach her at: [e-mail]  Kate Irvine's Three Take Home Tips: Don't feel alone! Don't be frightened to talk about it - communicate with your friends. Look for helpful evidence-based advice such as the resources on menopausedoctor.co.uk and the British Menopause Society website If your GP hasn't been the most helpful, look for a doctor that specialises in the menopause. They should be better informed.

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 Wellbeing Centre here in Stratford-upon-Avon. In this podcast, I'm really pleased to introduce to you, Kate Irvin, who's one of my patients actually, I've known for quite a long time. And when I last saw her in my clinic, she was telling me about a survey that she was doing and how she wanted to potentially put all the information that she got from the survey into a book. So I've been watching and following what she's done with interest.

So I'm really intrigued to hear more. So thanks for Tam and Kate. You're very welcome. So tell me a bit about you and your background and how you've managed to have this idea of putting all these women's stories and thoughts together in a book. Well, it all came about really because of my own experiences of the menopause and the periour. and the perimenopause particularly. The idea came to me really after I went on holiday and I was feeling absolutely grim

and struggling with teenagers and old parents and just feeling like I wasn't coping at all. And by that time I'd realised actually that I was in perimenopause but I wasn't taking any medication at all. And at the airport I picked up a book by Alison Pearson. Yes. And I couldn't put it down because I started to read it and the central character was a woman who was coming up to 50.

I think I was about 51 when I read it. Struggling with menopause, struggling with her family, all sorts of stuff going on in her life. And everything just chimed with me and I thought, yes, yes, yes. I recognise all of this. So this is the book, How Hard Can It Be? Yes. The character is Kate Reddy in the book. And it's interesting actually, I will digress, but I will get back to you because when her

first book came out. I just had my first daughter then and Kate Reddy had just had children hadn't she and she was going back to work and really struggling with her childcare being at work and there and there were lots of things that really echoed with me then and I thought yes we try and pretend how much in control we are at work and behind us we're trying to organise our children's PE kit, you know, their meals, you know and then suddenly they need to be dressed up as an Egyptian for the next day and all that sort of stuff goes on, doesn't it? So she teased that out really well and it was made into a film, wasn't it? Yes, it was. Yeah. And then she actually approached me about this book and said, oh, could you help with some of the menopausal symptoms? And I really wanted to help her

tease out the psychological symptoms. So to try and get people away from thinking about fleshes and sweats because they are very common. They affect around 70% of women. But actually, most women I talk to and probably the ones that you've spoken to, they're not the symptoms that affect them the most. And so I wanted Kate to realise that there was more about her own experiences. And so she's quite graphic and she, her mind is a real problem, isn't it? Her memory. And anxiety. Yeah. Panic attacks. Yeah. So it was a great honour to work with Alison on her book. And also for me as a not an artistic person to just see how a book evolves and how the content changes and, you know, just seeing it go into fruition. And, you know, it was amazing.

because it has done really well the book. And I think it's helped a lot of people, like you say. Well, exactly. And what I felt when I came to the end of the book, well, there were two things that came out of it. One was, I just felt incredibly cheered up by having read a book that had a men or pulls a woman in it. And also made me think,

somebody out there understands because they've written about it. But then when I got to the end of the book and I was reading through all the acknowledgements, which I think is something you do when you get to a certain age, I read about Dr. Louise News, who had given her so much help and support and believed that menopause women shouldn't suffer. And I thought, I'm going to get hold of this woman. And I'm going to go and see her.

Because by that stage, I just decided I was going to try HRT because I was fed up of struggling. Yeah. And had you tried? Have you seen anyone for help before? Well, I hadn't really. Early on, I'd been to see my GP. Actually, before I even realised I was perimenopausal. And she said to me, because I kept getting urinary tract infections.

Which could be very common, of course. And she was pretty good and she actually said, do you realize that you might be perimenopausal? And I hadn't really thought about it. But I suppose I was in my late 40s, so it wasn't surprising. And we talked a little bit about possibly going on HRT later down the line, but I wasn't really ready for that. And I had that feeling, as I think a lot of women do, that somehow it was wrong and something to re-avoid it. Yes.

