The Dr Louise Newson Podcast - 043 - Changing the Language Around Menopause and Midlife - Lorraine Candy & Dr Louise Newson

Episode Date: April 14, 2020

In this podcast, Dr Louise Newson is joined (virtually!) by Lorraine Candy - co-founder of the podcast series 'Postcards from Midlife'. Lorraine and Dr Newson chat about the stigma surrounding the word “menopause” and how we need to work together in order to break that down and really empower women so they can receive the correct help and treatment. They also discuss menopausal symptoms such as anxiety and fatigue and how they can have a massive, negative impact on women's lives if left untreated.  Dr Newson and Lorraine also talk about how important it is for women to receive the right dose and type of HRT. Many women wrongly think that HRT is a single treatment, whereas in fact, there are different hormones available and also different doses. The importance of exercise, nutrition and wellbeing is also discussed. Lorraine also talks very openly about her own experience and how she struggled for several years before receiving the right help.  www.postcardsfrommidlife.com Follow Lorraine on Instagram: @sundaytimeslorraine @postcardsfrommidlife Lorraine Candy's Three Take Home Tips: Feel your power - you have lived an amazing life and have an enormous amount of experience. Don't let that inner voice tell you you don't have the confidence. Arm yourself with information before any visits. Seek out the facts and write them down so you don't forget. Talk to your friends, family and other women about what you're going through. Let's spread the word!

Welcome to the Newsome Health Menopause podcast. I'm Dr Louise Newsome, a GP and menopause specialist, and I run the Newston Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. So today with me and my podcast, I'm really thrilled to have Lorraine Candy, who is the editor-in-chief for Sunday Times Style magazine. She's also a family columnist for the Sunday Times magazine, and more recently she's been co-hosting a fabulous podcast called Postcards from Midlife. So welcome Lorraine. Thanks for coming on today.

Hi, Lisa. So we met in real life a few months ago because you were doing a feature, won't you, for the Times Style magazine about spas. And as many of you know, I do not run a spa. I run a menopause and well-being centre. And you were really struggling to find somewhere that offered holistic care. So I enticed you up to my clinic for a day's experience. and when you were there, obviously, I started talking about your own experience. So I'm really delighted that you're going to share some of your story with us today.

Yes, I think it was, I was just perplexed that there was nowhere to go if you were a woman in your kind of mid-40s to 60 that focused specifically on that part, because it is a very holistic thing that is needed. And what is not needed is unnecessary intervention that's kind of very costly or, you know, yoga's not going to cure. perimenopause. So I was bizarre that I couldn't find, we tried the whole of Europe and we do a big spa special. So we try and tell a story behind each of the pieces that we do. So it's not just about kind of going away and relaxing. It's about a journey of some sort.

And I couldn't find anywhere in Europe or a bit more in America, in Europe or in the UK, that addressed the very specific symptoms of menopause and perimenopause. And would be helpful, I think, for that group of women and also not taking advantage. of that group of women, which I did could find a lot of those doing that. Yeah, and it's a huge thing because, as you know, menopause is just a word. It's a natural transition that happens to all of us if we live long enough. And a lot of people think it's just older women. The average age is 51, but around one in a hundred women under the age of 40 have an early menopause. And a lot of us experience perimenopausal symptoms, so menopausal symptoms when we are still having periods,

sometimes for up to a decade before that final period. And because, because, you know, Because it happens to all women, it is, like you say, quite weird that there aren't enough places where people can really receive evidence-based, non-biased care. And I think traditionally it's because a lot of us haven't had proper education as undergraduates or post-graduates. And a lot of healthcare professionals think, well, it's just about periods stopping. And once your periods have stopped, your menopause is over and you've got this new phase in your life. But as you know, it's when we don't have our hormones, those hormones we never regain because they're produced from our ovaries and once our ovaries stop working. We don't

