The Dr Louise Newson Podcast - 100 - Reflecting on Dr Newson’s and Dr Lewis’ achievements for women

Episode Date: May 25, 2021

Newson Health celebrates its 100th podcast episode with the Clinical Director of Newson Health, Dr Rebecca Lewis. When Dr Louise Newson began these podcasts with the aim of reaching more women, she didn’t envisage doing more than 10 episodes, let alone 100!    In this emotional episode, Dr Lewis and Dr Newson reflect on their joint menopause mission to help women globally with the perimenopause and menopause, as they talk about how their worlds have dramatically changed from being GPs within the NHS, to owning and running the largest menopause clinic in the world.    Their joint aims for the next decade:   1. See more women getting the right treatment for their menopause. Currently, only 14% of women in the UK take HRT despite it holding benefits for many more women. The Newson Health doctors would like to see 60 - 70% of women receive this safe and effective treatment.   2. Continue to raise the profile of perimenopause and menopause, not only medically but in society - especially in the workplace.   3. Raise the profile of menopause globally; many countries don't have a word for it let alone access to treatment.  

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. Today I'm very excited because this is very special occasion for me. This is the 100th podcast episode. And I set up a very excited. I'm very special occasion for me. This is the 100th podcast episode. And I set up. up the podcast just to really try and reach more women and I never thought I would be going more than 10, let alone 100. So on our special anniversary of the 100th podcast, I'm very delighted to be inviting back to podcast studio Rebecca Lewis, who is a clinical director with me at Neuston Health. She's also director of our free app balance, and she's also director of Newston Health Research Education. And above all, actually, she's a really good friend and mentor and companion to me. So thanks for coming today, Rebecca.

Oh, thank you. No, it's lovely being here. And wonderful to be for the 100th. Isn't that amazing? Hello. So I thought we would just have this as a bit of an informal two-way chat because obviously I quiz and question lots of people all the time. And I thought it's quite nice. Maybe for people to hear why we do what we do,

because neither of us set out, when we were at medical school, if someone has said to us, right, guys, in 25 years' time, the two of you will be running probably the world's biggest menopause centre. I would have just gone, don't be ridiculous. No way. No way. I wouldn't have thought that at all. Private medicine. No, absolutely not. No way. It wasn't, you know, always being committed to the NHS for 30 years. Absolutely. So strange things, isn't it? Yeah. So you set off not even becoming a GP initially, did you? Just explain what you were doing.

Well, initially, I went into hospital medicine like you were really, and specialised in anesthetics and got all my exams and was set to become, you know, on my way to be an anaesthetic consultant. Then I had a sort of change of heart, really, and wanted to do something slightly different that involved people a bit more. And so I swapped to general practice, had some training there, and enjoyed my time in general practice for the next 20 years, very much so. And then, of course, now my life has changed again. And here I am doing purely menopause work,

which I absolutely love. And you know, that has been the most rewarding part of all my medical experience so far. have been the most of rewarding medicine, you know, using a medication generally that helps women and is so low risk and for free has future health benefits. I have never ever had any experience with that in any other medication of medicine. It was quite interesting, isn't it? I think sometimes, I'm sure you felt the same. You've done jobs or you've done on call or you've done experience and you thought, where's this going? What are we doing? And as some of you listening, like, no, I've got a pathology and immunology degree. And I, my lab work was looking at collagen and how it changes.

And it was really isolating actually. Being a laboratory work is really hard. And you lose insight of what it's like to actually be a patient with, I was looking at disease called systemic sclerosis. And people get very tight skin and they can't open their mouth very much. And they can't hold things sometimes in very extreme forms. And at the end of my research, I thought, I better go and sit in a clinic actually and see what these women are like. And I was so taken, with goodness me, I'm looking at their skin and they can't open their mouth. They can hardly speak. And it really, really puts something in it.

And now, as you know, we're doing a bit of research, looking at skin changes in the menopause. And thinking, gosh, that's interesting. All this work I did then, now I'm looking at microscopic changes of the skin because of the hormone changes. And, you know, you wouldn't have thought that would have led to that then, would you, when you were in the laboratory? No, not at all. using those schools again. Yeah. And then I did a 10-week project as a student in a breast cancer unit because I wanted to do oncology.

