The Dr Louise Newson Podcast - 044 - Gransnet & the Menopause - Cari Rosen & Dr Louise Newson

Episode Date: April 21, 2020

In this podcast, Dr Louise Newson chats to Cari Rosen; author, writer and editor of Gransnet.com. Gransnet was set up following the success of Mumsnet. Gransnet has 320k users, bringing in 3 million page views a month. Many perimenopausal and menopausal women feel socially isolated and alone when they experience symptoms that often they don't even realise are related to their reducing hormone levels. It can be very useful to share symptoms and also discuss experiences with other women. Increasingly, women are turning to platforms such as Gransnet where they can be frank and open with people they don't know and seek out support at various times of the day and night. In this podcast, Dr Newson and Cari discuss the various ways women can support each other during the perimenopause and menopause, as well as dispelling some myths about the menopause and HRT along the way.  www.gransnet.com Cari Rosen's Three Take Home Tips and reasons to visit Gransnet: Know you're not alone - there is always someone to talk to. Share your experiences. It can be so helpful to talk to someone who has gone through something similar and come out the other side. If you are feeling frustrated, it's good to share those frustrations with others that aren't your nearest and dearest.

Welcome to the Newsome Health Menopause podcast. I'm Dr Louise Newsom, a GP and menopause specialist, and I run the Newsome Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. So today I'm very lucky to have with me, Carrie Rosen, who is the editor of Gransnet. We recently came connected over a survey that we're going to discuss. Many of you listening will have heard of Gransnet, and I'm sure. the majority of you listening would have heard of Mumsnet.

So welcome, Carrie. Thanks for coming. Pleasure. So tell me just a bit about Grands Nets, although it's got an older sounding name, it's not as old as Mumsnet, is it? No. Well, I suppose the daughter,

but should be mother site of Mumsnet or sister site, whichever way you lifted, but we do pretty much the same thing. The beating heart of the site is the forums where people can come and talk about literally anything from what was on the telling. last night, what if I have for tea, what's in the news, what the royals are up to, worries about

family, worries about health, and pretty much anything else that you might talk about in everyday conversation. And how busy are you? How many people do you have connecting with you? We have a lot of users. You know, on a monthly basis, we have hundreds of thousands of users and forums get very busy. And obviously, we offer content as well. A lot of health and style and beauty related content, exercise, things like that. The sort of things that are used to talk about on the forums all the time, we reflect in the content that we put together. We've got a great book club as well.

Oh, okay. So, and what's your demographics? What age people mainly go onto Gransnet? Most of our users are sort of 50 plus to, say, mid-70s, but we have people on either side of that as well. The average age is about 61 or 62. Okay. And so do people start off on Mumsnet and go across

to Grands Nets or how do they decide? Some do or some come to us. You know, Mum's Net is a fabulous site that I enjoy looking at every day, but posting on the forums isn't always for the faint-hearted and some people prefer GrandsNet because although it's sort of much the same, it's a little gentler most of the time. Right. Okay. And so obviously I'm interested in the menopause, but obviously you do a lot with health.

How commonly do you think people are asking about menopause and symptoms and treatment? Does it come up a lot on your site? It does come up quite a lot. In all sorts of different ways, people talking about, I mean, obviously perimenopause is more Mumsnet, but menopausal symptoms and the things that can go on, that sleeplessness is quite, and insomnia is quite hard to get rid of once you've got into that vicious cycle and weight gain and rain fog and those sorts of things. I mean, something I wasn't really aware of until I joined Gransnet

was that some people sell through the menopause without a problem. Yes. Some people have a year or two or even a few years of discomfort. But for some, the symptoms go on and on and on. And that was something I didn't really know. And so there's a discussion about taking HRT, went into 60s, and all sorts of things around that, I mean, as you would expect, really. Yeah, and I think it's really important.

