The Dr Louise Newson Podcast - 071 - Women’s Health Magazine - Claire Sanderson & Dr Louise Newson

Episode Date: October 27, 2020

In this episode, Dr Louise Newson talks to Claire Sanderson, the editor-in-chief for Women's Health magazine. Claire talks openly about her mental health and the struggles she has faced in the past in the past. She also talks with Dr Newson about the perimenopause and how so many women are incorrectly offered or given antidepressants for their low mood - a symptom that usually occurs as a result of changing hormone levels.  Dr Newson and Claire discuss how HRT can be beneficial for so many women and they also explore the benefits of regular exercise and nutrition. Claire talks about ways that celebrities can help to empower women with knowledge about their perimenopause and menopause and give them confidence that taking HRT is not something to be scared of. Together, they also talk about sexuality and body confidence issues related to low hormone levels.  Claire Sanderson's Three Take Home Tips: Find evidence-based information, such as that on menopausedoctor.co.uk, and take it to your doctor. You can demand the right treatment, don't be deterred. Look at your health generally, the changes you make now can benefit you for the rest of your life. Do you need help managing your weight, sleep etc? Put yourself first, preserve your armour so you're ready for battle! Speak to your friends and the women around you. Lean on your squad and be open and honest - others around you may be struggling too and you can help each other. Find Claire on Instagram: @clairesanderson Twitter: @c_l_sanderson www.womenshealthmag.com

Welcome to the Newsome Health Menopause podcast. I'm Dr Louise Newsome, a GP and menopause specialist, and I'm also the founder of the Menopause charity. In addition, I run the Newsome Health Menopause and Well-Being Clinic here in Stratford-upon-Avon. So today with me, I have Claire Sunderson, who is the editor-in-chief of Women's Health. And we first met at a Department of Health meeting, probably about 18 months ago, I think, Claire, didn't we? Yes, maybe a bit longer time-plines. Yeah, so it was a meeting that we went to to talk about the impact of menopause, especially in the workplace with Dame Sally Davis, who was then the chief medical officer. And I was really encouraged to see someone who was a journalist

who'd worked in women's health for a long time coming. And Claire's young, she's vibrant, she's had the most amazing career already, but she was really engaging with everything that we were saying. and we had a really good chat afterwards and since then we've sort of liaise quite a lot really and we both feel frustrated in different ways but also there's a big overlap in our frustration because we hear so many women who are suffering because of their hormones. So welcome to the podcast. Thank you.

So just tell me a bit about how you got into women's health and your sort of journey so far if that's all right. Thank you for having me today. Yeah, so I'm the editor-in-chief of Women's Health, and Women's Health is much more than just a magazine. It's the biggest wellness publishing brand in the UK, part of a global network of women's health, actually. So we have some leverage in terms of getting the right message across for our engaged audience. In the UK, I'm in charge of every aspect of the brand, the strategy and the direction. So that's the website, the social channels, the events, the magazine. and also I deal a lot with the commercial side of the business as well.

My background is that I'm a news journalist. I'm a trained news journalist and I started off in national newspapers and I remained in newspapers for seven, eight years and I then struggled a lot with my mental health. And if anyone was to Google me, I've been very honest about struggles I've had with depression and anxiety. And in my mid-20s, I ended up going into hospital twice for 11 weeks in total. in total. And it was at that time that I looked at my lifestyle working on newspapers,

which is hugely competitive, not very healthy. It was at a time when maybe the ethics within newspapers and not as scrupulous as they are now. So I certainly felt that my own personal beliefs were being compromised somewhat and it wasn't benefited by mental health. So I left to go into magazines in my mid-20s and I've been there ever since. So I'm not qualified in any aspect of health. I was employed to run woman's health because I have 20 plus years experience in national publishing under my belt, but I am genuinely and always have been obsessed with health and fitness. I used to be in competitive sport. I've trained all my adult life. So women's health is the sweet spot for me that it combines my passion with my long experience in journalism.

