The Dr Louise Newson Podcast - 135 - Tackling the Everest of menopause ignorance with Mariella Frostrup

Episode Date: January 18, 2022

Journalist and presenter, Mariella Frostrup, joins Dr Louise Newson for an energetic discussion and a whistle-stop tour through current insights and reflections on the way society approaches the menopause. Mariella talks about why she is ‘still banging on’ about the menopause, why you needn’t be afraid of HRT, and why it’s time to stop the silence and shame that surround it. In 2018, Mariella presented one of the first documentaries on the menopause and broke the taboo of celebrities speaking honestly about their own experiences. Mariella’s recent book, ‘Cracking the Menopause: While Keeping Yourself Together’, separates the myths from the reality and offers expertise, hope and advice for all affected by the peri/menopause. Mariella’s 4 hopes to improve the experience of menopausal women: Knowledge is our armour; we each need be more informed individually so we can combat the myths and ignorance we will be faced with. We need a trained menopause professional in every GP practice in the land and an invitation from the NHS for every woman to come for an appointment before the average onset of perimenopause, to let her know what will happen and how she can get help. There should be menopause groups everywhere, so everyone can find support and we should all educate our daughters about it. We need to ensure women are supported in the workplace so they can remain the valuable and experienced team members that they are. Find out more about Mariella’s work at www.mariellafrostrup.co.uk ‘Cracking the Menopause: While Keeping Yourself Together’ is published by Bluebird.

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 with me in the studio I have Mariella Fosterop, who some of you might know from all the amazing work she does, but some of you might know because she really did one of the

first menopause television programs actually about the menopause and really started the conversation. Since then, she's brought out a brilliant book called Cracking the Menopause. And I just thought I would get her here today in the studio really to talk about things that she's learned and what she feels about the menopause and if things have improved over the last few years since you've been talking and thinking about it. So welcome today, Mariela. Thank you very much. I'm so honoured. You are literally the empress of the menopause. So I am but a small little weakling in your great orbit. Oh, no, don't say that. I'm not at all. I've just got a big mouth and I'm really cross, actually. And I never wanted

to be this person. I really didn't. And when you did your program that you were very, brilliantly presented. I remember doing a bit of Twitter and then I stopped and I was getting really, really cross actually. And we can talk about why I got cross in a bit, not with you, but I hasten to add. And then, oh, just the more people I speak to either in my clinic or just on social media or literally in the street or in the supermarket, I just can't get over the suffering that's going on. And I'm not sure it's really improved much since your programme. So what your thoughts? Well, it's so interesting. You say, you know, talk to you about, what I've learned. Well, I mean, we could be here for weeks because honestly, I've learned everything,

but retrospectively in a way. And that's the situation I think, you know, the vast majority of women find themselves in. And I'm so with you on the rage. I mean, I know it's a menopausal symptom, but I don't really think it's to do with my actual menopause that I'm raging, but more to do exactly, as you say, with the injustice and the ignorance that we all seem to be experiencing, confronting something which is manageable, which is totally understandable, which should have no great secrecy wrapped around it. And, you know, the more you learn, the more empowered you are to kind of deal with it. And yet, ignorance seems to be the state that we've been left in for millennia. And it's fascinating to me because you sort of talk, I've worked a lot on women's issues

over my decades and, you know, always been a proud and loud feminist. So it was really shocking to me to find that I reached this kind of liminal stage in my life. And I walked into it absolutely pig ignorant. And, you know, I'm ashamed about that, but I'm also bemused by how with all of the information I've taken in over the years about, you know, women and women's lives and the injustices that women have to cope with. To find myself in this situation was really, really surprising to me. And as you say, you know, we've all been working on this now for quite a few years. And I keep thinking, oh, menopause, menopause, menopause, everyone knows about menopause.

Why am I still banging on about menopause? And two seconds later, a woman will walk up to me in the street or at the train station or in the train carriage. Sorry, I've got trains on the brain because I just got the train home. or, you know, in a toilet, in a restaurant, and say, you know, I'm feeling this and this and this. Do you think it might be menopause? Or we'll slide a hand onto my back and go, thank you. Thank you so much for what you've done. And you think, I really, A, haven't done anything in particular.

