The Dr Louise Newson Podcast - 058 - Changing the Perception Around HRT - Davina Mccall & Dr Louise Newson

Episode Date: July 28, 2020

In this podcast, Dr Louise Newson chats to one of Britain's best loved TV presenters, Davina Mccall. Davina talks openly and honestly about her own menopause experience and how she had no idea that she might start to experience symptoms when she was just 44. Davina and Louise talk extensively about the perception of HRT in the media, how women are often needlessly scared and ashamed when they hear those three letters and why it's so important that this starts to change. It's essential that women have access to evidence-based menopause information - we all have the right to make informed choices about our own care and treatment.  Davina Mccall's Three Take Home Tips: Inform yourself! You have the right to choose the best treatment for you, but make sure you find out all the correct information beforehand. Find a supportive community and exercise. Whether it’s a weekly class or an online platform like Own Your Goals – exercise can be great for your mental health. Judgement is often a reflection of how we are feeling within ourselves. Every woman has a story and has the right to make their own choices without fear of judgement. Find Davina on Facebook: @DavinaMccall Twitter: @ThisIsDavina Instagram: @davinamccall www.thisisdavina.com   Click here to watch Dr Newson and Davina discuss 'All Things Menopause'

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 absolutely really, really excited to have with me remotely, Davina McColl, who I have been stalking and pestering over Instagram for quite a few months now. and I'm just honoured that she's agreed to be interviewed for my podcast. So welcome, Davina. Hi. I mean, I think I was stalking you before you were stalking me, I think. Oh, that makes me feel better because I have this habit of trying to pick out people that I think will be very useful.

I'm very open. I don't have a hidden agenda, but my big agenda, as you know, is to help more women globally. And I need women with a voice. And you have a voice. And a president. and a lot of respect from a huge amount of women and men about your work over the decades, really. So when you started talking a little bit about the menopause, I thought, right, I'm going to carry on until I find her. And now I've got you. So there's a huge amount that needs to be done about the menopause. And we could talk for hours, which we're not going to today. But I thought before we start talking about your thoughts in a bigger way about the menopause,

maybe could I just sort of talk to you, if I had asked to interview you maybe 10, 15 years ago about the menopause, would you be thinking the same then as you are now about the menopause? Not at all. I mean, 10 years ago, I didn't really know about the menopause. I mean, I didn't know what it was, how it would affect me. My mum had died. My grandmother doesn't really remember or didn't remember back then what was going on. she had vascular dementia at that point anyway, so she wouldn't have been able to help me. I had one cousin who was the same age as me, but when I started getting symptoms, we had never talked about it or discussed it. Women just didn't discuss it at all. I didn't know. I didn't know what it meant. I didn't know what peri menopausal meant. So I would have been 42, 10 years ago, and I had no concept of anything to do with the menopause. And that's what I was. I was why when we had our chat the other day. I thought, you know, I need to get that chat and I need

everywhere because a bit like dying, you know, all women are going to have menopause. You might get it in a very small, easy way or you might get it with tons of really awkward, difficult symptoms, but that's not the point. That's not the point. It doesn't matter how you get it. We should all be taking HRT for the health benefits, and you know. But I'm had to. I had to. no concept, zero concept of any of that. So how did you learn? What happened? Did you start getting symptoms or did you start to read or what happened? I was, I mean, it all started on a Garnier shoot. I've been working with them for 16 years and at started when I was about 44. I was on a a Garnier shoot in Prague. I went to bed one night and I woke up in the morning and I had a pool of

water in the sort of tip in my neck and the sheets were wet, the duvet cover was wet. And I thought, Christ alive, like it was sort of six o'clock in the morning. I'd only had maybe five hour sleep. I'd gone to bed about one. I was feeling really restless. I thought, what's going on? So I had a long shower. And that's when I thought, or that I don't like this at all, this reminds me of when I used to take heroin. Like I was heroin addict and I'd wake up in the night having started kind of detoxing during the night and I wake up in a horrible wet sheets. And the thing possibly that I've been most grateful for in my recovery is waking up in

