The Dr Louise Newson Podcast - 143 - Fertility, pregnancy and perimenopause with Rhona and Tanya

Episode Date: March 15, 2022

In this episode, Dr Louise Newson is joined by two women, Rhona and Tanya, who share their experiences of fertility support, pregnancy, and having symptoms of low hormones after the birth of their children. Rhona asked the fertility specialists whether the hormone treatments she was taking to become pregnant would affect the onset of her menopause and she was told that it wouldn’t. 18 months after giving birth while still breastfeeding, Rhona experienced severe symptoms due to low hormones and spent 2 years suffering and seeking help before a friend suggested it could be her perimenopause. After seeing a menopause specialist and finding real improvements with HRT, Rhona wants other women to be aware that problems after childbirth might not simply be ‘baby blues’ but could be the start of perimenopause. Tanya also had a child with the help of fertility treatments in her 40s, and during screening tests it revealed that indications of perimenopause had begun. The IVF was successful, but after the birth of her baby and a relocation, Tanya’s mood plummeted and she experienced a range of symptoms caused by low hormones. Her GP offered antidepressants, but Tanya didn’t think it was postnatal depression and knew her hormones were involved. Tanya is now pregnant again and is apprehensive about what will happen due to low hormones after her next birth. Louise explains what is – and isn’t – known about hormones during pregnancy and in the postnatal period, and why this can affect women so much in the months and years after birth. She describes the benefits of topping up those hormones with HRT and the multiple improvements it could bring to women at this challenging time. Rhona and Tanya’s advice for women thinking about pregnancy and perimenopause: do you own research and seek medical help if you have perimenopausal symptoms don’t be scared to try IVF, but know the possible effects of low hormones after birth, especially if you’re in your 40s be aware of what your own body is telling you before you start fertility treatments, are there signs you could be in perimenopause? If you choose to do extended breastfeeding, know that your hormones will be low and this may cause symptoms For more information on breastfeeding and HRT, postnatal depression and another personal account relating to post-pregnancy hormones: https://www.balance-menopause.com/menopause-library/breastfeeding-hrt/ https://balance-menopause.com/uploads/2022/02/What-is-reproductive-depressionfinal-with-links.pdf https://www.balance-menopause.com/menopause-library/my-story-of-hormonal-depression-when-my-hormones-change-i-change/

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 Wellbeing 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 on the podcast, I'm very delighted to introduce you two lovely ladies. So Rona and Tanya, who are both very kindly agreed to share a bit of their stories. And we're going to talk about something today that we've not talked

before on the podcast. So this is about pregnancy, about fertility problems and breastfeeding, and how perimenopause and hormones might fit in with all of this. So quite a lot of to get through in the next half an hour. So welcome both. Thanks for joining me today. Thank you. Thanks, Louise. So, Rona, if we start with you first, are you able to just spend a few minutes talking about sort of your journey and why you've sort of reached out to share things today? Yeah, absolutely. So we tried to conceive for about four years before we had our daughter. And I was 39 when we started trying. We tried naturally for a while. Then we had three the IUIs, one of which was successful, which ended in miscarriage, two, didn't work. Then we had some

assisted cycles where you're using the medication and the injections that you would for IVF, but they don't actually conceive the baby in a lab. And then we had eventually one IVF treatment, which was successful. And I remember along the way asking various health professionals, would this have any effect on menopause in the future. And they all said, no, that it wouldn't. So then I had my baby and I breastfed her for three years. But when she was about 13 months old, I started noticing some quite severe symptoms. Extreme dry eyes, extreme dry skin. My hair started falling out quite dramatically. I had mood issues, anxiety, which I'd never experienced before. Sleep disturbances, which of course you put down to having a young baby.

Brain fog, again, everyone tells you, it's the baby brain. But I just didn't feel myself. Really quite dramatically didn't feel myself. And I was crying a lot. It didn't feel like a depression. It wasn't like the, I didn't feel it was baby blues. So I went to, I think I was, we always have kept in touch with our fertility doctor. He was amazing.