Amazing. And you've got two children as well. Yes. So anyone who's trying to juggle work and children and families and partners, it's hard, isn't it? And then you throw hormones into the mix. It's even harder, actually, which no one prepares us for. And there's been so much, hasn't there, about mental health awareness. And certainly when I was a medical student, even the word depression, everyone just thought it meant that you had a bad day, didn't really think about clinical depression. Whereas now, thankfully, we can talk about it.

And it's fantastic that you say, you know, you have been really open about your horrendous experience. and I'm sure you wouldn't want anyone to go through what you've been through. But then the menopause is still a taboo and we've talked a lot, haven't we, about the perimenopause, which is something that I'm sure a lot of people who engage with your platforms probably don't even know about. I don't know what your feeling is. Well, absolutely. So Louise, when you and I first met, I recently started experiencing perimenopausal symptoms. And I had no idea what was going on.

I'd never even heard the phrase perimenopause six months earlier. And it was only after going out for dinner with a doctor friend of mine and explaining my symptoms, which are textbook I now know. So really sore breasts. I remember saying it's almost like I'm pregnant again, even though I knew I couldn't be because my husband's out of vasectomy, you know, would be an immaculate conception. But my breasts were swollen and really, really painful and, you know, painful to even jump up down. My mood was much more up and down than it had been in years to the point where I was

considering going on antidepressants again. Irritability, lack of patience. I was having the hot flushes. My hands would get really hot and I was waking up and the bed would be soaking wet, you know, with sweat. But I never thought that someone at my age, which was around 40 at the time, maybe 39, could possibly be experiencing menopausal symptoms. until a friend of mine, as I say, who's an anaesthetist, by the way, but she was familiar with the symptoms because she's a little bit older than me and she said I'm going through the same. And it's only then that I became familiar with the phrase. And I realise that I have a duty heading up a brand like Women's Health, which is so much more than a fitness and nutrition brand, by the way. We cover women's health holistically.

It's one of my brand strategies to cover the type of topics that you don't see widely reported elsewhere. So we've done investigations into the mesh scandal, for instance, and endometriosis and even heart health for women, which no one talks about. They think it's something that's, you know, throw away to older men. So we were covering all that, but the menopause is not something that we'd ever really thought about doing. And certainly not the perimenopause. And you're right, the demographic of women's health, the median age is 37 in Prince, sways a bit younger in digital. So their prime age to be clued up about this. And it's only when I started doing a bit of researched myself and I read awful stats about the shocking number of women who are being misdiagnosed

with depression and given antidepressants when actually what they have is perimenopausal symptoms. But as you know, Louise, I come from a family where there's a lot of breast cancer. My mother had breast cancer in her 40s. Her cousins did, her sister. There's an awful lot of breast cancer in the family. So I was under the impression that I couldn't take HRT and I was even told that by my GP that it's not advisable for me to take. K-K-HRT, much like I'd been told in my 30s not to stay on the pill consistently for the same reason, which again is mis- messaging. Because only when I spoke to you and I went along to the Women's Health Task Force,

because I was part of the task force for over a period of, like, a year. And it's only sitting there, listening to the likes of you, the other experts in the room, that I realised the misinformation about HRT. And I remember Leslie Reagan, who is from the Royal College of Gynaecologist and an obstetrician. She was the president. And she said to me, the misinformation about HRT is the biggest injustice to women's health issues of our generation. So it's then that I really took it upon myself to increase in the velocity of content that we do across all the platforms about the menopause and peri menopause. Yeah.

And it's so important, isn't it? So for those of you who don't know who are listening, perimenopause, peri just means around the time of menopause is obviously when periods stop. But peri menopause is when people still have periods, but they often change in nature. or frequency, but they start to experience symptoms. And symptoms, like you say, can be the classic flushest sweats, but they often are the psychological symptoms. So they're the low mood, anxiety, just feeling, some people feel this impending doom, brain fog, memory problems, concentration, just this overwhelming fatigue. And often people find they get worse just before their periods.