So as many of you listening know, the menopause, when you break down the words, meno is menstrual cycle, pauses stop. So to define someone as being menopausal, they have to have a year since their last period. But actually, I'm trying to convert people into thinking about it as a female hormone deficiency. So it's not just about symptoms. We can't reproduce those hormones once they've gone, either because our ovaries have been removed or because our ovaries have run out of eggs. And there's a natural decline in hormones. wounds. We can't replace them. So it means that some women have symptoms for many years. I saw someone in my clinic last week who'd had her ovaries removed 27 years ago. She's now 74 and she'd had symptoms for

all this time. Oh my goodness. I know. And had hot flushes every half an hour. And every year she thought it's going to get better. And she'd been back and forth to various doctors who said you can't have HRT, which was actually incorrect. So a lot of women think they can just get through their symptoms. but also, which is something you might have picked up on, is that symptoms can change. So some women start with having flushes sweats and they can improve, but then they might get, that you quite rightly say, sleep disturbances or anxiety or memory problems or urinary symptoms as well because we know that we've got estrogen receptors in our vagina, but also our urinary tracks. So some women find they have increased frequency of urine infections, increased frequency

of just going to the toilet, they can't hold on to it as well. And a lot of these women don't realise their menopausal symptoms. And then, as you probably know, when you've got low hormone levels, it increases your risk of heart disease, osteoporosis, diabetes, dementia. So really important conditions. And most women die from heart disease. Yet a lot of women don't realise that replacing the hormones with HRT reduces their risk of heart disease.

I think a lot of people worry about the, breast cancer link. And I mean there's been a lot in the media recently which put it in perspective kind of saying that if you drink a glass of wine every day, that's more risky than taking h or tea, etc. So it does put it into perspective. And yes, when you look at it that otherwise the heart disease is likely to be a bigger player, you have to find a balance and find what it works for you. So it's a tricky one, but only with the help of your doctor can you work it through, I think. Yeah, absolutely. And I think, as you know, a lot of the work that I do is just about demystifying and it's about educating people so they make the right choices for them. And everyone's

menopause is very different because we're all different. And the way we choose to manage it is very different as well. And it's not just about replacing the hormones. You have to think about your lifestyle, about what you're eating, what exercise you're doing. It's bigger than just replacing hormones. and some women don't want to replace their hormones or can't for a medical reason, but these women have to still look at their lifestyle, ways of improving their bone strength, reducing the risk of heart disease. Because after all, the majority of us die from heart disease, even women that have had breast cancer,

the commonest cause of them to die is heart disease. So we need to be looking at that. And then a lot of women now who are in their 60s will have missed out of HRT because of the scaremongering that went on in the around 2000. there was a study that came out, which was misinterpreted, fueling this worry about breast cancer risk. And so there's a lot of women who we see and I talk to who are in their 60s, who have always been told they can't have HRT. And then they have awful symptoms. A lot of them can still start HRT, but if they have local symptoms, so the urinary symptoms or the symptoms related to

vaginaldriness, there are local hormone treatments that do not have the same risks as HRT. So I'm sure a lot of the people that go onto your platform probably would benefit and not realize. No, that's a really, really valid point. And do you think that there is a stigma around taking HRT? Because from what I read on the forums and elsewhere, I think that some people worry about it because of the health risks or not, if it maybe, and others worry that they're judged for it, that perhaps giving in and you should have a step up a lip and just manage it. Yes, and I think you're absolutely right. So I think there's a couple of things. The way that some of the medical evidence has been misreported to the media and even to the medical press, it scared people.

So there's people who think HRT equals breast cancer. So all they're going to worry about is breast cancer. What they don't realize is, as you quite rightly say, some lifetale factors increase the risk more. So a woman who's overweight has a far greater risk of breast cancer than a woman taking HRT. There are some types of HRT that there's no risk of breast cancer either. So it's very important to know that. So there's this, the people are scared. They don't realize the benefits of HRT. But then also, as women, we like to think we're strong. We like to think we get through all sorts of very difficult times, such as potentially pregnancy or even looking after our children, dealing with elderly relatives, our jobs, multitasking. So actually, the menopause is a natural process. Every woman will go through