And then after that, my symptoms, you know, I had other symptoms, but I didn't realize they were menopause symptoms at the time. So by the time I'd got to the end of this book, I had realized that all these symptoms were related to the perimenopause. And I had enough of it. And then I was just impatient. So then I just wanted to come and see a menopause specialist and try it. That was a little while ago, wasn't it?

I think that was about two years ago. Yeah. So you're much better, hopefully. I am much, much better. Yes, I'm much better. But I just thought then that book had made me feel so much better. wouldn't it be nice if other people felt better because they were sharing news and information about what other women have gone through really?

And I think it's really important, isn't it? Because, you know, life's really changed since we were younger. There was obviously no social media, no internet. So it's very hard to get information. And now almost we've got too much information because you can just pick up your phone that's always next to you and Google anything you like. Yeah. But I still think people are almost lonelier now than they were in the 70s, 80s,

I was growing up because you had to talk. Yes. You wanted to communicate or find, even if it meant going to a library, you'd have to ask the librarian for a certain book, whereas you can become, and I think when you're often perimenopausal, menopause, a lot of women find that they become very socially withdrawn and socially isolated, don't they? Absolutely. And often not realising it.

They think it's because their children, like you say, are driving them mad or they're pulled for their elderly parents or work or their partners. So they just think they're resigned to this. this new phase in their life. Yes. And unless someone sits down and says, have you ever thought some of these symptoms are not due to your life, they're due to your changing hormones?

They wouldn't know. No, it's so true. And many women who have replied to my survey have said, I don't want to go out anymore. I don't really socialise anymore. And quite a lot of them, I mean, it's lovely, but it's also quite sad, is that they're incredibly pleased and delighted with me getting in touch with them.

Because at the end of my survey, I say, you know, you could give your email, address so that I could ask further questions. And I would say that 90% of the women that have done the survey have done that. Quite something, isn't it? Yeah, because people, they want to, people want to talk about it. I mean, lots of people give their phone number. It's amazing, isn't it?

And lots of people have said, you know, thank you so much for taking an interest. Isn't that? I mean, that's sad, though, is it? Yeah, that it's, well, it's 20-20 now, and people are being neglected. Yeah. Feeling that they've got no one to talk to, which, you know, are there still. I hear all the time really sadden me and drive me to work harder to help more women, but it should never really happen.

Even if people aren't getting the right treatment, they should get the right support, shouldn't they? I mean, there are lots of Facebook groups and social media groups, but somehow they're a bit sort of faceless. I mean, I know I'm faceless as well because I'm just somebody at the end of a survey, but I suppose because I email them personally, then... It's a person rather than an organization. Yeah, so for some people I've become somebody. I mean, some people sort of correspond with me now.

Yeah. So tell me about the survey. then? What other questions in it or what's the aim of the survey? Well, there's about, I suppose, I haven't counted the number, but about 30 questions. And they go from yes, no answers to, you know, please answer in depth if you can. So have you seen the GP? Was the GP helpful? You know, tell me what your symptoms were, which were the symptoms that upset you the most? Things like, has it affected your self-confidence, your relationships and quite a lot of other things, really. And some things. And sometimes,

people literally go sort of through the survey saying yes, no, but a lot of people have given me huge detail and then I have emailed a lot of people and they've told me more about certain things. So what have you learned, do you think? Well, I've learnt a lot, really depressingly, the thing I've learned probably the most is that the majority of the women who've replied have not had a good experience with their GPs. Did that surprise you? The extent of it really did surprise me. I mean, I sort of thought there would be some sort of, I would say, old-fashioned or, you know, ill-informed GPs out there.

But really, I suppose at least 70% of my respondents have not had a great experience. I mean, from being flatly refused HRT or told they're too young or told they're too old or told that they can't take it because somebody in their families had breast cancer. And all of these clearly, as you know, are wrong. Yes. It's sad because GPs work really hard. The job's really changed. I was a GP for 15 years and it really, really did change. And now the time constraints are difficult.