I wanted to look after people who have cancer. And then part of my work was to write a booklet about tooxifen, which is obviously, you know, the drug that is given a lot now for breast cancer. And it's only really just come out because this was 1992. Yeah. There was no internet then, obviously, was there? So it was very hard to get information. So my consultant, Professor Tony Howell, who is very inspirational.

said, can you write a booklet about deoxifen? And I said, well, yeah, but I think women need to know a bit more. And so then I wrote a series of four booklets about cancer and about lymph glands and about chemotherapy. And it was very interesting, actually, writing for patients because my first draft, I sent to my mother, who, as you know, is not medical. So what do you think? She said, Louise, there's all these medical words. No one will understand them. I said, everyone knows what cancer is. Everyone knows what chemotherapy is. She said, Louise, they don't. It's because you know these words. So then I have to think, right, let me try again. And then there's a thing called readability and reading ease.

It's like a score. You count up the number of syllables and the number of words in the sentence. And now you can just run it through the computer, but in the old days, obviously you had to work it out yourself. And actually, that skill was really good, and that's helped me for the last 25 years of being a medical writer. Yeah, that really must actually, because it helps communication, doesn't it? You know, you are fantastic at that is getting the message across the women.

But it's quite hard actually, isn't it? Because when you've got a lot of science in your head, it's very hard then to translate. And it is a bit of a translation, isn't it? Yeah, it's a great skill to actually take quite a complex situation and still it down to something that's quite easy to understand and support accessible. That's a great skill, isn't it? And I think also going from hospital medicine, I was a hospital physician for a few years. And then I went into general practice and my trainer, John Sanders, who again was another very inspirational, really incredible mental to me. He said, Louise, you've got MRCP, which is a member of the

Royal College of Physicians. You are going to not do well in your membership of the Royal College of GP's examination. I thought, what do you mean? He said, because you will be too busy thinking about the disease and you won't think about the patient as a person. And you really stuck with me. And you know when someone said you're going to do badly? Well, obviously, you're going to do really well and prove them wrong. Yes. It was true because we used to be doing a ward round and say, bed number five asthma attack, bed number two, heart attack. Yeah. And you wouldn't realise that this poor people have got homes and families and careers

and, you know, they're sitting in their dressing gown, really vulnerable, where six of you doing a ward round in a teaching hospital. It must have been horrendous for them. Yeah. And I think general practice really does give you skills and tools to communicate, doesn't it? Well, it does. And actually, in general practice or primary care, you're seeing 99% of the population. It's only a very small amount that end up in secondary care, 1% or more.

That was my trainer told me that when I started general practice. And actually, the books, of course, are all written from secondary care point of view in general. It's slowly changing, but still that remains the case, which is a very skewed version of what illness is and disease is. It's all from secondary care viewpoint, which misses an enormous amount. It does, doesn't it? And I think you're trying very hard as a. physician to be a diastognition, you want to make that diagnosis.

Yes. You're trying to and you often can't. And then one of the things John Sonders really taught me was shared decision making and asking patients what they think is wrong with them. And I said, well, that's ridiculous because no one knows what's wrong with them. He said, no, ask. And also ask them what they're worried about. And I thought, that's quite hard to ask someone, isn't it?

They're coming in the symptoms. And I remember one of my patients was a young lad who's only to, 24 and he came to see me and he had a sore throat and he was really couldn't talk and he was being a bit wet and it was a bit oh I just got a really sore throat and I'm a bit achy and I just thought I'd come and see you as a doctor so I thought right I'm going to ask him what he's worried about yeah so I said well I'm sorry you feel like this I think you've probably got a cold is there anything you worried about and he said yes he said my mother is in intensive care she's really poorly and they've told me that if I've got something infectious I can't go and see her I feel quite emotional

