The Dr Louise Newson Podcast - 131 - Joining the dots through research and education with Lucy Chatwin

Episode Date: December 21, 2021

In this episode, Dr Louise Newson is joined by Lucy Chatwin, who is responsible for the not-for-profit organisation, Newson Health Research and Education. Lucy has had a portfolio career that has taken her through environmental science and operations, through human resources and management into health, in particular service improvement and transformation roles in the NHS. Her last role in the West Midlands Academic Health Science Network focussed on supporting the adoption of innovation into health services to improve health outcomes for people. Lucy is perfectly placed to bring together the often diverse worlds of industry, academia, and clinical organisations to drive improvements that will make a real difference to the lives of people in the perimenopause and menopause and those around them. Lucy discusses the range of opportunities for innovation in menopause research, education and management and encourages those working in health and academia to ‘think hormones’ as an integral part of their practice. A key catalyst for this is the soon-to-be launched Newson Health Menopause Society that Lucy is leading on. The society will provide a global arena for integrating and energising research, driving education and upskilling professionals working in the field of menopause care. Lucy’s tip for women is make time for yourself to unpick what is going on if you think you may be perimenopausal, don’t just assume it’s down to other things. Download the balance app at www.balance-menopause.com to help understand your hormones, the impact they’re having on you and how to get help for your symptoms. Lucy’s tips for healthcare professionals: Connect with other interested experts outside of your specialty, this is often the best way to expand your thinking Make your mantra, ‘could it be hormones?’ If you treat women, don’t underestimate the influence of changing hormones in so many health conditions and presentations. Register your interest in joining the Newson Health Menopause Society at www.nhmenopausesociety.org and follow them on Twitter at @NHMenoSociety or LinkedIn at Newson Health Menopause Society.

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-Aven. 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 on this podcast I have with me, Lucy Chatwin, who I met several months ago. And initially she was going to come and work in the clinic.

And now she's actually working alongside me, but not in the clinic. And we'll explain why in a minute. And so welcome Lucy to the podcast. Thank you. So Lucy can explain a bit more. But basically I was looking for someone to help try and expand the clinic a while ago as we were getting busier and her name was passed around and then I picked up the phone and we already had an operations director at this stage and I wasn't really sure what we needed and I

picked up the phone and within two seconds I thought I really need Lucy but I don't know how I don't know what role she's going to do but Lucy's got a huge amount of experience in the NHS she's very interested in women's house and so she's now working very closely with me on my not-for-profit company Newston House Research and Education which I set up just over two years ago. And what it does is what the title says, actually. It's about research and education in menopause and hairy menopause. So before we talk to much about that, Lucy,

can you just explain a bit about who you're, because you're not a medical doctor, although you obviously know a lot about different aspects of medicine. Can you just explain a bit about your background? Is that okay? Sure, yes. So I kind of tripped into health more than anything. I started my career in lean manufacturing.

So I left university with a degree in environmental management and went into a consultancy business as you do because I didn't really know what I wanted to do at the age of 20, having left university with a qualification that made me go, oh, how am I going to use this then? So I stumbled into a role where I became an office manager for a lean manufacturing consultancy. And what they did were they were predominant,

ex-Tiota workers that looked at how to take waste out of processes, and they travelled the world essentially sharing their knowledge and their skills. And I suppose what that role gave me was an insight into operations and how I could really make a difference to the people's side of the business. So I took time out of that role to do a master's in human resources and management at Aston. and that kind of led me into the HR world, which is where I then ended up in my first role at the Dudley group of hospitals. And that was my first sort of entrance into the health world, which was fantastic, really, because I think I spent six months building a glossary of terms of all of the acronyms that are used within health, I think, because so many people just talk in acronyms the whole time.

And it was really interesting not having a health background and then trying to decipher what it was that everybody was saying. So I had a varied role at the hospital. So I did HR and then moved into service improvement and became the head of transformation there. And that's where I really got a broad understanding of how health works, but also the system and the wider system. And then that led me to the West Midlands Academic Health Science Network, which was one of 15 AHSN. again, another lovely acronym that we can use that says, how do we support the adoption of innovation into the NHS in order to improve outcomes, and that's health outcomes,

and population health? And really, that was where the last seven years I've been working, and it was fascinating really, because I'd have a lot of interactions with industry, with academia, with other hospitals, and on reflection, not a lot of it was focused on women's health, A few was, but really not a lot. Why do you think that was, Lucy?