And it can be almost like an extension of PMS. A lot of women experience PMS, but it's only a day before their periods. They feel a bit flat. And then they feel. better and that's classically because the estrogen level is dropping, but because you're going from a slightly lower level all the time and then it drops, if people feel worse and it can last for longer. And so many women I speak to, and I'm sure people you engage with too, Claire, just think it's because they're busy because they've got children because they're jobs, you know, they're pulled in all directions. And I was the same when I had symptoms because you expect to be tired, you expect to be a bit stressed. And if you've got a history of depression or any mental

illness, then you're always going to be thinking, what is it that? And, you know, for someone like yourself who had a horrendous time when you were younger, it's very scary when you get these symptoms, because the last thing you want to do is have to go back and end up in hospital. But you say a lot of women, we did a study of 3,000 women and 70% had been offered or given antidepressants for their low mood associated with their perimenopause or menopause. And actually antidepressants won't work. They don't treat the underlying cause. And a lot of women actually say they don't feel any better, but they've got nothing else to take. So actually, it's really important with anything we do in medicine is looking at the underlying cause. But like you say, this isn't just about

symptoms. It's about our future health. And, you know, women's health would not have been a thing 100 years ago because we died in our 50s on average. So we didn't really have to invest in the same way that maybe we do now because the average age of death in the UK for women is 82. So actually all the work that you're doing now to improve women's health for people that engage with you who are in their 30s is an investment for their future, isn't it? It's not just about here and now, I want to feel good today. It's about our future decades, isn't it? Which is really important. Yeah. What I find interesting is the attitude towards taking HRT, certainly amongst extended family members of mine and I've spoken to staff who work for me and they've said that because

people have worked for me slightly younger, they've said that their mum or their aunties feel that taking HRT is a bit of a failure and that they should be able to tolerate and get through the menopause naturally. But I know that you've said before, Louise, there's nothing natural about not having hormones because we're meant to have them. And it's a huge challenge and it's why you're doing great work and I'm hoping that women's health can contribute as well to change this perception. Absolutely. And in fact, my practice manager this morning from the clinic just said to me, someone phoned up yesterday to cancel her appointment because she said, oh, I don't want to have these medicines pumped inside me. So I'm going to cancel the clinic.

I don't want HRT. And my practice manager said, but you had estrogen in your 20s and 30s. It's not unnatural. All you're doing is replacing. And she said, oh, gosh, I hadn't thought of it like that. And I think this is the problem. And I think when I first met you, well, in fact, just, before then, I had, I always think about how can I engage with more women and different women as well. So it's not just women who I would see in my clinical practice. It's women who are neglected, women who are disadvantaged, women from different ethnic groups. And wherever you look, you know, women who have cancer, women with HIV, wherever you look, there are groups of women suffering more, but there are a lot of women who are suffering anyway, and it's all needlessly suffering. And

I've always thought, well, actually, let me, as well as doing my medical work and being evidence-based in my practice, I want to engage with as many journalists as possible because journalists have been fed wrong information for years. And women have been fed wrong information. And sadly, healthcare professionals have also been fed wrong information. So let's just try and change that. And so, but it is the perception about what hormones do. And, you know, if someone has an underactive thyroid gland, of course you would give them thyroxin. If they were iron deficient, you would give them iron. So we're estrogen deficient and we start this deficiency when we're perimenopausal and it will carry on whether we have symptoms or not until the day we die. And it's not natural. Our bodies aren't

designed to live without the hormones because we are, if you like, designed to die just after our menopause, which is what we used to do. So it is completely changing that perception and it's very hard. And I know every time someone writes something about HRT, there's always breast cancer in the same sentence. And for a lot of women taking HHT, there's no risk. In fact, for a lot of women, actually, the risk reduces. So it's hard, isn't it? And I don't know whether you've got any sort of good ideas or strategies going forward to how to really empower women with the right information, because that's all we're trying to do really, isn't it, so they can make the right choices. So I mentioned my mother had breast cancer in her 40s, and she was very anti-me going on HRT,

and I wouldn't do it, I wouldn't do it. But what my mother fails to, acknowledge is that she chain smoked from the age of 12. You know, she's getting 12. This is the South Wales valleys, you know, until her mid-60s when she gave up because she had pneumonia and was told, you carry on, you're going to die. But she, you know, she chained smoked. She didn't do any exercise. She had a very beige diet, you know, sort of deep-fried everything, bread.

