The Dr Louise Newson Podcast - 050 - Empowering Women to Receive the Right Menopause Advice - Liz Earle MBE & Dr Louise Newson

Episode Date: June 2, 2020

In the 50th episode of the Newson Health podcast series, Dr Louise Newson chats to Liz Earle MBE about how they first met and the work they have done together. Liz is very open and candid about her own menopause experience and admits how little she knew about the perimenopause and menopause before meeting Dr Newson. She is now a great advocate for women receiving evidence-based menopause advice and treatment. Liz and Dr Newson also discuss ways that women can become more empowered and receive the right advice and treatment. Liz works tirelessly to help women to improve their knowledge and is always campaigning for improved menopause care in the future. Liz Earle's Three Take Home Tips:  Knowledge is power! Take a look on menopausedoctor.co.uk and if you are experiencing menopausal symptoms then fill out the Menopause Symptom Questionnaire - you can then print it off and take it to your GP. Go to your appointment armed with knowledge, be secure in that knowledge and understand that you may even know more than your GP about the menopause. Don't be afraid to ask for a second or even third opinion. It's your body and your life, don't give up if you don't get the right help straight away.

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. So today I'm very excited and delighted to have with me remotely, Liz Earle, who I have known for a few years, and I'm just so excited to have you here today, Liz. so thanks for joining me. It's such a pleasure. It's so great to connect,

even if we can't be in the same room. Yeah, so as a lot of you know, I've done, I think, three podcasts with you, Liz, which has been a real honour and delight. And so it's lovely to have our roles reverse. But I've just wanted to talk really about how we first met, because as some of you who are listening, know, as well as being a doctor for many years,

I've also done a lot of medical writing. And I was approached to look at a book that I think your mother had written initially, haven't she? Yeah, she'd certainly help me with it. This was a really old book. I had a little series of quick guides, they were called, and I did about 24 of them. Gosh, it must be 20 years or so ago.

And one of them was on menopause. And to be honest, you know, back then, I was in my 30s, and it was something that for me was dim and distant future. So I asked my mum to help me because she was going through it. And it was the time of the women's health. Health Initiative studies and everything was, you know, very anti-HRT and a lot of chat about breast cancer, et cetera. So she helped me with the research. And it was only a quick little guide. So, you know, we published it and it was fine. And then about, well, I guess 20 years later,

a few years ago, I was asked by my publisher to rework all my little books and to put them out as e-guides, so e-books. And I did this and it came to the menopause one. And by this time, I had a nurse who was helping me doing some research. And she came back and she said, oh, Liz, you know, I hate to tell you this, but virtually everything in this book is wrong. And I said, what do you mean? You know, I pride myself on my knowledge and research and everything. And she said, yeah, I've been talking to this amazing doctor called Dr. Louise Newsompson,

who's a menopause specialist. And, you know, well, I mean, she says it's all wrong. So I say, I let me speak to this doctor. You know, what does she know? And of course that was how we first connected. And gosh, what an enlightenment. Well, it was funny, wasn't it? Because she'd approached me and I read it. And obviously, I've always respected your work and held you in very high regard. And read it. And the HRT section was very depressing, really, because it was saying how you could take it if your symptoms were really, really bad and you were really struggling. And actually, most women who take HRT probably will get breast cancer. And I thought, my goodness, I would love.

to work with you, but actually I couldn't work with, you know, the knowledge that I have, obviously, and knowing. So we had this telephone conversation where I felt really bad that I was saying, Liz, it's a great book, but actually parts of it are completely wrong. And I remember you saying, but actually, but horses urine is what's in HART, isn't it? And it's all so bad. And it made me realise, as a doctor, because we grow up lowing about medical things all the time, we just presume other people know the same. And it was very interesting. And it was also very encouraging because rather than you saying, no, I'm right, Louise, you actually said, gosh, really, I'm going to have to do some research and look into this, which is what, of course, you've done.

And I really never mind being putting right. You know, for me, it's all about evidence-based research and writing and clinical evidence. And, you know, that's part. part of it, and especially as science not only moves on, but awareness moves on. And, you know, we now know how outdated and how appallingly misinterpreted that original study that was published was and how the authors have since gone on to publicly apologize for the amount of damage that they've caused. And I think from that, my eyes were really truly opened. And I work a lot, actually, outside of my well-being work, I campaigned for social justice in lots of different areas. and I have a charity and I work with victims of modern day trafficking and all sorts.