I think it's because there isn't really that much money in women's health. And I think if you looked at the areas where there was focus, it was maternity. And other than that, it was really quite limited. And I would ask the question to pharma companies and say, you know, where are the innovations in women health? And they'd go, oh, well, it doesn't really make us that much money. not of interest. And I think as women as well, we don't necessarily complain. We just get on with it, don't we? It's interesting, actually, this pharmacide. Let's just spend a bit of time if you don't mind talking about that because there's a lot of areas in medicine where things that move forward very

quickly. So if you think about cardiology and statins, for example, when I was a house officer, you didn't really have many statins and now we've got big choice. They've given a lot. GPs get paid to prescribe them. There is good evidence for secondary prevention. So if someone's had a heart attack, then they can be very beneficial. The jury is actually still out for primary prevention. And actually, the primary prevention in women. So primary prevention means to stop or reduce the risk of a heart attack in someone who's never had a heart attack. There's a lot of the studies been done on men, not women. So we haven't got really, really good evidence. Isn't that weird, that it reduces risk of a heart attack in women? Yet, as GPs, they're paid to prescribe statins.

But the statins make a lot of money for drug companies. And there's a lot of research that has been funded by pharma. And that's the same in some other areas of medicine as well, isn't it? When there's money from farmer that fuels research, therefore that gets translated quite quickly into clinical practice, doesn't it? Absolutely. And I read the book Invisible Women and was shocked to learn that it wasn't until, is it, 1993, when it was illegal for research not to include women? And I think that was astounding for me to kind of go, really? So how then, of all these medicines being developed without female bodies or hormones, obviously, that we have, been part of that?

And the impact that has on the studies that they undertake? It's incredible, isn't it? So I was talking, I met an old university, well, as old of me, so relatively old university friend last weekend. And there's a company called Medavan in Manchester. I don't know if it's still there where you could do experiments. And so as students, obviously, you're desperate to do anything. And so he used to do quite a lot because he could do residential ones. So he was studying philosophy. He wasn't studying medicine. So he had quite a lot of spare time. So he used to go and he used to get paid several hundred pounds. We were all really jealous of

John because he could go and spend this time. And they wanted young men for this research. The only research I could do as a woman was to donate my plasma, so give blood. And if I gave it caffeine-free, I would get 15 pounds. If I gave it with caffeine, so if I've been drinking coffee, it was 10 pounds. And I would still do it because I thought,

well, 10, 15 pounds is better than nothing. That was the only child. I could not get on any other trials at all. And at the time, I thought, oh, it's because they're worried that I could be pregnant, which is obviously the excuse that they always give. And I don't want to give you drugs

or whatever, do experiments on you because you're female and you could become pregnant, that would be really bad. But actually, looking back, that's outrageous. It's absolutely outrageous. Yeah. that we went to a lot of the drugs, they were never going to be terrestogenic,

they weren't going to ever affect an unborn embryo, but actually, why is it that all the research, all the studies are done in men? And we know that hormones are so powerful, aren't they? So estrogen and testosterone women affect the way our cells work and our body work and the function of every single organ in our body. Yet that's never accounted for, is it? No, and I count myself quite lucky,

because I think, you know, I've sailed fairly smoothly through my sort of puberty and into adulthood. And then I don't think it was until I had a child afterwards that for probably 12 months after having my first son that you go, wow, I didn't realize how powerful hormones were in how you feel and your mood and your memory and all of these things. And, you know, we talk about baby brain. And again, it's made a joke of, but we don't really understand then what underlies that. And therefore, okay, what do I need to understand? And again, from a research point of view, how is that investigated or looked into? Because all you get is a, well, all I had was a photocopy of a almost like a depression score afterwards to go whether I had baby blues or not. And then that was it. No explanation, no discussion. nothing more than that really. It's quite something, and this is really embarrassing, actually. I only recently put the pieces together and realised that the reason that I was getting nights before I was breastfeeding was because I had low estrogen levels. I thought it was just because of breastfeeding.