And when I tried to explain to her, they are far more significant contributory factors to developing cancer, then taking HRT, she won't listen to me. And then obviously we're from a big family, she's one of five. So that messaging then permeates around the family. And I think what is happening in the last 12 months, 18 months, where more and more celebrities are coming out and saying they're on HRT, and we're seeing this groundswell of well-known women who are owning, ageing. It's no longer something to be embarrassed about, you know,

it's something to be proud of. Look at DeVina McCall. She's on our cover at the moment, and she's 52, and I've met her being several times. I know you have, and she just... She's fantastic. She is, and she owns her sexuality. She has confidence emanating out of every poor, and she's very vocal about the fact that she takes HRT. And I think that means so much because women do look up to these women.

There's plenty of well-known celebrities who are in their 40s and 50s who are coming out. and saying openly I take HRT. I'm 42. I say it openly that I take it after being prescribed it by you. So hopefully I can do my bit as well. But what we need is more and more high profile women and women within their own social groups speaking to their friends and telling their friends that they're taking it. Yeah, it's absolutely right. And it's normalising it isn't it? And I think certainly Davina's quite open on a podcast I did with her about how she was told off for talking about her taking HRT because there's all this ageism as well. And as you know, many young women experience menopause and perimenopause. But even some of my medical professional colleagues have told me off because I take HRT and I've taken it since my mid-40s. And they said, but why are you telling people that's really private information? Well, it's not private to me when I was pregnant.

I told people I was pregnant. I get migraines. I tell people I have migraines. Actually, it's up to them if they choose to do with that information. But I think it's about making it normalised. And it's also about trying to. to think about our future health, as you say, but it's really our heart health, our bone health, our brain health. And it's a combination of things. So for those people taking HRT, they still have

to look at their diet, their exercise, their well-being, people who don't take HRT, it's essential they look at their heart, their bone, their brain. So it's not just about hormones, but hormones can often help, clearly, but it's about exercise. And I know you're amazing with your exercise, but different people actually want different exercises, don't they? And I'm sure you agree. There's not really a one-size-fits-all is there for exercise. Oh, absolutely not. The simple message is move more and you will feel better and move more outside, if you can, because fresh air does wonders for your immune system and your mood and reduction of cortisol. And I love nothing more than, you know, thrashing myself in a really intense hit class. But that's me. And I'm really.

anomaly but you know just going through a nice walk or I bought a bike recently 200 pounds second hand and it's wonderful just just going out on bike rides I'm not breaking land speed records you know went out on Sunday and my mood was noticeably better when I come back and I had to be encouraged to go because I was feeling a bit down and a bit miserable as you know I'm trying to work out the dosage of my HRT at the moment and my mood is a bit fluctuating but my husband encouraged me to go and I felt so much better when I come back. So that's my message to anyone. Even if you don't feel like doing it,

you will feel better afterwards. Absolutely. And it doesn't have to be a full hour, hour and a half workout. Sometimes 10 minutes is enough. And as you know, I do quite a lot of yoga. And at the weekend,

my older daughter was back from school and my youngest daughter, who's now and we just took some mats out to the garden and did some yoga. But after 10 minutes, my 9-year-old had enough. But that's fine. And there is something. And it's also about doing it with other people,

actually. I do yoga on my own, but I also, I have someone that comes to my clinic and there's three of us that do a class with James Critchlow. And I've known him for years. But actually, just to have someone else there is really powerful. Because we're also screen focused, aren't we, at the moment? And there's some amazing classes, obviously, online, but sometimes doing something. And even if it's going for a cycle with someone or going for a walk. And I certainly find even when I walk with my children, we have a different conversation to when we're inside. And I don't know. why it's a bit like being in the car, you've got their attention a bit more. And meeting friends for walks is really good, isn't it? Yeah, well, on Saturday, a friend of mine said, should we go for coffee? And I said, yeah, let's get a coffee and walk. And it was an hour. And we got through so much because it was a more engaged conversation. You know, we chat about our kids and her unhealthy husband, you know, as you do, you know, she's fed up with him. But we, it was lovely. It was sunny. And it really boosted my mood for that day. And you don't have to spend money on exercise and working out either there's so much free content online on YouTube on YouTube on YouTube, or I'm a big fan