And I guess, you know, part of me in this whole journey of exploration and discovery is about trying to put right this appalling miscarriage of justice that is being done for midlife women with their healthcare because of GPs not being trained properly and misinformation and media scaremongering. So it does see me kind of climbing onto my soapbox more often than not. just because there is so much misinformation. So I then went on to write a much bigger book, which was the Good Menopause Guide,

which came out, I think, three years ago. And you very kindly kind of proof read that and were my medical advisor. So we got to know each other much better then. And in that book, I wanted to put all the medical references in the back so that any GP or practice nurse or whoever could pick it up and really see where the information was sourced from and be confident that it was accurate. And then it just snowballs, doesn't it?

I mean, every day there's something new, whether it's talking about mental health and Alzheimer's or, of course, now potential immune support properties for COVID. I mean, it's just never ending. No, and it's interesting because I remember not long after we'd had this conversation, you invited me kindly down to your studios, and we did a Facebook live. And that was quite a few years ago,

and I can't recall whether you'd actually started HRT then or not, but if you had, it hadn't been for very long. I think I just started. And it was interesting because you were then aware that there was a big response from this Facebook Live. And any time you mentioned the word mendopause, people were really listening. And I know myself, it wasn't until I opened my clinic, I realized how many women were suffering. I had no idea before because in my GP practice, I just saw my cohort of patients and I would help them and they would go on their way and often felt a lot better, thankfully. but then I would suddenly see these women that had had symptoms for 10, 20, sometimes 30 years.

They'd given up their jobs, their partners, they're even sometimes thought about giving up their lives. And it's overwhelming and it still is now, as you know. But I think you've had that feeling as well, haven't you, from menopause being a word that we say in a very jokey way to suddenly realizing this massive impact. It's having not just on women, but on men as well, because men who know women clearly can have. be effective, can't they? Yes, absolutely. And I think when I think back to when I first wanted to write the main book I did, the Good Menopause Guide, I started it probably about four years ago.

And my publishers were very nervous about putting the word menopause on the cover. You know, they said, well, look, you know, you write about beauty and well-being. And can't we call it aging well? You know, because it's all about aging, isn't it? And I said, no, we're not flipping well calling it that. You know, let's call it out. It is menopause. And I felt awkward at the beginning about putting my name so firmly attached to the word menopause

because it's got potentially such negative connotations, or at least it used to. Thankfully, I think it's changing. But I didn't want to be seen as some decrepit old has been. And that was kind of the image, the stereotypical image of the unreliable, incontinent, frail old heap sitting in a corner. You know, that is not somebody identify with. And I think it's interesting, isn't it, looking at women in the media, there are a number of women who step out, people like Lorraine Kelly, for example, and Andrea on loose women and Meg Matthews.

And, you know, there are people who very clearly do and want to help and support and empower other women. And there are also other women, you know, in the media who look amazing in their 50s and beyond, who never say a word. And you think, you know, oh, come on. you know, can't you just be transparent and... Absolutely. And I think it's such a shame, isn't it? Because it's almost, I know myself, when I started taking HRT, some of my friends said, oh my gosh, don't you feel really old?

And that means you can't have children. And I was thinking, well, I've been sterilised. I'm in my mid-40s at the time. But it was very negative, there are very negative thoughts associated with it, as you know. And there's a lot of, I think we should change the way we think about the It should be really rebranded, I think, to be thought of as a long-term female hormone deficiency. That's great. I've actually started to use that expression. You first coined it and I used it in a podcast or something or an Instagram live or something the other day. I said, actually, you know, we need to be thinking about this as a hormone insufficiency. Like diabetes, you know, you lack insulin or fibroxin.

Absolutely. Yes. And if I said to you, you've got an iron deficiency, you would immediately say, well, how do I? I take iron. What's the best dose? What's the best formula for me? And it's the same with this because there are so many women, aren't there, who think they can just battle through their symptoms. They'll come out the other side. And, you know, we don't get any medals, do we, for suffering with symptoms. And, you know, there's a lot of people who sadly don't know they're having metaphors or symptoms. But even when they do, they feel ashamed to ask for help or they don't know how to ask for health. And then they think they should take HRT for the shortest length of time

rather than realising it's replacing our hormones because we need them for our health as well, don't we? Absolutely. And I think for me, you know, I'm always very wary and aware of vested interest. And it's been really interesting looking, particularly at social media, you look at some of these Facebook groups or you look at some of these websites. And I always say it's always important to follow the money and you go, what are you selling? You know, what courses are you selling? What books? What supplements? What gadgets? You know, where is this going to? What is the point of your website? Is it purely to inform and to help or is there an agenda, a financial agenda? And, you know, one of the reasons why I love collaborating with you is I know that you have

absolutely no vested interest. You know, you have no agenda. You don't want to see the same women months after month coming to your clinic, you know, for yet more repeat prescriptions. You know, you want to see them once, sort them out and send them back to their GP to carry on being properly cared for on the NHS. Absolutely. And, you know, the same is true with me. I have no vested interest. I have never taken any money from big farmer or small farmer.

