The Dr Louise Newson Podcast - 057 - The Irish Menopause - Sallyanne Brady, Claire Peel & Dr Louise Newson

Episode Date: July 21, 2020

The Irish Menopause was set up by Sallyanne Brady and Claire Peel - two ladies who suffered horrendously with their own menopause symptoms and met in an online support group. Ireland was lacking in knowledge, support and evidence based information, for women in particular, so they founded The Irish Menopause in April 2019 and the group now has 2700 members! Sallyanne and Claire chat to Dr Newson about the stories they hear day after day that are heartbreaking and unnecessary and how they are striving for change in Ireland.   Sallyanne's Three Take Home Tips for women in Ireland: Join The Irish Menopause - it's evidence-based support and you might find something you relate to. Find a doctor - if your doctor doesn't listen or you're not happy with what they have said, go to the next doctor and keep trying! Reach out - share, talk to others. You're not going mad, it's not just you, it's every other woman. Claire's Three Take Home Tips on how women can help themselves: Talk to other people, go online and find support groups like The Irish Menopause. Look after yourself, don't feel guilty for taking time to yourself. Rest! Give Yoga a try! It can do wonders during this time of your life. Find The Irish Menopause on Instagram: @theirish_menopause Sign #TheIrishMenopauseMission petition online here.

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 delighted I have two guests with me, who are virtually with me. They're not here in my clinic because they're in Ireland. So I've got Sally Ann Brady and Claire Peel, who both set up the Irish Menopause Group.

group who I've been liaising with remotely. So I'm really thrilled that we've managed to find some time to get together. So hi, both of you. Hello. Hi. So tell me a bit about yourself. You haven't known each other for very long from what you were saying. So how did you meet and how did you come to set up the Irish menopause group? We met in another internet support group for menopause and we were chatting and realizing that our symptoms were particularly bad. I'm not Irish, Sallian's Irish, and she suggested that we set up a similar group for Ireland because it was a little bit different. There were no support groups just for Irish women. And obviously the health system is different. And yet women are suffering just the same, same

symptoms, then problems, probably a few years behind the UK. But the group's gone, we've got two and a half thousand members in a year. Not even a year. Yeah, so it's quite a lot for Ireland because we're a country. As Claire said, the health system is different. But it's not really when you actually stand back and look at the situation. It's the same as in the UK. The doctors don't have knowledge. This is the huge problem. So as Claire said, you know, I wanted to do the group. We both said, yeah, definitely. There are other social media platforms and stuff, but it's more targeted at the natural approach and empowering. You know, and that's all wonderful and works for some. But, you know, a lot of us, you know,

we need medical management of this. It's gone to be, like I would not be able to function without HRT, for example, whereas another lady would get through. I wouldn't. Yeah. So tell me about both of you saying how awful your symptoms were. What were you experiencing? I think the other thing we've got in common is that we were quite young. Well, one of us is still quite young. I was 42 when everything seemed to go a bit wrong and I didn't have the normal symptoms. So I didn't have hot flushes, didn't know what's happening. I think my body just started to go wrong. Digestive symptoms. Pain in my joints and my muscles. was diagnosed with fibromyalgia and fatigue and saw so many doctors, none of whom realized it was

the menopause. I kind of knew it must be hormonal because it was a cyclical thing. So it changed with your menstrual cycle, did it, your symptoms? Definitely, yes. And because I was still having periods, they didn't think it was anything to do with hormones. But I kind of knew in my gut that this is what was going wrong, but I couldn't convince anyone else. So how long did that go on? for? It was a long time. So it started when I was 42 and I finally managed to get some HRT when I was 47, 48. It was a long, long time. Gosh. So five years or so, you've been back and forth to various

doctors, even though thinking it was related to your hormones. So how did you finally get help then? I saw a rheumatologist who said, well, might be fibromyalgia or autoimmune disease, but not sure. And I suggested to him, look, is this a hormonal thing? And he said, well, yes, some women really struggle with the withdrawal of estrogen. And I thought, oh, finally I have a clue here. And he said, go back to your GP asking for some HRT or even the pill. Just for a month, get some estrogen into your body. you will know if your symptoms will improve.