I didn't, even as a doctor, didn't really put two and two together. And then you think, like you say, baby blues, post-natal depression, well, of course a lot of it's hormonal, but how many of us get given hormones? And then it was only actually a few years ago we were allowed to prescribe the contraceptive pill to people who were still breastfeeding because we had to wait before until three months because there was a possible risk of clock. But actually, why aren't we giving HRT to some of these people? Why aren't we trying to improve their brain fog? You know, lots of women go back to work quite soon after having, I don't know, you, I didn't have my medical writing.

I never had a maternity leave. I needed my brain. And when you haven't got sleep, of course that's going to affect in the way you think. But then if you haven't got your hormones either, or you've had a big change in your hormones. And so, you know, we talk obviously all about the menopause and how poor research is into menopause, but let's look at PMS, let's look at post-edial depression. So these are still hormonal influences. And there's very little worked on on these, is there? Yeah. And I think they're kind of put into different buckets. And I think what I've found coming into this role is how, you know, silo the medical profession can be in that it thinks about its own condition and the impacts of that. And you kind of get a bit blindsided because all you're focused on is that element without really

necessarily opening your mind up to what else it could be. And certainly with hormones. And, you know, I still remember our first call where you said, you know, the impact that it has on cardiovascular disease, diabetes, dementia, osteoporosis. And that really took me by surprise how many different areas that were impacted. And then you go, so you start to join the dots. And I think in my previous role when you build a network of professionals, you join the dots more because you have these conversations. And that, that for me, is where innovation and the excitement starts to happen, because as you say, it's more like a light bulb moment happens and you go, oh, I never even thought about that. How did that come about? So, you know, from your perspective, how do you think

we start to have more of those light bulb moments, really? Well, I think they're starting to happen, But it's very interesting, because when you started, I started to go on and on about you, because we were in the middle of this pandemic. And I kept talking to you about the role of estrogen with respect to immunity, because we know it affects our immune function. We know women have better immune function than men when they've got hormones on board. And I said, you see, it's really important, actually, because we have got some studies from 17 countries showing that women who take HRT are less likely to die from COVID.

And so in my crazy way, I reach out to a lot of people all the time. And I used to think maybe one in 20 people respond. I now think one in 100 do because I fire off a lot of things, a lot of ideas, and very few people respond. And I think because they see the word menopause and they think, well, she's a menopause or crazy woman, which obviously I am, but they think the menopause is hot flashes. That's where they stop thinking.

And so since that, you've joined me on lots of calls about this, to eminent research groups to immunologists, to all sorts of research, as physiologists, pharmacologists, all sorts of people. And then the whole long COVID thing. We've also been looking, thinking, well, a lot of the symptoms of the perimenopause and menopause. So what's differentiating then we don't have a special test?

So we need to be asking people with long COVID. Could it be your hormones? Because then we can help the hormonal element. So you've been, again, on lots of calls with that. And I don't know how many research teams have we reached out to? So I have diligently been keeping a list of everyone that you reach out to. Maybe not that diligently because I'm sure I've missed a few. But there are over 80 different groups that we've been reaching out to globally as well.

And I think that's the key thing to say, you know, we've had conversations with teams in Brazil, in America, in Australia, and India. And I think all of them still are surprised. by how much we're championing the effect of hormones into different areas of the body, because it isn't really on their radar yet, is it? No. So we've had over 80 groups just with COVID and non-COVID, and the majority, I would say, have been with men, do you think?

Definitely. It has been. And I think that's where it's very difficult, because there's no real lived experience of the impact of hormones. I mean, I appreciate that men do have hormones. And I think they haven't thought about it, have they? And I realise how hard it is to make a change anyway, but how hard it is to tell people something they've never thought of before. You know, for me it's so obvious, but for other people, it takes a while and it's often two, three, four, five and more conversations until maybe the penny drops. But I think it's interesting because traditionally, the menopause has always been a gynecological specialty.

So when you have your training, if you do have any training as a doctor, then it's a gynecologist. And I've been thinking a lot about this recently. I'm thinking if I was a gynecologist, which I'm not, as you know, I would be interested in surgery and techniques. I would be interested in obstetrics because they usually go together. So obviously we know all about babies and maternity care. But the gynie bit is more about investigating women who have pain, have bleeding,

have endometriosis, have different types of cancers. Really interesting form of medicine. And a lot of it is surgery-based. So then if I think about the menopause, that's when our periods stop. And we experience symptoms and health risks. Well, why would I go and see a gylocologist? If I had an underactive thyroid gland, would I see a neck surgeon who operates on thyroid glands? I don't think I would.

