The Dr Louise Newson Podcast - 130 - ‘It‘s a scandal that more isn‘t known about the menopause‘ with Dr Richard Hull

Episode Date: December 14, 2021

Dr Richard Hull teaches philosophy at the National University of Ireland, Galway. Due to a coming together of work life and home life in lockdown and his wife’s experience, Richard began thinking and writing about the menopause from an ethical and philosophical perspective. As an issue under our noses all the time, he was astounded that more isn’t written about it, and he queries the lack of ethical concern for women regarding this time of life and the impact on those around them. Richard discusses with Dr Louise Newson the importance of raising awareness of perimenopause and menopause, sharing accurate information, training healthcare professionals and empowering women with the right knowledge to recognise what is happening to them and to get the help they need through treatment. Richard’s 3 hopes for change: Personal and public awareness of the impact of the menopause is crucial For everyone to have the confidence to seek support in all its forms and find out about HRT Talk more and spread awareness and knowledge with others. The more people are aware, the less it can be ignored. You can read Richard’s article on the menopause here. Richard’s wife, Jaany, has written about her experience here.

Hello, I'm Dr Louise Newsome and welcome to my podcast. I'm a GP and menopause specialist and I run the Newsome Health Menopause and well-being centre here in Stratford-Bron-Avon. I'm also the founder of the Menopause charity and the Menopause support app called Balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence-based information and advice about both the perimenopause and the menopause. So today I'm very pleased to be interviewing someone called Richard Hull, who's actually in Ireland as we speak. And we've never met face to face, but we've met virtually today.

And he wrote a very interesting article which really resonated with me and I really wanted to explore a bit more. So before we go into that, if you wouldn't mind Richard, just introducing yourself and a bit about your background, if that's okay? Yes. I'm a, well, I teach philosophy at university. I worked all over the place, really, in Keel. I did some work at Oxford University. That's where I did my post-grad training. And I've done a lot of research on issues to do with disability as well as issues to do with genetic technology, which is a big interest of mine. recently been doing some work on non-invasive prenatal testing.

And then through sort of life experience came upon the menopause as an issue. The lockdown was interesting because it brought work life and home life together a bit. So the first session I wrote a piece about the response to the pandemic, both in Ireland and the UK. And then latterly, I wrote a piece about the menopause, which is an issue that is sort of under our noses all the time. And I just was astounded, really, that there wasn't much written about it, nor any ethical concern about it. So that's how I got to where I am. Yeah, which is very interesting, isn't it? Because it is under our noses. And someone said to me recently, once you see it, you can't unsee it. And I thought that's very true. Certainly in medicine,

you know, there's hundreds, if not thousands of people I've seen in the past that I didn't even realize of menopausal, but I hadn't had the training and I didn't have the knowledge or experience. that I do now and I shudder to think about the people I've neglected. But even just people I've seen as who are teachers of my children or working in shops or it's everywhere, but we don't talk about it. We haven't spoken about it or seen it. So how did you come to even think about the menopause then? Well, I mean, probably in an obvious way, which was my wife started to go through it. And we were in that position where we didn't know what was going on. She didn't know what was going on and the response to the article, so many people have said, you know, they'd reported

things they felt and they didn't know what NIRTH was behind it. So we were suddenly dealing with differences. You know, my wife is an artist, Jani Ravenscroft Hull, and she kind of the light in her, which is very bright, became suddenly subdued. And the artistic motivation I noticed was lacking. And it just started a sequence of events whereupon, you know, life changed a and, you know, behaviour changed. And if you don't know what's going on, you search for reasons, whether in yourself or, you know, whether there's something not quite right that you don't know about or whether there's something you totally don't know about or, you know, whether you're suddenly persona non grata for some reason.

And, you know, it was an interesting experience to go through and a process of discovery for a vote. And how long do it take her to realise that it was associated with our hormones? I think the tribute to her and to us as a unit, I suppose, is that we're constant communicators. And there was a period where things seemed unsettled. You know, I was working away quite a bit and it was difficult to pinpoint what was going on. And it was easy to pin it on other things. The fact that I was away, you know, childcare and being a mother of a young child is challenging. So it was very easy to see it all sort of in other ways.

And if you don't have this kind of awareness of, you know, perimenopause, menopause, that transition, things that just occur in midlife for many, many people, then you're going to look in the wrong direction. And I mean, it was, I suppose, over the course of a year or so, that we started to think, well, there's something not. quite right here. And to her tribute, Jani went to her GP, had a bit of an MOT, as it was said at the time. But the response was not particularly brilliant in that, I'm sure this happens to a lot of people, the first response is to throw antidepressants at it. So that was, you know, another journey.