dry sheets every day. So to wake up in wet sheets was really scary. And I thought, what is going on? So then I went to work and I sat in the makeup chair and I then said to the makeup artist, is this chair heated? And they looked at me like I was on drugs of some school. thought, and they went, no. I thought, of course it's not. Why did I ask that question? My back was on fire. I was like, oh my God, I don't know what's going on. Like,

whof. And I thought, what this sound like? I'm sure I've heard symptoms of the menopause, but I can't be having the menopause. I'm only 44. Like, I'm not going to have the men. So then it kind of kept going and I thought, and I didn't tell anyone. I was ashamed. Is that awful? Ah, it was terrible. And I thought, this is something I was, it was a deep, dark secret. Then I called my cousin.

I was like, what's going on? Is this the menopause? She went, well, it sounds like it. Then I just didn't know who to talk to. And in dire need, because I do love the NHS and I do believe in supporting the NHS, but if I am in dire need of an appointment and I can't get an appointment anywhere and I'm really sick with worry. I have visited a private doctor in London.

I'm very, very, very lucky. I know I am to be able to afford to pay. I was lost and I was really frightened. She's a woman and she's very pragmatic and helpful. And I went and talked to her. She was like, oh yeah, you're definitely. And she explained everything to me. How lucky?

It was like having a mummy. I mean, what the mummy would do. And I then went to, I do. have a gynecologist as well that I go and see annually for checkups. And she suggested I go and talk to him. And he was brilliant, Louise. And he is just like you. And he said, look, the benefits for your health are so great, I would strongly suggest. And I talked him all about, oh, but what about these? Yes. Because did you think that's quite scary, isn't it? You suddenly been thinking about what's going on. Then menopause gets mentioned. And then,

HART gets mentioned, did you feel quite scared listening to those three letters or what, were you just so desperate for us somehow? Well, I am the girl. I'm clean, right? So I don't take drugs, I don't drink. I try not even to take paracetamol or neurofen unless I'm really meagint. I mean, you know, I just don't want to take anything. I've had a couple of operations and I would really, you know, only take the drugs that they prescribe if I absolutely have to. I just, I'm that kind of person. I had three home births. I don't want any kind of medical intervention.

But I was at that point. So probably I went to see the gynecologist, maybe six months after all my symptoms had started, where I thought I was going mad. So I just thought my career, my marriage is not sustainable. Everything is going to go to pot if I don't seek some kind of, I would have done anything. If somebody just said stand in Trafalgar Square and hot for three hours

and it will alleviate the symptoms, I would have done it, you know. I mean, I've said this before, but my phone was in the fridge, my keys were in the bin. It's really scary, isn't it? People often think that the menopause is about hot flashes and sweats and we get through those and we'll be fine. What people don't know, and also what healthcare professionals often don't know, is the importance of hormones in our brains.

We need it to help the sugar metabolism in our brains, the function of brains, every cell in our body. I can't think of one that doesn't have a receptor. for estrogen. So it responds to estrogen in our bodies. And, you know, when our brains are out of control, it's really scary. It's really scary. It's different. If you've had a few drinks and you're relaxed and you think, oh, I can't think straight, but you know why that's happened. Or if, you know, you've had drugs or whatever or a bad night's sleep, you know, you're tired. But when you're functioning, when you want to function in the same way and your lifestyle hasn't changed, you feel

robbed and scared. And I think what you're describing is so common for women. but then they can't get hurt because, you know, obviously you know how fortunate you were that you've got help, but you still had six months. That's a long time, six months of symptoms, but, you know, I see and speak to women that have had symptoms for years, decades, and you can see why women don't become top in their game.