it if they live long enough. So a lot of women feel that they need to get through the menopause. But actually, we don't get a medal for going through our menopause. No one says, well done, you've had 10 years of terrible sleep and awful symptoms that have really led you to reduce your hours at work. And actually, those women that do battle through and get through their symptoms, they still have this increased risk of heart disease and osteoporosis. And this is why we need to think about it as this long-term hormone deficiency. We need to think of it in the same way, as someone who's got an underactive thyroid gland or someone who's diabetic and needs insulin

because it is about thinking, why are we replacing the hormones? And actually, people take the contraceptive pill because it's important as birth control, but it's far more dangerous taking the contraceptive pill than taking most types of HRT. But we don't talk about that, and that's not a failure. So it's a weird thing.

It's a bit like childbirth. Some people, I mean, I have friends who perhaps pushed out a baby in a couple of hours without any trouble of very little pain and others who went through days of agonizing labor and ended up with an emergency leases. So everybody is different. Every woman is different. So, you know, thinking of conversations on the Grandinette forums, I think for those who've had a relatively easy menopause, it's easier to say, well, it was fine, just go with it. but we can't always put ourselves in other people's shoes. And if someone's having a hellish time and seeking medical advice, when we have the facility to do something about it,

so surely that's a really good thing, and we shouldn't feel any less. I mean, if you have a baby without any drugs at all, you're not going to wear a T-shirt saying I had a baby without a, you know, it's something you know, but it's nobody else's business. I think that's totally true. I mean, my first baby I had an emergency cesarean section, and I had a healthy baby, I was very lucky,

but I remember going to a yoga class afterwards and feeling of failure because everyone else had lovely natural deliveries and I wanted to but she got stuck I couldn't do anything else and I know when I personally started taking HRT about three years ago a lot of my friends said gosh doesn't that make you seem really old must know so there is this stigma about HRT partly because people are worried about it partly because people don't understand about it. And also the menopause, people think about it as an older person's condition. And actually, we know that one in a hundred women under the age of 40 have an early menopause. Clearly, there are people going necessarily onto Grands Nets,

but they'll have children who might be going through the menopause earlier. So it's not something that we should feel bad of. And certainly, women who have an early menopause, they have to have hormones to replace the ones that, they're missing because of the health risks. And there's no risks of breast cancer when young women take any type of HRT. So it's really important that people are given the right information so they can make the right choices. So I think having a forum is brilliant as long as it's directed in the right way because how do you stop it getting out of control and certain people

telling information that maybe isn't accurate? Well, yeah, that's interesting actually. It's a conversation we've had recently because I'm trying to think of the exact instance. I don't think it was about anti-vaxxers, but that's an example that you might even have been about that. We have so many posts, it's hard to keep track of them as well, but someone's saying, you don't need vaccinations and they're bad for you and you'll be fine without them. And the good thing, you know, if you post that on social media, you're kind of putting it out there as fake news, but on a forum, you're having a conversation. So when someone posts something like that, which everyone is entitled to their opinion generally in life.

It's free speech and everything. But there were certain things which are just not true. And if someone posts something like that, which taken at face value might be dangerous, there are so many people who will jump onto it and say, no, no, no, come on, we know this isn't the case and this is why. And it really helps give you perspective on stuff. It's great to be part of a conversation. You get so many, especially if you've got a problem or you're worried about something,

to have that wisdom of experience, so many people. You know, if it's a family matter or you're worried about a health thing, you can guarantee someone else would have been there. They would have had that treatment or that operation or that problem with their daughter-in-law or, you know, or they're worried about their child or any of those things. And it really helps you to know that you're not alone. It's really important to have that. So important. And do you think people are more open because it's an online forum as opposed to going to find a group to talk about it? I do. I mean, I'm not negating the value of groups and social. you know, bereavement groups and things face to face can be massively helpful.