have hormones in our body so that will last as long as we last if you like. And as you know, it can cause all sorts of experiences, many symptoms and a lot of people have symptoms that they don't realise are related to their menopause. And then there are health risks as well, such as increased risk of heart disease, diabetes, dementia, osteoporosis. So really doom and gloom for the menopause or women. So we need to think about ways of address. those in different ways, because we're all different, aren't we? Yes, I think also the thing from my point of view, having worked in style magazines and lifestyle magazines, I used to edit Cosmo and I worked on Marie Claire, having worked in that area and knowing that female audience as well,

there is such a stigma around the word menopause or perimen. In actual fact, I probably would have been difficult for me to find something physically labelled, the menopause spa but I just don't think women would want to talk about it and the stigma is there because culturally we have created a negativity around it and we've made women feel bad about it. It seems to signify the end and who wants to go to something like that or experience. So really it just needs a kind of, I think we've talked about it before, it needs to be viewed as a depletion of hormones. So that what is a hormone deficiency that women of this age group, majority of this age group are going through. And we need to look at the way it's

visually represented. We need to look at the way it's talked about and written about, and the way kind of those more male elements of the media consistently make fun of us for, you know, it's kind of the cartoons about the hot flushes. This conversation is skewed and wrong around women. So why would you set up a clinic? Absolutely. Yeah, I think, you know, you're right, because a lot of people think menopause is middle age, frumpy women, women with a fan, they're a bit hormonal, they're irritable, don't go near them, sort of thing. I mean, Jennifer Lopez is 50 and if you saw all the pictures, I mean, we can't all be J-Lo, obviously, because we're not that wealthy and we haven't been dancing that hard for 30 years. But when I try and do a piece on the menopause and we will look at stock pictures, I will be offered a huge amount of women kneeling on gardening pillows and looking tired and not looking in the way that most of us do at this age group.

And also, you know, being reframed as something positive, as a new stage, as a moving forward, is that's the kind of thing I'm trying to do with whenever we do features around this. And at the moment, there are quite some really good voices around it. I would say a couple of years ago, I wouldn't have been able to get anyone to write about it, whereas now I can get some quite glamorous women. I think Gen X has come through to their menopause with quite a vocal outspoken way about it. And it's also not about wanting to be younger. It's just wanting to be better

And I think it's very valid Sometimes we get a bit of flack If we do pieces around You know how to look after your skin over 50 Makeup to wear if you're that age That kind of thing And in somehow as if we are making it shallow It's all about making it shallow

But it is about how you feel And all those things are vital To the psychology of good mental health For some women They might not be for others But they are I remember we did a piece in the magazine About the anti-aging

And whether you use that phrase or not and we had headlined at anti-aging products that might work or something along those loans. And the whole our own menopause society and people are that laid into us. We said, no, no, no, you need to read the piece. Yes. Specific skin changes. You can call it what you like, but you're doing, you know. So we all need to be kinder and more positive, I think, around every woman's needs around this time.

But the conversation definitely has to change. It has to be much more upbeat. Yeah, I mean, it's interesting. As you know, I've produced a book, the Haynes Menopause Manual, and it took me 18 months to persuade Haynes to actually publish it or even be interested in it. And I wanted to use Haynes because I grew up in the 70s with the Haynes Car Manual, so I thought it would be a good platform and also a good way of men trying to engage with the menopause. And initially they said, no, we really don't need or want to book on the menopause.

Most of us are men. We've only got one female on our senior board members. We really wouldn't be interested. So I chipped away and chipped away. And now it's their bestseller. And I just found out yesterday that we're going to do an audio version. of it and it's going to be put in a Kindle as well. So, and now they're really grateful. And it's just getting over the word. And I know when I set up my clinic, it's the word. Yeah, it is.