You look at the, you know, boards of directors and it's all about equality, but no one talks about the menopause. Of course people can't work when their brain doesn't function. You look at divorce rates. Of course they are. increase, you know? Also, you know, like taking HRT became so shameful. I mean, I didn't tell anybody that I was on it for ages because a lot of my girlfriends who are like-minded to me were on the maca powder or like lots of herbal alternatives and, you know, we've just got to battle through

this bit and this kind of battle word, you know, come on, we've got to get our heads down. I think this is a thing, isn't it? And I think, like you say, we're given information at different stages of our lives and we're all prepared, well, often prepared for periods. Some people that obviously occurs a bit earlier. We're all told about sexually transmitted infections, about contraception, pregnancy, we get loads of help. And so people think it's just a very short-term thing that they can get through. And if you've had pregnancy and it's been very difficult or difficult experience as women, we just think, well, we'll get through it. We've got through periods which have been horrible for a lot of women, haven't they, every month, but we just get through it.

So there's this whole thing, perception that people have to get through their menopause and they'll be stronger. And even quite a few well-known people have written about their experience and they feel they've come out the other side and they've blossomed and they're enjoying and this new strength and whatever. But actually, they're never going to replace those hormones. And you alluded to at the beginning, this long-term hormone deficiency is what we need to consider because you've had symptoms, which is one thing. But as soon as you started to drop your hormone levels, that's when you're increased risk of, you know, as you know, heart disease, osteoporosis, diabetes, dementia starts. And these are really big and I don't want to scare people who are listening. But, you know, the commonest cause of death is cardiovascular disease. Women who take HRT have about 50%.

So 50, not 15, 50% reduction in heart disease. So, and it costs the NHS a few quid a month to put someone on HRT. It costs the NHS, I can't even tell you how much for diabetes care, dementia care, cardiovascular care, you know. But it's knowing that it's not shameful to be on a hormone. If you had an underactive thyroid gland and you've been having symptoms, putting on weight, being lethargic, being tired, had a test and you were found to have an underactive thyroid gland, there'd be no shame in you taking thyroxin. In fact, you'd be foolish not to. And it's just really sad to hear that it's shameful that you can.

and you know, you can't tell people. And I know when I started HRT, I was a similar age in my mid-40s, and some of my friends said, oh, my goodness, that makes you sound really old. So I'm not old. But then that one in a hundred women underage of 40 have an early menopause. So how do these poor women feel? They must feel dreadful because there's this stigma. And then there's other women, and I'm sure you know people who are denying that they're

menopausal because they think it's an aging thing. So they sit there a bit flushed, having been really tired. poor sleep. Oh no, my hormones are fine. Absolutely fine. Yeah. Oh, it's awful. Oh, my God, the sleep, Louise. The lack of sleep, I remember literally the first day I put the sticker on that night, the sleep that I had was so restorative. I remember waking up the next morning thinking all my Christmases had come at once, even if I carried on with the other symptoms, the actual sleep. Yeah, and this is something that I think, actually, most, it's the communist. reason that people thank me is for their sleep coming back and and as a doctor I never knew

anything about sleep and hormones because I was never taught anything about the menopause, let alone sleep. And I read Matthew Wallace Walker's book a while ago about sleep, amazing book, talking about people who don't sleep have an increased risk of heart disease, obesity, depression, early death. And I'm thinking, well, hang on, these are related to hormones as well. But in his book, sadly he hasn't mentioned hormones. So it's a double. all whammy when we don't sleep well. And I used to wake up at three, four in the morning and thinking, what the hell am I doing? I'm going to be really tired tomorrow. I need to get back to sleep. And it wasn't always because of a flush, or a sweat, it would just be, I'd wake

up. And I'd see my husband lying in bed snoring, thinking, that's really frustrating. And I, oh, it was so awful. And I didn't. I'm so, I was naive, I suppose. I didn't realize it was related to my hormones. And I feel guilty that I have good sleep. I don't sleep for particularly long. because I'm quite busy, but I sleep really well. And it's so restorative for our brains and bodies, as you know, isn't it? And so poor women who can't sleep well, then how are they expected to live healthy lives? And, you know, you're doing so much amazing work with all your exercise and own your own goals. But how can you achieve your goals if you're not rested? It's really hard, isn't it? Yeah. And also, I think that the brain fog and the, I mean, my thing was my anger. You used to get these