And I'd asked him, you know, reached out for help to see what it might be. And he, you know, didn't really have any answers for me. So I went to my GP and they ran some blood tests and, you know, everything normal. I started consulting with a nutritional therapist who was amazing and she did. Things started to improve, obviously, as if you know, if you're eating well, she found out that I had gluten intolerance. You know, I was just generally being healthier, which did help, but nothing helped enough to resolve, you know, my symptoms.

So it was only actually in a conversation with a friend, a very good friend of mine who suggested I might be perimenopausal. And I remember at the time being quite offended that I could be possibly perimenopausal, but I was 46 at the time. Right. And a seed was planted and I started to think about it and I started to do research and I thought, oh my goodness, I am perimenopausal. All these boxes were being ticked for me. So I went to my GP and I said, I know what it is. It's perimenopause. and she dismissed it and said no, it's not perimenopause. And it could be endometriosis and I'll send you for a scan. And I knew in my gutt it wasn't endometriosis.

I was having very heavy periods, very long periods, like 10 days. And I was having them every three weeks. So massive shift in my cycle. But again, I was still breastfeeding. So I put it down to hormones and just being a mom. And so that's when I reached out to the menopause hub in Dublin. where I live and I went and had a consultation with them. And the doctor said to me, I explained that I'd gone through, you know, years of fertility treatment. And I said, surely over-stimulating the ovaries

would deplete your estrogen more quickly than a woman who hadn't been through fertility treatment. And so surely that would throw you into either early perimenopause or more severe perimenopause. because by this stage I had accepted that I could be naturally perimenopausal anyway. But it did strike a chord with me that perhaps my symptoms were more severe because of my journey. Because my mom and my sister had never had severe perimenopausal symptoms. So the menopause doctor said 100% you're in perimenopause. She explained that the symptoms can be in three different categories. And I was touching on all three categories, multiple of them.

she said, I don't even need to do a blood test on you. We'll get you on HRT immediately. And it was like this hallelujah moment. It really was. I felt for the first time that somebody understood what I was going through and that there was help out there. And at this stage, I was inhaling all of your podcasts and all of your research and your website and everything. And it was about three weeks after I made contact with them, it became a topic that was being discussed in the Irish media and the Irish news and of course in the UK. And the waiting list went from one week to six months overnight, pretty much. Yeah.

And has it helped how you're feeling your HRT? Oh, overnight. I mean, they start you off low. I started on a low dose of estrogen. And within four days, my brain fog went away. And I felt a calmness, a balance. Then there was, you know, it's taken me about a year to get the balance right. There was my symptoms were coming back.

And I moved from the gel to the patch because I just wanted. the easiest application having been through, you know, medical treatment essentially for so long with fertility. I wanted the easiest route to the HRT. So it took a while to balance it. I'm now on the maximum dose of estrogen and yeah, I feel normal again. My hair is thick and glossy again. I don't have dry eyes or dry skin. My mood is great. I'm calm. I don't have anxiety. I sleep well. I'm just me. Me again. Which is perfect, isn't it? So we'll come back. to some of those questions about fertility treatments, but I just wanted to bring in Tanya if that's all right. So you've got a slightly different story, but similar in some ways.

Did you mind talking that through? Yeah, we started looking at fertility because I wasn't falling pregnant naturally and all the rest of it. And so we started investigations back in 2013, I think it was. And we've moved over from Northern Ireland back to England, so I had to almost start again, but not quite. And on one of the screens that they did, it says on the there that I was early stage perimenopause and that was age 43. So I already knew I was on the downward trajectory for hormones and everything. So it was pretty amazing. I'll just cut right to the IVF. So I had IVF and it's successful straight away. So I was really chuffed with that. My daughter was born and everything was okay apart from sleep deprivation and, you know,

just the usual, well, what I put down to the usual baby stuff. And then about eight months, we'd have to move house to a different area. I didn't know anybody or anything like that. And suddenly my mood just used to switch on a sixpence. And I was scared of myself or what I would do. My husband was pretty scared as well. And my little daughter, you know, I tried very hard to contain it, but sometimes, you know, probably shout at her a little bit and all that kind of thing. So I knew something was drastically wrong. My periods were really heavy, so heavy that I just couldn't control it and I had to sort of stay in the house a little bit. They were a bit erratic as well, so they weren't regular in any way, shape or form.