I was working with someone that was helping me with my sort of advertising. And she said, oh, actually, Louise, I think I can't work for you anymore. And I said, oh, gosh, really, why, what have I done? And she said, well, you're going to put a sign outside with a word menopause on it. And I don't think you should do that. I think you should just call it a women's health clinic. And I said, well, I'm really sorry that you obviously don't know me well enough. I'm working really hard to try and destigmatise the word menopause. So it has to be in a sign outside my building. Well, it's a medical diagnosis as well. And it's, you know, 50% of the population are going to lose. Well, men, indeed, as well, are going to lose their, you know, it's going to be part of their life is going

to change as well at that stage. So I think we have to keep using the word and we have to keep, But we have to remove it from the connotations that are with it as well. I think that's the hard part. Yeah, absolutely. And I think it's really important because, you know, we're both menopause or women. And we hopefully are enjoying, you know, this space of our lives. And it should be a positive experience. And I think we also have to, like you say, think about it as a long-term hormone deficiency.

We talk about obesity, not being an illness, but actually people who are obese have an increased risk of future conditions. such as heart disease and we know that menopause or women have an increased risk of diseases. So it's really important that we minimise this risk by looking at ways of treatments. So if we think a bit about treatment, obviously hormone replacement therapy, HRT is only one part of the treatment. It's some women can't have it for various reasons or don't start taking it first line. But it's not the only treatment, as you know. And that's one of the things you were trying to look at when you were trying to find somewhere that offered holistic care.

So talk me through your sort of experience around. I think the kind of odd background, and it's one of the reasons we started the podcast, postcards from midlife, is because both my co-presented, Trish and I were the same age, had hit about 46, 47, and genuinely thought something terrible was wrong with our mental health. I'd written, even written a bit.

I mean, I'm a journalist. You know, I've been a news reporter on the times, and I still didn't. put all of this together. I wrote a piece about suddenly experiencing anxiety and panic attacks, which had just never happened to me in my life. It was perplexing. I was confused. I looked at all the ways that you could possibly help or alleviate this. I'd been offered antidepressants by the doctor, which I just thought, I probably don't need these. This feels different from talking to my friends who'd suffered depression. So I wrote a piece in a newspaper. I wrote a piece in L magazine, which I edited at the time. And then there was a lot of response from women saying, yes, we're going

through this you should take the antidepressma. Yeah. And it kind of that it continued and I've been to the doctor several times saying I just this doesn't feel like there's other things wrong. My bones ache quite a lot and I can't and I am covered in sweat sort of three or four nights a week and it's like

you know, Armageddon type sweat. It's not just I'm quite hot and I can't say. So there is something physically and still as a journalist three years over that time I did not put any of it together. I was not able to make that kind of connection. And it's probably only in the last sort of couple of years I've thought, right, actually,

this is menopause and perimenopause. And, you know, we have been inundated with people saying, we had a woman last week email and say, I was going to leave my marriage. This is, you know, I just don't understand what's happened, but I've gone mad and I just thought it's best to divorce. But I've listened to the podcast. I've been to the doctor. I feel better two weeks later from the doctor.

We had a woman who said she was going to leave her job because she felt that there was something clearly wrong with her. She couldn't remember anything and she wanted to leave before she got fired for incompetence. And it was to be the end of her career. Again, she'd gone to the doctor. So I just think we have to keep talking about it and writing about it. And, you know, it feels odd to share it all personally because somehow we have a slight shame around, I don't know, or funny feeling like talking about women. It feels incredibly private to be talking about. But actually, I talked to a lot.

I had four children. I talked a lot about my pregnancies and kept a whole column through two of the pregnancies and talked about all the intimate, which is viewed in a much less shameful, embarrassing way. Yeah, which is weird, isn't it? And, you know, pregnancies usually last nine months, whereas menopause, the average time is 30 years. And, you know, all of us are going to go females are going to go through the menopause, whereas we're not all going to get pregnant or certainly we're not all going to have four pregnancies. I think a big learning curve, though, when I, after coming to see you, was that there is no one test. And I think women assume there's a test to show your pari-menopause

and there's a test to show you have gone through the menopause. It's a list of symptoms that you need to check off. And your list of symptoms is incredibly helpful. I've recommended it to so many women. And HRT is hormone replacement therapy. It's not a pill that you take that solves it. There are different levels that need to be off. And you can't check your levels because you don't know what they were before you were perimenopausal.