But the advantage of something like Gransnet is twofold. One, that it's there 24 hours a day, and there'll always be someone there. And you can go to groups or you can pick up a phone to a friend, but in the wee small hours when you feel very alone, you can't always do that. And actually, when you go online, one of our members in Australia or New Zealand might be there. So there's always people there, and that's a very nice safety net to have in life when things are not going well, or when you want to share good things as well, of course. And the other is that people post anonymously.

Now, you know, there are times when you don't even want to admit to your nearest and dearest that you're feeling low about something or feeling worried about something. Maybe you don't want to burden them with that knowledge. Maybe you feel a bit silly about it. Maybe you're embarrassed. A million reasons why we don't always want to be honest with everyone around us. But being able to share those things with people online, who don't know who you are, who can take the issue at face value without any of the other factors that weigh in from people who care.

about you or might judge you is massively helpful. It's huge, isn't it? Because certainly when I trained as a doctor, the internet didn't exist. We didn't have the beauty of this. And it's very, very powerful. And I think the menopause really is the hidden taboo. It's a last taboo, I think. And like you say, even just admitting that I take HRT, for some people, it's, they don't like the thought of that. But actually, when I was having symptoms, I thought I was just working too hard. So I was feeling very low. I had very poor sleep. I was waking up in the early hours. I had very low self-esteem. My confidence was bad. I didn't really have. I had some night sweats, but I didn't, I thought I had a cancer. I thought I had lymphoma. I didn't think it was due to my hormones.

So I knew something was changing about me, but I thought it was because I was working too hard and I've got three children and my husband's busy, he's a surgeon. So actually, if I had been brave enough, say, going on to Gransnet and saying, hey, has anyone else felt like this, would actually have been really helpful, but I suppose I'm a bit, I didn't really think about it. But actually, I can see how helpful it would be because, you know, it took my 14-year-old daughter to say, to remember, I think you might need your period because you're so irritable. My friends are a bit like before they have their period. And then I suddenly said, I haven't had a period for months. Actually, gosh, that's why I'm getting all these symptoms. How ridiculous. I hadn't realized,

even though I'm a menopause specialist. But if I'd gone onto a forum, someone else might just says, what about your periods? And then I might have thought, oh, actually. And actually, the other thing about the menopause is that we see a lot of women who think they've got dementia or they think they've got a brain tumour because they're getting worsening migraines or they think they need antibiotics for recurrent urinary infections. They're scared. And they're too scared maybe to ask a doctor because it seems trivial. But actually for someone to say, no, this is a really common symptom of the menopause. Most of us find our car keys in the fridge because our memory is going. Oh, yeah.

It can then be quite reassuring. So before even launching into what treatment, it's actually helping know what they haven't got as well. So, and then when you talk about really sensitive issues, such as libido or pain during intercourse, vaginal dryness, which we know from studies, effects around 70% of women, yet only 7% received treatment. It's shocking.

So if women can help other women, that's really good, isn't it, what you're doing? and offering, I think. It's really good. And when you have that volume of users, it's inevitable that someone will recognize what you're talking about. Do you know something I was the same,

but? I think everything in life, it really helps to know you're not alone. But you're right also about the symptoms. They're so wide-reaching and they're so vague a lot of the time. There's lots of reasons why you can't sleep, so you don't automatically think, oh, it's menopold.

There are lots of reasons why you might feel a bit absent-minded, oh, I didn't have enough sleep. or it could be PMT, that's why I want to, you know, side everyone down in my path. And, you know, there are so many things that you just, I guess we get used to putting up with as part of PMT or all of these other things that we go through at certain periods of life, that it's easy to miss the bigger picture. Yeah, absolutely. And I think as women, we're always, or often very busy, we're torn in very different directions. Often our days can be very crammed. So no one sits us down and says, right, Louise, tell me how you're feeling.