And in that period, you know, this was the more personal version. And Jani, found your app, which was life-changing further, I have to say, and it's a tribute to you that you've been pushing this. And then, you know, everything started to trickle down into an obvious this is what's going on, which was an extraordinary realisation because, you know, reading the app and the symptoms, I mean, even little things like restless legs and, you know, migraines that are unexplained and kind of it all starts to slot in. And that's when, you know, we had the confidence to push for a better response than antidepressants, as it were. But through that process and understanding, you know, in a sense it explains so much in our

life course over the two or three years of that process. There was just a time where I started to think, what if I put my ethical head on this? You know, because it's clear, the more you think about it, the more you share with others, the more you realize that this is happening across the way. the board. Different symptoms, of course. Some people have palpitations. Some people get very insular and anxious. So every experience is different. But it's all accountable to something that is staring at the face and has been for the history of our lives. So suddenly we were in lockdown and I thought, what would I have to contribute if I thought about this in a more philosophical sense?

and that's when I started to think about it in terms of my line of work. And it was quite easy to see that suddenly it's a gender equality issue. It's a public health issue. It's an ageism issue. And if you put that with gender equality, it's gendered ageism, as it were, the economic impact. I spoke to people and my wife spoke to people who clearly, you know, had problems maintaining a work life. You know, my wife was empowered in work and continued to be so. Other people find it really hard.

And so there's an impact of going part-time or giving up a job or being hounded out of a job. Another response told me about that. You know, people give bad references and warn people away. And that's just, it's not on from an ethical point of view. No, absolutely. But the crucial bit, the most important bit is the impact on well-being. and the way I put it is our capacities to flourish. And anything that has a big impact on quality of life

should be of ethical concern. And I was astounded that there was very little written about it, frankly. It's quite something, isn't it? Because it is, especially when there is still a choice. So I feel for so many women, because we know globally the minority of women are giving their own hormones back. So the majority of women are not having any treatment

although there is treatment available that we know is actually evidence-based and safe and reduces risk of disease as well as improving symptoms. And so it's a real dilemma in my mind is this denial of treatment. And in fact, I was reviewing some guidelines for a local trust recently about their HRT prescribing guidance. And it was very out of date. It was giving older types of HRT. And I was reviewing it with one of our nurses.

and she was saying, but Louise, this is dreadful because it's not the HRT we prescribe. How am I going to approach the trust? Because they're all men on the board. They're all doctors. I'm a female nurse. No one's going to listen to me. I said, well, then you should spin it on its head, actually, Sharon. And you should talk about shared decision making and talk about what does a patient want.

And actually, if the woman is there wanting a safer type of HRT, surely then it's up to her to be able to make a decision about her future treatment. and her future health. And that's quite hard in medicine when we've got very black and white rules almost as to what we should and shouldn't do. And medicine, as you know, isn't black and white. It is a science, but it's an art as well. And I think when you put ethics into it,

and I feel morally it's really absolutely scandalous that women are denied a treatment actually. And how can it be in 2021 that we've got to this stage where there is so much more about gender equality? so much more about so many things, but this is like a big white elephant that people aren't discussing. And it has such an impact, like you say,

in a workplace on women, on men, on anybody, actually, and everything. And it's an economic car crash as well. Yeah, I mean, it is extraordinary, frankly. It is a blend. It's not just a medical issue. And this is, I mean, my experience of writing about disability, the more you look into it, you see, yes, there's a physical. impairment there, but, you know, it's the way that society responds to that, which is crucial,

and it can exacerbate the experience of disability. You know, poverty can. But all sorts of things blend in there. And so if you're suffering with an issue that is, as we've said, right under our noses, it is extraordinary that more isn't done. You know, it is extraordinary that more is not expected in a medical sense. And I think my sense is that that's beginning to change largely thanks to people like yourself. Yeah, it's only very small steps though, to be honest. And, you know, for the last five years, I've really been trying to enable people to think about it. And I've had so many blockages and sort of ammunition thrown at me really. And I'm not going to go into it all now because otherwise we have to listen to you talk. But it's been quite astounding that I've been

sort of, well, you're only doing this because you run a private clinic. Well, I run a private clinic because I can't get a job in the NHS doing this work because the resources are so limited. And then, oh, well, it's just a women's problem. It's just, and then even women have been not believed. So one of the ways I've sort of been heard more is turning it into an economic problem. So let's forget about the women's suffering. Let's think about the suffering to the economy and that's the workplace and everything else. But then people then then say, well, let's get more workplace policies in and we can then understand the menopause. And I get really cross and upset with some of that because then it's saying, well, let's reduce women's hours or let's