like flashes of anger, not angry maybe, but impatience. So whereas I was always quite, I did this thing when I was a mum to like toddlers where I set my alarm earlier in the morning because I was always so stressed trying to get the kids out. And I set it half an hour earlier and it changed my whole life. That's such a good tip, isn't it? I'm really happy with the kids. But when I started going through these symptoms, I found an irritability in the morning and

an irritability and a short fuse just a, oh God, and I don't do that. I'm not that person. It's horrible. What then comes with that, it's not just the symptoms. It's a self-loathing. It's a self-doubt. It's a self-kind of, you lose yourself. You think, who am I? I'm not this person. And that's the other thing that makes me sad is that I see in partnerships, you know, sometimes the women's partners can kind of look and go, oh gosh, she's an absolute not you think, you don't understand what this is like. It's really hard for partners. You know, I have quite a few people that see me and it's their partners that have picked up because they've read something. And then I also have a quite a few number of patients who are in same sex relationships and they're often the same age. So then you've

got two men and pals or women together and that's really difficult. But, you know, I've been with my husband for a long time since I was 18 and I hated him. I could have strangled him. I could have pushed him down the stairs. I didn't care. Everything about him was annoying and I used to shout in front of the children and my my daughter, my oldest daughter who's 17 now said to me, Mommy, I remember a really big argument you had and I was there thinking, God, if they get divorced, I'm going to have to live with a mum because they always live with the mum but I don't want to live with her. It's just awful, And you know, I often think like we are beacons for our kids to look to to say, you know, it's going to be all right when we get older.

But I always think like when we go through menopause, they must be thinking that is not all right. But I mean, what's interesting for my children is, you know, we can talk about it. And all I do is talk about the menopause. So they know a lot. But now they're seeing it in their mum's friends. And in fact, one of my daughters was having a house party or whatever she does, you know, as they do in lockdown with some of her friends. And they all say, how do we get my mum?

to see your mom. It's awful because they're living with them. So they're, you know, normally if you're away, you can hide your mood a bit, can't you? But you can't when it's all day. You've got to explode at time. I think I think women that aren't on HRT feel like they can't allow themselves to do it because in some way they feel that they are going against nature's path. Yes. And I think that's an issue. It totally is. I totally agree because a lot of people say, well, I want to do it naturally. Well, I don't really know. Because actually, actually, if you think evolutionary we are designed to reproduce and then fade away and die. If you look in the Victorian times, we used to die a couple of years after our menopause.

This is the thing that really hit me the other day when you said that. And I was like, of course, we're supposed to have babies. Penipause die. And now we're living for another 40 years and I'm not going to live like that. No, absolutely. And this is why, you know, for example, a woman's risk of a heart attack increases by a factor of five after the menopause. We're protected before the menopause. because we've got estrogen in our body, and then we've got this increased risk.

So it's not actually natural. The other thing that also scares me is there's a lot of women who do try these natural alternatives, and they're labelled as menopause support or menopause this or menopause that. It's a big industry. But you look at some of these ingredients, and some of them contain something called a phytoeasterg which can stimulate the estrogen receptor, but we don't know how. There's no evidence, so it might be more dangerous than HRT. I saw a lady a while ago who had some.

menopause support thing and she said it was making a feel a bit sick so I said well what's in it she was oh I don't know it's frightfully expensive it cost me about £100 a month but my friend said I should take it before HRT so I googled it and looked it up and it actually had a bit of tissue it sounds awful but it's true I promise you it was porcine ovarian tissue so that's pork ovary and then it had bosecine pituitary tissue so perturates a gland in our in brains so it's a bit of pork a bit of beef And this woman was a vegetarian, you know, because she was so healthy. So she didn't even know. And like, why would you take that?