So it was all a bit scary, and I went to the local GP who basically was really to put me on antidepressant straight away because I'd had about depression before. And I was saying to her that, you know, it just isn't depression. It didn't feel like it. I didn't behave in the same way. I didn't sort of become a recluse as such or anything like that. So I knew it wasn't straight depression or even post-natal depression, not that I know. what that actually is defined as, and I don't know what causes that either. So I kind of,

I didn't know what to do. I was in despair. Then we moved again, and it put me off going through any kind of IVF again, even though I knew I wanted to have two children. So that's my story, really. There was no mention of HRT, no mention of anything, just a bit of counselling and antidepressants. When my daughter was about 18 months old, everything kind of leveled out, and I suddenly started to feel myself again. So whatever it was, it just happened naturally. It was a bit of a nightmare sort of 12 months or so between, which was horrid. And now you've got more hormones in another way, haven't you? Yeah. Yeah, I've been punted through with a few more to do the IVF again. And I'm feeling pretty good at the moment, I'm to say, but I'm really scared of what's going to happen after the baby's

born. So you're how many weeks, 31 weeks, pregnant? 31 weeks. Yeah. Yes. So obviously your hormone levels will be lovely and high at the moment. Naturally high now, yeah. Naturally high, yes. And these descriptions are very clear of people that have no hormone levels. And we know that with time, I've spoken about this many times, that with time, that's what happens as we, HR, ovaries don't work as well. The hormones associated with it decline.

And they often don't decline in a nice gradual way. It's a very chaotic way often. but then anything that puts more demands on our body can affect the amount of hormones. And so obviously pregnancy is a big demand on our bodies. And we have, as I've just said, high levels of hormones in our bodies when we are pregnant. And then afterwards there's a rapid decline. And we don't know, because I'm not aware of any good quality evidence or research that's been done, whether it's more the fallout or the big drop that causes the problem,

or whether it's the level that it goes to. And for a lot of people in that postpartum period, it can just be a short period of time, other people it can be longer. And, you know, for many years, we've talked about baby blues, we've talked about postnatal depression, but more and more, I'm sure it is hormonally driven

because it often is different to clinical depression, and a lot of people don't always respond to antidepressants as well. And someone who's sadly recently done, Professor John Stud in the 70s was talking about giving women who've had postnatal depression hormones. And people almost booed him off the stage when he talked about it at medical conferences. And at one stage, he actually had paint thrown over his car because people thought he was mad when he said most women over the age of 50 should take HRT. And I'd love to say things have improved, but I don't think they have actually.

I'd like to tell you, I haven't had paint thrown over my car. but I know a few people who would want to throw paint over my car or do worse, I'm sure if they met me. But actually, it makes sense, doesn't it, if it's related to hormones? And for both of you that have had difficulty conceiving, it's likely that your own hormones haven't been quite the same level as other people. And then your question, Rona, about whether giving the drugs that hyperstimulate your ovaries, does that cause a problem? And there's been no good evidence or research I'm aware in this. But I think there's two things. There's possibly, if you're forcing, forcing, forcing something to work or overwork, of course it's going to be

get more tired. But the other thing is I'm very struck by the many, many people that I see and speak to who have quite a history of fertility problems. And they often have a slightly earlier menopause. And I think whether they have IVF or fertility treatment or not, and I think it's probably those women, their ovaries just haven't got as much capacity as other people, if you see what I mean. And so they're more destined to have maybe a slightly early menopause. And of course, none of us know what our symptoms would be like. Otherwise, some women have horrendous symptoms, and some women don't have any symptoms at all. And how do we know and how do we compare? That's really difficult. And so most women in their 40s are going to have some perimenopausal symptoms.

and then you throw in having a baby when you're at perimenopausal. It's just a car crash because your own natural rhythm is out of balance because you've got a baby who's you've got to try and sort out. So even if you're not sleeping well because of your hormone deficiency, the chances are you won't be sleeping well because you've got a baby. So the two together is really difficult and it's very hard to tease out which is it. And that makes it quite difficult as well, doesn't it? Yeah, absolutely.