And, you know, I'm totally unbuyable. And I think that's really important because, you know, I just put out information there that I think is genuine and true without trying to tell you something. It is, and certainly for me as a doctor, it's really important. And most weeks I get asked to be quoted behind some menopause face cream or some supplemental or something. And actually, you know, we can't do that. And I have said to you, you know, people respect because your whole journey with well-being and health is being huge. And I know how hard you work to look after yourself from within, which is so important, isn't it?

And I remember when your book Skin came out and superficially you think, well, I've had the same face cream. It suits me. I'll carry on. And then you think, oh, actually, I've got to think about my diet and then the whole gut health. Yeah, gut health. And things are so important. And it's the same with hormones, isn't it? And knowledge is power, isn't it?

And I think what's been really interesting, I think, watching how you've learned yourself. And thankfully, not just from me, everything I've. I've told you you've gone and you've looked at the research yourself, read the papers, and you've also quite rightly spoken to a lot of other experts and doctors in the menopause field. And it really makes me smile when I hear a podcast and it's similar words to, I'm saying, because it's important that you have unbiased information and knowledge. Yeah, absolutely. I mean, you know, I've kind of stepping into this whole world.

I've got a whole new Rolodex, if you like, of contact, you know, from consultant professors, in the UK to, you know, far flung across in America, in L.A., in New York, it just goes on and on. And, you know, finding the good people, the knowledgeable people, is hard because there is, I think sometimes when consultants have got, you know, the word consultant or gynaecologist or specialist, and it's sometimes really scary how little they know. And I mean, interestingly, I think it was it earlier this year or the end of last year, I forget, it might be the end of last year, I was actually asked to speak at the Royal College of of obstetrician and gynecologists dinner and it was a room full of gynecologists. And I thought, you know,

what am I doing here? Why am I your guest speaker? Because, you know, what do I know? You are the guys and girls who are supposed to know. And we had the most fascinating discussion. And, you know, many of them, mentioning their names, came up to me afterwards and said, you know, that was completely fascinating. I wasn't aware of this research. And I thought, my goodness, you know, women had come, being referred to you as the expert and you aren't aware of this simple basic research. I mean, how can that happen? Well, I think it's very interesting, is it? Because menopause has always been a gynecological specialty.

And actually, yes, we know that the menopause is associated with period stopping. But actually, it doesn't need a surgical treatment and gynecologists are surgeons. And so we're not really sure why it's happened. And as you know, I'm quite different because I've done a lot of hospital medicine and then I went into general practice at a later stage. And so I'm very interested in the effects of estrogen all around our body. And I'm not actually, I'm not a specialist in gynaecology. So that's why I'm so interested in osteoporosis, heart disease, diabetes, dementia.

The conditions, as you know, increase with lack of estrogen in our bodies. Whereas gynaecologists, you know, won't have any training in osteoporosis or heart disease or migraines or dementia because they focus on the reproductive tract quite rightly. So their training is very limited. But then obviously, as you know, a lot of GPs aren't given any formal training about the menopause, but also neither are other specialties. And so anyone who sees someone, for example, in an osteoporosis clinic or a migraine clinic, or a heart disease clinic or a urology clinic,

if someone's got recurrent urinary tract infections, all these people need to be trained as well. and yet they're not at the moment, this will change, but this is one of the problems. So women aren't always aware that their symptoms are related. And then when they are, it can be sometimes very difficult for them to get help. Well, you know, one of the things, I think after about 18 months or so of taking HRT, you know, I began to realise all the other connected symptoms. And it's really interesting what you're saying there about general practice

and about looking after all the other areas of the body. And I remember in my sort of late 40s, early 50s, being aware that I was having issues with my hearing and getting kind of borderline tinnitus. I would get occasional ringing in my ears and kind of crackling and began to feel quite depressed about it thinking, oh my goodness, you know, is this going to be my, you know, lifelong problem now as I age,

that I'm going to lose my hearing or I'm going to have to live with tinnitus. And after about 18 months of HRT, I realised, actually, and my hearing is completely fine. So I started to look into it. And actually, I've just written a feature about it for Lizar Well-Being magazine because I'm writing about hearing in general and hearing loss and how our hearing works. And as part of that, I went on to the British Tinnitus Association onto their website. And I had a look at research.