It's really hard to keep up to date because there's lots of guidelines coming out all the time. But the menopause affects all women, doesn't it? And even if only a small proportion have really severe symptoms, that's still a small proportion of half the population. So it's a lot of women. And there is a thirst for, knowledge out there and certainly when I do training and education, there are a lot of GPs who want to know more and say, gosh, I didn't realise how safe HRT was. I didn't know we could

prescribe it in younger, older women or what have you. And I don't know if you know we've developed a menopause education program which is being launched with a company called 14 Fish, which will reach 50,000 GPs. So that's going to come out in the next few months. So that will really help. So there are a lot of GPs who really want more education, but don't know how to get it. And because they're so busy, it has to be done in a very easy, accessible way. So 14 Fisher, a fantastic company that are very savvy with education and bringing it up to the 21st century, which is what's needed. So that's exciting for me because I feel I don't want to sit here and be rude about GPs, but I think it's so hard for them. And it's not always,

doctors, I don't know if you've had any experience, but sometimes it can be the nurses or the pharmacists that maybe have not given them the right information. So it's, it's, you know, for all healthcare professionals really to have some knowledge and understanding and even if they can't treat they can signpost and help and I think like you said when you were experiencing symptoms if you had someone who could say actually Kate I think this is related to your hormones you would probably just feel like reading Alison's book it just makes you feel yes just makes you feel better you're not going mad you're not the only one yeah all of that and that's the other side of it and that's the thing. I mean, it's all about the education, isn't it? It's education of the health

service, but it's also educating women about what to possibly expect. Because, you know, I know this has been said numerous times, but we all tend to know about the flushes and irregular periods, but most of us didn't know that we were probably going to get brain fog, anxiety, aching joints, you know, all of that. I didn't know that any of that was coming. No, and it would be very useful to be prepared for it, wasn't it? I mean, I guess I'm rather naive, but I knew that these symptoms occurred, but when they occurred in myself, I still didn't realize. I'm going to my hormones, which is ridiculous.

But I think you're as a busy working mum, I suppose, you're so busy looking at everyone else. When you have symptoms, there's no one reminding you or telling you that actually this could be related. And then you always put it down to something else. And me as a doctor, I'll always put it down to a disease. As you know, menopause isn't a disease. So it wasn't in my radio.

which is ridiculous. But like you say, the peri menopause, so the years around the time before periods actually stop when women get menopausal symptoms, that's a real area where people are not being picked up, isn't it? Yes, and often sent off for innumerable tests and scans and things and getting actually really very frightened. Yeah, absolutely. And so I'm doing quite a lot of work behind the scenes trying to look at the health economics

of this sort of hidden cost of the menopause, really, because all these people that get sent off for scans and referrals and tests, it's costing the NHS and a lot of money. But also it's costing the women a personal cost, not just financial, but also they have time off work, the anxiety. A lot of women have worsening migraines, and then they're worried they might have a brain tumour. So while they're waiting for their results of their brain scan, you know, that's a lot of stress and anxiety. And like you say, they might be anxious anyway. So it's compounding that. It's a huge problem really, isn't it? Well, it is.

And also, the other thing that hadn't even really occurred to me at all until I read a lot of these surveys was how many women are either struggling terribly at work, move to part-time work or give an up work. And that's really shocking. Did you realise that before you used that? No. No. Well, I suppose I hadn't really thought about it.

But it never occurred to me that we were losing so many women out of the workforce in their early 50s or, you know, around 50. Because of their menopause, it seemed ridiculous. It does. And I, when you think about it, it's obvious, isn't it? When you list the symptoms such as poor memory, reduced concentration, brain fog, anxiety, low mood, fatigue. Yes. You know, these are going to have an impact on the workplace.

But until work organisations think about it, it's very hard. And these women are often dismissed as being depressed or not coping with their job. And then the women aren't recognising it. So they think, well, maybe I can't cope because I've now got teenage children or what have you. But when you look at the figures of the number of women leaving work early, it's really high. And it's great with me too. And various movements to keep women in the workplace. When they look at them senior board members, there's often a real predominance of men.

But no one really talks about why these women are leaving. And it's very hard to get figures because the women don't know why they're leaving either. but when you sit down and talk to them, as you have with your survey, you realise sadly. I think it's very sad because when I did a lot of work with the West Midlands Police, a lot of them used to retire at 50. But when I talk to them, they say, oh yeah, I've stopped working, it's great. But then they're sitting at home, staring into it on the four walls. They're falling asleep in the afternoon. They're not exercising.