But it's almost guaranteed, isn't it, that the dip will happen after you give birth as an older woman who's brought you on that? Yes, absolutely. And it's interesting because we know that night sweats are very common, especially in women who breastfeed. And I'm very embarrassed to admit that I never even thought that could be associated with a hormone deficiency. So when I lay in bed after each of my three children covered in sweat, I didn't even think, maybe I'd could have a bit of estrogen. Maybe that would help. And no one told me, and I didn't think, but I wish I could go back in time and try it, because the estrogen as a gel or patches, you know, it's just a natural estrogen. And I think as we're older, it takes longer for our ovaries

to recover. I think if I had a child when I was 16, and you see children, well, they are children on the 16. I've got some patients who are very young when they had their first baby, and they would be coming for their six-week check, they'd be in their skinny jeans again, they'd be absolutely fine, the periods would come back quite quickly. I think, that didn't happen to me when I was 40 and I had my third daughter. But that's just the way physiologically, we're different, aren't we, as we age? And I'm sure this rebound sort of recovery for ovaries is just not as good as we get older, because we have less reserve. But why is it that we're not offering hormones to women who are breastfeeding? And I don't actually know the answer to that. And I think it's because

we had never taught about it. I'd never thought about it. I'd never thought about it. at all. And now there's no research, so everyone's quite loads to do something if there's not research. But if we think of common sense medicine, what is the harms of having some top-up hormones? So we're not replacing hormones by giving HRT, we're just topping up a bit. And I think there'd be a lot less baby blues. There'd be a lot less postnatal depression as well. If women had access to some hormones that they could administer themselves as well, because it's a lot safer than giving the contraceptive pill. It has lost less risk, doesn't have a clot risk, is absorbed, doesn't interfere with other medication or anything. And actually for a lot of women, it's a lot safer than

antidepressants and can be used with antidepressants, if needly, as well. Yeah. And Louise, you mentioned, I like the way you called a common sense medicine, because all along, it just made sense to me that obviously your egg reserve, you're born with a finite number of eggs, and over time, over years, that depletes. And when they're depleted and the east. is gone, you're in full-on menopause. So it made sense to me that if you're artificially stimulating the ovaries every month and firing out, you know, 12, 14 eggs every month, that obviously you're speeding up time, essentially. So when I spoke to all the health professionals that I came across, you know, they were shaking their head. But in my mind, I kept thinking, just because

the science hasn't been done doesn't mean it doesn't exist. Absolutely. So what was frustrating for me, I mean, obviously, it wouldn't have changed what we did and we're absolutely overjoyed that we were successful in having a baby. And the reason why I approached the clinic, your clinic, and the reason why I'm on today is to try and help other women know that this may happen. You know, don't change your journey. We wouldn't have changed what we did, obviously. It wouldn't have changed a thing.

But it would have prepared me that I wouldn't have gone through two years of hell of, you know, not knowing what was wrong with me. And this is what I'd love is for women to know. and I'm sure you'll agree, Tanya. We want to know what may lie ahead. You may not experience it, but you might. And if you do, this is what can help you. Yeah, definitely.

That's one of my reasons for doing it, one to help myself a little bit and not have the same experience I had last time, but also share it with everyone because everyone needs to know, don't they? Yeah. And it can be so scary. I mean, just straight menopause,

let alone the pregnancy and everything, is people are losing their jobs, and they don't know what's happening to them. They're scared. And, you know, they don't need to be scared. You're so right. And one of the reasons that we develop the Balance app is that people can hopefully download it and be prepared. And, you know, I've got no idea.

I haven't got a crystal ball, Tadde. I don't know what it's going to be like when you've had your baby. But I can pretty guarantee that your hormones will be low. And what you don't want to do, certainly with two children, is to have the experience you had before. And so hopefully this conversation is making you more aware that it is safe to have hormones. and a low dose of hormones doesn't work as a contraceptive. So how can it switch off your own ovaries? It won't because the dose is so low.

And so we often don't know with symptoms, whether they're related to hormones. And as you said, Rona, you didn't know what your symptoms were due to. But often we'll give HART as a low dose and say to women, well, you can try it for three months and see how you feel. If you don't feel any better, of course, then stop it. or as you were saying, sorry, Rona, is that you might increase the dose. And that's absolutely fine as well.