And the GP said women of 47 should not be on any estrogen. There's a clot risk, there's a stroke risk. So again, you know, antidepressants were offered. And I had to go private to a private doctor in London in the end. And I just haven't looked back. It's just, you know, the change was instant. So even though you've been suffering for a long time, having the replacement estrogen work very quickly for you.

Absolutely. And I think this is really important for people to realize that often people are peri menopause also. Perry is the time around the menopause. And like you'll say, Claire, it had lasted for quite a few years, which can be quite common before periods stop. So your hormone levels often change before your periods stop. And that's because our hormones change every day, but they classically get worse before our periods. So PMS, for example, premenstrual syndrome. classically comes the few days before the periods and that you were experienced with a dip of estrogen, then you get symptoms. And estrogen is very safe. It's our natural hormone. And sometimes there's no easy blood test, as I'm sure you know, the blood test vary.

If I did a blood test on a lady with symptoms, on five different days, I'd get five different results. So usually, or quite often, we diagnose that perimenopause and menopause just from symptoms alone. And as you quite rightly say, you don't have to have hot flushes to have perimenopausal or menopausal symptoms. And unfortunately, most people just associate the menopause with hot flushes, don't they? Yes. But as you quite rightly say, they're not always. And sometimes as a clinician,

it's very hard to know, has this lady got arthritis or fibromyalgia or depression? You know, we don't know. But what we do often do is give people some low-dose estrogen. And as you know, through the skin as a patch or gel there's no risk of clot so it's very safe and then women will tell us like you you know you've made the diagnosis by having a short amount of treatment and you know because you're replacing the hormones so we know if you had an underactive thyroid gland for example you would be feeling more tired putting on weight lethargic and we would give you thyroxin the replacement hormone and you'd feel better so we would know that was causing your symptoms And this is the same, sadly, your ovaries were failing, a little bit younger than some women,

but they often fail very gradually. So that must have been really hard for you, though, having seen so many doctors in the NHS and then having to pay privately for having some replacement hormones which are available on the NHS that you couldn't get. It doesn't seem right. And certainly, I'm sure you know, I run a private clinic because I can't get a job in the NHS as a menopause specialist, because it's not a priority to have good menopause care at the moment. Hopefully that will change. So I find it very distressing that people have to pay for something that should essentially be given.

So I'm sure some of your frustrations has led you to your journey now with the Irish menopause grief. Is that right? Absolutely. Both my story and I also had a very good friend who had the same symptoms. We had the same journey. We confided in each other. I think what really changed me was her experience because she could not get any help. She couldn't go private.

She couldn't find support. And she actually took her own life. And I just, the chance to help with this group meant that even if one woman was directed to a qualified doctor who could help her, I would feel better. Yes. So that was my aim, really. Yeah, I'm sorry to hear that. And we know that the suicide rate increases. in the early 50s, and it's no coincidence that the suicide rate and the average age of the

menopause is similar. We see so many women in my clinic who have had suicidal thoughts. I've seen women who have even written notes, and one lady said to me that if I didn't know at the time, but if I hadn't have helped her, she would have killed herself. She knew exactly what she was going to do. And she'd been battling for many years and been refused HRT and just even having HR2 for a small length of time has transformed her life. And it's very frustrating because as a doctor, I was only really taught about the hot fleshes and sweats with the menopause. And it's only because I've done so much research myself and seen the volume of women that I've realized it's the psychological symptoms are the ones that affect women the most. And we know that a lot of women

are inappropriately offered or given antidepressants. And there's no evidence that taking antidepressants, improves a low mood if it's associated with the menopause. Antidepressants can be very good for treating clinical depression, but this is different. I want that person, Louise, that you're talking about when peri menopause arrived on my doorstep, I all of a sudden went from being, you know, a normal hormone woman to a suicidal woman for a week or two of every month. Now, you know, I didn't get to that point, thankfully, but I was a mess. And doctor after doctor, doctor it was just, oh, it was anxiety. I was offered every antidepressant you can think of and at one point I had a prescription for antipsychotics. I wouldn't take them and I told my GP I don't want to take