And B, the scale of gratitude is only illustrative of how little women are taught about what's going to happen and how to cope with it, how to be supported through it, you know. I mean, it's not a medical condition. I mean, it's a biological change that happens to 50% of the population. And yet it is one of our greatest secrets. Yes. And how wrong is that? And actually, it's very interesting, isn't it?

So it isn't a medical, for most of us, it's not a medical condition. As you say, it's a natural process. But actually, it has so many health risks associated with it. It has more health risks than high blood pressure. And we would never ignore high blood pressure. We would never ever be able to train as GPs or in secondary care without being able to take a blood pressure. So how on earth can we get away with being healthcare professionals knowing nothing about even to how to diagnose the menopause? And as you say, how can we as women not know what's going on?

And it's really awful, isn't it? I mean, I've been always very interested in the menopause. And I remember sitting in one of the clinics just after the nice guidance had came out six years ago. and I remember saying to the consultant there, how do you really know when a woman's perimenopausal? It's easy when they're menopausal or if they've had their own reasons. How do you know? Because there's no test, as you know.

And he just said, well, usually it's quite obvious, Louise. And I remember coming out and thinking, oh, really? And then literally about two or three weeks later, starting to work on my website, trying to build up my own clinic and just feeling dreadful. And I just thought it was all because I was working too hard. and the brain fog, the concentration problems, the memory problems, the rage that I really was getting, especially with my husband,

the poor sleep, the anxiety, even the night sweats, the muscle and joint pains, the back-to-back migraines, never once did I think I was perimenopausal. As a 45-year-old woman, it didn't cross my mind, writing every night, or trying to write, but I was too tired, about the menopause. And I'm just like, how on earth? Because I think our brains don't work for a lot of. or sereneopausal or menopausal. So any common sense just goes, because all we're trying to do is string together a sentence that makes sense, or we're trying to just make supper that,

you know, we just can't function. So even when it's staring at us in the face, we don't always recognise it. I don't even know that we can't function. I think that we go in and out of phases when we struggle to function. But I think we give ourselves an incredibly hard time as well. You know, for the vast majority of women, approaching your 50s and entering your 50s is a really traumatic time anyway. We live in an incredibly ageist society. The word menopause makes people, you know, shudder in horror because of the mythology that's existed around it for centuries. You know, we've had leeches applied to our vaginas to drain the toxic blood from our bodies. We've been described as deranged. We've been burnt at the stake. You know, the catalogue of

of great injustices that have been done women. You know, it's too long to go into in a half-hour podcast. But the fact of the matter remains that there are so many forces arrayed against a kind of balanced, relaxed approach to your 50s anyway. And when you're then blindsided by something, which as you described so well, you know, has myriad symptoms, is not in itself a medical condition, but actually is the catalyst for any number of medical conditions or can be. You know, you're actually expecting people, women,

to cope with a phenomenal amount all in one kind of great, perfect storm. And, you know, for most of us, the thing we're looking for is a hot flush. You know, if you have a hot flush, oh, gosh, what was that? Yes, oh, that means I'm menopausal. And yet nobody's told us about any of the other symptoms. And I mean, you're a doctor. And I've met so many doctors like you who talk about their own, you know, learning process when it came to menopause, mostly as a result of them entering it. And that, you know, to me is one of the greatest crimes of all is that, you know, we have brilliant medical professionals in this country, trained, you know, fantastically well in myriad diseases and conditions.