But it's having a starting point. You know, like you say, within a few days, you started to feel better. So you knew that the hormones are having an effect. And that's the same, you know, you won't know whether it's related to poor sleep because your baby's been awake or whether it's your hormones. But actually trying some hormones is not going to do any harm, even if you're breastfeeding, even if you're lying in bed with an increased risk of a clock, because you've just had a baby because the type of HRT is so safe.

And if it helps give you a bit more energy, then isn't that going to be good as well? And the other thing about HRT is it's very reversible very quickly. So the gel, for example, lasts in the body just the day it's used. So if you decided, oh, maybe I don't want to take this, well, you just stop. So I think the most important thing about any medicine is that the patient is in control, more than the doctor being in control, because you're living with yourself. all the time. Is there any sort of scientific way of knowing how much to take? So, you know,

you're talking about your progesterone and estrogen levels when you're pregnant are really quite high. And then over time, well, it could take a nose dive or it could over time gradually deplete, couldn't it? So is there any way of seeing what those levels are to monitor them? Yeah, it's a great question. What we don't do really is we never monitor levels, hormone levels, in pregnant women. So we've got a few, some idea from some studies, but not much. So I have no idea, for example, what your estrogen would be very interesting to do what your estrogen level is now and then what it is afterwards. And when we give HRT, it is a bit of a gut thing. It's not very formulaic because everyone is different. And so the beauty of having the estrogen as the

gel or the patches with different strengths is that you can change. And then it's more about improving symptoms rather than getting to a certain level. We often do do levels in women to see how much they're absorbing. And so sometimes, I know you said, Rania, you're on the maximum dose, but there's no maximum dose. So a lot of people, especially when they're younger, might need higher doses. So some people who are on a 100 microgram patch might still experience some symptoms. And then you might do their level and find that it's quite low. Increased to, say, 200 micrograms, they start to feel better, their level is just become more normal. And it's not so much what you put on, it's how you absorb it.

So some people's skin type doesn't absorb the whole amount, if you see what I mean. So there could be someone on half a patch absorbing more than someone on double the patch just because of the way it goes through the skin. Yeah, we get a bit of a raw deal, don't we? Because I know there's no way of measuring, you know, taking a blood test and telling a woman if she's in menopause or not because they fluctuate all the time. But, you know, even measuring the hormones as you're taking HRT, it's not a good enough indicator. No, it's very difficult. And so symptoms is what's most important, actually. And also doing blood tests

when you're perimenopausal, even if you're on HRT, can be very misleading. Because, as you know, with a perimenopause, you can have days where your levels are very high and even minutes later, it might be very, very low. So if I took a blood test, you can be very low, you know, when it was very high, then I might say, oh, goodness me, this woman's nowhere near perimenopausal or menopausal. But then if I did the blood test at two in the morning when you were feeling really sweaty and dreadful, of course it's going to be very low. And what we don't know is whether it's, I think a lot of people have worse symptoms in the perimenopause because it's, your body's adjusting to this big change in hormone levels rather than the absolute number. And that's again,

I think why people really struggle after pregnancy because there's this massive decline as opposed to it just being. So your level might be the same as it was six months before you were pregnant without any symptoms, but you've had this big decline in your body's just thinking, wow, hang on a minute. And so my thought would be, well, giving some women just some top-up estrogen will just make that big decline just a bit more smooth transition and plateau. Sounds good to me. And Louise, do you think that going forward with all this new information coming out about, you know, menopause and hormones, that the fertility industry might look at infertility differently

because when a woman goes for their first checks for infertility, they just do all of these tests on you to see if there's anything structurally wrong. For me, it was unexplained infertility. But I'd love to think that they might look at this more differently now and see it as a hormonal problem. I would love to say yes, but I don't know. No. When I first started my clinic, I was really shocked by, well, I'm always shocked by the stories that I hear, the number of women, the ages of women that I see. And I was quite surprised that I was starting to see a lot of young women who had similar stories to you, that they were struggling, quite a few rounds of IUI or IVF. Some of them got pregnant. Some of them couldn't, weren't successful. But then they seemed to have an earlier menopause. And so when I spoke to all these women, I said, but did anyone give you information? about what the perimenopause meant or the menopause mean or that you might have an earlier menopause. And they said, no, some people just said, well, you'll probably have an only menopause because your mum and your granny did. End off. No information about how important it is,