No. And given that the symptoms aren't localized to that area either. No, well, in fact, you do. Normally, sometimes people get some heavy. periods, of course. Yeah. But a lot of people don't get any gyne symptoms. Your ovaries shrivel up. Yeah. Your wound doesn't do anything. And so it does seem a bit crazy, actually. And I also think there's huge demands on anything in secondary care at the moment because of COVID. There's a massive backlog. And also, it's a lot more expensive, isn't it, for the NHS to see someone in a hospital?

Absolutely. Secondary care referrals is the bit that they want to avoid. And I think, think, you know, for me, this is kind of where the prevention piece and the self-diagnosis and the support that you can get through the balance app to do some of the self-diagnosis. And I thought, doing all of my reading around the perimenopause and the menopause before joining News and Health, that it was psychosomatic because I was looking at all these things going, oh, I've got joint takes, I've got fatigue, I've got this low-level anxiety. I just thought that was because of the COVID pandemic and other things. And it's a lot of. It's a lot of, not until you start joining up those different symptoms and my age, you know, I'm 44,

I'm not at the nice guidance threshold of 45, but hey, you know, I could really relate to some of those symptoms and it wasn't until this job that made me go, oh, it's a perimenopause and I'm actually a bit of a hormone sort of bore to my friends now because I keep saying, do you think it could be a hormone? Do you think, have you thought about this? And now just look at me as if say, oh, she's not going to raise it again, but then they're also fascinated because nobody's ever spoken to them about it before. And it's very interesting, isn't it? Because I think the menopause has just not been spoken about by women, as you say,

but also by healthcare professionals. So we don't think about it. And a lot of you who are listening have heard me say before, how sad and embarrassed I am that I've missed so many thousands probably, but certainly hundreds of women who have got bond or menopoles or symptoms like joint pains like urinary symptoms headaches, low mood and I've never once thought about the manopause. And so if it's not up there thinking about it, then it's very hard, isn't it, to pick it up and certainly some of the work I'm doing and you're helping with NHS England is how do we

get it on the agenda? How do we make it interesting for people? And at what stage do we try and screen for the menopause or ask people or ask clinicians to be involved? But I always think the first question should be when we see a woman is what your periods like. Do you think any of your symptoms could be related to your hormones? Yeah. One of the first projects that I was involved in over at Dudley was think glucose. So when people were admitted for diabetes, they even had their own sticker. Not that we want a great big sticker on ourselves that says we're menopause or a different uniform, but at least something that makes you go, the question has been asked and we've thought about it. But it is think hormones, I do.

Or think periods. Yeah. So many women. I mean, when I was at medical school, I was sort of a young woman didn't have periods. Just make sure she's not pregnant. And if she's not, then don't worry about it. So therefore, I sort of grew up almost thinking, oh, well, young women don't we become menopausal. And so actually, yes, of course. But if we educate women, then we can ask them themselves, can't we?

Yeah. And that's easier. I mean, it's harder because there's no test. But actually, she's really important. So with the not-for-profit, obviously, we should. talked about research and it's not just COVID research. We're involved, we're getting involved, don't we? Yeah. Quite a few different projects that are happening. Yes, I think, you know, looking at mental health, at sleep, there was even, I just saw today a grant come out for

urinary tract. So anything to do with urology, you know, before I wouldn't necessarily thought, you know, urology in the menopause, but now I'm going, oh, actually, is there something there? Because HRT does fit within that innovation bracket. because it hasn't been adopted. If you think about what an innovation is, it's something that is used in one place but isn't used in others. Well, hormone replacement therapy with only 10% of women who are on HRT, actually, there's a huge opportunity for adoption of hormone replacement therapy.