let me try and help you. It doesn't happen. We just have to help everyone else. So having time where you can reflect and be probably more open because, like you say, the strangers that are there. And I can see that even on my Instagram. I have quite a big following and a lot of people message me in desperation. And often there are people who are abroad. It's very isolating and they don't know where to go and get help. So it's incredible. And I can see why forums and platforms such as yours are probably just constantly expanding, aren't they? Absolutely. And I think it's very important for people to know

there are other people out there that they can talk to the day or night without having to put themselves out there or on the line. You know, you're hidden, and that's a good thing sometimes. I think you're right that menopause is the last taboo and we need to change that. Absolutely. And I think you're right that we need to demystify HRT

and weigh up the scare stories against the realities. I mean, the heart disease thing that you were quoting to me, I haven't realised the extent of that and actually absolutely sense. You know, why we put themselves at risk? So there's so many things that we need to get out there more and to broadcast and to share and the HRT shortage is not helpful at all to many women. No, so we're hoping this is short term, but at the moment there is a real shortage of estrogen patches and some of the combination estrogen and progestogen patches as well.

And I know you've done a survey, haven't you, through Transnet. Can you just talk us through the survey that you've done? Yeah, we surveyed more than 1,000 women, and I think 43% said they've been affected by the shortages, which is an awful lot. I guess. Maybe hard. For most people, that's a preferred way than taking stuff already or whatever.

And so I guess it's inevitable that so many people will be affected. I think it's difficult because people are finding a bit of a mystery as to why it's happening and that doesn't help. Certainly, GPs I know have suggested it could be a number of reasons and it might very well be all of those reasons. But nobody really knows, and I think there needs to be some clarity about why it's happening, what's happening, and when it's going to be solved.

Because so many women absolutely rely on this medication to live a normal balanced lifestyle and, you know, we need to see. So I think 40% were told by their GP or pharmacist that their medication wasn't available. That's a lot. It's a hell of a lot. And as you know, having estrogen through the skin, there is a patch or gel bypasses the liver, which produces our clotting factors. So if we have it in this way, there's no risk of clot. So it's a lot safer way than having tablet estrogen, even though the risk with tablet estrogen is low, it's still a preferred way. The gel is still available. And I have spoken to various key figures

in the UK and we still don't know the full answer. And I think it's probably a combination of different reasons why there's been a shortage. One of them is because there's been increased demand, which is great because more women are realising how safe estrogen is. Also, we now know that we can take estrogen and HRT in the long term. So it means we can take it forever. Because as as soon as we stop taking it, we're then exposing our body to these risks that I've mentioned because we can't replace the hormones. So not only are more people starting it, more people are continuing for longer as well.

Do you think that's something that people, a lot of the conversations around HRT that I've heard are people saying, well, you know, all you're doing is delaying the inevitable because the minute we stop, you'll get all the same thing. So what would you say then? So you're not delaying the inevitable. The thing is about HRT is it's just replacing the hormones

while you take them. So they only work the days that you take the HR, but many women have symptoms for a long time. So if, for example, I was going to have 10 years of symptoms and I took HRT for five years, I would still have five years of symptoms. I wouldn't then have 10 years of symptoms. But what we need to do, like I've said,

is not think about it as taking it for symptoms. So I could stop my HRT today and feel absolutely fine because my body is adjusted to not needing the hormones, but I would then have this increased risk of osteoporosis. and heart disease and diabetes and dementia. What I really worry about as an individual is my risk of osteoporosis because I've seen a lot of women with osteoporosis of their spine that really disables them. So I personally take HRT because I want to protect my body from heart disease and osteoporosis

and also dementia. I don't want dementia. I also exercise. I don't drink alcohol. I don't drink caffeine. So I'm quite extreme the way that I've decided to manage my menopause. So it's looking at why you're taking HRT, what you're taking it for and how long you choose. So one of the scary studies that came out recently about HRT was saying that women who stop HRT have a higher risk of breast cancer for longer after stopping it.

But this is with the synthetic progestogens, and we've known this for a while anyway. Although the study was new, it was based on older studies with older types of synthetic hormones. So the regulated body identical HRT that is available on the NHS uses this natural progesterone. So there's no risk of breast cancer for the first five years. And after that, the risk is lower than with the older types. We also know with that type, once a woman stops, their risk of breast cancer reduces as well. But the risk is so small, it's not even significant. So that's why carrying on in the long term is preferable for most women.