of Joe Wicks, if you go on his YouTube channel, there's short workouts that you can do in your living room. You don't need any equipment at all. You know, you don't even need a mat if you're on carpet, just, and there's more so than ever as a result of lockdown, you can get an abundance or fitness content online. So there's no excuse really, apart from your own resistance, which I feel if you can get over that hurdle, it will benefit you enormously.

And benefit your family. I'm a great believer that our families are so influenced by us as the mums of the family. Oh, I totally agree. You know, when my mood's down, the whole family get down, and it's really difficult, and you know that it's you.

And I know, certainly when I was experiencing perimenopals or symptoms, I was very irritable. I had this sort of demon inside me just saying, you can shout. It doesn't matter. You can hate your children, you can hate your husband, you tell them, and don't worry about it. And it's horrid.

I was really, really vile. And actually, when you were talking earlier about sexuality, I was going to pick up with you because there's a study that came out yesterday, actually, looking at sex in menopausal women, and they were saying 25% of women actually still want to have sex. And they were surprised. So a few journalists got in touch with me yesterday for my comment. And they were actually saying, gosh, 25%, that's far more than we thought, who want to. to have sex. And I was actually reflected on this and I thought actually that's really sad.

It's only 25%. And the journalist was saying, gosh, that's a lot. And I thought, gosh, if we said 25% of men were interested in sex over the age of 50, my goodness, everyone would say, why isn't 100% of men? But this was really weird. And I wrote a piece for the mail, which is in the paper today, actually, and really saying why there's a lot more women who want to have sex but actually can't because of their symptoms because of sometimes their physical symptoms, sometimes their psychological symptoms, and often libido itself is reduced because of low estrogen and also often low testosterone. So actually this number, I'm surprised it's as low as it is. But I thought, gosh, how sad really as a nation that we are as women not expected to enjoy sex. And I'm not even

talking about penetrative sex. Actually, it's about a sexual relationship or a relationship with another person, be it a man or woman. It's almost, why would women, as they age, want to explore their bodies and have any sex? And I don't know whether that was something you picked up on or whether that's something that you talk about. Because obviously talking about sex in younger women is obviously a lot more easier and it's a lot more open. But it's so important, isn't it? Well, we do a lot of sex content. And by sex content, I mean, we have a feature coming out in the next issue about questions the sex therapist gets asked and then a sex therapist answered.

We have one in the issue that's about to go on. So this week actually about how when women take antidepressants, they lose their orgasms and why it shouldn't be a choice. And so we do a lot of sex content. But the fact that you said that 25% is terribly low. And I think it's another example of sort of this ingrained misogyny in wellness and healthcare for women. I think a lot of that would come down from women who lack confidence.

when they get into their 40s. We did a survey last year for our Project Body Love campaign, which was a campaign to improve women's body confidence. And what research has found is that women who have low body confidence tend to have low self-esteem and therefore don't put themselves forward for work promotions, but also shy away from relationships with their partners. So we did a campaign last year and we did a big survey. And what came back is that the most body-confident age of women

is 55 plus and it's women in their 40s who are in the, you know, the battleground ears of the menopause are the ones who have the worst body confidence matched by the 18 to 25 year olds, but they have low body confidence largely because of comparison culture on social media and their love eyes. So it's quite different. Yeah. And I'm sure the 40-year-olds, you know, you have the average age of the menopause is 51, as you know, so the average age of the perimenopause is mid-40.

although obviously a lot of women still go through it earlier. But this is a time when emotionally you're changing physically, you're changing a lot of women find they put on weight because of the low hormone levels that occur. They have reduced muscle tone. They have this thing called sarcopenia where there's a reduction in bone density but also muscle mass as well. Plus skin changes.