talking about it because I thought, oh my goodness. So all he wanted was reassurance that it was a simple cold. He didn't have tonsilitis and he didn't have a temperature. And it really stuck with me because I thought if I hadn't asked him and said to him, you are 24, you have a cold, you're wasting my time. Yeah. He might not be dismissed. He would have been dismissed and he had this huge worry. But you're able to reassure him, which is lovely. And I think, you know, there's someone called Avran Blooming, who many of you, he might know who's written the most amazing book called eustrogen matters and he came and spoke to all the doctors that work with us now in the clinic and he said and i've heard him say before as a doctor he feels that he's a patient's advocate yeah and i think that's a really good word isn't it and i'm not trying to say that we're here to hold people's hands and stroke them and make them feel better but we're really here to listen and guide them and direct them into a direction that they want And I think that's really important, isn't it? Totally. I couldn't agree more, really.

That's our job as doctors, especially in general practice where we've had those skills and training. Secondary care maybe, but that is particularly with primary care, how important it is the patient. It's patient-centered. It's actually looking after your patient, wondering what they want, what are their choices, setting out the choices for them,

giving evidence-based advice, but actually at the end of the day, it's working with your patient. to try and achieve the goals they want to achieve really. You know, it's working together as a team. And I think, you know, I had no idea at the time doing all this communication work, which has been such a big building block to my future career.

But how important it is for menopause and HRT, because there's been so much misinformation. And as many of you know, when I started my clinic, I couldn't get a job in the NHS as a menopause specialist because there's no clinics near us and even in primary care and GPRAC. because they weren't interested in having me as a resource. So I just set up privately just to work one day, a week.

And there's been a lot of women who came and saying, I don't want HRT. I'm really scared. I don't want it. I don't want it. And it's a long time just talking about it. And it is really trying to get the facts over in a very clear way and then let women make a choice in an unhurried, clear, evidence-based way,

which can be quite difficult if they're not presented with all the facts and information, can't it? Completely. And that's really the nub of your work and how much work you have done to help women make an informed choice. And it's educating society and women in general about what their choices are, actually. But if they want to have this sort of treatment, that is fine, you know, if they're aware of their decisions and what it involves. and shared decision making is what it's all about, surely. But women have to understand that, and there's so many myths, still in the media, in medicine, in secondary care, in primary care, that are just plain wrong and still sticking, you know. Thank goodness things are changing a little bit.

But that's really, I think your work has been amazingly how you have managed to change society's you about the menopause and about treatments that are so safe and effective. And this is a turning point for women really. This is a real time, a zeitgeist time for women now is a time of change, how they can really manage their menopause properly. But it's very hard, isn't it? And I remember when I started my clinic and started to see women who traveled sometimes for three, four hours, because it was before we did remote consultations. And they would come on their knees and say, oh they still do sadly you know say that they could no longer

function as a woman they couldn't work and I remember going we met for a walk and we'd be jumping across meals and me talking to you and I think I just talked at you I don't think you even had a word in because I kept saying to you're like this is awful none of my GP patients I would ever let to get to this

stage what's going on and you said no surely I think it's just a few patients you'll never be that busy yes I was worried about that you were right and I said well that's fine I don't want to do more I feel very uncomfortable doing private medicine. I really want to carry on as my GP job and medical writing. And then it became quite busy. And then I remember saying to Rebecca, can you come and see some patients? And it was a big step for you as well, wasn't it, to do private medicine? Well, it was. Yes. Stepping out of the NHS,

which I've been for, I don't know, 20 years or so. It was a big, big step. But I had no choice because I wanted to, I'd heard these stories from you, which there was a revelation to me. I hadn't really realise how many women were suffering all over the country, really suffering, really suffering. And marriages were not able to work, you know, being put into mental hospitals and dreadful, you know, awful, awful time women had. I had no idea. So yes, I was desperate to come and help. And it was very, obviously we're very professional medically, but just for those you listen, we don't have business degrees and we don't have any, you know, we certainly don't work with any pharmaceutical companies, but we don't have any handouts for anyone.

So we just thought, well, let's just try it and see. And you were working in a different place to me. We had a remote PA and looking back, we had no idea what we were doing on the business side of things. But then we both became very busy. And I said, look, I want to open a clinic. And you said, well, I don't think there'll be enough patients for a clinic. And I said, well, I don't think there'll be enough doctors because a lot of doctors are so resistant to rescribing HRT. So you arranged at your GP practice, didn't you, to have an evening meeting with people that you knew that I didn't know and they didn't know me either.