them. I don't think it's what I need. I need hormones and he just said, well, you know, I can't help you if you can't be a good patient. That's what the doctor said to you. Yeah, it was a very difficult journey for me until I got to where I knew myself what I needed but my problem was my age. So how old were you? It all really got bad probably 38, 37, 38. It crept up on me slowly, but it got the bad point at 37, 38 and so on. But I bet for the correct treatment because I knew myself it was menopausal. My mum had had an early menopause too, but I was just ignored. So even when you suggested to people that, to doctors that you thought it was an early menopause,

they didn't think that was right? No, like some of them would have entertained it to a point and they'd do bloods and tell me my bloods were okay. I paid then to see a private endocrinologist in the hospital and he spent an hour and a half with me, basically just patting me on the head, telling me that menopause was part to life and to get on with it. So, I mean, I could talk forever about it and all the doctors and specialists I saw and nobody ever joined the dots. So how did you get help in the end? In the end, I went to every doctor there was. I actually got an appointment then with a clinic in Dublin and it was the gyny and menopause extoll.

and I went to see her and she was like my last attempt. So I went in, she did listen to me, she did write me prescription for combined patch and said to me, I was in a bad way now and said to me, take these, if you're not better in three months, don't come back, there's nothing I can do for you. So I went out and sat on my car and I cried and I just, I said, this isn't what I need. It's not the help I need. I didn't know what to do. and then I got a phone call.

It was a blessing for a cancellation, for a doctor I'd been sort of watching. Very expensive doctor, but quite brilliant doctor. So I took the cancellation and I went in and Dr. McGovern is my doctor for anyone in Dublin listening. He listened to me and it was the first day of the rest of my life. He said, you're not mad. You don't need any of this.

You need hormones. Let's get going. And I never look back. Now it took a long time to restore me and to get that the dosing is right because it was complicated. It took quite, but he worked with me all the way, like all the way, and nothing is too much trouble.

And that's what women need. Absolutely. I think it's really important for people that are listening out there because HRT is only three letters. There are different doses. There are different types. There are different ways of having it. And we're all different.

I sometimes say to people, it's a bit like finding a comfortable pair of shoes. You can try on quite a lot, and then suddenly you find the pair that you want to wear every day. And it's a bit like that with finding the right. dose and type of HRT, sometimes people come here and they say, oh, HRT doesn't suit me. And then I realize they've been on a very low dose, or they've been on a tablet when they should have been on a gel, or there's always ways. And I think what's very important for both of you, for listeners to

take on board, is that you were both young. So the guidelines are very clear if you are under 45, having HRT, any type of HRT, there's no increased risk of breast cancer. And because, without the hormones there's an increased risk of long-term health problems, such as diabetes, heart disease, osteoporosis, dementia, then women really have to have hormones unless there's a medical reason why they can't. So a lot of people say, well, it's a natural process, I've got to get through it. Actually, it's not because it's a mark of a future disease. And we know that the evidence very much supports if women have replacement hormones, this risk of heart disease, osteoporosis, diabetes, dementia and so forth, reduces. And so it's really

key for your health, but also listening to the way you were suffering your mental health as well, you know, replacing the hormones because you're treating the underlying cause. So as you were saying, some people say, well, I want something natural, but actually it's not natural to not have your hormones when you're in your 30s and 40s. Totally agree. And this is, you know, everyone is entitled to treat their well-being and this they put themselves. But it's a lack of understanding. And as I've always said,

if a woman says to me, I completely have a full grasp on what menopause does to the body and I know everything inside out, but I still choose not to take them. So be it. But the problem we're having is women don't realize the effect it has on the body,

and they think it's something they need to power through and they come out the other side. I suppose we're fortunate that we've seen the dark side if you want to comment on. I have seen what Low Easterton does. So as Claire has, and it's quite shocking. It really is quite shocking of what it can do to the body.

So in a way, we're kind of lucky. And look at it that way, yeah. We've at least put it right now. Yes. I would have hated to carry on, you know, five years. There is this notion, especially in Ireland, actually, perhaps. It's a little bit behind. There isn't personalities like yourself who are constantly on TV and educating people.