A lot of them say I can't even pick up my granddaughter because my joints are so sore. And so they're not actually having this wonderful retirement, that you think. which is even worse, isn't it? No, that's awful actually. I mean, I would very much, because I think often about, you know, women who are really at the top in their careers and in the city and places like that

where I suspect I may be wrong, but probably you can't really admit to what's going on around menopause. Yes, absolutely. And I sort of think, how have those women coped with it, you know, the ones that have had symptoms? Yes.

Because it must have been pretty tough. Yeah. I think absolutely, and I, Menopause is such a horrible word. Yeah, it is. It gives this sort of picture in your mind as some crazy woman in a flowery dress with a fan. And it was a lot easy.

I mean, in time gone by, even using the word depression was really hard. But now it's more acceptable to say, I have depression and the workplace will do more. But menopause still has this horrible, I don't know, it doesn't, whereas a lot of work I'm trying to do is trying to let people think of it as a female hormone deficiency. Like we have an underactive thyroid gland. It's the same with our female hormones. And a lot of women will think, well, I just get through those symptoms. So I'll have a really

bad year, two years at work, and then I'll be better. But what they don't realize is the symptoms can last and last and last. And then they can change. So a lot of women I speak to start with having the sweats, flushes, and then they improve and they think great. But then they become incredibly anxious, crippling anxiety, often become a housebound with their anxiety, or low mood or reduced motivation. But they don't realise that's still part of the... They think that they are depressed, probably. But that's the other really shocking thing that came out, actually, of the survey,

was the number of women that have been prescribed antidepressants. Even when they knew that actually they were perimenopausal. Yes. Antidepressants rather than HRT, which just can't be right. No, because there's so much, isn't there in the media about the number of antidepressants that are now prescribed. I mean, I can't remember the figures, but it's huge and it's certainly increased, certainly, since I was qualified as a doctor. But the guidelines and the evidence are very clear that antidepressants do not improve low mood associated with the menopause or perimenopause. Yet these women are offered them.

And a lot of women do actually say, I know I'm not depressed. Yeah. But I have, you know, all these symptoms. Yes, yeah. I mean, I know some of them are prescribed. they can help with the flushes. Absolutely, yes. But, you know, surely, actually, would be better to give them HRT.

Yeah. I mean, first line treatment, if someone doesn't have a contraindication, even for hot flushes, is giving HRT because you're replacing the hormones. So it is very low risk, as you know. And certainly in younger women, they really have to have hormones either HRT or the contraceptive pill because there's risks to their future health without having the hormones. And there isn't any evidence that the antidepressants actually improve low mood. So there is some evidence that they can help with their sweats and flushes.

So for some women who choose not to take HRT or who can't, for example, if they've had an estrogen receptor positive breast cancer, they wouldn't want to take HRT in the first instance. And so those people. But that's a small number of people, whereas you're talking about a lot of women. Really a lot of them. I mean, quite a few people have been prescribed them and just not taking them. them and then there are other people that have been taking them and I think the other really well a lot

of the women because I ask about other symptoms I sort of you know is there anything else that you haven't mentioned at the end and a lot of women obviously don't really want to talk about it because it's a bit embarrassing but you know vaginal atrophy yes I mean loss of libido it gets mentioned by almost everybody and then some people will go on to further mention you know vaginal atrophy and do you ask specifically about it or are they voluntary well if they're If they've mentioned loss of libido or anything to do with dryness, vaginal dryness or whatever, then I sometimes ask a follow-up question. And I had one lady who says she's on a mission to educate the whole of the north of England

about vaginal atrophy, who wrote me a great long screed about it. Because, you know, I want to try and put all these experiences, not all of them, but some of the experiences in the book that I'm hoping to compile. Yes. But of course, the book, what is it, my menopause vagina that you've got to. In Lewis, yeah. Which is excellent. We need more of that, really.

We need people to talk about it. Yeah, yeah, yeah. Because did you know how common vaginal dryness was? No. I had no idea. No. I mean, obviously as a doctor, I'm not embarrassed talking about dry vaginas. And it is embarrassing for a lot of women. But because the estrogen declines in our body,

estrogen receptors in the lining of the vagina. And as you know, also in the bladder, the pelvic floor muscles, can be really affected. And a lot of women have symptoms, not just of dryness, but of irritation, soreness, and it's not just because it's painful during sexual intercourse.