But menopause gets no training. You know, it's a half hour in the great span of fertility, and it's the half hour that's kind of glossed over because nobody really wants to talk about it. Anyway, so, you know, the scale of ignorance about it and the level of stress and trauma that so many women experience, I think, is off the scale. You know, so the idea that not a lot has changed, I think is, on the one hand, yes, it's frustrating that not enough has changed. But the fact that you and I are sitting here talking about it is already, and that's what's so scary about it, is already a fundamental change for the better. And we're clutching at straws here because actually the immensity of what needs to change is really quite daunting. It's a kind of Everest that we need to ascend and conquer. And, you know, we're getting there, but incrementally one kind of rung at a time.

and it really needs a sort of seismic change because there are too many women out there suffering, even as you and I are sitting here speaking quite frankly about it, suffering in silence, suffering in ignorance, suffering symptoms, they don't even connect with it. And then worst of all, going to doctors who patronise them, who put them on antidepressants, who don't understand all the other symptoms that they can be experiencing,

and therefore aren't in a position to give them the support they need. Yeah. There's just so many levels and so many layers that need sorting out. But it is huge, the problem. And so what I've been trying to do is think about all the injustice, think about how to reach more people and how to really make a bigger change. And as you know, I'm doing an author of work with NHS England as an advisor for their National Menopause program. But what I've been trying to do is take women out of it and take suffering out of it.

So let's forget that women are suffering. Let's forget that they're absolutely distraught a lot of them, not all, as you say, but some of them really are on the edge with their symptoms. Let's forget all that. But let's think about the economic cost of women giving up work. Let's think about that. Let's think about the economic cost of them not being able to look after their partners or their children because some people really can't.

Let's think about the economic cost of, as you say, the antidepressants, the investigations that are done for palpitations, for brain scans, for memory loss, for muscle pains or joint pains. having x-rays, scans. Let's think of all the specialists that they see. So cardiologists, neurologists, psychiatrists, you know, let's think of the cost of the healthcare systems. And then let's just look about the costs if these women just have their hormones back, which is obviously it's a hormone deficiency. If a woman goes to see the first healthcare professional, they know and says, I think I'm menopausal or perimenopausal, can I have my own

hormones back? Yes, of course you can. Here you go. Off you go. you're saving so much money. And that's where people have to wake up and listen, don't they? Because I think there is so much suffering for women we've already said. That's always happened. But even if you take women out of the equation, there's enough there that means that anybody should be worried around it, whether they have a company with women working in them

or whether they're running a health service that needs to save money. It's just awful. I mean, I'm desperately Googling here, actually. if you see me looking down because I'm trying to find there was a report the other day about the number of women who leave the workforce in their 50s as a result of the menopause. And I haven't found it yet. But I mean, the statistics were huge. But it depends what you mean. So it's about 20%. Yeah. So it's about one in five. We did a survey recently of 3,800 women and 99% of them had symptoms affecting them at work. And 50% said that they'd either retired early or left their jobs.

So that's horrendous. Absolutely. horrendous. And I'm interested in you talking about, you know, the fact that hormone depletion means supplement your hormones. It seems to me as a non-medical person, an absolute no-brainer. And yet, that is probably the most controversial thing of all. I mean, I'm quite keen to, and it's a challenge, to talk positively about it. Because I think that for too many women, And it is seen as this impossible traumatic period that, you know, they don't know how they're going to get through or even if there is a process by which you can get through it and kind of emerge at the other side feeling differently. But I think we probably have to deal with the negative things, first of all. And the thing about HRT for me is the greatest crime of all.

I mean, why there hasn't been a class action as a result of that 2002 survey, which then, you know, public. results that none of the medical team employed in conducting it were happy with that put, you know, hundreds of thousands of women off HRT who could have been taking it and has left them with heart disease, with osteoporosis, you know, with so many conditions that they weren't even aware they were in danger of. And so it feels to me like the thing that has to happen is twofold. On the one hand, we have to seriously address the support side of it when it comes to what modern medicine and modern hormone replacement can do. And we need to demystify the whole issue around HRT and all the sort of speculation about whether it's bio or body identical and whether you can take

it if you've got a history of breast cancer in your family or not and all of those things. And that really needs a kind of medical training revolution. That needs menopause to actually become something that is properly studied and people emerge. qualified with and are therefore able not to sit and go, oh, I don't really rate HRT, which is, you know, one of the things I've heard women coming back from the GP surgery with. Who cares whether he rates it, and it is generally a he, rates it or not? The fact of the matter is hormone depletion means you need to top them up. And if you don't, then you're going to end up with serious conditions as a result of it.