But the women in the grid, a lot of them seem to, And it's, you know, strong women who think, I'm going to power through it. I'm going to power through it. But actually, I don't know. It could last forever. I mean, people get hot flushes into quite old age, don't it? Yeah, and we know from research that the average length of time for symptoms is seven years. And none of us are average, I hasten to add.

But a lot of women, it's decades, but also symptoms change. So sometimes the flushes, sweats will improve with time, but people then get anxiety, or they get headaches or they get joint pains. So all vaginal dryness is something that around 70% of women experience. But also, even if a woman has no symptoms, they still have low hormone levels. So it's a bit like high blood pressure. You don't always get symptoms from high blood pressure, but it's a risk for heart disease. So having low hormone levels might not cause symptoms, but you've got this risk.

And I think we've got to see it as a long-term low hormone deficiency as opposed to just something that's going to cause symptoms that we have to battle through. So let's talk about the Irish Manifles group. This is a Facebook group, is it? It's a Facebook group, and there's obviously a page as well. We have, you know, we do a little bit on Instagram too. It's nothing fancy, but I think it was badly needed in Ireland. Now, it is, and, you know, we've had people say,

it was always very HRT orientated. Yes, it is. And that's okay, you know, if someone isn't into HRT, you know, there's lots of other places for them as well. You know, every woman is welcome, but we are passionate about giving women facts, not not. They need to know the facts. We're not putting HRT, but unfortunately or fortunately,

it's what's recommended for the female body at this point. And we're not going to lie about it and tell them to eat this and take this supplement. And, you know, we want women to be well. We want them to get their lives back. I think a lot of women who join, like ourselves, have been through many years where they've tried supplements. I mean, some of them obviously, I mean, they wouldn't. have come to us if they weren't. I mean, some of them are just really suffering. And they're at

the point where they need something else. It's not, you know, obviously diet and exercise is great, but sometimes it's not enough. Yeah, absolutely. And I think it's, it is very hard. There's so much antagonism about HRT and a lot of people feel that it should be last resort. Yeah. Because of the bad media press, really, and because there's been this association with breast cancer, people often have been given the wrong information. And doctors have been given the wrong information or no information, and that makes it very difficult. We're very fortunate now, as you know, we've got good guidelines,

we've got good evidence. And certainly all my work is evidence-based. It's non-biased. I don't get paid by drug companies to do my work. It's very much because this is what the evidence shows, and it does make sense. And I feel it's absolutely vital that women are given a choice. We choose which car we buy.

We choose, you know, what clothes we wear in the morning. We have to make choices about our health. And some people choose to drink loads of alcohol. Some people choose to drink nothing. But that's their choice. You know, some people choose to smoke. And as a doctor, I'm not here to criticise anyone, but it's about trying to educate them that actually smoking is not good for us.

Drinking too much alcohol is not good for us. But if that's what you choose, but actually, for the majority of women, the benefits of taking HRT outweigh the risks. but also women who can't take HRT first line, for example, those women who have had breast cancer, they still need to know they have an increased risk of heart disease osteoporosis. So they need to be given evidence-based help as to how to reduce that risk. It's so important.

So how are people in Ireland accessing HRT? Are they managing to get it? I know. With great difficulty, do you mean in general or in reference to the shortages? No. I mean, I'm hoping the shortages is going to be relatively short term. The problem we see in the group all the time is, I've noticed lately, we've a lot of members who are on HRT, but they're still not feeling good. I always say, you know, if you're on it, you're supposed to feel amazing.

You're not supposed to be struggling still. So to me, what's happening is a GP or whoever is writing them a prescription and off the go, there's no follow-ups. It could be on the wrong dose and been on for years, and then they go, this doesn't work. Quite often as well, actually, we have seen real old style, H-Rare. HRT being prescribed even now, and it just seems so worried. We are an information point. We direct them to your site. We're not medical.

We're not doctors. I was a librarian. I just gather information and put it out to other people. So all we can do is say go back to your doctor. Or sometimes there's women who've had hysterectomies who haven't been given HRT, it hasn't even been discussed. So all we can do is direct them back to the medical profession, but we need the medical profession to be better trained, I think.

