The Dr Louise Newson Podcast - 079 - Media & the Menopause - Nadia Sawalha & Dr Louise Newson

Episode Date: December 21, 2020

In this episode, Dr Louise Newson is joined by Nadia Sawalha. Nadia is a well-known British actress and TV presenter and has been part of Loose Women from the outset. While talking to Dr Newson, Nadia is very open and candid about her menopause experience and how frightened she was. She talks about how she has always been a very positive and outgoing person and found herself becoming very negative and argumentative. She has had some very dark thoughts which, understandably, were very scary to her.  Nadia talks to Dr Newson about how little she knew about menopause in the past and how important it is that women have access to evidence-based information and treatment. Nadia is determined to talk more openly going forwards to educate more women about the symptoms and also the numerous health risks associated with low hormone levels.  Nadia Sawalha's Three Take Home Tips: As women we have to talk about it, share information and be open to changing our minds about the menopause and HRT. Spread positive messages and don't be judgemental about the choices of other women. We need to challenge the myths and negativity surrounding the menopause and HRT.   

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 I'm absolutely delighted and thrilled and also honoured to have with me Nadia Suala from, well, she's known, she tells me, as Nadia from the... the telly so she can introduce who she is. That is what people call me. My husband started this joke because we've got a YouTube channel and we're on Instagram a lot and it's Nadia off the telly and that's become the way that people describe me now. So I'm Nadia off the telly that seats me by. So welcome Nadia off the telly. And you were saying which makes me feel very old, I'm always feeling old, but that you've been on loose women for 20 years. That's quite something. 20 years. The very, very first episode was myself.

Jane Moore, Kay Adams and Karen Brady. Wow. We were the first cousin. We all had bouncy boobs then. When we looked back on that first episode and we were coming out and we were just like young and foolish and knew nothing of the menopause. No, gosh. So how things have changed. Yeah.

So we, well, we've only recently connected really, but I've had you on my radar for a while, which is what I said. And I often have people on my radar because I look at them or read about them and hear about them struggling. and I think what's shame because we know there's some very effective, cost effective, but also effective for health treatment available. So I've got you under my snare and I've nice to invite you here. So you've no escaping. So this is really interesting. Let's go back in times.

20 years ago, if you had been told, look, in 20 years time, Madia, you're going to be talking to a menopause specialist about the menopause. What would you have said to yourself then? Well, I would have said, why on earth would I talk about something that just means my period stop because that's all that I knew about it. And I can't remember anybody ever talking to me about the menopause. And my mom is very, you know, she's a war baby, you know, she slept every night in the air raid shelter on her own in the garden because her mom didn't like it. So she was on her own. So she's stoic, you know, and everything is, well, I hardly noticed it. You know,

I didn't get the flushes. I didn't get the hot flushes. So therefore, I grew up, I suppose, thinking that you get hot flushes and that's the terrible thing about the menopause and you lose your collagen and you look old. So those were the sort of the two things that I knew about it. And so it was a terrible shock when it crept up on me. Yeah. Yes. Those two words don't really align really shock and crept up to me. But I would say I was in a persistent state of shock for a couple of years. I had huge symptoms. But because they weren't me sweating, I didn't really know it was the menopause. Which we hear so often, don't we?

I mean, certainly I hear my clinic all the time, but even more now people are talking about their stories. And because it comes on gradually, we don't always know what's happening. And we always put it down to other things, don't we, what's going on in our life? And also, like you say, we're not prepared for it. We think it's something that old people get. And it just causes fear to start one day, and then the next day you'll carry on. And we also listen a lot, don't we, to people who say they've battled through their symptoms or they've come out the other side.

And so you feel it's almost a bit of a failure if you admit that maybe you need some help. I don't like taking pills and antibiotics. And as much as I can, I try it after being a crazy drinker, mad party for years. I try very much to just heal myself with good food and exercise and meditation and all these things. So, yeah, there was a sense.