especially if you're young, to have hormones. So I reached out to some very big clinics. I won't mention their names and said, could we write some information together so that you can give a booklet to every single woman coming through your clinic? They weren't interested. And I feel like a lot of things with menopause as a financial thing going on with fertility and even with menopause. And if it's not about making money, then people find that they don't want to do that extra work. And I think it's really wrong because it's really sad. It's really sad. And actually, it's not difficult to give people information.

And that was one of the reasons I was so committed to doing the balance app and keeping it free so that people could get information that was evidence-based and accessible and easy. because I feel as women we're not stupid, but what is being very difficult for us, and I think it's worse for you in Ireland actually, is that we've been not allowed to have this information. So then we can't even, we don't know what's happening to ourselves. And then it becomes very frightening as well. The other thing is that there's a lot of people that go to fertility clinics and they're having treatment or they're planning treatment, and they are perimenopausal, but they're told they can't have HRT,

or they have to stop it because it will interfere or there'll be a problem. And actually, the HRT that most of us give is body identical. So it's topping up these missing hormones. And there is some studies that show that women who have reduced fertility as a result of their perimenopause, their fertility improves with HRT. And so actually, we shouldn't be denying women HRT if they're going to have fertility treatments. Which makes sense, doesn't it? Because if you have fertility problems, your ovaries are just slogging and working over hard,

whereas if you have HRT, your hormones, I think, in your ovaries, almost relax a bit. You know, your ovaries aren't slogging their guts out, so they're more likely maybe to pop out an egg. And I remember the first woman who became pregnant in our clinic phone to tell us, and my staff, oh, no, oh no, we're supernipals for clinic. We shouldn't have pregnant women. But this woman was absolutely delighted. and we've had a couple more and that's lovely and I'm not saying that HRT will definitely improve fertility. I don't want to give people false hope, but I am saying that it is actually safe to give.

Estrogen and testosterone and progesterone are natural hormones and in a low dose, which is all we give with HRT. But the knock-on effects of the HRT would have a holistic, you know, benefit to the woman anyway, whether it's mood or sleep or... Yes, absolutely. do you know, I don't need to tell you two, but going through any fertility treatment is incredibly stressful, not just for you, but for your relationship. And then not having hormones can cause symptoms of low mood, anxiety, everything else as well. Put the two together. How do you know which is which? And that's very, very difficult, isn't it? So I feel that we should definitely, and it would be lovely to come back in a few years and have this conversation and we can learn how much better

fertility services are educating and empowering women and preparing them because actually I would like to be prepared whether I go to my hairdresser or whether I go to a chemist or whether I go to my doctor. I want to be prepared about my perimenopause or menopause and I wish I had been because I wouldn't have had symptoms for the few months that I had them without realizing because the more you hear these messages from other people eventually the penny drops and I think that's what's really important. And it's not always from a doctor. It might be like you say, from a friend or from someone else. And that's important. Yeah, absolutely. I have to say that the GP I've got right now, I spoke to her at length about, you know, my mental state, potential mental

state afterwards. And she was right there with me. You know, she kind of properly understood. And I wonder if there was any sort of links that we could give GPs, you know, with some real detail there, some real evidence and some real science or real guidance. because, you know, with all the will in the world, not every GDP is good at every part of mess. No, but there's nothing else that affects 100% or 50% of their population. Yeah. So I think we're in this position.