And how is it changing over there? Do you think our GP's more on board, do you think, or doctors on board to prescribing HRT? Not really. There are some, but their daughters around the country literally. It was very poor. Now, as you know, I mean, we also started running a campaign similar to your own in the UK menopause matters with the Irish menopause mission,

and we're gathering signatures on that. but we're still at sort of a stuck in the mud point of people still don't think menopause as a thing. They just, these people are crazy, what are they talking about? Every woman goes through it, all of that. And we're in the situation. We're in because of what went before us. Because of our mothers or grandmothers never spoke of it, you know, the stiff up the lip. And that's why we're in the mess we're in.

Women need to stand up and be counted and to explain how they're feeling and make people realize it is a real thing. We can get very, very, very sick. You know, life, house, marriages, jobs. And you're finding that the support for the group is positive, are people saying that they're learning a lot and is it helping them? Yes, we've got some fabulous feedback and some of it, we well up a bit when we read it because, yeah. Now, not everybody, of course, you can never please everybody,

but overall excellent feedback and it's evidence-based support. And I think women realise, after a while, oh, God, yeah, they're right. Yeah, okay, that they're right. They're not telling stories. Yes. Yeah. I mean, I have had a lot of antagonism about my work sometimes in the media as well, thinking that, you know, I'm so pro-H-R-T,

but I'm, as you know, pro-giving the right advice to people. But there's a lot of scaremongering out there, which makes people really uncertain. But I think people are really scared, and they're really scared to talk openly because they feel they're going to be misjudged. And when you're close to giving up your work, it's really quite awful, isn't it? and you don't want to admit that you can't cope with your work. And certainly when I was having symptoms, I couldn't remember the names of lots of medication

that I prescribed for 20 or years. And I couldn't have carried on work. And what would I have done? I would have stayed at home instead at the four walls because I was good for nothing. And that's very hard to admit to your family, let alone other people as well. So there is this misperception.

And then I think when people think about the menopause, they often think, oh, crazy menopausal women, hormonal, let's, you know, have a bit of a cartoon, let's laugh about her. It's not laughable, actually. We don't allow jokes in the Greek because we're quite, you know, it's not to be laughed at. There's nothing funny about it because, you know, and this is the problem, that needs to be stopped.

You know, I see it the equivalent as joking and laughing about, you know, mental health, for example. Yes. You know, these comedies and these he or acts and that, you know, you wouldn't do that about another subject. No, I totally agree. And I feel, you know, you know, It's inexcusable, really, that we as doctors aren't given the right training for something

that affects half the population directly. Indirectly affects the whole population because anyone that knows a woman, works with a woman, loves a woman, as Diane Danza-Brick says, needs to know about the menopause. And, you know, my children need to know because they will go through the menopause if they live long enough, but also they will experience aunties or friends or teachers. A lot of my children, a lot of my children, a lot of them. so their teachers are actually menopause, and my children are recognising it,

which is sad as well because they can see. They say, mommy, they're sometimes in the middle of teaching us, and then they have to open the window, or they say, oh, I'm sorry, I've forgotten what I was saying, and that's horrible for the teachers. So I think there's so much that we need to do to change, to improve education. And you might know I'm developing a menopause education program

through a company called 14 Fish, which will be online. So anyone, anywhere in the world can learn about the menopause and it's going to be cheap and accessible and evidence-based. So that's good because that's providing a solution. And then you'll probably know about the app we're developing called Balance, which will be providing free evidence-based information globally to women. And we'll have a community on there as well so people can share experiences. Because some of the social media work I do, I'm learning every day that women really can help each other. more, I think, than I'm not sexist, but I don't think men would have the same support. But like, what you're doing with your menopause group is amazing because you're helping people hold hands

and helping people have the strength because it's quite scary, I think, as a patient to challenge what your doctor's doing. It's very very scary. Very long, yes. Yeah. And I know myself, if I go and see a doctor, I'm thinking, gosh, I've only got 10 minutes, they're running late. I feel a bit of a nuisance and I want to get this over really quickly and I often, even me as a medical person, forget what I want to say, I feel I'm really disjointed, I'm a bit embarrassed and so I can see why people aren't sometimes even going to go to their doctors because they think it's just the menopause and then when the doctor says, well, here's some antidepressants, to then push back and say, no, actually, I don't want antidepressants, I know they're not going to help is a really hard