But if you do get the right combination for you, which is a basic human right as far as I'm concerned, and should be something that women are talked to about in their early 40s. You know, every woman should have a health checkup in her early 40s where she's told about the menopause, talked through the many symptoms, talked through the choices she can make in order to support herself. You know, some of them just being healthy lifestyle choices, you know, weight-bearing exercise and maybe switching from white wine to red and, you know, eating more healthily and all of those things, you know, which do make a difference.

along with what HRT is, what it means, not this kind of, you know, terrifying, emblematic thing that spells breast cancer, you know, when actually nine glasses of wine a week are going to give you much more of a chance of that. And then to understand that centuries of propaganda have made us feel redundant. And we are anything but in our 50s and upwards. You know, the reason that evolution has favored us with menopause, you know, we're one of only two mammal species who have it, and the others are matriarchal whale pods, because older females in those pods are considered to be of such immense value to the pod that they need to have a period of time when they're not procreating in order to be able to use up all this other knowledge to help. And, you know, we are very much

the same as those, you know, whale pods. We are in many ways a kind of matriarchal society becoming and the knowledge and wisdom and confidence and strength that women have once they're equipped to get through this liminal phase are really, really incredibly valuable to society. And we are never told that. Women are never told that. And to me, that is, you know, alongside the medical side of it, which obviously I'm not well versed in, apart from the fact that I've encountered continually the ignorance, is the whole social and cultural, you know, mythology around it that needs to be broken down and addressed. Yeah, absolutely. And it wasn't really until I listened to the stories that I do

and heard about the suffering that I realised the bigger impact it has on other people. So it's not just something that happens to us as individuals. It has this ripple effect and it affects so many more. But you're absolutely right. We have got good evidence. We need more studies, but no one really has done really good studies in the last 20 years because there's no funding. We've had so many grants turned down. I can't even begin to explain how hard it is to get research in menopause. But even the evidence we have. But Louise, why is that?

Because if you think about it, the amount of money to be made from selling us the things that will make our lives easier in this period is phenomenal. I mean, even as a business brand. Yeah, I totally agree. So even if you look at COVID, okay, we're now maybe working from home. we don't know what our rules are. They're changing all the time. Everyone's scared about COVID and it's been here for a long time. Quite early on, we could see that men are more likely to die from COVID, more likely to have more severe COVID. And right at the start, I said to my husband,

estrogen's to play here. And he said, Louise, will you stop thinking about menopause of everything that you do? And I said, but it's obvious. We know that women with estrogen in their body, whether they're just young women or their women taking HRT, have a better immune system because estrogen can stimulate our white cells. It can help the way they work. It can genetically mean program in them. It can make them function better. And it can also attenuate this cytokine storm, which everyone was talking about very early on about these chemicals in the lungs that were just getting out of control. And I said to my husband, I'm sure there's more to it because we know that women on HRT have less severe Ebola infection, better with HIV, they're better with

hepatitis C. You know, estrogen's an antiviral. And then I managed to find a the study of 17 countries, world data, really good data, showing that women taking HRT had more than 50% reduction in mortality from COVID. So we've got really good work showing that there is some protective effects. And then someone, Hugh Montgomery, who you might know, he's been in the news a lot, he runs a moving ITU in London, amazing man, very clever. And he said as a pass-the-way comment, one of my colleagues, right at the beginning of the pandemic, when his ITU was flooded with people,

he said, right, I'm going to come back as a woman on HRT. I've not once seen a woman on HRT in my IT unit. And he still stands by that. And it's now further on in the pandemic. But no one's doing any research. I presented some data to Chris Witty and the team at senior clinicians meeting about a year ago. And they said, gosh, this is really interesting.