What's it supposed to do? What's the evidence? You know, it's, so I think if you are going to not consider HRT, and some women, I mean, less women, I think, once they're educated, say they don't want it. There are some women, clearly, have had an estrogen receptor positive cancer who wouldn't take HRT in the first line. But what's very interesting about this and we need to do more work urgently, but there's no funding for menopause research, is that estrogen used to be a treatment for breast

cancer, which is fascinating, isn't it? Yeah. So it used to be a treatment for breast cancer, and we actually know that women who have HART, some studies have shown they do better when they have had breast cancer and a given H.R.T. So it's not as simple as they've got estrogen receptor positive breast cancer, therefore they can't have estrogen. But it's scary for doctors because we don't know the answer. Is it a thing, Louise, that you're not getting funded, but is it a thing that you could go to, I work with Action Medical Research and they fund research into very rare illnesses and things, and they would possibly fund it because there is no funding into that. Yeah, it's really hard actually. And part of the problem is that all the evidence about HRT hasn't been updated for the MHRA, so the Medicine's Health Regulatory Authority, which is that all the evidence about HRT hasn't been updated for the MHRA, so the Medicine's Health Regulatory Authority, which,

which is basically run by the government. So if for me as a doctor, I prescribe HRT through my computer system, you get warnings. So if I was prescribing you something that could potentially cause blood pressure problems or whatever, it would warn me, which is all very useful when you're busy and everything else. But they haven't updated it. So if I try and prescribe you HRT, it will say risk of breast cancer, risk of clot. You're having it through the skin as a patch or whatever. So there's no risk of clot.

So it's not up to date. How can we campaign to get it up? to date. Well, we need to campaign. We are doing a little bit and I have written to them and it's very hard to get through to the right people. And the problem is also the people you get through to, they're absolutely wonderful and the medics there are wonderful, but they haven't been trained in the menopause. They don't have a menopause specialist on their advisory committee. And as you know, there was a paper that came out last year from the Lancet, a great journal. And it said that the risk of breast cancer with HRT is more than we thought. So it's more dangerous. And this study was

actually looking at lots of studies, some that had been published, some that hadn't, mainly on older types of HRT, so not the type that you are, I take. And they only focused on breast cancer. They didn't focus on death. And none of us want to die. You know, we don't really want breast cancer, but we don't want to die from it. They didn't look at that. And they didn't look at any benefits. It was all about breast cancer. And so the studies didn't really show us anything. we didn't know, but it was sensationalised to the press, but also the MHRA produced a document to all doctors and to patients saying it's more dangerous than we thought. But then when you come up with some other amazing piece of information, like what it's good for.

They haven't updated it. So they're not telling us that it reduces our risk of all these diseases. And we know even the worst type, like the old-fashioned type, if you like, that this old study was reported on, when they followed women up for 18 years, because a lot of women carried on after the study taking it because of the benefits, they found over 18 years women that carried on with HRT had a lower risk of death from all causes, including cancer. So, you know, this needs to be told to the press.

We have no study that shows that women who take HRT have a higher risk of death from breast cancer. They might be diagnosed slightly earlier, but that doesn't mean it's going to kill them. And a lot of women who have breast cancer don't die from their breast cancer. They die from heart disease. or they die from other diseases. Or, you know, I see women in my clinic who've had breast cancer before. They've had traumatic times with, you know, chemotherapy, hard treatments.

One lady said to me a few months ago, if I die with a recurrence of my breast cancer, I would be pleased because my life is awful. It's such not worth living, but I can't get any treatment. And so I gave us to M. H.R.T. Because she understood there might be a risk of it coming back. But she came back for a review, and she said, this is amazing, I'm going out.

I love my hairdresser. again, you know, this is fantastic. If I get breast cancer tomorrow, do you know what, I'm having the best time ever? And I know it's helping my bones and heart and everything else. And it's her choice because there is no study that shows that women who have had breast cancer who take HRT are going to do worse. And, you know, and even if they do, it's still their choice, you know. Louise, you fry my brain.

This is like, we have to just get this out everywhere. Absolutely. And we've talked about this before. You know, I'm not here saying that every. Every woman has to take HRT. I'm not saying that's all. What I am saying is that anything we do in life is about having a choice, isn't it? You know, the people that come on to your OIG website, they choose which exercise they do.

You're not telling them that they have to do your exercise program because that's not going to work for everyone, is it? They can choose. And we choose, you know, what car we drive. We choose who we're socialising with. We've got to choose about our health. and I feel women are being robbed. It's a bit like how I felt about birth that I wouldn't want to be able to choose where to have my baby.