But, yeah, the research is one piece, but then the education is the other piece and the confidence in the menopause course, how that's now being accessed by 18,250 healthcare professionals. and over 20 different groups of healthcare professionals as well, because that's the other exciting piece is that we're opening up that accessibility for whether it's a practice nurse, whether it's a pharmacist, a physiotherapist, you know, anybody can access it in any country as well to kind of go, oh, okay, I'm going to be seeing women, you know,

and actually, yes, I can now ask them about their periods and then understand what options are available to them and have a really informed discussion, which is what the education piece is there for. But equally, it's about listening and getting the feedback from others to say, well, how does it impact you in cardiology then? You know, you see women with heart palpitations. What information do you need to know about? And how can we turn that into some practical tools and support? Because I think we are very solution-focused in thinking about, you know, this isn't just a one-way push of information. It's about understanding

where there are still gaps in our knowledge that can then feed research. We can do the research which then feeds the education. So for me, it's that cycle effect. And back to my early days of plan, do, check, act with lean manufacturing. That's what it was about. It was always making sure from a continuous improvement point of view, we are thinking about what we don't know and how we fill that gap essentially. Yeah, and it's been absolutely amazing having you working with us

in looking at the education program because the National Institute of Health and Care Excellence came out in November 2015. So that's six years ago now, whereas you've already said 10% of women take HRT. Whereas the nice guidance, when they came out and they're still standing because of the evidence that the majority of women benefit from HRT. So actually, the guidelines are only as good as the dissemination. It's not about what's in them. It's not about the paper that they're printed on. It's about not only reading them, it's about doing it. And this is a big problem with any guideline, isn't it? It's only as good as the people who use them actively.

So when we developed the education program, I developed it where we've videoed consultations, we've got lectures, it's all evidence-based. But I wanted a really good platform for it because I thought there's no point me just hiding it on my website and letting the old doctor become involved. So as you know, we're working with 14 fish with great platform. platform that they've got. But when you started with us, we wanted to start pushing it out, didn't we, really optimising it? And we were going to make it just a low cost. And then we decided, didn't we? Yep. To make it free. Is that the royal we decided? Yes, I think so. Yeah. I think you

could understand my logic in doing it. And one of the reasons was because I'm so appalled and disgusted and upset the way that women are turned away from treatment, I thought it would just help. And the money is only one thing, really. And we want more money, or we want some money, into the not-for-profit so we can fund some research. But we're hoping that this will come. But the most important thing is for women to get help. We've got good research to show how safe HRT is. So disseminating this program has been really important, hasn't it?

And there's been a lot of work we've done on social media. We did a webinar, didn't we, recently, just to sort of wet people's appetite. But there's a lot of interest, isn't there, from healthcare professionals? There's a huge amount of interest. And the questions are really insightful into where they feel the gaps are in their knowledge. And you can tell there are a lot of the questions are coming from that nervousness on prescribing HRT and still that fear that it's related to creating more harm than benefit. And we know that that's in the front of their minds when they're thinking about, right,

I need to prescribe HRT, but what's going to be the safest way of doing it? Whereas, you know, what we're looking at for research and education is to provide some practical treatment pathways. You know, Alison, who worked with you on the confidence in the menopause course, supported us with in putting these treatment pathways together, where you can have a practical and sensible approach to how you then treat women, but equally we've answered a lot of the questions that they raise, whether it's a family history of breast cancer or endometriosis, You know, so I think it's about providing them with the knowledge around the areas that they feel most nervous about.

Because I think it's very similar to a role. My role before was looking at atrial fibrillation and the prescribing of the new novel oral anticoagulation drugs. And the main reason why they weren't being adopted was literally confidence in prescribing and understanding because they felt that there was a massive risk of bleeds. And actually, it was unfounded. So it's those things that you go, I can understand it's the same, you know, behavioral piece, which is why I think they work with NHS England and the behavioural team is really important because they do understand how to make some of that change happen at a system level.

And the NHS is a beast in order to change that practice because of it's not a whale, it's a shoal of fish, as we used to say. Yeah, and it's very interesting because a lot of the work we're doing is really trying to help the NHS. We're really trying to help as many healthcare professionals as possible and for women to access their treatment in the NHS. So with the education program, it's a very dynamic program. We're adding to it. We're changing it.

We're responding to the needs of healthcare professionals. And I think that's really important because I've certainly been to so many courses and I'm sure you probably have over the years. When you sit there and you think, actually, I've only learned one thing today. And I've had to put my children into it after school. I've had to get a train. I've had to get up, I've had it. And actually, you want something that's really responsive and what you want.