So all of that thing. was completely new to me and also the thinking around testosterone, which you prescribed for me, which I had read so little about it's so muddled and confusing. If you're not a journalist, if you're not a writer, if finding things out, it's not your job, it's really complicated and it's overlaid by this giant fear that you will get breast cancer and die. Absolutely. It is a feminist issue in a way because that's, ways really heavy on women. and a lot of the medical profession have not been helpful removing that fear. Because it's based on a very flawed study, as we've discussed.

Absolutely. And we have to look at the biggest context with everything as well. And, you know, one of the reasons that I set up my website, menopausedoctor.com.uk, because I was really shocked and saddened with how little good quality information there was for women across the world, which is a real problem. But, I mean, you had symptoms for a while. I had symptoms for six months.

And this was at the time that I was actually writing my website and lecturing to doctors, and saying to doctors you must not miss out or neglect women who have psychological symptoms such as anxiety, irritability, poor sleep, fatigue. And I was experiencing all these symptoms and getting night sweats. And I just thought I was working too hard and trying to juggle everything. I had no idea that it was related to my hormones. And you were embarrassed being a journalist. I'm a menopause specialist.

I had no, you know, it was only when my daughter was then 11, who says, remember, you're so irritable. I just think you need a period because some of my friends get like you before their periods. And I suddenly went, oh my gosh, I haven't had a period for five months. That will be why I'm getting all these symptoms. But then I really struggle because my own GP I'm registered with is very anti-HRT, so wouldn't prescribe it for me. I could have had antidepressants, which I know aren't appropriate.

They're not a treatment for the low mood associated with the menopause. So I'm fortunate because I could see one of my colleagues quite quickly. But then it's a bit like my children when they have their MMR vaccine. I knew MMR vaccine. Of course it's safe, but I was still a bit nervous when they had it. And then suddenly I'm thinking, oh, HRT, do I really want to take it? Am I really that bad? Maybe I could just carry on doing a bit more yoga or maybe I should change the way I life.

Yeah, I had. I just thought, I am very worried about this, but I just can't go on living like this. It will be grim for the next 20 years. So I made a desperate choice, which I think isn't fair, that women should make that desperate. Absolutely. Absolutely, no. And as you know, the early you start HRT, the better, because once our hormones start dropping, we have quite a big increase in bone turnover, so bone loss. So this really increases our risk of osteoporosis. We have a lot more inflammation in our blood vessels. So it increases our

risk of heart disease. And so we know from studies, the earlier we take HRT, the better. But like you say, HRT just means hormone replacement therapy. So estrogen is the most important hormone, but some women benefit from testosterone as well, which interestingly, we produce more testosterone than estrogen before the menopause. But what I probably hadn't really appreciated so much until I had my own experience is that the dose of estrogen really can change with time and also between women. So like you quite rightly say, it's not just a fixed dose, you know, one treatment for everyone. And when I started HRT, I felt a bit better, but my mother are in law and my mother. who both take HRT kept saying, don't you feel amazing? Don't you feel great? And I said, no, I still

can't be bothered to do the washing or do the dishwasher or do sort of mundane things. And then my specialist said, no, you need to increase. You need to wear two patches. And I said, no, that's too dangerous. And he said, no, it's not. You're still getting night sweats and your level is still low when we measure your estrogen level in your blood. And so I increased. And then I started testosterone. And after about six months, I suddenly realized I felt the best I'd felt for about six years. And it was, that's how I feel now. I just feel like a brain-changing situation.

Because when I saw you, you'd already started HRT, hadn't you? I had, but I was on such an unusual low level of it. I had stopped the kind of night sweats had stopped. But I think that was probably a bit of a lifestyle. I'd managed that quite well from a lifestyle. I'm into view with much healthier eating,

less caffeine and much more exercise and took up cold water swimming, which seemed to really help me. But I think I didn't feel great. eight and I was still quite anxious and tired and depressed and I remember being moments where I would sit on the sofa after doing all the lunch for the kids and things on a Saturday and then I'd wake up at 8pm in the evening and I think how's often it's six hours that something was clearly wrong and still on a very very low dose of HRT it wasn't now six I think it's probably what is it 10 weeks after seeing you I think maybe yeah I just wake up and I'd just wake up and I'd