It's crazy. I've got no idea. So, yes, I mean, through my not-for-profit company, we've developed an education program. Through balance-manipause.com website, we've got some educational resources for women, and we've just written one about breastfeeding as well. So my sort of mission really is to improve knowledge of women through balance

and the app and the website, improve healthcare professionals knowledge, all healthcare professionals knowledge from wherever country through my not-for-profit and then the dots can be joined and I think that would be really powerful. And just before you, we finish, I'll just leave you one story, one of my patients actually who, she's a lawyer, very, very clever, very bright, really, really struggled with post-examination. depression and she had lots of looking back perimenopausal symptoms. She had incredible anxiety, depression and she had crippling migraines as well. And she was very close to being sectioned because

her mental state was really bad. She had very intrusive thoughts and really thought about taking her own life. And so when she went to the psychiatric hospital, she decided to not be sectioned and went on her own because she was scared about these thoughts. And they were going to start her on a tablet called lithium. And she didn't really want to start it because she didn't think that it was due to a sort of clinical depression. She thought it was her hormones and no one was listening and said, of course, it won't be your hormones. So before she started lithium, they said, we need to do a pregnancy test. And she said, well, I can tell you for sure I'm not pregnant. Anyway, they said, we need to do it. And she was pregnant. And then she said, within days,

her mood lifted and she felt incredible. So she actually treated her own way out of her depression. Oh my goodness. It was incredible and she blossomed through her pregnancy and understandably crashed after her second pregnancy but knew what was going on. So she went on to HRT very quickly and as I'd like to say, the rest is history. But isn't that incredible that she could treat herself? So the body is an amazing thing. And I think as women, we shouldn't be underestimated and our power of hormones cannot be underestimated as well. And I'm very grateful for the two of you to give up your time. And not. Normally I ask for three take-home tips, but that's very hard to ask for one and a half each. So I'm going to ask you both for two, actually. So one thing that if you were struggling with fertility, what you might would like to know about or what you would offer that women should do to know more about their perimenopause and menopause. And then also after, if you're feeling low after having a baby or breastfeeding, what you might suggest.

So if you wouldn't mind going first, really? Well, I would just say, do you really? Do your own research and don't just blindly follow what your doctor says. Because for me, my doctor wasn't informed. And interestingly, when I went back to her after the menopause was being talked about so much in the media here, she changed her narrative, which was to say that it wasn't her field of expertise and to go to a hormone professional. So I would say do your own research, 100% do your own research as well as seeking professional help, medical professional help. Great. And the second one, when you're going through the perimenopausal symptoms,

is to get on HRT, ASAP. It will change your life. It will absolutely give you your life back, 100%. Brilliant. Thank you. And what's about you, Tanya? I was just thinking about that. I was thinking, don't be scared to go down the IVF routes. You know, if it's your dream, then to have a baby, then just do it. But forewarned is forearmed, isn't it? So if you know, you know, just by listening to and myself what the symptoms could be afterwards and you can deal with it you can there are people there that can help you you maybe have to do a bit of research and find those people but because they don't seem to be readily available or advertised very heavily or anything like that so I would just do that definitely it's worth it in the end yeah the other question well

I suppose we can be more direct to you what are you going to do after you've had your baby so it was really for people who are breastfeeding or as of today I would be looking at going on HRT because I'm no longer worried about the effect of having those little top-ups and, you know, what could be better than your own sanity and your own mental state when you're dealing with small children and all that sort of thing. But the other thing is, before you sort of embark on IVF, be very aware of what your own body is telling you. You know, do you have symptoms? Be very honest with yourself. And, you know, maybe jot them down and, you know, maybe do like a mood page or something like that that, you know, you can really sit down

and think about the symptoms that menopause might be, and whether you have any of them, say that you can maybe judge for yourself whether they've changed in any way, shape or form during pregnancy or even afterwards, or also are. And also, I'd love people to be informed about extended breastfeeding and that if you are extended breastfeeding, that your hormone level, your estrogen level will be even lower.

Yes. Yeah, I didn't know that. Which I didn't, yeah, apparently it's called mini menopause. So I had a sort of three-pronged attack on my hormones, IVF, older mom and extended breastfeeding. So my levels must have been on the floor. Well, I breastfed for a long time, about the same as you actually. And I had no idea. So that probably explains quite a bit, isn't it? There you go. Yeah. So we'll put links to the breastfeeding leaflet that we've just written in the notes below. So with a podcast so people can

access that. And we need to start this conversation. We need to keep it going. So we need to help other people. And I know you sharing your experiences will really help. So I'm very grateful to you both. So thank you very much and good luck to both of you going forward. Thank you. Thanks, Louise. 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.