I read a lot of books and there was a sense that, You know, it's the circle of life, you know, and I'm coming around to my circle and I'm going to find myself. And this was when I was desperately, desperately worried that I had Alzheimer's because my memory just became so awful that I went to such a dark place with it. I was so scared. So I was looking for something to pin this on. And so I did very much look at all the ideologies around the fact that when you get into. menopause, this is your time of life. And actually you need to reduce what you're doing a bit. You've over-schedulized. You've got too many things to remember. There's too much going on.

This is why your memory is fading. I was just desperate that it wasn't outsiders. I mean, to this day, I still worry I've got Alzheimer's. I think about it every single day. Do you? Every single day. Every single day. Yeah, it can make me emotional just thinking about it. Oh, gosh. And do you know people who have not outside? Is there people in your family? No, nobody. But it's like whenever I talk to anyone about the thought that I've got Alzheimer's, so you couldn't be less like how you haven't got Alzheimer's. But it's just this blank out that I've got the fogginess.

And I can track it back to everything else that came in when I was obviously having my menopause and I didn't know I was having my menopause. But the first thing that came was brain fog, not being able to remember. Then came a depression. Then a dark, just a dark, dark, dark, dark. place and I've always been somebody that can go to a dark place, but I'm naturally quite sunny. I'm a person that irritates everybody because I wake up singing, good morning, good morning. And I was like, oh, God, really? And I mean, that's right from when I was young. I'm a

cut path full sort of person. And in fact, I infuriate everyone I live with because something bad will happen. And I say, well, I suppose it's good because we've got, and I'm very much that. And I couldn't, I've lost that. I wasn't being able to do that and I wasn't being able to share that to anyone because I think part of my identity, if you like, on telly was oh, Bubbly Nadia. Oh, Nadia's always happy. People are always there to me. How come you're always so happy? I mean, of course, when I go on telly, I'm showing my very best self. I'm a miserable cow sometimes at home, you know, and I want to come home and kick girls and do whatever. So I am always showing my best side. Of course I am. That doesn't mean it's a fake side, but I'm showing my best side. And I was finding it harder and harder to tap into that. happy place that I've always been able to do. And so I started to lose, I started to question absolutely everything about myself. That's what I would say. Because I couldn't grasp myself. I started to really worry that everything that I was hadn't been real. Yes. It's a strangest thing. It's very scary because the hormones, estrogen, but also testosterone are really important for our brain function and we know that there's some really interesting pictures actually of scans of women

before and after the menopause and the activity in brains reduces by about a third after the menopause because hormones are so important in our brains yet we don't realise that until we haven't got them and you know you can see why so many women are misdiagnosed with depression and a lot of women tell me how scared they are of these very intrusive thoughts that they can't push out like the devil's got in there and starts to say to you do you know what the reason you can't be happy is because everything about you. And I was literally, like, I often talk on my social media about all these voices that come in my head. Like, nobody's ever been as nasty to me as me. And I've, through life, been able to balance those a bit. I've had therapy, but also, but when I went

into menopause, those dark thoughts were just overwhelming any positivity, really. And it was very scary. And I didn't want to tell my husband, because I am the, like, strong, happy one. And poor Mark, he didn't know whether he was coming or going. He says, It's the only time in our marriage where he thought we wouldn't make it. Gosh, that's scary, isn't it? Yeah, it's because of my race. It really has such an impact on partners. And often people, like you say, are scared to even admit to their partners how they're feeling because it's so out of character to how they've ever been before.

It's a bit like, I don't know whether you used to get premencial tension, but I used to terribly. And now it's interesting watching my girls have premenstrued tension and finally understanding what it must have been like for my husband. You know, so I would be like raging when I was premencial. Go on, get it out. I'll be slamming the door. I'd open the door and slam it five more times as he was going out and getting into his car, you know, because it just, and he'd be like, oh my God, you're premenstru. I am not.

This isn't because the rest of the month I have to suppress what I'm feeling. And the hormones are allowing me to express. And now I realize I was premenstrual looking back. But in my menopause or perimenopause, these rages were coming out of nowhere. Yes. with no warning. And I found that very, very scary and I did think I was losing my mind because I'm not somebody that would ever at work or anything like that ever lose my rag. But I remember twice losing my rag at work, which I would never have done. I mean, thankfully with very good friends,

so it was fine. And then I thought, oh my gosh, something really bad is happening in my brain. Yeah. No, I had no idea it was the menopause. And you can see, I mean, we see lots, and I speak to lots of women who have been misdiagnosed, given antidepressants, but also I switched to someone last week who'd been sectioned and she'd been diagnosed with bipolar. Other patients I've had have been given ECT, you know, electric convulsive treatment. And they've known it's related to their hormones, but the psychiatrists haven't had training. They've said, no, you've got a mental illness. But we know it is because they improve with HLT. And it makes sense.