So I was a bit really nervous actually coming and I remember I did a presentation just showing them a bit about me and my background and about some of the sort of media, social media work that I did. But I just chose to do it as a way of educating women. And I remember some of the doctors who now work with us saying, why are you doing this privately, Louise? because we do this all the time. And I said, come and sit in the clinic and you'll hear these stories of women that are being neglected. Yes.

And a few of them have sat in our clinic, haven't they, and just cried. Yes. Because the stories are so awful. Stories can be horrendous, really, really moving stories. But sadly, it's not just one story. It's over and over again. Yes.

We hear how women are suffering all over the country, all over the world. It's not a problem in the UK. It's a problem global. Absolutely not. And I know when I first heard some of these stories, I remember going to the chair of the Royal College of GPs, who's now changed. But when I went to go and see her, I said, Helen, I can't believe these stories, actually. This is really shocking. We need to improve education. And I've done a lot of education work with the Royal College of GPs over the last 15 years. And she said, really, gosh, I had no idea either. But, you know, we are very busy and we do lots of programs, which I completely understand. And that was three and a half years ago. And I don't think education for healthcare professionals, sadly, has really improved. And it's quite difficult to get menopause education. And certainly a lot of us haven't had formal education, or I now have, but before I hadn't.

Now we know what we know, and we know about the health risks of having low hormones. It does seem really strange, doesn't it? I can't think of, if you came to see me as a GP and you had raised blood pressure, And I said, oh, well, Rebecca, I'm sorry, you're going to have to see someone else because I don't know anything about raised blood pressure. You might think I was quite a bad doctor. Whereas if you came with a really weird skin condition, it caused a rash, and I didn't know what the rash was. And I'd say, I've never seen this before. I think you would accept that because it would be unusual.

Yes. But we're not, blood pressure affects probably about 10, 20% of the population, adult population. Yes. Whereas menopause affects 100% of female population. Yes. So how can we as healthcare profession, I don't know anything about the menopause? I can't help you.

It seems absolutely ridiculous, doesn't it, when you just say that? If you're explaining someone to Mars coming down, you know, medicine and society don't really understand the menopause, yet it affects 51%. And, you know, the problem is it's gone under the radar. It's been thought of a bit of a Cinderella subject

and hasn't been taken seriously by, of course, you know, medicine mainly dominated by secretary care. It has not been taken seriously. There's been scares and worries, so that's put people off anyway from investigating more. And it's only more, latterly, I'm saying, in the last 10, 20 years, that we've got some more evidence, how damaging it is to live without your hormones for 30 years. Now women are living longer. So it's come to the fore, I suppose relatively recently in the history of time, of course, but it's still a taboo in the medical world. world. It's that yes, yes, but that's normal. Don't worry about that. Yeah, that's exactly right.

And, you know, 25 years ago, it was promoted HRT for a treatment to reduce risk of heart disease. And they said, everyone should have it, regardless of race or background, to reduce risk of heart disease. And then this study came out in 2002, which was misreported and scandalized, actually. And then people stopped taking it. And then the incidence of heart disease and women has really rocketed. It's gone up by 44% in the last 20 years because people have not been having the protective effects of estrogen in their system. Yeah, that's an enormous part of why it's happened. It's become something you don't even want to get involved with it because of that study. It has scared people away unnecessarily. It's scandalous because it was wrong. It was absolutely

the opposite was in fact true. And we now know how helpful, how good it is for our vessels in reducing cardiovascular disease and also and many other diseases as well. And so certainly as a physician, as a doctor, helping men andposal women is the most transformational medicine I've ever, ever experienced. Couldn't agree more. I've seen some women today who are my follow-up patients,

so I've met them once or twice before. And every single one this morning has said to me, thank you, you have given me my life back. I wish I'd come sooner. That's my only regret. And yes, that's really lovely. course it's lovely to hear those stories, but I also know that I'm improving their future health, so they're less likely to be a drake on the health system, they're less likely to have