Absolutely. And you don't want to be judged by that. I mean, it's interesting because you were saying that you'd had home births and I had, my first baby was a very traumatic, typical doctor, cesarean section and went against all the grains of everything I wanted, but I wanted a healthy baby. And I remember six weeks after I'd gone to a yoga class

and it was a post-native class that you rock your baby. and it's all lovely and you do some yoga poses. And they went round asking about birthing stories. And I was the only one that had been hospitalized, let alone have a section. And they were really quite hostile to me. In fact, I never went back because they judged me for my procedure, not because I've got a lovely, healthy baby who was gorgeous. And it's the same, I think, people have been judged because they're on HRT.

And so what? And it's about making the most of our lives. We all could die tomorrow. So let's make the most of what we've got, well, we've got it. have it really. So there's a lot of work out there, isn't there, to really help. Well, I just feel, I feel like I can't tell you how many women I've spoken to since our chat. I just feel like we're so misinformed. That's what's frightening about it. And I feel that if women did have all the information, it's not just about choice. It's about informed choice.

Absolutely. You can't make the right choice without the right information. Absolutely. And this is what I have found really surprising with. my work because I've not always been a menopause specialist. As you know, I've been a GP for a long time and a hospital doctor. But when I wanted to try and find out information, I found it really hard to find information that wasn't biased and also is evidence-based. You know, there's a lot of bias out there. So creating, obviously, my website, but also the app, which is, as you know, coming out today, very exciting, my app called Balance. But it's about giving women information and then they can make choices because it's not enough to be told, as my teenage children are at school, that

the menopause is when your period stop. That's all they're told. And, you know, that's the best bit about the menopause, clearly. But, you know, we are hopefully going to be menopausal for decades. We only are pregnant for nine months at a time. Some women don't have children. Most women only have two, three. So it's not, it's only a few years of your life. But you get so much help. You know, you get so much advice, so much help, so much information. It's a bit overwhelming, in fact, when you're pregnant because you don't know who to listen to, whereas you're just dumped on a scrap heap when you're menopausal. You might never see a doctor at all. And you don't always need to see a doctor. There's some great nurses, pharmacists we're doing training with.

They're the people that can really help and make a difference. And those are the people that can inform. Absolutely. The people that can kind of get the message out. But I also think the good thing about women and the good thing about the menopause is it is something that women want to share about. Yes. And it is something that once we find the app or find the website or get the information that we will share it rabidly because that is one good thing. We're very good at sharing information on social media. And I think that we are very well known for supporting each other. You know, women do support each other. But I just don't think we've had the information at our fingertips. No, I mean I, at the beginning asked you about what the conversation would have been like between us 15 years ago,

but actually I couldn't have had this conversation with you. I didn't realize how it's affecting people. I didn't even know it was related to suicide. And I've seen so many suicidal women. I've learned through speaking to women and I've also learned from my own experience how scary it is. And I think what drives me even more is knowing that it's, for me, it's morally wrong that I can get hold of the right dose, the right type of HRT because I'm a menopause special. And I'm a menopause. and there's a lot of women that can't. And I also think it's wrong that I have to work privately. I can't even work in the NHS because I can't get a job. So there's a huge amount of work, but it's not fair on women because they're missing out. And if they're missing

out on information, that's even more sad, really, because information is freely available once we get it right. And just because I'd like to share this podcast. And if they haven't listened to your other podcasts, they should. But what's the name of your app again? It's Balance. Balance. It's just called balance, yes. And it can be downloaded through the app store or Google Play. And it's free.

That's what's really important. It's free. There's no hidden costs. Amazing tool. We should all share that. Thank you. All of our friends, we've got everybody on it. Everyone.