You know, you lose collagen in your skin. So people find that their skin becomes drier, their hair changes. It often can become drier and more brittle as well. So there's no surprise that you are just thinking, well, your body is not what it used to be. And there are so many women say to me, look, I'm exercising the same, I'm eating the same, but I'm putting on weight. And actually a lot of it is because they're not sleeping well, and we know poor sleep increases weight. And their metabolism changes because of the low hormones.

And I think probably, like you say, when you're in your 50s, you think, well, this is it. This is my life. So I might as well get on with it. And hopefully a lot of women who've had their hormones replaced. have been given some holistic menopause care and treatment feel better. And it's a really liberating time, actually, when your menopause are because you know you can't get pregnant. And a lot of people might have a bit more freedom because their children aren't at home, maybe, or the jobs just changed.

So maybe they're seeing a bit more of their partner as well. So it's really sad, actually, that 75% of women are not wanting sex. And that's what the article should be about, not 25% are. Absolutely. Was it a male journalist? No, it's actually female. It was female journalists. One of them was completely gets it. The other one I spoke to yesterday was quite young. And I was talking to how it's not just about libido actually. And women, for men, it can often be a hormone related if they've got low testosterone. Their libido will often go. But for women, it's not an on-off switch. We have to feel positive about ourselves. We have to feel good in general before even thinking about holding our partner's hand, let alone having a sexual relationship. And women are far more complicated, but we can't be ignored just because we're menopausal. And I think that's happened for so long. And I've said a few times about how young women experience the perimenopause and menopause. And a lot of women say to me what I've been told I'm too young, Rich Rte. And a lady I saw in my clinic yesterday is, well, she's now 35, but she was diagnosed with cancer of the cervix five years ago.

So she had horrendous time, mutilating surgery because everything was removed. And she had radiotherapy, chemotherapy. So she's got a lot of scar tissue around her vagina, of oval area. She can't have penishes to sex because there's so much scarring. But no one would give her HRT. And she said, I've battled through cancer. I've now five years after cancer and I should be doing well, but it's so hard. Every day is a struggle. And it's wrong. You know, so we need to change the images also, I think, of the menopause, because a lot of sites, when you Google them, it's Greyhead, in running down the beach with their children. And, you know, my youngest patient's 18. And she was floored into the menopause again after a cancer. She had a cancer on her thigh.

And, you know, she's nowhere near being grey hair. She's got a whole life ahead of her. But people have refused giving her HRT or the right doses of HRT. And we need to change. And I think a lot of the work you're doing by pushing out other people who have similar stories that people can relate to, is going to, people are going to recognise with, aren't they? And a lot of times people say, gosh, that was me, I had no idea. But they wouldn't know otherwise.

And so changing the, almost the demographics of the menopause is what we need to do as well. Yes, absolutely. I'm going to write a piece for women's self about the fact that I take it, but talk about the fact that there's a lot of breast cancer in my family as well, because I think that's the,

I know we touched upon it already, but I think some people struggle to get their head round, that A, I started taking HRT when I was 40. B, I do so even though my mother's had breast cancer in her 40s. And C, I'm not a great head woman running down the beach. I'm in really good shape. I train all the time. I'm very strong. I'm stronger than a lot of men, you know, so I completely contradict a lot of the common health images of menopausal women. Yes, which is really important. And for those listening who do have a family history of breast cancer, the evidence is very clear. that those women will not increase their risk of breast cancer if they take HRT,

and certainly when they're young, because you're just replacing the hormones and your risk because of your family might be slightly higher, but taking HRT won't make any difference. And in fact, as you quite rightly said earlier, your risk is probably lower because your lifestyle is so good. If you weren't taking HRT, you might end up like your mother was smoking, being overweight, during, you know, whatever, because it's so hard to be motivated to exercise. and to eat well and to sleep well when you haven't got those hormones. So we need to think about the bigger picture. Breast cancer is not about hormones. And the commonest risk factor actually for