diseases, they're more likely to have better quality of life, and I can't think of any other area of medicine that we can do that. So I think what a lot of what I've tried to do over the last three years is educate, like you say, women, but then we still hear stories and as we've both got children of similar ages. We've been playing a bit with social media, using it as a platform actually to give information. But what I haven't wanted to do is to make it so that more people come and see me because I don't want our business to be busier. We don't want to have a big way to get. It's not the reason that we're educating. It's not the reason at all. It's really, to get this message, it feels like sometimes the only people that understand it

will not the only people we know many more. We feel like we're in minority when it's a majority We need to get that word out. Yeah, exactly. So we've certainly spent a lot of time talking about what else can we do because we know that there's only two of us and we can't open clinics in every town. And we don't want to actually. I don't really don't. We could easily, if we were very business-minded, we could say, yeah, come on,

let's get a huge loan. Let's open a clinic in every town. And I know it would be busy, but it wouldn't feel right. I've still got this thing at the back of my mind that we shouldn't be. doing private medicine. So a couple of years ago, we set up this not-for-profit company called News and Health Research and Education. And we decided, didn't we, to set up our own education program with two other doctors, one works with us now, Dr. Sarah Ball and also Alice Duffy. And we decided to set up our own education program, but we wanted to make it really accessible

and cheap. And we know, because we're mums as well as GPs, that is very hard to get time off actually to go and do a one day or two day or five day course. So we wanted to make it remote. Obviously, this was before COVID, I hasten to add. So it was quite unusual to do something that was remote. But we got out of our comfort zones and we had lectures filmed that we were lecturing in, but also some of our other colleagues lecturing, like gynecologists and dermatologists. And we also did this day of filming, didn't we, with actresses who we gave them scripts and we asked them to pretend that they had migraines or that they'd had early menopause or that they'd had cancer. And my mother was the old lady talking about her vaginal dryness.

Thank you very much, Mum. And other things. And we had quite a fun day doing it, actually. That's made fun. Yeah, it was. It concentrated the mind, trying to get the salient points out in front of the camera and come up with your treatment plan. But I hope it was really useful for people to watch because there's nothing like watching

someone consult. So even when I did my advanced specialist training with the British Menopal Society, I still didn't quite feel. I had a handle on how much to prescribe what to do. And so then, as you know, I started HRT myself because I was getting symptoms. So I learned a lot for myself, which is always good. You're a patient. But then I went and sat in some clinics and that was the best thing that I did. I learned loads actually in the C. But also, I wanted to show that in 10 minutes you can transform someone's lives. it's very easy for people to say, well, of course you're going to help because you have half an hour or 45-minute consultations. So we timed them, didn't we? So we could do 10-minute

consultations. Yes. So that GPs, nurses, could really just help. And we've already had some fantastic feedback with them. And people, lady is a GP through to me yesterday. And she said, I love it because you do questions before. And the same questions after, and you can see how you've improved. Yeah. And then you got actually. access to the evidence as well. And one male GP said to me, it has completely transformed my way of treating women, actually. That's wonderful, isn't it? The first thing I do is ask them about their periods, and usually it's a problem, especially when they're in their 40s. And this has really made a difference, because then I start talking about hormones, and within months I can see they're feeling better.

So it reduces that need for all these referrals, for different tests and inappropriate prescribing and all sorts. That's right. That's the scandal as well. Not only that women aren't getting treated, but they're being misdiagnosed and referred at great cost for secondary care for their migraines, for their urine infections, and their muscle and joint pains, palpitations.

I mean, every area is affected of the body as we know. Absolutely. Because estrogen is important. Every cell in our body, it can really affect. And for years, women have been misdiagnosed many women with fibromyalgia, chronic fatigue. And now, obviously, we're looking into long COVID because many of the symptoms of long COVID are similar. And there are quite a few women who have noticed their periods have changed or stopped. And I'm sure some of their symptoms are related to the low hormone levels.