Yes, because also we've got period tracking on it. And I was looking at my teenagers' period tracking apps, and they're pretty useless, actually. They have the same colour depending on whether you're light or heavy flow, whereas we've changed the shade. So people, what I want people to do is to try. is to track their periods and then every three months they do a menopause symptom questionnaire. And then once they start to get symptoms, so if you had the app, for example, you'd started to get

symptoms and then you'd think, oh, actually, poor sleep, tiredness. Yeah, actually, this could be something. Then you haven't wasted six months of your life by being scared and alone. You've got information and there's a community on there so you can ask other people what they thought. they can share their experiences. You can also put your treatment and you can see what reviews of treatment. So, you know, did you feel better taking your hocus, whatever?

Or did you feel better on your patch? And how did it help? So we can also collect the data anonymously for research, which would be really powerful because we can't get research other ways. But also we can really help women wherever they are, whichever country they are. Yeah, it's exciting, hopefully.

It's going to be good. So I'm really so grateful for you. Thank you so much for sharing your time. But before we finish, you're not going to be allowed to go without me asking you three take-home tips. And I think I'd really like to ask for three tips for women who are struggling and feel alone how you did that time. You know, what would you say to yourself that time before? What would you say now? Well, I mean, I didn't really go to the internet.

I didn't know where to look or how to look. but I do think that there are a lot more sites that you can go to. So inform yourself. I mean, whenever anybody makes any decision, I am so sad to hear you, Louise, had a bad connection with women who judged you for your birth because I've always said whatever choice a woman makes in birth, like whether it be caesarian, home birth, natural,

like elective cesarean, go for it. Like if you want to do that, then you should have the birth that you want. And it's the same with the menopause. Like you said, if you want to go the natural route and you really feel that this is for how the body's meant, then by all means do that. But do it informed. Do it because you know that there are risks possibly for other illnesses in your future, but you've chosen to take that on board because you need to know this information. So inform yourself is like the biggest, most powerful tool I can connect any person with.

Due diligence, I always call it. I'm going to go and do my due diligence. Very good. So I do a lot of that. And I do due diligence a lot on everything. If I read a tweet by somebody and I think that's good tweet, I will go and do due diligence on that person before I tweet it. Or I want to know who they are, how good are they what they do, how long have they been doing it, but everything. So that's the first one. The second one, I would say, is exercise, obviously. Yes, love it. You know, my mental health is bolstered all the time with exercise. And I just find enormous support as well from communities. So, I mean, obviously on Own Your Goals, there's like an amazing community of all the people that are on Own Your Goals. They all come together and they all sort of support each other on the Facebook page. It's really nice. And that is also a very safe place to come with anything menopause or anything hormonal or periods or anything girly. It's a very girl-heavy community. So that's a really nice, safe place to come.

But find a community. And I mean, you don't have to come to my work at website. You can go to do classes even, you know, on Zoom or something like that. But come together as women. And I always say, like, women helping each other, there's no comparison. Like, there is nothing more powerful than women coming together to help each other. It's just like a, it's something I feel sad that I don't feel like men have that. I feel so blessed that we do.

No, absolutely. So find a community in exercise. And thirdly, I would say, and this is a really, really difficult one, but I always feel that judgment is a reflection on how I feel in myself. If I'm judging other people, if I sit there and I go, oh my God, look at her shoes. Oh, God, who'd wear those? Or if I'm going, oh my God, her hair looks terrible, I'm in a bad place. I think there's something going on with me. judgment, we've all been a victim of it and we've all done it. But when I'm doing it, it makes me feel really toxic. Yeah. That's so important. And I think women are very critical of themselves. And they can be very critical of others. And, you know, I spend a lot of time trying

to mother my children because it's so difficult, as you know, having children. And, you know, I have to say, would you want to be judged like that? There's a reason. And everyone's got a story. and you don't know that. I'm very privileged being a doctor because I've been told all sorts of stories that you would not believe when you see these people. You never know.

Never put bites cover. Absolutely not. And the older you get, the more you realize there's good in everyone. And we just need to help and build on strengths and push the weaknesses down. So I think it is a really key take-home message

is really powerful. And I really hope people that have listened to this podcast will just feel stronger and better women for doing it. So I'm really grateful for you spending some time doing this. Thanks. I think you're amazing. Thank you for having me. For more information about the menopause, please visit our website www.combeauter.com.