We need to do more research. And when I've spoken to researchers, they've said, yes, for estrogen causes breast cancer, doesn't it? Why would we give that? And it's like, really, no, it doesn't actually. Women have a lower risk of breast cancer. And then they say, yes, but that's women. No, actually, men have estrogen in their bodies too.

And I know if my husband was poorly with COVID, he would have a bit of gel rubbed on his body if it would help boost his immune system. Of course, it's, you know, short-term estrogen in men and women is safe. Yet there's nobody doing studies on something that costs pennies. Every day we're reading about these biological agents that are very expensive that have long-term effects, that affect the immune system by damping it down.

But we want our immune system to be really powerful and strong. And, you know, we've got thousands of women, about 20,000 women in my clinic. None of them have really been affected by COVID, whereas they have partners that have. I can't tell you whether, of course, that that's definitely proof, but isn't there enough signals that we should be doing

some really good studies looking at this? Because we need a get out of jail card for this, COVID, It's not just menopause, though, is it? I mean, it's women's issues right across the board, you know, particularly when it comes to medical things. I mean, I've been so happy in recent years to see more female CEOs of, you know, small companies developing things like the LV, you know, the pelvic workout and that brilliant LV breast pump, you know, which I remember having these two breast pumps that were like

something out of a Ukrainian milking factory, you know, that were, eh, eh, eh, eh, and, and, you know, suddenly a woman puts her mind to it and suddenly you end up with a little thing that subtly slips into your bra and you can be kind of doing your work, you can be doing a Zoom call, you can be cooking dinner, you can be doing anything and pumping your breast milk at the same time. And I just think that, you know, all of that is desperately needed and, you know, slowly changing. But I wanted to ask you something, which was one of the things I've got quite annoyed about. One of the many things is, okay, so I designed this book to be in every way really accessible. I wanted it to be able to be read by younger women, older women.

I wanted it to look friendly and appealing. You know, we designed the jacket specially to look, you know, with all its bright colours. And come on, we've cracked the menopause. Let's, you know, talk about it and think, I, the other day, had my first day off in about three months. I was on Marlaban High Street and I popped into Agnes B, as you do. And there was about 12 women my age all looking at kind of tank tops and nice shirts. And I thought, my goodness, this is a hotbed of men.

menopausal women this street. I'm going to go across the road to dawns and I'm going to have a look at my book. I love it. Yeah, yeah. But I thought I'm going to have a look and see my book piled on the tables because obviously it's a gorgeous looking thing and it's also been had so much attention and traction around it. It's going to be sitting there and I'm going to admire it. I walk in. I can't find it anywhere. I see a young man who works there and I think will he recognize me or not? And I sort of thought, no, I think he's young enough not to. So it won't be too embarrassing. So I said, do you buy any chance of a copy of cracking the menopause. And in the end, it turned out, he sort of looked at the computer, and he looked at the shelves, and he sort of said, instead of you tried women's health,

and then he looked at the community, and he said, oh, yeah, we had a copy, and we sold it. And I said, oh, okay. And have you reordered? And he said, no, but that's a good idea. I'll just reorder one now. I said, one. So then I was on a mission, and I went off to Waterstones on Piccadilly, looked all over the ground floor, all these wonderful tables, heaving with nonfiction about all kinds of things that not a single woman on the planet, would be interested in from cars to bars. I mean, I'm sorry, but it really is the case. And then I finally asked someone in Waterstones, and they said, oh, if we've got a copy, we might have one copy up in women's health on the sixth floor. And I go up to the sixth floor.