thing to do. So the more evidence-based information you guys are giving, you. to your group to empower them and strengthen. That's amazing what you're doing. It's really good. It started small, but we get so much from it. It's very satisfying, isn't it? When, you know, the ladies come on and say, well, I've got the gel from my GP and I feel amazing. Thank you so much. I slept last night. And it's wonderful. It is lovely. And I certainly get that still on my Instagram, you know, people say, because I've read your website or I've read your comments, I've now gone back and I feel so wonderful and you know i for me as a doctor it's it's incredible that i can help people without seeing them you know it's lovely to have this community are you getting support from any medical people

over there moral support we've seen doctors who think were wonderful okay good yes and i mean yeah and if you actually we see some members joining and they say my my GP recommended yeah and i'm going wow okay so but that's as far as it goes really so i'm far. We're trying really hard. Ireland is still so stuck behind with this and we're just hoping that something will happen that there's more training. There's very few doctors and slightly different over here than there. You've got like the private sector and then the public which is more like the NHS where you've got a medical card if you know depending on your income. There's nothing in that space at all for ladies and it's very unfair because all of the clinics we have which are very

expensive and it's not achievable for lots of ladies and they're just left it's really really sad it's quite heartbreaking when somebody you know they know what they need but they just don't have the money or their doctor won't listen to them you've got the more remote and rural areas where there might be only one GP clinic for the town and that GP happens to be a dinosaur those ladies are in a bad way it's not funny that's where the internet helps I mean that's where yeah I certainly agree I think if I was trying to do this 30 years ago, it would be so difficult. So I think we have to optimise and use it to our advantage, really, so we can empower and educate as many women as possible.

And I think there is a shift. I am usually quite a negative person and I am very frustrated most days of my life. But actually, I do feel that things are changing. And somebody said to me once, if you feel you're not being listened to you, just keep being consistent. And then eventually people will listen. And I think that's all we can do. And that's all you're doing with your group is saying the right messages and, you know,

you're doing it with the best intentions and also because it's evidence-based. So there's always going to be people that don't agree. But actually the majority are agreeing you must be doing something right. And certainly to have so many people on your group so rapidly shows how much people are respecting what you're doing. So before we finish, could I do? have from both of you, just three tips for women. So maybe Sally Ann, if you could have three tips about how the Irish menopause group can help. And Claire, if you could just do three tips very briefly, how women could help themselves, then that would be really good. Okay, so

to help yourself, I think, having been a bit of a veteran, talk to other people, go online, join the Irish Menopause. Look after yourself. Don't feel guilty about having time to yourself if you're tired, rest and yoga, because I love it. And I think it does wonders. It kept me going for quite a few years. Excellent. I like that.

I agree with that wholeheartedly, because as you probably know, I do quite a lot of yoga and it keeps my head. I think you're a bit better than me. For the ladies in Ireland, I suppose, yeah, join the Irish Manopause group. See what you think. it's evidence-based, it's factual. We have Diane Porterfield, who's a qualified nurse as part of the group. She validates what we say.

The support is there. I think it's very important for any woman struggling to join, to have a look, and I guarantee they would relate to some of the posts, if not most of them. Find a doctor. If your doctor doesn't listen, or you're not happy with what he or she is saying. Go to the next doctor.

Keep trying. Keep trying. To never give up. And I think, you know, to reiterate everything, Claire said, but to reach out and to share and to talk and don't feel like, you know, you might feel like you're going mad, but you're not going mad and you need to talk to somebody about it. It's not just you, it's every other woman. So I think that's the key thing here is sharing and openness because there's too many ladies suffering in silence and, you know,

we don't know where that's going to lead. Yeah. It's so important. And it's been brilliant having you on this podcast today. And I hope it will have helped so many people, not just in Ireland, this is a global problem. It's a worldwide problem that women are not receiving the right evidence and help for their menopause. So for any of you that are struggling, then please look up the Irish Menopause Group and obviously there's a lot more information on my website also. So thanks ever so much ladies for your time today. Thank you. Thank you so much. For more information about the menopause, please visit our website www. www.menopause doctor.com. Thank you.