make them have flexible working or let's look at the position of their fan or the temperature of the room or give them a little breakout room. They can sit and lie down and mock their head. Well, actually, they don't need any of that if they're on the right treatment. They can be promoted and they can run their companies and they can be working as a valued member of the team. But it's still a bit brushed under the car fit almost. And it just seems madness because you wouldn't not treat another condition that was associated with disease. So like blood pressure, if someone had raised blood pressure, you wouldn't say, well, let's ignore that and wait for them to have a heart attack. But we're doing it all the time with women with low hormones. And it just doesn't make

sense? I mean, presumably the workplace measures would be useful, especially in the early stages where proper diagnosis and the proper treatment is ongoing. So, I mean, I can see a point to some workplace measures. And certainly, I think that one thing that's growing out in the workplace is just more awareness. Yes, totally. But you're absolutely right that, you know, to deny the appropriate treatment is flatly absurd in this case when there seems to be clear options and clear and obvious ways of doing that. And that's another thing that clearly is coming on stream a bit. But there are parallels here with disability because the first time I heard a disability issue raised at a political level was at an election time where people were saying

you must take disability issue seriously because if you can't have people in wheelchairs come into your shop, then you're going to lose them, you know, their trade. So to be a bit of a trade. So to put it in economic terms is it's quite a savvy move, but I think it obscures the ethics sometimes, even if it's how you actually get heard. But that's a sad indictment on the situation we currently find ourselves in. Yeah, absolutely. And I think even when you compare menopause with a disability, there are a lot of women who are disabled by the menopause, and it should be considered a disability. And, you know, when we also look at inequality as well and looking at women who are missing out, we know women from low socioeconomic classes, women who don't have English as a first language,

are being marginalised even more, actually, with this. And certainly one of the things, if we ever get any money to support the app, because obviously it's a free app and I really want to try and avoid charging women, is to do more languages and more translations, because, there's so many people who don't have English as a first language and are really struggling to receive the information. And I think this is part of the problem. Like you say, Richard, when before you looked at the app, you didn't have the right information. And without the right information, you can't make the right choices.

And that's been taken away, I think, by so many people, or it still is, because of poor access. But over the last 20 years, it's been very difficult to actually access proper information. and that's caused a lot of confusion and actually ignorance as well, not just for women but for their partners or their colleagues or also for healthcare professionals. And then that's made it even worse, actually, and harder to unpick the truth really behind the hormones and the benefits and everything.

Yeah, I mean, it does make me wonder how many marriages have failed on the strength of misinformation and ignorance. I mean, it strikes me as effortlessly easy. in a sense to get the wrong end of the stick. If you're not communicating well, you think things are imploding at home. And all sorts of things can happen. I mean, it's an extremely serious impact on midlife. I've read comments time and time again saying if this was something that affected men,

something would jolly well be done about it. But it does affect men. Yes. That's not the most important issue at all. But it affects everyone. Anybody who has a relationship with a person who's in the menopause transition is going to be deeply affected by that. Absolutely. And, you know, in fact, my youngest daughter, who's 10, went to school.

She wears a few badges from school on her jumper. And then she took one that I got from Westminster on Friday, which is Caroline Harris, the MP's lovely hexagonal badge saying menopause revolution. So she'd nicked it from my desk and put it on her jumper. And I said, Lucy, what are you doing? She said, I'm going to wear it. many proud of what you're doing. And I thought, isn't that interesting? But there are so many children that are really affected by their mothers or their grandparents or whoever they're carer or whoever it might be who's female. And your children are so vulnerable anyway, but add the

menopause or perimenopause in, then that's really hard. And they often don't have a say when they get a bit older, they can have some understanding. And my 10-year-old understands just because of the work I do, but most 10-year-olds wouldn't even know what it is. or how it affects their relatives. And that's very difficult, isn't it? Yeah, I mean, I'm of a generation where the only mention of menopause was kind of in Les Dawson's sketch shows.

You know, and there is so little awareness. And the key, I think, is related to what you're doing, raising awareness, raising information levels, raising expectations of what you can go to your GP and ask for. I find it hard to believe that this isn't, you know, as you've said headline news more and more. I think the information aspect is key

and that so much would follow from that and so the publicisation that you're pursuing and in a sense why I got on board and wrote about it, it astounds me that boorism said and done and shared to gain some momentum with this issue because it is, as you say, an elephant in the room in a sense. Yeah, and I can't think of any other area of medicine. that's quite this badly managed as well.