I'm awake and I can do things and I'm not stopping as I go up the stairs and think, you know, I'm fixed and I was finding it difficult to walk up the stairs. And I think that's not. There was a, we had Professor Michael Baum, who's the kind of, I can't legendary breast cancer surgeon on who invented tomops fence, saved so many women's lives. And we had a very interesting conversation about him, about what women are expected to put up with. And, you know, he hasn't been in the medical profession as a surgeon for a very long time. He'd done a lot of research around women and pain and how even young nurses coming into the profession assumed that women just had much higher, could deal with much higher levels. They needed less painkillers because they were just able to cope with. And I think that attitude slightly pervades around menopause. You've got to be really desperate as a woman to get some treatment. You can't just go in and say, I'm not right. You've got to be on your knees and suicidal. I think I think with men, that's a slightly different conversation. So I think... No, I think you're totally right. I think men wouldn't put up with so many symptoms, but because we generally have this thought that we need to just get through things,

and a lot of women say, well, I've had a difficult pregnancy. I've had PMS for years. So this is just another transition, but I'll battle through it and I'll come out the other side. And they do feel a bit of a failure. And also what really saddens me is that a lot of women try and get help, but they still can't get it. And so we see a lot of women in my clinic who have left their partners who have given up their jobs. Who, their lives have fallen apart. I saw a lady recently who used to be a governor for a prison, so really dedicated to her job. And no one would give her HRT because her sister had had had breast cancer and women

with a family history of breast cancer can still have HRT usually. And she had put on five stone and weight. She'd stopped running, which was her real joy because her joints were so painful. She had also lost her job. So all she was doing was, well, all that she was dog walking. for some friends, this is pre-COVID. But she found that a real struggle. And she, like you, was falling asleep on the sofa.

Her life was in tatters. And she'd been going on for five years. Back and forth had been on five different antidepressants. And, you know, she was only 48. So her life has now been transformed. But it saddens me that she had to come all the way from Wales to my clinic to spend money, which should be available on the NHS. So there's so much that needs to change.

And I really feel that the more. women have the knowledge, then they can actually use that to be feel very empowered and then make the right choices and share the decision making with their healthcare professional. I think there is a kind of mini revolution happening, which we've talked about, which I'm probably going to try and write a big piece in Sunday Times about. I think there is a lot of changes in the research around estrogen and it's quite a powerful use now and the things it saves you from. And there's a lot of work being done by, you know, it's making the front pages. There's a whole slew of books coming out. There's documentaries being made. I think that the tide is

turning. I think the positive thing here is that it's all, there's a perfect storm of information out there. And this will filter through to the medical profession because it's quite difficult for doctors to know everything. How can they possibly? I mean, this is 50% of the population, so it could be more. They should know more about it, for sure. But I went to, but I went to a doctor who said, yes, you definitely do HRT, don't worry, I'm going to put you on it, but then didn't really understand how to prescribe it, please. And another

doctor who said, I'm not, and gave me a list of leaflet saying, these are the risks of HRT, you're going to take them at your own thing. I'm very anti-it, we don't feel it. And I just thought, well, you know, A, I'm quite a wealthy, white woman walking into a London surgery. Imagine if I wasn't wealthy, if I'm,

this is not my first language, and I come from a different place where this is not talked about, and it's not culturally part of where I'm from. It's unbearable to think that a whole group of women are going through just with no help and just kind of pushing on through. Yeah, absolutely. And one of the reasons that we're developing the app balance that you know about that's coming out of the next few months is to really reach globally women and especially women in other social groups and ethnic groups as well where it's not so acceptable to talk about. And I certainly know myself when I realized what

was going on and I said to some of my friends, gosh, I'm menopausal. I need to take HRT. And quite a few of them were really negative and said, but that makes you feel really old and you can't have children. And I said, well, I've got three. I've been sterilised. I don't want more children. But it was that real sort of nail in the coffin. And I thought, gosh, this is, this is amazing because I am vocal and I'm, you know, I'm very privileged in the way that I live. Whereas how could I talk about it if I didn't have anybody who I could talk about? And certainly women from ethnic minorities, it's all very much hidden. They're not allowed to talk about. any symptoms and certainly symptoms such as reduced libido or vaginal dryness.