Some women find they can't sit down or they can't wear underclothes. And it's a progressive symptom. So, as I've already mentioned, flushes and sweats often improve with time, but this doesn't. And the statistics you read vary in the medical literature, but some studies say 70 to 80% of women

will have it without treatment, yet only about 7% of women actually get treatment. That's shocking, is it? Which is really shocking. And even there was one study that I read that even when it's brought up in the consultation, only 30% of women will leave with a treatment. And the treatment is very safe. So I'm using it now.

So it's very different to HRT. And so even women who choose not to take HRT or who can't, even women who have had breast cancer can still use local treatments. Some of them are not hormonal, but even the estrogen, pezzary cream or the ring can still be used. safely. So it really saddens me that women are still experiencing those symptoms. Yes. Well, I think also, I suppose I was ignorant about it as well, but I suppose you imagine that when you take transdermal or oral HRT, that that HRT is going to do the trick for all of you, but of course it doesn't. No, that's right. So, I mean, when I first came to you, I didn't really have those symptoms and the transdermal

did the trick for all my other symptoms. And then I started to experience all sorts of problems. And now I'm using Vagifermin is helping. Yeah. It's really helping. And I think it's really important, certainly when I lecture doctors, for them to say that women who are on HRT need to be reviewed at least every year. And we need to directly ask about any local symptoms. Sometimes it's not even vaginal dryness.

It can be urinary symptoms. So people are going more frequently, or like you said, recurrent urinary tract infections, because the local estrogen can really help with that. And about a fifth of women have HRT as well as using local treatments. and it's very safe because the dose is so low. So it's really important. So tell me about the book. What's your idea for the book?

Well, what I want to try and do now is I've had about over 300 responses. That's a lot, isn't it? So I am going to do some quantitative analysis with that data. What I really wanted was qualitative data. So that's why I've been following up with emails because I want to put down people's experiences in their own words. So obviously I'm having to ask everybody that contacts me if I can quote them. And nobody has said no yet.

Which is amazing. I mean, I'm going to change their names. But everybody's said, yes, absolutely delighted to help you. And I think that's because women want to help other women, don't they? Yeah. Which is great. Yeah. Yeah.

So what I want to do is try and put together a book, which is not like your book, which is, you know, a medical, informative book in that way. I mean, there will be, obviously, pointers towards where to go to get the right information and some information in the book. But it's more about what women have experienced. at different stages and different aspects of their menopause. You know, the symptoms, I mean, a lot of women don't realize that they're in perimenopause. I mean, so that probably would be a whole section on that,

realizing that you're in perimenopause. So have you thought what you might call it, how are you going to get people who don't know that they need to read it to? Well, the survey is called the big M. And so I'm thinking about calling it the big M and then something like women's true experiences of the menopause or something along those lines. Yeah.

And I want it to be a bit like sitting down with a load of your mates and having a good old chat and a moan and a comparing notes session, which usually makes you feel so much better. Yeah. And that's the aim of the book, really. Yeah. I mean, and I know that there are a lot of podcasts

and online forums and things now, but I suppose because I like to curl up with a book that sometimes makes me feel better. But I think we've done a big circle with books, haven't we? came out, that was it. And I remember my mother gave me one a few years ago and said, I'm not sure you're going to like this present. I'm really worried. And I did like it for a year. Yeah. But it's not the same as feeling a book as this. No. It's something very comforting of having

books that you can feel and dip into, I think. Well, I mean, I sort of see it as that kind of book that you might keep by your bedside when you're feeling a bit fed up with it all. Yeah. Pick it up. And if you read about what other people have been going through or, you know, I don't want it to be all negative. But just, you know, think, oh yes, that happened to me too, or, you know, she got through that or this might help from other people's experiences. I just think that might make people feel a bit better. Yeah. And I think, like you said, there's so many people suffering. Some people are going to choose to join a Facebook group. Some people are going to want to speak to their friends, and a lot of people will still want books. So it is reaching out to as many people as possible in

different ways is really important, isn't it? Yes. Because it is hard to get accurate information. And certainly, as you know, I set up my website a couple of years ago, really just so people could have evidence-based, non-biased information. Because there's a lot of information out there that is heavily sponsored, or it's not factually correct, it's not updated. And it's a real worry. And it must be very hard.