You know, we have a lot of support from fellow healthcare professionals, which is phenomenal and lots of education that we're doing is really working well, which is amazing. But even today, we got a letter from somebody who was quite senior, and he told us off for wanting one of our patients to be given testosterone, which is a female hormone, as I'm sure you know, and women produce more testosterone than estrogen, so some could argue it's a very important hormone.

And he didn't think it was reasonable. that we should be prescribing it, and certainly that GP should be prescribing it. And he wrote quite an offensive letter to one of my colleagues to discuss his dismay. And it would be very tempting for us to write back and say, well, how about having your testicles removed and see how you manage without your testosterone then? And thankfully, we didn't. We have written a more considered response. But, you know, we see women all the time that have their ovaries taken out, and they don't get any hormone replacement,

estrogen or testosterone, especially when they're young women, I think it's really outrageous, actually, that they tried to function. But that's just how they feel. But one of the things that you really picked out of in the article or you wrote so well was about these health risks as well and even dementia as well, which is so important with our ageing population, isn't it? Yeah, I think the link with dementia is something I want to pursue. You know, as I said, this is my research in its infancy, but when I came across that link and the article's suggesting that, you know, with a particular genotype, you were particularly susceptible to dementia, that astounds me because my first thought is, well, you know, when you present in the menopause

transition, are you tested for that genotype? Because, you know, there could be treatment available to subvert the course that that could take. So, yeah, I mean, it's a question. I mean, it's a little bit of, you know, The health risks, the things that come with that, you know, the osteoporosis without HRT, there are a raft of different things which are highly concerning. And as I said, I want to pursue that connection with Alzheimer's disease. That's a particular, you know, flag of severity. Yeah. And I think it's so interesting because Alzheimer's obviously is so common and it's far more common in women than men,

but even some of the big Alzheimer's charities have got a lot of funding for research and no one's doing research into female hormones. Yet we know there's some good data that show that women who have their ovaries remove when they're young. Their risk of dementia is so much higher because they have longer without their hormones and we know the important role of hormones. So common sense would tell us that it's important for our hormones and certainly one of the reasons I would never stop my HRT is because of the health benefit.

It doesn't say that 100% I will never get dementia. Of course not. But it will reduce my risk. And certainly anything that reduces our risk of something like dementia has got to be good, isn't it? Yeah. And interestingly, some of the people I've spoken to have said they thought they were getting dementia. You know, when the perimenopausal symptoms kicked in. You know, people, the whole brain fog thing, forgetting simple words,

forgetting a sentence that's about to come out of your mouth. You know, people have gone to neurologists about this and wondered what's going on and do I have a tumor or what is it, you know. So, yeah, to defend against that is really, really important. And as you say, just a stark health issue that we can do something about. And in my line of work, you know, a lot of people make a big distinction between actions and omissions. That, you know, if we commit harmful actions, they are terrible and bad. but the corresponding emissions are less so. And that's how we get away with things like, well, poverty.

We're not doing anything about it, but that's not doing anything. In this respect, you know, what you're telling me about the lack of appropriate HRT treatment, the lack of the right type of HRT, it's very easy to jump on that bandwagon and say, well, it's not like we're doing anything wrong. It's just we're failing to provide the right kind of treatment. and that in an ethical sense is less condemned. But it's not at all obvious that it should be, especially when the outcomes, as you describe, are really serious

and have deep impacts on people's life chances and the life chances of everybody around it. Yeah, it's very interesting because I get a lot of hate mouth from other healthcare professionals saying, what are you doing? We're doing our best job. And of course they're doing their best job. They absolutely are. but they're not recognised, or some of them,

this is a generalisation, of course, a lot of them do recognise, but there's quite a few healthcare professionals, like the one your wife's or the first thing, doesn't have the right training, doesn't have the right knowledge, doesn't have the right confidence, but they will still go home at the end of the day and think they've done the best job by offering an antidepressant or whatever. And so it's very hard also to change people,

so that whole change cycle and behaviour change is very, very difficult. when they've been told one thing, and now there's someone like me who's a bit gobby saying to them, oh, no, actually, HRT is really safe. Forget all the lectures that you've had and all the tutorials to say that it's dangerous. But then I also think that we have a duty of care, obviously, to try and practice evidence-based medicine, but also fundamentally, and this is what I'm trying to do with balance app, is to allow women to make the decisions themselves and be empowered. And I think that's really important, isn't it, for anything that we do? And I think, especially when you think about it as a ethical or moral stance, that it's essential that we are given and allowed to be given the

right information to then decide how to go forwards. Absolutely. And information is key, I think. And, you know, mistakes are made in medical research, you know, MMR, for example, that a lot of people making the wrong choices because of scaremongering research and stories on the back of it. You know, we have to admit that we can get things wrong. I don't think I'm being bold in suggesting that medics perhaps aren't the best people to acknowledge that at times and I've taught in medical schools where if you get ethics in early

you see the change of medical students, they get involved in ethical issues and they carry it with them into their practice. but that is the last 10 years, not the last 30 years, and there are people practicing who haven't had that kind of input. And these people are doing the best they can. They're thoroughly overworked. And it's a pretty tragic situation all round.