So it's very important to know, but there's one manufacturer that has been taken over by a different company, and we're hoping that we will get the patches in soon. So maybe by the time this podcast is live, the patches will be available. So it is a short-term problem. And there are some older types of tablet combinations that are out of stock. But I think for those women, they should be converting to a patch or gel anyway. So a lot of women, we see in my clinic, we are transferring to the gel, because the gel is very easy to use. It just gets rubbed in once or twice a day. So most women find they can convert to that quite easily.

And if they're going to take it in the long term, they want something that's the lowest risk. And taking it that way is... Makes absolutely sense. So when it's broken. So, yeah, we need to be positive, I think, about the way women's health is changing because I think women have been neglected for a long time,

not just in the menopause, but in various other aspects of women's health. So I'm hoping that going forwards this will be a real change that we can feel more empowered because we can get the information easier, but we can get accurate information easier as well. And we can educate others because I think this whole ripple effect of passing on the right information to people is really key. Because I think as women, I don't know how it would work if you had a granddad's net forum. Men aren't very open, are they? I don't know if you have. We do have a few men on our forums, not as many as women, but we do have some male posters,

but I think generally in life, women are more open. Yes, which is good, but I think also a lot of the work I realize that women are really frustrated because they can't always be heard or they can't always get the right treatment. And certainly a lot of work I do is about empowering women so they can be given the right treatment for them because they've got the right knowledge. And I was a GP for 15 years, it's very hard, it's very stressful, having 10 minutes with a person. So if as a woman who's visiting their doctor, they can be armed with the right information to try and guide their doctor what the real problem is, then that can really be a very engaging and liberating experience for the woman.

Because as a doctor, we want to share the decision making. We've gone other days of us being paternalistic and telling patients. what they need. Every patient I see is an individual and they need to be treated as such and we need to understand their concerns, their expectations, their future life and their worries and their health risks. So, but if we can do our background, homework if you like, as patients, then we can really change our consultation and in 10 minutes you can get a lot done if you direct it in the right way. So by people going on to Grandinette and helping each other, that's the first part, really, of the pre-consultation phase, if you like. Good. I'm glad you can be so useful in that way.

Well, I think it's really important. So were there any other areas of health that you hear a lot of in Gransnet? Sleeping is a big one. I'm sure partly that's linked to menopoles, but I don't think it is totally, but insomnia is a big problem and weight gain as we get longer. Yeah. And we know more and more from research that if you don't sleep well, there's not only because it makes functioning day-to-day really difficult, but poor sleep is associated with obesity, heart disease, dementia, diabetes, even types of cancer as well. So there are, again, health risks.

A lot of people don't realise that hormones are very important, especially estrogen, but also testosterone, which is a female hormone as well as a male hormone. And a lot of women, we see and balance their hormones, one of the first things they do is come back and thank us because they sleep. And I hadn't realized until I'd seen the volume of women that I do, how important hormones are. Because when you replace them, sleep is better, but it's a better quality as well. And even women who aren't getting nights wet still find that they sleep better. But then also we need to look about other reasons why people aren't sleeping. So we're taking our phones into the bedroom. We don't switch up. Too many people I speak to

would drink, I see much alcohol. They often drink at night because they think it will help them sleep. doesn't. People often get poor quality sleep. Looking at caffeine, people say, well, I don't drink any coffee before I go to bed, but you count up how many coffees they have or teas. Tea has caffeine, but also chocolate. Everybody said, I don't do caffeine, so therefore I don't eat any chocolate at all. And a lot of people do have some chocolate. It's just hidden. And then even sugar can stimulate people. And those people think, I just have a few crisps before I go to bed, or I just have some munchy. actually that's not good. And it's getting into the right routine.