You just treat the underlying cause. But if you haven't got any warning and the people you're with don't know, then you're a healthcare professional doesn't know. There's this massive misunderstanding and mistreatment as well, women, which is really wrong. It's so... It's horrendous, really. It's a massive injustice to women's health, what's happening.

So you have all these symptoms, but did you ever try and get help or what happened? Well, then I started bleeding, like, profusely, and I thought, oh, I understand what this is. I've got cancer. I've got brain cancer, and now it's in my womb. Oh my goodness, me. I'm a pragmatic person, Louise. Quite, ovarian, I think, we should say. I remember years ago I got shingles and I went to my doctor and burst in floods of tears.

I was 17 and it took him 10 minutes to get out of me what it was. I went, I've got a syphilis on my leg. So I am very, actually, my health anxiety has got a lot worse. Yes, and that's what happens. Yeah. I wasn't an anxious person before my menopause. And now I get anxious about everything. So I flip from one day it's Alzheimer's, the next day it's cancer, the next day it's,

and my God, I sympathise now I understand health anxiety. It is exhausting. And because of my job, I have to look at all the papers and everything every day because really I'd prefer not to because every day there's something new to terrify you about what you could have. I mean, somebody the other day I read, you know, got sepsis from a paper cut. You know, this sort of thing, a postmenopause will play on my mind. and literally ruin my day. But I'm having to pretend for everybody

that I'm not thinking it because if I say it, I sound like a mad person. And the great thing is I've got this great Ben K. Adams, who your listeners will know, and we've been best mates for 20 years. And we both since our menopause have had this health anxiety.

And we book, like when we meet up or when we're on the phone, we book 15 minutes to talk about death and our fear of death and our health anxiety because we can do it with each other without anyone else thinking we're mad. And then we have to park it because we found if we didn't do that, if we didn't put it in a block,

the whole of our conversation would end up being health anxiety. Gosh, that's very interesting. And it's very, very common. And I think because people don't understand what's happening to their body, understandably they worry that they think they've got Alzheimer's, or they've got a brain tumour because they're having such bad migraines, or they've got really bad arthritis because I guess in muscle joint pains, or the list goes on.

But it's also the way your brain processes, rather than say, of course, Nadia, you haven't got a cancer that's gone from your brain. That would be ridiculous. It's just overwhelming. Or every time you see a piece of paper, you're thinking, well, I'm going to have sepsis, and then I'll die, and who's going to look after the children?

It's just all these things. And it's exhausting, actually. For menopause or women, their brains are full of exhausting thoughts and very sad thoughts often, which means that they can't actually then process information that helps them get on with their day as well. And I'm sure, you know, to women listening now, this sometimes is the perfect word to somehow, weary, just weary of the constant inner voices.

And like you say, because something has actually changed, I understand, you've got a different balance going on chemical or whatever way you would describe it as a doctor. Why wouldn't it occur to us that this is the reason? I think part of that is as well, actually, when people talk about the menopause, there's a lot of negativity in the way that we describe the menopause. I mean, I remember Kay years ago, coming back from a holiday, she'd been on a skiing holiday, and she just went, for God, seek, if I ever sit fanning myself with a men, you kick me under the table. Oh, it's menopause. You know, and she was very angry about menopause or women, and she was, like, in complete denial.

And I couldn't reach out to her as a friend even when I was scared about my menopause, because she was pretending she didn't have one. I mean, I had to properly out her. I had to do a menopause intervention. She was pretending she had a period. She was pretending everything because it was so embarrassing to be menopausal. So, you know, oh God, I suppose, oh, what is that a menopausal rage? All of this.