So there has to be a lot of understanding, but it has to be mutual. And mutual means admitting when things are particularly accurate, and we can improve, however difficult it may be to do that. And it is, but I think actually admitting that things have maybe, there's been, well, mistakes in the way the information's being given is really important. And in fact, yesterday I got a text from a gynecologist who actually complained about me three years ago about my clinic. She complained because she thought I wasn't qualified to do what I do. And she's very anti-HRT. And she actually messaged me yesterday to say, oh, well done with what's happened in Westminster.

And I know you're not behind it. and I just wanted to say, well done. And I thought, well, that's weird. But actually, isn't that nice that she's got the confidence to actually. I think it was her almost saying sorry in her text. I wasn't sure. But, you know, people are allowed to change their minds, aren't they? And I think that's very important, not just for healthcare professionals,

but for anybody that when we're faced with different information, we are able to change our minds. And that's really important. I think it's a life lesson, frankly, Louise, being able to say you're sorry and to be able to say you're wrong, it's crucial if you're going to have a decent chance of a happy life. So I think there's a lot of scope for understanding, but it requires more nuanced understanding,

that it's not an adversarial kind of position. Everybody can learn from everybody. There's give and take with it all. But the information is key. You know, it's a cliche, but knowledge is power. And I think what you're doing is crucial. I think more has to be written in an ethical sense about it. And it has to be fed in to medical training,

just as it should be fed into anybody's understanding of what life's like for half of the population. So, yeah, I think it's a critical issue. The more I think about it, the more enraged I've become, that it's not attended to. you know, because there are other more politically useful bandwagons to get on. But this is, you know, right under our noses. It has a serious impact on people's quality of life. It has a serious impact on the people around them.

It's something we can do something about. And to fail to do that is negligent. And catastrophic, I would say. Yeah. Absolutely. So it's been really interesting actually talking to you, not just as a partner of someone who suffered, but also as someone who's an educationist really as well as all the work that you've done.

And it's just really interesting, just having your take on it. So I'm really, really grateful for your time. But just actually to finish, it would be really nice for you to maybe, I always ask for three sort of take-home tips. But I think it would be really interesting to ask for you to give me three things that you would like to see change in the menopause. now you've understood and learnt so much about the menopause. What are the three things that you would love to see happening

over the next few years? Well, I think personal and public awareness is crucial. You know, that we talk about this, we share experiences, we get information. I think that that's a key to gathering momentum to change the way we look at this and to raise the profile of this. as an issue, then I would want to see everybody in this position just have the confidence to seek

support in all its forms, you know, whether through your balance app, through friends, partners, healthcare practitioners, to find out about HRT, to insist on it if necessary. You know, as I said, it's a cliche, but knowledge is power in this. And then further through, in a sense, talk some more. I think, you know, the awareness is key and then the spreading of that awareness is key because the more everybody is aware, the less you can ignore something like this. And I've seen it, you know, with disability issues,

see it with genetics where we could go down avenues that are quite frankly scary if we don't talk about them. So we need to spread the word and publicise this as an issue. Change does appear to me to be forthcoming. However slowly, I'm not a cold face and it must be frustrating for you. But from my quick dip into this issue, you know, it strikes me that awareness is key and it's much harder to resist change if everybody is aware that you're resisting it. That's, I think, what I'd like to see shift the momentum of this

issue and then experts like yourself can fine tune how precisely that is done, you know, with treatments and safety issues and more research from folks like me to back you up. So I hope this becomes, you know, as important an issue as the issues which are politically correct to talk about and politically momentous at the moment. Yeah. That's what I'd like to say. Excellent. Well, that's hope.

And I'm really looking forward to hearing more about the research you do. And certainly, we'll put a link to your article that you wrote that I, you kindly sent to me as well because I think it's certainly worth everyone reading and learning from it because you do write so well and it certainly I really enjoyed reading it. So thank you so much for your time coming on today Richard and maybe one day we'll meet in real life. I hope so. Yeah, I hope I can support you in some way, shape or form. Yeah, thank you very much. For more information about the perimenopause and menopause, Please visit my website, balance-menopause.com,

or you can download the free Balance app, which is available to download from the App Store or from Google Play.