Yes. There's no way they could talk about it to anyone. So these women are really needlessly suffering and it really frustrates and saddens me that something that's so easy to treat is not being addressed. Also, as I said to you and asked you, is it really expensive, H.R.T. And is it phenomenally expensive? And those are probably the underlying. No, not at all.

It's not. It's not. It's really easy to prescribe. It doesn't affect the budgets that surgery. It's not crippling the NHS. It's not a really experimental cancer drug. No, we've got really good long-term data as well because some of my friends who are more cynical about my work have said, yeah, but there'll be another study that come out tomorrow, Louise, that will say something different. But we've got studies that show that women who take HRT over 18 years have a lower risk of death from all causes, including from cancer. So that's pretty good. And this is following people up from the WHOHI study, the Women's Health Initiative study, which was the one that everyone looked at the breast cancer risk with. And there are big numbers of women. It was a randomised controlled study.

And it showed how beneficial taking HRT is. So we can't go back on good historical data. And like you say, it's cheap, but also I've been doing some work. I did a survey of 5,000 women recently. And we found that for a lot of women it's taken them several years to have the diagnosis made and also several appointments both for GPs and in hospitals often having unnecessary investigations. For wasting time, it could be better spent on much more needy patients. Absolutely. So, you know, like you, you went back and forth to many doctors, whereas now you're on

the right dose and type of HRTA. I'm hoping that you don't need to go back to a doctor. Likely, I'll want to go in again and unlikely I will have other complications. as you said off the process that will mean I take up time better serves someone else because this is a kind of very common. Absolutely. Yeah. And easy to treat.

Yes. So that's exactly right. And I'm developing a menopause education program with a company called 14 Fish, which is going to be launched soon. And this is helping GPs, but also nurses and pharmacists, because there's a lot of this that nurses can do. And even pharmacists can be involved as well. And for a lot of women,

And once they take HRT and start to feel better, it's then so much easier to look at your diet and exercise and well-being and sleep and everything. And you sort of tried almost the wrong way around because you were desperately trying with your exercise and diet. But it's hard. It's hard if you haven't got those hormones because we need them in our bodies. You know, we're designed to have hormones in our bodies. So one of the things that happened to me was a just giant drop in iron, which was all part

of the kind of ham it's metabolised in the body and lack of hormones make it almost impossible for it to be, for some women. And you can eat as much red meat like. If you're consistently affected by the lack of hormones, you can't change that. So, you know, it's just all the things that happen are so easily remedied. And I have been taking iron tablets that did practically 10 a day at that point, making absolutely no, it's just not being properly metabolite. I mean, there's so many little bits that can be changed so quickly. Absolutely, yeah. And a lot of people have low iron because of the heavy periods that occur. So a lot of people think that menopause periods get less frequent and lighter. But there's a lot of women where periods become closer together and heavier. And there are some really good treatments available for women who have heavy periods. And a lot of women choose to have a marina coil which thins the lining of the womb, stops periods. And it can be used as a progestogen part of HRT. And there are another non-hormonal treatments we often use for heavy periods. and I'm quite shocked sometimes by women telling me how heavy their periods are

and they're not getting any help for that, let alone their menopause as well. I mean, mine were debilitating, really. If a meeting was going to be longer than an hour, it would be a problem for me. And that's my job to be in meetings and to go and give talks and to be out and about of an evening and to, you know, I was trying to move my whole life around this kind of cataclysmic periods that were occurring, and thinking, you know, this is ridiculous. It can't be normal.

Having had the world's easiest simplest, almost non-existent periods up until that point. And again, presenting with a doctor saying, this is just, I can't, I don't know how I'm going to deal with this, I feel like there must be something wrong. Have I got a tumour? And still being told, no, no, no, it's just, you know, you just change as you get older.