So you don't want to talk about it. You want to hide it because all the connotations have been so negative that I've ever heard about the menopause. It's so true, isn't it? And I think certainly when you're in the media, it's just menopause equals you're sort of, of beyond it, you're past it, you're too old to be doing anything. And, you know, we know that young women are menopausal too. You know, lots of women have their ovaries removed for various reasons when they're in their 20s, 30s, 40s. They'll become menopausal. Yet no one thinks about that. So it's really hard. And I know we were talking earlier about some of the other

people that I speak to, to use them really, and to talk about menopause. And we were talking about Liz Earle, who is a very inspirational person, and for her to say, look, I'm menopausal. That's quite a big thing for her whole image and brand and everything she's building up with her wonderful well-being work, isn't it? Well, she fascinates me and, you know, and myself and a lot of my friends are into, you know, a very natural way of living and as Lizzie's, I've watched her over the years and I love her. And it was really quite earth-shattering to see that Liz Ear, I was taking HRT. I'm obsessed.

I'm working on her films now on Instagram, and she talks actually very openly about a book that she wrote where she gave like a tiny piece to HRT, you know, because she had this like complete mistrust of it and just how phenomenally her life has changed from taking HRT now. Yeah, I mean, I get goosebumps. I mean, I can't believe now that my choice of podcast and everything is anything to do with HRT.

I love it. Maybe it was like saying heroin, you know. Oh my God, taking HRT. Taking HRT. Oh, they'll just be doing that for their hair. You know, that's another thing. It's like a vanity. People take HRT.

If I'm honest, that was one of my things. People are poisoning their bodies just so that they can have plumped up skinners a little bit jealous too. I would have. Look at her hair. Do you think she's had HRT? And she probably has. But it's really interesting because, That's what people see from an outside.

But as you know, women who take HRT have a 50% lower risk of heart disease. You know, that's amazing, isn't it? Well, now this is what's become so interesting for me. Yeah. And also they have a lower risk of dementia and also a lower risk of osteoporosis and type 2 diabetes and obesity. So really big conditions. So once you spin it and think about the evidence, then it's a no-brainer for women taking HRT. but we've been given all this wrong information every time anything about HRT has got the word breast cancer next to it.

It's a lot about risks. Yeah. It never talks about benefits. And, you know, there's a risk for everything that we do. But we do make choices because we want to enjoy our lives and live healthily and so forth. And, you know, there was something in the paper yesterday about vegans are more likely to have osteoporosis. That's no surprise because they're less likely to have calcium in their diets. but actually eating vegetables is really healthy as well.

So there's a risk of osteoporosis, but they choose to have that certain diet and they should minimise their risk by other ways. And women who take HRT can often minimize their risk of breast cancer by exercising more, by drinking less alcohol, by reducing their weight, which often happens when you take HRT because you feel better. So it's really important.

I remember a doctor once saying that, the morning doctor saying that you can increase your chance of breast cancer with two glasses of wine and night. I can't remember what she said the risk value was between HRT or whatever. And I thought, my God. It's basically, if that women, yeah, women who drink a couple of glass of wine and actually have a slightly higher risk than women taking the worst type of HRT, the time we prescribe actually has never been shown properly in a study to have an increased

risk of breast cancer. And yet there's all these women that are self-medicating with wine. Yeah, totally. You know, it's that you get into your 50s and those women that start drinking so much more wine per second night, per second night. And actually it's to deal with, oh my God, you get to you in, you're more exhausted than you've ever been. You're feeling, you know, a bit disengaged, a bit, all this stuff that goes on with the menopause. And actually, drinking more wine kind of smooths it all out a bit for a couple of hours.

And actually, that's really, really bad for your help. It is. And also people who drink wine have an increased risk of osteoporosis and even heart disease if they're drinking too much. And dementia. So, you know, it's looking at the whole bigger picture of our health and I've, future health. But you're right. And actually, you know, I prescribe obviously a lot of HRT to the right people for the right reasons, but a lot of other doctors actually very scared of HRT and refuse it. And I sometimes joke and say, I think it would be easy if I was running a rehab

clinic and prescribing heroin because people would take it more readily sometimes because it's this whole misunderstanding which we need to change. Because we've got really good evidence. Well, it's because there was a big study in 2002 which showed there was this increased risk of breast cancer with some types of HRT, but it was reported to the media before it was analysed properly. And it was misreported, sadly. So when you talk about risk, if you say, for example, you have a double risk of something, but your background risk is low, a double of a low risk is still a low risk. But in the media, if you say two times, you know, double the risk, it's like, oh my goodness, why I'm not taking that there.