And I looked up some search terms. So I keyed in estrogen. No, nothing. Keyed in menopause. No, nothing. Keyed in HRT. And it just says no results that match your search. I think this is extraordinary.

So then I went on to PubMed and all the other kind of clinical references. And of course found not many, but some very statistically significant studies showing the use, the long-term use of HRT and estrogen in just helping that one thing, tinnitus. As you say, many, you know, audiologists, I know women who've been to audiology clinics and have spent a fortune on hearing aids and cochlear implants and blockers and all the rest of it. And, you know, a few months on estrogen, and the estrogen receptors in their inner ears are nicely topped up,

and they don't have a problem anymore. Yeah, we see so many women who have been to E&T, clinics and had quite a lot of investigations. And sometimes it can be dizziness, balance problems, but tinnitus as well, because we know that the estrogen receptors affect the way the nerves work and transmit the messages in the body. So just as pins and needles in the arms and the feet can be very common so you can get these other sensations. Absolutely fascinating. In fact, I'm just looking here at some of my research because I learned a lot about the workings of the inner ear. I learned a couple of new words. Where were they something to do with lymph? Oh yes, endolympe and peri limp. Yes. And these apparently, well, you know because you're a doctor,

these are unique ionic compounds that regulate electrochemical impulsors of the hair cells necessary for hearing. And they are influenced by estrogen. So isn't that fascinating? It's absolutely fascinating. I've had one patient, actually, and I have seen many hundreds, if not thousands of women who have been menopausal recently. And she was referred by one of my colleagues, who's an E&T surgeon, and he had realised that her symptoms had come on since she'd had her ovaries removed in an operation. So he'd taken a good history. And as you might know, 90% of our diagnosis is made in a history. and nearly 100% when it comes to menopause because there's no blood test that's reliable. And he had realised and thought, actually, you don't need to see me.

You need to go and see Louise. And lo and behold, it was related. So I was really encouraged, but it's a shame that people don't put the pieces together, really. There was a message on my Instagram, literally yesterday. Sorry to entrupchey. Literally yesterday saying, oh, my goodness, just listen to your podcast. I've had two rheumatology investigations and consultations, because I've got such aching joints. I'm 52. This all makes perfect sense. I'm going straight

back to my GP to request a trial on HRT. Yes, we see a lot of women who are misdiagnosed with fibromyalgia and even arthritis. And we know that women taking HRT have a lower risk of hip replacement and knee replacement due to osteoarthritis. And I'm going to do some work with some great people at Oxford University in their Department of Rheumatology looking at this because we know estrogen works as an anti-inflammatory in the joints and so you know arthritis especially in the hand can reduce with having estrogen but there's not enough research into it because as you know menopause research is very neglected which is appalling in my mind when it affects all women isn't it I mean one of the things that you know I try very hard not to do with with my work and that's you

know also why I'm so supportive of you is I don't want to bash doctors you know I'm not into bashing GPs or practice nurses. But what I do want to bash is the system that allows this to happen and the lack of education. And I know that that's something that you work very hard on, isn't it? You're not just treating women, but you're also trying to educate colleagues, you know, out of the business of your own heart,

you know, freely giving this time to try and bring everybody else up to speed. You know, it's obviously it is incredibly rewarding as a doctor to be able to really help women. and manage them properly, treat the underlying cause. And as you know, if women are on the right dose and tariff of HRT, they often feel so much better. And even women who can't have HRT in the first line, just talking about their symptoms, giving them choices,

talking about their nutrition, their diet, everything else, can make a huge difference. And it is such a shame. And before COVID, I was working with the NHS and we were going to do some big work this year, which has obviously been delayed because of, COVID-19 but as you know there's three other doctors and myself have written a menopause education program and we're working in conjunction with 14 fish an education company that do a lot of

appraisals and they're creating the platform for it so it was going to be available in the next few weeks and they can quickly access about 50,000 GPs really that's fantastic so how how will GPs get to know about that then so it's going to be all online and so it is linked in with their appraisal systems. So a lot of GPs will know about 14 fish, but also other health care professionals, so nurses, pharmacists, any other specialty as well. You've met two of the other doctors, Rebecca Lewis and Sarah Ball. And there's another doctor, Alice Duffy, the four of us, have created this program where there's a series of lectures that we've actually done that people can listen to and they have before and after questions so we can assess their knowledge.