It's very difficult because for a lot of women, the symptoms last for several years, sometimes even decades. So it's not something we can just cope with ourselves. And, you know, I often think, can you imagine what the world would be like if more women were on the right treatments and receiving the right help? Because I think traditionally in the past, historically, women have been very suppressed. And, you know, our role was at home with our apron on cooking supper for our husbands, which thankfully has changed. But for a lot of women, you know, they've worked really hard to reach the prime of their career. They might be at a place where their children have left home.

And they can really get to their next stage in their career or their life or decide to do something different. and then their menopause hits them. And I saw a lady recently who said to me that she had bought a new pair of walking boots and she'd had her previous ones for 10 years and never worn them. And then the past years since she'd been feeling better, she'd been out doing really good walks with her dog. And she said, it's amazing. She said, I don't have a walking stick anymore.

My walking boots have worn down. There's a whole army of women who now are being, I think, in the next five years, being treated well, properly, medically, who are now going to. going to be so much more valuable to society and part of life in a way. And I think that's the kind of mini revolution that's happening. We're kind of, we're back. Yeah, absolutely. And I think, you know, when we realized there was a whole army, I didn't realize until I had kids that there was a whole army of women functioning on two or three hours sleep night. And my God, weren't we amazing? Because we were still doing all this stuff, having spent the whole night being awake and

having to breastfeed for so long and all of these things, we were still doing that. And then to be hit by this and think, well, that's it. I really, I just give up now. I haven't I think sleep for 10 years. Now I've got to deal with this as well. But actually, the good thing is this is treatable. Within 10 weeks, people usually feel better if they get it right. And now there's a massive group of women, I think, who are, A, talking about it and be out there doing stuff back in society, dealing with life and sorting stuff out. Because we're so much more experienced than we were. We've got a hell of a lot to offer. And you get the right treatment. You can do anything you want. Yeah, it's totally right. And there's so much more about workplaces being involved in the menopoles,

which I think is good. But actually, what I don't. think women need is to have an adjusted work, they need to be more flexible with their times, because actually if they have the right treatment, then they're better at their work than they were before. So I feel a lot of companies should be working with their employees to try and help them access good quality menopause care in the same way that a lot of employees give health insurance, but sadly menopause isn't covered by health insurance. So they need to be savvy ways of really trying to help women properly in the workplace. So they can get back to their work and be the best that they want to be.

I've had so many women at the Sunday times come up to me to say, oh my God, I've listened to the podcast. I think I can go now today. I know what to ask the dot. I mean, these are, again, journalists, high profile, hardworking executives who've changed just by getting the right information. And I think, but it's still done in a kind of secretive conversation. There is no need to have a secretive conversation about something that's quite easily sorted. It's just another problem that women can sort out.

Absolutely. Yeah, no, brilliant. So thanks so much for sharing and I think there's so much more. So watch this space, everyone that's listening because I really feel we can really make a difference with all the work we're doing together. So, well, I think we're all making a huge difference. You make the information easy to understand, which gives us the power, I think, women, the power to kind of ask for what we want in simple terms, which is just doing it. Brilliant. So before I finish, Ray, can I just ask you for three take-home tips for women who want to feel more empowered and not sure how to to get the right help and advice?

I think feel your power for a start. You know, you have lived an amazing life. We have been through families. We've all got an enormous amount of experience. So don't let that internal voice in your head tell you that you don't have the confidence at this age. And secondly, just get the information before you go anywhere or do anything. Read it, write it down. I did a lot of writing down because I kept forgetting things.

make sure you write it down. And spread the word, you must talk to other women. When you meet them and they chat about how awful they're feeling or anxious or they've had a panic attack, they've never had it before. I think there needs to be a whole group of us out there saying you might be perimenopause or why don't you go to your doctor? Look at this website. Brilliant. Thank you ever so much. Thanks for your time. For more information about the menopause, please visit our website www. www.menopause doctor.com.uk. Thank you.