And aside from anything else, the women's health shelf is one single shelf in a seven-floor bookstore. And yet we are 50% of the population. And what I suddenly realized, which infuriated me, so much, which is why I'm banging on about it, is that actually, I'd say 90% of my book sales have been on Amazon, and not because I'm particularly promoting Amazon or anything like that, but because I think that there is still stigma attached and there is reticence when it comes. I mean, your book is a Sunday Times bestseller. I haven't seen it on one display table, Louise, not one. No, you're absolutely right. And I even said to Penguin, is it going to go in the supermarkets? Because I think on Tesco and Asda, it would be quite.

great. You know, one of the books is just to go to, oh, no, no, no, we haven't pushed it for that. We don't think it would be appropriate. Well, I'm really sorry, there's only so many cooking books that I can have on my shelf, and there's only so many diet books that you can buy, and they're always there. And you're honestly right, whenever I go into Waterstones, I'll have a look for your book, my book, and I want to pull them out onto a table, because why are they hidden? And it's not even really a women's health problem. It is just something we should all know about, whether it should go in the children's book section. It should I think they're the perfect stocking filler and this isn't, you know, I mean, I didn't write this book thinking I was going to retire on the proceeds.

Alice and I wrote this book because both of us, you know, coming at completely different ends of the menopause experience, her going into it and me coming out of it, both of us were just so shocked at our own level of ignorance and the level of ignorance and shame that we were feeling whenever we tried to bring it up and talk to other women about it. And I think, unfortunately, that the mythology is actually as important as the medical with this, because it's sidelined. It is treated like some sort of niche minority interest topic. And yet it's so far-reaching, so, you know, all-encompassing when it comes to the impact it has on men, women and children, if you will, that it's a crime against humanity that it's not being embraced and elevated. Well, it totally is. And it's also not just a phase, is it?

It's not just a new type of diet, which is going to be gluten-free one day and then an Atkins diet and then something like, keto diet, whatever. This is something that is here to stay. Women, as long as women live, they need to know about the menopause. And it is absolutely awful that it is just pushed under the carpet. And when I try and educate healthcare professionals, they go in two camps. So we did an event through this society that we're launching through my not-for-profit the other night. We had 80,100 people joined healthcare professionals. Really lovely support, amazing.

You know, they couldn't get enough information from us. There are other people who I speak to a healthcare professional say, do you know what, we're too busy. We can't do the menopause. Get away from us, sort of thing. And they're the ones that are often giving out the antidepressants and saying it's not a problem. They don't see it as a health risk.

They don't see it as something that is really detrimentally affecting women's future health. And we've got to change it, actually, where we think, actually, we have to find out. And obviously, I'm not saying every woman has to take HRT, but every woman has to have responsibility for her future health. And none of us really want to end up in nursing homes. I want to be able to use my Zimmer with strength. I want to be able to get out of the bath. I want my husband to hoik me out of the bath because I'm so weak because I haven't got muscle strength.

No, absolutely. But also, it shouldn't be a lottery for women. in terms of the treatment they get. You should be empowered to be able to decide whether or not you want to take HRT, but that should be based on facts, not on swirling mythology. And you also should have the right to have access to someone who understands what you're going through. And that is a fundamental, a fundamental. It totally is.

So I spend a lot of time trying to think, how can I reach women who I wouldn't know otherwise? And so I'm always thinking about how to reach people who don't have English as their first language, people who are more deprived. I recently wrote a newsletter that went to every single prison inmate. And in prison, they don't have mobile phones, so they can't use the balance app. Often the only healthcare professional, they have access to us as psychiatrists. Now, we're doing enough of work with the Maudsley Hospital, as you know, a great psychiatric hospital. And the treatment guidelines for depression do not even mention the word, menopause, or female hormones, or, estrogen or anything. So we're developing some guidelines and we're educating their staff,

but it's taken a few years to actually get them on board. So, you know, if you're an inmate in prison and you have a mental health disorder, which is exacerbated by your menopause, you have no one to help you and you have no one to talk to. So this, we wrote this, oh, I wrote this piece with their newsletter and it's had amazing feedback. But that's just the tip of it. the iceberg, you know, women are not being picked up, they're not being realised what's going on. And I think a lot about domestic abuse, actually, and how much that must increase during the perimenopause and menopause. And if you are a woman that's very vulnerable and you've got reduced self-esteem and low levido and a partner who is really struggling with you and thinks