And then we've actually had actresses coming to the clinic and pretending to be patients, with different scenarios. And so that in 10-minute consultations, we have recorded, and also we've used a nurse as well, so nurses can see what they can get out of 10 minutes with a patient. So there's, for example, someone with a migraine, someone who's elderly, who wants to restart HRT, someone with vaginal dryness, someone who's had cancer.

So different cases. So, again, people can do questions before and after. They can be referred to the evidence. So it's a very easy and very user-friendly way. And obviously we did all the recording a while ago, but even now with COVID, it's even better really because people are less likely to go to conferences and learn in their very traditional way,

whereas this is something, and it will be you can monitor the hours spent so that they can have a certificate. So it will be every year they'll have 10 hours and it won't be very expensive, so then we can get as many people as possible trained very quickly, which is really exciting. That's fantastic. It's something that, so the NHS use 14 fish, do they?

Well, the Royal College of GPs use it. And so, and actually they're very involved in the training of all GPs. So these, and there's a free module on there already that I've done for 14 fish. So anyone can join for free 14 fish and they can access a whole load of modules. So I've done one just for an hour. But this is going to be a specific medical in HR. education program. So anybody who has a GP who doesn't know very much, which is clear for, in some cases, you could just send a very nice email with a link to that saying, perhaps you might like to have a little. Yes, absolutely. A lot of GPs will respond,

won't they? Because actually, I mean, a GP is a general practitioner. So, you know, they will be generalized in their training. Yeah. When I do do training to GPs, actually, they're really interested and it's because they haven't had the knowledge and confidence to prescribe and then, as you know, there's a real problem at the moment because the warnings that are linked with our programmes in general practice, our computer prescribing program is linked with the MHRA, which now says to us how dangerous HRT is and they've updated it recently to say it's still really dangerous because of a Lancet paper that came out back end of 2019, which was looking at old type of of HRT. So a lot of people, women, but also healthcare professionals, don't realize how safe

through the skin estrogen is, how safe the natural progesterone is. Well, this is something that I'm definitely going to be taking up. And I know it's difficult for you as a doctor, sometimes perhaps to take on, you know, doctors' organisations. But, you know, for me, as a campaigner and as a writer and communicator, you know, I'm definitely got the M-R-H-A in my sites because the fact that they can allow this incorrect health damaging information to be put out is scandalous. I totally agree. And even if you take a step back and think about vaginal estrogen, so something like Vagifem, the vaginal pezzary, and as you know, around 80% of women have vaginal dryness and only about 7, 8% of women receive treatment. But we know that

local estrogen in the vagina is even, say, for women who've had estrogen receptor positive breast cancer, because it only works locally. But as you know, it can make a difference for someone being able to wear underclothes or being able to sit down or help with recurrent urinary tract infections yet. The insert clearly say risk of stroke, risk of breast cancer, risk of heart disease, and it's wrong. It's shocking. It's shocking. I recently tried the new spray version of estrogen, which was really interesting and I like it very much. And I thought, well, this is good because it's brand new, you know, hot off the press. And, of course, there was a little leaflet tucked inside there.

So I've spread it out and read it. And it was full of, you know, do not use, if you've any history of breast cancer, DVT, thrombosis, strokes, migraine. I thought this is completely wrong. This is totally, totally wrong. And the fact that GPs get that information and it flashes up as a red warning when they go to try and prescribe it, you know, it's no wonder. You have to be quite a bold, doctor, wouldn't you?

to say actually I'm going to override that because I know it's incorrect. Absolutely. And I think if they've come for a training day with me, for example, or with my colleagues, and they feel really empowered and then they try and prescribe and they get these warnings, they think, actually, I'm going to prescribe antidepressants because I don't get those warnings with antidepressants. It's easier and it's potentially going to be safer and I'm taking a risk here. Yes. So I think this is wrong and, you know, I would love to see some kind of class action.

I think there definitely has to be because when I've tried to be. because when I've tried to explore it, even with the drug companies, and they said, well, that's the way it is. That's the way it's always been. Well, as you know, that's not good. It can't be incorrect. No, it's absolutely not. And, you know, truth has to out.

Yes. You know, something's either true or it isn't. Yes. And if it isn't true, then it needs to change. Absolutely. It's got to be open and honest, incredible and trustworthy, and responsible and reliable and all those things. That as taxpayers, we expect our service providers and the health service to offer us.