And a bedroom is for sleeping. And yes, if you're intimate with your partner, then that's good as well. But it shouldn't be seen as a workplace. It should be seen as almost a sanctuary. So our bodies get into this. And it's very hard because when women and men don't sleep, you worry. And I used to wake up a lot when I was perimenopausal, worrying how tired I'm going to be the next day.

And of course, the anxiety that comes alongside menopause is just going to make it a vicious circle. Absolutely. And I personally do a lot of yoga, so I like to meditate. And even my children, when they can't sleep, I say, it doesn't matter. You relax your body and your mind. And sleep will come if it's needed. And it's so hard sometimes to switch off our brains. So it's really important of finding the right way for each person to rest.

I think rest needs to come before sleep. Oh, that's very interesting. That's a good thing for us to know. and the weight gain that so many people feel that it's inevitable with menopause, but is it? Well, it's very common. Weight gain is very common, and that's partly because we get metabolic changes that occur because of our low estrogen levels. Also, our body wants to try and retain any estrogen because we're designed to have estrogen in our bodies. If you think in the Victorian times, we used to die quite soon after our menopause, whereas now we're thankfully, due to advances in lifestyle and medicine, we live for about, 30 years during the menopause. So our body tries to conserve any estrogen it can, and our fat

cells contain a small amount of estrogen. So women often find they put on weight, especially around the midline. So taking HRT can actually help with weight loss because you're giving that estrogen naturally, usually as a gel or a patch like we've discussed. So a lot of people think HRT is going to make them put on weight, and actually most women lose weight. And then inevitably As you've said, for all of these things, exercise, whatever you're able to manage or enjoy, a healthy diet with the occasional treat thrown in because life's for living, is a good balance. Absolutely. I mean, diet is really important.

I love food and I eat really healthily, but I also eat for my bones. I eat for my heart and I eat for my well-being because we know if we've got good gut health, then it helps with our serotonin levels, our happy hormone in our brain. and we're less likely then to snack as well. And also, when we get older, our metabolism changes. I can't eat what I could eat 20 years ago. I look at what my teenage children put in their mouths, and I think, oh, they're lucky.

They can eat anything. So we have to change. But it's finding something that works for us is really important. And I think a lot of women really torture themselves because they're putting on weight sometimes. They're eating the wrong foods. They're feeling low, and there's this vicious cycle that goes on. So sometimes breaking that cycle by making very sense,

small steps, rather than torturing ourselves by cutting out food that we miss, if we do that, we need to replace it with something else, hopefully that's healthy, and enjoy food, because it's something we will have to do. It's not alcohol is a choice or smoking is a choice. Eating, we have to do it, so we might as well enjoy it, and then we'll feel better. That's actually another good thing on Gradsnet is that there are a lot of people who are trying to shift pounds, and so there's a very good support network of, you know, healthy things to eat, diet methods to try, exercise methods to try, or just support and cheering you on when you've lost around or two. It's like a free online group, if you like.

Which is brilliant. I think we all need encouragement. You know, I think especially as women, we crave a bit of attention, don't we, and a bit of a love. And if someone just says, well done, that makes you feel really good. So it's amazing how, what a difference, positive reinforcement can make. Absolutely. So, well, this has been really useful. And I'm hoping many of the listeners will be encouraged to pop over to Gransnet and see what they're doing because it's really life-enriching and empowering stuff. So thanks ever so much for sharing what you do. Just before we end, can I ask you for three tips really? And I'd really like, if you could give three reasons why a perimenopausal, menopausal woman could visit Gransnet and benefit.

To know you're not alone, there's always someone there to talk to, to share your worries and realised that other people have gone through them too and many have come out the other side so it's always good to know that there is a light at the end of the tunnel. And if you're feeling really frustrated, it's good to take the frustrations out and share them with people who are not

your nearest and dearest, because, you know, we've all had those times when our close family have suffered at the hands of our hormones or wrath or frustration or whatever. So if you can channel it elsewhere, it's good news for everybody. Fantastic. Really good tips.

So thanks ever so much. Thank you. My pleasure. For more information about the menopause, please visit our website www. www.menopause doctor.com.uk.