And we're all different into our learning needs. So we're shaping it all the time. And from it, we've also decided, haven't we, to set up a menopause society? Yes. Which you're again leading. You haven't got much spare time, I know. You're sort of heading up the society because, well, tell us a bit about what the society is, if that's okay. So the society is a multidisciplinary team

of healthcare professionals, looking at how we can improve women's health focused on the perimenopause and the menopause and looking at the impact of hormones in disease prevention and the maintenance of future health. The role of the society will be a subscription model where people can have become associates and from that will provide monthly webinars, podcasts, obviously not to rival this one, but to provide a different perspective from other health care professionals on the perimenopause and the menopause and practical tools and techniques in order to sort of help with their own management of women going through the perimenopause and the menopause, but looking at how we can almost catalyze research and education in this space across

the globe. So it will be focused internationally. And we've got some fantastic people on our advisory board from all different backgrounds to really help shape it to make sure that what we're not doing is missing out any particular area of medicine because we're keen to make sure that we respond to the whole person and that any aspect can be sort of investigated and we identify sort of subject matter experts that can really work with us to shape the content and any future research and education that we may have. So I'm really excited about the launch in January and I can't wait to sort of look at what conversations that sparks because I think that diversions. diversity of conversation and bringing multidisciplinary teams together with real different perspectives

and experiences can really spark innovation and who knows what will happen, but I'm really excited by it. Oh, I love it when you're excited. Yeah. It's a very different society because we're involving as many people from as many different specialties as possible, like you say, people across the globe as well. And also we're making it very cheap as well. We are. I drive people. people mad because there's no point having a very beautiful society that's very expensive and no one can afford. And I really want all healthcare professionals, regardless of their income of their part-time or they're newly qualified, their nurses, their pharmacists, whoever, to join or pelvic floor physios. Actually doesn't matter. I don't care who joins it, to be honest.

I think it's really important. And so we're just developing the website is nhmenopausesociety.org. And again, we're going to shape it. We're going to change it. We're not rigid. We're very fluid in what we do. But there's some very exciting times ahead. So I hope Lucy, maybe I can invite you back in against time and you can tell us how it's gone. Absolutely. But I'm very publicly very grateful.

And I'm very actually pleased that we met in the first place. Yes. Because these things, I always think, happen for reason, but it's been incredible watching and working with you and seeing how things have just escalated over the last few months. So, but before we finish, obviously I ask for three take-home tips, but I'm actually going to ask for one for women and two for healthcare professionals because we do have a lot of healthcare professionals to listen to this podcast.

So I thought it would be useful to ask for one tip. So how women might be listening to this or men and thinking, well, how can myself or my partner or friend get access? It's all very well when you're talking about education. So how can some patients, if you like, advise their healthcare professional, how to get the training? And then two tips for healthcare professionals, can they get involved, how can they get trained or how can they join, or what are the reasons

for joining the society? So if that's okay. So for women, I would say, never assume that it's just one thing and always do a bit of reading for yourself to sort of unpick what's going on and make some time for yourself. So I know it's a shameless plug for the balance app, but for me, it has all of the information and it really takes you to the point where you understand what's happening in order to get a diagnosis or at least the appropriate support because I think it helps you join the dots. And on the balance hyphen menopause.com website, there's a link for healthcare professionals. So there's a link there to the education program, isn't there? Correct. Which they can share with their healthcare professional. And I'd say for a healthcare

professional, it's about understanding where the treatment pathway can be supported with the balance at because again, it's about that two-way conversation and providing information for women to then allow them to have the right information to make a choice for themselves on what the best next steps are. I would say for healthcare professionals, connect with others outside of your specialty, because I think that's the best way to really expand your thinking in this space. And I know we covered it earlier, but we kind of said, could it be hormones? I know it's that, you know, famous, take that song instead of could it be magic? could it be hormones and hopefully that will be sticking in people's head now to kind of think about

it because it really could be and I think it's very underestimated in a lot of specialties so I just think it's about having that reflection about periods and hormones. Very good excellent so there's a lot of work that needs to be done but we've made a start my father actually always used to say the hardest part of any job is starting it so we've done that bit so maybe we've done the hard bit because I think We have. Yes. It's the next bit now which is going to be even much more fun. I hope so. So thanks ever so much, Lucy. And thanks for joining me today and giving up some of your valuable time. Thanks for bringing me on. For more information about the perimenopause and menopause, please visit my website, balance hyphen menopause.com. Or you can download the free balance app, which is available to download from the app store or from Google Play. Thank you.