So it's a real problem. So we've obviously got the education program. There's a lot more we're going to do with that. And then we've also worked to, found the menopause charity, which neither of us have got any charity experience at all, but you're on the clinical committee of it. And it's very interesting listening to the need from women, actually, isn't it? And the real reason for setting up the charity is so that we can try and reach as many women as possible globally to be a voice for them, actually, because I

think they've lost their voices, haven't they? They haven't got a voice? There's no unified voice for them really. They need that desperately to access treatment, which is not even available in that country. And it's absolutely dreadful. These women are suffering so much all over in our own country in different countries. The stories are, can be horrendous, actually. And they really need someone to fight their cause. Absolutely. So we've just launched the charity and by the time this goes out, the website will be live and it's called the menopause charity.org. And we have most amazing ambassadors and supporters and there's a lot more. So anyone who's listening who wants to help, certainly who wants to donate as well, we really want it to be a platform for women,

but also for men and employers to really get not just information, but know what to do with that information, know how to help, not just themselves, but their partners, their colleagues, their relatives. So we've got a lot to go, but we've got to start somewhere. And then the other thing that you're a director of is balance app. which is a different company that we've got. And this is the app that we've developed, and it's a free app. And we've already seen a massive uptake of tens of thousands of women are using it with some great feedback. And we're hoping that would be really pivotal to improve menopause care and perimenopause care,

because women can create this health report. And I know, I'm sure you'll agree, but if I, 15 years ago as a GP, if someone had said to me, I produce this health report from an app and I think I've got the menopause and I've got these symptoms what can I do? It would make the consultation very easy, wouldn't it? That would be brilliant. This is what I think

the app is so amazing. It's free. You can put your symptoms in and it can come out with a very clear suggestion of diagnosis with a health report that you can just take along to your GP because one of the problems Louise, isn't it, is that if you're beset by so many symptoms which menopause and women often are, they have three or four quite severe symptoms,

how do they start the conversation if they're not sure what it's due to? So they're very concerned about the palpitations. So the conversation goes down the palpitations line and all of a sudden they're single cardiologist. Whereas if they had gone to the app and put in their symptoms and they had tracked it with their periods, then the penny would drop, hang on, is this due to their hormones data? The health report will come out saying,

I think this could be due to your hormones and may like to talk to the GP about this and to discuss this because of these sort of things. with all of a symptom question there's score. So then as a GP, when you've got such limited time, it is really hard in general practice. If someone came in with a report saying, do you know what?

I think I'd like to talk about my hormones because I think this could be the cause of about three or four of my symptoms. Immediately you get off to the right start. You're thinking about hormones. And the conversation usually goes very well then. And I think this is very interesting because then it goes back to Dr. John Sanders, who is my trainer as a GP,

because he's always said, ask the patient what they think's wrong with them. And I thought at the time, that is ridiculous. But actually, patients, we know our bodies pretty well, especially when we've got a bit of information. So there's a whole narrative and a lot of educational lists are saying, at the moment, GPs are too busy to take on more education. They can't take on menopause education as well. Whereas my pushback is actually if they knew about the menopause,

not only is it very rewarding, but it will reduce. workload going forward because these women will be able to take control of their lives and their bodies as well. Wasn't there a survey that said that before they got to a diagnosis of menopause, they needed about nine consultations. And if they had downloaded the app and gone straight there, hopefully just one consultation to get to the right. Yes, and then they won't be referred off to all these other tests and everything as well.

And on the Channel 4 documentary with Davina that's recently come out, there is a lady who was getting pains in her arms and legs and losing hair. And she said to the doctor, well, I think it's my hormones. And he said, no, not at all, it won't be. Whereas if she had produced more information. Or she may have said on that, there's an example. I'm getting some pains and lost hair. And loss of my periods have become irregular.