And can you imagine, it being the same for any other medication, dare I say, any kind of male? Absolutely not. No. Well, Viagra, you can buy over the cancer, can't you? And there are actually more contraindications to Viagra, meaning reasons why men can't take it than there are to women, not taking estrogen as the gel or the spray or the patch. Yes, because if you've got heart disease, you have to be careful. And so, you know, it's, I mean, that's what I love about talking to you is. Every time I talk to you, I know something else. But every time I talk to you, I end up going away even more infuriated.

Because just as we begin to make a little bit of progress, we hear about other things. I hear with you, and that's why I love talking to you and supporting you with your work and your research. Because what you're doing is just so, so important. And if I can amplify it in any way. Well, it's great. And I, you know, I've said to you so many times, it's amazing what you do because, you know, you are a voice and a face of well-being and if you can stand there and say you take HRT, actually that's more than I can do as a doctor.

But it's reassuring for women, isn't it? I think the end of the day, it's about individual choice. And we're not doing this podcast to say every woman should take HRT. But what we are doing is trying to say people should have choice based on the right information. And that's what. And I do sometimes think, gosh, I wonder if I, if you hadn't been updating your book, I wonder how your life would have been

because you were starting to experience quite a few symptoms, weren't you? Absolutely, yes. I mean, I've never had a hot sweat, or maybe I would have done. But the main thing that really drove me to my GP to talk about HRT, having been made aware of it by you,

was lack of sleep, insomnia. But also now I know, looking back, I had the most debilitating headaches during my 40s and, you know, as I said, you know, problems with my hearing and incredibly dry skin. And I used to get repeater uin retract infections and cystitis and all of that, none of which I have now. So you're absolutely right. I'm quite sure that I have a massive debt of personal health care to you as do so many millions, I hope, of women who've recovered their health thanks to your work. Well, I think it's important.

And I think, you know, we need to end this on a very positive note because, you know, most of us, hopefully we'll be living in our menopausal years for decades. And it's got to be a positive phase of our life. And we have to be comfortable in the way that we choose and live our lives. And we're all different. So we make different choices. But it's important that if any of you are listening and you're not receiving the right help, then you should certainly go and see someone else and get the right help. And as doctors, none of us mind if a patient sees more than one healthcare professionals. So I know a lot of women worry that they're going to upset their doctor or they won't be able to go back to their doctor if they have a different problem. And actually,

doctors are often delighted. If they can't help or they're giving wrong advice, it's often because they haven't got the right training. And so it's really important, isn't it, that women do receive the right help and have the right knowledge. Absolutely. And you're putting it out there. So thank you. On behalf of womankind, thank you, Dr. Luen. Well, it's not just me. I have a great team. of people and, you know, none of us can do any of this on our own, can we? So it's great. We're very lucky. So it's great. And I think women working together are actually quite noisy and insistent and persistent, I should say, as well, which is good. What we need to be. Yeah. Onwards. Absolutely. Onward we go.

So thank you so much. It's really enlightening and I hope people have enjoyed it. So before we finish, do you mind just giving some, in a traditional style for this podcast, three take-home tips for women who maybe just aren't really sure and struggling and not sure what they can do, just three things that would make a difference for their future maybe. Well, I think the first is knowledge. You know, you said that knowledge is power. And, you know, you've got such a great website. I'm always on it and always delving deep to find great resources.

The Greens climacteric score is really helpful, isn't it? So I think any woman wanting to fill that in to track symptoms, And then you can print that off and take that to your GP. I think that's hugely helpful. That would be a really, really good starting point. I think knowing that you may know more than your GP is really helpful. So, you know, going into an appointment, even if it's an online appointment or a phone appointment, you know, armed with information. So that you feel secure in your knowledge, you know, you can print off the nice guidelines that say you don't need blood tests after the age of 45, that are unreliable and, you know, all these things.

is really important. So I think understanding that GPs may not know it all. And I think your point about not being afraid to ask for a second opinion or a third opinion or a fourth opinion, we just need tenacity, don't we? It's just not giving up, recognising this may be a journey. You may be lucky to postcode lottery. You may strike gold, the very first doctor you talk to,

but you may not. And I think, you know, I always say to comments on my Instagram, particularly, it's your body, it's your health, it's your life, it's your future, it's your choice. and I think just keep that in mind always. Absolutely great advice. Thank you ever so much, Liz. Thank you for your time today.

It's brilliant. Thanks for having me. Thank you. For more information about the menopause, please visit our website www. www.menopausedoctor. Dotco.uk.