And never, I've never seen anywhere, and I read a lot about health. I've never seen anywhere that HRT can protect you from heart disease, dementia and osteoporosis. And I think, I mean, speaking from my own personal point of view, I never think about heart disease as a woman. I think about breast cancer. Yeah, but what you're more likely to die from? Heart disease or breast cancer as a woman. Yeah, it's heart disease, isn't it?

Yeah, every time. Wow. But we're made to think it's all about breast cancer. And in fact, most women who've had breast cancer die from heart disease. The prognosis and outcome for women who've had breast cancer is so much better than it used to be. These women, thankfully, survive their breast cancer, but are more likely to die from heart disease. So it's interesting, isn't it, there was a study that, a long-term study, so 18 years it's been going on,

showing that women who take estrogen on its own have a 25% lower risk of developing breast cancer. But that never made it on the front page, because why would it be good news? I think it's because it's the woman's thing. Can you imagine if it was about testosterone? Can you imagine men being denied testosterone if they were castrated? You know, it wouldn't happen, would it? No, I mean, you can't go into any chemist these days without seeing, what's the stuff that men use?

Viagra. You can buy over the counter. Yeah, but you can just get over the counter. Yeah, I know. I mean, friends of mine have gone to see their GPs about loss of libido, they've always been offered antidepressant. Yes, so antidepressant use is very common for menopausal and perimenopause are women because women are being misdiagnosed.

They're not looking at the bigger picture. And a lot of women who take antidepressants that don't need it, just say it makes them feel numb, it fakes them all flat, it reduces their motivation. So they're more likely to drink wine and more likely to, you know, put on weight. So it's, you know, inappropriate antidepressant prescribing is huge, especially for women. And that needs to change, definitely. Yeah.

Can I just ask you one thing, another thing, of course, another thing that I think so many of us as women talk about when we talk about HRT, but horses we all men's out of hormones out of horse. horses with, but that's not even the case anymore, isn't it? No, you're absolutely right. It used to be. So 20, 30 years ago when I qualified as a doctor, that was the HRT we prescribed, horses urine. But thankfully, things have changed. And so we prescribe, the HRT we prescribe is derived from the yams, the root vegetable. So I hope there's a big lot of yams growing somewhere to help the world. But it's also, it's also body identical. And so therefore, it's the same

structure as the hormones we produce. So if you think of the contraceptive pill, for example, example, every single type of contraceptive pill contains synthetic hormones. So it's not the same structure. They've been changed a bit. So there's risks with these pills. So there's a small risk of clot. There's a small risk of raising blood pressure. But the estrogen, progesterone and testosterone we prescribe are the same structure.

So they don't have these risks. So actually, if you're going to start writing media reports, it should be about how dangerous the contraceptive pill is. But it's not dangerous because those risks are really low. And these women who take the contraceptive pill are usually healthy. So you're increasing a very low risk. But it's just something about menopause or women that the world doesn't want to address and look after. Because what do they need us for?

Exactly. I was watching, again, I was watching something that Lizzie Earl was talking about the other day. And I was like, yes, yes, Liz. Because I got my yam stuff, my lovely yam stuff from you. I'd had a wonderful conversation with you and really, really, we've just quite gobsmacked at everything I've been finding out recently

about what we need Eastern for. So happily took my pill out to take it. And then I read the leaflet inside. Oh, yeah. Which, yeah, Liz did it. And I put them back in the books. And Liz was great on this Instagram live that she was doing the other day.