you're changing and doesn't understand either, abuse is going to increase. The women who are abuse think they deserve it because of the way that they feel. And often there are children involved as well. And, you know, this is no one's fault, actually, but it is the fault of healthcare professionals and society that we're not picking these people up. We're not helping them. I think we have to start with society because healthcare professionals will only prioritize something that society deems important. And to me, you know, I think that it's very hard to keep it upbeat around the menopause because there's so much depressing news. But I do think that there is something, you know, the other day in Parliament Square after Carolyn Harris managed to achieve that

kind of historic triumph, I mean, minuscule in really in the great scheme of things, but enormous for women in terms of, you know, reducing the cost at least and making HRT not at least a socioeconomic consideration for a sway of the population, though unfortunately, I mean, it should be free and and it still isn't. But when you get a group of women together like that and you see the power and strength, you know, the reason that that success was achieved was because there was a cross-party alliance of women at the age when menopause registered with them and they understood it to be a priority and they understood how much it needs addressing for the rest of the female population. And we have power, we have huge power, but only when we lean in,

you know, I'm afraid in the words of Cheryl Sandberg. And we club together, which is something that we haven't really understood, I think, the power of we've done it naturally, but not with strategic effect. And I think one of the really fantastic things about what's happening with what I would deem a kind of menopause revolution going on at the moment has been the sort of collegiate way in which everyone who's involved in this area has kind of got together and supported each other. for you to support us has been such an enormous privilege in terms of Alice and I and our book. But, you know, I think that that's how we're going to move forward.

You know, this isn't an issue about, you know, marketing a load of things to people cynically kind of taking advantage of their vulnerability. This is really about empowering future generations to not have to go through the ridiculous, you know, hurdles that we've had to navigate in order to simply get the support that we need and deserve and we've paid for all our lives with our national insurance contributions. Let's not forget that as well. And aren't getting, you know, and it is fundamentally wrong and it's an injustice that every time someone patronizes me and sort of goes, oh, well, equality. I mean, we're there, aren't we? I think we're absolutely not. And it's for reasons like this, the really important stuff.

You know, I don't care whether I've got freedom to sleep with as many people as I want to or not. To me, that is far less useful than being able to navigate the menopause, you know, because I know that it's going to happen to my daughter as well, and it happened with my mother, and it's going to happen to my daughter's daughter, and so on through history. And we need to be informed, and we also need to feel empowered by it. Because I think one of the most important things to me is for other women to understand that this is not a death sentence. It's not a kind of shove you on the back shelf or in the corner of the room and just stay there quiet and just live out the rest of your days without getting in people's way because you're redundant. It's actually an incredibly powerful time for us as women when suddenly we have confidence in ways that we never expected to be feeling it. And if we channel that in order to change the status quo now when it comes to menopause, what we're doing is we're liberating whole. generations that will come after us to have that incredible empowering passage rather than the

cowering one that we're currently, you know, enduring. I love it. So, it's so good. And it's, no, it's brilliant. I wish we could, well, I'll get, I'll get you back and we'll talk further because you're absolutely right. There is so much. But I do feel it is like a movement. We are making a difference. And I'm very negative person and I think about all the things I haven't done rather the things I have done. But none of it is me. It's about a massive team of people. And we're all working together and we're not competing with each other. We are just trying to help more people. And it's very exciting, actually, I think. I really feel people are starting to listen. So I'm really grateful for your amazing word, very powerful words. Mariella. And I think anyone

that's listened will agree. It's been really stimulating. So thank you. But before I finish, I would just like three, I always ask for sort of three take-home tips, but I don't like to ask three things that you think women working together will make the biggest difference on over the next few years. Oh, that's a tough one. Okay. I thought I challenge you. I think first and foremost and perhaps most imperative is our armory is knowledge. And without knowledge, we can't achieve anything when it comes to menopause, you know, because there are too many people out there prepared to patronise us, ignore our symptoms, misunderstand what we're trying to express. And so we need each individually to arm ourselves with the knowledge. And that's what you do