breast cancer now is obesity and for all cancers. So it's overtaken smoking. So ways of reducing obesity and especially in view of COVID, because we know people who are obese, they're more likely to die from COVID. It's really key. Whatever your hormones are is looking at your weight and, you know, having a good nutrition plan because food's good we need to enjoy our food but we need to eat and a lot of people need to eat in a different way isn't they and I know that's something that you obviously write a lot about because it's so important. Well absolutely there's a phrase you can't out-train a bad diet so if you want to reduce your weight it is 90% nutrition and it is only 10% fitness I'm afraid people think that if you're going to kill yourself in

you know high energy class it's and burn 450 calories in an hour, fine, but you could eat 450 calories in 10 minutes and not even realize it if you're eating the wrong type of food and your portion control is not what it should be. So some people track their calories. That's a really effective way to lose weight, but some people find that too controlling. So if you go online, you can check your portions by using your palm.

So you should eat a palm-sized portion of protein with every meal, sort of a cap size your hand of carbohydrates, so vegetables. And I don't mean refined carbs like white bread. I mean potatoes, sweet potatoes, vegetables, etc. And then a thumb of good fats. So people try and avoid eating fat and actually good fats are really, really important. It encourages your body to metabolize food properly, reduces, it stops your body from storing food as fat. So it manages the glucose spike so, you know, it's not stored as sugar, etc. So it's really important. So good fats are avocado, nuts, olive oil, nut butters. So you must have fat in your diet if you want to metabolize your food properly to lose weight. But a good nutrition is absolutely key for mind and body.

Absolutely. For me, I do struggle with what I would, I live with what I would describe low level depression and sometimes it reads his ugly head, probably about twice a year and then I end up in bed for a couple of days and then I get back on an even keel. But for me, if I go off track a bit and consistently eat bad food, and to be fair, I don't ever eat bad food, I'm vegan for a start, but I can, if I overeat things like, you know, a jar of nut butter, which I love, it is my nemesis, you know, or if I have a few drinks and, you know, it affects my mood dramatically. So if you're someone who is eating refined sugars and saturated fat and stuff, that's really, really bad for your mood and ultimately your waste as well and your weight.

Absolutely. And a lot of it's linked with our gut health as well. And I've done a couple of podcasts with Emma Ellis Flint, our nutritionists about this. And it's really important to look at what we're eating. And it's not just about calories because I could eat, you know, like you say, 450 calories of McDonald's or 450 calories of nuts. And it's going to have completely different effects in my body. So we have to be really careful. So there's a lot to think about and there's a lot we need to do to invest for our future health. And the work you're doing is incredible and will really help so many women. So I'm really grateful, Claire, for your time today. So before we leave, though, in my usual way, I'd just like to ask for

three take-home tips. So for women who are perimenopausal who might be struggling, what ways would you recommend for them to try and get the right help and treatment? First and foremost, use you, Louise, use the information that you put out on your website, on your Instagram, and then take that information to your doctor and insist that you deserve HRT. And don't be deterred. I was initially, even someone in my position who has access to world leaders and experts in their field. it took me, I went on a journey before I finally was able to persuade my doctor's giving me a repeat prescription of HRT.

Secondly, look at your health generally because the changes you make now will make a difference in the future. So, you know, if you need to manage your weight, now's a good time to do it. Manage your sleep. So putting yourself first. As women, we are notorious for putting everyone before ourselves. We'll put our family, our husbands, the shopping, the cleaning, and then we come so far down the pecking order. But actually, if you put yourself first and preserve your armour, then you are much more prepared to go into battle and face the world and succeed as being a homemaker, a wife, a manager, whatever is you do in your life.

And speak to your friends about it. I think you'd be surprised, like I did, that others might be struggling as well. So lean on your squad, you know, lean on your girlfriends and be open and honest about it because somebody else might be struggling and you can help each other. That's brilliant. I love this. Preserve your armour. I think that's so important. We need to keep armour for as long as we live. And anyways, to preserve mine would be gratefully with me. Oh, thanks, Claire. It's been really useful. And I know this will help so many women going forward. So thank you. Great. Thank you so much for having me. For more information about the perimenopause and menopause, you can go to my website, menopause.com, UK, or you can download our free app called Balance, available through the App Store and Google Play.