And I'm getting some sweats and flushes. They would have had a different conversation. I'm sure. The doctor will have the most thought hormones. Well, I think the other thing is that there's this whole narrative which we won't go into too much but it's about listening to women and I think people

often will just say oh no, you're making that up. That doesn't fit into your disease category box and not just, this isn't about healthcare profession I think in general in society. Women are not listened to. Women are can be a bit of a nuisance actually

and we should be fading away behind our aprons a little bit, working from home, not complaining. And we do have this, let's just put up and get on with it and keep strong. But actually, we shouldn't be like that. You know, can you imagine if men even had periods? They went through pregnancy, but goodness, only knows what it could be like if men were menopausal. I know. Because... Well, it wouldn't be a problem, like we're saying. It absolutely wouldn't. So we need to think about women and women who are neglected as well, you know. The women we see in our clinic are more vocal because they've come and found us,

but they can't afford many of them to come. They shouldn't be paying. It's really outrageous, but we want to be reaching women who are far less privileged and struggling far more without the education, without the resources, and trying to reach as many people abroad as well, I think, is really important. So although I feel in the last half hour, I feel we've blown our own trumpet and said how well we've done, And I actually think we've got so much further to go, Rebecca.

So, you know, this is really the start of a journey, isn't it? This is the start of the journey. The work will always be there and we need to help these women. But I think it's a good start. And I think the tide is slowly changing thanks to your work. But yes, it's being believed is the crucial thing here for women being listened to and having a voice. And they really haven't. Even in this day and age, I'm quite shocked to hear myself saying that.

Yeah. I think that's so important. And I think that's a really good place to end about thinking about listening. But a couple of things before we finish. I obviously want to ask you for three take-home tips, which I'll ask in a minute. But I also wanted to publicly thank you for being such a good friend, mentor and supporter because it's not been all plain sailing the last two and a half years. And there are many a time that I phone you in tears and say, I cannot continue.

This has happened, that's happened. And you've just been such a voice of calm. And I really am very grateful, and I just thought I'd say it publicly because it's so important for everyone to think it's just me because it's my name. But it's not actually. It's a double act that we do. And it's very important that that's acknowledged. So thank you. That's so sweet of you to say that.

But it's, as you know, it has been just a joy working alongside you. And, you know, being able to help women has given me such passion and changed my life for the better in so many ways. I've met so many wonderful people. And as I said, it's the most rewarding job I have ever done. So to finish with the three things, I'm going to challenge you now and push you out your comfort zone and ask, what three things do you think we can? I'm not going to say you because we'll do it together because we have everything together. What three things do you think we can achieve over the next decade that we're going to be really proud of?

Right. Well, I would love to see the amount of women having correct treatment for their menopause increase at the moment. 14% of women get HRT. I'm not saying every woman definitely needs HRT, but a good deal more than 14%. I'd love to see that in 10 years into the 60s or 70% of the rate. So I think we can try and achieve that. That's one of the goals in my head. Number two, I really want to raise the profile of the menopause, not only medically, but in society and in the workplace. I think the workplace is huge. We see casualties of the menopause all the time, but

particularly about careers and their jobs. We talk about the glass ceiling a lot now in society. We talk about the gender pay gap, the pension pay gap, and a lot of the reason women leave their jobs is because of menopause. And if we can try and get

that information to businesses, to society, to help women while they're working with effective solutions for their menopause. to enable them to carry on working. Women often don't want to work or be early retired. They want to carry on the job that they once loved. And why shouldn't they be able to do that?

It would be wonderful if we could achieve that goal. But naturally, women have support in their menopause in the workplace. And I think raising the profile of the menopause globally, it sounds rather grand and grandiose perhaps, but it's such a serious problem for so many. countries that don't even have a word for menopause and certainly no treatment options. And the women there really, really do suffer. And it can be almost medieval what they're going through.

And I would love to help those women much more by awareness and provision of solutions. I think that's about three. Is that right? I think, so what you're trying to say is world domination. Oh, yes, in a nice way, in a sort of a quiet way. Yes, I am. I don't think there's any woman who wouldn't want to be more powerful and to be more in control, not just of themselves, but others as well.

So I think, you know, we've got a long way to go, but we've started and we can't stop because it's very addictive, helping more and more women and those around them as well. So thank you ever so much for your time today, Rebecca. And keep with me, keep me saying, please. There's no danger of that. We've got lots more work to do. we'll enjoy doing that and help you. Oh, thanks very much. Thank you. For more information about the perimenopause and menopause, you can go to my website,

menopausedoctor.com.uk, or you can download our free app called Balance, available through the App Store and Google Play.