Because we all read it word for word when it's HRT. We don't read anything else. You know, we've got a headache, we just take the headache. But, oh my God, I thought I was in a parallel universe because it said everything in the complete opposite, the complete opposite of what you said to me. And then Liz was saying that actually this very old information on these leaflets,

and it's actually what doctors now refer to when you go into... Yeah, and it what dictates our prescribing, so if we prescribe estrogen, it will pop up at risk of breast cancer risk of cloth, and it's inaccurate. So what the MHRA done have grouped everything together and they haven't looked at the different types of hormones, like I said, the oldest synthetic types, do have some risks. They've just grouped it all together and they haven't unpicked the evidence and looked at it properly in a very balanced coherent way.

And it's the same for some other medications, but it is definitely worse for HRT. And that's shocking. It is really shocking. Yeah, it is totally. And I don't quite know how they've been sort of almost allowed to get away. with it because they are a regulatory body, but they're giving wrong information. And it is scaring women. Like you say, I often say to them, don't read the inserts, but then people think, well, are you a proper doctor? You're saying what's, you know, against. And thankfully,

we have really good quality data and information and research about HRT. And the other thing is, though, Nadia, is that women have a choice. So even if HRT was as risky as in their inserts, You can still choose to take it. You know, we are allowed as consenting adults to choose a treatment, even if the risks are more than the benefits, if that's what we as individuals want and we've gone through it all with our doctors. And the GMC, the General Medical Council, produced a new guidance about consent a couple of weeks ago now. And again, it's talking about this whole, it's a shared decision-making with patients.

So even if I was told, right, Louise, what you're taking as HRT is definitely going to you breast cancer in 10 years time, which is not, by the way, I could then say, well, look, I still want to take it because without taking HRT, my husband would have left me, my job would be on the line, I couldn't help all these women. And my choice is to live 10 good years, thank you very much, than 20 years and I could die and have Alzheimer's. So, but I can make that choice. But actually, the risk isn't that high, so it's an easy choice for me to make. And I think this is a problem with HRT is that women have been denied a choice for a long time, and not even allowed to even start this conversation.

And I see a lot of women who are told, oh, my doctor says, I'm not allowed. Well, how can we not allow something as doctors? That doesn't make sense to me. I don't understand why when you get to a certain age in your menopausal, you don't just have an appointment with your doctor to see if you need this thing that you need. Yeah, wouldn't that be nice? When we did some research of 5,000 women,

and it took 9% of women, 10-10-G-appointments, just to make a diagnosis. Now that's not rocket science making a diagnosis. And the majority of women struggled to get help. Most of them were offered antidepressants. And a significant number were actually referred for other investigations because they were getting palpitations. So for their hearts, they were getting headaches or memory loss. So they were having brain scans. So the cost to the NHS is massive. And also the cost to these women, they're taking time off work to go to these tests. A lot of them have given at work because their brains don't work. So actually, wouldn't it be great if when you went for a smear or even when you were pregnant, they'd say, well, look, this will happen to you.

It might not be for a little while, but listen, read this information. Every time you go for a smear, what are your periods like? Fill out a questionnaire. Oh, you're getting some symptoms. Read this information and then make an appointment with a doctor. And you can go on and start HAT, a bit like if someone's got an underactive thyroid gland. But you don't even need a blood test for menopause, so it's even easier. You can just start.

And why not tell people at school what's going to happen to them? Because it's going to happen to every single woman on the planet. It is interesting. My children diagnose it all the time for their friends' moms. You know, their friends are saying, oh, my mum's so cross, she's so tight, she's completely rude. I bet their men and poor them on. I think they just need your HR too.

Yeah, I'm not very worried when I got to the stage and the only way I could do with my stress is plunging a knife in and out of the chopping board. Oh, gosh. It was this particular thought of time in our marriage. So I'm pleased, things are looking up for you and your plant them now. That's a big relief. Just another myth that I would like you to bust is testosterone. Whenever anyone talks about, oh, yeah, she can detect it. Still everybody thinks they're going to get hairy.

Yeah, they don't. I mean, I use testosterone and I tell you, I don't shave. I don't show my face. So we produce more testosterone than estrogen before the menopause from our ovaries. So it is a male hormone, but we produce testosterone too. And a lot of people talk about libido, and of course it can help libido, but more importantly for women, it really can help with mood, energy, concentration, stamina, so it can reduce that brain fog. It can help with this emotional energy, really. There's some evidence it helps strengthen bones, so good for osteoporosis reduction, and also a small bit of evidence it might reduce risk of dementia. So there's lots of ticks. The worst thing about testosterone is that it's not licensed for women in the UK.