I can quickly read something and know whether it's right or wrong, but especially if you've got a menoples or brain that's not quite working as well. It can be very difficult, can't it, to know what your reading is correct? Yes, absolutely true. What I tend to do now is because actually what's ended up happening is lots of people are sort of asking me for advice. Or they're putting things on their surveys and saying they've been told stuff and I just know it's not right. Because, you know, over the last year or so, well, I've been researching this. I've learnt quite a lot.

Yeah, I'm sure. So I tend to direct them either to your website or to, you know, to the British Menopause Society website to know that they're going to get proper information. So it's, I mean, you've got a really key role. It's quite a responsibility, isn't it? I get a lot of questions through Instagram or just some messages sometimes,

and I can't give advice as a direct message on Instagram, but if someone does ask something, I feel really sad not if I don't reply, so I end up do, but it has to be very generic, but if you can point them to the right direction, it's a nice feeling to be able to help people, isn't it? Well, I've actually felt quite conflicted, really. A couple of times I've had people.

I had a lady the other day who completed her survey, and it seemed quite clear to me. She was in her mid-30s. She'd been refused HRT by her GP, but it sounded absolutely certain to me that she had POI. And I just said to her, look, I think your GP is wrong. And I really think that you should find another GP and also look at your website.

and also is it the daisy chain network? Yeah, it's the daisy network. The daisy network. And I haven't referred to that. I said, look, I'm not medically qualified, but I really think that you should be looking at this. Yes. But that's kind of a big responsibility.

I felt, you know, should I be doing this? Yeah, but you're not doing anything wrong, are you? And I think if she didn't have an early menopause, she hasn't done anything wrong. But it is really important to empower women because that helps the consultation as well. And, you know, a lot of doctors only act on what they've heard. So if they hear about a low mood, they'll look at the low mood. If they hear about

a headache, they'll look at the headache because clearly not everything is due to the menopause. But if a woman is empowered and has gone to the Daisy Network or read some information from the British Menopause Society and says to the doctor, look, I have low mood headaches, my periods have stopped, I've read this information. Could I have POI, premature ovarian insufficiency? It changes a consultation within the first minute. So I think it's really good that you can help because you're not diagnosing, you're just helping and that actually helps the woman but also the doctor and then the doctor can be more tuned in for future consultations with other women too. So it has this sort of ripple effect really. Yes, absolutely. But you know,

I think that really, and I'm sure the NHS will say they can't afford this, but I think all women at around 45 or something should be being sent through some kind of information saying, you know, if you're getting low mood, perhaps your periods have gone erratic, you're feeling anxious, you know, numerous other common symptoms. These could be perimenopause. Yeah. I totally agree. And there is a check now for sort of, well, person check between the ages of 40 and 70 people can go.

But it's looking at heart disease, diabetes, which are really important. But if they added a questionnaire or just a few facts, did you know, it would really help. Reduce the burden for women, but also, as we've already said, reduce the burden for the NHS, which is really important, isn't it? Yes. Absolutely. It would be a great idea. Yeah. So we'll get there. So, well, thank you so much for giving up your time and coming here. So before we finish, I was just wondering if you could give three tips for women who maybe are struggling and like some of the women that you've experienced in the survey who feel that they're not getting the right help or support.

What would you say to these women? Well, I would, first of all, I would say, don't be frightened to talk about it. Do talk about it and talk about it with your friends because you'd probably find. that they're going through similar things as well. You should perhaps go to the Menopause doctor website because that's full of really useful information. And there's also the British Menopause Society website. And just try and seek out, if your GP hasn't been very helpful,

try to go to a GP that does specialise in women's health if you can find one because they should be better informed. Yes, that's really good advice, I think. So the important thing is do not feel alone is really key. isn't it? Absolutely. And if you don't get the right help, keep trying. And sometimes people have, you know, it's seeing a nurse or some people even change doctors.

But talking to others is really important. So I think that's been really useful and I hope very informative to lots of women out there and men, hopefully. And we look forward to seeing your book in print. Thanks. Thank you. Thanks very much. For more information about the menopause, please visit our website www. pawsdoctor.com.uk