so brilliantly with your balance app. It's what I wanted the book to do, which would just give anyone who read it, just a basic grounding in what's going on so that when somebody says something to you that you think you don't agree with, but you're not quite sure why, then maybe it'll give you the tools to be able to turn around and argue it. I think that, you know, the very first thing, you know, the very first that we need to have is we need to insist on a trained menopause professional in every GP clinic in the land, you know, and it can be a nurse. You know, one of our running little mum's running group that we have is a nurse and she listened to Alice and I banging on every day, or not every day, but the once or twice a week that we do our little run. And she decided

on the basis of it, not she's in her early 40s, to go away and train in the menopause. Now she runs free menopause clinics around the Somerset area that I live. in. And, you know, that is a hugely powerful thing because that means that every once a week, you know, women are walking into her clinic and they are learning about what's going on with them and they're getting the tools with which to kind of navigate it and increase their ability to cope during what can be a difficult period. So I think a trained medical profession in every surgery in the land, I think also an appointment for every woman in her early 40s, an invitation from the NHS to come and talk to a doctor like a midlife health check.

I mean, I think every man should be having a midlife health check and a prostate test and things like that as well. But I'm sorry, but I'm talking about women now. And so every woman in the land should be called in by the NHS, invited in and have somebody sympathetic and informed to talk to, to prepare them. Because the amount of money that we would save the NHS by early interventions in terms of topping up hormones and all of those things. I mean, you know, I had no idea that a lot of the detrimental stuff that happens invisibly in my body as my hormones decline starts happening in your early 40s.

So there was at least seven years that I could have been topping up and, you know, not ending up osteopedic on the cusp of osteoporosis just because I hadn't known that HRT would help to improve my bone density. So I think it's very, very important, you know, on the medical front, those two things I think I would definitely want. And then, I don't know, like, you know, do you remember when there were Tupperware groups? And people used to go around to women's houses and used to buy your Tupperware. I think there should be menopause groups. Like there are book clubs, you know, there should be menopause groups where we support women.

Older women who've gone through it can talk to younger women who are going through it. And every single one of us needs to talk to our daughters. And again, that's something that we can all do together, that we need to do together. We need to support each other because there are still so many women out there who are embarrassed to talk about it and who are treated with derision. Both in the work. I mean, the other thing, of course, sorry, fourth thing, is the workplace. You know, we need to ensure that women in the workplace are supported through their menopause so that they can remain the valuable and incredibly well-functioning and massively experienced members of the team. that they are by the time they hit midlife. And that, again, is essential and that they have

rights in the workplace. I mean, I don't know a single woman who's ever phoned up and gone, I'm sorry, I'm a bit menopausal, I can't make it in today. But I will feel that we've really succeeded when every woman in the land feels that that is a viable thing for her to be able to do. You know, not to phone up and pretend she's got, you know, cramps or, you know, pretend something But to be able to go, do you know what, I'm really feeling menopausal today. I'm really sorry, but I'm going to work from home. Yeah, we've got a long way to go. But I think the more we can work at it, the more the menopaus will be a positive rather than such a negative condition for so many of us. So I really appreciate you for your time today. It's been absolutely brilliant. And for any of you that hasn't read the book, we will put a link in the notes, cracking the menopause with a lovely bright cover that we should be seeing more in the bookshaws. And actually, any of you who are listening, I challenge to go to your local book still, as Marielna did with Dorns and find where the copy is.

Yeah, ask for Louise's book. Ask for my book. And I'd actually think that your idea is absolutely genius. These books should be in supermarkets. Because, you know, people don't mind, you know, keeping supermarket books as the sort of books, the titles that they think will appeal to women. Well, I absolutely know for sure that women want to know about the menopause. So please, get rid of some of the cookery books. We've seen. seen them all before. We've cooked everything and actually we're not going to do any more cooking until things change with the menopause. How about that? That's laying down the gauntlet. Very good. Great way to end. So thanks ever so much, Mariana. Thank you very much. For more information about the perimenopause and menopause, please visit my website, balance, balance, or you can download the free balance app, which is available to download from the app store or from Google Play. You know,