The last couple of days, it's been announced. It is licensed for women in Australia. which is really exciting, first country in the world that we've got a licence for testosterone. So we can still prescribe it just because it's not licensed doesn't mean it's not safe. We prescribe a regulated product. So it's regulated. We know it's got good standards, good quality control. We know exactly what it is. And we have to at the moment prescribe it privately.

Or you can get the male testosterone on the NHS, because obviously men are allowed testosterone. But hopefully this big move will mean that we can get it licensed over here. because it can make a huge difference to a lot of women. And it's safe. All you do is top up the bit that missing, the same with estrogen. And so we actually usually measure testosterone levels. And if they're within the female range, you'd be hard pushed to grow a beard or moustache with female range of testosterone.

So it's very safe. So not everybody that goes on HRT needs testosterone then. No, not everyone misses it. No, the estrogen is like the bread and butter, if you like. And the testosterone is like the icing on the cake or the... the jam in that sandwich. It can make a difference to a lot of women. Some women use it and say, you know, I don't feel much difference so they don't continue it. But the majority of women take it. But a lot of women can't get it because their doctors haven't been trained. They don't know that

they can prescribe it. So it's a real problem actually. And certainly women who are young have an early menopause benefit. I mean, I'm very open. I use testosterone and I could not work this hard without testosterone. My brain, it just works, which you never used to. So you have to have estrogen first and it has to be working and then you add in testosterone. And then we usually say try it for six months if it works great. If it doesn't, stop it. It's only a queen. You know, the good thing about all this HRT is that the woman's in control,

which is what's the most important thing. What a revelation. What a revelation this whole. I feel it. I think what happens for a lot of women that, well, a lot of the women that I'm, I mean, Kay and I are conversations because obviously Kay did this. this book and then she's and you know, HOT and we've started to have this conversation. It's almost like we've been whispering it.

Yes. And it is very interesting, Sue. I mean, when I saw my clinic and started doing some media work and working with Liz, we were sort of whispering how good it was. And now I actually feel like, no, I'm going to get to the top of that mountain and I'm going to shout and scream really loudly because we know that it's very safe and it's very effective. It's cost effective.

We've got evidence showing us that it's effective. So we need to keep. You want to get the newspapers interested in a different headline? Yes, totally. Absolutely. Because it's a headline actually that a lot of women would like to read. Yes, absolutely. I totally agree. Stuck on one track. It's so true. There's lots we need to do.

So we could talk for hours and I'm really grateful that you've given up your time. So just before we finish, Nadia, I'd really like you to just give three take-home tips. And maybe actually three tips to journalists who might be listening. If you've got three tips to try and get H.R. sold as a positive news story? Well, I think that we have to talk about it. I think we have to share about it. I think as women, we have to clear our minds a bit

from the prejudices that we may have around it and be open to hearing. I think Kay was so shocked that I was actually open to changing my mind and not to be rigid with thought because, you know, you could feel so much better. Something that you said to me, which was so interesting, and I hadn't even thought about it, was that actually we were meant to die when we lost our estrogen.

That was the end of our life. And sometimes it can feel a bit like that postmenopause. And actually we need to get out and about that actually we've got another 30, 40 years. We want to feel fantastic. What we do? We deserve to. We've done all the hard living work. I know.

Yeah, it's also true. So it's about positive messages, isn't it? Positive messages and about talking about it and not judging each other, not saying, hmm, is she just. having it for her hair, which is what we're doing. You know, oh, horses, we. You know, all of these, we have to challenge anything that you think that you know about the menopause. Just have a look around and think again. That's what I would say. That's the same for any journalists out there reporting on HLT. Absolutely. Really, really good advice. So thank you so much. I really appreciate

your time and I'm sure it will have lots of women. So thank you so much. Just spread the word. Thank you. For more information about the perimenopause and menopause, you can go to my website, menopause.com, or you can download our free app called Balance, available through the App Store and Google Play.